May 2007 | Back to Table of Contents

MMA News

Imaging Moratorium Rejected

The House Health Care and Human Services Finance Committee rejected an MMA-supported measure in March that would have placed a moratorium on high-tech imaging programs.

Earlier in the session, Rep. Thomas Huntley, DFL-Duluth, introduced H.F. 2003, which called for a moratorium on the practice of requiring prior “consultations” with third-party utilization review vendors before physicians could refer patients for MRIs, CT scans, and other high-tech imaging tests. Medica and HealthPartners have both been requiring these kinds of reviews, citing cost-containment reasons. The bill also called for a study during the moratorium, which would have required recommendations by December 2008.

The MMA pushed to have the bill introduced after hearing from physicians who said the health plan reviews waste time and resources and needlessly delay patient care.

A subcommittee of the House Health Care and Human Services Finance Committee considered the proposal when it was offered as an amendment to the House health and human services budget bill March 30. Testimony that lasted more than 90 minutes was offered by physicians, the MMA, Medica, and HealthPartners.

MMA CEO Robert Meiches, M.D., testified that the reviews have angered physicians because they add administrative costs, inconvenience patients, and intrude on the patient-physician relationship.
Charles Fazio, M.D., chief medical officer for Medica, suggested in testimony that the MMA’s call for a moratorium was an overreaction done on behalf of a small number of physicians averse to quality-improvement processes.

In the end, the House Health and Human Services Finance Committee voted against the moratorium but in favor of creating the study group.

To clarify several points of the debate during the hearing, Meiches sent a follow-up letter to the committee members in April and reiterated the MMA’s position and motivations.

In the letter, Meiches rebutted Medica’s claim that only a small number of physicians oppose the requirement. “During my tenure at the MMA, no single issue has generated the same volume and intensity of reaction from physicians as has this item,” he wrote.

Meiches also disagreed with Medica’s characterization of the program as simply a consultation because the program meets the state’s definitions for both prior authorization and utilization review.

“The MMA maintains that the review of physician orders for high-tech imaging studies (conducted by an external vendor—HealthHelp in the case of Medica) to determine the appropriateness of the service that is required to be done prior to the delivery of the service, constitutes prior authorization,” Meiches said in the letter.

Finally, he expressed concern about Medica’s testimony that the program will save $15 million, saying the approaches “undertaken by Minnesota health plans simply reduce health plan costs while shifting costs to clinical practices by adding to their administrative burdens.”

To read the entire letter, visit www.MMAonline.net.

Bill Seeks to Curb Online Drug Seeking

The Minnesota Pharmacists Association is supporting a bill that would try to prevent pharmacists from filling prescriptions from Internet firms that only require the patient to complete an online questionnaire rather than see a doctor before writing a prescription. Patients then fill the prescriptions at local pharmacies.

The author of the bill, Rep. Steve Gottwalt, R-St. Cloud, introduced it in response to the death of Justin Pearson, a St. Cloud resident who died last December from a complication related to the abuse of prescription drugs he obtained online.

The bill would not affect Internet-based mail-order pharmacies; instead, it would make it more difficult for Minnesota pharmacies to distribute drugs after receiving an order from an Internet company.

“We all have concerns about inappropriate use of prescriptions on the Internet,” says Dave Renner, the MMA’s director of state and federal legislation. The MMA has not taken an official position on the measure, which is expected to be discussed as part of the House and Senate budget bills.

George Schoephoerster, M.D., a family physician at CentraCare Health Plaza and chair of the MMA’s Membership Task Force, said in an April 15 St. Cloud Times article that obtaining medicine without the supervision of a doctor is dangerous. “Often, ... doctors are not aware; we’re not told when our patient gets something from somewhere else,” Schoephoerster said in the article. “People who buy from these sites are often less willing to tell us they’re on this medication, and if we’re prescribing something else for them and don’t know it, the health consequences can be severe.”

At the same time, patients also should be able to shop around for the best prices, and allowances should be made for emergency refills of existing prescriptions, he said.

Smoke Clears After Battle of Blue Earth

You might not figure soft-spoken, unassuming obstetrician Stephen Penkhus, M.D., to be a warrior. But as a physician at Mankato Clinic for more than 30 years, he saw too many patients with lung cancer, emphysema, osteoporosis, and other smoking-related health problems not to take on the fight against secondhand smoke. In 2001, he and other doctors from the Blue Earth County Medical Society got together and wrote a letter pitching an anti-smoking ordinance to the Mankato and North Mankato city councils. They waited for a response but never got one.

This became their first lesson as activists: Letter writing wasn’t going to cut it.

So the physicians paid a visit to the Mankato Area Smoke-Free Coalition, a citizen group formed to fight for clean air in 1999, which had since lost steam. “We rounded up four members and described our concerns,” Penkhus says.

Re-energized by the physicians’ interest, the coalition described how secondhand smoke affects the health of Mankato families to the Mankato City Council. They got a big yawn for their efforts.

“They resisted what we had to say. No one welcomes change, and that’s what we represented,” Penkhus says. “Plus, there were entrenched interests. Council members were sure the ordinance would hurt the economy.”

However, the group didn’t give up, and they were able to convince Mankato Mayor Jeff Kagermeier to bring the measure to the council for a vote.

In short order, the group brought together an allergist, an oncologist, two pediatricians, a family practitioner, two obstetricians, and a radiologist—all of whom testified about the dangers of secondhand smoke before the council voted. Despite their efforts, the measure failed.

“There was lots of opposition. People from restaurants and bars and bowling alleys spoke against us. It got pretty personal. Some of them said that doctors are just rich people who don’t care who they put out of business,” Penkhus remembers.

But the group kept at it, building support one council member at a time, and by the fall of 2004, they had talked the council into an ordinance banning smoking in bars and restaurants that would go into effect in 2006.

But bar and restaurant owners asked the council to postpone implementation until the following year. Instead, the city council decided to put the idea up for a citywide referendum. Penkhus says the period before the vote was an uncomfortable one. Some of his patients owned bars and restaurants. “One hearing was especially painful,” he says. “Over 150 anxious people on that side showed up. It was frightening for us … It boggled my mind that the health of customers and employees didn’t factor into people’s thinking more.”

But support for the referendum grew. More than 150 area physicians signed a petition that was published in the Mankato Free Press. Some of the physicians participating in the effort included MMA members Paul Matson, M.D., orthopedic surgeon and former MMA president; Philip Wold, M.D., internist and delegate to the MMA House of Delegates; Anthony Jaspers, M.D., family physician and an AMA delegate; and Thomas Drake, M.D., president of the Blue Earth County Medical Society.

And help flooded in from agencies around the state, including the MMA. “We didn’t feel we were all on our own,” Penkhus says.

Last November, with 61 percent of voters favoring the ordinance, the referendum passed. And American Lung Association tests now show that Mankato bar and restaurant air has 86 percent fewer dangerous pollutants than before.

Although the campaign had its challenges and took a lot of work, Penkhus says he’s pleased with the outcome and glad he stuck with it. “People come up to me on the street now,” Penkhus says. “They shake my hand and say, ‘Way to go, doc!’”

House and Senate Pledge Universal Coverage

In March, Minnesota DFL House and Senate leaders pledged to achieve universal health insurance coverage in the state within five years.

The House put forward a budget proposal that would set a goal of achieving universal coverage by 2010, and the Senate passed a budget proposal that would reach that goal by 2011. Although the House was still debating the health and human services budget bill in mid April, a proposal to set a timeline for universal coverage was expected to pass. The House and Senate proposals are in line with a proposal by Healthy Minnesota: A Partnership for Reform, an independent health care reform coalition originally drawn together by the MMA. Healthy Minnesota put forward its own health reform legislation this session, which called for universal coverage by 2011.

The Senate proposed covering approximately 50,000 more people than are currently eligible for state programs during the next four years, and the House proposed covering about 50,000 more children during the next four years.

To fund the expanded health care programs, the House and Senate proposed increasing the income tax for the state’s highest earners. Pundits expected a standoff because Gov. Tim Pawlenty vowed to veto tax increases when the Senate passed its budget bill on March 29.

The constitutional deadline for the end of the session is May 21.

MMA Seeks Members to Serve on Committees

The Minnesota Medical Association is looking for members interested in being appointed to a three-year term on a standing committee.

Most committees meet during the evening about four times a year. The new committee terms begin January 1, 2008.

The standing committees are Accreditation and Continuing Medical Education, Administration and Finance, Communications, Ethics and Medical/Legal Affairs, Legislation, Medical Practice and Planning, Minority and Cross-Cultural Affairs, Public Health and Preventive Medicine, and Quality Health Care.

For information about the responsibilities and current membership, visit the Committee section of the MMA website at http://www.mmaonline.net.

To be considered for appointment to a committee, complete the interest survey on the MMA website. Go to www.MMAonline.net and click on Committee Interest Survey in Featured Links. To discuss the appointment process, call Susan Sweezo at 612/362-3729 or 800/342-5662, ext. 729.

Smoking Ban Clears Final House Committee

The Freedom to Breathe Act, which would ban smoking in workplaces including bars and restaurants, passed the House Finance Committee in April. This was the last committee vote for the bill.

At that time, the MMA and other clean-air advocates were working to remove provisions that would allow bars and restaurants with liquor licenses to install special smoking rooms where patrons could eat and drink but not be served by employees and that would allow bars to apply for smoking exemptions from local units of government.

“It’s a big step forward to have the bill make it to the floor of the House,” says Dave Renner, MMA director of state and federal legislation. “But without changes, it does not meet the goal of protecting all workers.”

The bill was expected to be heard on the floor of the House at the end of April or the beginning of May.

The Senate version, which passed March 27, is a comprehensive ban that does not include the exemptions.