MMA News
Physicians Outraged by Budget-Balancing Plan
In response to an MMA Action Alert, more than 350 physicians emailed lawmakers in March to tell them not to balance the budget by tapping the Health Care Access Fund (HCAF).
MMA President-elect George Schoephoerster, M.D., also told members of the Senate Health and Human Services Budget Division, a legislative committee, that they should use the fund to cover the uninsured rather than balance the budget.
Gov. Tim Pawlenty’s budget proposal would use nearly $400 million from the HCAF over the next three years to help cover the state’s $935 million budget deficit. Pawlenty proposes withdrawing $250 million from the HCAF and then using an additional $48 million each of the next three years to pay for services that previously had been paid for with money from the general fund.
Pawlenty released his budget plan in early March and chose health and human services as his primary target for cuts.
During Pawlenty’s time in office, he and lawmakers have drained nearly $500 million from the fund to balance the budget. But last year, Pawlenty said he regretted previous withdrawals from the fund and told MMA leaders that he did not intend to do it again. Thus, the governor’s plan has many physicians now feeling betrayed.
Robert Zimmerman, M.D., of Grand Rapids, told his lawmakers in an email that “the latest proposal boggles the mind.” Zimmerman said the money in the HCAF should be used for its intended purpose of covering the uninsured. “Access to health care must be expanded. This requires money, and emptying the Health Care Access Fund to balance the budget will eliminate any chance of expanding access.”
Melissa King-Biggs, M.D., of Minneapolis, wrote that she’s willing to pay the provider tax to help the uninsured, but she strongly opposes using these funds for other purposes. “If you need funds for the general fund, this should be a general tax, not a tax on health care providers only,” King-Biggs wrote in a letter.
Schoephoerster, representing the MMA, told the Senate Health and Human Services Budget Division that “stealing” from the HCAF undermines the state’s ability to increase health care access and enact health care reform.
“Not surprisingly, the physicians of Minnesota are outraged,” he said. “This proposal is an affront to all the hard-working professionals in the state and their patients on whose backs the costs are ultimately borne.”
New Member Benefit: Financial Planning
Thanks to a new preferred provider agreement, MMA members have access to financial planning that is attuned to their needs at a special rate. Sterling Retirement Resources, Inc., a St. Louis Park-based financial planning service with expertise working with physicians and other health care professionals, can provide MMA members with investment and retirement counsel.
Sterling’s principals are Joel Greenwald, M.D., who practiced internal medicine in St. Paul for 10 years, and Steve Finkelstein. Both are certified financial planners (CFPs), and both have worked extensively with physicians and other health care providers. They work with individuals from early in their career all the way through retirement.
Services offered by Sterling include retirement planning, investment management, estate planning, insurance analysis, and college fund planning. “We begin with a simple conversation,” Finkelstein says. “We want to know where the physician is coming from, and what he or she wants to make happen.”
Greenwald, who became a financial planner 10 years ago, says physicians are better informed than most people about investment planning. “But there are things many physicians miss. For example, the best way to access your savings when retirement is finally at hand can be a tricky business, and we can help with it.”
Sterling Retirement Resources is planning a series of workshops for MMA members on key investment topics. The dates and topics will be announced on the MMA website, www.mmaonline.net.
For more information go to www.mmaonline.net and click on Products and Services.
MMA Steps up Opposition to Suspect Payment Reform
In March, there was growing momentum at the Capitol to pass a health care reform package that included a complicated and controversial payment reform proposal that resembles capitation.
The payment reform, known as Level 3, gained steam when it was added to the House health care reform bill. Previously, the payment reform measure was only in the Senate’s reform bill.
What is Level 3?
Level 3 would create a centralized data system that would calculate and publish comparative cost and utilization statistics of doctors and other providers. Using this data, providers would submit a bid for providing care to a particular population of patients.Physicians would be required to honor that bid as part of their commitment to manage the cost of care for those patients.
Initial participation in the payment mechanism would be voluntary; but as early as January 2010, it would be required of providers who care for state employees and Medical Assistance and MinnesotaCare enrollees. Private health plans would also start using the payment method at that time.
MMA Concerns
The MMA is concerned that Level 3 lacks sufficient clarity and that it resembles capitation.
Proponents of the plan claim that it differs from capitation in that it does not make physicians assume insurance risk. But the MMA is not convinced.
The MMA is also concerned that because it closely resembles past capitated plans, it could affect patient sentiment. Patients disliked the capitated approach because it made them feel as if their doctors had a financial interest in withholding care.
The MMA is also concerned that, absent clear agreement on how the system would work, this financing scheme would lead to unintended consequences such as a consolidation of health care providers. Because the bidding process appears so complicated, the MMA is concerned that small providers might not be able to compete against large, integrated systems. This could prompt consolidation of providers similar to that which occurred in the early 1990s, when the Legislature encouraged the formation of integrated service networks.
Finally, the MMA believes that having a centralized organization collect and publish data and manage the bidding process will likely add significant administrative costs.
The MMA is trying to convince lawmakers that instead of adopting this complicated, controversial, and poorly defined approach, they should focus on passing reforms that encourage medical homes and care coordination, both of which lower costs by supporting patients and physicians in their efforts to optimally manage chronic diseases.
Go to http://capwiz.com/mnmed/home/ to send a message to your lawmakers asking them to oppose Level 3 payment reform.
Board Calls for 600 New Psych Beds
At its March 8 meeting, the MMA Board of Trustees adopted the strategic goal of alleviating the psychiatric bed shortage in Minnesota by adding 200 beds each year for the next three years.
The new beds should include transitional beds at crisis centers, hospital beds for acute care, and beds for patients with complex medical-psychiatric needs.
The task force concluded that adding 600 psych beds would bring Minnesota closer to the national average. Minnesota has 16.8 beds per 100,000 residents compared with 28.2 beds per 100,000 residents nationally, according to the American Hospital Association.
The new beds would be distributed by region to ensure equal access across the state.
These recommendations follow a lengthy study of access to psychiatric beds in Minnesota. The task force used as evidence of a bed shortage the high number of patient diversions that occur, the long distances patients often must travel to find a bed, and the amount of time patients spend in emergency rooms waiting for a bed.
The Board also agreed that reimbursement for mental health care and substance abuse treatment ought to be a medical benefit rather than a separate behavioral health benefit. And it set a goal of having most patients (95 percent at least) wait less than six hours before transitioning from an emergency room to a psychiatric or complex intervention unit.
The recommendations are based on the Board’s conviction that improving access to care for patients with mental health and substance use disorders will reduce costs.
Board Adopts Imaging Policy
The MMA Board of Trustees adopted policies at its March 8 meeting on the controversial subject of imaging services.
The policies were the product of long deliberations by the MMA Imaging Task Force, which was established in 2007.The task force was led by Timothy Crimmins, M.D.
The task force concluded that there is a lack of timely, useful, and valid data about the use of imaging services in Minnesota and recommended that the MMA support efforts to develop and study communitywide data to understand utilization trends and concerns about overuse, underuse, and misuse.
The Board adopted 16 recommendations regarding imaging utilization and cost trends, legal and regulatory controls, quality-improvement strategies, and the role of payment policy. In addition, it recommended that the MMA:
- Urge health plans and payers to clearly document and share relevant data regarding claims of inappropriate use of high-tech imaging services;
- Support the development of appropriateness guidelines for improving the delivery of evidence-based imaging services;
- Support the use of decision-support tools to improve the appropriate use of high-tech imaging services; and
- Oppose the use of utilization review/prior notification as a way to mitigate high-tech imaging utilization and to push for a moratorium on its expansion.
For a copy of the report, send an email to mma@mnmed.org.