MMA News
2008 Legislative Preview
The MMA’s top priorities for the 2008 legislative session include health care reform, reimbursement for interpreter services, and protecting the integrity of the Health Care Access Fund.
When lawmakers start the 2008 session on February 12, their main job will be passing a bonding bill for capital expenditures that are expected to total about $965 million. However, the Legislature is also expected to take up a health care reform bill that incorporates recommendations made by Gov. Tim Pawlenty’s Health Care Transformation Task Force and the Legislative Health Care Access Commission.
The two work groups met throughout 2007 to craft reform proposals for expanding access to care and making it more affordable. “We have some reports coming back,” says House Minority Leader Marty Seifert, R-Marshall, “and we hope to extract some savings from the system.”
The MMA and DFL and Republican lawmakers seem to agree that health care reform should include a market-based approach, a strengthened public health system, and payment reforms that encourage disease management. Some of the health insurance reforms proposed by the governor’s group resemble those advocated by the MMA, such as requiring all Minnesotans to have health coverage, establishing an essential benefit set, and guaranteeing insurance coverage regardless of health status.
However, the MMA is concerned about other proposals by the governor’s group. Particularly troubling is a recommendation that seems to suggest the creation of a capitated system that would compel physicians to join large integrated care systems.
According to this recommendation, providers would be accountable for the cost and quality of a patient’s care. Providers would put forward a bid estimating how much they would charge to care for a group of patients for one year. Providers would then be paid per procedure, but payment rates would undergo quarterly adjustments up or down to ensure the providers only got paid their bid amount.
“The draft proposals have many good ideas,” says Michael Ainslie, M.D., chair of the MMA Board of Trustees, “but the MMA wants to make sure we don’t make the mistakes of the past and try to pound a square, capitated peg, into a round health care hole.”
Conflict between DFL and Republican lawmakers may arise because the governor’s group has been more focused on controlling costs whereas the legislative group has focused both on cost and on making health care more available to low-
income Minnesotans, according to Dave Renner, the MMA’s director of state and federal legislation.
DFLers are prepared to push for a constitutional amendment making health care a right if there isn’t progress on health care reform. “My sense would be that if there is not enough progress on affordable health care, then [a constitutional amendment] is something that might be in play later in the session,” says Senate Majority Leader Larry Pogemiller, DFL-Minneapolis. The MMA opposes pursuing a constitutional amendment because it would distract lawmakers from actually reforming the health care system.
Renner and others are generally optimistic progress can be made. “There seems to be momentum and bipartisan agreement that there are some reforms that are needed to improve the system,” he says.
“What you can expect to realistically see this session is a lot of the building blocks will be put in place for more Minnesotans to have more affordable health care,” says House Speaker Margaret Anderson Kelliher, DFL-Minneapolis.
Former MMA President Dies
M. Elizabeth Craig, M.D., former president of the Minnesota Medical Association, passed away January 13 at age 86.
Craig was the first female president of the Minnesota Medical Association, Methodist Hospital staff, and the University of Minnesota Alumni Association.
Besides serving as president of the MMA in 1985, Craig held positions on many other MMA committees.
She also served as a University of Minnesota regent, and as a member of numerous health care and civic boards. She was awarded the University of Minnesota’s Outstanding Achievement Award in 1995.
Judith Shank, M.D., recalls Craig as being “a tiny woman, but she stood ramrod straight, and she communicated great determination. She had tremendous energy and intelligence. She always had an irreverent twinkle in her eye.”
As a pediatrician, Craig worked passionately for the health of children. She was an early advocate for important public health issues such as preventing eating disorders and eliminating secondhand smoke. And she took a special interest in encouraging young women physicians, especially pediatricians, and put many on the path to successful careers. “We are a healthier population today because of her,” Shank says.
Help Returning Soldiers Get Proper Care
The MMA is inviting physicians to join a group of volunteers to assist in improving the care of military personnel returning from active duty.
Minnesota boasts a large number of veterans, and many MMA members have shown an interest in addressing the needs of those returning from Afghanistan and Iraq.
At the MMA Annual Meeting in September, delegates approved a resolution to establish a panel to address the medical needs of Minnesota’s military. Subsequently, the MMA Board of Trustees agreed at their November 17 meeting to create a Military Ad Hoc Group to serve as the MMA’s military liaison. Interested members should contact Nilani Jayatilaka at 612/362-3735 or njayatilaka@mnmed.org.
MMA Concerned About New Psych Bed Hospital
The Minnesota Medical Association submitted a letter to the Minnesota Department of Health in January expressing concern about a proposal by Prairie St. John’s, a for-profit Catholic health care organization, to build a psychiatric hospital in Woodbury. The MMA fears construction of such a hospital would not significantly relieve the current shortage of psych beds and could have an adverse effect on existing hospitals by forcing them to take the sickest and poorest patients, the letter said.
“They don’t have an emergency room, so they don’t have to take sick patients, and they don’t have to take Medicaid patients,” Roger Kathol, M.D., a member of the MMA’s Psychiatric Bed/Patient Diversion Task Force, was quoted as saying in a Finance & Commerce story about the hospital. “They are bringing beds to Minnesota; we definitely need beds. But they are not bringing the type of beds that are going to alleviate the bed shortage we are experiencing.”
The MMA has a number of concerns. First, the proposed hospital would not treat many mentally ill patients on public programs including adults on Medical Assistance or seniors on Medicare with co-morbid medical conditions. It only would accept children on Medical Assistance. Yet adult Medical Assistance patients constitute a large portion of patients with inpatient needs who end up in emergency rooms waiting for psych beds. Second, the hospital would not have an emergency department. The MMA believes its proposed needs-assessment department (which would be staffed 24 hours a day, seven days a week) would be far less useful than a psychiatric emergency room. Third, the hospital would not admit patients with unstable medical co-morbidities. Yet patients with psychiatric illnesses commonly have concurrent health problems.
To win MMA support, Prairie St. John’s would have to change its proposal in the following ways:
- Accept all patients regardless of insurance status or type.
- Provide 24-hour emergency access for psychiatric evaluations and admission.
- Provide medical care for psychiatric patients with stable medical illnesses and work with nearby medical facilities to arrange for acute-care psychiatric services for patients with unstable medical illnesses.
“The MMA understands the scope of the problem of psychiatric bed availability and its impact on emergency and general medical resources,” the letter states. “However, we also realize that having open beds that do not have the capability to take the breadth of patients who need admission hurts rather than helps the issue of access to psychiatric services.”
The letter was signed by Robert K. Meiches, M.D., M.B.A., chief executive officer of the MMA; and by MMA trustee Roger G. Kathol, M.D., and Steve P. Sterner, M.D., co-chairs of the MMA’s Psychiatric Bed/Patient Diversion Task Force.
Federal Balance Billing Legislation Introduced
The U.S. House is considering a bill that would override Minnesota state law and allow physicians to balance bill for Medicare services.
The proposal, which is based on AMA model legislation, would allow physicians who elect not to participate in Medicare to balance bill patients under the Medicare program by removing the current 115 percent limiting charge of the nonparticipating Medicare fee schedule amount. What’s important to Minnesota doctors is that the bill would pre-empt state laws.
In most states, physicians have the option of choosing a nonparticipation status that allows them to balance bill patients an additional amount, up to 15 percent, for services in exchange for taking a 5 percent reduction in Medicare reimbursements.
A Minnesota law passed in the early 1990s prohibits physicians from billing Minnesota Medicare patients more than the set Medicare reimbursement rate.
The federal bill introduced in December by Rep. Tom Feeney, R-Florida, was referred to the House Committee on Ways and Means and House Committee on Energy and Commerce.