MMA News
Health Fund Raid Largely Avoided
Physicians suspected lawmakers would go after the Health Care Access Fund (HCAF) to fix the budget shortfall this year, and that’s just what they tried to do.
At the start of the session, Gov. Tim Pawlenty proposed taking $250 million from the HCAF and using $48 million each year from the fund to offset other General Fund spending.
Hundreds of MMA physicians objected and told lawmakers not to raid the fund. Rep. Thomas Huntley, DFL-Duluth, and Sen. Linda Berglin, DFL-Minneapolis, also advocated preserving the integrity of the fund.
In the end, the governor and lawmakers struck a deal to make a one-time $50 million loan from the HCAF to the General Fund on June 30, 2009. The loan will be repaid with savings expected to accrue from the health care reform bill that also passed this session. The budget deal also shifted $18 million in expenditures for health care programs from the General Fund to the HCAF.
“This ‘loan’ from the HCAF is significantly better than the earlier recommendations to transfer $250 million and use an ongoing $48 million each year to offset other General Fund spending,” says Dave Renner, MMA director of state and federal legislation.
In total, the state balanced the budget by using $500 million of the state’s budget reserves, making $355 million in program cuts, and raising about $100 million by reconfiguring how some foreign-operating corporations are taxed.
As part of the proposed cuts, DFL leaders put forward a plan to cut physician payments for treating patients who are enrolled in fee-for-service public health insurance programs by 3 percent to help balance the budget. The MMA strongly objected to this proposal and was able to get it removed from the budget bill.
Hospital reimbursement rates took a big hit this session. In total, the budget cuts include about $170 million from health and human services in the 2008-2009 budget cycle and $206 million for the following two years. Nursing homes will see a 4 percent increase.
“The Health Care Access Fund isn’t a good mechanism for funding health care,” says MMA President James J. Dehen Jr., M.D., “but as long as they’re collecting the sick tax, we need to make sure it is spent on sick people.”
Other Legislative Highlights
Passed
Interpreter services quality initiative that does not address payment but establishes a voluntary interpreter roster and requires the development of a process for interpreter certification.
Teen driving rules that limit their driving in the first year after getting a license. During the first six months, teens are not allowed to drive between midnight and 5 a.m. unless for work or school functions. They also cannot have more than one other nonfamily member in the vehicle. For the second six months, teens can’t have more than three other nonfamily members in the vehicle.
Not Passed
Newborn screening bill clarifying parental privacy rights regarding the screening of newborns for metabolic and genetic conditions. The measure passed the House and Senate before being vetoed by Gov. Tim Pawlenty. The effect of the veto is that newborn screenings will continue as before, but it is unclear whether the state can continue to keep genetic samples for research purposes.
Seat belt measure allowing police officers to stop and ticket motorists for not wearing a seatbelt.
Booster seat requirement for children up to age 9.
Significant Health Care Reform Passes
The Legislature and Gov. Tim Pawlenty ended the 2008 Legislative session with the last-minute passage of a significant health care reform bill.
Reform Bill Highlights
Medical Home
The bill supports the medical home model—coordinating care primarily for patients with complex, chronic conditions.
The commissioners of health and human services will develop and implement standards for certification of medical homes by July 1, 2009. The model will be evaluated in three to five years.
“This reform will focus on chronic illness where most health care dollars are spent and where there are the most opportunities to improve people’s health and save money,” Dehen says.
Essential Benefit Set
The bill establishes a work group to make recommendations on the design of an essential benefit set that includes coverage for a broad range of services and technologies that are determined to be clinically effective and cost-efficient, and report to the Legislature by January 2010.
Public Health
The bill will provide
$47 million for statewide grants in 2010-11 for programs aimed at reducing obesity and tobacco use.
Move Toward
Universal Coverage
The package is expected to expand coverage to 12,000 more Minnesotans. The bill would increase health coverage in state programs by enrolling 7,000 more people by expanding MinnesotaCare coverage for people without children up to 250 percent of the federal poverty line. The state hopes that additional tax incentives will encourage 5,000 Minnesotans to buy insurance.
Cost and Quality
Transparency
The legislation directs the commissioner of health to develop a uniform and valid methodology for calculating providers’ combined performance on cost and quality and to promote payment reform that rewards quality and efficiency.
Bundled Services
The bill directs the commissioner of health to establish definitions for at least seven baskets of care and suggests that they include coronary artery and heart disease, diabetes, asthma, and depression. Providers may then choose to establish a price for the baskets, but the price cannot vary depending on who is paying it. The single price concept does not apply to workers’ comp, no-fault auto, and government payers.
Electronic Prescribing
The bill will establish standards by 2011 for physicians who write and send prescriptions to pharmacies electronically.
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“The Minnesota Legislature and the governor are to be commended for passing historic health care reform legislation,” says James J. Dehen Jr., M.D., president of the MMA.
Dehen also says the MMA can take a great deal of credit for the achievement, which moves Minnesota closer to the vision outlined in the MMA’s Physicians’ Plan for a Healthy Minnesota.
“The MMA really helped get the ball rolling with its reform plan and worked closely with both lawmakers and the governor to broker an agreement this session,” he says.
Lawmakers and the governor began the session saying they wanted to achieve health care reform, and early on they found common ground on issues such as cost and quality transparency, the need to increase public health investments, and the promotion of medical homes and chronic disease care.
However, the governor and DFL leaders also found plenty of points to disagree on.
The governor came out as an early supporter of a controversial payment reform scheme known as Level 3, which resembled capitated plans of the past and that would have held providers accountable for the total cost of caring for patients.
The MMA strongly opposed this feature of the bill and made it clear to lawmakers that it would not support any reform bill that included it. “It was very important for us to get rid of Level 3, especially for the small clinics and in the rural settings, since it presented some potentially unmanageable financial risks,” Dehen says.
In the end, the governor compromised and was willing to replace Level 3 with a provision that calls for standardized measurement and disclosure of providers’ comparative cost and quality of care. The bill calls for the commissioner of health to collect information about providers and then rank them according to peer groupings, which have not yet been defined.
Another bone of contention was whether the state could afford to expand state health programs. DFL lawmakers wanted to add about 40,000 Minnesotans to state rolls. Gov. Pawlenty vetoed the first health care reform bill that passed the House and the Senate because he said the state couldn’t afford it.
In the end, both sides compromised, with the final bill making about 7,000 more people eligible for public programs, while also including tax incentives expected to allow 5,000 people to buy insurance in the private market.
“We didn’t get everything we wanted,” Dehen says. “But we made good inroads, and clearly made some good moves here with the recognition of medical home, preventive health, and a step toward universal coverage.”
Although the bill is a good one for physicians, there are still parts of the MMA’s reform plan that were not included such as achieving universal coverage, a requirement that all individuals have insurance, and more substantial public health spending.
“The key is prevention, and we’ve made movement, but we need to look harder at that, and we need to achieve universal coverage. If this is going to work, everyone needs to be in the game,” Dehen says.
DVD Helps Providers Serve Returning Vets
Free educational videos are available to physicians wishing to better deal with the medical needs of returning troops.
The four-part series created by the HealthPartners Institute for Medical Education, discusses the most common issues returning soldiers face.
HealthPartners partnered with Twin Cities Public Television, the Minnesota Army National Guard, and the Minneapolis Veterans Affairs Medical Center to create the series. It is based on a medical conference awarded the 2008 Award for Outstanding Collaboration by the Alliance for Continuing Medical Education.
You can get your own free DVD by calling Nilani Jayatilaka, MMA policy analyst, at 612/362-3735 or by emailing her at njayatilaka@mnmed.org.
Visit www.joiningforcesonline.org to learn how to use the DVD to obtain CME credits.
Call for Officer Nominations
You are invited to recommend a colleague or yourself to be considered for an MMA office. The MMA Nominating and Leadership Development Committee will provide a slate of candidates to the 2008 House of Delegates for the offices of president-elect, secretary-treasurer, speaker and vice speaker of the House, and for American Medical Association (AMA) delegates and alternates.
The election will be held September 18 at the Annual Meeting in St. Paul.
The president-elect serves as a backup to the president, the MMA’s chief spokesperson, and is inaugurated the following year.
The secretary-treasurer manages the financial affairs of the association and chairs the Committee on Administration and Finance.
The speaker presides over House of Delegates meetings and is assisted by the vice speaker.
Trustees manage the affairs of the MMA and set policy between sessions of the House of Delegates.
The AMA delegation takes part in the AMA House of Delegates deliberations, representing Minnesota physicians in setting AMA policy.
If you are interested in being considered for an office or if you would like to recommend a colleague to the committee, please contact MMA CEO Robert Meiches, M.D., at rmeiches@mnmed.org.
The Nominating and Leadership Development Committee has asked the presidents and executives of the component societies and specialty societies, members of the MMA Board of Trustees, the AMA delegation, and committee chairs to recommend physicians for positions of leadership for 2008-09 and beyond.