MMA News
Legislature to Grapple with Reform Proposals
During the first week of February, the Legislative Commission on Health Care Access and the governor’s Health Care Transformation Task Force issued their plans for overhauling Minnesota’s health care system.
Both proposals share common ground with the MMA’s own Physicians’ Plan for a Healthy Minnesota, which was released in 2005.
DFL and Republican lawmakers agree with the MMA that health care reform should use a market-based approach, promote a strengthened public health system, and include payment reforms that encourage prevention and disease management. Other reforms being considered would establish an essential benefit set, support the medical home concept, and guarantee insurance coverage regardless of health status.
However, the two sides disagree over how to pay for care and the issue of universal coverage. DFLers favor increasing the tobacco tax to fund health care and requiring all Minnesotans to have health coverage. Gov. Tim Pawlenty doesn’t support either idea.
MMA President James J. Dehen Jr., M.D., says he’s pleased that the governor and lawmakers are talking about passing reform legislation this session. “We have been avoiding hard solutions for a long time. We need to move forward with the process of meaningful health care reform, and that is going to take collaboration and cooperation between legislators and the governor,” Dehen says.
Payment Reform Raises Concerns
However, the MMA is concerned about some of the payment reforms proposed by the governor’s Health Care Transformation Task Force.
The task force recommended a three-level approach to reforming the state’s health care payment system that would culminate in providers setting their own prices but also being accountable for the total cost and quality of care. The first level would use a pay-for-performance model to tie payment to quality. In the second level, care coordination payments would support medical homes. The MMA supports both increased reimbursements for care coordination and pay-for-performance programs that offer bonuses.
However, the third level raises troubling questions. By 2012, providers would put forth bids on how much it would cost them to care for a given patient population with a known risk profile.
The state would create a quasi-governmental body called the Health Care Transformation Organization to manage the bidding process, basically creating a market among providers, health plans, and purchasers. The Health Care Transformation Organization would work with purchasers to establish a standard benefit set on which providers would base their bids. Providers would submit bids, and insurers, employers, and consumers would select the care system of their choice. Providers would receive payment equal to their bid regardless of how much or little it costs them to provide care to those patients during the year.
The MMA has raised concerns about this payment model because it resembles traditional capitation models that require physicians to assume insurance risk.
Although the report says the system will not penalize physicians for accepting sicker patients because payments will be risk-adjusted upward for sicker patients, the MMA is not convinced current risk-adjustment methods can adequately control for variations among patients or protect physicians from risk.
“You can’t expect providers to be responsible for preventive costs and disease management and then also tell them that they have to capitate the care,” says Dehen.
MMA Files Joint Amicus Brief
The MMA and the Minnesota Defense Lawyers Association (MDLA) have weighed in on a legal case that considers the question: Are damages established at the time of misdiagnosis or when it becomes likely that the patient will not survive?
The MMA filed a joint amicus brief on January 30 in a malpractice case now before the Minnesota Supreme Court. The case was brought against two physicians and their employer, Group Health Plan, Inc. (HealthPartners), by former patient Roderick MacRae.
In 2001, a lesion on MacRae’s leg was biopsied and the results were misdiagnosed as a nonmalignant compound nevus. In September of 2004, MacRae reported swelling and pain in his groin and leg to his doctor. A subsequent biopsy revealed a metastatic malignant melanoma. MacRae died of the melanoma in August of 2005. In February of 2006, his wife Margaret MacRae filed suit against Group Health and the physicians involved.
Both the district court and the Minnesota Court of Appeals have held in favor of HealthPartners and the physicians, saying the statute of limitations for the claim had expired. In Minnesota, a wrongful death action based on medical negligence must be brought within three years of the date of death but not later than four years after the date of the accrual of harm or, in this case, the misdiagnosis.
The lower courts based their decisions on two Minnesota Supreme Court opinions, Malloy versus Meier (2004) and Fabio versus Bellomo (1993), which stated that medical malpractice actions based on the failure to diagnose “generally accrue at the time of misdiagnosis, because some damage generally occurs at that time.”
However, MacRae’s attorneys argue that the statute of limitations for a misdiagnosis of a malignancy does not start until it is more likely than not that the patient will die. The appellant bases this argument on a 1992 Minnesota Supreme Court case, Leubner versus Sterner, which held that “there is generally no medical malpractice cause of action for negligent aggravation of a pre-existing condition, and a plaintiff cannot establish that a misdiagnosis decreased the likelihood of survival until there is proof that it is more probable than not that the plaintiff will not survive the cancer.”
The MMA and the MDLA are urging the court to reject the appellant’s argument.
The MMA is concerned that overturning the lower courts’ decisions will create gray areas under the current statute of limitations law by lengthening the time in which misdiagnosis of cancer claims may be filed and doing away with the clarity and predictability that the current statute
provides.
MMA Staff Reaches Out
Two MMA staff members are working on the front lines to help physicians get the most out of their membership.
Mandy Rubenstein and Dennis Gerhardstein can help members participate in MMA programs such as Capitol Rounds, a personalized tour of the Capitol that includes a meeting with lawmakers, and District Dialogues, meetings between lawmakers and members in their home district.
Rubenstein works with physicians in northern Minnesota. Gerhardstein covers the metropolitan area and southern Minnesota.
You can contact Rubenstein at mrubenstein@mnmed.org or 612/362-3742 and Gerhardstein at dgerhardstein@mnmed.org or 612/362-3745. Both may be reached by calling the MMA’s toll-free number, 800/342-5662.