August 2009 | Back to Table of Contents

MMA News

Appeals Court Ruling Favors Physicians

The Minnesota Court of Appeals ruled in July that a physician who makes a good-faith decision to not place an emergency hold on a psychiatric patient is immune from negligence claims. 

The MMA, along with Fairview Health Services, recognized the importance of the case, Losen et al. v. Allina et al., and filed a joint amicus brief with the court in December of 2008. 

“This is an outstanding result,” says Karolyn Stirewalt, J.D., policy counsel for the MMA. “An adverse ruling would have seriously impacted both Minnesota physicians and treatment facilities that admit psychiatric patients.” 

The Minnesota Commitment and Treatment Act (Minn. Stat. § 253B.23, subd. 4) says that physicians who are acting in good faith are immune from legal liability for holding and hospitalizing a patient for up to 72 hours when the patient shows signs of being harmful to himself or to someone else. 

The issue in this case was whether physicians who are acting in good faith can similarly be held immune from liability for discharging a patient if the patient later harms someone. In the case of Losen et al. vs. Allina et al., the patient was discharged and two weeks later, shot and killed his mother and assaulted his father and stepmother. The events took place in 2003. 

The MMA and Fairview Health Services advocated that physicians should make civil commitment determinations based on good faith and actual knowledge of the patient, not on the fear of legal liability, which could inadvertently increase demand for psychiatric beds that are already in short supply. 

The Minnesota Court of Appeals upheld the district court’s ruling that states: “An examiner’s good-faith determination that a proposed patient does not meet the statutory criteria for an emergency hold qualifies as an act―pursuant to any provision of the Minnesota Commitment and Treatment Act. … Respondents are therefore entitled to statutory immunity, and the claims against them for failure to place a 72-hour hold on (the Appellant) were properly dismissed.”

AMA President To Address MMA

James Rohack, M.D., American Medical Association (AMA) president, will be the featured speaker at this year’s Awards Luncheon to be held during the MMA’s Annual Meeting September 17 in Rochester. 

Rohack, who took the helm of the AMA in June, has become a key player in the nation’s health care reform debate. He is a professor at the Texas A&M Health Science Center College of Medicine and director of the Center for Healthcare Policy at Scott and White Health Plan, a nonprofit HMO in Temple, Texas, where he continues his clinical practice. 

There is limited space for MMA members who are not delegates but would like to attend the 12:30 p.m. luncheon. The cost for members who are not delegates is $25. If you are interested in becoming a delegate or attending the luncheon, contact Vicki Westling at vwestiling@mnmed.org.

Be a Booster Seat Booster

Minnesota’s new booster seat law went into effect July 1. Under the new law, children must use booster seats until they are 8 years of age or 4 feet 9 inches tall, whichever comes first. 

Physicians should remind parents that traffic crashes are the leading cause of death for children in Minnesota. The Minnesota Medical Association advocated for the booster seat law, which passed this year.

Medicare Payment Needs Fixing

ational health care reform plans could undercut Minnesota’s statewide efforts if Congress expands Medicare’s current payment methods. Representatives from the insurance industry, employer groups, the Legislature, and the health care industry, including MMA President Noel Peterson, M.D., raised this concern at a recent forum hosted by the Mayo Clinic Health Policy Center. The event, “National Health Care Reform: Implications for Minnesota,” was held in St. Paul and cosponsored by the MMA. 

A common concern among participants was that Congress won’t reform the payment system in a meaningful way. A potential risk is that Washington lawmakers will expand Medicare without fixing the payment issues that plague the health care program for seniors, according to Peterson, who participated in a panel discussion. The current Medicare payment system rewards volume, paying physicians for ordering tests and doing procedures that may not improve a patient’s condition. 

Participants argued that Congress should reform the payment system so that Medicare pays for health care that is efficient and results in positive outcomes. 

“More than ever, we need to understand that what we need to do is pay for value in health care and embody that in federal law,” said Douglas Wood, M.D., chair of the Division of Health Care Policy and Research at Mayo Clinic and an MMA member. 

Sen. Amy Klobuchar, D-Minn., who also spoke at the event, echoed that sentiment and brought up the fact that Medicare costs are different in different parts of the country. For example, in Miami, Medicare spends about twice as much per year on the average patient as it does in Minneapolis, although the quality of care is higher in Minneapolis. “Medicare could save $50 billion over five years if people in the rest of the country were as efficient as Mayo,” she says. 

In June, Klobuchar introduced the Medicare Payment Improvement Act, which authorizes the secretary of Health and Human Services to create a value index for determining physician fees. The goal of the legislation is to create a payment system that is fair and encourages preventive care and effective management of chronic diseases. The MMA supports Klobuchar’s legislation and believes physicians in Minnesota would likely benefit from such a change in payment structure. 

Minnesota Model 
Klobuchar and others at the event agreed that now is the time to promote Minnesota as a model for rest of the country. State Rep. Thomas Huntley, DFL-Duluth, who was recently invited to Washington by the Obama administration to discuss health care reform, suggested that Minnesota seek a waiver that would allow it to include Medicare beneficiaries in tests of innovative payment methodologies. The MMA’s Peterson noted it would be a distinct advantage for Minnesota’s reform efforts if Medicare patients could be included in the state’s efforts to use medical homes and better coordinate care. 

In the end, Huntley wants to see a payment system that rewards high-quality care. “My concern is that we end up with a plan that rewards good states, and we need to make sure that this part of the country is not disadvantaged,” Huntley said. 

The MMA met with members of Minnesota’s Congressional delegation in July and August to let them know that incorporating Medicare’s geographic payment disparities in a new public health insurance plan would be disastrous for Minnesota. 

A reform proposal in the House would base public plan payments on Medicare rates plus 5 percent, which the MMA considers unacceptable. 

“Any reform that sets reimbursements based on Medicare payments, even with a 5 percent increase, will be devastating for Minnesota,” said Dave Renner, the MMA’s director of state and federal legislation. “Medicare penalizes low-cost, high-quality states like Minnesota, so extending that to a public option will result in physicians going out of business.”