MMA News
MMA Urges Governor to Protect Safety Net
MMA President Noel Peterson, M.D., sent a letter to Gov. Tim Pawlenty urging him to recognize the importance of the state’s health care safety net during the current economic crisis.
The letter was written in response to the governor’s State of the State address, which did not list protecting the health care safety net for adults as a budget priority.
During the January 15 address, Pawlenty reiterated that his top priorities for his 2009-2010 budget were education, veterans’ programs, and public safety.
He said that although he would maintain current health care coverage for children, the state had to slow the rate of growth of its health programs, which he called “expensive” and “unsustainable.”
Pawlenty proposed resolving the state’s $4.8 billion budget shortfall without raising taxes. He also mentioned an increase in education funding and a 50 percent tax cut for businesses. The governor was scheduled to release his budget January 27.
In his letter, Peterson said he feared that health care programs were going to bear the brunt of upcoming budget cuts, and he urged Pawlenty not to ignore the state’s need for health care coverage provided by MinnesotaCare, Medical Assistance, and General Assistance Medical Care. “As more people lose their jobs, we can expect more demand for safety-net programs. This is not the time to reduce funding,” Peterson wrote.
His letter also pointed out that Minnesota’s health care safety net is already on shaky ground. Payments for medical services in public programs have been increased across-the-board only once in the last 16 years (a 3 percent raise in 2000). Meanwhile, the cost of running a medical practice has gone up 30 percent in the last 10 years. It also stated that ignoring low-income or unemployed Minnesotans’ health care needs will lead to less preventive care and higher long-term costs, and increasing the ranks of the uninsured will lead to more cost shifting to private payers.
In his address, Pawlenty had urged legislators to remember families sitting at the kitchen table struggling with financial questions: “How do we pay these bills? How do we fix the car? How do we pay this mortgage? How are we going to afford college or even retire someday?”His message was: don’t raise taxes.
Conspicuously absent were questions related to health care. In his letter, Peterson urged the governor to pay attention to other questions a family might ask: “Now that I’ve lost my job, how can we afford health insurance? Should we put off having the kids’ sore throats checked out? Should I skip refilling my blood pressure medicine?”
The MMA urged the governor to make funding for public programs part of a long-term health care reform strategy that is fair, doesn’t just shift costs, and makes sure all Minnesotans have access to health care.
Deadline Arrives for E-verification of Benefits
Time is up for Minnesota clinics to implement a system that allows them to electronically inquire about a patient’s insurance coverage.
January 15 was the deadline for providers to comply with a provision in a 2007 state law that requires common health care business transactions between providers and payers to be exchanged electronically.
According to the law, providers must be able to request and receive information electronically about the following:
- A patient’s eligibility to receive health care under a group policy,
- A patient’s health care coverage under that group policy, and
- The benefits associated with the patient’s health plan.
However, the state isn’t yet ready to impose stiff fines on those not in compliance with the new requirement. The law emphasizes voluntary compliance and allows those providers and payers who are not in compliance to take corrective action before they are penalized. However, if compliance cannot be achieved voluntarily, the commissioner of health can levy fines of up to $100 per occurrence or up to $25,000 for identical violations in a calendar year.
For more information, read “A Blueprint for 21st Century Health Care,” in the January 2009 issue of Minnesota Medicine.
Preventable Errors Up in Minnesota Hospitals
The state’s annual adverse events report, which was released in January, showed that an almost three-fold increase in preventable errors occurred in Minnesota hospitals, ambulatory surgical centers, and community behavioral health hospitals over the previous year.
The number of adverse events increased from 125 in 2007 to 312 in 2008.
However, much of the increase was caused by new reporting requirements. Hospitals now must report disabling falls, whereas they previously only reported fatal falls. In addition, hospitals now report unclassifiable pressure ulcers as well as Level 3 or Level 4 wounds. Using the old standards, the number of adverse events reported in 2008 would have been 141—or a 13 percent increase over 2007.
The number of reported preventable deaths, which is also included in the report, has fluctuated in recent years. Eighteen preventable deaths were documented in this year’s report, compared with 13 during the 2006-2007 reporting period and 24 during the 2004-2005 period.
MMA President Noel Peterson, M.D., says that it is disappointing that the results have not improved more, but he believes that facilities are making progress toward preventing errors and deaths as more of them use evidenced-based practices to reduce risks.
“To really improve patient safety, we have to change the culture so that everyone—at all levels—feels free to speak up. Most physicians recognize this and are working toward a health care culture that supports health care teams working together to improve patient safety.”
Peterson was quoted in a Star Tribune article about the report saying the majority of physicians support the new emphasis on safety and public disclosure, and that it eventually “will be second nature” to all of them.
MMA Weighs in on Psych Patient Case
In December, the MMA filed an amicus brief with the Minnesota Court of Appeals in a case addressing whether or not physicians have immunity under the Minnesota Civil Commitment Act after discharging a psychiatric patient who later harms someone.
Minnesota law says that physicians who are acting in good faith and with actual knowledge of a patient are immune from legal liability when they hold and hospitalize a patient who shows signs of being harmful to himself or someone else for 72 hours.
At issue in the case of Losen, et al. versus Allina is whether a physician who is acting in good faith and with actual knowledge of a patient is also immune from liability for a decision not to place a patient on a 72-hour hold if that patient harms someone after discharge.
The plaintiffs’ claim is that the defendants, Allina Health System, Minnesota Epilepsy Group PA, and three physicians, were negligent in releasing a patient who was admitted to United Hospital for behavioral changes following alterations to his anticonvulsant prescription medication regimen.
The patient was admitted to the hospital July 28, 2003. The next day, he tried to leave against medical advice and was restrained. Two hospital physicians assigned to the patient (one of whom was a psychiatrist) believed there were insufficient grounds to place a 72-hour hold on the patient because he did not have a history of violence and he agreed to take his medications and have a follow-up visit.
The patient was discharged. Two weeks later, he shot and killed his mother and assaulted his father and stepmother. The plaintiffs alleged that the defendants were negligent for not holding the patient. The defendants argued that the hospital and physicians were immune under Minnesota law.
This is the first case in Minnesota to address this issue. When it was brought before Ramsey County District Court, the judge awarded a summary judgment in favor of the defendants, who argued that the hospital and physicians were immune under Minnesota Statute 253B.23. The plaintiffs appealed that decision, and the Minnesota Court of Appeals is now considering the case.
The MMA and Fairview Health Services filed an amicus brief with the appeals court on behalf of the defendants. The MMA argued that the district court’s ruling was consistent with the language of the Minnesota Civil Commitment Act and Minnesota’s public policy to treat patients in the least restrictive manner possible.
The MMA and Fairview argue that physicians should make civil commitment determinations based on good faith and actual knowledge of the patient and not because of fear of legal liability, which could increase demand for psychiatric beds already in short supply.
An adverse court ruling would negatively affect all Minnesota physicians or treatment facilities that admit psychiatric patients by exposing them to potential liability for discharging a patient on the grounds that he or she did not qualify for forced admission.
Oral arguments for the Court of Appeals case are expected this spring.