MMA News
MMA Leaders: Low Pay Threatens Safety Net
MMA leaders met with top lawmakers in December as a first step in a campaign to update health care safety net payment rates, which have been nearly flat for 16 years.
The long-term goal of the campaign is to raise payments so they better cover the costs of caring for patients covered by MinnesotaCare, Medical Assistance (MA), and General Assistance Medical Care (GAMC).
During meetings with Sen. Linda Berglin (DFL-Minneapolis), chair of the Senate Health and Human Services Budget Division, and Rep. Thomas Huntley (DFL-Duluth), chair of the House Health Care and Human Services Finance Division Committee, MMA Trustee Donald Jacobs, M.D., MMA CEO Robert Meiches, M.D., and MMA staff made their case for updating fee-for-service reimbursement rates. They explained that reimbursement for care provided through these safety net programs is lower than what Minnesota physicians receive from all other public and private payers. In addition, physicians here are paid considerably less for office visits and evaluation and management of patients in public programs than physicians in Iowa, North Dakota, South Dakota, and Wisconsin.
Minnesota physicians have received only one 3 percent increase in the last 16 years, in spite of escalating practice costs. The consumer price index has increased by more than 21 percent since 1999.
The MMA delegation also told lawmakers that although state payments to health plans for covering participants in the Prepaid Medical Assistance Program (PMAP) have increased every year, those increases have not been passed along to physicians. About 64 percent of Minnesota’s Medical Assistance (Medicaid) recipients are enrolled in managed care plans through PMAP. Participating health plans receive capitated payments from the state to cover these enrollees.
During the past eight years, the state has increased its payments to the health plans an average of 10 percent a year. The assumption was that the increases were necessary to cover rising costs, including provider costs. The MMA leaders alerted lawmakers to the fact that health plans were accepting sizeable pay increases from the state but were not increasing payments to providers. “One of the concerns that we have is that in addition to Medicaid fee-for-service rates being very flat, payment rates from PMAP have also been inadequate to cover the cost of caring for this population,” Jacobs says.
Another reason for the low payment rates for primary care services is the state’s use of an arcane methodology from the early 1980s for computing fee-for-service payments. The Minnesota Department of Human Services (DHS), which pays for care provided through public programs, is the only large payer in the state that does not use a resource-based relative value scale (RBRVS) system, which Medicare and private payers use to determine physician payments. The Legislature mandated the move to such a system in 2003, but DHS has yet to make the change.
Ultimately, the MMA would like to see yearly inflation adjustments to the fee-for-service reimbursement rates for physicians, a requirement for health plans to pass along payment increases to providers who see patients enrolled in PMAP, and implementation of an RBRVS payment system.
Given the fact that lawmakers will be grappling with a multibillion-dollar state budget deficit this session, Jacobs says the purpose of the meeting was not so much to push for a payment increase as to make sure lawmakers understand how vulnerable the safety net is because payment rates have been inadequate for so long. He says the big push on the part of the MMA this year will be to prevent any cut to reimbursement rates. “The phenomena we are likely to see if cuts go through is that more and more physicians will limit the number of Medicaid patients they see or they will stop seeing them altogether.”
Tough Session Ahead for Health Care
Minnesota is facing an historic budget deficit that could result in an attempt by legislators to cut health care programs and increase the provider tax.
State officials released a two-year budget projection in December that predicted a short-term deficit of $426 million for the balance of the 2009 fiscal year and a $4.8 billion shortfall for the 2010-11 biennium. The total equals about 14 percent of the current state budget.
Health care spending and aid to local governments have emerged as early targets for cuts. Gov. Tim Pawlenty was making cuts to eliminate the short-term deficit through a process called “unallotment” during the final weeks of December.
Lawmakers will start the budget process for the upcoming biennium when the 2009 legislative session begins January 6. “Lawmakers have been saying that nothing is off the table,” says Dave Renner, MMA director of state and federal legislation. “But our message to them is that given these tough economic times, the health care safety net is the last place they should be cutting.”
The governor says he’s sticking with his no new taxes approach and that budgeting for the 2010-11 biennium is an opportunity to re-examine and restructure state government. He called the current level of health care spending unsustainable and said his top three priorities were veterans affairs, public safety, and K-12
education.
DFL leaders have agreed that lawmakers should first try to reduce the deficit with spending cuts; but they did not rule out tax increases. They also seemed less inclined to cut health care spending.
Renner says House and Senate leaders have urged the governor not to balance the budget by raiding the Health Care Access Fund, which collects revenues from the provider tax to pay for the Minnesota-Care subsidized insurance program, or by using money set aside for health care reform in 2008. The access fund will end 2008 with reserves of about $260 million; but based on projected spending trends for MinnesotaCare, the fund will be in the red by 2013.
The bottom line is that physicians should be prepared for an extremely challenging session, Renner says, adding that as budget negotiations move forward, the MMA will fight any efforts to increase the provider tax. “It’s pretty likely that lawmakers will be looking for ways to raise funds,” he says. “We need to make sure they don’t decide to do it on the backs of patients with the sick tax.”
Credentialing to Get Easier
More than a dozen health care organizations, including hospitals and clinics, will start using a new online system for credentialing physicians this month.
The Minnesota Credentialing Collaborative (MCC) credentialing process, which was developed by the Minnesota Medical Association, the Minnesota Council of Health Plans, and the Minnesota Hospital Association and has been in a testing phase, is now being tried out by most health plans, and a select set of clinics, and hospitals. If all goes well, the MCC will start offering credentialing services to all providers by the end of March.
The MCC provides an affordable, easy-to-use way to prepare, save, and send credentialing applications. Once you or your clinic enters credentialing information into the MCC’s secure website and attest to its accuracy, the system checks your data to decrease the amount of missing or incorrect data. It then sends it electronically to the health plans and/or hospitals with which you have selected to be credentialed.
The new system speeds up the credentialing process by making sure applications are complete and accurate the first time they’re submitted.
If you have questions or would like to be included in the start-up group, contact Tracey Torgersen, MCC program manager, at tracey@mncred.org, 612/360-9793.