MMA News
Doctors at the Capitol
Gov. Tim Pawlenty’s proposal to fix the state’s nearly $5 billion budget shortfall and nice weather brought out a strong showing of physicians at the MMA’s Day at the Capitol February 5.
More than 100 physicians attended the event in order to register their concern about the governor’s plan to shred Minnesota’s health care safety net in his effort to balance the budget. Pawlenty has proposed eliminating state health care coverage for at least 84,000 Minnesotans who currently receive it, cutting provider payment rates by 3 percent, eliminating benefits such as coverage for dental care and physical therapy, and rolling sick-tax revenues into the general fund.
“The direct cuts will limit people’s access and result in more people going to the emergency room, which will increase the cost of care,” said David Thorson, M.D., a family physician in St. Paul and an MMA trustee who attended the event. “The more subtle cuts will result in us providing care to patients who can’t afford it, and we will have to cost-shift to figure out how to keep our doors open.”
Stephanie Stanton, M.D., who practices at the HealthEast Roselawn Clinic in St. Paul, said she was stunned by some of the governor’s plans. “I can’t believe that Gov. Pawlenty wants to slash funding to my adult Medical Assistance patients, so that when they have back pain they will no longer be able to receive physical therapy, which is the most appropriate treatment,” she said.
Stanton said that not covering conservative treatments such as physical therapy would result in more patients eventually needing expensive imaging tests and back surgeries.
During the event, physicians heard speeches from prominent legislators, met with lawmakers from their home districts, and attended advocacy training.
Stanton, who has attended the MMA’s Day at the Capitol for several years, said getting to know her lawmakers makes her feel like she is part of the political process. “This is the only way I know of to affect change in our Legislature and do something for my patients beside provide care to them,” she said.
Bad Info Causes Prescribing Confusion
The MMA is trying to clear up the confusion created by an article in the January 2007 Minnesota Board of Pharmacy newsletter that stated that the U.S. Drug Enforcement Agency (DEA) allowed Schedule III and IV prescriptions to be electronically created and transmitted. It does not.
Based on that inaccurate information, some physicians started using electronic prescribing and electronic signatures for these controlled substances.
Cody Wiberg, executive director of the Minnesota Board of Pharmacy, told the MMA that the interpretation of the federal regulations that appeared in the article came from a letter written by the DEA to the Minnesota Board of Pharmacy. However, it turns out that the information in the letter was wrong.
The error was discovered last June when a proposed federal rule was published that included a discussion of the current requirements for prescribing controlled substances. Included in the discussion was this statement: “A pharmacist may dispense a Schedule III or IV controlled substance only pursuant to a written and manually signed prescription from an individual practitioner, which is presented directly or transmitted via facsimile to the pharmacist, or an oral prescription, which the pharmacist promptly reduces to writing containing all of the information required to be in a prescription, except the signature of the practitioner.” Prescriptions for Schedule V substances also require a manual signature.
The bottom line is that the DEA calls for a manual signature on prescriptions for Schedule III, IV, and V controlled substances pursuant to 21 C.F.R. 1306.21, and it appears it has never permitted electronic prescriptions and electronic signatures for these drugs.
The AMA, however, would like to see this changed and has urged the DEA to create an e-prescribing process for these drugs.
Rx: Read to Your Children
Robert Fisch, M.D., would like very much to see children in pediatric clinics across the state listening to tales of wild things and Dr. Seuss’s star-bellied Sneetches.
The retired professor of pediatrics at the University of Minnesota and expert on phenylketonuria, a genetic disorder that can be managed with diet, believes that what goes into the mind of a child is as important a consideration for doctors as what goes into the body.
That’s why Fisch would like to see reading promoted in all clinics in Minnesota that care for children and why he put forth a resolution to the MMA House of Delegates calling for the MMA to promote clinic-based reading programs.
“Doctors are not just there to say eat cheese or a yellow vegetable,” he says. “It is also important for the brain to be stimulated.” His prescription for doing that: “Read to your child.”
He notes that there is a strong connection between reading to children at an early age and their linguistic and cognitive development. Yet only about 50 percent of toddlers and infants are read to routinely by their parents, according to the American Academy of Pediatrics.
However, studies show that physicians and other health care providers can influence parents to read to their children. Researchers at Brown University Medical School found that families who participated in a clinic-based reading program in Rhode Island read to their children more frequently than parents who did not take part. In addition, they found the 18- to 25-month old children who were involved in the reading program had higher vocabulary scores than toddlers who weren’t part of the program.
“To me, the most important thing is the education of the children,” Fisch says. He then points out that the word “doctor” comes from the Latin word that means “to teach.”
He believes that clinicians have a special opportunity to positively affect the mental development of children. Unlike schoolteachers, physicians see children during their first years of life—a period that is critical to brain development. And he notes that because physicians hold a unique position of trust and authority in the minds of parents, they can use their influence to convince parents of the importance of reading.
Project Read
Fisch first got inspired to include reading in clinics in 1994, when he noticed children watching television in the waiting room of his own clinic at St. Paul-Ramsey Medical Center, now Regions Hospital. Wouldn’t it be better, he thought, if the clinic instead used that down time to promote reading?
To achieve that end, Fisch started Project Read, in which volunteers read books to children during the clinic’s busiest hours. The volunteers also encouraged parents and older siblings to read to the younger children in the family and sometimes gave children books to take home. Watching the volunteers primed the parents to hear the doctor deliver a message at each visit about the importance of reading to their children. Parents also received a videotape that reinforced the message.
The program was endorsed by the MMA in 1996 and was expanded to some HealthPartners clinics, Hennepin County Medical Center, and the University of Minnesota Medical Center, which is still using it to some extent.
Although Fisch, a Holocaust survivor, who has written and illustrated his own books, including Light from the Yellow Star: A Lesson of Love from the Holocaust, retired from the university in 1997, his interest in the importance of reading never faded.
Involving the MMA
Several years ago, after talking with Arthur Rolnick, an economist with the Federal Reserve Bank of Minneapolis who has become a vocal advocate for investing in early childhood education, Fisch again took up the cause of getting reading programs into clinics and brought his resolution to the MMA, which adopted it in 2008.
He says incorporating reading programs into clinics doesn’t have to be difficult. To get started, Fisch says, physicians and clinic administrators need to:
- Designate a program coordinator (it can be staff member or a volunteer);
- Find volunteer readers through community service organizations, churches, hospital volunteer services, or other organizations;
- Collect donated books and books from libraries that can be used by volunteer readers or given to children;
- Display posters that tell parents to read to their children;
- Designate a section of the waiting room as the reading area and schedule volunteers to read to children during the busiest hours; and
- Encourage doctors and nurses to ask parents if they read to their child every day and let parents know that children’s minds need to be fed in the same way their bodies do.
Fisch promises that those who do launch reading programs will see rewards. “It was incredible,” he says of the program he started in his clinic. “The children loved it and asked for it.”
Physicians Testify against Budget Proposal
MMA President Noel Peterson, M.D., testified against Gov. Tim Pawlenty’s budget proposal at a Senate Health and Human Services Budget Division committee hearing on February 12.
The governor has proposed eliminating state health care coverage for at least 84,000 Minnesotans who currently receive it, cutting provider payment rates by 3 percent, eliminating benefits such as coverage for dental care and physical therapy, and rolling sick-tax revenues into the general fund in order to erase a nearly $5 billion deficit in the state’s budget.
“We are extremely disappointed with the budget proposed by Gov. Pawlenty. It is a step backwards from last year’s bipartisan health care reform bill,” Peterson said.
Also testifying that day was Gordon Alexander, M.D., president of the University of Minnesota Medical Center and an MMA member.
“These cuts should not and cannot fall disproportionately on the backs of low-income Minnesotans and on our safety net programs,” he said.
Around the time of the hearing, Pawlenty said that he planned to accept economic stimulus funds from the federal government. By doing so, the governor would be prevented from dropping people from the MinnesotaCare and Medical Assistance programs, as the stimulus package requires states to maintain existing eligibility requirements in health care programs funded by federal dollars.
The governor and lawmakers would still be able to cut benefits and payments and reduce the number of people enrolled in General Assistance Medical Care, which is entirely funded by the state.
Bill Would Add Dental Mandate to Checkups
A bill was introduced in February that would authorize Medical Assistance (MA) to pay for primary care doctors to do dental checkups and fluoride treatments on MA enrollees during well-child and teen visits.
The MMA has not taken a position on the bill, but members of its Legislative Committee have expressed concerns about it, since it would impose a new mandate on primary care physicians. The bill says primary care physicians must provide the following dental services as part of a general well-child or teen checkup:
- an oral examination,
- a risk assessment,
- a fluoride application for 1-year-olds at high risk,
- educational materials about caries prevention and a list of dental providers in the community.
The MMA Board of Trustees is expected to consider the bill at its March
meeting.