MMA News
Save the Date: February 9
The MMA will hold its 2010 Day at the Capitol the afternoon of February 9.
The MMA will need a strong showing of physicians in order to emphasize the importance of preventing further cuts to state-run safety net programs and reimbursement rates. We also will need physicians to weigh in on other state reform initiatives.
Mark the date on your calendar. The MMA’s Day at the Capitol is a great opportunity to meet other physicians, get the inside scoop, and talk to lawmakers about the issues you care about.
Pawlenty Outlines 2010 Reform Proposals
At a press conference last month, Gov. Tim Pawlenty outlined a series of health care reform proposals he plans to push during the 2010 legislative session.
His proposals, which are aimed at reducing costs, include requiring people in the Medical Assistance (MA) program to pick a primary care clinic, adding a provider tiering system to public health plans, and allowing people in Minnesota to purchase health insurance products from other states.
Pawlenty said that requiring MA beneficiaries to select a primary care clinic that would act as their doorway to the health care system would result in better care coordination and clinical outcomes as well as cost savings. He also outlined his ideas for tiering. The Minnesota Department of Human Services would rank health care providers and place them in tiers based on the quality and cost data that is being assembled as a requirement of Minnesota’s 2008 Health Care Reform Act.
The governor said that people on MA who choose a provider in a low-cost, high-quality tier would receive money on an Electronic Benefit Transfer (EBT) card, which they could use for items not typically covered by state-funded health insurance such as reading glasses or over-the-counter drugs. He suggested the incentive might be about $100.
In addition, the governor would like to increase the copays and deductibles for the portion of MinnesotaCare enrollees who earn between 133 percent and 275 percent of the federal poverty guidelines. His proposal would provide those individuals with money in a health savings account to cover copay and deductible costs.
MinnesotaCare enrollees who choose a provider in a low-cost, high-quality tier would receive more money in their accounts than those who choose providers in a more costly tier.
In September, the MMA’s House of Delegates debated whether to support incorporating health savings accounts into public health insurance programs. Some MMA members support the concept, arguing that making public programs more consumer-oriented would result in enrollees making better choices, such as going to an urgent care clinic instead of an emergency room for minor problems. Opponents said administering such a program would be difficult and would result in increased costs without accruing any significant benefits. The House of Delegates ultimately rejected the idea.
Competition From Other States
The governor also would like to make Minnesota the first state in the nation to allow residents to purchase health insurance from other states. Under Pawlenty’s proposal, Minnesota residents would be able to buy health insurance policies available in any one of 20 states considered by the Minnesota Department of Commerce to be good insurance regulators.
Pawlenty believes that more competition would result in lower health insurance costs. Premiums in Minnesota currently run about 7 percent higher than the national average, according to a Kaiser Family Foundation study. Pawlenty would like Minnesota to help establish an interstate health insurance compact that would create a common regulatory standard and facilitate health insurance purchasing across state lines.
The MMA has not formally weighed in on this issue. “Our concern would be that allowing patients to have health benefits from 20 different states could result in an administrative nightmare for doctors who would have to juggle all of those insurers,” says Dave Renner, MMA director of federal and state legislation.
MN Senators Vote for SGR Repeal
In October, the MMA urged physicians to rally around a Senate bill that called for the repeal of Medicare’s flawed physician payment formula and the elimination of backlogged physician payment cuts. “This was the best chance we’ve had in nearly 10 years to get rid of the SGR formula,” says Dave Renner, the MMA’s director of state and federal legislation.
The MMA sent out an Action Alert to members shortly after the bill (S. 1776) was introduced by Sen. Debbie Stabenow, D-Mich., on October 13. More than 200 Minnesota physicians responded by sending emails to or calling Sens. Al Franken and Amy Klobuchar.
The bill not only would have repealed the sustainable growth rate (SGR) formula but also stopped a 21 percent payment cut to physicians scheduled to take place in January.
Sens. Franken and Klobuchar both voted in favor of the bill, which ultimately failed on a vote of 47 to 53, with 12 Democrats and one independent senator joining all 40 Republicans to oppose to it. Under Senate rules, the measure needed 60 votes to advance.
“Although it is disappointing the measure failed, we want to thank the hundreds of MMA members who sent emails and made phone calls, and we want to thank our senators for voting yes on behalf of seniors and physicians,” says Renner.
Opponents of the measure said they objected to it because technically it would add about $247 billion to the national deficit over 10 years. “The point that we tried to make was that this was not a vote for a new program or a new obligation. Rather, this is an existing obligation that Congress has known about for many years and has refused to deal with,” Renner explains.
After the vote, it was unclear whether a permanent SGR fix would be possible this year. Instead, physicians may have to focus on securing a temporary measure that stops the payment cuts scheduled for January.
MMA Physicians Urge Parents to Watch for Flu Signs
Ehe MMA issued a press release in October urging parents to watch for the warning signs that their child is having a severe case of H1N1 and to seek out the H1N1 vaccine for their children when it becomes available. The press release was prompted by increased awareness of the H1N1 virus in Minnesota following the death of an otherwise healthy 6-year-old and the first shipment of the H1N1 vaccine.
The press release, which was picked up by Minnesota Public Radio, WCCO radio, and other media outlets, directed parents to look for these signs:
- rapid or difficult breathing
- bluish skin color,
- not drinking enough fluids,
- lethargy,
- extreme irritability,
- flu-like symptoms that improve then return, and
- fever with a rash.
Linda Van Etta, M.D., FACP, an infectious disease consultant and epidemiologist at St. Luke’s Hospital in Duluth, was quoted saying that parents should watch for information from their pediatrician or from their child’s school about opportunities to receive the vaccine. She also advised patience, since at the time, it was not clear when the vaccine would be widely available.
The MMA also launched a page on its website with H1N1 resources for physicians. Go to www.mmaonline.net and click on “Key Issues.”
H1N1 Vaccine Billing Codes Medicare
G9141 – Influenza A (H1N1) immunization administration (includes physician counseling for the patient/family)
G9142 – Influenza A (H1N1) vaccine, any route of administration
AMA Current Procedural Terminology Panel
90470 – H1N1 immunization administration (intramuscular, intranasal) including counseling
90663 – Influenza virus vaccine, pandemic formulation, H1N1
Learn more by going to www.MMAonline.net and clicking on “Key Issues.”