MMA News Now
GAMC Bill Restricts Provider Payments
Representatives from the MMA testified before House and Senate committees in March, arguing that a proposal to reform the General Assistance Medical Care (GAMC) program agreed to by legislators and the governor was not realistic. Gov. Tim Pawlenty and lawmakers were supporting a plan that would allow a scaled-down version of the GAMC program to temporarily continue.
If a bill that is making its way through the Legislature in March becomes law, after May 31, hospitals and counties would be able to join together to form care coordination organizations (CCOs) that would receive lump-sum payments to provide care to all GAMC enrollees in a given geographic area. All GAMC care would be delivered through the CCOs by December 1, 2010.
The bill would allow 17 hospitals, which care for about 80 percent of the 32,000 people enrolled in GAMC to voluntarily become CCOs starting June 1. These hospitals would then be required to provide all of the enrollee’s inpatient and outpatient care and would have the option of subcontracting with outside physicians and clinics for some services. The state’s other 131 hospitals could become CCOs after November 1.
It is unclear whether any of the hospitals will want to assume the financial risk of being a CCO, however, as funding for the program would be reduced by 60 percent.
Administrators from SMDC Health System in Duluth testified against the bill saying it would cost their system millions of dollars because its hospital, St. Mary’s Medical Center, would be the only hospital in northeastern Minnesota designated to serve GAMC enrollees. The amount of money SMDC would receive to care for GAMC enrollees would shrink from $20 million to $2 million under the new arrangement. The new capitated arrangement would also compel SMDC to negotiate agreements with other providers to deliver care the hospital does not provide—a job leaders of SMDC do not want, according to news reports.
Under the proposal, Hennepin County Medical Center would receive $22 million to provide outpatient and inpatient care for GAMC enrollees. Last year, it received $49 million, according to reports.
“This is not real reform,” says Dave Renner, the MMA’s director of state and federal legislation. “This is just cutting payments drastically, giving a lump sum to hospitals, and saying ‘the risk is yours.’”
Clinics and providers that don’t have a contractual relationship with a CCO would not be eligible for reimbursement for care provided to GAMC enrollees. In addition, the legislation includes a provision that would allow clinics to decline to treat GAMC enrollees and still be reimbursed for care they provide to state employees. (Agreeing to care for patients enrolled in state-sponsored health plans such as GAMC has been a condition of being able to get reimbursed for care provided to state employees.)
Renner told members of the Senate Health and Human Services Budget Division and the House Health Care and Human Services Finance Division that despite the MMA’s concerns, it was not opposing the bill because it was preferable to Gov. Pawlenty’s earlier proposal to transfer GAMC enrollees into the MinnesotaCare program.
The GAMC debate may not be over, however. Rep. Thomas Huntley (DFL-Duluth) and other lawmakers proposed reopening discussions after the passage of national health care reform in mid-March, as the federal legislation would allow Minnesota to receive funds that could be used to shore up GAMC.
MMA Seeks Officer Candidates
The MMA is seeking nominations for officers. As a member, you are invited to nominate yourself or a colleague for the offices of president-elect, secretary-treasurer, speaker of the House, and vice speaker of the House, or to serve as an American Medical Association (AMA) delegate or alternate.
The MMA Nominating and Leadership Development Committee will provide a slate of candidates to the 2010 House of Delegates. The election will be held September 16 during the MMA Annual Meeting at Breezy Point Resort near Brainerd.
The president-elect serves as a backup to the president and is inaugurated as president the following year. The secretary-treasurer manages the financial affairs of the association and chairs the Committee on Administration and Finance. The speaker presides over House of Delegates meetings and is assisted by the vice speaker. The AMA delegation represents Minnesota physicians during AMA deliberations.
If you are interested in being considered for an office or if you would like to recommend a colleague to the committee, please contact Shari Nelson at snelson@mnmed.org. The deadline for recommendations is May 1.
Commissioner Opposes Peer Grouping Timeline Change
An MMA-endorsed bill to improve the state’s provider peer-grouping initiative easily passed a House committee in March, but it ran into trouble in the Senate when Minnesota Commissioner of Health Sanne Magnan, M.D., testified against giving doctors more time to analyze their cost and quality scores before they’re released to the public.
Doug Wood, M.D., had testified before the House Health Care and Human Services Policy and Oversight Committee March 10 on behalf of the MMA, urging lawmakers to change the state’s provider peer-grouping plan by adding a quality-improvement component that would help physicians and clinics improve their performance, extending by eight months the public release of the cost and quality data, and repealing a law that precludes providers who score in the bottom 10 percent on the quality and cost measures from participating in state-subsidized health insurance programs.
The House committee voted unanimously in favor of the bill (H.F. 3056/S.F. 2815). However, the Senate Health, Housing, and Family Security Committee voted in favor of an amended version after Commissioner Magnan voiced her opposition to the MMA’s proposed timeline. She said hospitals’ and clinics’ scores should be made public after a 60-day review period by providers.
Originally, hospitals and clinics were expecting to get their first look at their cost and quality scores in June 2010, and the state was to publicly report those scores in September. The state’s contract with Mathematica Policy Research, the Princeton, New Jersey, firm that’s designing the cost and quality measures and analyzing data, will delay the release date to providers until October 2010. The Commissioner expressed her intent to publicly report the data no later than January 1, 2011. The committee amended the Senate version of the bill to reflect the commissioner’s wishes. The MMA would like to delay the public release of the data until September 2011 to allow clinics and hospitals time to review the data and to test the state’s methodological approach. The MMA was in discussions with the Minnesota Department of Health about how to resolve the disagreement.
Your Personal Day at the Capitol
Teresa Gurin, M.D., discussed medicine and family with Rep. Phillip Sterner (DFL-Apple Valley). Gurin says she stepped forward to meet with her lawmaker “because this is such an important time for physicians to get involved.” The MMA set up the meeting as part of its Capitol Rounds program. Learn more at www.mmaonline.net/grassroots.
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Peer grouping is designed to strengthen incentives for consumers to choose high-quality, low-cost health care providers by allowing them to compare the cost and quality of the care provided by hospitals and clinics. Clinics and hospitals will be ranked on performance measures related to total care for six conditions or procedures: diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement.
The data will be drawn primarily from insurance claims, which the Minnesota Department of Health is collecting from all Minnesota payers—both public and private. Physicians also will report some quality data.
The peer-grouping initiative does not emphasize using data to improve the quality of the care, something the MMA strongly supports. Wood indicated that this is a serious oversight because research has repeatedly shown that quality improvement programs that give providers such data and the resources to make changes lead to improved results. There is far less evidence that publicly reported quality scores either improve outcomes or are used frequently by consumers.
“The MMA is not looking to limit public reporting,” Wood testified. “But quality improvement is where the real benefits can be gained.”