MMA News
MMA Completes Blue Cross Contract Review
As a result of MMA advocacy, a troublesome clause in the 2010 Blue Cross and Blue Shield of Minnesota (BCBS) Aware Provider Service Agreement will not be enforced this year.
Physicians are required to accept the 2010 agreement in order to be part of Blue Cross’s network. The agreement automatically renews on July 1 each year unless notice is provided to BCBS.
Included in this year’s agreement is a definition of “Regular Billed Charges.” The MMA, which conducts an annual review of the contract in partnership with the Twin Cities Medical Society and the Minnesota Medical Group Management Association, contacted BCBS and argued that the new language was in conflict with Minnesota law that prohibits so-called “most-favored- nation” clauses. Such clauses seek to assure a payer that it will get the lowest payment rate that a provider has agreed to with any other payer. Most-favored-nation clauses are illegal under Minnesota law (M.S. § 62A.64).
Under the BCBS agreement, the clause could be invoked for certain services paid on a percent-of-charge basis. Blue Cross agreed not to enforce the provision in 2010 but intends to clarify its intent, which is that physicians would charge Blue Cross no more than what private-pay patients are charged, in an update to next year’s agreement.
The MMA has asked the Minnesota Department of Commerce to explain how the provision passed regulatory review and was allowed into the contract.
Board Holds Strategic Planning Session
AMA Delegate Sally Trippel, M.D., Trustee Robert Koshnick Jr., M.D., and MMA Board Chair Dave Thorson, M.D., discuss the MMA’s future direction at a strategic planning session in July that included board members, staff, and other MMA leaders. The event was facilitated by consultant Glenn Tecker, who led the discussion about the MMA’s current and future goals.
Physicians and Hospitals Call for MA Expansion
The MMA and the Minnesota Hospital Association (MHA) called on Gov. Tim Pawlenty or the state’s next governor to expand Medical Assistance, the state’s Medicaid program, in a commentary published in the opinion section of the Star Tribune.
The July commentary from MMA CEO Robert Meiches, M.D., and MHA CEO and president Lawrence Massa reiterates health care providers’ disappointment with the governor’s decision in June to forgo $1.48 billion in federal dollars that would help provide 100,000 Minnesotans with better health care.
Under the federal health care reform law, all states will expand Medicaid eligibility to low-income adults without children in 2014. States were given the option of expanding Medicaid enrollment earlier at the current federal-state Medicaid matching rates. Given Minnesota’s tradition of using state funds to provide coverage to low-income adults, the op/ed emphasized that this option was an obvious choice not only for patients but also for the long-term benefit of the state’s budget.
MMA Opposes Proposed Workers’ Comp Change
The Minnesota Department of Labor and Industry (DLI) rejected a proposal to change workers’ compensation rules after the MMA opposed the change. The MMA submitted comments in July to DLI officials regarding proposed amendments to workers’ compensation rules governing medical services and fees, penalties, and managed care. Of particular concern was an amendment that would allow certified managed care plans to negotiate health care provider reimbursement rates.
The MMA strongly discouraged the DLI from adopting the change. Minnesota rules currently prohibit this practice and call for a statutorily mandated workers’ compensation medical fee schedule. Certified managed care plans are not authorized anywhere in Minnesota statutes to negotiate rates lower than those dictated by the fee schedule. The concern is that if negotiations drove down fees, some doctors might no longer be able to afford to treat injured workers, creating a potential access problem for patients.
In addition, the MMA was concerned that the proposed rulemaking in this case circumvented the proper process, where workers’ compensation fees are vetted at the legislative level through the Workers’ Compensation Advisory Council (WCAC).
The MMA’s position was that circumventing the legislative process and deviating from standing practice to push through rules without consulting the WCAC was a bad precedent that could erode the quality of Minnesota’s workers’ compensation system.
P4P Programs Cut Red Tape
The MMA’s effort to reduce the paperwork associated with participating in pay-for-performance programs is paying off. A recent MMA inventory of the state’s pay-for-performance programs has found a significant decrease in the number of measures used in these programs.
The MMA and the Minnesota Council of Health Plans have worked together since 2008 to advocate for a common set of measures, specifications, and data-collection methods. Submitting data to multiple payers that have their own pay-for-performance programs and set of measures can result in significant administrative costs. A review of the measures used in Minnesota’s programs showed:
- A 46 percent decrease—from 56 to 30—in the number of measures used in Minnesota’s quality-incentive programs between 2008 and 2010;
- A 66 percent decrease—from 33 to 11—in the number of measures used by only one incentive program during that same period; and
- Increased use of MN Community Measurement’s measures and data sources between 2009 and 2010.
“This effort shows the value of physicians working together to address an administrative burden that is too large and complex for any one practice to take on,” says MMA President Benjamin Whitten, M.D.
President Signs Bill Stopping Medicare Cut
President Barack Obama signed a bill into law at the end of June that canceled a pay cut for physicians who serve Medicare patients and replaced it with a 2.2 percent pay increase. The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act is retroactive to June 1, when a 21.3 percent cut took effect.
Following the signing of the bill, the Centers for Medicare and Medicaid Services directed its contractors to reprocess physician and provider claims submitted in June and July. The new Medicare physician fee schedule is valid through November 30, 2010. Starting in December, physicians will face a 23 percent cut that will jump to 30 percent in January 2011. The MMA supports a permanent repeal of the SGR formula, which is used to determine physician payments.
“Congress is playing a dangerous game of Russian roulette with seniors’ health care,” says MMA President Benjamin Whitten, M.D. “Congress must replace the broken payment formula that continues to create uncertainty and distrust among patients and physicians.”