MMA News Now
Medica to Rate Individual Physicians
In an unprecedented move, Medica has announced that it will publicly release cost and quality rankings of individual physicians this month. The assessment program, called the Premium Designation Program, will rate individual physicians on cost and quality of care based solely on claims data. The program, which was designed by UnitedHealth Group, will grade physicians on a zero- to two-star scale, with two stars indicating that they met both the quality and efficiency criteria. One star means they met the quality criteria, and no star indicates they met neither.
Medica will add stars to its provider list. When a Medica enrollee searches for a physician online, the names of physicians who received one or two stars will come up before the names of those who received no stars. Medica has not said how else the system will be used, but large employers in other states have used it to create benefits that tier providers and encourage employees to choose two-star doctors. Although it supports valid and reliable performance measurement, the MMA is concerned that this program is flawed. Some physicians’ results could be based on claims from as few as 10 patients.
“Measurement and public reporting at the individual physician level are plagued with very serious challenges,” says MMA President Patricia J. Lindholm, M.D. “Ensuring the statistical soundness of measurement at the individual physician level is foremost among such challenges. In addition, physician-level analysis fails to recognize the numerous other health care providers involved in delivering patient care and the complex systems in which such care is delivered.”
On December 3, Medica sent letters detailing individual results to the approximately 9,400 physicians in the Premium Designation Program. Physicians were given until December 24, 2010, to request a formal reconsideration of any of data in their report.
The MMA sent an action alert to members about the new program in December and contacted Medica to voice concerns about the underlying design of the program.
Board Takes Stand on Mandatory Staffing Levels
The MMA is calling for health care providers and organizations to create safe practice environments without resorting to legislatively mandated staffing levels.
The MMA Board of Trustees voted in November to approve a recommendation put forward by the MMA Medical Practice and Planning Committee that considered the issue of mandated nurse-to-patient staffing ratios in hospitals.
This issue dominated contentious labor negotiations between several Minnesota hospitals and the Minnesota Nurses Association in 2010, and it may come up during the 2011 legislative session.
The committee reviewed a number of studies regarding staffing levels and concluded that although adequate nurse staffing is critical to high-quality care, mandating staffing levels is an approach that is too inflexible and narrow in scope given the complex factors affecting patient safety and the delivery of health care.
The Board approved the following policy position:
The Minnesota Medical Association encourages physicians in hospital practice and hospital leadership positions to work with interested stakeholders to assure a safe practice environment. These efforts should include careful analysis of the application of technology and impact of workflows to develop the best structure and systems for patient care without resorting to legislatively mandated staffing levels.
MMA Sets 2011 Legislative Priorities
The MMA’s top priorities for the 2011 legislative session, which started January 4, include accepting federal dollars to implement early Medicaid enrollment, protecting access to health care for Minnesota’s most vulnerable residents, preventing reimbursement cuts to providers, and stopping lawmakers from using money from the Health Care Access Fund to balance the budget or increasing the provider tax. A complete legislative preview is included in the January Physician Advocate. Look for it in your mailbox or go to www.mnmed.org/advocate.
Law Stops Medicare Cuts for 2011
In December, President Barack Obama signed the Medicare and Medicaid Extenders Act of 2010. The law includes a 12-month reprieve from the 25 percent Medicare physician payment cut that was scheduled to take effect January 1. It also extends a number of other payment policies that were set to expire at the end of the year.
The goal now is to permanently fix the sustainable growth rate (SGR) formula in 2011. Each year, this formula generates a cut in Medicare payments to clinics and physicians, despite the fact that practice costs rise.
After the bill passed the House, President Obama issued a statement saying, “It’s time for a permanent solution that seniors and their doctors can depend on, and I look forward to working with Congress to address this matter once and for all in the coming year.”
The MMA urged members to contact their lawmakers to stop a 25 percent cut. Several hundred responded.
This year, the MMA and other state medical associations worked with the AARP to turn up the heat on Congress. In Minnesota, the MMA and the Minnesota chapter of the AARP conducted a media campaign to raise awareness about the issue.
Get the Latest Legislative Updates
For a week-by-week update on what’s happening at the Capitol that might affect physicians, read MMA News Now, the MMA’s weekly enewsletter. To subscribe, go to www.mnmed.org and click on Publications and MMA News Now.