Physician Patient


Minnesota Physician-Patient Alliance, Inc. ("MPPA") is a not-for-profit organization committed to improving our health care system. We do this by communicating information to the public and within the industry about important health care issues.

MPPA believes that efficient, quality health care depends on strong doctor-patient relationships. Interference in the doctor-patient relationship by third parties such as health plans and the government, is widespread in today's health care system and often limits what doctors or patients are allowed to do, altering market-based reimbursement, and undermining the traditional ethics of the medical professions. While the intentions of the third parties in interfering with the relationship may be honorable (for example, to control costs or improve quality), ironically the cumulative effect of this interference is unnecessarily high costs and reduced quality. Efforts to reform health care, therefore, must first and foremost address the issue of strong doctor-patient relationships.

The MPPA board consists of physicians, health care consumers, and others who share these concerns and values. We seek to communicate our message by collaborating on research and publication, sharing information about market developments, and individually being active in a variety of health care and community organizations.

To see who belongs to MPPA, please visit our Who We Are page by clicking on the link to the right. To see some of our communications, click on one of the Publications links to the right. If you would like to learn more about MPPA or our positions, click on the Contact Us link to the right.

MPPA was established in 1997 as a Minnesota 501(c)3 charitable nonprofit organization. If you would like to be added to the MPPA listserv, the respected MPPA online discussion group, send us your contact information and we will add you.

Feb 1

The hospital emergency department (ED) is not the proper setting to do an in depth assessment of a patient’s future needs and provision of ongoing medical or psychiatric or addictions care. This is particularly true for assessing the diagnosis, impact and treatment of chronic pain conditions. And the ED is certainly not the preferred venue for establishing a trusting doctor-patient relationship; at best, it may be a start. But it takes two to tango. And what is the next step? Emergency Medicine in the Age of Managed Care has, for various reasons, become the default “provider” for many too many medical assessments. The ED doc is in the necessary business of triage.

EHRs are no panacea. Calls for alerts and stops on the electronic chart may be OK, but they often lead to CYA (defensive medicine) and patient abandonment. Limiting ER dispensing to ten opioid pills might help, but the real question is what happens to the patient next. Followup? Stigmatizing patients and doctors is not the answer. Crying wolf and putting Prince on a plane? Yes, patients do have rights, I know. But as all parents know, sometimes intervention is necessary.

The Minnesota Prescription Monitoring Program is a valuable tool. Its use should be enthusiastically promoted. In my addictions practice I’d use it as a tool to put data on the table and discuss plans with the patient. PMP registry is a recent requirement for Minnesota medical  licensure. This is good.

Opioid deaths in Minnesota continue to rise.  Obviously this bad situation has both supply and demand dimensions. But physicians and pharmacists are being blamed inordinately. Drug advertising is ubiquitous. And of course pot (both medicinal and recreational) is viewed in the media as a a different matter. We need a lot of education and common sense. And patients and families are key in endorsing (or not) all drug using behaviors.

Two Minnesota experts on effective primary care relationships with patients understand its value for pain management, and also the limited ability of the ED in reversing the current “opioid epidemic.”

Dr. Scott Jensen ( ) and Dr. Wayne Liebhard are two physician authorities on the marginalization of Minnesota primary care, and they authoritatively write about it. They wear both the hat of a primary care physician who espouses professional relationships and alliances with his/her patients and also (in recent years) emergency room physician. Many well trained primary care doctors have become ED doctors due in large part to the lack of administrative support and payment for relationship-based primary care services in Minnesota’s managed care clinic and health insurance systems. Dr. Wayne Liebhard wrote  The Vortex Effect and Elephants in the Examining Room

Below are two articles (perhaps) linking opioid prescriptions (for pain) to Medicaid funding. The argument goes that economically challenged patients on Medicaid have a heightened incentive to sell their prescription opioids on the street. And criminal drug dealers entice them to do so. yet, rich, white suburbanites are dying at high rates. See:


Prescribers allow too many (opioid) pills before individual patients are properly evaluated and treated.  And as a condition of further treatment. The ED is not the best venue to do such evaluations. Funding for addictions treatment is insufficient in Medicaid and other third party pay, almost always program-based rather than patient-centered, programs funded by Medicaid are not properly evaluated and compared for their effectiveness (cost-effectiveness), and demonstrated continuity of relationship-based, patient-centered pain and addiction care with qualified personnel is not currently the key to funding care by third parties.

Pain clinic physicians have been unfairly targeted as opioid enablers.

Opioids will be a political issue in 2018. We should empower patients with money, information, and sound health care choices. I had a lot of Medicaid people who paid cash to see me and get on track reversing opioid dependency. Carfentanyl Law enforcement? Yes. Yes.

Both supply of and demand for opioids must be addressed.

Dec 11

As the ACA is Reformed/Repealed, What Should Minnesota (and other States) Do?

In this excellent presentation (click on, below), Beverly Gossage shows how the 2010 Affordable Care Act came to be and what steps are need to be taken to reform US (and Minnesota) health care law to empower patients, their families, and the physicians who care for them.

Beverly Gossage is a former educator who became an independent health care insurance agent. She was at first passionate about reducing health care premiums for her parents’ small plumbing business in Lawrence, KS. Their family company became the “poster child” first full replacement group MSA/HSA. Engineering this important health care innovation thrust Beverly into the national spotlight. In her 15 years as a health insurance agent (licensed in nearly half the states), she’s championed Consumer Driven Health Plans for her clients. She is a respected expert on health care related issues and is sought-after as a speaker at policy and advocacy groups such as State Policy Network, ALEC, NCSL, Chambers of Commerce, NAHU, and NFIB. Beverly is an honored recipient of the National Consumer Driven Health Care Innovator Award.

Beverly was invited to meet with the Trump White House health reform staff. Previously, she was a hit when President George W. Bush featured her at a 2006 White House roundtable on HSAs.  Beverly has conducted Capitol Hill briefings in DC, testified on free market health care policy in several states, and assisted in crafting legislative policy (such as HB818 in Missouri and HB2107 in KS).

Ms. Gossage was a research fellow for the Show Me Institute, on the advisory board for Doctors and Patients Medical Association (DPMA) and is a Senior Fellow for Independent Women’s Voice. Beverly has leadership experience in the National Association of Health Underwriters. Kansas Governor Sam Brownback appointed her to the State Board of Indigents Defense Services in 2016; she has served on multiple commissions on health care in her home state of Kansas. She is frequently interviewed by local and national news stations and writes op-eds for multiple publications, including The Hill, Forbes, and USA Today. “Good medicine” and health care policy is apparently in the family, since her daughter-in-law is a surgical oncologist at the Mayo Clinic. 

The 64 billion$ question is: What will employers do? Beverly reports that 56% of Americans and their families are now insured through employers, and 16% have private insurance. Regarding expanding government programs, 19% are on Medicaid, 17% on Medicare, and 5% on Military-related programs.