Physician Patient

Archive for November, 2015

MPPA Meeting Wednesday Nov. 11, 2015, 6 PM at the Central Medical Building, St. Paul.

Wednesday, November 11th, 2015

1. Those present: President Lee Beecher, Don Gehrig, Dave Feinwachs, Bob Geist, Mike Ainslie, Doug Smith, Wayne Zuehlke, Rick Morris, Dave Racer, Hannelore Brucker, Greg Plotnikoff, and Scott Jensen.
2. Reports:
1. Feinwachs discussed at length the operations of public and private sector HMO business as it pertains to the Hilex v, MI Blue Cross wherein the federal court found 20 years of fraudulent reports and stealing money from Hilex. The Court said that the Blues shall pay all claims presented by plaintiffs thereafter. Subsequently many MI companies have been paid.
• He discussed the problem of getting a MN ERISA (self-insured) company or labor union (insurance payments are paid by workers) to do an audit in MN. One problem is that the HMOs went back to the federal Court and asked that their defense testimony be sequestered. The defense testified that all HMOs in the nation similarly pocketed public and private money or they would not make money! They appealed to the Court, that if this testimony was allowed to stand, that it would destroy the nation’s insurance industry—and won hiding the testimony about all HMOs were stealing money.
• He recently spoke to the FL Hospital Assoc., which is opposing HMO take-over of the state’s Medicaid program as is the IA Hospital Assoc.
• He said that there is a solid political wall in MN built to stop an audit of our MN public medical programs; essentially Medicaid and Medicare Advantage are similar to an ERISA plan.
• There is no way to delve into the proprietary insurance industry Claims Exchange. In other words a business or union or other group would need to match what an HMO said it paid to a provider and what was actually paid—something legal to ask under ERISA law.
• To date, no large legal firm or company has found it expedient to take on the HMOs, albeit, employers have a fiduciary duty to their stockholders if their ERISA plans are being systematically raided.
• [We have previously discussed the fact that MN citizens and clinics are being short-changed, and patients endangered by HMO Medicaid profiteering in collusion with the State. ObamaCare waivers allowing massive mergers and legalizing collusive profiteering through ACO bedside rationing of care brings similar possible fraud to the national scene.]
• Feinwachs also discussed the ramifications of the Somali community suit regarding patients not being offered fee-for-service as an alternative to mandatory HMO enrollment.
• Under federal law, people are able to choose their own providers including fee-for-service clinics. Further, the MN Medicaid HMO program was started as an experiment and still is so designated in which case the Somali community has a right to choose providers. The NAACP has joined the suit.
• It is rumored that Health Partners is a likely buyer of UCare.

2. Beecher will be discussing “Behavioral Health Integration at the MN physician round table on Nov. 12—the problem with EHRs will be an issue (pertinent to last summer’s Ranked item #3—see addendum below).
3. Racer—will be discussing the MPPA website publication section later.
4. Racer, Beecher. Gave a handout of their recent MetroDoc article, “The patient—honoring choices”.
5. Greg Plotnikoff was elected to the Board
6. Ainslie. Opened discussion of Ranked item #2 Mission Statement and Values Report (see addendum). After much discussion and word-smithing suggestions, including those by Wayne Zuehlke, the Committee was asked to rewrite the Report including additional comments for the next meeting.
7. RWG—Said that ranked item #1, ObamaCare was being addressed and that no action was required.
8. RWG—noted that ranked item #5, a MN Family Medical Account proposal, can be discussed, when the political climate changes. Racer noted that insurance agents strongly support expansion of HSAs, including making some form of HSAs available to low-income individuals, even those on Medicaid.”.
9, Morris—will discuss ranked item #4 at a later meeting.

Next meeting is scheduled for 6 PM January 21, 2016. In-house Pizza before meetings was approved!

Respectfully submitted, Robert W. Geist MD, Secretary pro-tem

Ranked Items for MPPA Season Agenda 2015-2016

The Job of All Doctors is to Improve the Health of Their Patients: What Can IT Do to Help?

Wednesday, November 4th, 2015

As we shape the MPPA’s mission this year, we’ll pay close attention to the fine work that Douglas Wood, MD and the Mayo Clinic Center for Policy Innovation are doing.
See https://transformconference.mayo.edu/ Their research and recommendations are in synchrony with the energy, mission, and goals of MPPA.

I heard an excellent presentation by Dr. Wood yesterday at the Minnesota Academy of Medicine http://www.mnacademyofmedicine.com/ on how IT will transform the future of medicine. Here are my takeaways from his talk:

The practice of medicine will be transformed and IT will be a big help in personalizing medicine:
Very Importantly, not by using Big data to drive allowable (reimbursable) treatments — which is now the strategy of managed care, insurance companies, and the government (DHS, CMS, Obamacare) but rather by providing accurate, timely, confidential, and relevant information to patients and doctors in the course of their clinical work.
Given that the true goal of medical care is to improve a patient’s health, it follows logically that both patients and doctors need to first understand why he or she is doing whatever interferes or prevents achieving and maintaining the patient’s (and his family’s) health. And then the patient and doctor can implement strategies to improve health. So the new emphasis is on enhancing a patient’s health rather than controlling doctors and others who provide healthcare to patients.
Instead of viewing patients primarily as fitting diagnostic categories or disease groups and evaluating doctors by adherence to (population-based) disease treatment algorithms, change the role of most physicians to work for a patient as his or her consultant, advisor, and only when indicated a provider of expert medical techniques.
There will not be a US doctor shortage in the future. Today many too many doctors today spend an excessive amount of time and energy documenting what they are doing for the electronic health record (EHR) rather than focusing on improving the patient’s health. Dr. Wood estimates that most primary care physicians today spend only 6% of their professional time doing things that only a well-trained physician can do, an appalling fact if true!
The annual physician medical check is obsolete. We knew that.
Supercomputers like IBM Watson http://www.ibm.com/smarterplanet/us/en/ibmwatson/what-is-watson.html are not needed or useful to crunch numbers (data is cheap and often unreliable) but rather to afford doctors and patients ongoing access to personalized information which is relevant to the needs of a specific patient’s circumstances (including family support and financial status).
To provide this new person-centered care, there is no particular need for physicians and other health care professions to be required to work in large groups or be employees of large organizations. Innovative IT permits virtual conversations PRN. Professionalism is important. Solo and small group practices will be in the healthcare marketplace.
There is no intrinsic value (and there are high costs) for expansions of hospitals and other health care ventures using expensive real estate. Home healthcare will dramatically expand.
This transformation will require radical changes in private sector and government payment policies.