Physician Patient

Archive for September, 2016

MPPA Meeting Monday Sept. 22, 2016 at 6 PM in Central Medical Building, St. Paul.

Thursday, September 22nd, 2016

Those present: President Lee Beecher, Bob Geist, Dave Feinwachs, Doug Smith, Wayne Zuehlke, Dave Racer, Hannelore Brucker, Scott Jensen, Merlin Brown, Rick Morris.

1. FMA bill discussion. RWG and Dave Feinwachs outlined the proposal for a bill to implement a bill similar in intention to the one on the House shelf for some years. See appended pages 2 and 3. The Somali community (and others) is anxious to have the choice that a free-market FFS system would give them. The FMA debit card would be tied to the ACA mandated preventive procedures funded by CMS. The bill would fulfill the goals of wise government economic policy. Joseph V. Kennedy, PhD economics; M.S; J.D., a noted economist, has written that, “Government policy is far more effective when it channels market forces than when it overrides them”.
2. Dr. Merlin Brown discussed the breakup of his independent cash only + Medicare practice, His new project is a new Health Plan, SolarteHealth, modeled along the same lines as the recent Ben Carson plan. There were many questions and a long discussion of the new program, which will essentially be directed at self-insured (ERISA) employers.
3. Dr. Scott Jensen discussed the progress of his campaign for Senate and again thanked the strong support he has had from MPPA members. He then led a long discussion about the issues likely to be foremost on his legislative agenda including price transparency with HSAs, inter-state insurance availability, resurrecting MCHA, an Any Willing Provider approach to narrow networks, address the problems of regional price setting, prior authorization problems, and so forth.
4. The MDH request for information regarding consent forms was noted as an effort to get rid of or strict patient privacy law. Dr. Beecher was asked to reply within the time frame allowed expressing our support of the current law protecting privacy. Apparently the HMOs want to get rid of protecting patient records so that collection agencies could use patient clinical information to force payments—a few years ago a leak of patient records to a collection agency became a serious scandal for the Fairview system.
5. Dr. Beecher and Dave Racer discussed a pending book recounting his experiences in medicine. From medical school, to specialization, to medical director, then to private practice, and eventually to a cash only practice.
6. Dr. Doug Smith said that patients are finding out about the CCHF Wedge program connecting patients and independent practices.
7. Dave Feinwachs briefed us on developing a payee data base for self-insured (ERISA) employers to have access to the real prices paid in the market place.
8. Next meeting will be Thursday January 12. 2017

Respectfully submitted, Robert W. Geist MD, Secretary pro-tem
Family Medical Accounts (FMAs) for Medicaid:
Cost savings, improved access, and equity, when families are empowered with money
Update 3-10-16
• Major Medicaid funded Medical coverage—Medical Assistance benefit schedule
o Insures unpredictable and unaffordable risk (catastrophic expense)—consider re-insurance bids
o Insures preventive/prenatal services/well child and baby care/meds for some chronic conditions (diabetes, hi BP, cholesterol, epilepsy etc.), and so forth.
• Deductible FMA Medicaid funded self-Insurance for predictable and affordable risk (routine expense)
o FMAs are money, not vouchers for insurance.
o Debit card is cash for medical use only and gives seamless access to major medical expenses—there is no cash gap.
o Electronic deposit banked by state (or contracted private bank)
o Personal/family Ownership à later portability.
• FMA surplus portability (under state, not personal, rules).
o State benefit set flexible with allowable [213(d)] services at State’s choice.
o Choice of provider: network and/or Any Willing Provider out of network
o TPA coordination of all accounts (FMA; major med; investment)—state may contract.
o Patient/family money = economic equity and medical market power
• Medicaid “cash gap” is eliminated before major medical coverage.
• Patient-centered quality care with market power choice: personalization, timeliness, continuity, and trust in referral.
o State financial risk low: program eliminates expensive corporate middleman.
• Funding: Medicaid by MN State/CMS money (no change)
• Decreased administrative costs ( maybe >10%) and family prudence may cause same decreased inflation rate seen in the private sector.
• The initial program excludes the dual eligible Medicare/Medicaid and disabled populations—but could be later extended and even could include MNCare with graduated premiums.
Other issues:
• Community and bipartisan political support to be established.
• Federal waivers—a problem if feds favor corporations and hostile to families controlling money.
• Affordable near universal Health Insurance might be achievable using FMAs and private HDHP policies focused on the MCHA population and the few MN uninsured.
• Poor pay of Medicaid providers is an important issue if Medicaid “coverage” is to mean adequate access. (At least providers would have immediate debit card payment and no AR problem.)
• Medicaid population health generally poor; may require higher FMA deductible (contribution limit) to encourage prudent use—not a paradox.
Goals: Joseph V. Kennedy (PhD—economics; M.S; J.D.), a noted economist has written that, “Government policy is far more effective when it channels market forces than when it overrides them”. Individuals owning and controlling the resources that the government shares with them are likely to be prudent, while gaining equity in choice of medical care access and quality. “Ownership of resources is the path to a decent life free of poverty and dependency: a goal for all Americans.”3

* Overhead best estimate by CMS: CMS Health Care Industry Market Update—Managed Care March 24, 2003:15 [23.7%].
** Preventive and chronic disease care is paid by the Major Medical Insurance (as in most private sector HDHPs) including prenatal services/well child and baby care/smoking cessation/mammograms, prostate exams, colorectal exams/chronic disease management (e.g., meds for diabetes, hi BP, cholesterol, epilepsy)/and so forth.
Poor pay of Medicaid providers is an important issue if Medicaid “coverage” is to mean adequate access.
• At least providers would have immediate debit card payment eliminating AR problem.
• Legislators must allow payments to cover the real cost of delivering services and for any willing provider-like coverage—savings from eliminating corporate overhead would be available.

For a more detailed and referenced program outline, contact:

Robert W. Geist MD
(651) 484-6968


1. Kennedy JV. Introduction ix, and Chap. 7 Affordable health care: In: Ending Poverty. Rowan & Littlefield Publishers Inc. Lanham, Maryland. 2008
2. McKinsey and Co CDHC Report, June 2005. Scandlen G. Working as intended. Consumers for Health Care Choices Report. Nov. 2007 Phelps CE. Chap. 5. Empirical studies of medical care demand and applications. In: Health Economics. Addison-Wesley. Boston, MA,2003:137-148. Sullivan ME. Blue Cross Blue Shield member experience survey 10-20-08. Kaiser Family Foundation survey 2007. AHIP 2008 Census of HDHPs and HSAs (accessed 5-28-08)
3. State FMA controls possible, since the account is not a fed qualified HSA insurance policy, but rather a state program of money.
4. Kennedy JV. Introduction ix, and Chap. 7 Affordable health care: In: Ending Poverty. Rowan & Littlefield Publishers Inc. Lanham, Maryland. 2008