Physician Patient

MPPA Meeting Thursday September 14, 2017 at 6 PM in Central Medical Building, St. Paul.

Those present: President Lee Beecher, Bob Geist, Dave Racer, Hannelore Brucker, Carl Burkland, Don Gehrig, Wayne Zuehlke, Mike Ainslie, Dave Feinwachs, Tim Herman, and Doug Smith.

1. Minutes of the May 16, 2017 meeting had been circulated to all before the meeting and were not discussed further.
2. 2017 Senate Select Committee on Access and Cost was discussed by RWG. The committee Chair, Sen. Scott found himself unable to get to the meeting and sent his regrets.
3. 2018 Legislature. David Racer and Feinwachs led the discussion.
• It was noted that the Reinsurance bill passed this session had some serious problems, especially since MCHA was not revived—MCHA ought to be a priority.
• The fate of the Health Care Access fund (and provider tax) remains problematic.
• The new option for discounted fist dollar care coverage (by Golden Rule and UHC corporation) was briefly discussed—catastrophic insurance would be needed.
• It was noted that with Guaranteed Issue (GI) and Community Rating (CR) there is no true insurance underwriting—the corporations are on the public-private dole. One person observed that the ObamaCare promise was that, if you back the bill, we’ll give you all the patients and the money—the result is the corporations complain that they don’t get enough money with all the patients. Trump so far is not coughing up the dollars; if the mandate is not enforced, the “plans will collapse.” [IMO, maybe. But we got what was a medical system handed to government protected HMO-ACO cartels as a path to UHI—this time to commercial corporation health services or corporate socialism (aka “privatization”) unlike to national socialized NHSs as done abroad—RWG.] The corporations are looking at a bipartisan Congressional recue at this moment.
• The HMOs make their money in Medicaid. [The expensive disabled are steered into the FFS sector (run by DHS); the well are steered to the Medicaid HMOs (aka “cherry picking”). Confirmation came from DHS, this morning: “MA recipients with a disabled basis of eligibility are excluded from this requirement (to enroll in HMOs) and largely served under fee-for-service.”
• A problem has occurred to those age >55 no Medicaid. They are finding out that their homes are being owned by the government with liens based on how much premiums would have cost; not on how much was spent on their care—if they had no Medicaid expenses, they could still lose their house. Apparently, folks have found out and are dropping out of Medicaid. The legislature has not corrected the problem.
• The problem with MN Medicaid is that the HMOs are spending state money but claim that how it is spent is a “trade secret” (i.e., proprietary information). DHS thus has no idea how money is spent on enrollees [with exception that a childless adult cost $7,992/person in 2016—RWG]. If federal block grants happen, full disclosure of encounter data ought to be mandated.
• The Hi-Lex vs. Michigan Blues was brought up because Medicaid is a self-insurance program akin to a private company ERISA self-insurance program—Hi-Lex is one of thousands of such ERISA companies using HMOs as TPAs. Medicaid uses HMOs as 3rd party administrators (TPAs). The MN HMOs would have us believe they are “at risk” insurance companies yet they tell the state what was spent and the state “believes” it and pays up—without an audit! Hi-Lex won the suit in 2015 with the result that the Blues illegal fraud cases have jumped to > 200 all of which the Court said shall be paid without question. [There remain efforts to open-up Medicaid HMO books to see, if MN (and CMS) Medicaid has been similarly defrauded. No state audits have been done!
• Action item for Dave Feinwachs: It was suggested that members co-sign a letter to the Office of the Legislative Auditor (OLA) to obtain paid claims data—many agreed; Dave Feinwachs will arrange.]
4. Family Medical Account bill. RWG discussed his testimony to the Senate Select Committee last week. A copy of the FMA briefing letter was handed out and was previously attached to the emailed agenda. FMA program is basically a method of FFS payment for Medicaid enrollees in categories families with children and childless adults. Mike Ainslie wondered if this could be used for the disabled—this is not in the bill but ought to be considered for a separate bill for a program of Personal Health Budgets for high need patients. [Pilot studies have begun in the UK NHS of all places—RWG. See O’Shea L, Bindman AB. Personal Health Budgets for Patients with Complex Needs. N Eng J Med. 2016;375(19):1815-1817.]
• Action item for RWG. I hope to get hearings on the FMA bill when the legislature re-convenes.
5. Other legislative items.
• Tax-free insurance equity for those not in employer-based insurance is a federal, not State issue.
• Out-of-pocket expenses credited to deductibles (the Fairness bill) for out of network care failed in the legislature so far.
• “Up to 50% of EHR data entry clerking” is an unpaid expense for un-paid data collection mandated by state law. It was suggested that using the VAH system (a public free EHR system) cold break the strangle hold on the IT involved.
1. Action item for Smith Racer, RWG: [All members were sent an email this morning regarding the IT problem and it ramifications thanks to the work of Doug Smith and Dave Racer—please note the recommendations of how to deal with the problem using legislation to negate a bad law—RWG].
6. MPPA. It was pointed out that MPPA is an excellent irritant of importance stimulating political action thanks to the synergy of the group and its wide-spread connections. No one is alone, as long as MPPA exists and our many Fellows freely discuss the issues of political malpractice, which continues to threaten patients, professional integrity ( the covenant of loyalty to patients first), and has already resulted in toxic financial results for families and the nation.

6. The meeting adjourned at 8 PM—with the usual post meeting confabulations!

7. The next meeting will be sometime before the legislature re-convenes. Congressional acts may determine the MN 2018 legislative session activities. During this summer and fall, there has been and will be continuous member activity regarding the next legislative session.

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

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