Physician Patient

MPPA Meeting Thursday January 18, 2018 at 6-8 PM in the conference room at Crutchfield Dermatology, Egan MN

Those present: President Lee Beecher MD, Bob Geist MD, Dave Racer MLitt, Hannelore Brucker MD, Carl Burkland MD, Wayne Zuehlke CPA, Dave Feinwachs JD, PhD, Marie Olseth MD, Phil Raines MBA, Sen. Scott Jensen MD, Rep. Glenn Gruenhagen, Jon Thomas MD, Greg Plotnikoff MD, Charles Crutchfield III MD, Chris Foley MD, and Comfort Anyieh MD (triple boarded in IM and introduced by Dr. Plotnikoff) [4 members canceled at the last moment because of illness or unexpected travel plans—RWG]

1. Minutes of the Sept. 14, 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 reviewed by Sen. Jensen, the chair of the committee. He recounted the issues that he hoped to introduce in the legislature regarding Transparency (more on that below), drug mark-ups, gag-orders, any-willing provider to preserve the patient-physician relationship, equal 3rd party payments for equal work, HIPPA law problems, and HMO audits. Facility fees were briefly discussed later.
• Transparency legislation. 4 state bills were reviewed. Discussion with Sen Jensen was led by Dave Feinwachs, Dave Race, Marie Olseth, and Phil Raines,
• Proposed MN legislation was discussed at length (see the bill in appendix p 3-4). The rationale for the bill was brought out in commentary by the discussion leaders and all those present:
• BCBS does not reveal fees prices for services. Contract prices depend on size/power of group. Everyone except providers has access to “all-payer” prices.
• HMOs oppose Transparency: claim that contracts are already done and can’t be re-done.
• The cost of care problem is not alleged clinician or patient cost culprits but rather the self-serving insurance industry accounting methodology (NIAC) hiding where state money is spent. For example, NIAC does not detect the lack of connection between encounter and payment unlike generally accepted accounting principles (GAAP) used everywhere else. What’s happened to raise prices?
i. Facility fees
ii. The problem with MN Medicaid is that the HMOs are spending state money. claim that how it is spent is a “trade secret” (i.e., proprietary information), and self-report need for state money without state oversight of where the money goes.
iii. 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-payment data might be mandated.
• It was noted that the Office of the Legislature Auditor (OLA) has yet to report where MN spends its public sector medical money. There is a letter circulating at the legislature with specific questions that the OLA needs to answer.
• Is the OLA capable of doing an audit? It was suggested that the answer was no! Another opinion is that OLA did a good job on MNSure and special education audits. [The problem apparently is in MN HMO audit bookkeeping methodology separating encounter and payment, which makes a forensic audit impossible]
• Sen Jensen noted that this bill is a first step. Patients want the best price and have nowhere to find it.
• A question now regards transfer of BCBS Medicaid money to its new a for-profit joint-venture partner, Anthem corporation.
• Quality metrics used to determine payments was noted. Balance billing ought to be allowed [Current federal Medicare regs and state Medicaid regs would have to be repealed to do this for public programs—RWG]
3. Maintenance of Certification (MOC) discussion was led by Dr. Jon Thomas, former long-time chair of the MN Board of Medical Practice. Protests over the American Board of Medical Specialists (ABMS includes 24 societies) handling of exams and their cost has resulted in ABMS Board rancor and hopes for progress. The problem with periodic exams is that they have not been shown to be effective and yet are a required mandate by insurance corporations and hospitals. Dr, Thomas favors continuous learning through the state CME program; a program method that he thinks needs to be strengthened. The coercive nature of the MOC program continues to be a problem, [I am told that MN legislation is being considered to deal with periodic MOC exams, the common irrelevancy to medical practice, and coercion problems—RWG].
4. Buy-in to MnCare proposal of Gov, Dayton. Discussion was led by Dave Racer, Rep. Gruenhagen, and Drs. Beecher and RWG. It was pointed out that poor pay public program force clinics out of practice. They have apparently been ruinous to rural physicians where the population of public program recipients is large. Expanding this proposal would be a state financial disaster. [This maybe a big item at the legislature. Another public Medicaid program of more serious nature had just come to my attention since the MPPA meeting. The is the MN DHS agency’s “New Gen IHP” proposal—I’ll be emailing the fellowship an analysis done by one of our regular correspondents— RWG]
5. The attendees applauded Dr. Crutchfield’s gracious hospitality in the use of his splendid conference room.
6. We did not get to all items on the agenda. This includes a briefing on Medicaid proposals (of which the most serious might be DHS’s Next Gen IHP (aka ACO) initiative and EHR problems and possible solutions if entities wanting clinical reports were mandated to pay for them by contracting directly with willing clinics—the state’s mandate reports are a free-loader’s tax on clinics.
7. The next meeting is on Feb. 22 and focused on Independent Practice led by Dr. Neil Shah.
Respectfully submitted,
Robert W, geist MD
Secretary pro tem

Transparency bill. (Sen. Scott Jensen and Rep. Bob Loonan)
A bill for an act
1.2 relating to health; requiring transparency in health care costs; proposing coding
1.3 for new law in Minnesota Statutes, chapter 62J.
1.5 Section 1. [62J.815] HEALTH CARE PRICE DISCLOSURE.
1.6 Subdivision 1. Program requirements. (a) In order to facilitate price transparency in
1.7 health care costs, the commissioner of health shall establish the health care price disclosure
1.8 program. Notwithstanding any nondisclosure agreement or contractual obligation, all 1.9 individuals and business entities, including hospitals, physicians, nurses, pharmacies, 1.10 pharmaceutical manufacturers, dentists, and any other health care related provider that
1.11 furnishes health care related items, products, services, or procedures for sale to consumers
1.12 shall disclose the price for each item, product, service, or procedure. The price disclosure
1.13 must be made to a consumer at the time of service or sale of a product and must include the
1.14 provider billed amount, the health plan reimbursement rate for the provider’s highest-volume
1.15 health plan payor, and, if they apply, the Medicaid and Medicare allowable reimbursement
1.16 price the individual or business entity accepts as payment for each item, product, service,
1.17 or procedure.
1.18 (b) The disclosure of price and provider billed amount required under this section shall
1.19 not be considered a violation of any confidentiality obligation contained in any binding
1.20 contractual agreement. 1.21
Subd. 2. Information on costs. The individual or business entity specified in subdivision 1.22 1 must provide continuous, ongoing price disclosures to the commissioner. The price of
1.23 each item, product, service, or procedure must be made available on the individual’s or
1 Section 1.
business entity’s Web site and must include all wholesale, retail, subsidized, discounted, or
2.2 other price the individual or business entity accepts as payment. The information on the
2.3 Web site must be continuously updated. If the individual does not have a Web site, then the 2.4 price disclosure must be made through the group practice the individual is associated with.
2.5 The commissioner shall maintain a Web site for the health care price disclosure program
2.6 and shall post reported prices from each individual and business entity specified in
2.7 subdivision 1. The program Web site must be updated continuously.
2.8 Subd. 3. Penalty. A person who intentionally or repeatedly violates a provision of this
2.9 section is guilty of a petty misdemeanor, and may be fined not more than $300 for each
2.10 failure to disclose prices under this section.
2 Section 1.

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