Physician Patient

Archive for February, 2019

MPPA Meeting February 26, 2019 featuring discussion of health care bills now before the 2019 Minnesota state legislature

Thursday, February 28th, 2019

MPPA Meeting Tuesday, February 26, 2019 at 6-8 PM in the conference room at Crutchfield Dermatology, Egan MN.

Those present: President Lee Beecher MD, Bob Geist MD (RWG), Carl Burkland MD, Wayne Zuehlke CPA, Vince Hunt MD, Mike Ainslie MD, Sen, Scott Jensen MD, and Mark Holder MD (a new member) was warmly welcomed. It’s of interest the we had 23 responses to the meeting announcement; 13 to attend, but last-minute illnesses, political activities, and some unexpected cancellations (snow, ice, and cold?) reduced the group to 8. The result was an excellent conference with Sen, Scott Jensen. One person sent questions for Scott about two bills.

Please note: my [RWD] comments are in


and see the 3 attachments (pp. 3-5)

1. Minutes of the Sept. 23-2018 meeting were circulated before the meeting.

2. Legislative issues were discussed with Sen. Scott Jensen

a)      [277] DPC establishing direct primary care service agreements between patient and physician. Makes clear that agreements are not health care insurance and not under jurisdiction of the insurance commissioner. No discrimination in fees [risk adjustment] allowed for health reasons—one price for each patient services. Effect on concierge practice was discussed.

b)      [SF 354] requiring health carriers to offer one​ health plan that is an any willing provider (AWP) option. Neil Shah thought that restricting payment to 120% of health plan price was too low and ought to be 160% for primary care and 180% for specialists—Scott Jensen agreed.

c)    [SF 278] PBM regulation requiring licensure, increasing transparency on prices and rebates, disclosing any conflicts of interest, and requiring an expansion of pharmacy networks so that patients have more options to fill a prescription. Imposes fiduciary duty to Plans and patients. Transparency gag clause removed. Channel 11 PBM program broadcast planned for this Wed, 2-27, at 10 PM.

d)   SF 353] “Affordability” of drugs. Set’s ceiling prices by an independent commission with no end date. Based on Canadian system [sounds like the UK’s NICE program of allowable annual expense for care and drugs ] with review of annual cost over $30,000, of any large $10K annual increase,  or of any 10% immediate increase. [Allows MD dispensing meds]. Discussants worried about possible future system fraud. [This is a price-fixing bill for drugs with unintended consequences. We did not discuss the ramifications of health care price fixing in general].

e)      [SF 03] Providing best value for care [through patient action] and choices

  • a “right to shop act” requiring health plan companies to develop and implement
    a shared savings incentive program. This is a very complex bill aimed at incenting patients to shop for the least expensive elective referral for care. However, “savings” will be shard 50/50 by patient and plan—the discussion was that this proposal is ridiculous, since the patient saved the money, not the Plan.
    • Ln 5.19 specifies that the administrative expense is “a medical expense”! [Which seems equally ridiculous and nothing more than a profiteering center for the insurance corporations at the patient’s expense.]
  • [SF 349] eliminating the State mandate for interoperable electronic health​ records (EHRs) ​ At Senate Committee hearing today it passed with only 2 negative votes!
  • Protecting access to care for patients with pre-existing conditions has been inserted into the PBM bill, SF 278.
  • The following Senate bills were briefly discussed: SF 350 prohibits non-compete clauses—opposed by hospitals; SF 351 requires uniform rates for primary care services located within a certain geographic area [ln 1.71—concern with mandated utilization and referral requirements were not discussed]; SF352 establishes a refundable tax credit for premium support—former MCHA program was a prospective cost program and this bill is a retrospective cost program, wherein the state reinsures 80% of cost > $50K to $200K and insurance company picks up coverage of >$200K. Thus, corporate insurance risk is minimized.
  • Provider Tax—Scott said that the state doesn’t want to lose the revenue. [Previously opposed by organized medicine in Minnesota. A bad tax really on consumers of health care that looms again!]
  • Bill to allow pricing of bundled care for individuals. The current CMS mandated transparency for billings features un-bundled individual procedures. Posting costs of 25 or 50 commonly bundled health care services (such as anesthesia services related to out-patient surgeries) would have a beneficial purpose to complement the popular price transparency Act last which passed year. Senator Jensen thought this issue has merit.

3. Patient and clinic protection issues.

a)       HF pending Medicaid Reform FMA bill, which would fund enrollee-owned debit cards for outpatient care, was briefly outlined by RWG.

  • MN legislature resolution briefing by RWG about repeal of FTC and CMS regulatory waivers of patient protection laws including amending MACRA law to allow clinics to take underwriting risk or not; no authors as yet—attachment p. 3.

c)      Patient financial bill of rights (Rosenthal) was thought inappropriate at this time by Senator Jensen.

d)   [HF 3] The MN Comprehensive Health Act MNCare buy-in. [The Acronym, MCHA, is cleverly expropriated from from the successful Minnesota Comprehensive Health Association program for covering patients with (expensive) pre-existing conditions who prior to Obamacare had been denied insurance coverage by Minnesota insurance companies (health plans)]. BTW, there is no audit clause. [We need the original MCHA program!]

e)      [Clinic Fair Contract Act has been dropped—it is Fed reporting requirements that are a problem and not state mandates at this time; more data from more clinics is needed in order to proceed—RWG.]

4. Future MPPA Directions.

  1. Lee Beecher eloquently discussed future needs to involve patient and doctors in re-establishing patient-centered care—this was warmly received.
  2. A new proposal for reference-pricing insurance by Dave Racer and Greg Datillo was discussed. It includes having virtual discussion-action groups. Dave Racer will be asked to give a presentation of this idea at a future meeting.
  3. Mark Holder thought that it would be good to explore a cash-only group of primary and specialty clinics, which could be city, state, or nation-wide. [I will ask Matt Flanders to forward to him the CCHF Wedge cash-practice program details].
  4. The nature of MPPA, as a health care think tank, was briefly discussed. MMPA is a 501(c)3 organization with 83 members who discuss issues and actions proposed by individual Fellows. A briefing is attached, p.4
  5. Former Representative Steve Gottwalt sent us an interesting message, which we did not have time to discuss—attached p. 5.

We are again grateful for Dr. Crutchfield’s gracious hospitality for use of his conference room.

The next meeting date is to be determined. Respectfully submitted, Robert W, Geist MD, MPPA Secretary

To lower costs and increase access to quality health care, we need innovation, marketplace competition, and expanded patient choices

Friday, February 1st, 2019

Successful reforms must ease limitations on both demand and supply, promoting innovations that can alter the nature of health care delivery and lower costs.

The idea is to identify every potential limit on the supply of health care services, and then [if feasible] eliminate it. If the United States doesn’t do this, other countries will, and America will lose its leadership position in medical innovation.
[D]octors came to believe that, for any set of symptoms (and given certain patient data sets), there is only one correct, deterministic treatment pathway. This has stifled the variation that innovation requires.
[H]ealth coverage [has become] not so much insurance as prepaid medical care.

  • Taxes. Federal tax law favors employer-based coverage, which artificially lowers the cost of group insurance and raises the cost of individual plans. This may be the single most anti-competitive factor in the health insurance market, limiting the variety of available health plans. Breaking down these barriers could start with establishing tax parity for health insurance premiums and individual contributions to health savings accounts.

[H]ealth care innovators must be free to supply new goods and services and consumers must be free [and empowered financially] to purchase them.

  • [The FDA] can approve drugs in stages so that patients with serious, time-critical illnesses could gain early access, and benefit from “right to try” legislation that would grant terminally ill patients early access to drugs still in the approval process.
  •  [A]llow nurse practitioners and other professionals to practice independently (as they already do in numerous states) and authorize pharmacists to write certain prescriptions independently of physicians.
  • Reciprocity agreements or interstate licensing compacts could make it easier for doctors to move from state to state [and for their prescriptions to be honored in more localities].
  • [Training in inter-disciplinary treatment concepts and techniques:] Medical schools today remain focused on individual knowledge rather than [teaching and practicing in] the interdisciplinary teams and networks that characterize much of modern medicine. This results in overly specialized medical fields [and de-emphasis on effective collaborative, patient-centered  team work].
    • [Reform] Malpractice law. [Currently] Tort law invites lawsuits and discourages innovation while also raising costs. The vagaries of tort law also discourage the production of vaccines and the development of new drugs and devices. Potential remedies include capping awards for non-economic damages and shortening the statute of limitations on malpractice suits.

[Politically] This decentralized approach would eliminate the need for one [national] grand bargain—or for total control [of health care in] Washington, DC, by one party.

[My additions] and excerpts above on this fine Mercatus article from MPPA Board member Michael Ainslie, MD