Physician Patient

Archive for the ‘Minutes of MPPA Meetings’ Category

MPPA Meeting Minutes: May 16, 2019

Tuesday, May 21st, 2019

Those present: President Lee Beecher MD, Bob Geist MD (RWG), Carl Burkland MD, Wayne Zuehlke CPA, Rick Morris MD, John Tyler, Tim Herman, Dave Feinwachs JD, PhD, and Lyle Swenson, MD.

Please note: my comments are in [brackets]


Minutes of the Feb 26, 2019 meeting were circulated to all before the meeting.

MPPA website update recommended by president Lee Beecher. The group approved $750 to revise the site. Lee will coordinate efforts with MPPA webmaster Kevin Hauge in consultation with the MPPA Board of Directors (see the tab “Who We Are”). We want to make our MPPA website a user-friendly and accurate resource for patients and families (health care consumers), professionals, employers, politicians, and the media interested in health care competition in Minnesota, informed patient and family (consumer) choices, and price transparency for services and products. The site will : 1. Include online links to Minnesota independent medical practices and consumer-directed health care insurance products. 2.  Highlight current health care policy discussions and opinion/inputs from contributors to the MPPA Listserv.


1. Reference-based pricing of services and related insurance—Dave Racer.

 Here is the link to a video of Dave Racer’s presentation— Just below the website picture, you see on the left the video—hit the start button >. I think you will find this in person presentation far more intriguing and informative than my too brief summary:

  • Legislation to approve RBP can be found in MN Revisor’s web site; see SF 2814. [The bill is blessedly brief—an easy read so look it over—RWG]
  • The reference price is the Medicare price, since it is ubiquitous with regional (state) and academic rate adjustments.
  • The related insurance products look like indemnity insurance—subd. 4 (c). Levels of insurance can vary widely. Racer gives examples, but “real time” plans in theory could be 100% to 300% or more of Medicare – although most likely they would be more like 175% for physician services, and 225% for facility charges or some such combination.
  • “Balance billing would be ideal”. [Let’s hope it is included, since clinics or hospitals will be subject to real open (free) market competition on price. Unfortunately, in Subd. 3(d)line 2.8 balance billing appears to be prohibited—RWG].
  • Clinic option is to accept insurance payment vs. assignment of benefits to the patient. The Racer version would accommodate balanced billing as the concept rests on patients and physicians dealing directly without interference. No MN insurance company allows assignment of benefits now.
  • Video highlights
  • Video highlights
    • 15:05—re reference-Based Pricing (RBP)
    • 17:55—4 hospital and 4 clinics examples.
    • 21:41—Insurance plan design.
    • 24:06—pricing insurance plans
    • 26:12—balance billing.
    • 30—assignment of benefits or not
    • 29:30—for doctors
    • 1300good for the nation

2. A Legislative issue for 2020: HF 2639, SF 3601 Mr. John Tyler. [This is a big bill that is not easy to summarize—RWG.]


  1. a) Health insurance underwriting, renewability, and benefit requirements modified; Minnesota health risk pool program created; unified personal health premium account creation allowed; Minnesota health contribution program created; health plan market rules eliminated; and waivers requested. [This is the Revisor’s summary—RWG].
  2. b) House File 2639/SF 3601 Bill Summary [The following is John Tyler’s summary—RWG.]

Introduction:  The Affordable Care Act has imposed narrow open enrollment periods for privately-owned coverage and federal mandates for coverage and tax penalties through 2018.  The purpose of this bill is to reintroduce fundamentally sound underwriting and basic insurance principals that allow for premium affordability, enhanced coverage tailored to the consumer’s needs and a more stable market at all fully insured levels.  “A formula for affordability” for all fully insured plans in Minnesota.


  1. Privately-Owned, Affordable Individual Coverage: Lines 11.26 – 26.5, Article 2.  Re-invents the Minnesota Comprehensive Health Association with the (MHRA).  Not a reinsurance plan – a high-risk pool.  Cedes adverse risk to the new MHRA at time of application.  Underwriting is restored allowing for standard and preferred-risk rating for those that qualify, estimated 70% to 75% of applicants.  Rating +25% or – 25% off-of standard rating.  Guaranteed-issue with underwriting to establish preferred-risk rates for applicants.
  2. Small Employer Groups (2 – 49 covered employee lives) Affordable Coverage Restoration:
  • Mid-Sized Employer Group (50 – 100 covered employee-lives) Affordable Coverage Implementation:
  1. Re-establishes Pre-existing Condition Clause Penalty for Those W/O Previous Coverage Only: Lines 6.5 – 6.13, Lines 7.27 – 8.6, Lines 4.18 – 6.13. All fully-insured contracts for those applying for coverage without prior coverage – meaning does not apply to individuals that have maintained coverage without a break of 63 days or longer.  Motivates maintaining continuous coverage without imposing penalties that are a disincentive to becoming insured.  Conditions diagnosed during prior 6 months of the start of coverage are not covered for the next 12 months of active coverage.  All other conditions covered.  and large groups and short-term individual plans and all government plan coverages qualify as “prior coverage.”  Motivates maintaining continuous coverage without a break.
  2. Defines the Sole Purpose of the Health Care Access Fund to be the funding of Minnesota Health Risk Association (MCHA 2.0). 20
  3. Defines the Funding of the MN Health Risk Association and Transfers from the Health Care Access Fund:

Reinstates the Healthy Minnesota Defined Contribution Program:  Lines 29.6 – 30.22.  Once passed into MN Law, it uses a choice of private individual policies with a government subsidy for those MNCare income earners at 200% of federal poverty and up.


  1. Legislative 2019 wrap-up and 2020 speculation[cancelled since legislature entanglements prevent Sen. Scott Jensen from attending, while Rep Glenn Gruenhagen was going on TV at the time of the meeting—RWG].


  1. MPPA legislative patient-clinic protection issues: These issues are not on this May 16 agenda—.
    • Free market alternatives,
    • Threats to kill Stark law—so far, only at federal level.
    • MN Legislature Resolution to repeal 2011 ACO-HMO waivers of patient protection laws including legalized bedside kickbacks (bribes) for rationing care.
    • FMAs for Medicaid briefing—HF 2873, Gruenhagen
    • AWP and patient freedom to choose providers
    • Patient financial bill of rights.
    • Models of national health insurance: the Scandinavian experience, US single payer proposals, and Medicare overhead vs. private insurance
  • SF 399 provider tax
    • Matt Flander’s article analyzing the 2% provider tax.
  • a preliminary briefing on the April 17 MN Supreme Court Decision on Warren v Dinter—the MMA position on the liability of a corporate ‘team physician’ employee.
    • Transparency amendments;
    • “Analyzing The House E&C Committee’s Bipartisan Surprise Out-Of-Network Billing Proposal.” Paul B. Ginsburg, Mark Hall, Erin Trish. The Trump administration has set the goal of transparency in pricing to avoid ‘surprise’

o   Apropos is the proposed MN bill: Mandate posting of pre-ante pricing of common bundled services for individuals. We have an unbundled problem. Hospitals are gaming the CMS transparency mandate. CMS’s transparency doesn’t work—unusable endless coding prices, surprise billings post care.


  1. Next meeting to be announced.


Again, our thanks to Dr. Charles Crutchfield for his kindness in lending his office meeting room and for the wonderful help of his staff: Kelly and Allison.


Robert W. Geist, Secretary

Friday, March 1st, 2019

Archive for the ‘MPPA Publications & Pronoucements’ Category
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.

Lee Beecher eloquently discussed future needs to involve patient and doctors in re-establishing patient-centered care—this was warmly received.
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.
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].
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
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