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Archive for the ‘Minutes of MPPA Meetings’ Category

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

MPPA Meeting: September 25, 2018

Friday, September 28th, 2018

MPPA Meeting Wednesday September 25, 2018 at 6-8 PM in the conference room at Crutchfield Dermatology, Egan MN.
Those present: President Lee Beecher MD, Bob Geist MD, Carl Burkland MD, Dave Feinwachs JD, PhD, Neil Shah MD, , Wayne Zuehlke CPA, Steve Burgeson (new Fellow), and Matt Flanders. It’s of interest the we had 25 responses to the meeting announcement. Last-minute illnesses of some, the active political campaigns, and a very busy group of people reduced attendance to eight from the scheduled 16! Two sent remarks regarding their experiences in Canada’s Medicare system, which I read at the meeting.

A fruitful meeting attested to by the long length of these minutes. Please note that my comments are in [brackets]. We had excellent open discussions of all issues! Read on…

Minutes of the May 23, 2018 meeting were circulated to all before the meeting and were not discussed further.

1. Election issues—Single payer panaceas [Favored by 26% of physicians 2018 survey.]
• Bob Geist described the two Medicare-for-all bills now in congress including BernieCare and another from the Physicians for a National Health Plan—neither has a CBO fiscal note. Bob then discussed the Mercator Center (George Mason U) 10-year cost analysis of BernieCare at $ 32 Trillion (with a T) and found near the same cost as the end result of implementing the ObamaCare cartel-like program now in progress. BernieCare advocates claim that it will be $2T cheaper. The problem is that these are two socialized programs with the same catastrophic result albeit one is to be run by the feds (B’Care), and the other by a government-backed (i.e. crony) HMO-ACO industry (O’Care).
• Dave Feinwachs described the MN MNCare buy-in (DaytonCare) proposed by the DFL—MNCare is a state program linked to Medicaid. The opinion was that this is a state supported premium for an expensive poor product. His estimates are that it would save a family buyer $69/mo., or about $800/year with the same high price (hidden with tax-payer props) and poor benefits plus access problems due to poor pay rates for clinics. The same HMO-ACO industry will run the program—a middleman expense of what was described as enormous, as is already evident in the MN Medicaid program. In the discussion, one suggestion was for a real FFS alternative of 80% state major med insurance and 20% individual insurance and cash payments [I hope this is an accurate recounting of the idea, It’s of interest this mixed concept is favored by a significant 35.5% of physicians: 2018 survey RWG] In regard to the election, hanging in part on the DFL DaytonCare proposal, absentee ballots, pre-filled out, have been sent to all registered Democrats for early mailing—the GOP has no such program as far as is known. Re-constituting a MN high risk pool (the successful old MCHA program killed by Obamacare) was discussed. It was pointed out that merger mania continues with the Blues outsourcing back office work to Anthem. Finally, the Office of Legislature Auditor (OLA) claimed it could not find an independent auditor for MN Medicaid as required by law and would do the audit itself—this is a highly suspect excuse and a continuing story.
• Critiques of SP panaceas. I read two brief letters from two ex-pat Canadian doctors regarding problem with the Canadian Medicare system. Its attributes are that it’s free open access, It’s problems are that the appearance of free care generates unlimited demand too often met with harsh rationing of care measures resulting in a rotting infrastructure of equipment and available clinicians plus long queues for the ill paying a high price in lost wages, morbidity and occasional mortality. The burden of triage for an interventional radiologist recounted wait-times of 7 months for a CAT scan and 13 months for an MRI. In one case the doctor had only the typical 2-line limited clinical history on the referral; a triage to the end of queue resulted in a preventable death—the doctor could no longer in good conscience practice in such a harried poorly funded system. He moved to the US to practice good patient care rather than impossible bureaucratic care. He wrote: “I quickly realized that the moralistic Canadian system is not really about providing care, but about providing an illusion of care.”
• Free-market Alternatives.
o Bob Geist described the Family Medical Account (FMA) Medicaid program, which funds an enrollee-owned debit card for outpatient care. The simplicity of onsite payments eliminating the expensive HMO middleman function ought to meet the state goal of lowering Medicaid costs much as has happened after Conn. fired all its Medicaid HMOs. Would lack of independent primary care docs be a problem? [Probably not the way the program is constructed; details on request.]
o Cash only practice was discussed, and in some detail, both the CCHF “Wedge” program and concierge practice.
o It was noted that Denmark will run a large trial using the Medibid program.
o We have in the past discussed at length expanded and reformed HSAs—p. 6-7
2. Sen. Scott Jensen’s priorities for the 2019 session were discussed. These are appended to the minutes (see p. 4) including SF numbers. Please note that these priorities mimic almost all of the MPPA initiatives discussed in part #3 of these minutes. The exceptions are MOC reform and the possibility of a state legislative Resolution to a) repeal of 2011 federal waivers of patient protection laws and b) amend 2015 MACRA franchising law (i.e., payments for services exclusive to providers underwriting-insuring population costs). Repeal and amending federal law would eliminate coercing providers into underwriting (insuring) the risk coercion population costs and mandate that clinics have freedom to contract for underwriting or not. Scott has just completed a new AWP bill—more on that later.
3. Legislative Patient-Clinic Protection Issues.
• Freedom to choose Any Willing Provider (AWP). Neil Shah noted that since insurance is vital for clinic survival, patients ought to have freedom to escape a network for care paid at least the same rates as are providers in the network. Balance billing is a non-starter. A SD state referendum approved freedom to choose by > 60%–a freedom to choose bill was promptly passed by the legislature, Other states (e.g., Utah) have passed similar bills, but some state laws are more limited in scope.
• Clinic Fair Care bill would mandate payments for deductible services by the insurance corporation holding the patient’s deductible money, which the patient ought to be able to spend as they please.
• Clinic Fair Contract Act would eliminate state mandated quality reports, would require any entity wanting clinic data to pay for it, would mandate that a clinic be free to contract or not. It would require that patients opt-in to reporting their clinic data to 3rd parties even, if the clinic contracts to report data to a 3rd party.
• A patient financial bill of right would require itemization in plain English, never receive a surprise bill, and 7 other common-sense requirements including price transparency (see P. 5).
• Transparency bill amendments would eliminate gag clauses, include all providers, make sure that facility fees are posted up-front before a service is provided, pre-care estimates of all (4 possible) fees, and truth in pharmacy pricing.
• Amend MN CON law to eliminate requirement of no overnight stays.
4. Matt Flanders briefly discussed the CCHF Wedge program and Twila Brase’s new book, Big Brother in the Waiting Room. I personally give it highest praise—a book that for the next few years will be a necessary reference for any healthcare activist. It’s #1 in sales in its category; going like hot cakes. A second printing is pending—only four more at the Amazon warehouse as I write, but more coming. My recommendation: Buy it on-line now!!
5. A MN Legislative Resolution to repeal waivers of patient protection laws was discussed. This will be sent to the Fellowship when completed,
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