Meeting Minutes – 05/31/23

MPPA Meeting Minutes 5/31/2023 Legislative Session Roundup & Current Topics

The MPPA meeting was held at the Shoreview Community Center from 6:30 to 8:30 PM on the 31^st of May.

Attendance: There were seven people in attendance in person: Dave Feinwachs, Bob Geist, Bob Koshnick, Sue McClernon, Rick Morris, Peter Nelson, and Wayne Zuehlke. There were seven people attending online: Lee Beecher, Don Gehrig, Tim Herman, Vince Hunt, Dave Racer, Kip Sullivan, and Dan Zismer. After introductions, the following items were discussed.

Freedom to Choose bill reviewed by Dave Feinwachs

The bill that would have allowed fee-for-service made it through both the house and senate in identical form. In discussion of the Omnibus bill that included the Freedom to Choose bill, Hennepin County Medical Center came in and said that they would lose a lot of money through the 540 B Drug Discount Program. Dave hypothesized that there may be some double dipping and is putting together a team of attorneys to look further into this. Does HCMC order drugs through the 540 B program and then sell them elsewhere as a major profit item? The 540 B program is not monitored in any way by the federal government, so it is open to profit manipulation.

Health Care Affordability Board reviewed by Peter Nelson and Kip Sullivan

The original Health Care Affordability bill would have set growth target caps on health care entities by a board in the House chosen by the Commissioner of Health and in the Senate in a more bipartisan manner with the power to levy a $500,000 penalty for noncompliance. The Mayo Clinic threatened to pull their $2 billion Minnesota expansion off the table. All 71 of the hospital CEOs in the state wrote an editorial strongly opposing the bill. The bill was revised and the Act was renamed the Center for Affordability, which Peter notes will lay the foundation for a growth target cap legislation like the one in Massachusetts later. Kip Sullivan gave us a glimmer of hope in that the language in the bill specifically points to the need to address administrative waste, though he also warned that the bill suggests expanding the value-based model of managed care to rural areas of the state.

Keeping the Nurses at the Bedside Act reviewed by Peter Nelson

This bill met the same resistance from Mayo and the 71 CEOs. This bill was replaced by the Nurse and Patient Safety Act, which provides loan forgiveness and addresses worker safety. The major objections, the mandated hospital staffing committees with 50 percent nurse representation and that nurses could legally refuse to take on another patient, were removed.

The State Public Option Act reviewed by Dave Racer, Peter Nelson, Dave Feinwachs, Kip Sullivan, Don Gehrig, and Lee Beecher

The State Option Act sets up a committee that is to start meeting the day after the legislation is signed to analyze the costs of a universal healthcare financing system, reporting back by February 1, 2024. The bill is very expansive in that it is to cover medical, hospital, dental, hearing, durable medical products, radiology, etc. The reimbursement rates were not identified, but it appears to be centered around MN Care rates, where the rates are between Medicaid and Medicare. Many health care entities would find it hard to function with those reimbursement rates. Dave R. notes that many terms in the legislation, such as black, various sexual orientations, etc. would need to be defined by the courts. Peter notes that MN would have to have waivers to fund this program and that other states elsewhere and the federal government have had trouble implementing these types of programs other than by reducing provider reimbursement rates.

Dave Feinwachs expects the state option will be politically popular. Antitrust considerations are tossed aside because it is the state that is doing it. Kip Sullivan points out that the numerous reports (health subcabinet by March 21, 2025, the Center for Affordability continuously, the DHS by January 1, 2026, the cost study option of the public option, etc.) in the Omnibus HHS bill may address the added cost to healthcare by third-party managed care. He notes that over the last 50 years health care policy has been driven by what he calls managed care theology (costs are driven by greedy doctors over prescribing care that needs to be managed) that has severely disrupted the patient-doctor relationship. Kip suggests through the legislative passed in this session may be able to address and rectify the third-party theology of managed care. Don Gehrig noted that in his experience there are no independent practicing internists left in the Twin Cities, and that the solution is to put the patient at the center of payment, not add more bureaucracy. Lee agreed with Don, stating that he does not know any happy psychiatrists, but does not think more top-down medicine will improve things.

Scott Jensen lawsuit

There was a brief discussion of Scott Jensen’s lawsuit against the Board of Medical Practice and the Attorney General. The six medical board actions, including the last one involving the Attorney General, were not based on medical practice issues, but rather on freedom of speech issues. Rich Morris notes that the board must address complaints. Peter pointed out the complaints could easily have been dismissed as politically protected speech irrelevant to their function. Dave F. points out that the board is a politically appointed organization and operates as such. Scott has raised sufficient funds to move the case forward in the courts. We hope to be able to discuss it further at our October meeting.

Sanford/Fairview merger – Dan Zismer and Dave Feinwachs

There was a vigorous discussion of the proposed Sanford/Fairview merger. Dave F. pointed out that Fairview is one of the few systems without an insurance company, one of the main reasons that it is not doing well. Dan Zismer’s main concern is that the University of Minnesota staff, which he is on, not be acquired by Sanford.   Dan notes that the Fairview system depends heavily on state subsidies and wonders how Sanford can afford to make the acquisition. Dan pointed out the mergers and acquisitions bill gives a lot of power to the Attorney General, Keith Ellison, over any merger or acquisition in the state. The MMA’s understanding, when I asked the question of the MMA lobbyists, is that the legislature outlawed out-of-state interests owning or operating University of Minnesota medical education programs. It does appear that any final merger and acquisition decisions after the recent legislation are in the hands of the attorney general with the recent law changes.

Unionization

This topic has had increasing interest among physicians who are unhappy with their loss of autonomy moving from independent practitioners to primarily corporate employees. Physician satisfaction and the role of unionization was the number one topic identified by the Policy committee in setting up their work plans. However, another MMA work group was already working on this, so four of the policy committee members were assigned to that committee. With the Mercy hospital physicians unionizing and North Memorial threatening unionization, other hospitals suddenly have become more responsive to staff concerns.

Legislative quick hits review by Bob Koshnick

Of the five priorities of the MMA, four passed.

1. Creation of a Statewide Registry for POLST Forms with recommendations due Feb 1, 2024.
2. Communication and Optimal Resolution (CANDOR) for medical error disputes after July 1, 2023.
3. Extending Coverage for Audio-Only Telehealth Services covered through June 30, 2025
4. Offering Recuperative Care Coverage for Those experiencing Homelessness with new coverage of $300/day.

Limiting Mid-Year Formulary Changes, the fifth priority issue, did not pass.

Other items that passed:

• A Firearm Safety Policy with red flag laws that allow various classes of people to petition courts to temporarily remove guns if a person is thought to be a harm to themself or others and expanded background checks.
• The Reproductive Options Act with the right to make autonomous decisions about reproductive health, the repeal of obstructions to reproductive care, the removal of statutes that have been found unconstitutional by the courts, the Reproductive Freedoms Defense Act (RFDA) that protects patients and providers providing abortions if the patient comes from a state that has outlawed abortion. This includes Medicaid funding for long-acting contraception.
• Gender-Affirming Care legislation. This law protects what is deemed medically necessary care that respects the gender identity of the patient. The law provides legal protections for those providing and seeking gender-affirming care.
• A Conversion Therapy Ban law that seeks to change an individual’s sexual orientation or gender identity, prohibiting it for children under the age of 18.
• Expansion of medical care to a 6-year eligibility for kids under 6; 1-year eligibility for kids under 21, MinnesotaCare coverage for all undocumented Minnesotans, the elimination of all co-pays in MA on Jan. 1, 2024, and easy enrollment for MNSure at the time of tax filing.
• Restrictive Covenant Ban on non-compete clauses are now prohibited in employment contracts signed on or after July 1, 2023. This applies to all employee contracts with no income-based restrictions. It does not include nondisclosure agreements, protections of trade secrets, restrictions on using client lists, and agreements in the sale or dissolution of a business.
• Rural Health Workforce funding for a rural primary care residency program, rural clinical training grants, pediatric primary care mental health training grants, nursing loan forgiveness, mental health loan forgiveness, and as mentioned earlier assess readiness of rural communities and rural health care providers to adopt value-based pay.
• Paid Family and Medical Leave through a new state family and medical benefit insurance program funded by a 0.7% payroll tax increase up to 12 weeks of paid leave for “serious health condition” and up to 12 weeks of paid leave for “bonding, safety leave, family care,” with a maximum of 20 weeks for both effective July 1, 2026.
• Legalized Adult-Use Recreational Cannabis for Minnesotans aged 21 and over after August 1, 2023. This includes a tax of 10% for addiction treatment and services. There is to be a warning label as to the effects on brain development up to age 25 and strong enforcement against marketing for children and prohibition for use in public spaces, schools, etc.
• Increasing funding to deal with nicotine cessation programs.
• Required coverage for tests after abnormalities are identified on mammograms.
• An Opioid Improvement Program that loosens treatment guidelines to allow physicians to adequately treat pain.
• An All-Payer Claims Database that is updated to include non-claims value-based pay data, and racial/ethnic data.
• Funding for a study to provide primary care without cost sharing to patients.

Dan Zismer gave an update on what is happening in Minnesota with private equity acquisitions of medical practices. This started with MN Eye Consultants and Northwest Eye, and has progressed to dermatologists and anesthesiologists, and now is moving into orthopedics. Minnesota has a corporate practice of medicine law, but this is being circumvented with management service organizations (MSO) or “friendly physician” arrangements which, through contracts, private equity can control the flow of money. Private equity can then sell their holdings in 5 to 7 years to larger private equity firms.

Open discussion:

Representative Pete Sessions has introduced a sweeping health care bill, the Health Care Fairness For All Act, in Congress. Examining this bill will be on the October agenda.

Twyla Brase will present a program on “Three Decades of Health Care Changes,” along with what the HIPPA law does and doesn’t do.

Sue McClernon suggested inviting Natalie Belinikoff (sp?), her state representative in the Duluth area, to discuss long term care issues of which there are many.

Peter Nelson brought up that a price transparency law was passed during this legislative session. Exactly what and how effective that price transparency law turns out to be can discussed at the October meeting.

Dan Zismer brought up the fact that hospitals have no place to send patients that no longer require hospital care but need help in transitioning back to their commuities. Hospitals that have 100 percent occupancy are losing money because there is no place to put these patients. This might be another topic for October.

Sincerely,
Bob Koshnick