Meeting Minutes – 09/24/15


1. Those present: President Lee Beecher, Don Gehrig, Dave Feinwachs, Bob Geist, Mike Ainslie, Doug Smith, Wayne Zuehlke, Rick Morris, Peter Nelson, Dave Racer, Hannelore Brucker, Greg Plotnikoff, and Scott Jensen.

2. New guests Drs. Scott Jensen and Greg Plotnikoff were welcomed. Greg briefly recounted his 2 year experience of teaching professionalism in a Japanese medical school—there is now word of concept of profession in Japanese.

3. A new publication committee was approved. Dave Racer and Doug Smith will co-chair and develop appropriate policies. Lee will take care of cleaning up the website.

4. The Board will each receive and may use the MPPA roster—updates will sent when needed. Use the “To” pane for emailing to the roster or to the Board.

5. Geist presented the survey done last summer to attempt ranking of a number of priorities for an MPPA agenda to use in the new 2015-2016 season—see results in addendum to the minutes.

6. Beecher discussed the MPPA mission. After much discussion Ainslie moved that a subcommittee review the old and develop a new mission statement, 2nd by Gehrig and passed. The subcommittee will be Ainslie, Morris, and Beecher.

7. Nelson reviewed 3 congressional bills regarding independent practice: Rep Jenkins bill repealing IRS limits on use of HSA money, Sen Cassidy’s bill to repeal IRS regulations that treats fixed primary care periodic fee clinics money not billed through any 3rd party as a health insurance plan, and move by the Direct Primary Care Coalition to pass a bill, The Primary Care Enhancement Act of 2915, that clarifies Direct primary Care (DPC) medical homes and medical services are not health plan and thus would remove prohibitions on use of HSAs in DPC practices, defines DPC services as qualified health expenses, and creates an alternative payment model in Medicare including a waiver allowing qualified physicians who have opted out of Medicare to participate in the program in an ACO-like structure associated with a major insurance company in Medicare Advantage plans.
Discussion: The rest of the meeting was devoted Nelson’s presentation of these bills and their ramifications and member comments: clarification of what is a qualified medical expense; can we do anything or are these bill likely to pass—the answer was no until 2017; is there coordination of HSAs with ACA—no but a government-HMO industry effort to restrict HSA use is evident, which the various bills hope to correct; HSAs are essential if medical care is ever to become affordable and the system corrected; ACA has created the problem of completely unaffordable deductibles and the paradox of unaffordable major medical insurance; ACA marginalizes patients and doctors [a noted at our January 22 meeting, “you will not want to see a doctor, who doesn’t want to see you”]; the Cassidy bill requirements for a medical home are onerous; there is no consesnsus in the primary care association of a definition for “Direct Primary Care”; 65% of old patients will stick with their doctor opting out of all insurance (and Medicare) into a cash practice; legislation is to fix the government and industry attempts to restrict HSAs will have to be incremental; local ACO-HMO policy is to capture dollars and patients through narrowing networks and dictating what qualifies as a deductible expense as being one only prescribed, delivered, or approved by the ACO system.
Further Discussion: do patients/public know about all this?; local mergers of ACOs, clinics, HMOs are creating oligopoly control; health insurance brokers and independent clinics will be extinct; it’s possible that the only way out for some practices may be ACO-like coalitions sponsored by (in MN) non-HMO insurance companies (“insurance against insurance” concept as an affordable bridge to use of catastrophic insurance); enacting legislation that would make HSAs the deductible may not be a feasible solution; patients have the illusion of insurance and are going broke; catastrophic insurance is all one needs the caveat at this time is the unaffordable deductible and restricted use of HSAs for use engineered by mega-merged ACO-HMO corporations; what are the political party responses?; Republican HC TF strongly favors HSAs unlike the national party congressional delegation’s passage of the “doc fix” (SGR repeal) bill; patients are fungible commodity [auctioned for services]; the State disqualification of UCare in Medicaid bidding displaces 70,000 Somalies—a law suit brought under the MN Human Rights Act will be joined with the UCare suit, which could open MN Medicaid to FFS and choice of provider [already 175,000 in MN Medicaid FFS system]; our Family Medical Account program (FMA) is on the MN House shelf and could be a template for rapid state affordable expansion of the MN Medicaid FFS system through cutting out high HMO overhead.

8. Dr. Scott Jensen gave an eloquent summary of why he is running for the MN State Senate and introduced us to his book published Sept 1. He said we need the patient back at the helm; we need to tell stories to get public attention and to get it done. He volunteered to create with others a 5 point plan for discussion at the next meeting. The MPPA Board of Directors strongly backs his plan to run for the Senate.

9. Not all items of the survey were discussed as the meeting was already prolonged to 8:15 PM

10. Next meeting is scheduled for 6 PM November 11, 2015 at the splendid new meeting room on the 4th floor of the Central Midway Building.

Respectfully submitted
Robert W. Geist MD
Secretary pro-tem

After the meeting David Feinwachs gave to a few of us an eloquent discussion of the 6th US circuit ruling in the MI Hi-Lex case, which found HMOs acting as 3rd party ERISA plan administrators (TPAs-similar to MN and other state Medicaid programs) were fraudulently bilking customers. Unfortunately the Court agreement sequesters the testimony of the HMO expert, who said that all HMOs in the nation acting as TPAs do this or they could not make money! [Crime pays is the message!].
Dave will be speaking to the FL medical association on the subject in a few weeks. He has consented to do the presentation to those interested—his presentation to a large local medical group that I heard was brilliant. I will try to assemble an audience locally for a Feinwachs seminar on the topic of Medicaid HMO and auction bidding fraud.
We citizens are being robbed, clinics short-changed, and patients endangered by HMO Medicaid profiteering in collusion with the State. ObamaCare waivers allowing massive mergers and legalizing collusive profiteering through ACO bedside rationing of care brings similar possible fraud to the national scene. More later.—RWG.

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