Communications: Advocacy News

MAFP Board Member Testifies in Support of UM Funding for FP Residencies + More Legislative Activity

Saturday, March 4, 2017   (0 Comments)
Posted by: Dave Renner, CAE, MAFP Legislative Representative
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MAFP Board Member Testifies in Support of UM Funding for FP Residencies

In its budget request for state funding the University of Minnesota is requesting an increase of $5.25 million in FY 2018, growing to $7.25 million in FY 2019 for family medicine residencies. This past week, both the Senate and House higher education committees heard from University President Dr. Eric Kaler and Medical School Dean Dr. Brooks Jackson on the importance of this increased funding.

Joining the President and the Dean was MAFP Resident Board member Dr. Lauren Williams. Dr. Williams told the committee why she chose the University to complete her residency and its importance to meet the workforce needs of Minnesota. Dr. Williams also distributed a letter from MAFP President Dania Kamp, MD, stating the MAFP’s strong support for the proposal. Dr. Kamp stated that the funding was critical for the University to continue its mission of training doctors that care for Minnesotans.

The University’s Department of Family Medicine and Community Health ranks number one in the country for the number of family physicians it trains, yet because of recent budget problems has been forced to reduce the number of its residency slots. This has partially been caused by UCare’s loss of the state contract to participate in the Medical Assistance program. Revenues from UCare had been used to subsidize the cost of running some of the residency programs.

Over the last 45 years the University has trained over 1,900 family physicians and over 70 percent have practiced in Minnesota. Over 90 percent of the University’s Family Medicine residents practice in Minnesota, with one-third practicing in rural Minnesota. This increased funding is critical to address Minnesota’s health care workforce needs in the future.

Budget Forecast Paints Somewhat Rosier Picture for State Finances

The most recent state budget forecast released on February 28 by Minnesota Management and Budget (MMB), the state’s finance department, showed an improved budget picture. A surplus of $743 million is projected for the remainder of the current biennium, and a robust $1.65 billion surplus is projected in the upcoming 2018-2019 biennial budget. The budget picture even looks positive into the FY 2020-2021 biennium, though MMB notes that the forecast is subject to change, particularly given the significant uncertainty emanating from Washington, DC.

This forecast is what the Legislature will use to develop their budget bills this year. The good budget news should make agreement on a final budget package somewhat easier, as there are more dollars available for both spending and tax cuts. However, the debate between the Governor and the Legislature will be how must of the surplus to use for new spending and how much to use for tax cuts. The two sides will have to reach agreement by the constitutionally mandated close of session, set for midnight on May 22 or risk having to return for a special session.

Quality Measure Alignment Subject of House Hearing

A bill to align the quality measures required by state and federal entities, HF 1517, was heard in the House Health & Human Services Reform Committee on March. Under the bill, authored by Rep. Matt Dean (R - Dellwood), the quality measures required to be reported in the Statewide Quality Reporting and Measurement System (SQRMS) would be required to align with the new Medicare Merit-based Incentive Payment System (MIPS) measures. The bill further limits the number of measures that clinics would be required to report to six for a single-specialty clinic and ten for a multi-specialty clinic. The intent of the bill is to reduce the administrative burden associated with reporting to both the state and federal governments, as the measures required by both were slightly different from one another.

It has been a priority of the MAFP for many years to reduce the burden causes by quality measures that fall disproportionately on family physicians and other primary care clinics.

The bill passed unanimously and was re-referred to the House & Human Services Finance Committee. The Senate companion is authored by Sen. Scott Jensen (R – Chaska), a family physician is scheduled to be heard in the Senate committee on March 14.

Capitol Pace Quickens as Deadlines Loom

With the first committee deadline fast approaching on March 10, many House and Senate committees have been meeting late into the evening. The House Health & Human Services Reform Committee, for example, heard 21 different bills over the course of hearing that met for more than five hours on February 28. The pace will remain very quick for the next few weeks as legislators rush to move bills through the committee process to “make deadline.” In an effort to winnow down the number of proposals considered viable, legislative leaders set deadlines by which legislation must pass certain committees. By March 10, bills must pass through the required policy committees in one body, and by March 17 the companion bill must clear the committees in the other body. A third deadline of March 31 sets the benchmark for finance bills to clear.

House and Senate Consider High Risk Pool Proposals

In an effort to stabilize the individual market by subsidizing the cost of high risk, high cost patients, both the House and Senate have taken up bills to establish a reinsurance mechanism, though the approach on how to fund them differs between the two bodies. With premium costs in Minnesota’s individual market increasing by over 50 percent last year, legislators are seeking ways to provide some stability in the market.

Both bills provide a state subsidized reinsurance pool that would cover up to 80 percent of the costs of patients whose annual health care costs are between $45,000 and $250,000 each year. As currently drafted both bills also uses a portion of the Health Care Access Fund to pay for the reinsurance. The Senate proposal, SF 720, authored by Sen. Gary Dahms (R - Redwood Falls) uses a direct appropriation from the Health Care Access Fund (HCAF) of $180 million in each of the next two years. Many provider groups, including the MMA and the Minnesota Hospital Association spoke in opposition, noting that drawing funds from the HCAF would weaken the state’s ability to provide coverage to low-income Minnesotans in the coming years. The proposal does not alter the sunset of the provider tax, currently set for December 31, 2019. The Senate bill will next be considered by the full Senate Finance Committee.

The House proposal, HF 5, authored by Rep. Greg Davids (R - Preston) transfers the 1 percent premium tax on health plans that currently goes to the HCAF to the new reinsurance pool . It also takes a one-time, direct appropriation of $80 million from the HCAF to provide startup funding for the program. The bill passed the Commerce Committee on February 28 and was referred to the Health & Human Services Finance Committee.

MinnesotaCare “Public Option” Plan Considered in Committee

The Senate considered an alterative approach to reinsurance, and one of Governor Dayton’s central health care proposals for 2017 on March 1. Under the proposal, SF 78, authored by Sen. Tony Lourey (DFL - Kerrick), all Minnesotans would be eligible to purchase an unsubsidized MinnesotaCare, regardless of their income. Supporters of the plan argued that it is necessary to ensure that all Minnesotans - particularly those in rural Minnesota where there are fewer choices of health plans - have access to a high quality, affordable health product. Opponents, including the MMA and the Minnesota Hospital Association (MHA), noted that the public option is projected to less expensive largely because the reimbursement under MinnesotaCare is the Medical Assistance reimbursement rate, which is very low relative to commercial payers. Some procedures, they noted, are reimburse as low as 26 percent of commercial insurance payments. Many argued that the proposal would lead to even more instability in the individual market as the risk pool shrunk as individuals enrolled in the public option.

No vote was taken on the proposal and it will not be included in any final budget omnibus packages.

Prescription Monitoring Program Use Debated

Legislation from Rep. Dave Baker (R – Willmar) to mandate the use of the state’s Prescription Monitoring Program (PMP) by all prescribers and dispensers, HF 1137, was heard by the House Health and Human Services Reform Committee on Tuesday February 21, along with a number of other bills designed to address the continuing opioid crisis in Minnesota. February 21 was Opioid Awareness Day at the Capitol.

MAFP Past President Dave Thorson, MD testified on behalf of the MMA raising practical considerations related to the use of the PMP. Thorson stated that the PMP is a helpful tool to assist prescribers in determining whether a patient seeking opioids may be abusing or diverting them, but he also pointed out that the PMP is not always an easy tool to use. He stressed the ultimate goal is to embed the PMP into the electronic medical record so a physician will see the patients opioid history automatically, but to mandate its use prior to any and all opioid prescription is not the right step.

Partially in response to Thorson’s testimony, the bill was amended to provide a number of exceptions to the PMP mandate. The PMP would not be required to be checked if opioids were being used to treat cancer, for patients in hospice or diagnosed with a terminal disease, or for 30 days or less for acute pain following surgery, an invasive procedure, or a delivery.

Further discussions with Rep. Baker have limited the requirement to check the PMP even more. Baker is planning on further amending the bill to only require a check for an initial opioid prescription in the emergency room or an urgent care center. In all other cases the requirement would only apply upon a refill or continuation of an opioid for more than 30 days.

While this bill passed the House Health & Human Services Reform Committee, it has not received a hearing yet in the Senate and it is unclear whether it will this year.

Anti-Vaccine Bill Introduced in the House

Introduced on March 2, HF 2005 would make sweeping changes to the laws governing required childhood vaccines. Under the bill, authored by Rep. Cindy Pugh (R - Chanhassen), a Minnesota database to track adverse reactions to vaccines would be created. The database would be managed by the Minnesota Vaccine Safety Council, a prominent anti-vaccine group. Additionally, the bill would require physicians and those who administer vaccines to children to give parents a written informed consent document that states, among other things, that the parent “understand(s) that by receiving this vaccine, I may endanger the health or life of myself or my child, and others I/they come in contact with.” The bill also requires that each parent be given a copy of the manufacturers’ package insert of the vaccine, a document crafted with physicians, not parents who are not well versed in the pharmacology of vaccines, as the audience.

Minnesota’s vaccine law is already considered by many to be among the weakest in the nation, as it allows parents to opt out of mandated vaccines for “conscientiously held beliefs,” a very low bar relative to other states.

The bill does not yet have a Senate author and the bill is not expected to get a hearing.

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