MN Legislature Poised to Tie Doctor's Hands?

Posted 6/22/05

MN Legislature Poised to Tie Doctor's Hands?

BACKGROUND:

The 2005 Minnesota legislature is in special session. Health care remains a major issue of contention. Prior to the Special Session, the Conference Committee on the Health and Human Services (HHS) finance bill had been meeting to resolve the policy differences between the House and Senate HHS bills.

One of the health care cost containment strategies under discussion is the Senate's proposal to require the establishment of a government reporting and "pay-for-performance" system for health care providers. Due to House resistance (despite the House passing a similar proposal in last year's controversial and due-to-expire-in-2006 "best practices" law), the Senate conferees dropped the proposed pay-for-performance system on May 19, but kept the performance reporting system. On June 20, the House committee members agreed in their counter offer to accept the Senate's proposal with a few changes. The Senate could respond to the counter offer as early as Thursday, June 23. No patient consent is required.

Find below the actual language of the Senate proposal (as amended 5/19/05) and the House's counter offer (issued 6/20/05).

If enacted, expect the proposal to impact the health care access and medical privacy of all patients treated in Minnesota. According to at least one major study, government reporting systems have led to worse health outcomes, particularly for sicker patients. Furthermore, it will solidify the state government's access to everyone's medical records (currently authorized by Minnesota Statutes 62J.301 - 62J.43.)

Senate Proposal (6-13-05)

Sec. 25 [256B.072] [PERFORMANCE REPORTING AND QUALITY IMPROVEMENT SYSTEM.]

(a) The commissioner of human services shall establish a performance reporting system for health care providers who provide health care services to public program recipients covered under chapters 256B, 256D, and 256L (ie. Medical Assistance, General Assistance Medical Care, MinnesotaCare), reporting separately for managed care and fee-for-service recipients.

(b) The measures used for the performance reporting system for medical groups shall include, but are not limited to, measures of care for asthma, diabetes, hypertension, and coronary artery disease and measures of preventive care services. The measures used for the performance reporting system for inpatient hospitals shall include, but are not limited to, measures of care for acute myocardial infarction, heart failure, and pneumonia, and measures of care and prevention of surgical infections. In the case of a medical group, the measures used shall be consistent with measures published by nonprofit Minnesota or national organizations that produce and disseminate health care quality measures or evidence-based health care guidelines and that meet the criteria set forth in section 62J.43, subdivision 2. In the case of inpatient hospital measures, the commissioner shall appoint the Minnesota Hospital Association and Stratis Health to advise on the development of the performance measures to be used for hospital reporting. To enable a consistent measurement process across the community, the commissioner may use measures of care provided for patients in addition to those identified in paragraph (a). The commissioner shall ensure collaboration with other health care reporting organizations so that the measures described in this section are consistent with those reported by those organizations and used by other purchasers in Minnesota.

(c) The commissioner may require providers to submit information in a required format to a health care reporting organization or to cooperate with the information collection procedures of that organization. The commissioner may contract with a reporting organization to assist with the collection of reporting information and to prevent duplication of reporting.

(d) By October 1, 2007, and annually thereafter, the commissioner shall report through a public Web site the results by medical group and hospitals where possible of the measures under this section, and shall compare the results by medical group and hospital for patients enrolled in public programs to patients enrolled in private health plans. To achieve this reporting, the commissioner may contract with a health care reporting organization that operates a Web site suitable for this purpose."

House Counter Offer to Senate Proposal (6/20/05)

KEY:

House-Requested Additions: written in ALL CAPS
House-Requested Deletions (excluding the title of the section): [ ]

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Sec. 25 [256B.072] [PERFORMANCE REPORTING AND QUALITY IMPROVEMENT SYSTEM.]

(b) The measures used for the performance reporting system for medical groups shall include [but are not limited to, ] measures of care for asthma, diabetes, hypertension, and coronary artery disease and measures of preventive care services. The measures used for the performance reporting system for inpatient hospitals shall include [but are not limited to,] measures of care for acute myocardial infarction, heart failure, and pneumonia, and measures of care and prevention of surgical infections. In the case of a medical group, the measures used shall be consistent with measures published by nonprofit Minnesota or national organizations that produce and disseminate health care quality measures or evidence-based health care guidelines [and that meet the criteria set forth in section 62J.43, subdivision 2]. In the case of inpatient hospital measures, the commissioner shall appoint the Minnesota Hospital Association and Stratis Health to advise on the development of the performance measures to be used for hospital reporting. To enable a consistent measurement process across the community, the commissioner may use measures of care provided for patients in addition to those identified in paragraph (a). The commissioner shall ensure collaboration with other health care reporting organizations so that the measures described in this section are consistent with those reported by those organizations and used by other purchasers in Minnesota.

(c) The commissioner may require providers to submit information in a required format to a health care reporting organization or to cooperate with the information collection procedures of that organization. The commissioner may [contract] COLLABORATE with a reporting organization to [assist with the collection of reporting information] COLLECT INFORMATION REPORTED and to prevent duplication of reporting.

(d) By October 1, 2007, and annually thereafter, the commissioner shall report through a public Web site the results by medical group and hospitals where possible of the measures under this section, and shall compare the results by medical group and hospital for patients enrolled in public programs to patients enrolled in private health plans. To achieve this reporting, the commissioner may [contract] COLLABORATE with a health care reporting organization that operates a Web site suitable for this purpose."