"From the Winter 2004 Newsletter (mailed December 18):

MN Clueless on "Quality," Set to Standardize Care

The Minnesota Governor's Health Cabinet traveled across the state in August and September laying out a plan to cut health care costs by injecting government-decision-making into the trusted patient-doctor relationship.

Ostensibly, these ten town hall meetings were held to obtain community input. However, one person who attended the Rochester meeting wrote in an email to CCHC, "I found itŠset in a tone of this is the way it is going to be, and we are going to move forward regardless of what anyone might say."

The Pawlenty administration has the law on its side. The 2004 Minnesota legislature passed legislation requiring the state health department to begin standardizing the practice of medicine, essentially telling doctors how to practice medicine (M.S. 62J.43). Gov. Pawlenty signed the bill May 29, 2004.

Claiming the State has too long paid for "volume rather than value," the State will now "partner with the private sector" to make sure doctors are providing, and government and health plans are only paying for, 'quality' care.

However, the Cabinet has no idea what "quality" is. CCHC's president attended 6 of the public meetings, and during the last one in Marshall, MN asked the Cabinet to define the term.

Despite tossing the term "quality" around for two months like it had a universally agreed upon definition, the Cabinet members were reluctant to answer the question. Kevin Goodno, head of the Dept. of Human Services, delivered many words, but no answer. Health Commissioner Diane Mandernach admitted that quality is "a little bit in the eye of the beholder." Cal Ludeman, head of the Dept. of Employee Relations, and cabinet chair, finally said "quality" is about "outcomes and results."

Not so, objected a physician in the audience. Outcomes and "quality" of physician care are not equal. Outcomes, he said, are impacted by patient behavior, including whether the doctor's treatment plan is even followed. Cabinet members said more time should therefore be spent calling patients on the phone, prodding them into compliance-something the physician quickly informed the Cabinet that he does not receive any reimbursement to do.

The cabinet members know the administration's plan is not without detractors. At almost every meeting, Mandernach declared that this plan is "not government-imposed medicine." Goodno admitted that their plan is controversial "at every step," but said the State has to "push through" the public's concerns about data privacy and "cookbook medicine." And as Ludeman reiterated, the Cabinet is "not seeking consensus."

ALERT: On Nov. 29, the Governor released his plan: the State will establish a "confederacy," purchasing "quality" health care with large employer groups for at least 60% of Minnesota citizens. The problem: 1) Patients lose when government and business partner to define, and only pay for, "quality." 2) These employer groups pushed the 2004 "best practices" law to standardize medical care. 3) Quasi- single-payer? Governor: 1-800-657-3717; 651-296-3391; tim.pawlenty@state.mn.us."

Example of CCHC Newsletter, Summer 2003