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December 2012 Heather E. Gantzer, MD, FACP


Governor's Message

Dr. Gantzer's photo

Minnesota ACP Mission: To foster excellence, education and professionalism among all internists in our community and to work together to shape the future of healthcare in Minnesota.

Minnesota ACP Vision: To be Minnesota’s recognized leader for patient care, advocacy and education and to enhance career choice, satisfaction and collaboration for specialists and subspecialists in Internal Medicine.

Over the past six months, how is Minnesota ACP progressing toward these goals set in the Vision statement? The annual chapter meeting led the way.

Many efforts culminated in the success of the 2012 Minnesota Chapter Scientific Meeting November 1-2 at the Minneapolis Convention Center. Thanks to the leadership of the program chairs John Bundrick, MD, FACP and Mary Miley, MD, a record number of participants was set: four hundred and twenty three. The MN ACP is grateful to Dr. Bundrick and Dr. Miley for their willingness to lead this very large endeavor; to Charlie Reznikoff, MD who directed the medical student and resident poster session with 217 posters presented; to our Executive Director Katherine Cairns who saw the larger vision but who also left no detail to chance; and to the planning committee of Drs. Richard Adair, Sally Berryman, Kimberly Cochran, Katherine Helgen, James Langland, Robert Lohr, Anne Lukasewycz, Andrew Olson, Craig Roth and Jason Szostek. Here are the slides for the 2012 Minnesota Chapter Scientific meeting and Pain Management pre-session.

Steps in Leadership for Patient Care: Prescription drug abuse is a serious and escalating problem across our country. Charlie Reznikoff, MD, addiction specialist at Hennepin County Medical Center, led the Nov. 1 afternoon session of “Prescription Pain Medicine: Avoiding Pitfalls and Climbing Out of the Pit.” Speakers explained current theories regarding potential negative effects of narcotics on chronic pain; ways to script patient expectations and to educate patients about ways to manage pain; legal issues of narcotics and driving; risk assessment and informed consent n the prescribing of controlled substances; management of pregnant patients addicted to opioids; and the use and misuse of benzodiazepines. Practical recommendations were included in each lecture. The session concluded with the patient perspective: we heard from patients who had become addicted to pain medication, asking to be treated as human beings with a difficult problem; and from family members of people who had died from their prescription drug addiction asking for physicians to be cautious in their prescribing and coordinated in their follow-up. The Steven Rummler Hope Foundation gave an unrestricted grant to the program, which allowed medical students and residents to attend without charge, in the hope that their educated and thoughtful prescribing of controlled substances will help patients in the future and save other families from grief.

Steps in Advocacy: Undeterred by Hurricane Sandy, ACP Executive Vice President and CEO Steven Weinberger, MD, FACP arrived from Philadelphia and spoke on High Value, Cost-Conscious Care: Wasting the Buck Stops Here. As the ACP works to ensure all Americans have access to health care, we recognize every health care dollar needs to be put to good use. With clear direction and specific examples, Dr. Weinberger illustrated how ACP is leading the nation to increase the quality and reduce the waste of health care. As health reform efforts evolve, if you would like to sign up to be an Advocate for Internal Medicine and receive Legislative Updates by email, please let Katherine Cairns know.

Steps in Education: Drs. Amit Ghosh, James Newman and Jason Szostek presented the SEP Pre-course Thursday afternoon November 1 at the Convention Center. The topics were the Internal Medicine 2012 Update and the Hospital Medicine 2012 Update. Participants registered with the ABIM to obtain the modules; then brought their tablets or laptops to the session. Each question was discussed in an interactive format, and each person was able to have completed 20 points of knowledge modules for their Maintenance of Certification. For those who were not able to attend, this SEP Pre-course will also be given in Duluth Saturday morning March 9, 2013 at the Inn on Lake Superior; watch the MN ACP website for registration details.

Steps in Career Choice: MN ACP supports Minnesota medical students interested in Internal Medicine. At the Council meeting November 1, we heard reports from the Internal Medicine Interest Groups (IMIG.) The Mayo Medical School IMIG described recruitment of incoming first year students at the new student organization fair in August; Executive Director Katherine Cairns attended representing the ACP. The Mayo IMIG also hosted a “What is Internal Medicine?” lunch meeting with a panel of Mayo internists and subspecialists talking about their careers. They also sponsored an outing to a game of Rochester’s minor league team, the Honkers, where new students had another chance to network with Mayo Internal Medicine faculty and upperclassmen. The University of Minnesota Medical School IMIG described their updated website providing resources for medical students interested in Internal Medicine. They also organized an Internal Medicine Residency Dinner and Information Panel at Coffman Union in November, well attended by medical students, where leaders of the Internal Medicine residency programs at Abbott Northwestern, Hennepin County Medical Center, Mayo, and the University of Minnesota were able to describe the unique features of their programs and answer questions.

Steps in Career Satisfaction: Throughout the audience, heads were nodding in agreement as Mark Linzer, MD, FACP of HCMC spoke on Physician Satisfaction. He described the pressures and challenges of medicine today as we know all too well; but he also outlined data pertinent to the world of medicine and the world of finance, and suggested practical steps to regaining control over one’s schedule and professional fulfillment.

Steps in Collaboration for Specialists and Subspecialists in Internal Medicine: The talks November 2 were applicable across specialty lines, and included the US Preventive Task Force Guidelines on the PSA and the evidence-based approach underpinning those guidelines; DVT prophylaxis for medical inpatients; short term and longterm effects of radiation therapy to which internists need to be alert; fitness vs weight issues in the obesity epidemic; the present and future of bedside ultrasound; management of the positive PPD and common questions in the approach to a new diagnosis of tuberculosis; trends in preventive cardiology; and highlights of new issues in inpatient and outpatient Internal Medicine. By presenting an array of topics, each internist was able to learn of advances in Internal Medicine beyond their own specific area of expertise.

The Minnesota Chapter of the ACP has grown to over 2300 members. If you have thoughts of additional ways the ACP can serve Minnesota internists and their patients, and if you would like to be further involved in these efforts, please email me at Heather.Gantzer@parknicollet.com.

Heather E. Gantzer, MD, FACP
Governor, Minnesota Chapter of the American College of Physicians

Scenes from 2012 MN-ACP activities:

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MN ACP Members Receive Distinguished Awards

Amit K. Ghosh, MD, MBA, ACP, FASN was announced the Minnesota ACP 2012 Laureate. Dr. Ghosh is renowned for his expertise in nephrology and in medical education; but the Minnesota ACP has a special regard for his dedicated work for the chapter over the years, from the resident poster session of some years ago to his leadership in the ongoing SEP Maintenance of Certification Module sessions held in Minneapolis and Duluth.

Randall Edson, MD, FACP, infectious disease specialist who has worked with the ACP in many capacities has been named a Master in the American College of Physicians and will receive his Mastership at Convocation in San Francisco in April 2013. The Minnesota Chapter is honored to have a new Master in our ranks.

Charles Reznikoff, MD, was given the MN ACP Community Volunteer Award for his work helping people in the field of addiction. For the past three years, he has worked with the Northfield Healthy Community and Mayor’s Drug Task Force, helping investigate root causes of teens’ deaths from heroin and putting together a drug advice and prevention program in that community. He works with the Anonymous Addiction Advice hotline, and in educational outreach to parents, guidance counselors and students on topics of drugs, addiction and resources. He is currently serving as a volunteer board member on the Steven Rummler Hope Foundation.

Dr. Ghosh and family
Dr. Amit Ghosh and family- 2012 MN-ACP Laureate Award winner

Dr. Reznikoff
Dr. Charles Reznikoff- 2012 MN-ACP Community Volunteer award winner

Abstract competition winners

With a record-setting number of posters in the medical student and resident poster exhibition, competition was fierce and we all appreciated the high quality of work presented by the participants. The following were the winners of the poster competitions:

Clinical Vignette- Shauna Morrow, MD AIDS Masquerading as Dermatomyositis: Underscoring the Importance of Sexual History

Clinical Vignette Finalists-

  • Hope Pogemiller, MD, An Ancient Rash
  • Aaron Chan, MD, Acute Hepatitis and Pancreatitis: An Unusual Etiology.
  • Jill Bowman, MD, Do You Hear What I Hear?
  • Brian McChesney, MD, The Fragile Red Blood Cell: Hemolysis in Pernicious Anemia
  • Adam Foss, MD, Thrombotic thrombocytopenic purpura with associated posterior reversible encephalopathy syndrome in a 16 yr old female; a rare clinical presentation.

Quality Improvement- Daryn Collins, MD, Venous thromboembolism prophylaxis for medical patients: Implications for a standardized order set.

Research- Malini DeSivla, MD, Asymptomatic Transaminitis in Newly Arrived Refugees to Minnesota

Medical Student- Joshua Dorn, Effect of group visits on outcomes in patients with Type II Diabetes

Medical Student finalist- Sameet Sangha, Testosterone related Portal Vein Thrombosis

Winners of the Clinical Vignette, Quality Improvement, Research and medical Student poster competitions were awarded a $200 prize and travel scholarship to attend the national ACP meeting in San Francisco in April 2013 representing Minnesota to compete nationally. Finalists in each category were recognized at the annual meeting and presented with a prize. Winners will have their abstract published in Minnesota Medicine in early 2013. An additional prize was presented to each of the Peer Judge Winners: Noah Goldfarb, MD , Siu-Hin Wan, MD, Thomas Waterbury, MD, Sarah Yamaguchi, MD, and Marina Zakharova, MD

Vignette finalists
2012 Clinical Vignette finalists and winner- Drs. Adam Foss, Jill Bowman, Brian McChesney, Hope Pogemiller, Shauna Morrow (winner), Aaron Chan

Dr. DeSivla
Dr. Malini DeSivla- Research award winner; Dr. Daryn Collins- Quality award winner was unavailable for photo

Dr. Olson and others
Dr. Andrew Olson with 2012 Medical Student abstract winner Joshua Dorn and finalist Sameet Sangha

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Internal Medicine 2013

Internal Medicine 2013 will be held in San Francisco April 11-13, 2013, with Pre-courses April 9 and 10. It is a chance to learn about advances in your own field and related fields from top experts in the country, in the company of fellow internists of all specialties. Look at the program and register.

Minnesota ACP will be holding a reception jointly with the Mayo Alumni Foundation and the North Dakota Chapter of the ACP 6pm on Friday April 12; we look forward to seeing you there.

Also note that Convocation in San Francisco Thursday April 11 at 6pm is a meaningful gathering time, with plenty of pomp and circumstance, acknowledging the new Masters and Fellows of the College. Fellows elected since 2010 and not yet inducted are invited to the Convocation and need to complete the Fellowship inductee response form by Feb. 22, 2013.

I encourage you to consider applying for Fellowship. There are several routes to Fellowship. The deadline for Fellowship applications is January 7, 2013, to be eligible to participate in 2013 Convocation at San Francisco. Fellows approved by March 1, 2013 are invited to the Convocation.

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Check out JournalWise

I encourage you to explore JournalWise. The reviewers of JournalWise at ACP continually follow over 120 journals to bring you the most important articles.

When enrolling, you choose the threshold at which you wish to be alerted of new articles pertinent to your interests. First you choose your fields of interest (geriatrics, cardiology, emergency medicine, oncology, hospital medicine, nephrology, mental health, etc.) You then choose relevance and newsworthiness thresholds. You decide how often you wish to receive alerts: weekly, daily or other frequencies. Look at the estimate number of articles you would receive by alert, and modulate your settings accordingly.

This is a free benefit of your ACP membership and a valuable way to expand your knowledge of medical advances beyond the journals which you usually receive.

If you also have a tablet or a smart phone, I recommend you sign up for the new, free Annals of Internal Medicine app.

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The Top 10 Things ACP Advocacy has done for you….

ACP has prepared this informative piece on benefits of your ACP membership. More info on each topic.

Because of ACP advocacy efforts and working with other organizations:
  1. Medicare will pay you and your staff for the work outside of a face-to-face visit involved with transitioning a patient from the hospital to the community setting—as much as $231 for each time you bill for this service under new codes that will be effective on January 1, 2013. Because of this and other changes advocated by ACP, internists on average will see their Medicare payments increase by 4-5% next year.
  2. Starting on January 1, 2013 and continuing through 2014, Medicaid payments to internists for their evaluation and management services and vaccine administration will be no less than the comparable Medicare rates—a very substantial increase in Medicaid payments in most states. And, as advocated for by ACP, this increase applies to both general internists as well as internal medicine subspecialists—and will include services that are not currently paid for under Medicare, such as the consultation services codes.
  3. In addition to the above payment increases, Medicare will continue to pay a 10% bonus to primary care internists, and other primary care physicians, for your office visits and other evaluation and management codes—an average annual increase in Medicare revenue of $8000 per internist over the course of 5 years (from 2011 to 2015).
  4. Two additional hardship exemptions from participation in the CMS Electronic Prescribing (E-Rx) Incentive Program will become available for you in 2013 and 2014. Internists or group practices who (1) achieve meaningful use during certain e-Rx payment adjustment reporting periods and/or (2) demonstrate intent to participate in the electronic health record (EHR) Incentive Program and adoption of Certified EHR Technology could be exempted. These exemptions were advocated for by the College to help align the e-prescribing program with meaningful use and therefore reduce the burden on physicians to participate.
  5. Five hundred primary care practices in seven regions- including some Minnesota practices- will received substantial increases in Medicare revenue—plus financial and other support services from other payers in their communities—for providing patient-centered, coordinated care. ACP has been actively engaged in advising on this project from its inception. CMS is paying the participating primary care practices a risk adjusted care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries.
  6. New national standards for insurance companies will simplify claims payments, allowing internists to spend more time with patients and less time on paperwork. This is due to significant improvement in the way electronic fund transfers are made for health insurance claims—across both public and private payers—and is something ACP has been advocating for over a number of years. Starting in 2014, and in some cases sooner, physician practices and other healthcare entities will receive claim payments electronically, and then be able to automatically match (re-associate) explanations regarding any adjustments to these payments by the health plans with the corrected claim.
  7. Most internists will have additional time before the Medicare Value-Based Payment Modifier (VBPM) will be applied to your payments. The VBPM is a program within the Affordable Care Act that will affect all physicians' payments starting in 2017 by modifying Medicare fee-for-service reimbursements depending on how well a physician scores on measures of cost and quality of service. ACP strongly advocated for CMS to phase in the program in a way that will allow CMS to gain experience before applying the VBPM to all physicians in 2017. CMS has decided to apply the VBPM to groups of physicians of 100 or more eligible professionals during the first year—instead of their original plan to apply it to practices of 25 or more—noting that this change will help them gain additional experience and be able to produce data to enhance physician acceptance of their methodologies and approach.
  8. CMS will align the VBPM attribution method with the methodology used for the Medicare Shared Savings Program and the Physician Quality Reporting System (PQRS) – something ACP had strongly advocated for. This attribution approach involves a 2 step process that emphasizes primary care services furnished by a physician or group of physicians.
  9. In fact, due to the ongoing feedback from ACP and others, CMS is working toward significantly greater alignment of program requirements across their quality initiatives, including the eRx incentive program, EHR incentive program, Medicare Shared Savings Program, and the VBPM. There is still more work to be done on this front and ACP will continue to push CMS in this direction.
  10. Finally, Medicare has initiated an additional means for internists and other physicians to successfully participate in PQRS. This new administrative claims reporting mechanism will be available for PQRS (as well as for the VBPM program) in 2015. ACP had strongly supported this option as it provides a feasible alternative for physicians and groups to participate in the program, particularly if they have not yet been able to effectively use the traditional reporting mechanisms (claims, registries, or electronic health records [EHRs]) for this purpose or have otherwise not been able to meet the criteria for successful reporting for the 2013 and/or 2014 incentives.

More details on these payment changes.

ACP Advocacy in Action

Physicians as well as patients can learn practical points about the implementation of the Patient Protection and Affordable Care Act at a website designed by a coalition including ACP, AARP, AAFP, AHA, AMA and others. On that site, click on “Health Care by State” then: “Minnesota” to see how the provisions of the new law impact health care in Minnesota now and in the coming years. Patients may especially appreciate this website.

Minnesota ACP Participates in the Minnesota Medical Association Day at the Capitol in St Paul Thursday, February 7, 2013. It is a chance to review state issues relevant to physicians in Minnesota, then to meet with your senators and representatives to discuss these issues from an internist’s point of view. You need not be a member of the MMA to participate. Register here. If you are attending, let us know at Minnesota.ACP@gmail.com so we can assemble as an ACP group that day before the session begins.

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Patient Resources on Health Reform

The American College of Physicians, American Academy of Family Physicians, AARP and others have combined to create a website for Americans (aimed at the 8th grade literacy level) with the goal of explaining the changes that are coming with health care reform and how to navigate the new system. People can click on their state and proceed from there. It would be well worth publicizing this to patients and potential patients. Consider bringing this information to your clinic marketing staff. It is very straightforward and useful information for physicians, too!

Within this site also is a website sponsored by the US government Department of Health and Human Services for patients to get additional information about the implementation of the ACA including state-specific information.

Health Reform in Minnesota

The ACP is the largest medical-specialty organization in the country with more than 133,000 members nationwide; it is a professional organization of internists (including generalists, hospitalists and subspecialists) with a mission to improve the excellence of medical care, and so continuing education, preparation for Board exams etc is a significant part of this. However ensuring access to care for all Americans and patient advocacy is also part of our mission. In the immediate future ACP is urging states to proceed with Medicaid expansion (as Minnesota is doing) , is giving input into details of the creation of the state health insurance exchange, and is encouraging the publicity of the practical benefits of the ACA, particularly health insurance enrollment, to eligible Americans.

The Minnesota Chapter of the ACP which has over 2300 members in the state of Minnesota (more than half of the general internists and more than a third of the subspecialists in the state), can be of assistance in providing information on health reform to our Minnesota patients by encouraging its use in your patient education materials.

The goal here is not political campaigning—in fact ACP is not a political organization and has members with a wide diversity of opinions though united in our goal of the best possible care for all patients--but about the effective implementation of the ACA, realizing of course over time improvements are to be expected.

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Chapter Vital Statistics—

There are 2,307 members of the Minnesota American College of Physicians as of December 2012. The table below shows a comparison of membership growth over the past year. This represents steady growth of our membership in the past five years.

MN-ACP membership profile
2011
2012
Masters 19 20
Fellows 567 571
Members 950 976
Associates (Residents) 461 494
Medical Students 222 240
Affiliates 3 6
Total members 2,222 2,307

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Path to Fellowship for Current Members

If you are now a member- become a Fellow. Find which pathway to Fellowship is appropriate for your career path. In Minnesota, there are 665 current members who are eligible for a pathway to becoming a Fellow of the American College of Physicians (FACP). Questions about eligibility requirements can be directed to ACP Credentialing at 800-523-1546 ext 2709 or emailed to FACP@acponline.org. As a reminder, the deadline for fellowship applications is January 7, 2013 to be able to participate in the Convocation ceremony in San Francisco on April 11, 2013.

Congratulations to new Minnesota Fellows

In the past six months, the following internists have been identified as new Fellows of the American College of Physicians (FACP): Tony Y Chon, MD, FACP; Samuel J. Dardick, MD, FACP; Murali K. Duggirala, MBBS FACP; Howard A. Fink, MD, FACP; Durga P. Komaragiri, MBBS, FACP; Neel B Shah, MBChB, FACP; Kenneth J. Warrington, MD, FACP

.

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Recruit a new Member and Reduce Your Dues

If you have colleagues who are not yet ACP members-encourage them to join now, particularly anticipating the national ACP meeting April 11-13, 2013 in San Francisco. The Recruit a Colleague process shows you how you can have your dues for the next year reduced by $100 or more. A dues discount is always welcome! However, the real reason to encourage your peers to join is to encourage them to become engaged in the community of Internal Medicine in Minnesota and to strengthen the voice of our profession, increase lifelong learning, mentor medical students and residents, and take advantage of the professional resources national ACP has to offer including education at meetings and on line, insurance benefits, the Annals of Internal Medicine, assistance with choosing an electronic health record and medical home, electronic medical decision making resources, and patient and professional advocacy.

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2012 Chapter Excellence Award and ACP Evergreen Award

Chapter Excellence Logo

I am pleased to announce that our chapter was honored at the 2012 ACP national meeting and awarded the Evergreen Award in recognition of the abstract judging process and peer involvement in judging. Additionally, the MN chapter is in receipt of the 2012 Chapter Excellence Award. The award recognizes chapters which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria. Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. I would like to extend a special thanks to those chapter members who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

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2012 Call for Nominations

The Laureate Award is designed to honor a Fellow or Master of ACP for at least 15 to 20 years, who has demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, research, and service to their community, to their chapter, and the ACP. A Laureate nominee is a senior physician with a long history of excellence and peer approval in the specialty of internal medicine and served the chapter and community with distinction in some clearly definable manner.

The Volunteerism and Community Service Award recognizes a Master, Fellow, Member, or Associate of ACP who has provided volunteer service post-training. Self-nominations are not permitted. Performs services on a voluntary basis and not required for the completion of teaching, training, or position requirements. Volunteer work must have been done as a physician and be medically related. Awardees are eligible for the national award, Oscar E. Edwards Memorial Award for Volunteerism and Community Service.

Nominations for the 2013 MN-ACP Awards will be open in January. Contact Minnesota.ACP@gmail.com for nomination forms.

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Upcoming Dates

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Become an ACP Chapter Advocate for Internal Medicine and Apply for ACP Leadership Day Scholarships

ACP’s Key Contact Program provides you with legislative updates and easy-to-use grassroots advocacy tools to communicate effectively and develop valued relationships with our elected federal officials and their staff. Over 210 Minnesota internists, medical students and residents are members of this advocacy network. Sign up today. Medical students and residents who are interested in public policy are especially encouraged to sign up. You must be a member of this network to be eligible for a travel scholarship from ACP and MN-ACP to the ACP Leadership Day events in Washington DC. National scholarship applications are due January 30, 2013.

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ACP Minnesota, Thanks!

We want to recognize the tireless efforts of Drs. John Bundrick and Mary Miley, as 2012 Program Chairs who led the planning for the 2012 ACP Scientific Session in Minnesota. Special thanks to Mayo Clinic for the use of their equipment for the ABIM SEP Module and Hennepin County Medical Center for use of their equipment for the Pain Management pre-course.

We want to also recognize our poster judges and oral vignette judges who helped determine our outstanding winners. Special thanks to Charlie Reznikoff, MD for chairing the competition and to Andrew Olson, MD for coordinating the medical student competition. Kudos to all of our presenters and our judges.

Poster/Abstract Judges included: Drs. Anne Pereira, Shama Bhan, George Sarosi, Sally Berryman, Dietlind Wahner-Roedler, Mary Miley, Heather Buum, Mark Liebow, Richard Adair, Loren Bosmans, Laxmana Godishala, Benji Mathews, Paul Kleinschmidt, David Tierney, Jeff Rubins, Anita Udayamurthy, Nacide Ercan-Fang, Lauren Drevlow, Amy Holbrook, Tom Hauth, Dan Schnobrich, Robert Jeddeloh, Chaitanya Anand, John Song, Meghan Walsh, Mumtaz Mustapha, Loren Bosmans, Kristen Kopski, Robert Lohr, Brad Benson, Wendy Miller, David Williams, Anya Lukasewycz, Sam Ives, Christine Schwab, Aaron Rutzick, Peter Lund, Michael Rhodes, Jennifer McEntee, Alison Wing, Brian Duffy.

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How Will the Medicaid Expansion Benefit Minnesota?

The Minnesota chapter of the American College of Physicians believes that it is imperative that the state of Minnesota accept the unique opportunity that is now available to use federal dollars to expand Medicaid to everyone who has an income up to 133 percent of the federal poverty level.

No matter where one stands on the Affordable Care Act itself, the evidence is clear: Minnesota will greatly benefit by accepting federal dollars to extend Medicaid, and Minnesotans will be harmed it if does not:

  • Extending Medicaid coverage to Minnesota’s low-income uninsured will improve health status and quality of life.
  • Medicaid coverage may also help curb racial and ethnic health care disparities that are exasperated by lack of insurance, such as lack of usual source of care or receipt of preventative screenings.(i) About 21% of adult Minnesotans newly-eligible for Medicaid are people of color, a population that is more likely to be uninsured than whites (ii).
  • Extending Medicaid coverage will reduce the numbers of uninsured Minnesotans by as much as 34 percent (iii).

Medicaid status

Source: Kenney GM, Zuckerman S, Dubay L, Huntress M, Lynch V, Haley J, Anderson N. Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured. Urban Institute. June 29, 2012. Assessed on August 28, 2012

  • Nine percent of Minnesotans – about 460,000 were uninsured between 2009 and 2010. According to one estimate, 168,000 adult Minnesotans would be eligible for Medicaid coverage, including 130,000 who would be newly eligible under the health reform law. (iv)
  • This is a significant expansion, as the Medicaid program is open only to childless, non-disabled adults with incomes up to $8,168. Parents with incomes up to $39,840 (for a family of three) are eligible for coverage. (v)
  • Medicaid expansion will help the “safety net” of physicians, hospitals, and academic medical centers better serve their low-income patients and reduce cost-shifting to the rest of us.
    • In 2008, the last year for which information is available, Minnesota’s Medicaid primary care payment rates were 58% of Medicare rates.(vi) While Medicaid physician participation lags behind Medicare and private insurance, evidence shows that physicians are more likely to accept new Medicaid patients in states that pay closer to Medicare rates. (vii)
    • Hospitals will benefit from reduced uncompensated care costs, as the newly-insured will no longer be forced to seek free care provided by hospitals. Uncompensated care costs are shared across the public and private sectors.
    • The Medicaid expansion is especially crucial for hospitals, since the health care reform law cut the federal share of uncompensated care payments because lawmakers assumed the Medicaid expansion would heavily reduce the need for uncompensated care. In 2010, Minnesota’s hospitals received about $75 million in Medicaid federal funds to help offset the cost of covering the uninsured. (viii) Medicaid’s rising costs are a growing burden for Minnesotans, mainly because the federal government does not pay a fair share of Medicaid costs while imposing costly federal mandates on the state. But this new program is different, because the federal government pays almost the entire cost.
    • Right now, the federal government pays about 50% of the cost for Minnesotans enrolled in Medicaid; our state pays the other 50%. (ix) But starting in 2014, the federal government will pay 100% of the cost for the first two years of extending Medicaid to all Minnesotans with incomes below 133% of the federal poverty level. Gradually, the federal government’s share will go down to 95% and then 90% over the next ten years.
    • The CBO estimates that states will incur an additional 2.8% increase in Medicaid costs compared with what they would have spent in absence of the health care law, an estimate that includes those currently eligible for Medicaid coverage. (x)
    • A 2011 Urban Institute report estimated that the ACA could save Minnesota up to $545 million over 2014-2019 when enhanced Medicaid spending, uncompensated care reductions, and other savings are factored in. (xi)
    • Should Minnesota accept the federal dollars now, the state is not locked in if the federal government reneges in the future on the commitment to pay for most of the Medicaid expansion. If the federal payments are reduced, then Minnesota could revisit its decision to expand Medicaid.
  • What would happen to the uninsured if Minnesota chose not to expand Medicaid? The Urban Institute estimates that about 103,000 uninsured adult Minnesotans with incomes under 100% FPL could be denied coverage if Minnesota chooses not to expand its Medicaid program. ii And, under the health reform law, they would not be eligible to get the subsidies to help pay for health insurance available to people who earn more than the federal poverty level, because Congress had expected that they would be covered by Medicaid.

As an organization representing Minnesota’s internal medicine physicians and medical students, our greatest concern is for the working people—our patients—who will be left behind without any access to health insurance coverage if Minnesota declines the federal money to expand Medicaid. We are speaking for them when we commend Governor Dayton for doing the right thing by indicating that Minnesota will accept this unprecedented opportunity to provide coverage to our poorest patients, at minimal cost to the state. It is imperative that our state’s leaders follow through by working with the federal government to ensure that Medicaid coverage is expanded to eligible Minnesotans.

(i) Kaiser Family Foundation. Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities. Kaiser Family Foundation. September 2010. Accessed on August 20, 2012.
(ii) Kenney GM, Zuckerman S, Dubay L, Huntress M, Lynch V, Haley J, Anderson N. Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage? Urban Institute. August 2012.
Accessed on August 20, 2012.
(iii) Kenney GM, Dubaty L, Zuckerman S, Huntress M. Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured. Urban Institute. June 29, 2012. Accessed on August 29, 2012.
(iv) Kaiser Family Foundation. Minnesota: State Medicaid Fact Sheet. Statehealthfacts.org. Accessed on August 29, 2012.
(v) Kaiser Family Foundation. How will the Medicaid Expansion for Adults Impact Eligibility and Coverage? July 2012. Accessed on August 24, 2012.
(vi) Statehealthfacts.org. Medicaid-to-Medicare Fee Index. 2008. Statehealthfacts.org. Accessed on August 29, 2012.
(vii) Decker SL. In 2011 Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help. Health Aff. 2012. 31(8);1673-1679.
(viii) Statehealthfacts.org. Federal Disproportionate Share Hospital Allotments. Statehealthfacts.org. Accessed on August 24, 2012
(ix) Statehealthfacts.org. Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier. Statehealthfacts.org. Accessed on August 24, 2012.
Angeles J. How Health Reform’s Medicaid Expansion Will Impact State Budgets. Center on Budget and Policy Priorities. July 25, 2012. Buettgens M, Dorn S, Carroll C. Consider Savings as Well as Costs: State Governments Would Spend at Least $90 Billion Less With the ACA than Without It from 2014 to 2019. Urban Institute. July 2011. Accessed on August 20, 2012.

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Contact Information

Heather E Gantzer, MD FACP, Governor, Minnesota Chapter

Chapter Staff:
Katherine Cairns, Executive Director
1043 Grand Ave. #215
St. Paul, MN 55105
651-492-1994
Fax: 651-699-7798
Minnesota.ACP@gmail.com