• identify medical practices they think all doctors should follow
• require adherence (SF1760) or "monitor and track" adherence (HF1681) to these practices using access to patient medical record information. The Senate bill proposes to start by having government target the medical records of patients with asthma, diabetes, hypertension, and stroke. The House doesn't define the diseases/conditions.
• provide "financial and other incentives" to doctors who cooperate with these government-issued practice directives for medical care. (HF1681) Doctors who comply with state-approved guidelines will also be promised protection from certain malpractice lawsuits (HF2778/HF1681/SF1915/ SF2385).
  

NO TESTIMONY HAS BEEN ALLOWED ON MOST OF THESE PROVISIONS IN HF 1681!

(Article 2 - see below)

PLEASE SIGN THE PETITION (below) and mail, email, or fax it (#651-646-0100) if you want medical decision-making to be between you and your doctor (and not the government), and if you want to preserve and protect individualized treatment and access to the full range of medications and treatments (including innovative, new, and cutting-edge options) for your medical care.

SEND YOUR CITIZEN PETITION to CCHC as soon as possible! These bills are moving fast!

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CITIZEN Petition to 2004 MN Legislature

OPPOSING GOVERNMENT-ISSUED MEDICAL PRACTICE GUIDELINES, AND STATE GOVERNMENT MONITORING AND TRACKING OF PHYSICIAN USE OF GUIDELINES

I, the undersigned citizen, oppose "best practice guideline" initiatives  found in bills such as House Files 1681 and 2038, and Senate Files 1760, 1915, and 1112, because they will empower Minnesota state government to:

* MAKE MEDICAL TREATMENT DECISIONS: The Government must not be authorized to decide what medical practices physicians and other
practitioners should follow. This will politicize medicine, limit individualized patient care, undermine medical decision-making, and ultimately lead to government-run health care.

* COERCE AND INTIMIDATE DOCTORS: The Government must not be allowed to "track and monitor" practitioners or require physician adherence to government-issued practice directives. Such exercise of state power to modify physician practice behavior will limit individualized patient care and is inconsistent with a free society.

* VIOLATE PRIVACY RIGHTS: Health officials must not be authorized by Government to invade the privacy of patient medical records to track patient care or to monitor physician compliance with government-issued practice directives. Patients have a right to keep their private medical records free from government inspection. Patient confidentiality is essential to building and maintaining patient trust, and critical for facilitating frank discussions between patients and their doctors.

* CREATE CONFLICTS OF INTEREST: Government agencies must not be allowed to offer "financial and other incentives" to encourage physician cooperation with government-issued practice directives. This threatens the patient-doctor relationship, violates the private contract between patient and doctor, creates conflicts of interest, and encourages breech of medical ethics.

* RESTRICT INNOVATIVE TREATMENT: The legislature must not grant doctors who follow state-approved practice guidelines an "absolute defense" against medical malpractice allegations. Such a law will discourage doctors from thinking and acting "outside the box" in medical decision-making, ultimately leading to less individualized and less innovative patient care.

Please deliver this signed Citizen petition to Governor Pawlenty and legislative leadership.

Signature________________________________________Date____________________

Name (PLEASE PRINT) ______________________________________________________

Address____________________________City___________State____Zip____________

Phone___________________________ Email (opt.) ____________________________

Citizens' Council on Health Care
1954 University Ave. W, Ste. 8
St. Paul, MN 55104
Phone: 651-646-8935
Email: info@cchconline.org

COMPLETE AND FAX TO CCHC: #651-646-0100  (or email to info@cchconline.org)

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PROPOSED LAW:

TO READ BILLS: Click Here to read the bills online

(The language is likely to change after each committee hears each bill)

** This is all newly proposed language. If you read these sections online, you'll see all the words underlined. We're sending it as "plain" text, not "styled" so unfortunately, you will not see the underlining that indicates that this is all newly proposed language.


HOUSE FILE 1681

                            ARTICLE 2

   7.36                 BEST PRACTICES

   8.1      Section 1.  [144.7035] [IDENTIFICATION AND TRACKING OF USE

   8.2   OF PRACTICE GUIDELINES.]

   8.3      The commissioner of health, in consultation with medical

   8.4   researchers, consumers, and representatives of health care

   8.5   providers and health plan companies, shall review health care

   8.6   best practice guidelines and identify five best practice

   8.7   guidelines for which, in the determination of the commissioner,

   8.8   greater adherence to by Minnesota health care providers would

   8.9   lead to a significant improvement in patient health outcomes.

   8.10  The commissioner shall encourage Minnesota health care providers

   8.11  to follow the guidelines identified and shall monitor and track

   8.12  the extent to whichMinnesota health care providers follow the

   8.13  guidelines.

[...]

   8.19     Sec. 3.  [147.38] [BEST PRACTICES GUIDELINE.]

   8.20     Subdivision 1.  [HEALTH-RELATED BOARD.] For purposes of

   8.21  this section, "health-related board" means the Board of Medical

   8.22  Practice established under section 147.01, the Board of Nursing

   8.23  established under section 148.181, the Board of Chiropractic

   8.24  Examiners established under section 148.02, the Board of

   8.25  Optometry established under section 148.52, the Board of

   8.26  Physical Therapy established under section 148..67, the Board of

   8.27  Dentistry established under section 150A.02, the Board of

   8.28  Pharmacy established under section 151.02, and the Board of

   8.29  Podiatry established under section 153.02.

   8.30     Subd. 2.  [BOARD APPROVAL.] A health-related board, in

   8.31  consultation with a relevant professional association or

   8.32  specialty organization and the commissioner of health, may

   8.33  evaluate and approve best practice guidelines and shall make any

   8.34  approved guidelines available to interested practitioners

   8.35  through the board's Web site.

[...]

   9.14     Sec. 5.  [BEST PRACTICES PILOT PROJECT.]

   9.15     The commissioners of human services and employee relations

   9.16  shall develop and implement a one-year best practices pilot

   9.17  project to encourage greater use of at least three of the best

   9.18  practice guidelines identified by the commissioner of health

   9.19  under Minnesota Statutes, section 144.7035.  The pilot project

   9.20  must provide health care providers and health plan companies

   9.21  serving state employees and enrollees of state health care

   9.22  programs administered by the commissioner of human services with

   9.23  financial and other incentives to increase the use of the best

   9.24  practice guidelines selected.  The commissioners shall implement

   9.25  the pilot project beginning January 1, 2005, and shall report

   9.26  the results of the pilot project to the legislature by June 1,

   9.27  2006.

HF1681/(SF 1915 has slightly different language)

   9.28                             ARTICLE 3

   9.29                     MEDICAL MALPRACTICE REFORM

   9.30     Section 1.  [147.37] [BEST PRACTICE GUIDELINES; USE IN

   9.31  MEDICAL MALPRACTICE CASES.]

   9.32     (a) In an action against a provider for malpractice, error,

   9.33  mistake, or failure to cure, whether based in contract or tort,

   9.34  adherence to a best practice guideline approved by either a

   9.35  recognized specialty organization or an organization established

   9.36  for the purpose of developing community-based clinical practice

  10.1   guidelines is an absolute defense against an allegation that the

  10.2   provider did not comply with accepted standards of practice in

  10.3   the community.  This paragraph does not apply if the best

  10.4   practice guideline authorizes or recommends denial of treatment,

  10.5   food, or fluids necessary to sustain life on the basis of the

  10.6   patient's age or expected length of life or the patient's

  10.7   present or predicted disability, degree of medical dependency,

  10.8   or quality of life.

  10.9      (b) Evidence of a departure from a best practice guideline

  10.10  is admissible only on the issue of whether the provider is

  10.11  entitled to an absolute defense under paragraph (a).

  10.12     (c) Paragraphs (a) and (b) apply to claims arising on or

  10.13  after August 1, 2004.

  10.14     (d) Nothing in this section changes the standard or burden

  10.15  of proof in an action alleging a delay in diagnosis, a

  10.16  misdiagnosis, inappropriate application of a best practice

  10.17  guideline, failure to obtain informed consent, battery or other

  10.18  intentional tort, or product liability.

SENATE FILE 1760 (similar to SF 1112):

(this is no longer accurate, but "best practices" language remains in the bill. An amendment was added 3/11/04 that will change this language significantly. In particular, it adds a withhold - money that can be withhold from doctors, and returned to them dependent on their performance. The language is not yet available online to post)

9.23     Sec. 7.  [62J.411] [BEST PRACTICES DATA.]

9.24     (a) The commissioner shall collect from primary care

9.25  providers information on patients who have been diagnosed with

9.26  or who are at risk of one of the following conditions:

9.27     (1) diabetes;

9.28     (2) hypertension;

9.29     (3) stroke; or

9.30     (4) asthma.

9.31     (b) The information collected shall include for each of the

9.32  conditions identified in paragraph (a):

9.33     (1) the number of patients who have been diagnosed with or

9.34  suffer from the condition; and

9.35     (2) the health care services provided to the patient within

9.36  the reporting period that are related to the specific condition

10.1   in terms of the percentage of patients identified in clause (1)

10.2   who received the service.

10.3      (c) The commissioner may not collect information in

10.4   individually identifiable form in which the patient is or can be

10.5   identified.

10.6      (d) The information collected may be used to:

10.7      (1) track and target best practices in the delivery of

10.8   health care for these conditions;

10.9      (2) assess the health care system and physician's quality

10.10  of care;

10.11     (3) identify utilization trends; and

10.12     (4) provide early identification and targeting of

10.13  populations at risk.

10.14     (e) Health care providers shall submit the required

10.15  information for the period of July 1, 2004, to December 31,

10.16  2004, by April 1, 2005.  For calendar year 2005, the health care

10.17  providers shall submit the required information by April 1,

10.18  2006, and each April 1 thereafter shall submit the required

10.19  information for the preceding calendar year.

SENATE FILE 1760

Sec. 26.  [256B.075] [DISEASE MANAGEMENT PROGRAMS.]

[...]

  27.10     Subd. 2.  [FEE-FOR-SERVICE.]

[...]

         (c) The commissioner shall request the identified

  27.27  recipients to choose a primary care provider from the list

  27.28  established in paragraph (b).  The provider shall be responsible

  27.29  for:

  [...]

  28.3      (5) adhering to evidence-based best practices care

  28.4   strategies.

  28.5      (d) The provider may create incentives for a recipient to

  28.6   ensure cooperation and patient engagement in the care plan and

  28.7   management.

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Citizens' Council on Health Care
1954 University Ave.W., Suite 8
St. Paul, MN55104
651-646-8935 phone
651-646-0100 fax
http://www.cchconline.org

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