Louis J. Ling, Chair, Morris Davidman, James R. Davis, Sandra Edwardson, Daniel D. Foley Timothy Gaspar, Robert Howe Jim Kohrt, Larry Kuusisto, Kirstin Libby, Dawn Ludwig, Donald Marsh, Kathleen Meyerle, William Fehrenbach (for Carl Patow), Peter Rapp, Michael Till, James V. Toscano, Cathy Wisner.
Interested Parties Present:
Numerous other visitors were present.
MDH Staff Present:
Scott Leitz, Tom Major, Moira Gaidzanwa, Michelle Strangis.
I. Introductory remarks from MERC Advisory Committee Chair
Dr. Ling opened the meeting at 1:05 and welcomed committee members and visitors. Dr. Ling noted that the PMAP subcommittee met this morning, from 10:00 to noon, in this room. The agenda for this meeting includes a report from that meeting.
II. Presentation on Minnesota Health Provider Demand Assessment - Ms. Sally Buck, Minnesota Center for Rural Health, Duluth
Ms. Sally Buck presented the results of the Minnesota Health Provider Demand Assessment, which analyzes provider demand in Minnesota over a five year period, 1994-1998.
A copy of the handouts from this presentation may be obtained from MERC staff at the Minnesota Department of Health. The major points of the presentation were:
- In 1998, 110 family practice physicians were in demand in rural Minnesota. There are a total of 105 resident slots for family practice in Minnesota medical education programs, a number that is less than the demand in rural Minnesota alone. Ms. Buck stated in her conclusion, "the demand for family physicians in rural Minnesota [in 1998] surpassed the supply of new providers."
- The demand for physicians has increased after a steady decrease over the past four years.
- The majority of family physicians are recruited within 2-12 months.
- Minnesota rural communities have spent an average of $30,765 on physician recruitment, and $8,676 on APN and PA recruitment.
- The data on demand for advanced practice nurses and physician assistants indicates that there has been a significant decrease in demand since 1995. However, this decrease is not seen in the number of APNs and PAs hired, which suggests that some APNs and PAs are recruited during their clinical rotation and not reported in the "demand" assessment.
III. Report on PMAP Subcommittee Meeting - Mr. James V. Toscano, Chair, PMAP Subcommittee and Scott Leitz,
Director, Health Economics Program
Mr. Toscano presented the information discussed at the PMAP subcommittee meeting which was held prior to lunch. Mr. Toscano summarized the proposals that were presented at that meeting as alternatives to current statutory formulas. Morris Davidman, on behalf of Hennepin County Medical Center, proposed that medical education dollars carved out of PMAP and PGAMC captiated rates be distributed by regions (Hennepin, other Metro and Non-Metro) according to where the dollars came from. For example, dollars from Hennepin County sites would be distributed to teaching sites in Hennepin County. Within each region, funds would be distributed in proportion to weighted medical education FTEs.
Mr. Toscano proposed that the carve out be limited to a range of 1.2% to 3.6 % statewide, and that organizations be given credit against the provider tax for unreimbursed medical education costs. A new handout was distributed that showed the estimated MERC payments for the carve out for each of three regions (Hennepin, Metro and Non-Metro) under three scenarios, the current formula, statewide carve out of 3.6% and statewide carve out of 1.6% (handout attached).
For more information on the PMAP subcommittee meeting, please refer to the meeting minutes and handouts.
The Advisory Committee members discussed these proposals. There was no consensus on an alternative to the current statutory formula. Kathy Meyerle moved to recommend to the Commissioner of Health that the Department initiate a technical amendment to the MERC statute to delay implementation of the PMAP carve-out until January 1, 2002 . 16 members voted in favor of the motion, one member was opposed, and one member abstained. Motion passed.
V. Update on Legislative Issues - Scott Leitz, Director, Health Economics Program
The Department of Health submitted three changes to the MERC statute which are contained in a bill, referred to as the MERC technical bill. The legislation expands the definition of "accredited clinical training" program in order to continue the eligibility of clinical training sites for the Augsburg College Physician Assistant Program. The legislation extends the annual application deadline for MERC Trust Fund grant applications from September 30 to October 31. Finally, the legislation simplifies the MERC Trust Fund application by requiring audited cost data plus funding and revenue data for each teaching program for an initial period of three consecutive years. In subsequent years, teaching programs must submit this data in the first year of the biennium, instead of annually.
There was no new business.