Monthly Archives: March 2016

Improving Care for Unilateral Hearing Loss

Improving Care for Unilateral Hearing Loss:
New research on language outcomes

A multi-state research project is providing new information about Language Outcomes of Children with Unilateral Hearing Loss. With the support of fourteen participating state EHDI programs, the National Early Childhood Assessment Project (NECAP) summarized characteristics of 132 children with unilateral hearing loss, reviewed language outcome data, and hoped to identify characteristics of children with more successful language outcomes.

Some characteristics of participants included:

  • 79% of children were identified by 3 months
  • More than half were utilizing amplification

Assessment was completed on one to five occasions, and assessment tools included the Minnesota Child Development Inventory, and the MacArther-Bates Communicative Development Inventory. Data showed:

  • 25% to 35% of participants demonstrated delayed language
  • Language delays became evident as early as 2 years of age (Language Quotient dropped below 80)

Current data (study is ongoing) has not clearly identified subgroups of children with unilateral hearing loss who may be more at risk for language delay. However, the data suggest that children with unilateral hearing loss should be re-evaluated again just after age 2, so that data driven decisions can be made regarding care delivery and early intervention.

Another recent publication in Pediatrics highlights the negative impact that delayed intervention has on auditory system development for children with asymmetric hearing loss / single-sided deafness.  Providing early and effective stimulation of the ear with hearing loss using auditory prosthesis (hearing aid or cochlear implant) plays a large role in securing function of the impaired ear.

Unilateral hearing loss and amplification in Minnesota
 (2014 data)

  • 42% were fit with amplification
  • 8% declined amplification at the time of diagnosis
  • 23% did not have amplification recommended at the time of diagnosis
  • 27% had unknown plan regarding amplification (e.g. status not reported, testing in process, family undecided)

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Legislative Update – 3/18/2016

MAO Legislative Update
March 18, 2016
Eric Dick, MAO Lobbyist
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Session Off to a Bumpy Start
With the start of the legislative session at noon on March 8 legislators wasted little time before drawing sharp partisan lines. The minority parties in both the House and Senate quickly took the majority to task for various issues as the very short 2016 session began.

The fight in the House of Representatives was centered upon how to best move forward additional unemployment relief for laid off workers on the Iron Range.  The DFL minority was also highly critical of GOP legislative leaders for the way in which the Capitol has been used to continue to host House floor hearings.  Because of continued construction in the Capitol building, only the House chamber is open and access is strictly limited to a small number of legislators, staff, and press.  No public access is allowed.  The Senate Republic Caucus took Senate DFL legislative leaders to task over changes in the structure of committees with jurisdiction over energy and environmental issues.

The state constitution mandates that the session conclude no later than midnight on May 24.  Given the short length of the session, committee deadlines already loom in the coming weeks.

Provider Tax Extension Bill Receives Hearing
A Senate bill to repeal the 2020 sunset of the provider tax received a hearing in the Senate HHS Policy Committee on March 14.  Set in motion in a bipartisan agreement in 2011, the 2 percent provider tax is set to be repealed on December 31, 2019.  Some legislators and interest groups have begun calling for a permanent extension of the tax.  SF 2552 is being carried by Sen. Kathy Sheran (DFL – Mankato) and the House bill is authored by Rep. Jennifer Schultz (DFL – Mankato).

Testifying in opposition was Dave Renner, the Director of State and Federal Legislation for the Minnesota Medical Association.  Renner was joined in opposition by representatives of the Minnesota Chamber of Commerce, the Minnesota Chiropractic Association, and the Minnesota Psychologist Association.  Stating that the health care coverage and programs supported by the provider tax remain of critical importance to many low income Minnesotans, the Minnesota Hospital Association offered their support for the bill while suggesting that the tax should be lowered to better fit the current financing need.

The bill passed the committee and was referred to the Senate HHS Finance Committee.   Sen. John Hoffman (DFL – Champlin) joined Republican Senators Carla Nelson (Rochester), Julie Rosen (Vernon Center), and Michelle Benson (Ham Lake) in voting against the bill.  The Republican leadership in the House have stated unequivocally that the bill will not move in their body.

Governor Announces Supplemental Budget Proposal
Governor Dayton kicked off the work of crafting a supplemental budget when he announced his proposal on how to manage the state’s $900 million budget surplus.  While there are many pieces that will find favor among physicians and health care interests, the budget plan also includes a significant shift of provider tax dollars out of the Health Care Access Fund (HCAF).

Under the proposal, reimbursement rates for primary care services provided under Medical Assistance and Minnesota Care would rise by 5 percent.  The proposed budget also seeks added investment in mental health services, including additional staffing for the state’s Anoka Metro Regional Treatment Center and support for certified community behavioral health centers.   Governor Dayton’s proposal also includes funding to upgrade the cannabis registry to allow non-certifying providers and emergency personnel access to limited data about cannabis use.

The budget also includes dramatic shifts of dollars out of the Health Care Access Fund to support programming traditional funded by the General Fund.  The Health Care Access Fund is where revenue from the provider tax is deposited.  The shift amounts to $56 million in 2017 and $241 million in 2018-19.  Certain to cause consternation among Republicans (and some DFLers) is a provision that funds a $500,000 study of single payer out of the HCAF.

Physician-Aid in Dying Proposal Heard, Tabled
A Senate hearing on a proposal to allow physicians to aid in the dying of terminally ill patients elicited passionate testimony on both sides of the bill but no committee vote on March 16.  The bill, authored by Sen. Chris Eaton (DFL – Brooklyn Center), was tabled by the author before a vote was taken.

The proposal is built on similar laws in Oregon and several other states.  Under the bill, patients who have been given less than six months to live would be eligible to receive medications to aid in their dying.  Patients would need to submit two requests for aid in dying to both their attending physician and a consulting physician, and witnesses would be required.  Physicians would be tasked with certifying the terminal condition, confirming that the patient was voluntarily seeking the aid, competent, and not suffering from a psychiatric or psychological condition or depression.  Patients would be allowed to withdraw their request at any time.  The bill contains explicit language that provides criminal liability protections for physicians who lawfully participate in the process.

Testifying in support of the bill were a number of relatives of people who had died painful, agonizing deaths, including Dan Diaz.  Diaz is the husband of Brittany Maynard, the native Californian who moved to Oregon in 2015 to take advantage of that state’s physician aid-in-dying law as she battled a terminal brain tumor.  Also testifying in support was David Plimpton, MD, a Minneapolis gastroenterologist.  Opponents to the bill included a young woman also suffering from a brain tumor, church leaders from different faiths, and physicians.

Following testimony, members of the committee debated the proposal.  With successful passage out of committee in doubt, the author tabled her bill to avoid a negative vote.  The bill will not be back for consideration this year.  The House bill is being carried by Rep. Mike Freiburg (DFL – Golden Valley) but it is unlikely to receive a hearing.

Bill to Extend APCD Usage Clears Committee Hurdle
The state's All Payer Claims Database (APCD) could continue to be used for analysis of health care costs, quality, utilization, and disease burden under a bill that cleared the Senate's HHS Policy Committee on March 14.  The bill, SF 2340 successfully passed the Senate Judiciary Committee on March 18th and was referred to the Senate floor.

The APCD is a repository of de-identified patient billing data that was established as part of the landmark 2008 Minnesota state health care reforms.  Current law sunsets the authority of MDH to use the APCD for the study of health care costs and quality within a geographic area or population in July 2016.   The original language of the bill called for a permanent extension of the use of the database for these purposes, though the author, Sen. Melissa Halvorson Wiklund (DFL - Bloomington), amended the bill to allow its use until July 2019.

The House bill, authored by Rep. Nick Zerwas (GOP - Elk River), has not yet been scheduled for a hearing.

University Takes Heat for Research Practices
The House Higher Education Finance and Policy Committee took aim at the University of Minnesota and its research practices during a March 15 hearing. The wide ranging hearing looked at not only research practices, but also tuition, campus safety issues, and the athletic department.

Much of the hearing focused upon the use of aborted fetal tissue in University research.  The controversy around the use and sale of fetal tissue in medical research that erupted in the summer of 2015 led to many questions from legislators here in Minnesota.  Some legislators active in the “pro-life” movement believed that the University had not been forthcoming with adequate or complete answers to whether such tissue is used here in Minnesota.  University President Eric Kaler and Brian Herman, PhD, the university’s Vice President for Research, and Brooks Jackson, MD, the Dean of the University of Minnesota's Medical School presented a strong defense of the University’s use of the tissue in research into spinal injuries, Alzheimer’s disease, and many other conditions.

Legislators also received an update on University policies regarding human research protocols.  A participant in a psychiatric drug clinical trial, Dan Markingson, committed suicide while under the care of a University of Minnesota Department of Psychiatry researcher. The Star Tribune and the Office of the Legislative Auditor (OLA) have been highly critical of the University's handling of the case, citing serious ethical issues and conflicts of interest during the study and in response to inquiries following the suicide.  The widely respected, nonpartisan OLA found in a 2015 review that the University's human research protections were inadequate and that the Department of Psychiatry "lacks a culture of excellence, compliance, and accountability."  The House committee reviewed the 2015 report and heard from University officials about steps that have been taken to improve research practices.

White Coat Day at the Capitol Set for March 23
Make plans to join your physician colleagues for the annual Minnesota Medical Association’s Day at the Capitol set for March 23, 2016.  This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine.  Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.

With most of the Capitol closed to the public due to ongoing construction, our 2016 Day at the Capitol will begin away from the Capitol building.  Like last year, we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders and MMA advocacy staff.  From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.

The “White Coats Day” at the Capitol is a key piece of the organized medicine’s advocacy strategy, and your participation is important to our efforts.  Please make plans to join us for this fun and enjoyable day.  More information and registration details are available here.

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Midwinter CME Conference a Success!

Our January Midwinter CME Conference was a great success!

With more than 75 providers in attendance, our faculty provided updates on clinical topics focused on otology, general otolaryngology review, and practice management.  Click here to see slides from many of the live presentations.

We ended the day with a reception and Resident Poster Session overlooking the Minneapolis night sky.

We awarded 1st, 2nd, and 3rd place prizes in our Resident Poster Session.  We are pleased to announce the winners of this year’s competition as follows:

1st place:
Qi Zhang, MD - Effect of Triptolide on MDM2 Expression in HPV-positive Squamous Cell Carcinoma

2nd place:
Alexander Marston, MD -  A Unique case of Penetrating Neck and Cervical Spine Trauma Cresulting in Vertebral Artery Transection and Internal Carotid Artery Laceration.

3rd place:
Wade Swenson, MD - A Potential Role for Pioglitazone in the Chemosensitization of Human Sinonasal Undifferentiated Cancer Cells (SNUC)

Many thanks to those who attended, those who helped to plan the meeting, and those who presented.  We are very fortunate to have such amazing talent right in our own back yard.

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Legislative Update – 3/4/2016

MAO Legislative Update
March 4, 2016
Eric Dick, MAO Lobbyist
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Session Set to Begin
Legislators from around the state will return to St. Paul for the 2016 legislative session on March 8 for a brief but likely frenetic period. The session must conclude no later than midnight on May 23.

The start of the session this year is later than any time in recent memory, largely due to the fact that the ongoing Capitol restoration has left almost the entire Capitol building off-limits to legislators, staff, and the public. Only the House floor will be open once the session commences, and a strict limit on capacity has been set. The Senate will hold its floor proceedings in the recently opened Minnesota Senate Office Building. The construction of the new building was the source of significant controversy in 2014 as the Republican minority attacked the building as both too expensive and unnecessary. And while DFL members have moved into their offices in the new building, the Republican Senate Caucus remains in their old offices in the State Office Building.

With the late start, the deadlines set by legislative leaders to help guide the work of the House and Senate also point to a furious pace of committee hearings. The first deadline, set for April 1, is the date by which bills must have been favorably acted upon in the policy committees of one body or the other. The second deadline falls on April 8, and is the date that those same bills must have cleared the other legislative body. April 21 is the third deadline and is the date by which all spending or tax proposals must have reached the floor of the House and Senate. The aggressive timeline will make for a very speedy start to the session.

Casting a shadow on the entire session is the looming election season. All 201 legislative seats will be up before voters in November 2016. While many observers believe both the majority GOP in the House and DFL in the Senate are in good positions to retain their majorities, a strong national election tide in either party’s favor could tip the scales in favor of either party.

Taxes, Transportation, and Bonding Likely to Dominate Session
Three issues are anticipated to dominate much of the headlines out of St. Paul during the legislative session. With House Republicans and Senate Democrats unable to reach agreement on both a tax bill and transportation plan last year, those two issues will remain front and center in 2016. House Republicans have made tax cuts a central priority for the session, though the contours of a tax bill have yet to emerge. Both parties have stated their desire to invest in transportation improvements, though the means to do so is in disagreement. Senate DFLers and Governor Dayton have expressed their support for a hike in the gas tax while Republicans have supported increased transportation spending from the General Fund or via a bonding bill.

The second year of the biennium is traditionally the year in which the Legislature considers a bonding bill, and that will be the case this year. Bonding is the means by which the state funds major projects like new or improved university buildings, municipal civic center restorations, and the like. The question this year will be how large a bonding bill will be considered. Bonding bills are often among the last pieces of a session to come together. Because passage of a bonding bill requires a two-thirds majority, proponents of the bills must find bipartisan support. As such, bonding projects in a legislator’s district are often a “chit” used to secure votes. Bonding bills are also often used as leverage for the passage or defeat of other proposals, too.

Governor Dayton has also pledged to make investments in early education a priority, though it remains to be seen if agreement can be reached on the issue. Dayton and many DFLers have supported proposals to provide universal pre-K while House Republicans have spoken of their supported for more targeted investment via expanded scholarship programs for low-income Minnesotans.

Key Issues for MAO Consideration
While it is always difficult to predict exactly which issues will garner attention at the Capitol, the MAO will be carefully monitoring action at the Legislature for a number of specific issues.

Thanks to a bipartisan agreement reached in 2011, the state’s provider tax is set for repeal on December 31, 2019. That said there has been a growing chorus of calls by some in the Legislature to rescind the repeal, effectively extending the tax indefinitely. The MAO will partner with other physician and provider groups to strongly oppose any effort to extend the provider tax.

The MAO will also continue the partnership with the Minnesota Medical Association and others to pass medication prior authorization reform. The “Fix PA Now” coalition, of which the MAO is a member, will continue to press for passage of SF 934 (Sen. Melisa Franzen, DFL – Edina) and HF 1060 (Rep. Tony Albright, GOP – Prior Lake), a bill to simplify medication PA and ensure patients get the medications they need in a timely manner. The bill passed all necessary committees in the Senate last year but did not receive a hearing in the House of Representatives. Advocates for the bill have held multiple meetings with key legislators in the House in an effort to ensure hearings in 2016.

There have been some rumors that audiologists will be pursuing legislation in 2016, though the intent of any potential legislation remains unknown. The MAO will carefully watch for bills that would change or broaden the scope of practice for audiologists at the risk of patient safety.

Budget Picture a Bit less Rosy
Officials from the state’s fiscal agency, Minnesota Management and Budget (MMB), announced a picture of the state’s budget health on February 26, and the figures represented a slight weakening of the state’s budget forecast. MMB’s latest projection estimates that the state will have a $900 million budget surplus for the 2016-2017 biennium, down from an estimated $1.2 billion surplus that had been forecast in December. The pullback in the surplus estimate, MMB reported, is due to a somewhat weakened economic outlook and slower than previously projected revenues coming into state coffers. Estimates for the 2018-2019 fiscal year are even more impacted by the slowdown, with the projected surplus down from more than $2 billion to $1.1 billion. The lower General Fund surplus figure will likely further complicate plans by the Governor and legislative leaders to make new investments in transportation and education, as well as paying for broad tax cuts.

Estimates for the fiscal health of the Health Care Access Fund (HCAF), however, took a positive turn in the new forecast. Thanks to lower expenditures, the forecast for the HCAF improved to a surplus of $610 million in fiscal year 2016 and $1.166 billion in fiscal year 2019.   The surpluses in the HCAF are positive news, though legislators of both parties have too often used surplus funds to pay for purposes outside of the original intent of the provider tax, the source of funding for the HCAF.

Senate Committee Studies Prescription Drug Pricing
The Senates HHS Policy Committee convened a hearing on February 29 to consider the rising costs of pharmaceutical drugs. The hearing featured testimony from Stephan Gildemeister, the Minnesota Department of Health’s (MDH) health care economist. Gildemeister presented early results from an analysis of medical and retail prescription drug spending. The study was largely derived from data from the state’s All Payer Claims Database (APCD).

Not surprisingly, the study found that prescription drug prices are rising rapidly and consuming a growing portion of overall health care spending. Of note, the study found that spending on prescription drugs administered in a medical setting – in a clinic or hospital – is growing markedly faster than spending that is part of a clinic or retail pharmacy. Also presenting at the hearing was University of Minnesota professor Steven Schondelmeyer, PharmD PhD. Schondelmeyer discussed a number of examples of spikes in drug pricing, including the high profile case of Turning Pharma and its recent action to increase by 5,000% the price of Daraprim, a drug used to treat a parasitic infection.

A number of bills related to prescription drug pricing are likely to be introduced at the legislature in 2016. One proposal, authored by Rep. Joe Atkins (DFL – Inver Grove Heights) has already been pre-filed. Rep. Atkins’ bill would establish a program that would make drugs reimported from Canada available to Minnesotans. Another pre-filed bill would require greater reporting by drug manufacturers around “ultra-high priced pharmaceuticals,” defined under the bill as those with a wholesale cost of more than $10,000 per year or per treatment. The intent of the proposal is to bring about greater public transparency of high cost drugs. The likelihood of any of these proposals gaining traction in a short session with split partisan control remains to be seen.

Many New Faces at the Capitol
With the legislature returning to session next week a number of new legislators will be taking their first official acts as legislators. Since the end of session in May 2015 four special elections have been held to fill seats vacated by retiring legislators or, in one case, the death of a legislator.

House Republicans had a surprising win in early February when they picked up a usually reliable DFL district. Rep.-Elect Chad Anderson (GOP – Bloomington) will replace Rep. Ann Lenczewski (DFL – Bloomington), who retired in late 2014 to take a job as a lobbyist.

Rep. Elect Rob Ecklund (DFL – International Falls) will take the seat of Rep. David Dill (DFL – Crane Lake), a long-serving representative who passed away in August 2015. Rep. Ryan Winkler (DFL – Golden Valley) left the legislature last summer to move with his family to Belgium for a career opportunity and was replaced in his reliably DFL district by Peggy Flanagan (DFL – St. Louis Park). Rep.-Elect Flanagan had previously served as the executive director of the Minnesota Children’s Defense Fund.

One familiar face is among the new legislators. Former representative Jim Abeler won election in the race to succeed former Senator Brandon Petersen (GOP – Andover). A chiropractor and past chair of the House HHS Finance Committee, Abeler had retired from the House in 2014.

Also new at the Capitol this year is Emily Johnson Piper, the new Commissioner of the Department of Human Services. Commissioner Piper replaces former Commissioner Lucinda Jesson, who was appointed by Governor Dayton to a seat on the Minnesota Court of Appeals. Piper had previously served as Dayton’s general counsel and deputy chief of staff.

White Coat Day at the Capitol Set for March 23
Make plans to join your physician colleagues for the annual Minnesota Medical Association’s Day at the Capitol set for March 23, 2016. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.

With most of the Capitol closed to the public due to ongoing construction, our 2016 Day at the Capitol will begin away from the Capitol building. Like last year, we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.

The “White Coats Day” at the Capitol is a key piece of the organized medicine’s advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.

Read more →

 
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