Minnesota looks for statewide "best practices"

Buried near the end of a 149-page omnibus budget bill for the state of Minnesota, right after a clause requiring insurance companies to provide coverage for scalp hair prostheses, was a short piece of legislation that got some people very worked up.

Entitled "Best Practices and Quality Improvement," the new law calls on the state health commissioner to identify, promote, disseminate and encourage the adoption of best-practice guidelines and measurements. The bill, signed by Gov. Tim Pawlenty May 29, received a controversial endorsement from the Minnesota Medical Assn., which preferred it over a related bill that mandated the use of best-practice guidelines.

"I think physicians have nervousness whenever an outside entity tells them how to practice medicine," said Dave Renner, director of the MMA's Dept. of State and Federal Legislation. "We don't think this does that, but I think that's where the nervousness comes from."

The controversy was fueled by a consumer activist group called the Citizens' Council on Health Care, which denounced both versions of the bill as "cookbook medicine," and delivered to the governor a foot-high stack of petitions signed by people opposing best-practices legislation.

State Commissioner of Health Dianne Mandernach has sought to ease doctors' concerns by saying that they will be "front and center" in the process of developing best practices.

"I think the bottom line is that they are key to this whole situation, and we will be looking to them for guidance," she said. "We are not in the business -- and it isn't my intention -- to determine best practices."

The MMA continues to receive "pushback" from its members over its endorsement, Renner said. But as long as the guidelines are designed by physicians, and doctors are not penalized for not using them when they feel they are not applicable, he said then the government can play a useful role in improving health care quality.

"Our analysis is that it doesn't give the state that much more power than it already has," Renner said. "So our focus has been, if it's really designed to improve quality, then it's something we're willing to work with."

The law calls for developing measurements first for asthma, diabetes and at least two other "preventive health measures," followed by standards for treatment of hypertension and coronary artery disease.