Minneapolis Star Tribune. April 11, 2021.
Editorial: Keep moving forward on expanded telehealth in Minnesota
The pandemic ushered in changes that enhanced patients’ access, convenience.
The COVID-19 pandemic forced sweeping changes in how we work, with many workers doing their jobs remotely for much of the past year.
A swift though lesser-remarked-on transformation happened as well in medical care. As lockdowns loomed, state and federal regulators eased restrictions on “telehealth.” That led to more virtual visits in Minnesota and elsewhere, with doctors and patients communicating via video or a phone call in lieu of a clinic appointment. A year later, there’s a timely debate at the Minnesota Capitol over whether to maintain telehealth expansion measures, which are set to expire 60 days after the end of the peacetime COVID emergency. The answer should be yes, let’s keep going. A dispute between two key health care stakeholders — providers and insurers — over payment levels for telehealth care shouldn’t derail the legislation to do so.
Telehealth changes during the pandemic have provided convenient new options for patients. Previously, Minnesota patients may have had to drive to a clinic or hospital to use their telemedicine facilities. Now, they can connect from home using a personal device. Including mental health practitioners also is an advance.
Legislation to extend telehealth changes is enthusiastically backed by respected medical providers and organizations, including the Minnesota Medical Association (MMA) and the Minnesota Hospital Association (MHA). If this yearlong experiment wasn’t going well, these organizations would be the first to sound the alarm.
The MMA — whose membership includes over 12,000 active and retired physicians, residents/fellows and medical students — tracked telehealth utilization in the state after regulations were eased. In 2019, just 3% of patient visits used telehealth. In 2020, that rose to 28%, according to data released last August. In addition, 83% of physicians surveyed reported that telehealth met patients’ needs “acceptably, well or very well.”
The MHA also reports that its members are seeing benefits. Among them: “Improved attendance at appointments, with fewer no-shows, particularly for mental health visits,” and “the ability for some providers to treat more people by delivering services from their own homes because of the pandemic or by reducing drive time between health care sites.”
Rep. Kelly Morrison, DFL-Deephaven, and Sen. Julie Rosen, R-Fairmont are commendably leading the efforts to pass the telehealth bills (HF 1412 and SF 1160) this session. Morrison is a physician, and Rosen has an admirable record of forging compromise and muscling legislation through.
That latter experience will be crucial. The telehealth legislation faces some headwinds. A key challenge is resolving differences between large health care lobbies over payment. The dispute involves “payment parity,” meaning providers are paid the same for a telehealth visit as they are for one in a traditional clinic. Before the pandemic, Minnesota was one of six states requiring comprehensive telehealth parity, said Lucas Nesse, president and CEO of the Minnesota Council of Health Plans. Since the pandemic, 14 more states have established parity during the pandemic, with requirements often in effect only for the COVID emergency, he added, citing a National Conference of State Legislatures report.
The MMA points out that doctors’ salaries are the same if they see patients via telehealth or a more traditional setting, and technology investments are needed to continue and expand telehealth. The state’s insurers and businesses reasonably see telehealth as an avenue to reduce health care costs.
A February telemedicine report points out one potential compromise: “setting payment parity as the baseline while expressly allowing providers and plans to voluntarily negotiate alternate payment rates and depart from the baseline.” This solution, or other innovative approaches, are needed to ensure that Minnesota moves forward on telehealth, not backward.
St. Cloud Times. April 9, 2021.
Editorial: Accountability is only for the big city? We disagree
When is a town just too small for its citizens to expect accountability from its taxpayer-paid leaders?
That would be our answer, too. But under current Minnesota law, residents of small cities — those with fewer than 7,500 people — have less access to information about the personnel records of city leaders than people who live in larger towns. If you need a definition of “defies logic,” that’s a good place to start.
A change to the state law championed by Sen. Jeff Howe, R-Rockville, would tighten that exemption. But first, lawmakers will have to bypass resistance from the League of Minnesota Cities and the Minnesota Association of Small Cities. Those organizations say there’s a need to balance employee privacy with the public’s right to know about its government’s inner workings.
We don’t disagree. We do, however, think their idea of balancing those competing interests puts the public on the losing side. The compromises that are on the table to satisfy them — basing the exemption on the number of direct reports the employee has, rather than city size — takes the teeth out of this very necessary change. But more on that later. First, here’s a real-life, close-to-home example of how the current law falls short:
In June 2018, St. Joseph’s sitting police chief resigned after facing undisclosed allegations into which the city conducted an investigation. A not-insignificant number of people stood up for the chief, questioning the process and outcome. By resigning before that process was complete, the public was legally shut out of knowing the nature of the accusations and making their own judgement.
St. Joseph city leaders said then and have said since that they wanted to be up front with constituents about why the matter. But the state law prevented it.
Ultimately, the protection that law provided for the former police chief proved pointless anyway. A different state law made records from a police licensing board public. Reporting into those public records by the St. Cloud Times’ Clairissa Baker eventually brought the circumstances of the resignation and investigation into the open, as it should have been all along.
We sympathize with the argument put forth by Cap O’Rourke, executive director of the Minnesota Association of Small Cities, who points out that in a small city, the person who plows the road might very likely also be a department head. The implication is that it’s not fair to expose those folks to the same accountability as public servants in larger communities.
While we sympathize, we don’t believe the direct-reports compromise will allow for enough change in the law to matter. In a small city, a department head — the person who controls a lot of taxpayer money and determines how to provide a city service — might not have any direct reports.
To the association’s credit, O’Rourke said, “we do think public safety officials, police chiefs and fire chiefs should be held to a different standard. And so regardless of city size, we do think this should apply to them.”
We think it should apply to every public official with significant oversight of public funds, public policy and public works in cities and towns of all sizes. Accountability isn’t just a privilege of the urban taxpayer.
Mankato Free Press. April 9, 2021.
Editorial: Reparations Evanston leads on racial justice
The city of Evanston, Illinois, has approving a package of reparations for its African American residents in recompense for a legacy of discrimination. It’s an act other governments and organizations should embrace and carry out.
The city will provide up to $25,000 for any resident who can show their ancestors or relatives suffered discrimination in housing in the city between 1919 and 1969. The money could be used for down payment assistance or other costs associated with housing. A 3 percent tax on recreational marijuana will provide the program with $10 million over 10 years.
Other cities, states, universities and religious organizations have considered implementing reparations programs as payment for past discrimination and the far reaching effects of slavery. President Joe Biden has called for a special committee to study the issue of federal reparations.
The far-reaching effects of slavery and other discrimination woven into the fabric of American life has become more clear to Americans across the country. Those suffering discrimination deserve to be awarded damages, just as a plaintiff who had been cheated by others can win recompense in a court of law.
We know from studies in Minneapolis and elsewhere that housing covenants and housing deeds frequently contained clauses prohibiting ownership by anyone other than Caucasians. Discrimination in employment, education and other building blocks of economic success were staples of the American landscape since the country’s founding and continue today.
In fact, as slavery ended in 1865, an order by Union Army Gen. William Sherman called for every freed slave to get “40 acres and a mule.” But the order was reversed and the program ended just a few years later by President Andrew Johnson, the successor to President Abraham Lincoln.
Research shows the cotton industry became dominant in the world on the backs of southern enslaved people and created hundreds of millionaires in the Mississippi River Valley.
Georgetown University and Virginia and Princeton theological seminaries have already committed to setting up reparatios funds for families of enslaved people who helped build the institutions or who were sold to pay off institutional debt.
The economic effects of slavery reach into every institution and city in America. Evanston took a first step in what should be due compensation to victims of an un-American and reprehensible institution.