MANKATO — By Mark Fischenich

mfischenich@mankatofreepress.com

MANKATO — Representatives of the Mayo Clinic and the Mankato Clinic made it clear that they don’t endorse politicians or pieces of legislation. But the doctors were standing beside Congressman Tim Walz — literally — during his first stop in Mankato following his vote in favor of the historic and controversial health care reform legislation.

“The Mayo Clinic doesn’t endorse specific bills or individuals,” said Dr. Glenn Forbes, former CEO at Mayo and now its director of state government and local affairs.

“We recognize though, and we’re appreciative of his efforts,” Forbes said of Walz. “We believe that’s a step in the right direction.”

Forbes and Dr. Rolf Storvick of the Mankato Clinic were talking of the efforts by Walz, Wisconsin Congressman Ron Kind and others to work for changes in how Medicare reimbursements are paid. The current system rewards high-cost regions of the country, penalizing high-quality low-cost medical providers in places like Minnesota.

“These are individuals who are moving the country in the right direction in terms of payment reform,” Forbes said of Walz and others in the House Quality Care Coalition.

The provision pushed by the Coalition creates the Medicare equivalent of the base-closings commission in the 1980s that shuttered unnecessary military bases.

Those bases continued to operate, even though they had long outlived their purpose, because individual members of Congress didn’t want to lose the economic benefits of having a base in their district. An independent commission was established to make the unpopular decisions, and the unneeded bases were finally closed.

Walz said the House reform bill requires the independent Institute of Medicine to recommend a system that establishes payments to doctors and hospitals based on their success in making patients well — not on the number of visits or the volume of procedures performed. The Institute of Medicine must also recommend changes in the reimbursement formula to eliminate geographic disparities.

Those recommendations must be implemented by the secretary of health and human services unless Congress — by a two-thirds margin — votes to block the changes.

Previous attempts to reform Medicare reimbursement have been rebuffed by powerful states that benefit from the current system such as New York, California, Texas and Florida.

“Well, we got it in,” Walz said, adding that the performance-based pay should spread beyond Medicare over time. “... If we do it in Medicare, it will be the driver for other payment methods.”

Although Walz said he supports much of what the House reform bill does — including getting more Americans insured and prohibiting insurance companies from discriminating based on pre-existing conditions — his support is likely predicated on the Medicare reimbursement changes surviving during upcoming negotiations in the Senate.

Those negotiations are expected to take weeks, possibly even months, and Forbes called the health care reform process “a long and winding road.” But he liked the turn the House took with Medicare reimbursement.

“We’re making progress in the right direction,” he said.

Republicans were less favorable about the House bill and about Walz’s vote.

“Tim Walz used the health care bill to show southern Minnesota his true colors,” according to a National Republican Congressional Committee statement that criticized the bill’s trillion-dollar cost over 10 years and its reductions in Medicare reimbursements to providers. “... Next November, Walz will be held accountable for this stunning betrayal of Minnesota values.”

Walz said he’s hopeful the final reform bill will be one that benefits Americans for generations to come. And he said he isn’t worried that the Republicans disagree with his vote.

“They’d disagree with what I had for breakfast this morning,” he said.