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 June Hospitals gain, doctors lose money on Health Plan Oregon physicians are frustrated with the Oregon Health Plan because of the imbalance in the funding stream between hospitals and doctors. SUMMARY: The hospitals have raised their fees at will, subsidizing their bottom line with risk-withold pools that otherwise would have shown up in doctors' paychecks. Physicians intend to urge a state panel, auditing the Oregon Health Plan's performance, to delve into this issue. OMA President J. Thomas Hoggard MD, believes the OMA should conduct its own in-depth analysis. "Quite frankly, the hospitals need to make adjustments the same way physicians have," said Joseph Henery, a Portland consultant who conducted the analysis of the Oregon Health Plan. Gorge physicians upset with all health plans Regence HMO Oregon isn't the only target. Even though the 80-doctor Columbia Gorge IPA refused to renew its contract with HMO Oregon, physicians see problems ahead with all health plans and contend they aren't paid enough to cover their operating expenses. The problem is magnified because hospital costs are higher in rural settings, he said. So the health plans skimp on the physician portion of the contracts, said Charles Haynie, MD, a general surgeon who feels health plans such as HMO Oregon base their offers on big city costs. "It's a generic problem" endemic to rural settings, he said. The cost discrepancy between rural and urban hospitals is huge, based on information the rural hospitals have given to area physicians, said Daniel Kelly, MD, president of the IPA. The hospitals in the Gorge say they must receive about 20% more than the DRG rates paid to Portland hospitals to keep their doors open, while at the same time, insurers say they must base premiums on state regulations and competitive realities. Advocates push patient rights Consumer advocates are talking about what they'll ask the next legislature because the patient protection law passed in 1997 doesn't go far enough. "In managed care, the top priority is the bottom line. Patients get left behind," said Bob Duehmig, who chairs the Oregon Health Action Campaign's board. However, Deborah Seyfert, government affairs director for Regence HMO Oregon, said health plans are doing a pretty good job. Instead of discussing new proposals, advocates ought to focus on the outcomes of the existing act. Advocates point to several weaknesses--among them a requirement that people enrolled in a managed care plan go through a gatekeeper, a primary care physician, before seeing a specialist--even those with chronic conditions. Another hot issue concerns an external grievance process where consumer complaints could be heard. Currently, grievances are aired inside the health plan. Geographic access standards are another concept advocates want to see on the drawing board. HMO enrollment slows to a crawl during first quarter of 1998 Oregon may have reached the saturation mark in the HMO market. Evidence of a slowdown is apparent from the first quarter insurance reports filed by the major players with the State Insurance Division. Oregon Health Forum examination of the data shows that Regence HMO and Pacificare membership is slowing down while Kaiser Permanente's continues to grow. Providence lost the biggest chunk of its membership in the Willamette Valley, from Salem to Roseburg. United Healthcare's net income fell into the red despite a jump in total assets. Other headlines
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