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 December Mental health system gets a scathing review Multnomah County's public mental health system is rapidly deteriorating. Not only are counselors saddled with 100 clients, but people are being turned away from the crisis triage unit at Providence Medical Center. There are long waits (up to six hours), with people placed in restraints, while the police struggle to find emergency rooms that will accept the mentally ill when the triage center is full. Local health departments have become a psychiatric dumping ground. In fiscal 1996-97, they cared for 2,455 people without reimbursement. A hotline run by Aging and Disability Services is clogged, while clients are discharged without follow-up. More people live on Portland streets, 2,700 seek shelter every night, 30% of whom are mentally ill. The number of mentally ill inmates in county jails has doubled since 1996, reaching 3,000, with little access to medications and counseling. Between 30-35% of the mentally ill population have chemical dependency problems, which are compounded because the dollar stream is separated, with chemical abuse dollars going to the health plans, which subcontract with providers such as CODA, while mental health dollars go to CAAPCare, run by Multnomah County, or a for-profit company, Ceres Behavioral Healthcare Systems. These are the facts gathered by a special Multnomah County Health Task Force, which presented its findings to Multnomah County Commissioners on Dec. 16. Clinical labs turn power over to HFCA On Jan. 1, the Oregon Health Division stopped licensing nearly 2,000 medical labs and turned the regulatory problem over to the federal government. Officials were forced to make the change because of a stunning fee hike of nearly 400% imposed by the Health Care Financing Administration (HCFA). "The fee increase priced us out of business," Audrene Horton, laboratory licensing program manager, told Health Division employees. This decision will lead to staff reductions, a lower quality of service and higher assessments to clinical labs by HFCA. Since 1996, Oregon has been exempt from the high fees imposed by HFCA after Congress passed the Clinical Laboratory Improvement Amendments, or CLIA, which require that clinical labs be certified by the Department of Health and Human Services. Under the exemption, Oregon handles the licensing and collects fees from state medical labs. Oregon Health Plan faces another $8 million hole Danger lurks around the corner of the Oregon Health Plan. Despite a $6.5 million infusion by the legislative emergency board, the health plan could run out of money this biennium. Tobacco tax revenue, estimated to reach $224 million, is falling $8 million short of projections, said Hersh Crawford, Medicaid director. All but 10% of that money is dedicated to the Oregon Health Plan. In April, state officials take this quandary to the emergency board with another re-balance plan. The money shortage is precipitated by a growing number seeking services - 20,100 more people than budgeted. On Nov. 27, there were 357,061 people on the health plan - 80,632 adults and couples; 174,173 other Phase I eligibles; 87,515 aged, blind, and disabled and 14,741 children (CHIP). Because Oregon has very little flexibility to change the Oregon Health Plan, with federal officials unlikely to approve the elimination of 10 conditions from the priority list, Hersh Crawford and Dr. John Santa, deputy administrator of the Office of Oregon Health Plan Policy and Research, want to draw up alternative solutions before the 2001 legislature meets. Oregon may need stronger laws to protect medical records In transitioning from paper to digital medical records, physicians often find they no longer hold the only set of keys to their filing cabinets. Computerization of health information and other technological developments have made insurers, state agencies and health care administrators equal gatekeepers - increasing the potential for disclosure and the need for comprehensive medical privacy legislation. "Without the security of medical confidentiality, people begin engaging in privacy protective behaviors," said Peter Kane, executive director of the National Coalition for Patients' Rights. "They isolate information from their doctors, or don't go for treatment at all. That endangers the quality of the health care system and has serious health repercussions for the individual." Although the federal government has previously enacted laws to protect the privacy of health data - including the privacy act, the freedom of information act and the electronic communications privacy act - these statutes do not provide far-reaching protection, nor do they reflect the new challenges inherent to the electronic age. Jackson County physicians unite behind PrimeCare For the first time in its nine-year history, PrimeCare, Jackson County's IPA, will represent 90% of doctors in negotiations with HMOs and other insurers. The key to PrimeCare's major shift in membership is the closing of the Medford Clinic, which had more than 50 physicians, as well as participation by Providence Medical Group. Both groups had belonged to Physicians Health Alliance, formed in 1997 to compete with PrimeCare. Now they're part of PrimeCare. With the demise of the Medford Clinic, PHA decided it was no longer viable because its physician base was diminished from 110 to 25, said Will Break, PMG's administrator. "Everything I read is pointing to this kind of coming together and splitting apart and coming together, as doctors try and find the right mix," he said. Medical practices that are too large, like the Medford Clinic, risk having unwieldy and ineffective operating systems. Those that are too small face the risk of not having the personnel needed to run a business. Hospitals, HMOs proceed with tobacco settlement initiative The medical community is being torn apart by a ballot measure promoted by Oregon hospitals and HMOs to dedicate 75% of the state's earnings from the tobacco settlement to the Oregon Health Plan. Tobacco prevention advocates, as well as the public sector and nursing home industry, fear it could bring down the health plan. "Their measure can be beat," said Tom Novick, who represents the cancer, lung and heart associations, which insist some revenues must go toward prevention. "By doing a money grab for the whole thing, they'll jeopardize the health plan." But Ed Patterson, chief lobbyist for the Oregon Assn. of Hospitals and Health Systems, is convinced voters will solidly support its measure. On Dec. 10, his board reconfirmed its stance, despite efforts by John Lee, vice president of Providence Health System, who tried to convince the association to broaden its scope and include population-based services, such as safety net clinics. Lee was speaking as a member of the Oregon Health Council. Even Gov. John Kitzhaber has urged the hospitals and HMOs to allocate some money for prevention, said Mark Gibson, his health policy advisor. The governor will support the initiative, but won't be its chief petitioner. Also in this issue...
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