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 June Mental health parity update Agreement struck on June 16th to achieve full mental health parity On June 16, an agreement was struck with the Republican Leadership -- Senate President Brady Adams and Senate Majority Leader Gene Derfler -- along with Senator Lenn Hannon to achieve full mental health parity. If SB 1331 passes, mental health and substance abuse benefits will increase by 25% for children and adults starting July 1, 2000. An interim legislative committee will be chaired by Senator Hannon. If it can be shown that full mental health parity will not increase insurance costs more than 3%, which was predicted by the actuaries, full parity could be reached within two years and, at the latest, by the year 2005. SB 1331 was heard in Senator Derfler's committee on June 25, and must then pass through the Senate and the House. The insurance industry, along with AOI, is opposed to this bill. Physician Partners faces more problems Medford Clinic may bail out of Physician Partners. When HealthFirst Medical Group unravels August 31, the physicians at Medford and Corvallis clinics have to make some tough decisions. Their management company, Physician Partners, Inc., owes US National Bank $8 million and First Union Capital $15 million. Although rumors are swirling PPI will dissolve and declare bankruptcy, potentially erasing this debt, officials emphatically deny it. "We're in discussions with Medford and Corvallis to come up with a reasonable solution," said Mark Charpentier, CEO. If PPI does fold, nothing may be owed to First Union because it purchased a share in the company. Only 10 physicians have left the clinic, but there are rumblings in the hallways about the clinic's future. Mortality rates drop when hospitals share data Pennsylvania's Health Care Cost Containment Council on cutting edge of outcomes reporting. Since Pennsylvania's Health Care Cost Containment Council (PHC4) began giving out report cards, the state's health care providers have been working hard to make the grade. State law requires Pennsylvania's providers to share hospital charges, treatment and financial data on a quarterly basis to PHC4. Nearly 2 million inpatient and 1.5 million ambulatory surgical records are submitted each year--which is having a profound effect on Pennsylvania's health care market. "People are voting with their feet," said Joe Martin, director of communications and education for PHC4. "Hospitals with low mortality and morbidity rates tended to gain market share in years subsequent to our studies, while those with poor ratings lost market share." Ken Rutledge, president of the Oregon Assn. of Hospitals and Health Systems, believes the issue of mandatory public of data outcomes is a tough one. "You can have physicians trying to avoid the complex surgical cases, fearing public scrutiny based on how providers may come out on the scorecard." Umatilla County blasts managed care State of Oregon challenges the legality of Umatilla County ordinance. On May 18, Umatilla County voters passed a controversial "Patient's Rights Initiative" that would keep insurers from restricting a patient's choice of physician or limiting treatment, punishable by a $1000 fine. The ordinance excludes Medicare, Medicaid, workers' compensation and Umatilla County's employee health programs because they fall under state and federal regulations. Attorney General Hardy Meyers and Department of Consumer and Business Services Director Mike Greenfield announced June 23 that the State of Oregon is seeking to invalidate the ordinance. The lawsuit filed in Umatilla County Circuit Court alleges that state law preempts it. "The State respects the message that Umatilla County residents sent with the passage of Ballot Measure 30-4," Myers said. "However, the local initiative process is not the appropriate forum for adopting this type of law." First quarter financial data in Providence, QualMed, Kaiser made money during first quarter. Providence Health Plans appears to have the secret to success. Among the six HMOs doing business in Oregon and southwest Washington, it stood alone. Providence's net income not only came out in the red, but grew by an astounding 118% since December 1998. Only two other HMOs stayed in the black -- Kaiser and QualMed. Health plan officials blame their losses on increased hospital and drug costs. Overall, the HMOs grew their net worth by 3%, while membership dropped by 8%. Although it's difficult to draw comparisons between medical costs from year to year, physicians received 6% less, while inpatient costs rose 13%. This information comes from Insurance Division filings. Heart transplant programs could merge Providence and OHSU: Their hearts may beat as one. Dr. Donald Trunkey may have slowed down Providence's desire to start its own heart transplant program. There's promise of a collaborative program at Oregon Health Sciences University. Trunkey, who chairs its department of surgery, is eager and willing to let Providence physicians perform heart transplants. "It's always been my desire to incorporate community surgeons in the program," said Trunkey, who's continuing to meet with Dr. Gary Ott, a Providence heart transplant surgeon who once worked at OHSU. Oregon hospitals targeted The Department of Justice investigates improper billing. The Department of Justice refuses to back down from its investigation of Oregon hospitals for improper billing of outpatient laboratory tests. Last December, 31 Oregon hospitals were under the gun and Assistant US Attorney Bob Nesler told Oregon Health Forum, "We anticipate these cases going forward. They will continue to be investigated and hopefully resolved." Oregon's hospitals are waging a vigorous fight. Last year, on the urging of the American Hospital Assn., Congress adopted new guidelines for the Justice Department to use before alleging hospitals violated the False Claims Act by improperly billing. But Oregon isn't getting off the hook. The Justice Department intends to continue its probe "in a fair and reasonable fashion," according to a June 1 letter from Lou DeFalaise, counsel fro Attorney General Janet Reno. Genetic privacy keeps swirling Gov. John Kitzhaber has joined the battle to protect patients' genetic information. "Any legislation...must ensure complete confidentiality," he wrote Oregon's senators on May 28. Although SB 937 passed the Senate by a 16-11 vote, a compromise may be reached. The Oregon Medical Assn. objects to SB 937 because there aren't enough safeguards to guarantee anonymity. Several OHSU faculty members also raised objections, including Dr. Brad Popovich and Dr. Michael Garland. SB 937 makes it easier for researchers to use DNA and genetic samples gathered during medical procedures. Barney Speight, administer of the Oregon Health Plan Policy and Research, has convened a group of stakeholders to resolve this issue. Qutub, Lewis slash STARS program Legislators push alternative programs aimed at abstinence. Sen. Eileen Qutub (R-Beaverton) is leading the march to deflate STARS (Students Today Aren't Ready for Sex), which teaches sixth graders to abstain from sex. The Ways and Means Subcommittee on Human Resources chaired by Qutub slashed STARS in half -- cutting $151,000. Qutub insists youngsters should be taught not bo have sex before marriage. "There are other programs where we can get more bang for our buck," she said. "STARS does a good job of reaching young people about the whole issue of sex and teaches them to say no," countered Bob Dernedde, executive director of the Oregon Medical Assn. "It's a realistic breath of fresh air and puts things at a level where kids can understand. It's not like preaching Sunday School." Letter to the editor State long-term care ombudsman Meredith A. Cole responds to Assisted Living Concepts rebuttal to Oregon Health Forum articles "My sole reason for writing this letter is to express my dismay that ALC is attempting to defend its record in Oregon in a way that diminishes the magnitude of its problems in this state. The Forum rightly created the impression that 'ALC had experienced a widespread quality problem' in Oregon. In fact, regulators and ombudsmen independently scheduled meetings with corporate personnel in late 1997 (SDSD) and early 1998 (ombudsman) to discuss their concerns. With approximately 20% of the assisted living facilities in the state, ALC had almost half of the total substantiated complaints. Further, there was a high turnover of both administrative and caregiver staff...I would have preferred not to respond to ALC's rebuttal, and I would have remained silent if ALC had taken responsibility for the situation it created here in Oregon. It continues to be my hope they are making the necessary changes to consistently deliver quality services to the residents of their facilities. The citizens of Oregon deserve nothing less." To obtain a copy of the entire letter, call Oregon Health Forum at (503) 226-7870. Also in this issue...
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