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 November Advocates inflamed about giving up $618,000 RWJ grant The Oregon Health Plan is crying out for help. Not only are too many people enrolled, but managed care plans are walking away from rural communities, leaving physicians and hospitals to pick up the pieces. Even worse, advocates fear the legislative emergency board will return a $618,000 grant from the Robert Wood Johnson Foundation to bring children, many of whom are homeless and high risk, onto the health plan. Advocates are stomping Gov. Kitzhaber's office, pleading with him to save the day. But state officials are preparing a balanced budget proposal for the Dec. 9-10 emergency board, which recommends the $618,000 be sent back. Even without that money, the Oregon Health Plan faces a $20 million shortfall this biennium because 15,000 more people are enrolled than projected, said Hersh Crawford, Medicaid director, who wouldn't say how the Department of Human Services intends to present a balanced budget. To make certain enrollment remains stable, officials may pull applications from outreach sites and stop publicizing the toll-free number where people learn about the health plan. "Walking off with the big chunk of the emergency fund is not going to happen, nobody's talking about asking for more money," Crawford said. "It's too early in the biennium. We've got tow fire seasons to go through." The emergency board has $40 million at its disposal. Only one doctor in Brookings sees OHP patients The Brookings community is desperately looking for physicians who'll accept Oregon Health Plan patients. The last straw occurred when Curry General Hospital closed its clinic in late October because of the financial drain. That left 700 people without a primary care physician. Among the 20 doctors in Brookings, only Dr. Lawrence Witt accepts OHP patients; he has 300. Part of the problem rests with the Brookings Harbor Medical Center, where Dr. Mark Silver practices. "It only deals in diseases of the insured," said Witt, who called the group "The Wall Street Clinic on Fifth Avenue." One of Silver's colleagues, Dr. Mark Ruben, left in June to run a clinic financed by the hospital to treat low-income and OHP patients. Almost immediately, Silver filed a lawsuit, alleging Ruben violated a non-compete clause, prohibiting him from practicing medicine in the area for two years. Since then, that clinic closed and Ruben moved to California, but Silver is still seeking $10,041 from Ruben, and $250,000 from both the health district and its CEO, Randy Scholten. "We've tried to settle, but Dr. Silver isn't open to that at all. He has a vendetta against the hospital." Roseburg nurse midwife sues medical community A certified nurse midwife in Roseburg is taking the medical establishment to court. Katherine Jensen, who runs WomenCare, PC, contends the physicians and hospitals in Roseburg have a monopoly, which violates the Sherman Anti-Trust Act. Her attorneys have filed lawsuits in circuit and district court, seeking $2 million in damages from Mercy Medical Center, Roseburg Women's Health Care, Douglas County IPA, SureCare and Drs. William Hollander and William Hayton. "This case is not just about Katherine Jensen or WomanCare , it's about the practice of independent midwifery being thwarted by physicians attempting to control the universe," Jensen told Oregon Health Forum. "This medical community is slipping into the dark ages; there's are real struggle going on to allow anyone who doesn't play according to their rules to stay here." In 16 years, Jensen's delivered 3,000 babies in Douglas County. The lawsuit started as a breach of contract between Jensen and Hollander. For 14 years, Jensen had an amicable relationship with Hollander and delivered babies at Mercy Medical Center. Then, in December 1997, the argued about the contract, and Jensen was fired. "He expected me to go away but I wouldn't," she said. Regence and PCP, Inc. see eye to eye PCP, Inc. is close to reaching agreement with Regence HMO Oregon for its commercial and Medicare patients in Portland. "Things are going very well with Regence," said Dr. William Miller, president. The 85-member primary care physician group also has contracts with PacifiCare, ODS Health Plans and PacificSource. In 1996, Miller conceived the idea behind PCP - a contracting arm where physicians could stay in small groups, yet receive the negotiating leverage reserved for larger clinics. Eventually, Miller anticipates having 100-125 physicians aboard. PCP doesn't accept everyone. Physicians must have a positive attitude toward managed care, concern about cost control and not have a record of excessive utilization, Miller said. About 15% are turned down. "Our goals are not to franchise and go up and down the West Coast but manage HMO risk contracts with effective cost conscious care," Miller said. "If the organization becomes too big, it will turn into HealthSecond." Crisis hits home health agencies across the state The Balanced Budget Act of 1997 (BBA) may have put the federal government in the black, but home health agencies are experiencing frustration and their bottom lines are plummeting. More than 1,200 agencies have closed their doors nationwide, and the American Federation for Home Health Agencies predicts thousands of additional closures if the BBA isn't amended. According to the Oregon Health Care Licensure and Certification Board, more than 30 home health agencies have already folded in Oregon since the legislation was enacted. "People need to pay attention to what's happening because we have a potential health care crisis," said Pam Matthews of Home Care Network in Albany. "Patients who can't get help at home will end up in emergency rooms, hospitals and nursing homes." Even with the financial security afforded by its association with Albany General Hospital, Home Care Network closed its Salem branch in October 1998. "Volume has always made sense, but under the new Medicare reimbursement system, volume has become detrimental," Matthews said. Fisher/Kruse hold the keys to mental health parity When advocates learned Sen. Bill Fisher (R-Roseburg) was going to chair the interim task force on mental health parity rather than Sen. Lenn Hannon (R-Ashland), they reacted with disbelief. After all, Fisher had refused to hold a hearing on parity last session. Seen. President Brady Adams (R-Grants Pass) admitted he asked Hannon to chair the task force before the legislature adjourned, but had a change of heart. Given Fisher's responsibilities, as co-chair of health and human services, "it made sense for him to take on the interim position," Adams said. Hannon hasn't been overlooked, said Sen. Majority Leader Gene Derfler (R-Salem). "We need to divide things up; there are a lot of big egos in this building," he said. Hannon chairs the Human Resources Subcommittee during the interim. Derfler said the task force was his idea. He suggested the group look at how many people are denied treatment because their benefits run out and study how treatments for mental illness overlap with those for physical illness. Redesign of health care system needed Dr. Donald Berwick has a prescription for America's ailing health care system because it no longer suits the needs of a 21st-century world. Berwick, who heads the Boston-based Institute for Healthcare Improvement, advocates "a comprehensive redesign" beginning with clinical offices, where most patient-physician interactions occur. He wants health care to become more efficient, accessible, satisfying and financially stable. With these goals in mind, Berwick helped initiate a national project called "Idealized Design of Clinical Office Practices" or IDCOP. He described the project at a lecture sponsored by The Foundation for Medical Excellence and Kaiser Permanente. Since January 1999, more than 40 health care providers around the country have participated in IDCOP. PeaceHealth is the only Oregon participant. Also in this issue...
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