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 October Is Regence HMO Oregon backing away from the Oregon Health Plan? Portland physicians are aghast at the contract proposed by Regence HMO Oregon for Oregon Health Plan patients in the year 2000. Even though Regence will receive 2.3% more money from the state, it has reduced physician compensation. If physicians sign the contract, they'll be guaranteed a $24.95 conversion factor, which is 15% lower than their current compensation and equivalent to Medicaid's fee-for-service rates. Doctors wouldn't feel the pinch right away because Regence won't keep any of the money in a risk pool. In fact, if there's money left over in January 2001, Regence will take 8% off the top, then split the remainder with the medical community, giving 67% to primary care and specialty physicians and 33% to hospitals. McMinnville doctors terminate Regence HMO contract After months of negotiations, the 57-member McMinnville Physicians Organization (MPO) has severed ties with Regence HMO Oregon after failing to reach agreement on a health budget. In correspondence obtained by Oregon Health Forum, Regence told physicians their budget would remain the same as 1998 with a 15% withhold. Yet, at the same time, Regence pushed its premiums higher for employers such as Willamette Valley Medical Center, whose rates would have gone up 34%. On Jan. 1, it switches its 1,000 employees to ODS Health Plan. Oregon Health Forum asked Regence to comment on its relationship with provider groups. However, Donald Sacco, president and CEO, declined to share details. "It is our intent to keep those conversations and issues within the domain of our physician and hospital relationships and conduct any dialogue affecting them directly with the groups involved." Regence will keep its other products in McMinnville - the PPO, indemnity and Medicare plans. Surgeon calls for resignation of Salem Hospital's CEO, board In a stinging editorial, which appeared in the Marion-Polk County Medical Society's newsletter in October, Dr. Peter Bernardo urged the board of directors and the CEO of Salem Hospital to resign. "The eventual failure of Salem Hospital will be the fault of the board of directors," according to Bernardo, a general surgeon. "Their over-inflated sense of the hospital's importance, coupled with their complete disdain for the medical staff, has directly led to the current situation." Bernardo told Oregon Health Forum he wasn't speaking as president of the Marion-Polk Medical Society, but said his views were shared by most of the 17 surgeons at Salem Hospital. "The medical staff perceive Salem Hospital to be aloof and disdainful of the medical community," he wrote. "Salem Hospital has often acted as though physicians were not important to its long-term health." Roseburg swamped with lawsuits A Roseburg hospital has filed suit against its chief rival, accusing Mercy Medical Center of trying to steal its outpatient surgery business. Douglas Community Medical Center filed a lawsuit in mid-September, seeking unspecified damages. Also named were Roseburg Surgery Center, Professional Management of Oregon (PMO) and Dell Gray. Douglas Community claims it suffered at least $7 million in damages from the defendant's actions. Mercy, along with Gray and PMO, is accused of misappropriation of trade secrets, interference with a business relationship and assisting a breach of fiduciary duty. Roseburg Surgery Center is accused of breach of fiduciary duty, breach of contract, interference with business advantage and misappropriation of trade secrets. "It seems they are blaming us for some of their own internal issues and some of their own mismanagement," said Mercy spokeswoman Kathleen Nickel. AIDS community fears name reporting Fearful of confidentiality breaches, community activists are irate about a proposal to require name reporting when people test positive for the HIV virus. The proposal is expected to be announced in early November. However, Dr. Mark Loveless, program director of the Health Division's HIV/STD/TB Program, isn't taking their opinions seriously. "What we heard from the community is heartfelt, but based on hypothetical and mythological views of what government does." said Loveless. The Committee on Expanded HIV Reporting, which was created by the Health Division to articulate the values of Oregonians on HIV expanded reporting, feels snubbed by Loveless (a committee member, himself). The Public Health Advisory Board narrowly defeated a resolution that recommended the Health Division not pursue HIV name reporting. Oregon's HMOs offer external appeals procedure While Congress debates whether patients have the right to sue their health plans, the industry is taking the first step. Most of Oregon's HMO's are establishing an external appeals procedure, giving patients an opportunity to voice their concerns outside the courts. PacifiCare of Oregon is leading the pack. On January 1, an independent organization will be given authority to overturn the HMO's decisions, said Chris Palmedo, public relations manager. Until the contract is ratified, Palmedo couldn't name the organization. "But its decision will be binding," he said. "We don't anticipate many decisions will be overturned." By July 2000, HMOs that are NCQA accredited must have an external appeals process, said Ed Nieubuurt, director of regulatory affairs for Providence Health Plan, which is developing its own version for implementation by mid-year 2000. "We think it's good for both our members and the plan because eventually it will be coming down the road by either state or federal legislation." Insurers rely on bonds, stocks to offset operating losses Although most of Oregon's insurers lost money this year because of higher utilization and expensive pharmaceuticals, their investment portfolios held steady over the last 12 months, with most of their holdings in the bond market. Oregon Health Forum did a detailed analysis of the bond and stock holdings of Oregon's major insurers, using reports filed with the Insurance Division. Short-term investments were not included because of their liquidity. Oregon's major domestic insurers had $788,526,072 in investment holdings on June 30, when the second quarter ended - 64% in the bond market; 36% in stocks. That represented a 0.6% jump over the previous 12 months when their portfolio stood at $784,022,793 with a 66-34% ratio between bonds and stocks. See the print version of October 1999 Oregon Health Forum to see what the health plan's investment portfolio looked like. Giving birth control pills to teenagers irks commissioners Yamhill County is getting out of family planning. In a compromise one county health official called a "win-win" solution, commissioners handed off family planning to a nonprofit agency that will be chosen by the Health Division. The problem flared up after Yamhill County Commissioners - Tom Bunn, Rob Johnstone and Ted Lopuszynski - expressed concern about giving birth control pills and counseling teenagers without parental consent. The commissioners decided to place the issue on the November ballot. "The Yamhill County Board of Commissioners is a very conservative board," Johnstone said. "We've had concerns for a number of years that countys family planning services were providing minors with birth control pills, shots, IUDs, condoms - all of it - without parents knowing anything about it. We believe parents ought to be involved in those kinds of decisions with their children." By proposing a ballot measure, the commissioners "probably" were trying to inject personal philosophy into local law, Johnstone said. "I don't know that there's anything wrong with that." Also in this issue...
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