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 May Wyden prepares to defend physician-assisted suicide law When the U.S. Senate debates the Pain Relief Promotion Act, which would strike down Oregon's physician-assisted suicide law, Senator Ron Wyden, D-Ore., will be armed with evidence that may impact the vote. A study appearing in the Western Journal of Medicine next month reveals people experienced a much higher level of pain before dying in hospitals compared to nursing homes or at home. "This definitely bolsters our case," said a Wyden spokesman. "The senator feels very strong about Oregon's law. He'll do whatever he can to stand behind it." Dr. Susan Tolle, director of the Center for Ethics in Health Care at OHSU, who conducted the research, was surprised by the findings. "This is the very first time anything we followed has gone in the wrong direction," she said. Medicare+Choice entices newcomer to market The nation's first fee-for-service plan under the Medicare+Choice initiative will begin selling policies late this spring in Oregon, one of just 17 states where the groundbreaking plan is available. But it took a newcomer to the Medicare marketplace to bring such a project into existence. Sterling Health Plans, an offshoot of Combined Insurance Company of America, expanded into the Medicare business - from selling credit life insurance and similar products - within the last several months. The firm's officials are hoping the 6,000 or so Medigap subscribers they have nationwide will grow into a flood of fee-for-service fans, eager to reclaim more authority over health care decisions for themselves and their doctors. "Physicians will like the plan because their current patients will be free to continue to see them," said Craig Bodway, compliance officer for Sterling, in Bellingham, Wash. Public believes all hospitals are for profit "The single most important problem facing health care in America is the erosion of public confidence in us," Dick Davidson, president of the American Hospital Assn. told a Hood River audience recently. "Our future lies with connecting with the community." Recognizing community volunteers serve on hospital boards, Davidson said this connection is the key to restoring public faith in hospitals. He signaled out Providence Hood River Memorial Hospital. "Even with your new organizational structure, that had the potential for disconnecting things, you gained strength." "You still have your board, and the hospital's done more things in the community than they could afford to do in the past. That's a real plus and a real focus." Medical board seeks increases Next session, two licensing boards hope to increase the compensation board members receive. But they don't intend to ask for a fee hike, contending they have enough money in their current budgets. The Board of Dentistry and Board of Nursing want to change the per diem rate from $30 to $150 per day. The idea is long overdue, said Jo Ann Bones, executive director of the dentistry board. "Thirty dollars doesn't even cover baby sitting charges. Most of the board members make more than that (at their jobs) per hour." Bones acknowledged the new amount is still inadequate for the time board members devote. "There's no real way to compensate. It's just a token." Dentistry board per diems haven't been adjusted since the 1970s. Last session, the dentistry board proposed a similar change, which was defeated, said Bones, who blamed poor lobbying efforts for its failure. HCFA calls off threats against Legacy Oregon hospices are mulling what to do next after a state and federal investigation of the Visiting Nurse Assn. Hospice briefly threatened to cut off Medicare funding for Legacy Health Systems's hospice program. "The whole hospice industry is really looking at some of these findings because some of them are very different from what we've been instructed to follow in the past," said Ann Jackson, executive director of the Oregon Hospice Assn. "There have been different interpretations by HCFA over the years of the guidelines for hospice care, which themselves haven't changed." HCFA sent Legacy a letter on April 28 saying certain practices its branch hospice program, Health Dynamics in McMinnville, was following at two nursing homes "constitute an immediate and serious threat to the health and safety of patients." Legacy, Providence hospitals financially profitable in 1999 Despite the ramifications of the Balanced Budget Amendment, which crunched Medicare revenues, the two major hospital systems in Portland did quite well the last two years, based on financial reports filed with the Office of the Oregon Health Plan Policy and Research. Legacy Health System ended fiscal year 1999 earning 7.80% in net income and 5.88% in its operating margin, representing a 23.6% increase from the previous year. Its competitor, the Sisters of Providence, fared slightly better, posting a net income of 8.23% and an operating margin of 6.27%, a 30% boost from 1998. Health care needs to focus on early intervention To be cost effective, managed care systems should emphasize prevention and early intervention. That's where more dollars should be spent, according to Providence Health System psychiatrist Dr. Magnus Lakovics. "Somebody has to look at the prevention mode," he said. "Right now a significant portion of health care dollars is spent on (patients') last six months of life. Spending money on other populations may be a better option." Lakovics was a guest speaker at a CareMark Behavioral Medicine Lecture sponsored by Legacy Health System. Discussing "Managed Care: Revolution and Evolution," his topics included the history of managed care, the Oregon Health Plan and "population management," which, he said, is the way to achieve more effective health care. Penalties advocated to protect DNA Should researchers, insurance companies or others who violate Oregon's Genetic Privacy Act be charged with a crime, or are stiff financial penalties sufficient punishment? Should Oregon law continue to protect a person's genetic tissue as private property, or are there other, equally effective ways for people to retain control of their DNA. These are some of the difficult questions the Genetic Research Advisory Committee is tackling as it considers changes to Oregon's Genetic Privacy Act, which will be reviewed by the 20001 legislature. The legislatively-authorized committee has been a meeting monthly to hash out legal and ethical dilemmas relating to privacy and genetic research. Determining penalties to impose on researchers and others who violate the state's genetic-privacy law is of paramount concern. The current law has no sanctions. Also in this issue...
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