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 October Providence resolves financial difficulties with physicians After refusing to budge, Providence Health Plans has succumbed to the demands of its physician groups. The Portland Clinic and Northwest Primary Care Group are back on board, rescinding the termination letter they sent to Providence in mid-September. Once it became clear these clinics had negotiated a better deal for their 74 physicians, the InterHospital Physicians Association, which represents close to 1,500 Providence physicians, had its contract re-adjusted and signed a sweetheart deal. " We've come to a separate agreement, and have a far better contract for primary care physicians, " said Dr. James Waskey, a radiologist, who's the IPA's president. The earlier 2001 contract gave physicians a conversion factor of $50 for non-capitated services; $40 for Medicare and $14 for capitated contracts (per member per month), Waskey said. Now it's obvious Providence must come to grips with several tough questions -- where will it come up with the additional revenue to pay physicians? Will their premiums take a bigger jump next year or will Providence make up the difference from its hospital and home health budgets? Because the physician contracts hadn't been finalized, Providence officials were reluctant to comment. Regence sends termination letter Regence BlueCross BlueShield has sent a termination letter with a big " if " to state officials. According to the letter, Regence will pull out of the Oregon Health Plan by year's end unless the state, provider groups and health plans are able to find a way to make the program work better. During the early days of the health plan, in 1996, Regence had 115,000 members. At last count, its enrollment had dipped to 45,000. Regence officials insisted they will continue participating in discussions with everyone involved. However, by giving a 90-day notice, the health insurer could stop participating in the Oregon Health Plan in January. " We need to exercise our option if necessary, " said Ken Strobeck, assistant vice president of corporate communication. " We'd like to stay, but need to make sure we're covering our bases as evaluated by our financial performance. " Safety net clinics take their appeal to Gov. Kitzhaber Wouldn't it be nice to concentrate on giving quality health care to patients of safety net clinics, instead of spending so much time chasing money to fund them? Jeanne Bowden, associate dean at Oregon Health Sciences University nursing school's campus in LaGrande, sighs as she asks the question. The answer is obvious to Bowden and anyone else involved with the dozens of safety net clinics that serve low-income patients. Yet the reality for most of the state's safety net clinics -- especially those in rural and remote areas -- is that funding these vital services is a critical and constant challenge. Consider clinics in the LaGrande area. The nursing school staffs several clinics, primarily in the small towns of Union and Elgin. Distance, transportation problems, lack of insurance and low-income jobs are among the barriers to access. Meanwhile, patient revenues only cover 70 percent of the clinics' operating costs, Bowden said. A grant from the Office of Rural Health runs out this year. Grand Ronde Hospital has helped the nursing school fund a clinic in Elgin, but those funds will end as well. " We're scrambling and doing our best to keep the clinics alive, " Bowden said. " My hope is the state will finally say, Here is a permanent endowment for people who are running safety net clinics. It's not that we need full funding, but each clinic needs help when seeing uninsured or Oregon Health Plan patients. " PacificSource joins HMO ranks in Jackson County Just when HMOs appeared to be a dying breed in Jackson County, with the recent decision by Regence to withdraw, a new player has emerged -- PacificSource. By January, this Eugene-based health plan intends to be writing business after signing a contract with PrimeHealth, which represents the majority of physicians and hospitals. Not licensed as a federally qualified HMO, Greg McCumsey, CEO, said PacificSource would offer an HMO-look-alike plan. " Our strategy is to negotiate the most fair arrangement we can, " he said. " Fair is in the eye of the beholder. " Insurance agents weren't surprised by Regence's decision to withdraw its commercial HMO from Jackson County. " It hadn't been competitive for two years, " said agent Jack Strauss. The only groups with coverage were the city, the county and the school district. " People who don't look at what the premium is. " Regence insisted medical costs had outstripped its ability to maintain competitive. " The cost to provide a HMO program throughout Jackson County has become prohibitive, " said Dr. J. Bart McMullan, senior vice president and chief medical officer at Regence. " Our data shows the cost of medical services in the Medford area is significantly higher than other areas of the state. This is a trend we have been watching closely in hopes that it would improve. Instead, costs are increasing. " LifeWise lowers commissions, irks agents Insurance agents around the state are up in arms about LifeWise's decision to slash their commissions. Some are even urging their colleagues to unite and form a strong organization to protect themselves. " We don't have anyone who speaks for us when we're negotiating with insurance companies, " said an agent in southern Oregon who was unwilling to share his name. " They're pushing agents around. " In a Sept. 28 letter to 3,000 agents, LifeWise announced it was cutting commissions on individual policies by 20 percent, to 8 percent of premium, and would no longer pay commissions after 10 years. Group commissions were also lowered. That proved too much for the agent community, which met with LifeWise executives who agreed to rescind the " no commission " clause. " What right do they have to take away something that we brought them? " said another agent from central Oregon. " What does a 2 percent loss in premium mean to them? LifeWise is still the most affordable individual health plan out there. " He's concerned other insurers will follow suit, lowering commissions on individual policies, similar to what happened when Regence cut commissions on group policies last year. Almost immediately, PacifiCare, Health Net, PacificSource and Providence followed Regence's example. LifeWise appears to be the last to fall in line. State may stop collecting hospital data The state agency that collects data from hospitals, nursing homes and ambulatory surgical centers may recommend that the legislature lift that obligation. An analysis is underway by the Office of the Oregon Health Plan Policy and Research, said Dr. John Santa, administrator. " We're trying to figure out how important it is, such as how many people use and request the data. " From a budgetary standpoint, Santa said his office is looking at everything it does and its impact on Oregonians. " Surely the public expects state agencies to do this on a routine basis." Susan Prows, PhD, who took over as research manager from Chuck Sigmund, is handling the analysis. " There's disagreement on what may be required and what isn't, " she said. Prows will make a recommendation to Santa within a month after consulting with her staff -- John Martin, Michael Kennedy and Terry Kliever. "We're also attempting to see if it might be useful to collect information that we haven't in the past, " said Prows, who wouldn't be specific. OHPPR collects discharge data, financial reports, outpatient and inpatient utilization, the number of staffed and licensed beds, the demographics of hospitals and specialty information such as MRI usage. Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems, believes it's extremely important to have a state repository for hospital financial and utilization data. Spiritual pain comforted by unique hospice program Oregon is generally regarded as a leader in palliative care because practitioners have a strong desire to ensure a dying person's last days are as pain free and comfortable as possible. What's been neglected, though, is a patient's spiritual pain, says Richard Groves, a Bend chaplain, educator and director of a retreat center, The Sacred Art of Living. Based on a belief that the spiritual pain of terminally ill patients is as important to diagnose and treat as physical pain, Groves and his wife Mary have developed a widely used program for hospice workers called Sacred Art of Dying. Drawing upon their experiences working for the Bend-LaPine Hospice, where Richard Groves spent seven years as executive director and Mary Groves was a bereavement educator, they established courses that combine ancient and contemporary therapies to relieve spiritual pain, including music, prayer, touch therapy, " coma therapy " and other rituals to help people die more peacefully. Groves defines spiritual pain as " that intangible area we find at the end of life, sometimes an element that has nothing to do with physical symptoms. You can have the best of treatments, medications, but there is a crisis in meaning, or in relationships, or loss of home or forgiveness. If you have a huge area of unreconciled hurt, there's no way you can shove it under the carpet at this time. This person just lays there in huge pain and no way to access it. We give (dying patients) permission to talk about these things, to bring the pain to light. " Also in this issue...
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