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 April Insurers, attorneys argue over rising malpractice rates A malpractice crisis could be looming in Oregon, the likes of which haven't been seen since 1987 when the Oregon Medical Association passed a tort reform measure limiting non-economic damages to $500,000. Now physicians are being hit hard, with premium hikes ranging from 14 to 125 percent. What's responsible for this sudden rash of high rates that could throw a gauntlet over malpractice costs? Depending on whom you ask, the answers vary widely. The insurance companies believe there's been a significant trend toward multi-million dollar verdicts since 1999 when the Oregon Supreme Court upheld a decision declaring the $500,000 cap on non-economic damages unconstitutional. The defeat of Ballot Measure 81 last May, giving the legislature authority to set limits, was another blow. However, trial lawyers have their own spin. They contend insurers sat on their laurels, reaping profits, and should have increased premiums during the 1990s to keep up with inflationary growth. They also blame HMOs for inducing physicians to seek profits instead of good patient care by delaying necessary tests. Oregon struggles to care for non-qualified immigrants Health Services Commissioner Jono Hildner believes it's impossible to protect public health and exclude a segment of the population. Millie Lane, who runs Virginia Garcia Memorial Health Center, couldn't agree more. Her health center, which serves an 80 percent Hispanic population, up to half of whom are farm workers, deals with the repercussions of an exclusionary health policy every day. Although patients at Virginia Garcia are not asked their immigration status, they are charged fees based on their income. "When that income level is below the level required to join the Oregon Health Plan, the disqualifying factor is more than obvious," she said. Pharmaceuticals on tap When Congress returns from its Easter recess, pharmaceuticals are going to be on the minds of Sens. Charles Schumer and John McCain. They're planning to introduce legislation closing loopholes so that brand-name drug companies can't get extensions on their patents and generics could be introduced, said John Golenski, EdD, president of the Health Priorities Group. "We've been working with both staffs to develop the content of this bill and will probably endorse it as a coalition," he said. "McCain's very effective and has been interested in pharmaceutical issues for a long time." Golenski will discuss this when he appears at Oregon Health Forum's breakfast seminar on April 26. For reservations, call (503) 226-7870. Derfler defeated Mental health killed Senate President Derfler's basic benefit package for small employers, which was defeated 16-14 when three Republicans crossed the aisle. But Senate Bill 89 could be revived at the close of the session when "gut and stuff" becomes the rule of the day, said J.L. Wilson, lobbyist for the National Federation of Independent Business. "We'll try to make another stab this session if we can get in the legislative mix at the end game where we do horse trading," said Wilson, who's willing to add mental health benefits if his members agree. "I'll take a half a loaf over nothing. But I don't know if my fellow business lobbyists feel the same way." Drug money unspent Because of the "strings" attached, Multnomah and Washington counties won't come close to spending $1.7 million allotted for atypical psychotic medications by the 1999 legislature. Only 30 percent of that money could be spent on case management, and only non-Oregon Health Plan members could benefit. OHSU was given $250,000 to evaluate the cost effectiveness of the program which ends June 30. After eight months, both counties had only spent $357,668, said Frances Baker, special projects coordinator with the Office of Mental Health Services. Drug budget cut Oregon Health Plan contractors will see their drug budgets slashed by 7 percent on Oct. 1. The state made this decision after its actuary conducted a survey, said Lynn Read, deputy administrator. Only five out of the 14 health plans responded. Of those, one plan refused to share information even though they were assured their name would be kept confidential. Among the remaining plans, rebates ranged up to 10 percent, Read said. Jeff Heatherington, CEO of FamilyCare, said he was never asked to complete a survey. "They claim they surveyed the plans when they know they literally were misrepresenting themselves." OHP expansion Gov. John Kitzhaber has organized a Mahonia Hall Group to reach consensus on expansion of the Oregon Health Plan. "We're trying to craft a public-private partnership that's not so expensive, that will take us up further into the uninsured population," said Rep. Alan Bates (D-Medford). Rep Jeff. Kruse, who drafted House Bill 3553 feels strongly about the expansion effort, as does the governor. "We're trying to close that loop and are plugging away until everyone gets on board."What's being discussed is the creation of two significantly different health plans. One model, intended for children, pregnant women, the aged, blind and disabled, would retain the current benefit package without any cost sharing. Single adults and couples would receive fewer benefits and make co-payments. But if the contractors lose a significant portion of the eligible population, it would seriously undermine their ability to run the current delivery system, said Jeff Heatherington, CEO of FamilyCare, adding the contractors unanimously voted to oppose HB 3553. "If they destabilize the current health plans, the vast majority of which are physician and hospital driven organizations, we won't come back to the table," said Pat Gibford, CEO of Central Oregon IHS. "Physicians and hospitals have real long memories." New clinic, new doctor, no waiting It was December when the Douglas County IPA announced its intention to open a new clinic catering to the Oregon Health Plan. There was just one minor problem -- they couldn't find a doctor. So DCIPA lured longtime area Dr. Lee McCullough into its fold. He was working at Columbia Basin Hospital in Ephrata, Wash., as a doctor-for-hire, when he heard about the opening. "I thought it was great," he said. "I could come back home." The decision to develop a clinic exclusively for Oregon Health Plan members was born of the recent regional doctor shortage. In 1998, Mercy Medical Center contracted with American Medical Consulting, which found that compared with federal physician-patient ratio standards, Roseburg was deficient. Also in this issue...
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