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 October Oregon's health care crisis threatens low-income citizens As the state’s economy continues to struggle, health care providers and programs are under the scalpel. If voters don’t approve a January referendum to raise taxes, the state’s poorest citizens will pay with their health. Few can remember as gloomy a time. “Everything’s depressing right now,” said Scott Gallant, lobbyist for the Oregon Medical Association. “It’s overwhelming — we have to get our economy back on track,” said Ruby Haughton, director of legislative and public affairs for CareOregon. Meanwhile, the state’s blistering unemployment rate — the highest in the nation — is driving the demand for public health services. Northern exposure Border patrol agents quickly recognize the legality of a swimmer trying to cross the Rio Grande, but what about a retiree bringing a three-month supply of Claritin into the United States from Canada? Physicians don’t see a problem. Internet pharmacists in Canada endorse the idea. The Food and Drug Administration, however, disagrees. Sort of. “It’s illegal to bring prescription medication into the United States,” said an FDA source. “Customs officers are allowed to exercise enforcement discretion, however, when it’s less than a 90-day supply.” Drug plan burdens pharmacists Pharmacists moaned when the legislature created the senior drug assistance program without allocating any money for them. Now even advocates are scratching their heads. The Emergency Board approved the entire $1.3 million funding request in early October, but then only sanctioned 10 limited duration positions to run the program instead of the 28 requested. Sandy Wood is the only full-time staff. “We need to go back to the November Emergency Board and get some direction on where they want us to go,” Wood said. There’s a need for caution, she said, because of the state’s economic woes, but the permanent positions eliminated aren't necessary to meet the February rollout date. Where drugs grow on trees The Portland Adventist Community Clinic in northeast Portland may need to build a loading dock to handle the flood of free medications it receives from pharmaceutical companies. In September alone, over $7,000 worth of drugs poured through the clinic’s doors, bringing the annual total to almost $60,000. “Pharmaceutical companies get a lot of bad publicity,” said Nanette Ringering, clinic coordinator. “As far as we’re concerned, they’re very, very generous.” On the cheap The tentacles of the pharmaceutical industry continue strangling the bottom line of insurers, and pharmacists are the latest soldiers on the front line. In January, BlueCross and BlueShield of Illinois will start paying pharmacists $1 each time they convince a patient to switch to a generic medication. No similar programs exist in Oregon, but Illinois pharmacists may have started a trend, said Tom Holt, executive director of the Oregon State Pharmacists Association. Regence BlueCross BlueShield of Oregon, for example, already tracks the generic fill rate of pharmacists, said Cathy Lavin, assistant vice president of corporate communications. Regence may use the data to create an incentive plan for pharmacists. “Health plans are finally realizing pharmacists can be an asset,” Holt said. Mending broken hearts A powerful new weapon will likely land in the toolboxes of cardiologists in the next few months when the Food and Drug Administration approves the first drug-coated heart stent. The product, known as a Cypher heart stent, and offered by Johnson & Johnson’s Cordis Corporation, posted shattering results in recent clinical trials. The Centers for Medicaid & Medicare Services is so confident in the technology it’s taken the unprecedented step of creating a diagnostic related group before the FDA has even approved it. The only problem, for hospitals, however, is the bundled payment for the new technology will only be 17 percent higher than the payment for a traditional stent. AIDS Project's revival In 1994, Cascade AIDS Project (CAP) was about to turn 10 years old, but no one was in the mood to celebrate. The state’s biggest and oldest community based AIDS organization was teetering on the brink of bankruptcy and lacked organization and leadership. Founded during the darkest hour of the storm, the organization, which provides direct services, such as emergency financial assistance and transportation, as well as education, was fueled by activist ideology more than sound business sense. When an employee functioning as a bookkeeper was caught stealing from the budget, it made front page news in The Oregonian, prompting an investigation by the Attorney General’s Division of Charitable Solicitation. The board was disgraced, the confidence of private donors plummeted and the county and the state were looking to yank CAP’s contracts. View from the Cassel Most players in the health policy arena have tunnel vision. Either they’re employers obsessed with cost or activists blind to it. But not Dr. Christine Cassel. OHSU's first female medical school dean in its 114-year history sees all sides. An ethicist, a leading physician in geriatric medicine and a policy guru, she's apt at pulling the disjointed pieces of health care together to create a clear picture of the future. She recently spoke with Oregon Health Forum Associate Editor Rory Carroll. For the complete, unedited transcript of this interview, visit www.healthforum.org. OHF: What are the biggest ethical issues on the horizon? CC: There are old and new ones. The biggest and oldest one for our nation is the problem of the lack of universal health insurance. It’s an ethical issue not only for the individual clinician and institution, but just importantly, it’s an ethical issue for us as a society to decide the nature of the social contract — which is a philosophical and ethical issue. Yet we rarely have the debate on that level. Until we deal with it as an ethical issue, we’ll continue to be distracted and sabotaged by all the complexity. Docs, attorneys differ Picture fitting a square peg into a round hole. That’s how Jim Dorigan feels about creating a malpractice insurance company for physicians similar to the Professional Liability Fund for attorneys — even though he once served on its board of directors. “They’re different situations,” said Dorigan, CEO of Northwest Physicians Mutual, the state’s largest medical malpractice insurer with 2,200 physicians. On cue, trial lawyers disagree. They believe a similar system is a great way to stabilize premiums, according to Chris Bouneff, spokesperson for the Oregon Trial Lawyers Association. Medical errors discussed A new state coalition is so amorphous that after two meetings it doesn’t even have a name. The lack of a proper title, however, is no reflection of the gravity of its purpose. The Chicago Tribune estimated there were 90,000 deaths in the United States from hospital infections in 2000. The coalition, which consists of employees from various health systems, associations, providers and consumer groups, will address the rate of medical errors in Oregon. Also in this issue...
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