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 April Hospitals file suit, cite report on hospital reimbursement Midway through this legislative session, hospitals are engaged in a difficult balancing act: trying to keep favor with the state while simultaneously suing it. In a letter to legislators, Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems, said legal action against OMAP and DHS was regrettable but necessary to protect hospitals from what he alleges is the illegal and unilateral decision to eliminate retroactive eligibility. If the cut — which was adopted March 1 — goes unchanged, DHS claimed it’ll save $49 million. Under retroactive reimbursement, hospitals are paid when an Oregon Health Plan patient is admitted, even though they may not have been previously enrolled. The new policy would delay coverage until the first day of the month following when DHS determines eligibility. Regence BCBS supports mental health parity Mental health parity is headed toward the finish line. “It’ll be part of the end game,” predicted Alan Tresidder, who lobbies on behalf of several mental health organizations. In a move that surprised many onlookers, John Powell, representing Regence BlueCross BlueShield, proposed amendments to the parity bill, Senate Bill 1, that would actually expand mental health benefits. At the same time, the insurance industry would manage those benefits — contracting with providers, handling pre-admission screening, prior authorization and utilization review with regulatory oversight from the Department of Consumer and Business Services. Implementation would start January 2005 rather than a year earlier, as proposed in the original bill. Insurers would have to treat mental disorders the same as physical conditions such as diabetes, and additional co-payments or visitation limits could not be imposed. Nurses working overtime They’re exhausted, beaten down and ready to rumble. A new law intended to improve nursing conditions in hospitals will leap out of the books and into the real world after three nurses from Providence Milwaukee Hospital filed complaints against their employer. They’re charging the hospital insufficiently staffed its operating room, forcing nurses to work dangerously long hours. The Oregon Federation of Nurses and Health Professionals, the union representing the nurses, alleges the hospital violated the law by failing to produce a written, hospital-wide staffing plan. It also claims the hospital hasn’t provided a posted list of on-call nurses to serve as replacements when a nurse is exhausted. One nurse worked 16 hours in a single day and the other two worked 17½ hours. Mercury toothache Mercury activists came to the legislature with high hopes for Senate Bill 681, which would ban mercury amalgams in children under 19 as well as fertile women. By 2008, amalgam fillings would be outlawed altogether. At first it looked like they were going to get their wish. The bill was initially sent to Sen. Bill Morrisette’s (D-Springfield) Health Policy Committee. Although he doesn’t completely subscribe to their arguments, he sponsored the legislation to facilitate the discussion. “It’s important they at least get an opportunity to tell their story.” Audit committee saves Oregon Health Plan A new twist is slowly coming to life that could save the Oregon Health Plan $19.4 million next biennium by shifting the purchase of pharmaceuticals — and putting the state in charge rather than the fully capitated plans. That savings would be reaped from drug rebates. “Fully capitated health plans and their pharmaceutical benefit managers receive a lower rebate than the state,” said Rep. Jeff Kruse (R–Roseburg). In other words, the state is eligible for larger discounts by purchasing drugs in bulk. Health plans readily admit they’ve been using some of their monthly capitation payments intended for prescription drugs to offset rising physician and hospital costs, and it seemed like a battle would ensue when legislators drew up this proposal. Surprisingly, they were very supportive. What’s in a name? Not that it needs to with a moniker like Plexis, but Ashland-based Plexis Healthcare Systems continues building a name for itself. PacificSource purchased the company’s claims processing software that allows health care organizations to streamline their claims payment and medical care management requirements. It joins organizations such as the Yavapai County Department of Medical Assistance in Arizona and Florida’s SunMed International that purchased the software. Citizen Kitzhaber Dr. John Kitzhaber argues that physicians are an independent thinking bunch that don’t like being told what to do. If so, then the go-it-alone former governor is Exhibit A. A blue jean clad Kitzhaber sat down with OHF’’s decidedly overdressed Associate Editor Rory Carroll to discuss problems with the preferred drug list, the absurdity of Medicare and why he won’t be returning to the emergency room. Read the full interview at www.healthforum.org. OHF: Let’s start with some national issues. Is Oregon ready to export the preferred drug list? JK: We’ve got good evidence and theoretically it causes drug companies to compete on the basis of cost. But it’s only targeting the Medicaid population, which is a very small subset of people who use prescription drugs. The question becomes, are physicians going to use it? We saw an initial 25 to 30 percent shift in the market share, but it hasn’t changed much beyond that. It puts the ball in the physician’s court, giving them two options. They can take that evidence and use it, or they can face a prior authorization regulatory model, which is probably what’s going to happen. Increase in medical and hospital costs outpaces drug spending Despite nearly a 9 percent drop in membership for Oregon’s HMOs, medical, hospital and prescription drug spending increased in 2002. Prescription drug spending* increased $289,989 (0.4 percent) while medical and hospital costs increased $32,894,943 (1.3 percent). “Drug costs continue to go up,” said Pat Hogan, senior vice president and employee benefit consultant for Marsh USA, Inc. “However, hospital costs are now increasing at a rate very close to prescription drugs.” The migration from HMOs to PPOs also continued in 2002. The loss in membership and rise in cost resulted in a dramatic loss in net income of $8.2 million (13.4 percent). Despite the drop in income, HMOs still earned a 14.8 percent increase in net admitted assets ($134.1 million) and a 7.3 percent increase in net worth ($31.1 million). Lastly, the HMOs shielded themselves from the woes of Wall Street by a wholesale movement away from stocks and toward more conservative investments in bonds. In 2002, the bond holdings of HMOs increased $96.7 million (34.8 percent), while their collective stock investment dropped 76.7 percent to $19.7 million. Letters to the Editor To the editor, We are disappointed with the article entitled, “Board of Nursing abolition” (Oregon Health Forum, March 2003). According to the article, Mr. Wimmer, Senator Harper’s legislative aide, described the meeting between Senator Harper, Executive Director Joan Bouchard, and their respective staffs, as unproductive. We wanted to understand Senator Harper’s concerns and be responsive to them. It appears from this article that Mr. Wimmer also misunderstands the purpose of letters the Board sends to psychologists regarding mental health evaluations. We include in the letters a brief summary of the complaints we’ve received concerning the licensee in question, his/her background and the questions we need addressed -- not to assign guilt, but to give a context in which the evaluation can be performed in order for it to be meaningful and related to nursing practice. For instance, it's not helpful to the Board to know if someone has issues with his/her mother, but it is helpful to know if he/she has boundary issues dealing with female patients. We’d also like to address the sentence in the article that “[i]n June, the Board’s selected psychologist refused to perform the evaluation because the psychologist was required by the Board to assume the allegations against the practitioner were true.” In this particular case, Board staff and licensee’s legal counsel could not come to agreement on an evaluator. Thus no selection, no letter, no contact nor any request was ever made to any evaluator to perform any evaluation. The statements in the article that any Board action was precipitated by “chiding” of Board staff by an evaluator are patently false. Joan Bouchard
Oregon Health Forum responds: It is true that Corcoran’s license was suspended for two years, not indefinitely. OHF regrets the error. To the editor, In “Malpractice reconsidered” (Oregon Health Forum, March 2003) Jason Reynolds is quoted as saying “The economic damages for an infant are zero.” I believe that statement is inaccurate as a damaged infant could receive a considerable judgement. A person or entity found guilty of malpractice would be liable for all economic expenses of custodial care and medical treatment which would run in the millions. I also believe the infant could collect damages on future loss of earnings. The only limit would be $250,000 on non-economic damages, i.e., pain and suffering. No one is challanging a person’s right to sue and collect full economic damages as determined by a court of law. Richard Allen, M.D.,FACOG Also in this issue...
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