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 November A prison within a prison: the life and death of Billy Owens On paper, Oregon’s prison system reads like a shining example of health care delivery. Administrators boast of low costs and high quality, and the numbers back them up. The Department of Corrections (DOC) operates at one of the lowest per patient per month rates in the country. But there’s another side to the story, and it involves the estimated 20 percent of America’s 2.1 million prisoners who suffer from mental illness. Disproportionally placed in solitary confinement, their suffering is often exasperated by the prison system, which has seen its population of mentally ill patients spike as access to mental institutions has tapered off. They can no more escape the prison of their minds than they can break free of the bars that surround them. The give and take of charity care Charity care is quickly climbing the hot list of health care topics. In his July decision, Attorney General Hardy Myers allowed McKenzie-Willamette Hospital and Triad Hospitals to transfer assets in return for meeting a specified level of charity care. “We addressed it simply because it was the community’s desire,” said Victoria Cox, his spokesperson. “It was clear at the public hearings in Springfield that charity care was one of the major concerns the community had.” No dialysis hearings Watch out for the snakes in the Grassley. That’s the message from Arlene Mullin, a fierce advocate for dialysis patients. In early November, Sen. Chuck Grassley (R–IA), chairman of the Committee on Finance, wrote a scathing letter to Tom Scully, administrator of the Centers for Medicare & Medicaid Services. Grassley said he was “outraged” at the “lack of improvement in the quality of care being given to Medicare beneficiaries on dialysis.” Meridian Park blues The October celebration of Legacy Meridian Park Hospital’s 30th birthday got crashed in a big way. First, Oregon Health Forum’s report on hospital profitability revealed the hospital’s census declined from 70 in 2001 to 66 in 2002. CEO Robert Pallari subsequently assembled a team explicitly charged with getting the census back on track. Shortly thereafter, Pallari saw his name and photograph on the front page of The Oregonian’s business section in a story critical of hospital executive salaries. Who’s the boss? An interview with ESCO’s Patrick Pine If you follow the money circulating through the health care maze, you’re likely to end up at an employer’s desk. But just because they’re signing the checks and picking the plans doesn’t mean they feel empowered. “Most employers feel a little bit helpless right now,” said Patrick Pine, corporate benefits manager for steel parts manufacturer ESCO. He spoke with Oregon Health Forum Associate Editor Rory Carroll about the rising cost of health care, alternatives to employer-sponsored insurance and why he doubts consumer directed health plans will catch on. OHF: What could result from the growing outrage over the soaring salaries paid to health executives? PP: As with any other industry, if prices keep rising, customers will take their business elsewhere. The health industry is a little more capable of avoiding that. But if this doesn’t abate soon the public will seek alternatives the providers find distasteful like a single-payer system. Another intriguing concept coming back is regulating hospital rates. Twenty years ago there was talk of regulating their rates much like utility rates are regulated today. Awaiting the waivers The Oregon Health Plan has become a waiting game. The feds are sitting on their hands and have given no indication about the future of a waiver that would shave 30 medical treatments from the prioritized list and offer mental health, chemical dependency and adult dental benefits to the Standard population. Because of the delay, Oregon’s budget faces a $1 million hit every month starting in January. The revenue loss, however, will be partially offset by fewer people enrolled in the Standard health plan — 48,612 compared to projections of 85,000. Another 314,000 people are on the Plus plan with 19,000 children on CHIP. Another cut for mental health With state revenues shrinking, the mere thought of taking a 16.3 percent hit in revenue would startle anyone. Yet the news took very few mental health contractors by surprise. Ralph Summers, manager of community treatment systems, had sent up warnings for months. For the first time, the capitation rates for the mental health contractors would be based on encounter data from the previous fiscal year — which documents the number and type of services delivered and their cost. However, because the contractors failed to provide sufficient encounter data, their rates over the next two fiscal years plummeted to an all-time low. Disease management ups and downs With health care costs outpacing a runaway train, disease management is becoming a cornerstone of many health benefit designs. But it’s not quite the magic bullet. “Disease management is not it,” said Dr. John Santa, a PEBB consultant. “But it’s on the way to it.” The Public Employees’ Benefit Board started a disease management program in 2002, but has yet to realize significant cost savings. Part of the problem is the difficulty in predicting who’s going to need medical care during any given year. Among those who get sick during a particular year, research has shown that only 40-60 percent will need medical care the following year, Santa told PEBB. Also in this issue...
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