 |
 |
 |
 |
 |
 |
|
|
 March Lifting the veil on hospital costs An effort by employers to inform consumers about the “true cost” of hospital care is being met with strong resistance. Despite growing controversy, the Oregon Coalition of Health Care Purchasers is sticking to its guns, dispelling previous criticism that the group is timid and ineffective. In fact, its board of directors voted unanimously to complete the project after being threatened by lawsuits from the Oregon Association of Hospitals and Health Systems and individual hospitals. The coalition is paying Milliman & Robertson $51,000 to collect and compile claims data from seven insurers for its “Total Cost of Care” project. Radiology costs surge Will Oregon insurers follow the lead of Harvard Pilgrim Health Care and require physicians to get prior approval before ordering non-emergency imaging tests such as MRI and PET scans? That question could rise to the forefront when Oregon Health Forum brings a nationally renowned panel to Portland on March 24. At Harvard Pilgrim, which insures 750,000 members, radiology costs are growing faster than the cost of prescription drugs. Last year, its patients underwent 130,362 advanced imaging tests, which cost the health plan $73 million, a 62 percent increase in two years. Even though physicians are outraged about this decision, Harvard Pilgrim isn’t backing down. Its executives told the Boston Globe (Feb. 27, 2004) that some imaging tests, particularly for headaches and low back pain, are not needed, but promotional advertising is creating the demand. April Emergency Board won’t save OHP Standard Legislators treating the ailing Oregon Health Plan have returned with a mixed diagnosis. Sen. Kurt Schrader (D-Canby), who holds the purse strings on the Legislative Emergency Board, said there’s good and bad news. The good news: by using money from the E-Board as well as funds from the Department of Human Service re-balance, he predicts the state will come up with $57 million to keep the Oregon Health Plan Plus program alive, despite the rejection of Measure 30. The benefit will be rich, not only paying for doctors and hospitals, but optional services such as prescription drugs, mental health, chemical dependency, durable medical goods and dental coverage for its 314,200 members. Operating below Standard What’s going to happen to the 45,000 people who’ll lose coverage Aug. 1 if the Standard plan is eliminated? Depending on where they live, they might be out of luck. Primary care physicians in Dr. Lyle Jackson’s area have reached their limit, he told the medical directors on March 8. “If nothing changes, there’ll be blood on the streets.” Mid-Rogue IPA in Josephine County has the second highest percentage of OHP members in Oregon, and no safety net clinics exist to help its 5,400 members, of whom 875 are on the Standard plan.” Our health center is very nervous,” Jackson said. Why did Jean Thorne leave DHS? Health officials are still trying to understand why Jean Thorne, sometimes called the “mother” of the Oregon Health Plan, was booted out of her position as head of DHS at such a critical time. She was replaced by Gary Weeks and placed in charge of the Public Employees’ Benefit Board, a move widely viewed as a demotion. Thorne didn’t leave the agency willingly. Many legislators viewed Thorne as problematic after she gave conflicting testimony last session about managed care savings and caseload projections, said one insider. “There was no credibility in her numbers from the perspective of Democrats and Republicans,” he added. As the 2005 session approaches, agency officials are busy preparing budget projections for next biennium. “And, the governor wanted to dispatch someone who had confidence in the budget.” Q&A: David Ford A year ago, it looked safe to write CareOregon’s obituary. The state’s largest OHP managed care plan was down to its bottom dollar and reeling from an embarrassing dispute with Legacy Health System. In a series of bold moves, the board fired CEO Mary Lou Hennrich and dropped out of Standard, moving 24,000 members to other plans or open card. Then it looked out of state for help to straighten its books. It worked. Maryland resident David Ford took the reigns in March 2003 and a year later, CareOregon is back in the black. Not only does it have 85,000 members, but CareOregon’s brimming with enough confidence that it’s backing a provider tax to offset health costs for the Standard population. And that confidence continues. Ford remains optimistic the Standard population won’t lose coverage. To accomplish that task, he’s developing a campaign targeted at legislators. His persona earned accolades from Sen. Kurt Schrader (D-Canby). “I’m impressed by how CareOregon has been able to turn its plan around,” he said. “I hadn’t given them much hope.” Oregon Health Forum Associate Editor Rory Carroll sat down with Ford to discuss how he stopped the downward spiral. OHF: When you took over at CareOregon, the financial situation was terrible. How did you manage to turn things around? DF: We were down to about four days of cash. When you’re talking about a $200 million business, that’s not a lot of money. We had 96 hours. So we had to get our hands on the numbers and work through it. We built some projections based on previous history and then worked with the state to see if we could collaborate around an answer. It was a tough time for the state and they said, ‘You’re on your own.’ But we went to creditors, essentially the hospitals, and they said, ‘We’re interested in you staying. We’ll support your organization.’ Slowly we worked our way out of the negative cash position by reducing staff, putting in expense controls and re-contracting, Gripe line decline The employees at the Oregon Insurance Division must have thought their phones were broken last year. After documenting 539 complaints against Oregon insurance companies in 2002, they only confirmed 342 complaints in 2003 — a 41 percent decrease. “It’s a good sign,” said John Piper, spokesperson for the Insurance Division. “(Insurers) are doing a good job handling claims and getting complaints resolved before they get to us.” Providence Health Plans and LifeWise made the greatest improvement. Gunning for the top The Oregon AFL-CIO won’t pursue a ballot initiative this fall to mandate health insurance for all children in Oregon. Instead, its executive board decided to spend its energy electing labor-friendly candidates in the presidential and congressional election. That decision was made, said Tim Nesbitt, president, “because the focus in this election is going to be at the top of the ticket. A lot of people rightly view the solution to the health care crisis as having to come from the federal level.” Macadam Rx Oregon Health & Science University isn’t the only tenant looking forward to new digs on North Macadam. Oregon State University plans on relocating its College of Pharmacy in 2006. “It’s long overdue,” said William “Frosty” Comer, RPh, vice president of federal health services for Coram Healthcare, who’s an OSU alumnus. Architects envision a 10- or 12-story multi-use building with the College of Pharmacy taking up five floors. OSU will pick up $30 million of the $60 million tab. Now pharmacy students spend their first two years in Corvallis, their third year at OHSU and end their program by doing a clerkship. Also in this issue...
|
|
 |
