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 November Samaritan and Regence broker last-minute deal A disaster was averted after a regional hospital system that dominates the marketplace took a step backwards. Samaritan Health System, which owns the only hospitals in Corvallis, Albany, Lebanon and Newport, had insisted Regence BlueCross BlueShield increase its rates by 35 percent and change its reimbursement formula, paying them a percentage of charges for commercial and Medicare patients rather than relying on the prospective payment system starting in 2005. Regence turned down the offer, which led to a termination letter from Samaritan. “No way could we pass that onto our consumers in the mid-valley,” said Dr. Bart McMullan, Regence’s president. “People cannot afford it. If we bury this in the premiums, people wouldn’t understand what’s happening.” Measure 35 defeated Despite raising slightly over $6 million, Oregon physicians came up 26,062 votes shy of placing a cap on non-economic damages in medical liability cases. Four years ago, Oregonians trounced a similar measure by 410,000 votes. So where do Oregon physicians go now? “If (the movement to cap non-economic damages) is not quite dead, it’s very close to it,” admitted Dr. Peter Bernardo, who chaired this year’s coalition. “We won’t be able to bring it back to the voters in the near term. Potentially in two or four years we might, but not soon.” Legislative preview With razor-wielding legislators getting ready to pare another $1 billion from an already anemic budget, lobbyists are going to play a lot of defense when the session opens. To gauge the mood, Oregon Health News interviewed a swath of lobbyists to get their predictions and wish lists. The makeup of the new legislature is the hottest topic amongst insiders. While many are characterizing the Capitol as more conservative in the House and more liberal in the Senate than two years ago, Tim Nesbitt, president of the Oregon AFL-CIO, took the opposite view. “There are four, maybe five (Republican) legislators in the House...who have proven... they’re willing to be open to progressive legislation, whether it’s revenue raising or tax reform.” (Topics in the preview include labor unions, hospitals, employer groups, medical malpractice insurers and dentists.) FACCT closes up shop David Lansky always knew the days of FACCT, The Foundation for Accountability, were numbered. In fact, he only expected the consumer-focused foundation to survive five years at best. When he finally closed the doors, in early November, after nine years, Lansky had few regrets. In an interview with Oregon Health News Editor Diane Lund, he explains why and also talks about what the future might hold. OHN: Do you have any remorse about FACCT coming to an end? DL: No, our time was done. The good news is a lot of what we cared about is being accomplished by the National Quality Forum and the Centers for Medicare and Medicaid Services. Three to five years was the original game plan. I surpassed myself. I thought all the problems in health care could be solved by then. What we needed at the time was pretty modest, that we could develop measures and encourage major purchasers to use them. After nine years of encouraging, we accomplished everything we could and made a small difference. There’s some regret we couldn’t be more successful. Failing patient safety Not flunking, but close. The Institute of Medicine is giving the health care system a C+ in the five-year follow-up to its controversial 1999 report “To Error is Human.” The original report estimated between 44,000 and 98,000 people die annually from preventable medical errors. One expert commented it’s the equivalent of a 747 crashing every day. Yet five years after the original study caused waves in the health care community and in Congress, little has been done to reduce the number of catastrophic errors. Legislation to create a federal agency to oversee patient safety is bottled up in Congress. Many of the recommendations of the original report have gone unheeded. OMAP releases rates for 2005-07 The sparks falling from the sky can’t be blamed on shooting stars. What’s likely emerging is a battle as physicians and pharmaceutical companies begin realizing they’re in for a pretty big bang when the dollars are doled out to managed care plans next biennium for Oregon Health Plan members. Both physicians and pharmaceuticals could take a hit in the preliminary budget documents released by the Office of Medical Assistance Programs and now headed to the governor’s desk. The hospitals have nothing to fear from this document, which shows inpatient revenues increasing by 30.4 percent, while outpatient dollars go up by 25.8 percent OHP looks ahead In one of his first public appearances after taking over the helm at Medicaid, Barney Speight didn’t waffle about what the future holds for the Oregon Health Plan. Calling it the “worst of times,” Speight emphasized the need for collaboration among state government, providers and the private sector when he spoke at the Oregon Health Action Campaign’s membership meeting. “We need to keep our heads cool and work collaboratively,” he insisted. “There won’t be a lot of opportunity for growth next biennium. We have to partner with providers or we’ll face access issues. It was a lot easier to be creative in 1992 when we had a lot of money. People need to lay down their arms and talk rationally.” LIPA’s new lease After months of haggling with consumer advocates who contended Lane County IPA treated clients rudely, denied care and provided poor service, the Oregon Health Plan contractor has a new lease on life. No financial penalties are being assessed, and LIPA won’t lose its ability to manage medical care for 29,000 OHP members. Instead the health plan reached a settlement with state officials that includes a voluntary 18-month action plan during which it will implement a new complaint tracking system and form a durable medical equipment committee to review claims. LIPA also will submit a monthly log of complaints, denials and appeals to Medicaid along with its grievance system policies and procedures. Reimbursements low When it comes to paying for medical services, Medicaid doesn’t measure up very well. In fact, the numbers show the state is only paying 81 percent of cost when everything is added together, said Dr. Bruce Goldberg, administrator of the Office of Health Policy and Research. Also in this issue...
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