Lawmakers put health care on priority list

With less than five months until the start of the next legislative session, Democrats have come out swinging with a plan to insure every child, inform consumers about the true cost of hospital care and create an independent board to review insurance rate increases.

Republicans, in general, support the children’s health initiative, although it’s unclear whether they favor a tobacco tax increase as a funding mechanism.

In July, leaders on both sides of the aisle e-mailed their legislative agendas, outlining health care, among other issues.

Measure a tough pill to swallow for some

A card-carrying member of the AARP, Jim Thompson may have a conflict of interest come November.

The Oregon State Pharmacy Association, of which Thompson is executive director, has yet to take an official stance on a measure to expand the state’s prescription drug purchasing pool to all Oregonians. But the association is likely to oppose the measure. AARP State Director Jerry Cohen, along with Sen. Bill Morrisette (D—Springfield), was the measure’s co-petitioner.

The decision hinges on the dispensing fee paid to pharmacists, Thompson said. The current program covers 7,600 uninsured Oregonians over age 55 who earn below 185 percent of the federal poverty level. Pharmacists receive $2.50 for generic drugs and $2.25 for brand names.

Advisory team wants EMS out of DHS

Oregon’s Emergency Medical Services and Trauma Systems may be going back to school. Members of an advisory team examining the embattled agency are considering, among other things, using the Board of Education as a model. Talks about how to overhaul EMS have been ongoing since March, when a report by the National Highway Traffic Safety Administration concluded that the agency has displayed “dramatic deterioration” since 1992, the last time a similar report was published.

Since then, it has “become lost in the basement of state bureaucracy,” and turned into a “revolving door for short-term state EMS directors,” according to the report.

Accountability and prominence have plagued the group for the past 15 years, according to advisory team members. “Frankly, no one is watching the hen house. There is no accountability for the performance of the group,” said Dr. Jon Jui, EMS’s medical director and a professor in the OHSU Department of Emergency Medicine.

Bariatric surgery could become the next employer mandate

Obesity has turned into a national epidemic. In fact, 25 percent of the spiraling medical costs over the past 15 years can be attributed to this epidemic, according to research published in the journal, Medical Care, in August 2006.

The latest estimates reveal that 30 percent of Americans are obese. For many the answer is bariatric surgery, which increased by 400 percent between 1998 and 2002. Hospital costs in 2002 alone amounted to $948 million, and 11.5 million adults were candidates that year.

Transparency movement hits road block

The Oregon Insurance Division’s hospital cost transparency movement is in its 11th hour. The insurance division plans to ask insurers for its hospital charge data by Sept. 1.

A new development, however, could stall the entire process, or prevent one of its biggest stakeholders from being on board when it goes forward.

If hospitals are expected to share confidential information about their charges, insurers should do the same, said Kevin Earls, vice president of finance and health policy for the Oregon Association of Hospitals and Health Systems, at a public meeting in early August. "That way both parties are giving something up in terms of transparency.”

Insurers on upswing

Health insurers are a profitable industry these days. Joel Ario, Oregon’s insurance commissioner, acknowledges that fact. That wasn't the case five years ago when they were losing money. “There’s no question they are in a better place,” he said. “The carriers are making more money than they expected.”

The Oregon Insurance Division intends to release a report in mid-September that reveals aggregate financial information about the insurance industry, including medical-loss ratios, the five largest non-medical administrative expenses, the amount spent on claims and the revenues received from premiums. This report is a requirement following the passage of Senate Bill 501.

“Lots of insurers have bottom lines above 5 percent,” said Ario at a recent Health Insurance Reform Advisory Committee meeting.

Benefits and tradeoffs for long term care

Seniors and people with disabilities will have greater protection over their estates and be less likely to face a collection agency for long-term-care services. Getting Medicaid to foot the bill, however, will probably be more difficult following the passage of a federal law.

To encourage people to purchase long-term-care plans and take the burden off Medicaid, Congress passed the Long Term Care Partnership Act in 2005. But senior advocates are doubtful.

“They are tightening up asset rules to a point where they do more harm than good,” said Jim Davis, a lobbyist for several senior groups. “There was not a lot of compassion behind this. It was simply a way to save money on Medicaid.”

Doctors face pain

Oregon’s Pain Management Commission has its work cut out for it in educating primary care physicians and other providers on ways to treat people with incurable pain, said its chair Kathy Hahn, a Bi-Mart pharmacist in Springfield.

But there’s not universal agreement about the extent of the knowledge gap. “As if doctors do not get that in medical school,” quipped Jim Kronenberg, chief operating officer for the Oregon Medical Association.

Providence pays board

Providence Health & Services is the richest health system headquartered in the west. It’s also one of the only hospital boards with facilities in Oregon that pays its board of directors.

By doing so, Providence can attract national leaders and experts, said Cheryl Sjoblom, spokeswoman, who is based at its corporate headquarters in Seattle. "The board recognized that it limited the pool of potential candidates for directors when it had a purely voluntary board.” Despite being paid for their time, more than half of its 15 members send their checks to a charity or a religious community, she added.

But other large hospital systems in Oregon, including Legacy Health System and Oregon Health & Sciences University, do not compensate their board members. Yet, according to their spokespersons, they are still able to attract top talent.

Settlement sets standards for charity care

A virtual charity care standard has been created by settlements reached with Legacy and Providence health systems over fair pricing to the uninsured. That could spell trouble for other hospitals, said Ellen Pinney, executive director of the Oregon Health Action Campaign, a consumer advocacy group.

“Any hospital that is not looking at discounting hospital bills to uninsured patients earning less than 400 percent of the federal poverty level is looking at a potential lawsuit,” Pinney said.

Also in this issue...

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• CHC taps new leader
  
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• Realtors band together
  
• A holistic welcome
  

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