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January

Gov. Kulongoski keynotes Oregon Health Forum event

Governor Ted Kulongoski shared his vision for improving the health care of Oregonians when he delivered the keynote speech at Oregon Health Forum's annual leadership awards dinner on Jan 17. That event honored three exemplary health care leaders — Leda Garside, RN, BSN, clinical nurse manager at Tuality Healthcare, Dr. J. Bart McMullan Jr., president of Regence BlueCross BlueShield of Oregon and Dr. Rick Wopat, vice president and chief medical officer Samaritan Health Services.

The governor used this opportunity to outline his health care priorities — the uninsured, including children, the need for greater transparency to make better health care decisions and his thrust to improve the quality of health care professionals, while focusing on work shortage issues — saying these would be incorporated into his 2007 legislative agenda.

Health leaders weigh in on Kitzhaber’s plan

Governor John Kitzhaber’s far-reaching proposal to reform Oregon’s health care system is short on details, but those in the know are hard at work refining the edges. Insurance executives, hospital officials, physicians, consumer advocates and employers are meeting behind closed doors — sifting through the nuances to come up with a workable plan. Although their names remain anonymous for now, ultimately their fine tuning will be revealed.

On the surface, Kitzhaber’s plan completely changes the way the state uses its Medicare and Medicaid dollars as well as going after additional tax dollars from businesses that would no longer pay for health insurance.

As critics and supporters weigh in, high on the list is James Whitfield, not commonly known in Oregon circles, but a man with tremendous clout as he’s the regional director of the Centers for Medicare and Medicaid Services in Seattle.

Multnomah County reshuffle draws ire

The decision to dissolve Multnomah County’s Department of County Services and reorganize mental health, addictions and services to seniors and the disabled has advocates up in arms. Meanwhile, county officials claim their motives are pure — to improve services to clients by streamlining operations.

“We’re still unwrapping the proposal; this is a good opportunity for everyone to say what they don’t like,” said Rex Surface, who’s been interim director of the Department of County Human Services since August. Under the reorganization plan, mental health would move to the Health Department led by Lillian Shirley; alcohol and drug treatment become a part of the Community Justice Department run by Joanne Fuller and seniors and disabled programs would move to the School and Community Partnerships Division under Lolenzo Poe.

Patients left behind in power struggle

Who’s in charge here? That question’s up for debate between nurses and physician assistants who find themselves immersed in a power struggle. But a compromise could be in the works with ongoing discussions between the Oregon Nurses Association and the Oregon Medical Association.

“We’ve met with the president of the Oregon Medical Association and had a very productive conversation,” said Susan King, executive director of the Oregon Nurses Association. She contends patient care is the responsibility of physicians and registered nurses, not physician assistants. The Oregon Medical Association takes the counter position, insisting nurses should carry out medical orders from physician assistants even if the supervising physician hasn’t given the okay.

Dual eligibles turn Part D guineas pigs

In the ingenious thinking of the federal government, the nation’s most vulnerable population has become the guinea pigs of the complicated Medicare prescription drug plan.

Drug coverage under Medicaid for the 52,000 dual eligibles in Oregon ceased on New Year’s Day only to be picked up by Medicare Part D, which is wrought with difficulty. By comparison, other Medicare recipients have until May to choose a drug plan.

“It’s confusing for all of us,” said Leslie Foren, program manager of Elders in Action. “I’m sure for those who are in this vulnerable situation they feel the sense of being overwhelmed. It’s a real kick in the shins.”

Subsidy winds down

Mothers in rural Oregon may soon be hoping for an early visit from the stork.

A malpractice subsidy, which has benefited more than 1,000 rural physicians since 2003, is set to end in 2007. If the legislature fails to keep the program alive, pregnant mothers could find themselves looking for a physician. For many obstetricians, malpractice premiums almost equal the amount of income derived from delivering babies.

“It doesn’t take a rocket scientist to understand. If there’s not a renewal or some sort of relief, obstetrical care will be unheard of in rural areas,” said Dr. Chuck Hoffman who practices at St. Elizabeth Health Services and is mayor of Baker City.

Insuring Lane County

It doesn’t take a constitutional amendment or a new law for folks in Lane County to try and provide universal access in their own backyard. They’re doing it themselves with a breakthrough initiative that could be turning into a model for other communities and even a nationwide plan.

Led by the United Way of Lane County, the “100% Access Coalition “ came together as a grassroots initiative involving local physicians, non-profit groups, case workers, educators, insurance executives, providers, religious leaders and politicians. Workgroups have pulled together about 70 volunteers.

“To have one community entirely come together and say we want to make this work is a total accomplishment,” said Rhonda Busek with Lane Individual Practice Association, an Oregon Health Plan contractor.

Plan for a Healthy Oregon criticized

Apparently two isn’t better than one in the eyes of Rep. Mitch Greenlick (D—Portland) who views a second ballot measure seeking universal health coverage as "an enormous waste of time, energy and money.”

Measure 111, with its proposed ballot title “Plan for a Healthy Oregon,” calls for the 2007 legislature to create the financial and organizational framework for universal health coverage. Meanwhile, Greenlick’s “HOPE For Oregon Families” initiative, Measure 40, for which he’s already begun gathering signatures, would create a constitutional amendment declaring health care a human right.

Dr. Evan Saulino, PhD, and Dominga Lopez, RN, who penned Measure 111 and work at the Virginia Garcia Memorial Health Center have good intentions, Greenlick said. But “it’s a naïve approach that would confuse the issue.”

Rural patients left in critical condition

Oregon’s rural hospitals are seeing more black and less red thanks to an increasing number of critical access designations. Not all patients, however, are reaping the benefits.

To receive the designation, hospitals must cut their bed size to 25. For a hospital like St. Elizabeth in Baker City that doesn’t pose a problem. Its average daily census hasn’t peaked above 14 since 1999, according to reports filed with the Office for Oregon Health Policy and Research.

But, for hospitals like St. Anthony’s in Pendleton and Grande Ronde in La Grande, which both cut staffed beds from 49 to 25 in 2004, the reduction can turn into a struggle.

Sen. Smith left hanging

If Sen. Gordon Smith (R—Oregon) was a player on the television show Survivor he’d get voted off the island like others who’ve had their alliances shattered. Smith expected six other Republican senators to vote along with him in opposing any cuts to Medicaid. But when the mustard hit the table only four of those senators kept their word, forcing Vice President Dick Cheney to rush back to Washington D.C. to cast the deciding vote in favor of the Medicaid cuts.

The Federal Budget Reconciliation Act coming out of the Conference Committee and heading to the House in late January includes $4.8 billion in Medicaid reductions. It allows states to increase premiums and co-payments on previously exempt groups such as poor children. And it lifts an agreement for states to cover vision, hearing and periodic screenings.

Also in this issue...

• Smooth sailing for Northwest Physicians
• Dalto fine tunes initiative
• Washington County embraces Kaiser
• Compromise proposed for AHPs
• Drug courts gain bucks

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