Psychiatric drugs given to OHP kids

Psychiatric medications intended for adults — to relieve their anxiety disorders and depression — are being prescribed to preschool children on the Oregon Health Plan. Although the numbers are quite small — 246 children out of 86,828 in a study conducted by the Office of Mental Health and Addiction Services — most of these drugs have never been researched on young children because of ethical, health and safety concerns, said Dr. David Pollack, medical director. His team analyzed encounter and pharmacy claims data from the Office of Medical Assistance Programs.

“Diagnosing mental illness in a very young child is problematic,” said Dr. Erick Turner, medical director of the Portland VA Medical Center’s mood disorders program. “It’s a lot trickier than making a diagnosis in an adult. No diagnosis is rock solid. Even outside of psychiatry there’s always going to be some doubt, even for the things we think we know a lot about.”

Oregon’s hospitals and ASCs duke it out

The boxing gloves are off as competition heats up between physician-owned ambulatory surgical centers (ASCs) and hospitals. Lured by financial incentives and managerial freedom, surgeons across the state are venturing out on their own in increasing numbers, taking with them an important source of revenue from the hospitals.

As the struggle intensifies, ASCs have one important advantage in their corner, said Mark Charpentier, president and CEO of LifeWise Health Plan of Oregon.

They’re much cheaper. After analyzing his internal claims data, Charpentier discovered procedures such as colonoscopies and knee anthroscopy surgeries cost twice as much at a hospital compared to a physician-owned ASC. He shared this data at a seminar sponsored by Oregon Health Forum on Feb. 28.

Action expected in Providence anti-trust suit

It’s no secret Providence Health Plan and its family of hospitals and providers has control over a large segment of the health care market in Portland. But whether its actions are illegal is a question being posed in federal court for the first time not only against Providence, but any integrated health plan in the country, according to prosecuting attorneys.
Two Portland-based diagnostic imaging companies, which were booted off Providence’s provider panel in May 2005, want the health care giant to pay them for lost revenue. And they want to be reinstated on the panel.
But first, District Court Judge Garr M. King must decide whether the case should go to a jury trial. A decision could come by late March.

St. Charles-Bend gets special treatment

Last year St. Charles Medical Center was named business recycler of the year by Bend Garbage and Recycling. This year it earned another recognition — its own spot in the corner of Knott’s Landfill.

The special treatment resulted after landfill employees recorded 17 instances of improper disposal of untreated infectious waste during a three-month period that began Oct. 21. The problem was first noticed when a tube containing blood became entangled in the drive system of one of the landfill’s bulldozers.

“It’s a violation of our permit so we had to report it to DEQ,” said Tim Schimke, director of solid waste for Deschutes County.

Funding flies away

Questions are swirling about why Oregon should have to spend $1.36 million in federal grants to prevent a flu pandemic that may never occur. Aren’t there more vital public health issues, asked Dr. Susan Allan, public health director with the Department of Human Services.

“I was upset frankly they had so much pressure on avian flu when I thought the lessons from Hurricane Katrina and the tsunami were lessons we should be taking more to heart in this country,” said Allan, who believes more resources should be spent preparing for a major earthquake, which is far more likely.

The statewide emergency preparedness program desperately needs more money for staffing. Much of the $1.36 million grant will go toward improving disaster plans such as quarantine procedures, vaccine distribution, evacuation planning and general communications. While the state doesn’t have its own stockpile of emergency vaccines, working out logistics to receive medicines through the national strategic stockpile is a top priority, said Ken Murphy, director of emergency preparedness.

Hospitals get a surprise

For as long as the Joint Commission (JCAHO) has been accrediting hospitals, some have viewed its “gold standard” of approval with the kind of asterisk that goes next to Roger Maris’ home run record. It just wasn’t the same.

JCAHO visits were usually scheduled well in advance, while state inspectors surveying non-JCAHO hospitals arrived unannounced. Joint Commission hospitals pay between $26,000 and $30,000 per year for accreditation. All but seven Oregon hospitals belong, according to the Oregon Association of Hospitals and Health Systems.

“The only time we inspect a JCAHO hospital is if we have a complaint,” said Ron Prinslow, manager of the health care licensure and certification section at the Department of Human Services. “We’ll ask permission from Medicare to go in and do an inspection, which they always agree to.”

Kaiser beats out Regence in PEBB battle

Kaiser Permanente reigned supreme against Regence BlueCross BlueShield when it came down to chronic disease management results. The competition was waged by the Public Employees’ Benefit Board.

Its disease management program tracked patients with asthma, diabetes, coronary artery disease and congestive heart failure, measuring factors such as emergency room visits and how many patients regularly took their medications. Clinical measures such as blood sugar levels and high blood pressure were also considered.

On nearly all measures, Kaiser appeared more effective than Regence in 2004 following a study by AON Consulting, which analyzed clinical measures and cost data.

Banner year for SAIF

SAIF Corporation had its first banner year since the national economy collapsed in 2001. It ended 2005 with $135 million in net income, said Jerry Dykes, vice president and CFO.

The company blew through its sales targets by $6 million in 2005, bringing in 4,200 new policyholders and losing just 150. Most of the new revenue came from Oregon Health & Science University, which switched to SAIF last year and has 11,500 employees. Meanwhile, premiums rose by 9.9 percent compared to 20 percent in 2004.

SAIF has enough reserves to cover claims for the next 50-60 years. “We’re feeling comfortable about the strength of our financial position,” said Chris Davie, vice president of corporate policy and external affairs.

Douma takes over Medicaid reigns

The new face of Medicaid — Dr. Allen Douma who takes over June 1 — isn’t shy about his desire to create change. He’s a champion of information technology, the need for transparency and empowering patients to use medical services more wisely.

“My broad vision is for everyone to start working together — payers, providers and patients,” said Douma, 60, who’ll earn $114,516 annually. “We’re collecting a tremendous amount of information that could be used to help drive the future of medical care.”

Douma, who intends to hit the job running and begins working at the agency part-time Mar. 20, said he’s never met an organization that didn’t benefit from doing more. “Communication is the key to success,” he added.

Dentists and hygienists battle over scope

Children living in poverty will still have a hard time getting access to basic dental care because the Oregon Board of Dentistry has refused to change its rules. It all came down to scope of practice.

The board’s decision ended up pitting dentists against hygienists. And the dentists won, insisting only they — not dental hygienists with limited access permits — should have the authority to determine if tooth sealants are necessary.

“My understanding of tooth sealants changes by the number of times I’ve drilled into something and seen decay,” said Dr. Jean Martin, who sits on the board. “I’m not comfortable with anyone doing the diagnosis of a sealant without the proper experience.”

Also in this issue...

• ODS Companies heads to high desert
• Salem’s big health care spenders
• EHRs receive a jolt
  
• Insurance Division goes public with transparency
  
• OHP gets ESSUREance