Bates takes on universal access

An omnibus health care package is in the works for the 2007 legislature spearheaded by Sen. Alan Bates (D—Medford). He intends to have a bill drafted by November so he can start courting his colleagues on both sides of the aisle. “This is not about me putting something together,” Bates said. “My job is to do something right for Oregon and start a serious conversation about ways to bring about significant change in our health care system.”

As co-chairman of the Senate Interim Health Care Access and Affordability Commission, Bates has the perfect platform to delve into all aspects of health care reform — the Oregon Health Plan, mental health and chemical dependency services, provider reimbursement, new technology, workforce shortages and what he calls “our Byzantine insurance system.” Simply by having a standardized claims form for all insurers to use could significantly curb the paperwork at physician offices and reduce cost, he said. “Now everything is so complex. We have 42 different insurance companies for Medicare Part D. My patients are going crazy with all these forms.”

Bates isn’t alone in trying to make a difference. “If we don’t do something bold and comprehensive, we’ll end up in the same box,” said Dr. Rick Wopat, a commission member and vice president of Samaritan Health Services.

Metro debates its health care role

Metro officials may want to spend some extra time in Portland’s parks this summer.

Douglas firs and green grass could take on a new appeal if the agency dedicated to land use and transportation planning delves into the messy politics of health care. It took the first step on this murky path April 27 following a unanimous vote by council members.

Even though Metro isn’t certain about how far it might go, its potential role has already sparked controversy. Its chief critic — the Oregon Association of Hospitals and Health Systems — is questioning the scope of Metro’s reach, which is limited to the tri-county area surrounding Portland.

Money divides OMA

It was a house divided against itself by slightly less than biblical proportions.

The Oregon Medical Association clearly agreed to make health care access its top priority, but a proposed resolution at its House of Delegates in late April divided the members to no apparent end. It called for paying primary care physicians higher fees at the expense of specialists who raised objections. After much discussion, the resolution was squashed until the OMA staff and its physician leadership could do some fine tuning.

Imaging suit appealed

Lawyers for two Portland-based diagnostic imaging companies wasted no time taking their legal fight with Providence Health System to a higher court.

EPIC Imaging and Body Imaging Radiology brought their anti-trust case to the Ninth Circuit Court of Appeals in San Francisco on May 3 in the hope it will reverse a Portland District Court’s ruling which dismissed their case. It could take a year before a decision is reached.

ID required for OHP

Oregon Health Plan enrollees will deal with yet another change July 1 when federally-imposed identification requirements to crack down on illegal immigrants take effect. But few would know.

Notices won’t go out until June because officials are still in the dark about the rules, which the feds have yet to clarify. The Department of Human Services is still trying to determine if it can use a database listing birth records rather than having to produce an actual embossed birth certificate. That way people would only have to show a photo ID.

“We’re hoping we can use those screens but we’re not sure yet how far they go back,” said Karen House, program manager of the Children, Adults and Families division of DHS. “We have concerns for the homeless population, the mentally ill, developmentally disabled and those not born in a hospital.”

On the record with Peter Kohler

Put computer software and medical assistants in the same room, and what do you have? A new approach to solving the health care workforce shortage. Dr. Peter Kohler is captivated by such a concept. He’s leading an effort to turn the idea into reality before stepping down as president of Oregon Health & Science University in December. Recently Kohler shared his thoughts with Diane Lund-Muzikant, editor-in-chief of Oregon Health News. To read the entire interview, log onto our Web site www.healthforum.org and check out our What’s New section.

OHN: Your idea sounds very intriguing. Tell me more.

PK: The proposal is to try to test a different way, at the lowest level, to deliver health care by forming teams with medical assistants on the front line who’ll use an online medical diagnostic tool. They’ll have a portable screen with them, a device that’s large enough to have readable medical records and imaging studies for the initial screening.
If people need a more thorough physical examination, they’ll get referred to a nurse practitioner or a physician. Now physicians may have a panel of 1,250 patients they try to take care of. Maybe with this they could handle 5,000 patients because others would be doing a large part of the work.

Insurers fight Dirigo

Since the administrator of Maine’s ambitious state-sponsored health plan spoke to Oregon Health News (On the record with Trish Riley, September 2005), the plan’s been in a heated battle with insurance companies. Despite its struggles, key ingredients may serve as catalysts for Oregon lawmakers.

Dirigo Choice, as the plan is known, covers about 9,700 people — 43 percent were uninsured during the past year and another 10 percent were about to lose coverage. About 2,200 small businesses have enrolled their employees.

Hospital transparency movement rolls on

Joel Ario’s transparency train appears to be pushing full steam ahead. In June, he’ll ask Oregon’s major health insurers to share hospital charge data — in other words, how much they actually pay for specific hospital procedures. Thus far he’s received minimal opposition from the Oregon Association of Hospitals and Health Systems, which has, in the past, fought similar actions.

The two sides, however, aren’t sharing drinks in the lounge car quite yet.

One major sticking point revolves around private versus public information. It’s important that Medicare and Medicaid costs are bundled together with the commercial charges for each procedure, said Kevin Earls, vice president of finance and health policy for the hospital association. “We’re relegated to a cost-shifting role because we’re constantly and systematically underpaid by Medicaid and Medicare. The only place we can make that up is the negotiated rate we charge commercial carriers.”

Santa wants to probe medical errors

While much of the focus around medical errors involves reducing or eliminating them all together, an equally important question is whether hospitals and physicians are actually getting paid when they make a medical error.

An outspoken critic, Dr. John Santa, suggested the high risk pool take the lead to make certain medical errors are never paid for, while admitting it might be impossible to differentiate when, in fact, a mistake has actually occurred.

“It bothers me to see my colleagues being rewarded for their errors,” Santa, who sits on the Oregon Medical Insurance Pool Board, told his colleagues in April. “It’s time to not pay for those mistakes, and to say we’re going to start that process.”

A better view of imaging

It’s a misnomer that hospitals are alone in performing imaging scans for little or no cost to low-income Oregonians, according to Bill Dunlap, center manager of EPIC Imaging. In 2004, his company provided $339,000 of free and discounted services.

“Hospitals don’t like to have to worry about competition and pricing because it takes away from their profitability and control of the market,” Dunlap said. “Competition requires hospitals to focus on improving customer service and control pricing. Hospitals should be a place where the patient is directed when all lower cost outpatient options fail rather than the other way around. I believe that many health care administrators have forgotten that physicians practice medicine, not hospitals.”

Also in this issue...

• Insurance Division unveils its 2007 legislative concepts
• Oregon nurses question complaint system
• State’s CON office keeps its hands full
  
• Children’s health plan up for grabs
  
• OMA shortens its tort reform approach

Want to read the entire stories? Click here to subscribe! Or call our office at (503) 226-7870 or email us at staff@healthforum.org and we'd be happy to send you a complimentary copy of this month's issue. .