RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Reimbursement without insurance: The cost of free medical care at the Cottage Grove Emergency Department. Project Date: 6/29/2009 The burden of loss of healthcare insurance has been a politically hot topic recently as our country’s leaders are struggling to find a solution to our failing healthcare system. I investigated the problem of uninsured patients seeking healthcare in the Emergency Department at the Community Hospital in Cottage Grove, Oregon, by analyzing financial records and determining total charges and reimbursement characteristics over several years. Comparison of data from 2005, 2008 and estimates for 2009 indicated a steadily increasing proportion of charges were made charged to uninsured patients. Furthermore, there was a coinciding steady decrease in the amount of charges made to patients with commercial insurance. These results indicate a shift in charges, which coincide with national trends indicating increased loss of insurance as unemployment levels continue to rise and other factors are contributing to patients’ loss of insurance. Through programs such as PeaceHealth’s “Bridge Assistance,” our regional healthcare systems are struggling to stay afloat as Congress continues to debate healthcare reform and the Federal Government continues to bail out major healthcare systems across the nation. Assessment of the Mental Health Resources in Milton-Freewater, OR Project Date: 10/13/2008 There is a universal need for mental health services in all areas of rural Oregon, including communities like Milton-Freewater. Additionally, there is an appreciable discrepancy between the services that are available for those who have private insurance, those who use state or federal plans such as OHP and Medicare/ Medicaid and those who have no health coverage. While this may be true for both urban and rural communities alike, there are other additional obstacles more unique to a rural area. Also, some of the mental health care can be provided by local primary care practitioners, however, they often lack the time and the specialized knowledge necessary for anything but maintaining patients that are already stable and in good control of their disease. Additionally, in a rural setting where social workers are not readily accessible, making it more difficult for physicians to know the local resources available in order to effectively help their patients. It was a general consensus from those interviewed for this project that the mental health resources of Milton-Freewater are lacking in many ways; however, there are still some very important services to be used. The goal of this project is to show both what resources are and are not available with the hope that those resources that still exist will be more effectively used. Only YOU Can Prevent Colorectal Cancer The Prevalence of Colorectal Cancer Screening at Philomath Family Medicine Project Date: 9/8/2008 Colorectal cancer (CRC) is the third most common type of cancer and the second most common cancer killer in the United States. As a result, an effort is being made to emphasize screening for colorectal cancer to find it before it starts. The methods that are now recommended that can detect pre-cancerous lesions are colonoscopy and flexible sigmoidoscopy with fecal occult blood testing (FOBT), and only FOBT. I was concerned that in a smaller town such as Philomath, OR that these new recommendations may not be in practice. Through my observation of physicians in the practice I was at I saw that indeed these guidelines are in practice. I also did a chart review to get a feel for how many people have been screened for colorectal cancer and if so which methods they used. Eighty patients ages 50 and older were investigated via chart review or direct questioning and it was found that 68 had been screened for CRC and 12 of them had not. The most common method chosen for CRC screening was colonoscopy. Patients who had not been screened were contacted and asked if they would be willing to state the reason they had not been screened for colorectal cancer. Reasons included cost, lack of insurance coverage, lack of doctor visits, lack of discussion with physician, or simply they have not wished to be screened. A brochure explaining the importance of CRC screening and the methods available for screening was sent to patients who had not been screened. Emergency Contraception in Baker County: Compliance with Laws Governing Access and Dispensing Project Date: 4/28/2008 In August of 2006, the FDA approved the emergency contraceptive Plan B to e available over-the-counter in pharmacies nationwide. In 2007, during the Oregon Legislative Assembly passed House Bill 2700, which requires health insurance plans in Oregon to cover prescription contraceptives. It also requires emergency rooms to provide information about emergency contraceptives to all female victims of sexual assault, and to administer emergency contraceptives to these patients while they are in the emergency room if they so desire. Interviews with the county's five pharmacists revealed that four of the five pharmacies in Baker County carry Plan B and dispense it over-the-counter to those 18 and older, and with a prescription to those 17 and under. Conversations with Emergency Department staff at St. Elizabeth Health Services revealed compliance with the spirit of the law, as it applies to victims of sexual assault. Access to emergency contraception in Baker County is further improved by the efforts of the health department, where it is available for free. The final area investigated in this project was the state of the high school health curriculum, which competently addresses contraceptives, including Plan B, and teaches students how to access birth control. A letter detailing these findings was distributed to health department workers as well as 7 physicians and 4 nurse practitioners in Baker City. The Oregon Prescription Drug Plan & the Uninsured and Underinsured Residents of Harney County Project Date: 12/31/2007 Senate Bill 362 is an amendment passed in the legislature in April, 2007 that expanded the Oregon Prescription Drug Plan (Ballot Measure 44). All Oregonians are now eligible for a free discount card for prescription drugs. Unfortunately, the bill did not include adequate funding to promote the program. Given the high costs of prescription drugs and the difficulty many Harney County residents have paying for their medications, this project was designed to increase local familiarization with the program and also to better understand the workings of the program. How well known is the program? How does it work and is there a true benefit? Is it possible for it to be sustainable in the long term? To answer these questions, staff members at the clinic and hospital were interviewed. Community resources to help patients pay for medications were evaluated, and interviews with the pharmacists in Burns, the director and assistant director of the OPDP, the executive director of the Oregon Pharmacies Association and a reporter from the Oregonian were conducted. In the end, two articles were written for the Burns Times Herald, the first informing citizens that the program is available with instructions to register. The second article focused on the details of the program, its funding and its future. Notifications were placed in several church bulletins in town, and the hospital, clinic and senior center were provided with resources to promote enrollment in the program. The benefits and drawbacks of the program were discussed with staff at the hospital and clinic so they could continue to educate patients in the future. Pattern of Emergency Department Use at Mountain View Hospital in Madras, Oregon Project Date: 9/10/2007 The emergency department use in the United States has reached an unprecedented level. The overcrowding and runaway costs that have resulted are an impetus to investigate ways to redirect nonemergent patrons from the emergency department to the primary care clinic. Despite the common opinion that patients who do not have a primary care physician or health insurance account for the majority of misuse, this is not well supported by published evidence. In single urban center research studies and a nationwide survey have found instead that lack of a regular primary care physician or insurance do not correlate with decrease emergency department use. Studies of single urban centers in particular may not be representative of rural healthcare entities. The issue of ED misuse has not been addressed in the specific setting of a rural ED. In this community-oriented primary care project, it was hypothesized that discernible groups among a small community may disproportionately use the emergency department for nonemergent care and thus provide a suitable target for interventions to decrease this misuse. To this end, emergency department visitors with various local primary care providers were documented for a one-week period and categorized as emergent or nonemergent. Although the numbers in the study were low, they suggest that patients from certain primary care clinics do have disproportionately high levels of emergency department use for nonemergencies. Reasons for this may include deficient patient education measures at these clinics and low weekly business hours. Med-Help: A booklet designed to guide those who need prescription assistance Project Date: 8/6/2007 For many ailments, prescription drugs are the backbone of current treatment. Many times, medication compliance has a direct impact on ones quality of life as well as longevity. Between 1998-2000, the cost of prescription medications rose more than triple the rate of inflation, putting them out of reach for many.1 In order for these patients to continue taking their medications, they need financial assistance. This study was designed with two objectives: First, to identify the population seen at the Wellness Clinic in Roseburg, Oregon. This was accomplished by running billing reports to establish populations by insurance type, since this has a significant impact on what assistance programs are available. Second, to research prescription assistance programs available for this population and design a simple means of delivering that information. It was decided that a booklet would be the best means of delivering the information. It was found that 47% of the patients were on Medicare, 5% were uninsured, and 2% on OHP. Those figures were used in researching prescription assistance programs for this population. A nine-page booklet was then constructed, using only resources already available to the clinic. This strategy was to minimize the burden to the clinic in continuing to make the booklet available to their patients. Physician Shortage: Who Will Bear the Burden? Project Date: 4/30/2007 A primary care physician shortage currently affects or is predicted to affect America. While much-deserved, growing attention is being directed at populations who are unable to access medical care because they lack medical insurance, this study attempted to support an observation that certain subsets of the medically insured population would bear a growingly disproportionate burden of the predicted physician shortage, despite medical insurance. The subset of the medically insured population studied was Medicare patients. The study design consisted of primary and secondary data collection in the form of physician surveys and population demographics. Data collected touched on both the deficiency of health care coverage in rural counties, and perhaps more importantly, the flux of disparity in access to this precious and increasingly limited commodity. Data collected clearly revealed a present access inequality in Douglas County and Roseburg, Oregon. Data also revealed that access to primary health care was reduced even among the medically insured population, specifically Medicare patients. Analysis of this data further demonstrated that three explanations were readily available for the growing disparity in access to care between the general insured population and Medicare patients: diminished rates of reimbursement; increased medical complexity; and demographic shift. Interpretation of this data would suggest that the predicted primary physician shortage would only aggravate this disproportionate burden already borne by the underserved and now by Medicare patients. Does the presence of a After Hours Pediatric Clinic Reduce the number of Pediatric Emergency Room visits in a Rural Oregon Community Project Date: 4/30/2007 Increasing health care costs continue to be a major problem for the Oregon Health Plan (OHP). OHP continues to find ways to lower costs in order to provide more health care coverage to more people. The objective of this student was to evaluate the efficacy of an After Hours pediatric clinic (AHPC) in decreasing the number of pediatric emergency department visits, particularly in pediatric patients with OHP insurance. In an effort to decrease the number of ED visits OHP agreed to help subsidize the AHPC with a fixed rate per day, with the goal of decreasing the number of ED visits, by OHP patients, by an average of 4 visits per day. Two Coos County pediatric practices, consisting of 9 pediatricians, collaborated to start an After Hour pediatric clinic. The clinic was to be open from 5-8 pm on weekdays, and 8-noon on Saturdays, with the goal of decreasing pediatric emergency department visits. Community-based health insurance: an innovative solution for John Day’s un- and under- insured. Project Date: 3/19/2007 The community of John Day, Oregon has a number of un- and under-insured citizens who pay large amounts out-of-pocket on healthcare. Many wait to see an MD until they are sick and do not seek preventive care. They represent the fastest-growing group of uninsured in America: the uninsured who are employed and do not qualify for categorical eligibility for public programs (Medicare, OHP). Patients of the Strawberry Wilderness Community Clinic were surveyed regarding their demographics, insurance status, and opinions on a potential new healthcare plan. This plan, known as community-based health insurance (CHI) is used in developing countries and involves patients contributing a small amount of money per month ($10) to a risk-pool which can then defray healthcare costs among the community. There are certain limitations, and for John Day, the initial plan would only cover the cost of a clinic visit (no meds/labs). Nearly all un- and under-insured surveyed would be interested in this plan and willing to pay the proposed fee. Their concerns were about overuse of the system by a few. Physicians surveyed were all interested in the program, but had serious concerns about cost and too few patients for it to be economically feasible. Momentum for the plan would a barrier to implantation, as healthcare in the US seems to be “stuck” with a lack of innovation for new ways to ensure access. CHI would be one such way. Access to Care and the Impact on Emergency Department Utilization in Madras, Oregon Project Date: 3/19/2007 Access to health care is an important issue nationwide and is particularly salient in Oregon right now with multiple health care reform measures headed for the legislature. Utilization of emergency services can be used as a proxy to measure access to primary care. Key informant interviews were administered in tape-recorded sessions with health care providers and administrators in a rural Oregon community. The key informants were providers and administrators from Mt. View Hospital (MVH) in Madras, Oregon and from the four clinics that serve MVH. The interview sought to explore primary care providers' perceptions and experience with access to care issues in their communities, including questions about what affects access, trends in access and utilization, perceived needs to improve access and delivery of care, Emergency Department use, and strengths and challenges of primary care. Interviewees indicated that access to care is affected by health insurance, cultural and educational barriers, and common (misperceptions. Trends include a changing population that brings changing health care demands and narrowing financial margin. ED is thought to be overused for non-urgent/non-emergent care, in particular by those who feel no financial consequence. In the opinions of providers as well as administrators, access needs to be improved by legislation that changes the structure of health care programs. The Bridge Assistance Program: Improving access to necessary health care in Florence, OR Project Date: 8/7/2006 Access to health care is a problem in rural communities no less than it is in cities. Indeed, rural communities often have fewer organizations and resources to assist people in accessing health care than do their urban counterparts. As the primary source of medical care in Florence, Oregon, the Peace Harbor Hospital and Health Associates utilize an innovative program to assist those members of the community who would otherwise fall through the cracks among private means, insurance and social programs. The Bridge Assistance Program provides medically necessary services to patients at reduced or no cost once it has been determined that payment for those services cannot be obtained from outside resources. The program focuses on providing preventive and early care in order to reduce costs related to acute care and collections processes. This project explores the criteria used to determine eligibility for the program and the types of health care the program helps patients to access. Patient feedback was analyzed to determine the circumstances that led patients to seek assistance from this program, the satisfaction patients have with the assistance they received and what patients believe the program could do to improve. Study results found that the Bridge Assistance Program serves a vital role for patients who cannot afford necessary health care and do not qualify for sufficient assistance from other aid programs to meet their medical needs. Patients were generally very satisfied with the assistance they received from this program, though lack of dental and vision services at Peace Harbor as well as the high cost of prescription medications continue to be factors that limit access to health care for these patients. Attempts to Document Healthcare Perceptions and Expectations of Scappoose Oregon Residents Project Date: 7/3/2006 This study intends to document the perceptions and expectations of healthcare in the rural community of Scappoose, Oregon for use in future healthcare reform. Despite multi-faceted aggressive public invitational postings no community members attended “town hall” style meetings. Further verbal invitations to local churches resulted in five parishioners who perceived most to least significant healthcare issues as being; 1)unavailable/inadequate health insurance, 2)inadequate access to providers, 3)lack of transportation options to an urban center and 4)treatment plans unrealistic in a rural setting. Their expectations included reform to be driven at the federal rather than state level and that such reform include adequate funding. Overall, the failure to generate adequate community participation in this study must be considered in all future efforts to understand healthcare in rural Oregon. Assessment of Housing and In-Home Care Options for Seniors in Astoria Project Date: 5/1/2006 In Clatsop County, the percentage of the population over the age of 65 was 15% in 2005, but this number is projected to increase to 24% by the year 2025. The need for long term-care services is steadily increasing as well. Initiating the conversation about the need for more assistance in the home can be difficult for seniors and their families. Furthermore, once the decision has been made, determining the level of care needed and researching the options is complex. Within Pacific Family Medicine, it has been observed that seniors and their families are uninformed about the housing and in-home care options available in their community and lack adequate resources to make informed decisions about long-term care. The purpose of this project was to provide information about different types of housing and in-home care options for seniors, facilitate discussion between families about the need for more assistance in the home, and provide tools to help people assess their level of need and evaluate their options. The final product of this project is a resource guide to be utilized by seniors and their families. Medicare drug plans in Burns, Oregon Project Date: 3/20/2006 In the town of Burns, Oregon, Medicare-eligible patients who had been receiving their medications for free from drug company patient assist programs (PAPs) were informed that most of the drug company assist programs would no longer provide their medications after the Medicare Part D deadline of May 15, 2006. In response to such news, there was much confusion for health care providers and patients. In addition to Medicare Part D, the federal government also instituted a separate subsidy program for the drug plan through Social Security to assist low-income patients. My project looked into all Medicare-eligible patients in the Burns health clinic who had received drug company assist in the past six months to see whether patients were deciding to join a drug plan and to gauge the extent of their knowledge of the additional help through Social Security as more patients on drug company assist would probably qualify for the extra subsidy than the general Medicare patient population. In Burns, there were a total of 163 patients who had received medications from drug company assist programs in the past six months, 116 (71%) of whom were Medicare-eligible. I conducted a phone survey to all the Medicare-eligible, PAPs patients and spoke to 71 patients (61%). Each patient was called at least twice over a course of three days. Maximizing Access to Prescription Medications in Ontario, Oregon Project Date: 3/20/2006 Medicare Part D is an insurance plan for prescription medications that recently became available to everyone enrolled in Medicare. It was designed to provide coverage for prescription medications regardless of income, health status, or costs. With over 450 different plans available in Oregon, and insurance coverage that varies depending upon prescription costs, many patients have questions about choosing a specific plan, and determining if Medicare Part D is right for them. The deadline for joining Medicare Part D without penalty is rapidly approaching, making it even more important for patients to be able to make informed decisions in a timely manner. This study looks at how residents in Ontario, Oregon are making important decisions regarding Medicare coverage, and identifies resources that patients have found useful. In addition, some of the complications with Medicare Part D have been identified, so that they may be avoided in the future. It is hoped that the results of this study will help patients make informed decisions about Medicare Part D, and maximize their access to prescription medications. Babies First! in Baker County Project Date: 10/17/2005 Home visit services by public health nurses have been repeatedly shown to improve health outcomes (Olds & Kitzman, 1993). Oregon’s Babies First! Program was started in 1990 to provide public health nurse visitation services to families of infants who were at risk for poor health or developmental outcomes. In 2004, 63 of 151 births to mothers residing in Baker County (40%) were paid for by Medicaid/Oregon Health Plan (OHP), yet the Baker County Babies First! program few clients because of poor community reputation and a lack of physician referrals. This project developed a referral slip and presentations to physicians to increase awareness of the services available, and the program revisions. The information and referral slips were well-received by physicians, but further work remains to strengthen Babies First! in Baker County. The effect of the new Medicare Prescription Drug Benefit on the 65 and older population at the OHSU Scappoose Primary Care Center Project Date: 9/12/2005 A significant number of the OHSU Scappoose Primary Care Center's patients who are 65 and older do not have prescription drug coverage. These patients bear the entire cost of their medications, and many carefully weigh treatment decisions based on cost. In the author's time at the Scappoose Clinic, numerous encounters were noted with patients from this population where prescription cost was a larger consideration in therapy selection than for those who have prescription coverage. This project describes how the clinic's patients will potentially be affected by new Medicare legislation, effective January 1, 2006, that will provide prescription drug coverage for millions of retired Americans. Pediatric Follow-Up for Infants of Uninsured Hispanic Women in Madras, Oregon Project Date: 9/12/2005 Pressure from restraints of the current health care system, as well as recent advancements in methods to prevent and treat disease have put preventative health care in the forefront of the minds of primary care physicians and public health professionals. Unfortunately, in the area of pediatrics, recommendations for preventative services have not always been supported with well studied and documented evidence. This is true of the current standard system for well-child visits to general pediatricians. Although routine immunization has been strongly supported with clinical trials, very few of the current accepted practices of behavioral counseling and routine screening during well child visits are supported by solid evidence. Despite the lack of evidence, the American Academy of Pediatrics' Guidelines for Preventative Pediatric Health Care have become the standard of care and are expected by pediatricians and parents alike. This study looks at a population of children born to uninsured Hispanic mothers in Madras, Oregon and attempts to answer two questions. First, chart review and a database of national health statistics were used to determine whether this particular population of young infants is receiving preventative health care at a rate equivalent to national levels. Second, two subsets of the population were compared in an attempt to assess the efficacy of well-child care in preventing disease and its usefulness in contributing to the full vaccination of this subset of children. Results show that the study population is receiving preventative healthcare services that meet the current community standards. They also suggest that children that receive higher levels of those services are more likely to be healthy, immunized and free of disease. Healthcare for the Underserved Population of Grant County. Project Date: 9/12/2005 Rural areas in Oregon tend to have large percentages of patients on Medicare or Medicaid than do larger more metropolitan areas. Grant County Oregon is served by four family doctors who not only see patients during clinic hours, but are on call 24 hours a day, seven days a week to staff the emergency room at Blue Mountain Hospital, the only hospital in the county. Grant County has a very vulnerable and needy population in terms of the ability to access and pay for medical care. 25% of people live at or below the poverty level, and 60% live at or below 200% of the poverty level. More than 60% of the patients who are treated at the Blue Mountain Hospital are on either Medicare or Medicaid. According to the US Census Bureau, about 18% of the population is living with some sort of disability. This situation is a reality in Grant County. Medicare and Medicaid programs only paid about two thirds of the charges that were billed to them from the Strawberry Clinic. This resulted in a loss of $30,000 last year. In March, 2005, the clinic became a Rural Health Clinic in an attempt to continue caring for the rural community. Patient Education Materials at the East Linn Community Clinic: Providing a Much Needed Resource. Project Date: 9/12/2005 The East Linn Community Clinic provides free medical care to uninsured citizens of Albany and Lebanon, Oregon and their surrounding communities. The clinic has struggled to obtain and provide educational handouts for the patients who utilize their services and they desired to improve this aspect of their care. Interviews with two individuals closely connected to the clinic were conducted to better understand their need and educational materials were loaded onto a laptop computer donated to the clinic. Materials were downloaded from well-known medical sites on the internet and a letter of request for a donation was sent to a prominent patient education software company. In addition, readability levels of patient handouts were compared. Utilization of Eye Care Services by Patients of Scappoose, Oregon Project Date: 2/7/2005 Blindness and visual impairment currently affects over 3 million Americans and this number is growing. Visual impairment and blindness are easily prevented in many circumstances through timely eye screening and treatment. Rural populations are traditionally limited in availability of specialized care. The aim of this project is to determine patterns of utilization of eye care services in the rural town of Scappoose. To achieve this goal, patients were surveyed during a 2 week period regarding their risk factors, utilization of eye care services, and vision coverage. Seventy-three patients completed the survey. All of the patients were over 18, with a mean age of 46.57 years. Nineteen patients reported having existing eye disease that included age related macular degeneration, glaucoma, and multiple sclerosis. Seventeen patients reported a history of diabetes, 35 % of these patients had not received a comprehensive eye exam in the past 2 years. The most common reasons given for failing to seek eye care were lack of vision insurance and lack of tangible vision problems. Based on the findings of this survey, an informational brochure was produced for patients. This brochure focused on: 1. Highlighting current screening recommendations, 2. Educating patients regarding common eye disorders, and 3. Providing uninsured patients with resources to obtain vision coverage. This brochure was made available to patients in the clinic waiting room. The four primary care providers at Scappoose were also provided with copies of a recent review article tailored to PCP’s that highlights the recommended role of PCP’s in preventing blindness and visual impairment. Informal discussions were held with each provider to highlight the findings from this project and emphasize their role in vision screening. Increasing Access to Prescription Medications in the Elderly Population of Malheur County Project Date: 2/7/2005 Many elderly patients take prescription medications on a daily basis; however, the rising costs of these medications make it difficult for patients, especially those with fixed or low incomes, to afford them. For elderly patients in the rural setting, the problem of access to affordable medications is even greater because of the lack of social workers and other staff available to assist patients with applying for prescription assistance programs, Medicare discount cards, and other lower-cost prescription medication programs. Many patients report that their prescription drugs cause them financial hardship. This often leads to patients skipping or cutting down on doses or not filling the prescriptions at all. This is frustrating for both the patient and physician who both are trying to manage what are usually complicated medical conditions. Oftentimes, the physician, nurses, and other office staff take on the responsibility of helping patients access medication assistance programs, which is both time and resource consuming for the staff. This project looked at the elderly population represented in one family practice office in Ontario, Oregon, which is the largest city in Malheur County. A prescription drug questionnaire was utilized to query patients about out-of-pocket prescription medication costs, methods of cost savings (e.g. buying online, skipping doses, etc), and knowledge about cost saving prescription drug programs. A total of 22 patients, age 65 and over, completed the survey, with 45% responding that the cost of prescription medications cause them financial hardship. These patients spent an average of $187.00 a month on prescription medications, and 70% report having no prescription drug coverage. Of the 55% that did not experience financial hardship, 92% had some type of drug coverage and spent an average of $49 a month on medication. Of all the patients surveyed, 45% report using cost-saving methods, including using mail-order companies in Canada, price comparing among different pharmacies, using samples, skipping doses, and not filling prescriptions. Ultimately, the goal of this project was to identify ways to help patients gain access to affordable prescription medications in the most time and resource efficient manner. Development of a simple one page handout with prescription medication resources and consumer buying tips, which could be easily distributed to patients, was found to be the most efficient and helpful to patients. How Oregon Health Plan Cutbacks Have Affected Rural Oregon: Trends in Emergency Department Use at Blue Mountain Hospital, John Day, Oregon Project Date: 1/3/2005 In early 2003, Oregon’s Medicaid program underwent a number of revisions in order to comply with new budgetary limitations that were a result of the state’s fiscal crisis. Among the changes were reduced benefits and increased cost sharing via premiums and co-payments. Rural communities in Oregon face a unique set of healthcare challenges, to which these Oregon Health Plan cutbacks were added. The purpose of this study was to compare emergency department use at Blue Mountain Hospital in John Day, Oregon, in the months preceding and following the cutbacks. Total ED visits and payer type data were gathered using the hospital’s computerized billing system. The results were analyzed at 95% confidence intervals for both percent changes in absolute number of visits per month and proportion of ED visits due to each group; T-values and relative risk were calculated where appropriate. OHP managed care visits decreased 24%, and the proportion of all ED visits for which they were responsible fell from 13% to 9% (RR 0.904), whereas OHP fee-for-service visits increased 95% per month, their proportion rising from 2% to 4% (RR 1.79). Uninsured visits rose a statistically insignificant 6% and their proportion of total ED visits was practically unchanged. Following the cutbacks, the percentage of Grant County citizens eligible for OHP who were enrolled dropped from a monthly average of 86% to 72%. In addition to the sudden drop in OHP enrollment and resultant decreased use of the ED by OHP managed care beneficiaries, new barriers to healthcare may have caused the significant rise in ED visits by OHP fee-for-service patients. Although the number and proportion of visits by the uninsured was unchanged, deteriorating health and continued lack of state support will force this growing group to turn to emergency departments for care. A new way to save on prescription drugs? Educating the physicians and Medicare patients of Klamath Family Practice on the Medicare-Approved Drug Discount Cards Project Date: 1/3/2005 The cost of prescription drugs continues to be a major health issue in the United States, especially for elderly patients on Medicare. The goal of the project was to educate the physicians and Medicare patients of Klamath Family Practice about Medicare-approved drug discount cards so that patients could take maximum advantage of the offered savings. First, the project was designed to interact with Medicare patients and try to understand how they currently try to save money on prescription drugs and determine how familiar they were with the new Medicare-approved drug discount cards. After determining that the physicians and patients knew very little about this new program from lack of available information, the program was thoroughly researched to determine if Medicare patients would benefit from these new discount drug cards or not. The physicians were educated about the new program, and the final product of this project was the development of a poster for the lobby and a brochure to educate Medicare patients about this new program and help them save money on prescription drugs. Financial Burden on Lower Umpqua Hospital (LUH) Due to Traumatic ATV Accidents of Uninsured Patients’ During 2004 Project Date: 1/3/2005 Reedsport, Oregon is located within the Oregon Dunes National Recreation (ODNR) area, a vast landscape of sand dunes that is used, among other activities, for riding all-terrain vehicles (ATV). Riding is open all year long, but there is a four-day event at the end of July known as DunesFest during which riders come from all over the nation to race their ATV’s and party. Alcohol is not strictly regulated on the dunes and, this, combined with periods of heavy ATV traffic, results in a significant number of trauma accidents throughout the year. Given that ATV riding is an expensive sport, nearly all riders could afford insurance. However, many of those that are injured are either inadequately insured or, more likely, do not have health insurance. This puts a great financial burden on LUH, as one of its very important functions within the community is acting as a “safety net” hospital, treating many uninsured patients’ for unforeseen illness and acute injury. The added impact of expensive ATV traumas that go unpaid compromises the ability of the hospital to act as a safety net. This research showed that uninsured ATV traumas were costly to the hospital during 2004 and that during the month of July the amount unpaid was a significant percentage of the total billed. Additionally, it was shown that July, August and September were particularly hard hit by uninsured ATV trauma and that most of the patients were either from out of town or from a different state. Finally, the results were used to formulate a plan to contact a state legislator to discuss the feasability of mandating accident insurance for all ATV riders riding within the ODNR area. Addressing A Possible Solution for Specialty Outreach Clinics. Project Date: 9/13/2004 OHSU Scappoose Family Practice was recently designated a Rural Health Center. While this designation provides adequate primary care reimbursement for Medicaid and Medicare patients, these patients still experience delays establishing tertiary care. To address a possible solution to this problem we researched the plausibility of specialty outreach clinics. We reviewed 1,000 referrals from the OHSU Scappoose Rural Health Center in 1999 to identify potential specialties with enough patient demand to warrant regular scheduled visits to Scappoose Family Practice Clinic. We also identified which specialties are limited to location by technology, and finally we asked the question if specialties did come to the Scappoose clinic on a regular schedule, would this expedite Medicaid and Medicare patient access to tertiary care. Our findings identified five tertiary specialties that have met these preliminary criteria; Orthopedics, Cardiology, Otolaryngology, Rheumatology, and Dermatology. The rising cost of prescription medications continues to impact the lives of many individuals. Project Date: 9/13/2004 The rising cost of prescription medications continues to impact the lives of many individuals. It is one thing to hear that prescription medications are expensive, it is quite another to put a name and a life to the out-of-pocket cost than an individual has to pay in order to maintain health. The majority of prescription medications are utilized by individuals greater than 65 years old. In the retirement community of Florence, individuals 65 years and older represent 35% of the population and also represent the fastest growing group of individuals. In order to better understand the impact of the price of prescription medications on the elderly population of Florence, the aims of this study were to 1) determine the average out-of-pocket price of medication for individuals on Medicare or Private insurance; 2) research the price of commonly prescribed medications; and 3) to conduct a survey in order to better appreciate the impact of the cost of prescription drugs on patients in Florence. This experience not only helped me to become more aware that simply writing a prescription for a medication was not necessarily going to mean that a patient was going to be able to take the medication. Lastly, through observing patients as well as my preceptor, I learned that there are alternative ways to obtain prescription medications in order to ensure that patients are able to receive the medicine that they need to maintain health. Lack of Health Care benefits Project Date: 3/29/2004 In the past 6 weeks I have been very fortunate to work with Dr. Lance Loberg, Medical Director for NW Human Services community clinics. Because of the comprehensive care provided through this agency, I had the unique opportunity to see patients at the West Salem Clinic, Total Health in Monmouth and H.O.A.P. Mental Health clinic for the homeless and underserved. The experience of being immersed in the lives of such diverse populations enabled me to learn their different interests and life dreams as well as their common fears and frustrations. In a short time, it became frightingly apparent to me how many members of the Salem communty were living with diabetes and felt like they were fighting against more barriers than they could handle. With the decline in health care benefits and services, most patients had lot their mental health and prescription coverage. This left them using unavailable financial resources to provide for medical care and medications. Combined with the current unemployment rate and the increase in costs of living, many hard working people found it necessary to choose between their health and the basic welfare of their family. Success of OHP in Coos County, Oregon Project Date: 1/5/2004 In 1989, the state of Oregon embarked on a controversial experiment in the financing of health care. The state planned to add many uninsured people to the Medicaid program and to pay for this expansion by reducing the Medicaid benefit package -- more people would be covered, but for fewer services. To keep the costs of this policy within affordable limits, the legislature determined that the services provided should constitute a basic healthcare package, and it sought to ensure that Medicaid recipients were, whenever possible, enrolled in managed care plans. This program was titled the Oregon Health Plan (OHP). Since implantation of OHP in 1994, there has been a statewide decrease in per capita health care costs, a greater than 50% reduction in uninsured children, and a nearly 50% reduction for adults. It appears that OHP has improved accessibility of health care in Oregon. The emphasis of my research project was on the impact of OHP on Coos county. Specifically I studied whether OHP has accomplished it’s goal of ensuring adequate health coverage to the people in Coos County and whether accepting OHP patients puts Coos county physicians and clinics at a financial disadvantage? In 1995, Doctors of Oregon Coast South (DOCS) was found in Coos County as a managed care program that would serve the county’s Medicaid population. Since that time, profitability for physicians and access to care for citizens have improved. The project investigates the relative success of the managed care program in Coos county, it’s downfalls and it’s possible future. This investigation reveals that even under a fully capitated managed care environment, the clinic can be successful and the community is well served by OHP. Following is a compilation of information I gathered for this project. Most of this information stem from different sources such as physicians, financial officers and other health care workers. Reports published by Oregon Health Policy and Research have also been used in conjunction with financial data provided by the clinic administrator, and legislative reports. Views on Medicare Reform Bill from people who it affects most Project Date: 11/10/2003 Over 35 million US seniors today rely on Medicare as their primary health insurance. These seniors have very few/no options for prescription drug coverage, and none of these options are part of a routine Medical benefit package. In an attempt to address this situation, this year the Medicare Prescription Drug Improvement and Modernization Act of 2003 was passed by the U.S. Congress. The intent of this bill was to offer seniors a limited drug benefit as well a competitive choices in health plans, a number of reimbursement increases for physicians, and many other changes to Medicare in general. The intent of my projects was twofold. My first objective was to determine how well the seniors understood this new legislation and what their general view of it was. Secondly, I wanted to determine the legislation's impact on the sample of elderly Medicare recipients from the Florence, OR family practice clinic where I worked. A phone and office interviews were conducted to examine these issues. The results indicated of an almost even 48% to 52% division in support for and against this reform, repectively. However, the understanding of the details of this legislation was lacking for a majoirty of seniors. It was also evident, that if the sample is representative of the Medicare recipient community in Florence, at least 40% will not see any relief in their current prescription medication costs. Emergency Eminent: Dunefest 2002 Project Date: 7/1/2002 OBJECTIVE: To assess the emergency preparedness of the Umpqua Lower Hospital's Emergency Room, EMS system, and Operating Room for Dunefest 2002. To offer suggestions for next year's Dunefest based on the problem areas identified through this assessment. METHODS: Dunefest planning meetings, sponsored by the Reedsport Chamber of Commerce, were attended. Records of past Dunefests were reviewed, including ER and EMS logs, and these were discussed with personnel who were present those years. An assessment was made concerning the state of preparedness for Dunefest 2002. After the event, preparedness was reassessed based on experiences in on ambulance rides, in the ER and OR, and through discussion with hospital and EMS administrators. RESULTS: Chart review and previous Dunefest experience from 1999, 2000, and 2001 dictate the importance of increasing law enforcement and decreasing the number of people camped at the event site. This year, EMS was well prepared and easily handled their responsibilities. Increased staffing in the OR allowed for the multiple orthopedic cases that were expected; however, some supplies were low or unavailable. The ER physicians were challenged in keeping up with the number of emergencies resulting from the event. The hospital is most likely losing money through the event, due to the increased influx of uninsured patients. CONCLUSIONS: This year's preparation was adequate. An internal audit is recommended to determine whether Dunefest is resulting in a net loss in the hospital's finances. The Dunefest committee for 2003 should consider a fee for event insurance to offset the costs of treating the uninsured accident victims. The OR and ER should be stocked at least three days prior to the Dunefest events. A backup plan should be devised for overburdened ER physicians during the event. Effects Of The Oregon Health Plan In John Day, Oregon. Project Date: 9/24/2001 Since the Oregon Health Plan was implemented in 1990, there has been a statewide decrease in per capita health care costs, a greater than 50% reduction in uninsured children, and a nearly 50% reduction for adults. (1) OHP has clearly made a positive impact on the shape of health care in Oregon. I became curious about the impact of OHP on rural clinics and communities while rotating at Strawberry Wilderness Family Clinic in John Day, Oregon. Does accepting OHP patients put rural physicians and clinics at a financial disadvantage? Has OHP accomplished its goal of ensuring adequate health coverage to the people in rural communities? SWFC has three family physicians and one PA who, along with two other family doctors, provide the entire population of Grant County with primary care. These five physicians see outpatients, manage inpatients, and cover the Emergency department. They are extraordinarily dedicated and possess diverse skills. The sources of my information were varied, including discussions with professionals in various realms of the health care industry, statistics and reports published by the Oregon Health Policy and Research office and AHEC, financial data provided by the clinic administrator, and legislative reports. What follows is a synopsis of the information I gathered. This information leads me to believe that even under a fully capitated managed care environment, the clinic is quite successful and the community is well served by the Oregon Health Plan. Access To A Creative Solution: The Siuslaw Plan: Are Clinic And Emergency Department Personnel Doing Their Part? Project Date: 7/2/2001 The purpose of this project is two fold, to describe the Siuslaw Plan, a creative attempt to increase health care access by the growing uninsured population, and to assess the degree of active participation by the Florence, OR Peace Health primary care clinic and emergency department personnel in facilitating access to this plan. The Siuslaw Plan is a local charity program specific to the Peace Health organization targeting residents of Florence, OR and surrounding communities who do not have health insurance, yet have an income that disqualifies them for the Oregon Health Plan. Access to such a plan can be greatly facilitated by a knowledgeable staff. Staff directly involved in outpatient interaction and care was interviewed to assess awareness of and referral to the Siuslaw plan. 100% of Doctors and Nurse Practitioners were familiar with the Siuslaw Plan, the highest group interviewed. The percentage of doctors and nurse practitioners that knew the eligibility criteria and actively participated in referring a patient to the Plan was consistently higher than the nursing staff and other support staff. The Outpatient clinic staff consistently outperformed the Emergency Department staff in all aspects studied. Back to subject search page or search by preceptor site