The Oregon legislature is back in session and the economy is on the top of everyone’s agenda. Unemployment remains high and the state is expecting a $3.5 billion shortfall this biennium. Governor Kitzhaber released his budget proposal which does not call for any new revenue. It does call for cuts to K-12 schools and proposes reducing payments to doctors and hospitals, as well as cutting services paid for under the Oregon Health Plan.
Unlike past sessions where one party had a clear majority, this session is evenly split between democrats and republicans in the House, creating co-speakers and co-chairs in committees. Neither party has the number necessary to increase any taxes without the support of the other. In the Senate, democrats control by only one seat.
During the 2010 election, voters approved annual sessions, creating changes to the legislative calendar, including limitations on the number of days legislators are allowed to be in session. The Legislature now convenes annually beginning in February. In odd number years, the session may not exceed 160 days. In even number years, they are limited to 35 days. Five day extensions are allowed by a two-thirds vote in each house.
The ORH will be working with the Oregon Rural Health Association and our other partners to follow legislation that is important for rural health.
Here are a few of the bills we are tracking:
HB 3580—EMT Mobile Training Unit (MTU)
EMT Mobile Training Unit takes EMT training to rural communities across Oregon. They are key element in providing continuing education to rural EMS providers that otherwise would have to travel great distance to maintain their license. During 2010, one of two MTUs was cut. The Governor removed funding for the last MTU in his budget. Rep. Jim Thompson (R-Dallas), co-chair of the House Health Committee, agreed to use one of his five priority bills to introduce legislation to fund the EMT mobile training unit. The program would cost $300,000 for the next biennium.
HB 2377—Elimination of Type B Hospital Reimbursement
HB 2377 would eliminate cost-based reimbursement if a Type B hospital (50 of fewer beds and less than 30 miles from an acute care hospital) has a rolling five-year operating margin of more than five percent. Because the reimbursement level is critical to smaller hospitals, its removal could cause a cut in services and put some hospitals survival in jeopardy.
HB 2400—Loan Repayment
Loan repayment is an affective recruitment tool to bring providers to rural communities, by agreeing to pay off loan debt in lieu of time served in these communities. On average, medical students graduate with $150K - $200K in loan debt.
According to Sarah Williams, a second-year medical student at OHSU, and her husband Jay, a third-year medical student, their medical school loans will total $500,000 when they graduate. Sarah testified that their payments, at 8% interest, will cost $4,000 a month, every month for 25 years. Sarah said, “If Oregon had a loan repayment program, we could get those payments down to $1,400 per month and that might be manageable.” The Oregon State Loan Repayment Program was discontinued during the 2009 legislative session. In 2010, the program was restructured to include underserved areas, as well as rural and moved to the Office of Rural Health without a restoration of funding. HB2400 would fund the program at $3.1M. Scott Ekblad, Director, Office of Rural Health, emphasized that loan repayment is a program that works. Since 1993, “Less than $4 million investment by the State of Oregon has resulted in 570 years of health care services that would likely not have been otherwise provided.”
HB 2397—Loan Forgiveness
Loan forgiveness is different than loan repayment in that it targets students who know early in their medical education that they want to practice rural medicine. The program would cover physicians, nurse practitioners and physician assistants who commit to working in rural Oregon. Loans of up to $35,000 per year would be awarded to students beginning in their second year of medical training. Bill would appropriate $625,000.
HB 2401—Residency Network
This bill is designed to help Oregon’s primary care workforce grow by increasing the number of residency slots available to primary care providers and by encouraging more effective cooperation among residency programs.
There are currently 27 residency slots per year for family physicians in Oregon (12 at OHSU, in Klamath Falls, and 7 at Providence-Milwaukee.) In 2009, more than 800 allopathic and osteopathic medical school graduates applied for these slots. In addition, there are two family practice residency slots at Samaritan Health Services (Corvallis) that are currently restricted to osteopathic physicians.
A number of Oregon hospital systems are actively evaluating the addition of residency programs at their facilities. These include: St. Charles (Bend), Salem Hospital, PeaceHealth (Eugene), Providence Willamette Falls, Asante (Grants Pass and Medford), Providence Hood River.
Many of these hospitals are working with OHSU on the feasibility of a network or consortium that could share resources such as a common faculty development center, joint regulatory monitoring, and grant writers for outside funding. Ed Keenan, President of the Foundation for Medical Evidence, emphasized that this bill would increase the number of primary care physicians that practice in Oregon, improve access to health care, and improve the health of Oregonians, saying that, “Oregon’s strategy of importing physicians cannot continue.”
HB 2391—Transformation Initiative
This initiative will help urban and rural primary care practices innovate ahead of the curve, improve health outcomes, and lower costs by promoting effective inter-professional education and collaboration while aiding practices transition to patient-centered primary care home models throughout Oregon.
Locum Tenens would provide relief for heavily burdened rural physicians, physician-assistants, and nurse practitioners. The relief workers (Locum Tenens) would act as Health Care Extension Agents bringing knowledge of best practices from other areas and helping clinics and providers transform their practices into primary care homes.
Rather than traveling to a centralized location for CME, physicians could participate in interdisciplinary practice and community-level programs, aimed at implementing learning and transformation strategies more effectively. This program would set up and facilitate community-based learning collaborations, and evaluate the effectiveness of implementing delivery system and practice changes in primary care home models. It would also provide ongoing training for Locum Tenens to optimize their effectiveness in initiating practice transformation throughout Oregon.
SB 99—Health Insurance Exchange
This bill is important in Oregon’s attempt to meet the guidelines of the new health care reform and to pool populations, negotiate better health insurance options, and provide alternatives for individuals and small businesses not currently covered by the Oregon Health Plan. If Oregon does not have an Exchange ready and approved on January, 1, 2013, the federal government will set one up. The bill, would establish a Health Insurance Exchange which would have the power to negotiate the most favorable terms with commercial insurers for consumers. The Oregon Health Authority says any exchange will include any carrier; plans will meet certain standards of eligibility, voluntary participation by individual and small groups. The Exchange will do trainings and certify insurance agents. The Department of Consumer and Business Services will be the regulating agency.
SB 608—Oregon Rural Medical Liability Program
Created by the 2003 legislature and modified in 2007, the Oregon Rural Medical Liability Program currently provides liability premium subsidies to qualifying rural physicians and nurse practitioners. The Program helps to retain and attract these providers to rural Oregon by offsetting some of the cost of high liability insurance. The program focuses the subsidies primarily on those who provide rural obstetrical services. There are currently over 800 physicians and nurse practitioners participating in seven frontier counties, 17 rural counties and six mixed counties. The program is set to run out of funds and sunset at the end of 2011. The funding request is for $8 million.
Medical liability insurance costs have had a detrimental impact on the availability and affordability of health care services in rural areas. Specialists in the areas of obstetrics, pediatrics and neurology have left practices in rural areas because the cost of insurance combined with overhead has become too high. Continuation of the program is key to ensuring access to health care, specifically obstetrics, in rural Oregon. According to a 2006 OHSU survey, 86.2 percent of the physicians receiving the subsidy would stop delivering babies and 46.8 percent would stop practicing in a rural community if the subsidy was eliminated.
SB 675—Uniform Prior Authorization
This bill will move Oregon to a uniform prior authorization (PA) process, allowing for more streamlined administrative functions. SB 675 is part of a larger move toward cutting cost and preparing for more efficient administrative function with the implementation of EHR.
Health System Transformation Team—Challenged to Transform Oregon’s Health CareThe Health System Transformation Team, chartered by the Oregon Health Policy Board at the request of Governor Kitzhaber, “is developing a common vision and guidance for planning a new, integrated health and services delivery system for Oregon's Medicaid programs, which can then be built upon for broader statewide markets.” This new plan will be designed to better coordinate the benefits for Oregon Medicaid clients. The proposed integrated system would include physical health, mental health and addiction services, oral health, long-term care and social support services. The Transformation Team is set to . Questions being addressed by the team are also available for public comment on OHA Feedback. Questions are updated weekly!
Stay connected with the Oregon Health Authority
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Oregon Health Connect
The Department of Consumer and Business Services and the Oregon Health Authority have announced Oregon Health Connect. Oregon Health Connect gives Oregonians struggling to find medical care or health insurance a new resource. The new website and toll-free number (1-855-999-3210) will help connect consumers with local programs and information to meet their needs. The site also provides information about health reform and how health insurance in Oregon works. Use the directories and links to search for health care services, health clinics, and insurance options.
Oregon Health Care Quality Corporation Issues Primary Care Performance Report
The Oregon Health Care Quality Corporation has released a new report revealing trends and variations in primary care across the state. The report, called Information for a Healthy Oregon, also identifies opportunities for patients and practitioners to work together to improve care.
Northwest Health Foundation has been a participant in this collaborative effort that includes doctors, hospitals, health insurers, purchasers, government officials and consumers.
OMA and O-HITEC Pair up to Offer Unique Program to OMA Members Seeking EHR Incentive Funds
Since Wednesday, February 23, OMA physician members have had access to a new program on achieving Meaningful Use of an EHR. This program is through and arrangement with O-HITEC, Oregon’s Regional Extension Center.
The program includes:
- Professional consulting support and services towards meeting the Meaningful Use requirements
- Discounted rates on certified EHR products
- Benchmarking and reporting tools required for meeting Meaningful Use requirements
OHSU Physician Re-Entry Program
Physicians decide to leave clinical care for many reasons. Sometimes they regret the decision and wish to return to patient care. In Oregon, the OHSU Physician Re-entry Program gives physicians the opportunity to refresh and update their knowledge, and then to become active again in patient care. The program is an innovative way to help address physician workforce shortages. It is individualized and the admissions process is selective.
Programs are currently available in general internal medicine and pediatrics; training in other disciplines is offered as resources permit.
Elizabeth Bower MD, MPH, Assistant Dean for Continuing Medical Education and Director of the Re-entry Program, says "Our goal is to provide an organized, well-conceived, meaningful re-entry training program to encourage physicians in good standing to once again provide up-to-date, skilled patient care to Oregonians."
Program Director: Elizabeth Bower, MD, MPH
Program Administrator: Alex Cotgreave
Contact Information: 503-494-4904, firstname.lastname@example.org
President Obama expresses support for Senator Wyden’s Waiver for State Innovation Act
Earlier this year, Senators Ron Wyden (Democrat—OR) and Scott Brown (Republican—MA) reintroduced legislation that would amend the Affordable Care Act (ACA). The Waiver for State Innovation Act would allow states to obtain waivers from provisions in the ACA, provided states could demonstrate that other methods would allow them to cover as many people, with insurance that is as comprehensive and affordable, as required by the ACA. If states can meet those standards, they can ask for waivers on the following provisions of the ACA as early as 2014:
- The individual mandate;
- The employer penalty for not providing coverage;
- The exact standards for a basic health insurance policy;
- The health insurance exchange; and
- The design for how federal subsidies would have to reduce premiums and co-pays.
A state could then collect all of the federal money—the subsidies for premiums and co-pays as well as tax credits for small businesses—and put the money into financing coverage for individuals in its own way. Currently, states must wait until 2017 to obtain these waivers. President Obama voiced his support for this legislation in his remarks to the National Governors Association. The announcement marked the first time President Obama has called for altering a central component of his signature health care law. The President described the Waiver for State Innovation Act as a common-sense date change that would give states the freedom to innovate, while still guaranteeing health care reform to the American people. The prospects for Congressional approval of the proposal appear dim, however. House Republican leaders said Monday that they were still committed to repealing the law, not amending it.
Federal court validates the Affordable Care Act
A third federal judge upheld the constitutionality of the Obama health care law. Judge Gladys Kessler of Federal District Court for the District of Columbia rejected a constitutional challenge to the Affordable Care Act. The D.C. case was filed by five individuals represented by the American Center for Law and Justice, a conservative Christian legal group. Judge Kessler ruled the requirement to purchase health insurance (the “individual mandate”) as constitutional, suggesting that not buying insurance had clear effects on the marketplace by burdening other payers with the cost of uncompensated medical care. Two other federal judges have ruled the same requirement as unconstitutional.
Meanwhile, a federal judge in Florida stayed his own ruling against the Affordable Care Act, allowing the act to be carried out as the case progresses through the Courts of Appeal and on to the Supreme Court. Judge Roger Vinson of the Federal District Court in Pensacola sought to speed up the appeals process by conditioning the stay on the Justice Department’s pursuit of an expedited appeal, which he ordered must be filed within seven days. The stay—essentially a suspension of the judge’s order pending appeals—settles the confusion that arose after Judge Vinson ruled on Jan. 31 that requirement to purchase health insurance was unconstitutional, and that the rest of the law must fall with it.
Appeals for cases regarding the constitutionality of the individual mandate are pending, with oral arguments scheduled as early as May. The constitutionality of the individual mandate is considered almost certain to be determined by the U.S. Supreme Court.
Changes to the FCC Universal Services Fund
The FCC has proposed to modernize and streamline its universal service and intercarrier compensation policies. Building on recommendations contained in the FCC’s National Broadband Plan and extensive input from a wide array of stakeholders, the NPRM proposes four key principles to guide reform: Modernizing USF and ICC To Support Broadband Networks, Ensuring Fiscal Responsibility, Demanding Accountability, and Enacting Market-Driven and Incentive-Based Policies. The NPRM proposes immediate steps to cut waste, reward efficiency, and close loopholes. Long-term proposals call for simplifying and unifying USF into a single, streamlined Connect America Fund, and gradually eliminating per-minute intercarrier charges.
The FCC will hold a series of public workshops on key issues in its reform proposals. These workshops, in addition to submissions of written comment, will provide ample opportunity for public input to improve and refine the proposals in the NPRM as the Commission moves toward an Order on these issues.
NTIA and FCC National Broadband Map
The National Telecommunications and Information Administration (NTIA) and the Federal Communications Commission (FCC) have released the National Broadband Map. The map is a conglomeration of data provided by NTIA and an interactive tool developed by FCC. The map shows broadband availability nationwide by technology (wired and wireless), provider, speed, anchor institution. It also offers multiple geographic data cuts that can be married with population demographics and contains 25 million searchable records – all downloadable by public. The site houses an interactive classroom to facilitate usage of the tool and has a number of predetermined reports. Two reports of interest include:
Atlas of Rural and Small-Town America
The Atlas of Rural and Small-Town America is a mapping application that provides a spatial interpretation of county-level, economic and social conditions along four broad categories of socioeconomic factors: people (using newly released demographic data from the American Community Survey, including age, race and ethnicity, migration and immigration, education, household size and family composition), jobs (using economic data from the Bureau of Labor Statistics and other sources, including information on employment trends, unemployment, industrial composition, and household income), agriculture (using indicators from the 2007 Census of Agriculture, including number and size of farms, operator characteristics, off-farm income, and government payments), and county classifications (using typologies such as the rural-urban continuum, economic dependence, persistent poverty, population loss, and other ERS county codes). Maps are interactive and also provided for download; raw data are provided for download.
Council on Graduate Medical Education
The Council on Graduate Medical Education (COGME) recently released its 20th report Advancing Primary Care. COGME, which advises Congress and the Department of Health and Human Services on physician workforce trends and training issues, recommended that policies be implemented to increase the percentage of primary care doctors to 40 percent of the total number of U.S. physicians.
Around the State
Thanks to a recently awarded federal research grant, Lincoln City will become one of a select number of communities where new techniques will be attempted to combat the country’s obesity epidemic. The Oregon Rural Practice-based Research Network (ORPRN) at Oregon Health & Science University is sponsoring the effort through funding by the Agency for Healthcare Research and Quality. It will allow researchers from OHSU and communities—including Lincoln City—to study their populations and come up with creative solutions to the obesity problem with the goal of promoting lifelong fitness.
For more information, contact the Oregon Rural Practice-based Research Network at email@example.com
SAVE THE DATE: 2011 Leadership Symposium and Supervising Physician Forum
2011 Leadership Symposium will be held May 12th, 2011 in Salem, Oregon at the Salem Conference Center located in the Grand Hotel-Salem, 201 Liberty Street SE, Salem, OR 97301
2011 Supervising Physician Forum be held May 13th, 2011 in Salem, Oregon at the Salem Conference Center located in the Grand Hotel-Salem, 201 Liberty Street SE, Salem, OR 97301
NOTE: Watch the ORH Website for more registration information or contact Shellye Dant at firstname.lastname@example.org
2011 Rural Hero of the Year Award!
Nominate your favorite Hero for the Hero of the Year
“There are many hard working, dedicated people out there who have made a major impact on health care in rural Oregon,” says Scott Ekblad, Director of the Oregon Office of Rural Health. “Think about nominating someone whose actions have had a notable, positive impact on the health of the community, or a successful program that other communities might want to duplicate. How about a teacher or coach with a unique approach to educating students on health care risk prevention, or a health care provider, clinic or health department that has demonstrated a unique devotion to the populations they serve?”
Nominations are available through June 24, 2011—but don’t wait! Get your nomination in today!
You can get a nomination form on the ORH website. If you have questions, contact the ORH at 503-494-4450.
28th Annual Oregon Rural Health Conference
Wednesday, September 21, 2001 - Friday, September 23, 2011
Registration begins July 2011
2011 Apple A Day Dinner and Auction
Thursday, September 22, 2011
6.00pm – 10.00pm
Riverhouse, Bend, Oregon
You don’t have to wait that long to support Oregon’s Rural, Volunteer EMTs.