OHSU

ORH Newsletter-April 2009 Share This OHSU Content

ORH News

{To receive this in your Inbox, please subscribe to our newsletters.}

2009 Oregon STEMI Summit and Cardiovascular Symposium

2009 Oregon STEMI Summit
2009 Oregon Cardiovascular Symposium

Discovering the Oregon Solution
Friday, May 29 – Sunday, March 31, 2009
Doubletree Lloyd Center Hotel – Portland, Oregon  

Oregon EMS Supervising Physicians/Medical Directors Forum
Friday morning, March 29  

Bright Futures for Women's Health and Wellness, Physical Activity and Healthy Eating Tools for Rural Women

HRSA Office of Women's Health is pleased to share their new HTML (Section 508 compliant) Bright Futures for Women's Health and Wellness (BFWHW), Physical Activity and Healthy Eating Tools for Rural Young Women and for Adult Women. The Adult Women's Tools include a booklet and a set of 10 Tip Sheets. The Young Women's Tools include a booklet and a bookmark. All tools are based on the 2005 Dietary Guidelines for Americans. To access the HTML links, please go to www.hrsa.gov/womenshealth and scroll down to the Bright Futures for Women's Health and Wellness section.

Free print copies of these and other BFWHW tools are available through the HRSA Information Center at 1-888-ASK-HRSA or http://ask.hrsa.gov/

2009 Small & Rural Hospital Summit

 2009 Small Rural Hospital Summit

2009 Small & Rural Hospital Summit
May 20-22, 2009
Salem Conference Center, Salem Oregon

Join us in Salem at the Salem Conference Center for the 2009 Small & Rural Hospital Summit. The event begins Wednesday, May 20 at 5:30 p.m. with dinner and a rural health strategy session bringing the best minds in rural health together for lively debate as we launch our state rural health plan.

The 2009 Rural Hospital Summit focuses on strategy and solutions to meet the top challenges facing rural hospitals. With bad news rolling out every day, now more than ever we need to meet to recharge and share ideas that will refresh our journey and further our rural health agenda. The program will feature the following sessions:

  • Taking Your Organization to the Next Level
    Greg Paris, Studer Group Hardwiring Excellence in Your Organization
  • Undaunted in Daunting Times
    Keynote address by Stacy Allison, first American Woman to summit Mount Everest
  • Ten Growth Strategies Health Care Executives Must Know
    Keynote address and strategy session with, Nate Kaufman, leading health care business analyst
  • National Trends and Issues
    John Supplitt, Senior Director, AHA
  • Oregon Innovation and Success Stories
    Grande Ronde Hospital NRHA's 2009 Outstanding Rural Health Organization
  • Networking and Strategy Sessions
  • Meet your Legislator — Reception and Networking

For registration information and additional details, go to:
http://hospitals.oahhs.org/site/Calendar?view=Detail&id=100641

Sponsored by:

Oregon Association of Hospitals and Health Systems (OAHHS)
Oregon Rural Healthcare Quality Network (ORHQN)
Oregon Office of Rural Health

Mark your Calendars!!! November 5 – 7, 2009

Oregon Rural Health Conference
Salishan, Gleneden Beach, OR
Watch for Details—This is one conference you won’t want to miss!

Rural EMTs Take Message to Salem

 EMTs/Salem

Rose Howe is a volunteer emergency medical technician (EMT) in Monument, a community of 135 about 60 miles northwest of John Day. Rose recently wrote to Scott Ekblad in the Office of Rural Health to thank the Office for its efforts on behalf of rural emergency medical services (EMS) and offered to be of assistance. Little did she know that Scott would take her up on that offer in short order. HB 2460 was being heard by the House Veterans and Emergency Services Committee, and Scott asked Rose if she would travel to Salem to tell the committee what the Rural Volunteer EMT Tax Credit Program means to someone who provides emergency medical services in a frontier county. The program gives a $250 tax credit per year to rural volunteer EMTs, and HB 2460 aimed to expand the number of communities eligible for the program. Rose and her fellow volunteer from Kimberly, Lynda Thomas, drove 12 hours round-trip to spend 10 minutes telling the committee how much the programs means to her and her fellow volunteers as a token of the state’s appreciation for their service. Her testimony was very well received and surely had a big impact on the members of the committee.

The Oregon Office of Rural Health submitted amendments to the bill to further expand the eligibility criteria and to extend the sunset on the program from January of 2011 to January of 2015. If you are interested in testifying in support of HB 2460 when it is next heard, please contact Bob Duehmig at .

North Dakota Nurse to Lead HRSA

Mary Wakefield, a nurse and Director of the Center for Rural Health at the University of North Dakota, has been named the new head of The Health Resources and Services Administration (HRSA).

“We are very excited,” says Scott Ekblad, Director, Oregon Office of Rural Health. “As Director of the Center for Rural Health, Mary understands the role our office plays in rural health. And most of all, she truly does understand rural health and its challenges.”

Known as HRSA, the agency oversees some 7,000 community clinics that serve low-income and uninsured people. It also runs the government's Ryan White HIV/AIDS program, providing medical care and medications for 530,000 low-income patients. The recently passed economic stimulus bill gives HRSA $2.5 billion to spend for improvements to health care facilities and training medical professionals.

Wakefield is familiar with Washington, having served as a top staff aide for two North Dakota senators. Her deep experience in health care policy includes a stint overseas as a consultant to the World Health Organization's global AIDS program.

HRSA is part of the Health and Human Services Department. President Obama has appointed Kansas Gov. Kathleen Sebelius as his nominee to head the Department. That nomination is before the US Senate. Other major posts in the department, including the heads of Medicare and the Food and Drug Administration, remain unfilled.

Salem Update

The Oregon Legislature is working its way through the 2009 session. It is no secret that a bad economy and balancing budgets are high on the legislative priority list. But work continues on other important issues, including health care. “Legislators don’t want to spend money, but they are definitely looking at health care reform, says Scott Ekblad, Director of the Office of Rural Health. “There is a lot that can and needs to be done and I think they are very serious about doing what they can.”

The Office of Rural Health, working with the Oregon Rural Health Association, is tracking legislation that impacts—both positively and negatively—rural health in Oregon. Below is a list of bills dealing with rural health. The ORH will keep updates on various bills on our website and in future newsletters.

Senate Bills

SB 12 – Tax credit for rural health providers’ loan repayment
This bill would provide a tax credit for principal and interest payments on qualifying student loans made by health care practitioners serving medically underserved areas. To qualify for this credit, you would need to meet the following criteria: The provider must be serving a medically underserved area as a health care practitioner and the provider must devote to qualifying service more than 60 percent of the provider’s working hours during the tax year. The amount of the credit allowed under this section may not exceed $12,000 for the tax year and will be reduced by any amount that the provider has received offsetting the qualifying loan during the tax year.

Scott Ekblad, Director, Office of Rural Health, told the Senate Rural Health Policy Committee that there is a desperate need for providers in rural areas and we need strategies to attract health care providers, but did not believe this is the ideal method.”

According to Ekblad there would need to be a number of amendments to make this plan work. Currently, there is no clear definition in the bill for underserved areas and there needs to be a mechanism to determine who is really eligible by contacting each lender for each eligible provider to verify debt. In addition, the minimum service requirement of 60 percent doesn’t take into consideration part-time providers.

There were also questions raised about how many medical professionals would really qualify for the tax credit since there is already a $5,000 tax credit available for rural health care professionals.

SB 37 – Prompt pay for rural clinics runs into fiscal land mine
SB 37 would require the Department of Human Services to ensure that all rural health clinics receive full reimbursement within 45 days for health services provided to persons enrolled in prepaid managed care health services organizations.

When the Senate Rural Health Policy Committee first heard SB 37, they were told it would take $50,000 to speed up Oregon Health Plan payments to rural health clinics. However, when the committee was ready to move the bill forward price tag jumped to $200,000 General Fund, $500,000 Total Funds, plus one FTE at DHS for an additional $77,000.

The change in the cost estimates had several committee members confused. Sen. Joanne Verger (D-Coos Bay) said, “We were told this was just a timing issue.” While Sen. Chris Telfer (R-Bend) stated, “I’m perplexed at the cost of doing this. Why does it cost $77,000 in personnel just to change the timing of these payments?”

According to Jim Edge, Director of the Division of Medical Assistance Programs (DMAP), it would require them to first make an estimated payment and then make a final settlement payment. He said the real delay comes from Medicare, which often takes six to eight months to pay its share.

Committee Chair Sen. Bill Morrisette, (D-Springfield) said, “This is a very important bill that would keep some clinics from closing.” He is working with interested parties to see if they can come to a resolution.

SB 453 – All-payer, all-claims database
During the Oregon Health Fund process, the Office of Health Policy and Research learned how difficult making health policy decisions and knowing where to target investments is without good data. As result, they proposed SB 453 to create a statewide health claims database. It would allow consumers to compare price, and eventually quality, by procedure across hospitals, help policy makers better understand cost and outcome disparities between providers or regions and enable providers to compare their performance against those of their peers.

Six states currently have an all-payer, all-claims database. Three states are implementing one and Oregon is one of eleven states considering the option. During House Health Committee testimony, a regulator from Maryland stated the database was the single most important component of their health reforms.

SB 453 would require an initial investment of about $1 million.

SB 455 – Evidence-based health care
This bill would require the Health Resources Commission to conduct comparative effectiveness research and to develop or identify and disseminate evidence-based health care guidelines. It would also require public bodies and public purchasers of health care to pursue purchasing strategies that encourage adoption of research findings and evidence-based health care guidelines.

This is one of the seven Oregon Health Fund Board proposals. Supporters of the proposal encouraged the state to use evidence to make purchasing decisions, citing examples such as a recent study on the efficacy of bariatric surgery. Others talked about the medical technology explosion as one of the leading causes of increased medical costs.

The Oregon Health Fund Board’s report claims that using evidence-based guidelines and best practice clinical standards could save Oregonians up to $650 million in 3 years and $4.2 billion in 10 years.

SB 456 – Integrated Health Homes
SB 456, part of the Oregon Fund Board package of legislation, would establish the Oregon Integrated Health Home Program in the Office for Oregon Health Policy and Research. OHPR would establish the standards for certification of an integrated health care practice as an integrated health home and establish collaboratives to exchange information about quality improvement and best practices. In addition, it would require the Administrator of Office for Oregon Health Policy and Research to appoint an advisory committee.

The bill would also create the Statewide Health Improvement Program to develop goals for the reduction of chronic disease factors and implement the strategy to achieve goals. It would require the department to collaborate with health insurers and purchasers of health plans to develop strategies to reward publicly funded health plan enrollees for receiving care in line with the Statewide Health Improvement Program. Under the proposal, the Oregon Health Plan would reimburse for integrated health homes.

The Governor did not include that $900,000 in his proposed budget. Amendments have been drafted to strip out the payment requirement. Supporters of the bill believe that will make the bill too weak to be affective. Proponents of removing that portion say it is the only way for the bill to pass the legislature that has so many budgets constraints.

SB 457 – Workforce data collection
This bill would require the specified healthcare workforce regulatory boards collect pertinent information from licensees and report the information to Office for Oregon Health Policy and Research for the creation of a healthcare workforce database. Currently, there is little date to assist the state and education institutions in the appropriate health care workforce investments.

SB 457 would require health care licensing boards to collect workforce data as part of its licensing process. The Oregon Board of Nursing has been doing this since 2001 and it has been invaluable at targeting the scope and nature of nurse shortages.

Information on physicians, for example, isn’t nearly as good.

  • In 2008, the Board of Medicine showed 11,000 active, licensed MDs.
  • In 2006, an OMA survey showed 8,100 MDs and;
  • In 2006, the Oregon Employment Department estimated there were 6,700 MDs.

SB 507 – Payment during credentialing
SB 507 would require health insurers to approve or reject participating provider applications within 30 days of receipt of the application. It would also require insurers that fail to approve or reject applications to reimburse those providers for services provided after 30-day period.

Currently, the Board of Medicine must first license physicians moving to Oregon. Then physicians go through credentialing by the hospital(s) where they will practice. After that, they may need to go through an additional credentialing process by 20 to 40 health plans. This process is very time consuming and expensive.

Sen. Alan Bates, DO (D-Medford) says doctors with a valid medical license should not have to undergo additional competency reviews by health plans. Sen. Frank Morse (R-Albany), who has served on the Board of Samaritan Hospital, says it’s incredulous that we have 20 health plans all reviewing the competency of a physician.

SB 605 – Nonjudgmental Rx dispensing for Nurse Practitioners
This bill would allow certified nurse practitioners or certified clinical nurse specialists, approved to dispense prescription drugs, to delegate the nonjudgmental dispensing functions to staff.

Nurse practitioners say a glitch in the law requires them to be physically present to hand some prescriptions to a patient, when the same drug prescribed by a physician can be handed to the patient by any staff in the office.

Legislators on the Senate Health Care Committee say this bill simply clarifies what they thought they passed in a previous session.

There was no opposition to the bill. The Senate committee passed the bill and forwarded it to the Senate.

House Bills

HB 2581 – Moves loan repayment program to Office of Rural Health
This bill would move the Rural Health Services Loan Repayment Program from the Oregon State Student Assistance Commission (OSAC) to the Oregon Office of Rural Health. Almost all of OSAC’s other programs are designed to help students with scholarships while they are in school, not repayment of debt incurred after leaving school.

HB 2581 would move the program to the Office of Rural Health. Scott Ekblad, Director of the Office of Rural Health, says he’s talked with foundations that may be interested in supporting the loan repayment program, but not if it is in a state agency, and while OSAC is a state agency, the Office of Rural Health is not. He believes by moving the program, there can be more focus on using the program to recruit additional providers to rural Oregon.

HB 2460 - Expand Rural EMT Tax Credit
Volunteer Emergency Medical Technicians spend 150 - 200 hours and $1,000 - $1,500 of their own money for EMT training. They also pay up to $400 each year for continuing education. HB 2460 would extend and expand a tax credit to rural volunteer EMTs. The credit is currently set to expire in 2011.

Scott Ekblad, Director of the Office of Rural Health, says this tax credit program reimburses these dedicated individuals for out of pocket expenses. HB 2460 aims to:

  • Expand the credit from $250 to $500 per year.
  • Add eligibility for first responders.
  • Redefine which rural parts of the state qualify.
  • Remove the sunset on the tax credit that is scheduled for January 1, 2011.

Currently, about 500 people qualify for the tax credit. There’s no estimate yet on how much it would cost to expand the program.

HB 2631 – Increases funding for the Rural Health Services loan repayment program
Funding for the Rural Health Services loan repayment program has been stuck at $400,000 per biennium since the program began in 1989. HB 2631 would increase the funding to $3 million. Scott Ekblad, Director of the Office of Rural Health, says Oregon is competing with other states for young providers who are willing to work in rural areas. Last year, there was only enough money for four awards: one physician, one dentist, a nurse practitioner and one physician Assistant. The State of Washington, our nearest competitor, funds its program at $9 million per year.

Testifying on behalf of Oregon Academy of Family Physicians, Evan Saulino, MD, said the loan repayment program is a short-term fix to attract physicians to rural areas. Nick Gideonse, MD submitted testimony saying, “We annually have many more qualified candidates and communities than we can fund at current levels.”

The House Health Committee says it will hold onto this bill until later in the session when it decides which spending bills are its top priorities. Those bills will be ranked and sent to Ways and Means.

HB 3257 – Graduate Medical Education
HB 3257 would require that state funds for graduate medical education be used for training primary care residents. Hospitals would have to pay primary care residents 150 percent of what they pay other specialty residents. Every Democrat on the House Health Committee signed on to a package of bills designed to strengthen primary health care in Oregon.

HB 3258 – Primary Care Education Loan Fund
HB 3258 creates a Primary Care Medical Education Loan Fund. It would pay 50 percent of the cost of medical school. In exchange, the doctor would have to practice primary care in Oregon for five years. This is part of a package of bills designed to strengthen primary care. Like HB 3257 and HB 3259, the cost of these measures may limit the success.

HB 3259 – OHP Primary Care Reimbursement
HB 3259 would increase the OHP reimbursement to primary care physicians to 150 percent of Medicare. This bill is designed to increase access to primary care providers.

Upcoming Deadlines
The next big deadline is April 17. To keep a bill alive in the legislature after April 17th, committees in the house of origin (Senate or House) must hold a work session on the bill. They have until April 28 to actually pass the bill out of committee.