Oregon Health Care
Like most metropolitan areas in the USA, the Portland area has a comprehensive array of health care facilities and medical specialists. This includes a university with a medical and dental school and a hospital. Also a children’s hospital and veteran’s hospital. We all know what the problem with healthcare is in our country: Cost.
Time magazine devoted an entire issue in February 20, 2013. to the cost of health care in the USA. It is good reading and perhaps the most comprehensive review of health care ever written up in a magazine and it’s about the high costs of health care. Titled “Bitter Pill: Why Medical Bills are Killing Us.” Unless you subscribed to the Time magazine you will have to read it at the library as it not available online to the general public. You can read an excerpt by clicking here.
Oregon Noted for Innovation, Low Cost Health Care, and Low Immunization
Oregon has two decades of pioneering Medicaid reform work, much of it under John Kitzhaber. In the early 90s, Oregon received a widely noted federal waiver to cover all residents earning up to 100 percent of the poverty level by limiting benefits to services that had demonstrated clinical effectiveness and value. Then, in 2003, with Kitzhaber in his second term as governor, the state again expanded the Oregon Health Plan–the state’s name for its Medicaid program–to cover pregnant women and children in households earning up to 185 percent of the poverty level.
Statehealthfacts.org calculated the per enrollee Medicare spending at $8,247 for Oregon in 2011. The national average was $10,365 per Medicare enrollee. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed provide free, up-to-date, and easy-to-use health data for all 50 states.
Regional variation in Medicare spending is striking. Among the 306 hospital referral regions in the United States, Medicare reimbursements varied more than threefold in 2007, from about $5,200 per enrollee in the lowest spending region to more than $17,000 in the highest spending region. From 1992 to 2006, total Medicare spending grew at an average rate of 3.5% per year, but this growth was not also spread evenly across regions. The rate of average annual growth varied from a low of 1.6% in Honolulu to a high of 8.3% in McAllen, Texas. The Dartmouth Atlas website has an excellent tool for determining Medicare costs — you can customize reports and pull up some interesting numbers.
Oregon has the nation’s highest rate of childhood vaccination exemptions — 17% of Oregon kindergarten students are exempt. At 69 percent, Woodland Charter School, a three-year-old K-8 school in southern Oregon, has the highest exemption rate among Oregon public schools. It’s very easy to obtain a nonmedical exemption in Oregon.
Oregon Public Health Division
The Oregon Public Health Division collects and analyzes data on health behaviors, diseases and injuries, disseminates findings, and designs and promotes evidence-based programs and policies to improve the health and safety of all Oregonians.
The Oregon public health system comprises federal, state and local agencies, private organizations and other diverse partners working together to protect and promote the health of Oregonians.
An essential function of the Oregon public health system is to provide data and information about the health of Oregonians. Most of the information about the frequency of or risk factors for deaths, illnesses and injuries across the state comes from the public health system’s “surveillance” activities. The data sets and documents spotlighted here represent the work of the various programs conducting these surveillance activities.
See Oregon’s State Health Profile (PDF) for a broad set of indicators that offer a snapshot of the health of people in Oregon.
Health Care Regulation and Quality Improvement
The Health Care Regulation and Quality Improvement (HCRQI) program ensures that Oregonians have wide access to the health care they need and that it will be safe and of high quality.
HCRQI regulates health care facilities, providers and suppliers in acute care and community-based programs. These include hospitals, home health agencies, in-home care agencies, hospice programs, ambulatory surgical centers, rural health clinics, special inpatient care facilities, end-stage renal disease dialysis facilities, birthing centers, rehabilitation agencies and clinics, comprehensive outpatient rehabilitation facilities, community mental health centers, hemodialysis technicians and portable x-ray suppliers.
Affordable Care Act (aka Obamacare)
Health insurance exchanges outlined in the federal Affordable Care Act are regulated online marketplaces for state residents to comparison shop for coverage. Congress called for their nationwide establishment by 2014. The federal health care overhaul required all 50 states to have an exchange where small businesses and uninsured individuals can shop for health coverage and access federal subsidies.
Key features of the law are these rules:
- It will be illegal for insurance companies to discriminate against people with pre-existing conditions.
- Ensure families buying their own coverage get basic essential benefits similar to what private insurers offer.
- Help employers promote wellness.
Affordable Care Act: Comparing Physicians, Hospitals, Nursing Homes, Home Health Agencies, and Dialysis Facilities
The Affordable Care Act is designed not just to control health care costs, but also to improve quality of care. The federal government has created several tools that allow you to compare a variety of quality measures of health care and service providers. In addition, the Partnership for Patients program highlights hospitals and other providers that have made a commitment to reducing medical errors, improving health care quality, and reducing costs. The Medicare website has a complete page where you can compare. Here is the list:
- Partnership for Patients The Partnership for Patients includes hospitals, medical practices, and others that agree to support programs that improve patient safety, increase health care quality, and lower costs. Use the map to find members in your area and learn more about the Partnership, including information for current and prospective members.
- Compare Physicians Use this tool to help you search for and compare physicians and other health professionals. It provides information on medical specialty, clinical training, foreign languages spoken, and more.
- Compare Hospitals This tool can help you compare the quality of care that hospitals provide. It provides a list of U.S. hospitals which includes hospital demographics (location, hospital type) and 44 quality-of-care measures. It also includes data on some Department of Veterans Affairs medical centers.
- Compare Nursing Homes Use this tool to help you compare the quality of care that nursing homes provide. It provides a list of U.S. nursing homes which includes demographics (location and type of facility) and nursing home ratings, which include health inspection reports, staffing data, and quality measures.
- Compare Home Health Agencies This tool can help you compare the quality of care that home health agencies provide. It provides a list of U.S. home health agencies, including demographics, services provided and quality measures.
- Compare Dialysis Facilities Use this tool to help you compare the quality of care that dialysis facilities provide. It provides a list of U.S. dialysis facilities which includes services provided, quality measures, and resources.
Consumers should be aware that a top five-star rating from Medicare, achieved by a fifth of the more than 15,000 nursing homes nationwide, may mask serious and potentially dangerous deficiencies. The rating system has major flaws including an over reliance on self-reporting by the nursing homes and failure to include negative information gathered by states. The ratings are based on three criteria. Two of the three — staff levels and quality statistics — are reported by the nursing homes and accepted at face value by Medicare without verification. Only the other criterion — the results of annual health inspections — relies on independent assessments by state inspectors. In addition, the ratings do not take into account other potentially damning information gathered by state authorities.
Insurance Exchange: Cover Oregon a Failure
In early March 2016 the Oregon legislature sent Senate Bill 1 to Governor Kate Brown, closing the door on the failed Cover Oregon health insurance exchange, and placing the remaining state functions for facilitating the online portal under the control of the Department of Consumer & Business Services. Despite spending over $82 million the online exchange never enrolled anyone.
The bill passed over the threats from the Oracle Corporation — the software company the state has vilified for its failure to provide a working exchange portal — that the tech company would go to court to stop the bill from becoming law. Oracle has argued that the state is dissolving the independent public corporation and moving the exchange to a state agency to get around copyright laws that protect Oracle’s software from unauthorized use.
The state contracts with the federal web portal, healthcare.gov, to provide the consumer interface for Cover Oregon, which will continue indefinitely. If the state plans to develop its own portal for the small-business market, or wants to undertake any information technology project for the exchange that costs more than $1 million, it needs legislative approval.
In August 2014 the Oregon Department of Justice filed suit against the developer of its catastrophically broken health-care exchange, accusing Oracle America Inc. of false statements, fraud and racketeering, among other misdeeds.
The Cost of Insurance Under the Act
Insurers and state officials are bracing for major upheaval for more than 200,000 Oregonians who buy their own insurance. The general outlines are clear: Under the new federal health law, the reasonably well-off can expect to pay higher premiums in the individual market, especially if they’re 49 or younger. For many of the rest, there’s good news: Costs of coverage will drop significantly thanks to tax credits.
But important details remain to be worked out, including how big a role age plays and specific rate hikes. The coverage cost shake-up for those purchasing their own coverage is just one of many major changes to the health care landscape rolling out this year courtesy of the Affordable Care Act.
Currently about 200,000 Oregonians purchase their own insurance. More than 70,000 more of them are expected to purchase individual insurance next year, with more signing up in years to come.
Oregon’s incoming health insurance exchange could serve as many as 471,000 state residents by 2016. In early 2013, Rocky King, the Oregon Health Exchange’s executive director, acknowledged that the estimate is at the high end but said the figure is realistic. The exchange is a federal health reform-driven initiative that aims to provide a transparent marketplace for small business and individual insurance buyers.
King said as many as 357,000 Oregonians could utilize the exchange’s services by 2015, or the end of its first full operational year.
King revealed the estimate at a meeting of Cover Oregon, the state group that will oversees the exchange.
Find Insurance Rates
Rates for the insurance exchange can be found at the Oregon Health Rates website. The site allows you to search for insurers offering coverage in your area, and download a chart comparing proposed premiums for a limited selection of plans. The rate proposals all may be modified by the state after a review of reasonableness. The website shows examples that apply to individuals who are buying their own insurance, as well as to businesses with 50 or fewer employees. The proposed rates don’t apply to people with Medicare.
Co-ops Are Required for Health Care Insurance Exchanges
The Affordable Care Act called for at least one co-op in every state to boost competition and bring health care costs down. But federal budget woes put a stop to the program after 24 received funding. The only state to receive federal funding for two co-ops was Oregon. These two will have to sink or swim in an insurance market already ranked among the most competitive in the country.
Armed with federal loans, two startup health insurers jumped into a crowded and confusing Oregon market just as the biggest changes to U.S. health care in generations rolls out this fall. Oregon’s Health CO-OP and Health Republic aim to offer something different: A consumer-run experience.
Oregon’s Health CO-OP also is filling a niche for care from naturopathic doctors. It worked with the state Association of Naturopathic Physicians to credential naturopathic doctors to let them act as primacy care providers and bill for procedures other insurers currently don’t allow. The two companies filed new policy details and proposed rates with the state, which can be found at oregonhealthrates.org.
Health Republic proposed premium for a single non-smoker, age 40, is $251 a month. Oregon’s Health CO-OP proposed premium is $234 a month for the same conditions. In October, they will go head-to-head with about a dozen established insurers to appeal to small businesses as well as more than 200,000 expected to buy their own insurance next year. Rates and benefits for small business and individual consumers will be easily compared at the state marketplace, Cover Oregon set up to help people enroll and qualify for new federal tax credits.
Oregon Health Plan: The State’s Medicaid Program
The Oregon Health Plan (OHP) is Oregon’s state Medicaid program. OHP was conceived by emergency room physician (and current Oregon governor) John Kitzhaber, then a state senator, and Dr. Ralph Crawshaw, a Portland activist.
It was intended to make health care more available to the working poor, while rationing benefits. This meant that Oregon was one of the earliest states to end payments for unnecessary non-therapeutic circumcision. Oregon uses a list of hundreds of conditions and their treatments and higher priority is given to conditions that can be successfully treated.
In 1994, the plan’s first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%. The plan’s costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001. Significant cuts were made to the Oregon Health Plan’s budget in 2003.
New enrollment in the program was closed from mid-2004 until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan. The winners were picked from roughly 50,000 names of uninsured, low-income adults whose income qualifies them for the Medicaid program.
In late 2012 former Governor John Kitzhaber proposed to add at least 160,000 people to the Oregon Health Plan — but his budget has to get through the Legislature first.
In early 2013 the U.S. Supreme Court ruled on the federal Affordable Care Act, saying it’s up to each state whether they use the new law to expand Medicaid — which includes the Oregon Health Plan. Under the law, eligible incomes would jump from 100 percent of federal poverty level to 133 percent, or $30,656 for a family of four.
Under the law, the federal government picks up 100 percent of health care costs at first, leaving Oregon to pay only for administration. By 2020, the federal government’s share ratchets down to 90 percent. A recent report by the Urban Institute for the Kaiser Family Foundation pegged Oregon’s expansion costs at $506 million over 10 years, but said it could also reduce government costs of providing other free care by $280 million.
There are *665,000 people currently in the plan as of late 2012. If the plan is expanded another 225,000 would most likely be covered. There are 130,000 already on the waiting list.
The projected increase in the state OHP expenditures over 10 years is estimated to be *$506 million and the projected increase in federal OHP expenditures over 10 years would be about $12.8 billion.
*Numbers are rounded and some enrollment numbers fluctuate month to month. First three numbers are from Oregon Health Authority and the dollar figures are from Kaiser Family Foundation.
Controversy over Rationing
The Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program.
During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.
Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice but lost both times. Tarceva drugmaker Genentech agreed to supply her the $4000-a-month drug free of charge. Wagner’s plight garnered a flurry of attention from the media and triggered protest from religious groups. Wagner died in October 2008.
A New Way: Coordinated Care Organizations (CCOs)
Under an agreement signed with the Obama administration in 2012, Oregon and the federal government have wagered $1.9 billion that — through a hyper-local focus on Medicaid — the state can show both improved health outcomes for low-income Medicaid populations and a lower rate of spending growth than the rest of the nation. If Oregon fails on either front, the consequences are grave, potentially tens of millions of dollars in penalties a year, bleeding a state budget still wounded from recession.
Fifteen Community Advisory Councils have been established across the state, charged with setting local goals. Oregon has essentially 15 experiments going around the state.
Coordinated Care Organizations or CCOs is a network of all types of health care providers who are working together for people who receive health care coverage under the Oregon Health Plan. CCOs integrate physical, mental and eventually dental care with the goal of better health, better care and lower costs. CCOs focus on prevention of illness and disease and improving care to keep patients healthy and to manage existing health conditions.
Medicaid patients will now get all their care through a regional CCO. The CCO brings together doctors, hospitals, mental-health workers, even competing managed-care insurers. It gives them a single per-patient budget to coordinate care. Most important, the new CCOs will target the highest-cost patients — the ones with chronic conditions like heart disease and diabetes. It’s these people who end up in the hospital again and again.
A new accountability plan reached with the federal Centers for Medicare and Medicaid Services in late 2012 sets rules for state officials as they use the five-year funding pact to try better coordinate care for more than 600,000 low-income members of the Oregon Health Plan.
The broad outline of OHP reforms were approved by lawmakers in 2011. The state is handing off many spending decisions to CCOs that integrate mental, physical and dental health, with a hefty dose of prevention to cut down on costly emergency visits. Under the “Accountability Plan and Expenditure Trend Review” announced in late 2012, Oregon agrees to curb the health plan’s per-member spending growth to 3.4 percent over the final three years of the pact.
There are also quality goals to assure federal officials the state doesn’t sacrifice care to rein in spending. Measures include customer satisfaction, use of electronic health records, and success in enrolling people in primary care homes that improve chronic disease care.
Oregon must pay hefty financial penalties if it doesn’t meet the spending and quality goals. For more information on the new accountability plan, see the state’s website.
Medicare Provider Utilization and Payment Data
The U.S. government released payment data for 880,000 physicians in April 2014. Everyone can finally see what doctors are charging and being paid by the government. After nearly 35 years of legal suits and battles, this week, U.S. Centers for Medicare and Medicaid Services released payment data detailing how much doctors are reimbursed by Medicare, the healthcare service for people disabled or at least 65-years-old.
- Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America. The Hospital Care Intensity (HCI) index, available on the Dartmouth Atlas website for chronically ill patients in their last two years of life. The HCI index is a weighted average of hospital days and inpatient physician visits, and thus is impervious to price differences across Hospital Referring Regions (HRRs); it is based entirely on utilization.
- Robert Wood Johnson Foundation efforts focus on improving both the health of everyone in America and their health care—how it’s delivered, how it’s paid for, and how well it does for patients and their families.
- Statehealthfacts.org is a project of the Henry J.Kaiser Family Foundation and is designed to provide free up-to-date and health data for all states.