Legislative Update
March 2, 2009

OAFP Day at the Legislature
Fifty OAFP physicians converged on the Capitol to hear and be heard about health care reform. Here’s a sampling of comments from our speakers:

Chuck Hoffman, M.D. – member of the Oregon Health Fund Board
· Where are the cost savings really going to come from?
1. Better data on workforce, insurance claims and coverage
2. How we provide care, i.e., paying for quality, not services
3. Most importantly, rebuilding a robust primary care workforce

Sen. Alan Bates, D.O. (D-Medford)
· Primary care physicians are grossly underpaid and specialist physicians are grossly overpaid.
· If caps on medical malpractice are OK for OHSU and public employees (SB 311), they should be OK for the rest of us.

Bruce Goldberg, M.D. (Director, Department of Human Services)
· You can help legislators connect the economic crisis and budget shortfall with the need for health care reform.
· Quoting Winston Churchill: “A crisis is a terrible thing to waste.”
· The state purchases health care for more than 25 percent of Oregonians. We could make the Health Authority the locus for rational health policy. How many of you, he asked, are involved in a Quality Initiative? How many are involved in more than one? More than three? More than 5? And aren’t they all very similar. What about formularies? How many of you deal with five or more? Are they really that different? Wouldn’t it make sense and help all of us to standardize those aspects of health policy?

Tim Nesbitt (Governor’s Deputy chief of staff)
· On the Governor’s proposal to tax hospitals and health plans to pay for OHP expansion: “We think we can make this work.”
· We’ve never had a better offer from the feds. The SCHIP bill increases the federal match rate and there’s a one-time $64 million available through the stimulus package.

Carol Robinson (Interim Director of the Oregon Health Fund Board)
· (The Health Fund Board’s plan) isn’t going to solve the problem. It’s going to stem the tide.
· Evidence-based standards and clinical guidelines could save Oregonians millions of dollars, to which Glenn Rodriguez said, “I’m skeptical there are any meaningful savings there.”
· After a lively give and take about the real value of the Oregon Health Fund Board’s proposals, Robinson said, “Well, it’s all about the money,” to which a half dozen OAFP member said, “No it’s not!”

Kathy Bakke, M.D. (OAFP President)
· “Bruce Goldberg told us politics is a contact sport. We make the contacts here in Salem.”

OAFP members spent much of the day meeting with Senators and Representatives, talking about the needs of their patients.

HEALTH CARE REFORM

SB 455 – Evidence-based health care
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.
Sen. Jeff Kruse (R-Roseburg) asked why this bill was necessary at all. “The bill says PEBB and OEBB ‘shall vigorously pursue health care purchasing strategies that encourage the adoption of the research findings.’ Isn’t that what they should already be doing?”
Sen. Frank Morse (R-Albany) wants to know why the legislation is just advisory. “If it’s worthwhile, why isn’t it required?”
No one testified in opposition to the bill at its first hearing in the Senate Health Committee.

SB 457 – Workforce data collection
There’s not much good data on where or how much health care professionals work. 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 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 457 would appropriate $475,000 so the Oregon Workforce Institute and the Office of Health Policy and Research (OHPR) can collect and analyze health care workforce data.

HB 2009 – House Health Committee begins work on amendments
The House Health Committee began a section-by-section review of HB 2009 and proposed amendments that are still at legislative counsel waiting to be drafted. Committee Chair Rep. Mitch Greenlick (D-Portland) says he hopes to be done with this process by March 23.
Some provisions, like the cigarette tax, will be taken out of HB 2009 and dealt with in other bills. (The cigarette tax is in HB 2122.)
No decision has been made yet about whether the provider tax will stay in HB 2009 or be in a different bill.
Greenlick says his proposal would delay some big decisions until the 2011 session including whether to have an individual mandate and how to pay for it, and what the Insurance Exchange would look like.
Big debates this session are expected on:
· How much authority to give the new Health Authority,
· Price controls for medical services and
· Rate regulation for insurance.
The House Health Committee has work sessions on HB 2009 scheduled for the next two weeks as they work their way through proposed amendments.

OMA BILLS

SB 506 – Easing prior authorization requirements
Physicians say they waste too much time trying to determine eligibility and receive prior-authorization for treatments. One Portland-area orthopedic clinic testified that for 12 surgeons, they have 2.5 FTE employees who do nothing but eligibility and prior-authorization.
The worst-case scenario, they say, is when they confirm eligibility within 72 hours of surgery, only to have the health plan deny payment.
SB 506 would require health plans to set up phone or web-based procedures to determine coverage and eligibility. It would also require health plans to pay if coverage and eligibility are confirmed within 72 hours prior to treatment.
Insurers say many ratepayers wait until the last possible day to pay their premiums. Often they seek medical treatment during the grace period during which health plans are waiting for their payments. If the insured drops coverage instead of paying at the deadline, the claim is denied.
The Senate Health Care Committee asked the OMA and health insurers to put together a work group to see if they can work out a solution to SB 506 and the other bills listed below.

SB 507 – Payment during credentialing
The Board of Medicine must first license physicians moving to Oregon. Then physicians go through credentialing by the hospital(s) where they hope to practice. After that, they may need to go through an additional credentialing process by 20 to 40 health plans. The OMA says this process is time consuming, redundant and expensive.
SB 507 would require health plans to pay for services provided to patients during the credentialing period.
Sen. Alan Bates, D.O. (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 508 – Overpayment recovery
Physicians complain that health plans come back to them years after a claim is settled; say they overpaid and expect to collect from the physician, even if it’s the health plan’s mistake. One clinic submitted a payment demand letter from a health plan that came 28 months after the claim settled.
SB 508 would require health plans to resolve overpayment issues within 12 month. Insurers and the OMA will be negotiating on these issues in a work group for the next few weeks.

OTHER HEALTH CARE ISSUES

SB 12 – Tax credit for rural health providers’ loan repayment
Scott Ekblad from the Office of Rural Health told the Senate Rural Health Policy Committee, “There is a desperate need for providers in rural areas and we need strategies to attract health care providers, but I don’t believe this is the ideal method.”
Ekblad says there would need to be a number of amendments to make this plan work including:
· There is no clear definition in the bill for underserved areas.
· Determining who is really eligible by contacting each lender for each eligible provider to verify debt.
· The minimum service requirement of 60 percent doesn’t take into consideration part-time providers, e.g., an OHSU professor could qualify if they worked four hours a week in an underserved clinic.
· Administrative costs are not included. He estimates it would require at least .25 staff.
Questions were also raised about how many medical professionals would really qualify for this tax credit since there is already a $5,000 tax credit available for rural health care professionals.
It’s unclear whether the committee has a serious interest in moving this bill.

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 $400 each year for continuing education.
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 450 people qualify for the tax credit. There’s no estimate yet on how much it would cost to expand the program.

SB 14 – Repeals sunset on Patient Safety Commission
The Patient Safety Commission acknowledges that its data are imperfect. They believe hospitals underreport adverse incidents, infections and falls. But the Commission says Oregon’s voluntary reporting system has as good a track record as other states, e.g., Minnesota, that have mandatory reporting.
The House Health Committee acknowledged the good work of the Patient Safety Commission and quickly passed the bill to keep the commission.

SB 161 – Hospice Licensure
DHS would implement a new state-licensing program for hospice agencies. DHS says an unintended consequence of SB 16, passed in 2007, inappropriately gave hospice-licensing authority to agencies outside of state government.
The bill also permits DHS to assess fees, so it can increase on-site inspections of hospice agencies to once every three years. Currently, inspections take place every six to ten years.

HB 2506 - Marriage and family therapist mandate
Marriage and family therapists hope the third time is the charm. They came close to passing their insurance mandate in 2007. Their bill lost by one vote on the House floor in 2008. They continued to meet during the interim and say they reached consensus with all the interested parties on HB 2506.
The bill creates a practice act for licensed therapists and professional counselors. It also includes an insurance mandate, adding them to any plan that already covers clinical social workers or nurse practitioners.
No one spoke in opposition to the bill.

GENERAL LEGISLATIVE ISSUES

Closing the 2007-09 budget gap
The House and Senate are expected to pass a series of spending cuts this week to bring the 2007-09 budget back into balance. The package includes $306 million in budget cuts, plus the use of federal stimulus dollars and state reserves to fill the $855 million budget hole caused by shrinking state revenues.
Now the Ways and Means Committees can focus their attention on the 2009-11 budget where the latest forecast shows revenues $3 billion below what it would cost to continue current programs.

Bill deadline March 2
Monday, March 2 is the last day to introduce new bills for the 2009 session. To date 1,668 bills have been introduced. Probably another 500-600 will be added before the deadline. Then it takes a few days for all the bills to be printed. By March 9 or 10 we should see most of this session’s proposals.
The next big deadline is April 17. To keep a bill alive after that date, committees in the house of origin must hold a work session. They have until April 28 to actually pass the bill out of committee.

UPCOMING HEARINGS

Monday, March 2
3 pm – House Health Care Committee
HB 2581 – moves the Rural Health Services Loan Repayment Program
HB 2632 – funding the Rural Health Services Loan Repayment Program with $3 million for 2009-11

Wednesday, March 4
8 am – Senate Human Services and Rural Health Policy Committee
SB 37 – Prompt pay for rural clinics
SB 39 – Cigarette tax for rural safety net

Friday, March 6
3 pm – House Health Care Committee
HB 2468 – Requires Pharma to report compensation to physicians
HB 2376 – Requires Pharma to report gifts, fees and subsidies

Tuesday, March 10
8 am – Senate Health Care Committee
SB 456 – Integrated health homes

OAFP’s bill tracking Website: http://www.capitolonramp.com/lts/guests/1477220/
For more information contact Doug Barber at doug@lobbyoregon.com or 541-221-3072.