2009 Legislative Report
MONDAY UPDATE

Prepared for OAFP
March 16, 2009

HEALTH CARE REFORM

SB 456 – Integrated Health Homes
It felt like OAFP day at the Senate Health Care Committee. Eight OAFP members testified — half in support and half opposed — on legislation to create medical homes, what Oregon has decided to call Integrated Health Homes. By the end of the process OAFP hopes we can get all of the family physicians moving in the same direction.

Glenn Rodriguez, MD, OAFP President-elect, told the committee a healthy primary care system is the essential foundation for health reform in Oregon. “Primary care is the last good deal in health care,” he said.

John Saultz, MD, Professor of Family Medicine at OHSU said national evidence suggests that only 25 percent of current primary care practices are currently able to perform all of the functions of an integrated health home. “Transforming current practices into integrated health homes will take time and require significant reimbursement reform to offset increased practice costs.” But, he told the committee the evidence is excellent that this will result in lower overall health care costs.

SB 456 would require the Oregon Health Plan to reimburse for integrated health homes. The Governor did not include that $900,000 in his proposed budget, so amendments were introduced to strip out that require. Rick Wopat, MD says that would be a mistake. “We can not wait,” he said. “If we wait ‘for funds to be available’ we may never take the leap or make the change.”

Family physicians who work with OHP managed care organizations in Klamath Falls, Grants Pass and Salem said they are already developing models of integrated care that work in their communities. They said while they support the concept of integrated health homes, the way SB 456 is written would take flexibility away from local plans while adding an expensive new layer of government.
Lyle Jackson, MD from Grants Pass said, “SB 456 pigeonholes what an integrated health home is. The strength of primary care is local flexibility. I oppose another state agency or another certification.”
Language about certification was a big part of the problem.

The committee asked that a work group be formed to work on amendments. “I’m an optimist,” said John Saultz, MD. “Collectively we can define what an integrated health home is, make changes in the reimbursement system and pay for a broader scope of services. We’ve got smart people here. We can figure this out.”

BEEFING UP PRIMARY CARE

Every Democrat on the House Health Committee signed on to a package of bills designed to strengthen primary health care in Oregon.

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.

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.

HB 3259 increases OHP reimbursement to primary care physicians to 150 percent of Medicare.
These House Democrats say one of the keys to health care reform is revitalizing the primary care workforce in Oregon.

SB 453 – All-payer, all-claims database
The Office of Health Policy and Research says it learned during the Oregon Health Fund process that it is difficult making health policy decisions and knowing where to target investments without good data. So together they proposed SB 453 that would 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.
· Enable providers to compare their performance against those of their peers.
Six states have an all-payer, all-claims database. Three states are implementing one and Oregon is one of eleven states considering the option.
A regulator from Maryland told the House Health Committee that the database was the single most important component of their health reforms.
SB 453 would require an initial investment of about $1 million.

OTHER HEALTH CARE ISSUES

SB 519 – State tort cap for MDs who treat Medicare and Medicaid
Sen. Bill Morrisette’s bill would allow physicians to register as agents of the state and fall under the umbrella of the state tort claims act to the extent those physicians are treating Medicaid or Medicare patients. The Oregon Medical Association and health plans who serve Oregon Health Plan patients testified in favor of the bill. Sen. Morrisette (D-Springfield) said his real interest is that Oregon’s Rural Medical Liability Financial Reinsurance Plan may run out of funds in 2010 and sunset in 2011, and SB 519 has the advantage of not costing the state any money.
Richard Lane of OTLA, Bob Joondeph of Disability Rights Oregon and Rick Bennett of AARP testified that the bill discriminates against the poor and the aged by allowing them to recover less than similarly harmed Oregonians who are not Medicare or Medicaid patients. Jim Edge of DMAP testified that state administrators support the idea of a state workgroup to identity incentives for primary care physicians in underserved areas.
Sen. Doug Whitsett (R-Klamath Falls) asked Lane that if this bill is discriminatory, must SB 311 (the new state tort cap) be discriminatory as well, because a patient can sue the state for less that a nongovernmental health care provider? Lane said SB 311 is designed to cover the vast majority of torts, but that a patient could still sue a provider directly and exceed the cap, in the same way the Clarke case exceeded the old cap.
Senate Judiciary Committee Chair Sen. Floyd Prozanski (D-Eugene) said that the committee would not consider this bill or other medical malpractice bills during the session, and that he would host a workgroup during the interim.

HB 2794 – HPV vaccine mandate
The House Human Services Committee heard compelling testimony about the value of human papillomavirus (HPV) vaccines. It’s one of the few vaccines available that prevents cancer.
Statistics from the Public Health Division indicate that there are 111 new cases of cervical cancer in Oregon each year and 41 deaths. They testified that cervical cancer is 100 percent preventable if women get regular pap smears. They said the vaccines are particularly important for those women who might not get regular exams.
Testimony indicated that all major insurance companies and the Oregon Health Plan already cover the vaccine. Self-insured plans and labor trusts don’t necessarily cover the vaccine, but they are not subject to state mandates, so this bill would not affect them. That raised the question for some legislators about why legislation is necessary? Is it just the symbolic or educational value? The committee said it would try to get some answers before the next hearing on the bill.

HB 3022 – Antibiotics for sexual partners
Physicians say, too often when a patient comes in with gonorrhea or chlamydia, they say their partner won’t come in for treatment. In those cases, HB 3022 would allow the physician to write a second prescription for antibiotics for the partner.
In testimony before the House Human Services Committee, physicians said they know this is not the best option. They would prefer to see the partner in person. But too often that doesn’t happen. The Centers for Disease Control describe this “expedited partner treatment” as an important alternative. CDC says there is strong evidence that these second prescriptions help break the cycle of re-infection.
California and ten other states allow this practice. Sponsors of the bill say they will introduce an amendment to allow the name to be left blank on the second prescription.

SB 355 – Electronic Rx Database amended
The Senate Rural Health Policy Committee passed a number of amendments to the Prescription Drug Database proposal. The changes include:
· Limiting the database to Schedule 2 – 4 drugs
· Requiring compliance with HIPAA
· Prohibiting pharmacists from refusing to fill a valid prescription just because they can’t get information from the database
· Expanding the board to 15 members
· Requiring probable cause for law enforcement to get access to the database.
Apparently, ACLU still opposes the bill.
The bill and amendments are complicated enough that the committee wants to see a printed version of the amended bill before taking action on it.

HB 2468 & HB 2376 – Reporting gifts from pharmaceutical companies
It’s hard to escape the direct marketing of prescription drugs to consumers, but backers of these bills say pharmaceutical companies spend five times as much on marketing to physicians and hospitals. They say consumers should know if their health care provider is being influenced by pharmaceutical company gifts.
Mark Gibson with the Center for Evidence-based Medicine at OHSU told the House Health Committee, “You should know who the person who is giving you health care advice is working for. It’s that simple.”
Both bills require the pharmaceutical companies to disclose gifts to physicians, hospitals and pharmacists.
A number of physicians testified in support of the bills. Rep. Ron Maurer (R-Grants Pass) says it’s easy to blame the pharmaceutical companies but “all the doctors have to do is say ‘No’.”
Tom Holt testified that small biopharma companies now employ 14,000 Oregonians. He said these bills would be “like putting a Do Not Disturb sign on the Oregon border.” Holt says the bills would require the disclosure of intellectual property including venture capital investments in pre-clinical research. “Our competitors would love to know where we are heading.”
Opponents of the bills say Pharma has taken an active role in cleaning up its own industry. They say many of the abuses related to pharmaceutical marketing don’t happen anymore, to which committee chair, Rep. Mitch Greenlick (D-Portland) said, “If they aren’t doing it there’s nothing to report.”

SB 598 – Rx take back program
Public health and DEQ are proposing a pharmaceutical take back program modeled after one in British Columbia. In 2007, British Columbia collected 52,000 pounds of unused drugs.
Supporters want to keep prescription drugs out of the water systems and landfills.
Sen. Bill Morrisette (D-Springfield) asked, “Don’t drugs just pass through our bodies? How do we know they come from people flushing drugs down the toilet?” Representatives from Public Health say all we know is that trace amounts of drugs are found in our rivers and drinking water.
Opponents of the proposal say public health studies show that 90 percent of drugs in the water come from excretion. Even though flushing accounts for a small percentage of drugs in the water, Pharma says it now recommends that unused drugs be disposed of in the trash. Over-the-counter drug manufacturers say medicated toothpaste, anti-perspirant and lip balm would all be considered drugs under the definition in this bill and would have to pay into the program.
The Senate Rural Health Policy Committee did not take any action on the bill.

HB 2432, HB 2433 & HB 3145 – Insurance rate review
The House Consumer Protection Committee began hearings on a series of bills that would increase the level of scrutiny for rates proposed by health insurance carriers.
The Insurance Division introduced HB 2432 and 2433 that would add public hearings on rate filings and expand the factors weighed in the rate review process to include profits, surplus levels, investment income and require insurers to separately justify proposed increases in administrative costs.
HB 3145 adds additional layers of regulation that insurers describe as arbitrary.

SB 520 – Hepatitis C testing
The Public Health Division estimates that 48,000 Oregonians carry the hepatitis C virus and many of them do not know they are infected. Hepatitis C is the most common cause of chronic liver disease.
SB 520 would create a pilot program for voluntary Hepatitis C testing and fund a health education campaign about hepatitis C. Both would target those with a history of intravenous drug use.
Legislators may have a hard time coming up with the $230,000 for the project but one of the proponents said, “It’s less than the cost of one liver transplant.”
The Senate Health Care Committee will wait until it has a formal fiscal impact statement before deciding what to do with the bill.

SB 528 and HB 2183 – Eliminate field burning
Dueling measures on field burning were heard in Salem last week. The Senate bill would ban the practice, while the House version, introduced by the Governor, would phase out field burning over three years.
In 1991 the Legislature capped the number of acres that can be burned after smoke from a field burn caused a 23-car accident on I-5 near Albany. Currently, about 30,000 acres are burned each year. Only 11 percent of farmers still burn their grass seed fields to rid them of pests.
Now the debate has shifted to the health effects of smoke from field burning. Grass seed farmers packed the hearings and testified that they are in the smoke and it hasn’t hurt them.
Rep. Paul Holvey (D-Eugene) says the field-burning smoke that drifts into cities and towns in the southern Willamette Valley is dangerous for those with asthma and respiratory disease. He testified that a number of health care groups including the Lane County Medical Society, PeaceHealth, Oregon Nurses Association and others support a field burning ban.

UPCOMING

March 16, 18 & 20 – HB 2009 work sessions in the House Health Care Committee. The committee will continue looking at proposed amendments to the health care reform bill. Joint sessions with the Senate Health Care Committee are scheduled for the evenings of March 25 & 30.

March 27 – HB 2581 to move the loan repayment program to the Office of Rural Health. Work session in the House Health Care Committee. 3 pm.

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.