hospital voice 2010 web final

8/9/2019 Hospital Voice 2010 Web FINAL

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H ospital VoiceA magazine for and aboutOregoCommuityHospitals

Collaboratioat its BestGive and take between hospitals

and lawmakers helped insure115,000 more Oregonians

ReormPerspectivesAn inside look withSenator Ron Wyden

6 12

Care or theSake o CarigHospitals provide carewithout promise o payment

18

Winter/Spring 2010


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This is whaT They mean by

www.cna.com/healthpro

One o the top fve underwriters o healthcare proessional liability insurance,

CNA has helped hospitals, other healthcare organizations and physicians in

Oregon manage their risk or more than 40 years. Our experience, A rating rom

A.M. Best or fnancial strength, local underwriting authority and seasoned claim

proessionals enable us to support you, however and whenever you need us. When

you need an eective prescription or managing risk o ou o.

CNA is a registered trademark of CNA Financial Corporation. Copyright 2010 CNA. All rights reserved.

Fo o foto, pl ott ou pt gt o

vt ..o/ltpo.

smarTmedicine.

i

4 Oregos Hospitals

Stad Out

5 Letter rom thePresidet/CEO

16 Locator Map adHospital Fast Facts

23 What HospitalsAre Doig

24 Patiet Saety isPriority Oe!

26 Where Have All theDoctors Goe?

29 Hospitals Race toAdopt MedicalRecord Techology

H ospital VoiceChairma, OAHHS Boardo Trustees

Mel Pyne,

PeaceHealth Oregon Region

Presidet/Chie Executive Ocer

Andy Davidson

Vice Presidet, Policy & Advocacy

Kevin Earls

Director o Commuicatios

Andy Van Pelt

Editor

Chris Santella,

Steelhead Communications

Cotributors

Jon Bell

Shelly StromSenator Ron WydenLinda Lang

Robin MoodySonney Sapra

Diane Waldo

Desig

Sharon McKee,In House Graphics

Salem, Oregon

Cover Photo

im Hall,Grande Ronde Hospital,

La Grande, Oregon

Hospital Voice, a publication orand about Oregons 58 communityhospitals, is published two times a yearby the Oregon Association o Hospitalsand Health Systems, 4000 Kruse WayPlace, Suite 2-100, Lake Oswego,Oregon 97035, 503-636-2204.

Inquires should be sent toHospital Voice, 4000 Kruse WayPlace, Suite 2-100, Lake Oswego,

Oregon 97035. Advertising ratesmay be obtained by contactingSchadia Newcombe at 503-684-0360.Advertisements do not implyendorsement by OAHHS.

No part o this publication may bereproduced in any orm withoutwritten permission o the publisher.Opinions expressed in the publicationdo not necessarily reect ofcialpolicy o OAHHS.

ACKNOWLED

GEMENTS

ReormPerspectives | 12

An inside look with

Senator Ron Wyden

Collaboratioat Its Best | 6Give and take between

hospitals and lawmakers

helped insure 115,000

more Oregonians

Care or the Sakeo Carig | 18

Hospitals provide

care without promise

o payment

3


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All awards given to Tuality Healthcareunless otherwise noted:

HospitalInfectionPreventionProgramVHAWestCoastPerformanceAward- HighReliability

HospitalPressureUlcerPreventionProgramVHAWestCoastPerformanceAward-PerformanceAchievement

ElectronicMedicalRecordsSystemVHAWestCoastPerformanceAward-InnovationTrophy

Tobacco-freeCampusTransitionVHAWestCoastPerformanceAward-PerformanceAchievement

IDTheftDetectionandPreventionVHAWestCoastPerformanceAward-

PerformanceAchievement Tuality Center for Geriatric Psychiatry

HorizonHealthCorporationhonors ProgramoftheYearBestClinicalPractice,WesternRegion

All awards given to ProvidenceHealth & Services Oregon Regionunless otherwise noted:

2009SDITop100IntegratedHealthcareNetworksMost integrated health systemsin the United States

PracticeGreenHealth(EnvironmentalLeadershipCircleofHospitalsforaHealthy

Environment)sustainedmembership:

Providence Portland; ProvidenceSt. Vincent; Providence Milwaukie

100TopHospitalsAward,nationalwinnerThompsonReuters(formerlySolucient): Providence St. Vincent Medical Center,EverestAwardwinner,2009

HealthGradesPatientSafetyAwardandClinicalExcellenceAward,2008:Providence Medford Medical Center

During 2009, several Oregon hospitalswere recognized for outstanding effortsin clinical quality and patient safety:

Cascade Healthcare CommunityandPeaceHealthwerenamedinthenationstop50healthsystemsbyThomson-Reutersinanewstudyonhealthsystemsqualityand

efciency.Fivemeasuresofperformancewereusedtoevaluatesystems:mortality,complications,patientsafety,lengthofstayanduseofevidence-basedpractices.

Kaiser PermanentewasselectedtoparticipatewiththeJointCommissioninapatienthandoffprojectaspartofthenewlyannouncedCenterforTransformingHealthcare.Kaiser PermanentewasselectedbasedontheirexpertisewithLeanand SixSigmamethodologies.

Pioneer Memorial Hospital,Prineville,ORreceivedtheOAHHS2009OutstandingCommunityPartneraward

Silverton Hospitalisoneofonly48hospitalsnation-wideandtheonlyOregonfacilitytoberecognized

withthePressGaneySummitAward.TheSummitAwardisgivenonlytothosehospitalswhosepatientsatisfactionscoresstayinthe95thpercentileofallparticipatinghospitalsforthreeconsecutiveyears.

Oregon Health & Science UniversityhasonceagainbeenrecognizedinU.S.NewsandWorldReportsannualrankingsofAmericanhospitals.AstheonlymedicalcenterinOregononthisyearslist,OHSUwasagainrecognizedinthemedicalspecialtiesofcancerandendocrinology.OHSU istheonlyhospitalinOregonthathasrankedinU.S.News&WorldReportsBestHospitalsfor

15consecutiveyears. Grande Ronde Hospital,LaGrande,OR

receivedthefollowingawardsin2009: OutstandingRuralHealthOrganization of2009awardedbyNRHA GoldStandardCriticalAccessHospital 2009awardedbyLarsonAllenLLP LeaderinInnovativeExcellence2009 awardedbytheOAHHS

Mountain View Medical Center,Madras,ORreceivedtheOAHHS2009awardforRuralHospitalQualityLeader

OREGONSHOSPITALSSTANDOUT

Betty Johnson of Corvallis Named 2009 OAHHS Community Advocate

TheOregonAssociationofHospitalsandHealthSystems(OAHHS)honoreditsthirdrecipientoftheEllenC.LoweCommunityAdvocateAwardduringitsannualmembershipmeeting.Thisisthe

associationshighesthonorforacommunitymember.ThisyearsrecipientisBettyJohnsonfromCorvallis,Oregon.ShehasbeenacommunityvolunteerandhealthcareadvocatewithinCorvallisandaroundthestateformorethan30years.TheawardwaspresentedbyEllenC.Lowe,OAHHScommunityadvocateandinauguralrecipient.

Inthepastseveralyears,Mrs.JohnsonhasbeenheavilyinvolvedinthepublicdialoguethatsurroundshealthcareinOregon.Sheservedasstatechairfrom2000-2002forHCAOwhichledtheMeasure23ballotinitiativecampaignforuniversal,single-payerhealthcare.Also,shehasorganizednumerouspublicforumstoeducate

localresidentsaboutchallengesfacingthehealthcaresysteminourstateanddevelopingpossiblesolutionsincludingtheArchimedesMovementandSB329.

Afull-timeadvocateforahealthyOregon,Bettyhasparticulartalentforinvolvingthewidercommunityindevelopingprolesofneed,possibleremediesandaviewofthemanyroadsthatmightbridgethegap.Weoftentalkabout

theneedforpublictrust.Bettytruststhepublicenoughtoinvolvethem,statedLowe.

Mostrecently,Johnsonhasservedonthe OregonHealthFundBoardsBenetsCommittee.Herinuencehelpedshapetherecommendationslateradoptedbythe2009Legislature.Lowecontinues,Bettysstatewideinterests hadherandherfellowMid-ValleyHealthAdvocatesomnipresentduringtheHealthFundandsubsequentlegislativedeliberations.TheywereusuallyinthefrontrowandIlookedforwardtotheirpositiveexpressionsofinterest.

ThisisaveryspecialawardwhichIfeelIsharewithallthehealthcareadvocatesfromthemid-valleyareawhohavebeensofaithfulintheireffortstoimproveaffordability,accessandqualityofhealthcare,commentedBettyJohnsononreceivingtheaward.

Bettypossessesallthequalitiesthatembodythisaward,statedKevinEarls,vicepresidentofpolicyandadvocacyforOAHHS.Shehastheabilityto

connectwithpeoplewheretheyareonanygivenissueandbringthemalongtoseethebigpicture.Bettyisnotjustanadvocateforpatientsbutallparticipantsinthehealthcareconversation.WeareproudtohonorherasarolemodelofsuccessandleaderinOregonshealthcaredialogue.

About the Award: Started in 2007, The Ellen C. LoweCommunity Advocate Award honors a communitymember for his or her unique, unusual or continuoussupport of a hospital mission and/or the health ofits community. The recipient possesses compassion,understanding, wisdom and a clear vision to see tothe core of community issues. This is an award for acommunity member and not a hospital employee.

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We have all see the icoic blue ad white H hospitalsig as we drive throughout our state. Have you everthought about what the H stads or besides directiosto the earest commuity hospital?

Iwanttobethersttowelcomeyoutotheinauguralissueof Hospital Voice,acollaborativepublicationforandaboutOregons 58hospitalsandhealthsystemsandthecommunitiesweserve.Yourcommunityhospitalhasadeep-rootedmissioninprovidingservice24hoursaday,sevendaysaweek,365daysayear.Theworkdoneeverydaybythe55,000hospitalemployeesinOregonisnothingshortofremarkable.Theysaveandchangelivesforthebettereachandeveryday.Andtheworkneverends.

Lookingbackon2009,IamamazedatwhatourhospitalsaredoingintermsofpatientcareandcommunityserviceinOregon. HereisjustasampleofwhatIamtalkingabout:

Morethan9millionpatientvisits(inpatientandoutpatient) Morethan1.2millionemergencyroomvisits Morethan46,000births Morethan$1.1billioninuncompensatedcare

Lookingahead,wemustaskourselves--howwillourcommunitiessustainthehighqualityofcarewehaveallcometoexpectfrom

theblueH?Howwillwesustainthesafetynetofcareforpatientswhocannotaffordhealthcare?Howwillweworkwithstateandfederaldecisionmakersaswemovetoreformthecomplexsystemofhealthcareinourstate;whatwilltheimplicationsbe?Thesearequestionshospitalsandtheirassociationaredealingwithrightnow.Thedecisionsmadetodaywillhaveadirectimpactonthepatientsandcommunitiesoftomorrow;weallhavearoletoplay.

InthisrstissueofHospital Voice,webegintoaddresssomeofthesequestions.Duringthe2009stateLegislativeSession,Oregonshospitalcommunityforgedasolutionwithpolicymakerstobringmorethan115,000individualsintotheOregonHealthPlan.Thiswastheresultofasignicantcollaborativeeffortduringanhistoricaleconomicrecessionwhenboththestateandthehospitalcommunitywereforcedtomakesignicantnancialreductionsthemselves.CollaborationatitsBestwilltakeyouthroughthatdelicateprocessanddemonstratehowthepartnershipbetweenthestateandOregonshospitalshasproventobealife-savingexerciseformanyOregonresidents,includingOHPrecipientGaryCobb.

Ourmissionascommunityhospitalsistogivebacktoourcommunities;itssewnintothefabricofourprofession.Hospitalswishtomakethecommonpracticeofgivingbackmoretransparentandconsistentacrossthestate.In2007,hospitalsbroughtitupon

themselvestointroducelegislationthatwouldrequirepublicreportingofhospitalcommunitybenets.Wenowknowthathospitalshaveprovidedmorethan$1billionincharitycaretolocalcommunitiesthroughclinics,educationalworkshops,preventativecare,vaccinationsandemergencyroomvisits.ApiececalledCarefortheSakeofCaringhighlightsthebackgroundofthecommunitybenetprogramandwhyitisavitalpartoftherolehospitalsplayinthedeliveryofhigh-quality,patient-centeredhealthcare.

Finally,wehaveallbeenpartofahealthreformdiscussioninoneformoranotheroverthepasteighteenmonths.WhatdoesOregonsleadinghealthcareadvocate,SenatorRonWyden,havetosayontherecentdevelopmentsoutofWashingtonD.C.? Hospital VoicehadanopportunitytotalkwithOregonsseniorsenatoronthisissue.Hehasamessageforhospitalsandsomecandidthoughtsabouthowweasanationaregoingtoprovidecaretothe30millionuninsuredAmericansifthecurrentreformpackagebecomeslaw.

Oregoniansmaynotalwaysthinkaboutitthisway,butweareallpartofthehospitalcommunitybecauseatsomepointinourlife,wereallengagedwithandtouchedbyourcommunityhospitals.TheiconicblueHsignsaremuchmorethanaguideposttoyourlocalhospital.Itspeakstothecommitmentofacommunityofcaregiverswithadailymissionofprovidinghigh-qualityhealthcareto thepeoplewhoneeditmost.Itisabouttheroleweallplayinthistremendouslyimportantmission.

Thanksfortakingthetimetoreadthisissue.Iwouldpersonallywelcomeyourthoughtsandfeedbackatadavidson@oahhs.org.

Cheers!

AndyDavidsonPresident&CEOOregonAssociationofHospitals&HealthSystems

Tondoutmoreaboutyourcommunityhospitals,pleasevisitusonlineatwww.oahhs.org.

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COLLABORATIOnat Its Best

Give and take betweenhospitals and lawmakers

helped insure 115,000more Oregonians

By Jon Bell

LynnHowlett


7/32

Teres a pretty simple reason that Gary Cobb isa huge an o the Oregon Health Plan (OHP): It savedhis lie.

Getting that benet package rom OHP is thesole reason I am alive today, said Cobb, a 38-year-oldcommunity outreach coordinator or the Portlandsocial service agency Central City Concern. It madeall the dierence in the world.

A ormer heroin addict, Cobb used to head tothe emergency room when he needed health care.In 2000, he ound himsel in a detox program atCCC, where sta enrolled him in a drug and alcohol

treatment program through OHP Standard. He wentthrough treatment, utilized his OHP coverage or aew more months and then got a job as a janitor orCCC. Hes had his current post with the agency or thepast year and hes been clean or the past nine.

Knowing what the health care plan did or him,Cobb said he was glad that legislators and hospitalsacross the state ound a way to expand coverage tomore than 115,000 Oregonians last year. Having thatplan dialed me in, stabilized me and got me back onthe road to health, he said. I think its a great thing

that the hospitals came to the table or this again.

It wasnt easy, though, especially considering howtough last year was on Oregon.

Te states unemployment rate crested at12 percent in May. As a result o statewide job losses,84,000 more Oregonians are estimated to have lost

their health insurance, leaving one in our working-age adults in Oregon uninsured. And the state,acing steep budgetary shortalls stemming rom therecession, ound itsel in no position to help meet anincreasing need or health care services. Yet at a time

when other states were cutting coverage, Oregon andOregons 58 community hospitals actually managedto expand health care or 80,000 Oregon children and

35,000 low-income adults.

Who benets here really are those who donthave access to insurance and coverage, said James

Diegel, CEO oCascade Healthcare Communityin Bend. None o us like to see people who areuninsured, so were really happy that were expanding

coverage or at least some low-income adults andchildren in Oregon.

echnically, Oregon lawmakers passed alaw last spring that expanded OHP. Signed byGov. ed Kulongoski in early August, the law taxesthe states largest hospitals as well as commercialhealth insurance premiums. Te taxes will generateabout $1 billion and secure an additional $1.8 billionin ederal health care unds over the next our years.

But what really brought about this unlikely goodnews can actually be distilled into one single word:collaboration. Collaboration by turns smoothand a little rocky between hospital leadership,representatives rom the health insurance industryand key lawmakers allowed Oregon to make headway

on health care reorm and provide health coverage toa greater number o uninsured Oregonians.

The importat thig, ad thisgoes or everyoe who was atthe table, is that we everlost sight o what we were alltryig to accomplish: to d aworkable solutio to udig

expadig access or Oregosmost vulerable citizes.

>> Andy Davidson, President/CEO, OAHHS

I was really impressed with how everybodywas able to work together, said Bruce Goldberg,MD, director o the Oregon Department o HumanServices. Every state is having really diculteconomic times, and the response o most stateshas been primarily to cut Medicaid unding. Herein Oregon, we did just the opposite. In the ace oincreasing need, we stepped up.

History lessonsAlthough the expanded coverage and increased

ederal dollars that resulted rom the legislationare new, the hospital tax itsel has been around

or close to seven years. Te original idea was thatthe tax would be used as a way to improve state

Winter/Spring 2010

7


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reimbursements to hospitals, which have alwaysbeen ar below hospitals costs. But nancial hardtimes in Oregon in 2003 caused some changes incourse. Tanks to budgetary shortalls that year andthe deeat o the Measure 30 income tax increase in

February 2004, the state was aced with cutting itsOHP Standard program, which covered more than110,000 Oregonians.

Worried about the impact that 110,000 moreuninsured people would have on hospital emergency

departments and the general health o the state

the hospital community agreed to a temporary taxthat would help keep at least 25,000 people coveredunder OHP Standard. Te tax was set to expire in2007. In the meantime, the Legislature was going

to be working to restore unding or OHP Standard.But as the deadline approached, it became clearthat an extension was necessary, so lawmakers andstakeholders negotiated an additional two years.Tat extension was to sunset at the end o September

2009, but with no alternatives in sight, somethingelse needed to be done. Unortunately the rst ideaon the table, a 4 percent tax on hospitals straightrom Gov. Kulongoskis oce in early 2009, wasntgoing to cut it.

We elt that that was opposite o one o ourmajor tenets o reorm, Diegel said, noting that thehospital association believes everyone individuals,hospitals, employers and the government shouldhelp und health care. Tat proposal didnt sound

like everyone had some skin in the game. A studyconducted or Oregon Association o Hospitals andHealth Systems (OAHHS) by Health Management

Associates ound that the initial proposal would haveaced hospitals with more than $400 million in lossesover the ollowing two years. It would have put usin the red or sure, said Norman Gruber, presidentand CEO oSalem Health. Tat kind o a tax wouldhave created a problem or hospitals that many peopledidnt realize.

Greater goodOn the other hand, such a tax would likely have

beneted Oregons 32 small and rural hospitals.Unlike their larger counterparts, the small and rural

hospitals dont pay the tax, yet they enjoy the benetso the matching ederal money. Te large hospitalshave been providing a subsidization o ederalmatching dollars or the smaller hospitals, saidDennis Burke, president and CEO oGood ShepherdHealth System in Hermiston. Tey have been willing

to shoulder this or all the hospitals in the state.Te larger tax would have probably meant

increased ederal money or the small and ruralhospitals in Oregon. But, Burke said, the resultingnancial hit to the larger hospitals, which regularly

provide key services and care that smaller acilitiescant, would have had negative impacts on allhospitals in Oregon.

I think the Legislature expected that smallhospitals would put our interests rst, said Burke,

who now chairs OAHHS Small and Rural HospitalCommittee. But we were unanimous in ouropposition to that tax. We took the broader view andrecognized that this would be detrimental to ourlarger urban hospitals.

Te hospitals alternative to the 4 percent tax onhospitals was a 1 percent tax on all health insuranceclaims, a plan that would have spread the tax out overa broader base. Te proposal would have generated

It was the hospitals themselves whostepped up ad oered to assist usthrough this method. I they had otmade that oer, the we would otbe where we are today.

>> Sen. Jackie Winters, R-Salem

LynnHowlett

8

>>A magazine for and about Oregon Community Hospitals.H ospital Voice


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even more money than the Legislatures tax. But thehospitals plan proved to be politically uneasible.

And so the real negotiations began.

Back and orthAmong those at the table were OAHHS CEOAndy Davidson, Kevin Earls, the associations vicepresident o policy and advocacy, Bruce Goldbergrom DHS, and several Oregon legislators, includingRep. Dave Hunt, D-Gladstone, Sen. Betsy Johnson,D-Scappoose, Rep. Mitch Greenlick, D-Portland,and Sen. Peter Courtney, D-Salem.

Everybody came to the conversation interestedin nding a solution, said Rep. Mary Nolan,D-Portland, who also helped negotiate the two-yearextension o the original assessment in 2007.

Reaching the current solution, however, wasntexactly a walk in the park.

It was rough and tumble and dicult at times,Davidson said, but the important thing, andthis goes or everyone who was at the table, is thatwe never lost sight o what we were all trying to

accomplish: to nd a workable solution to undingexpanding access or Oregons most vulnerable

citizens.

It wasnt antagonistic, added Nolan, but itwas challenging.

As in any negotiation, the various participants

came in with principles they couldnt give an inch onas well as some areas o greater fexibility. OAHHSstood rm on the point that the tax could not exceedthe amount the state would reimburse hospitals.

Te tax needed to be treated as a long-term,

no-interest loan, Davidson said.

Among its goals, the Legislature had hoped toimplement the new tax or longer than our years,according to Nolan. However, lawmakers agreed tothe our-year timeline in exchange or somecompromise rom the hospitals on the terms o theagreement. Tere were a lot o negotiations aroundwhat the assessment should be, said Sen. Jackie

Winters, R-Salem, whos been involved in theLegislatures health care endeavors since 2003.We needed to make sure we were not taking morethan we needed to capture the ederal dollars onthe table.

Its a Bad-Aid or some

period o time. You have to

just be hopeul that its goig

to get us through the gap.

>> Norman Gruber, CEO, Salem Health

Because o the complexity o the nancial

arrangements, the negotiations also involved agreat deal o education on everything rom hospitaloperations to leveraging ederal money. Goldberg,who helped hammer out the rst two taxes in 2003

and 2007, said one o his primary roles in the processwas to provide the technical inormation on whatcould and could not be done. He also mined expertiserom DHS sta and national consultants to help laythe groundwork or a new deal. Youd think that bythe third time itd be easier, said Goldberg, but itwasnt. Tere were more players involved this time

around, he said, and more money. Te stakes werehigher this time because o the state o Oregons

economy and huge problems with the numberso uninsured and the rising costs o health care,Goldberg added. Te whole issue o greater needand a worsening scal situation or everybody reallymade this complicated. But, with greater risk camegreater opportunity too.

A Win, or NowIn the end, ater more than 40 hours onegotiations, compromises and collaboration,

hospital leadership, lawmakers and governmentocials emerged with their solution: a foatingassessment on the revenues o the states 26 large

hospitals and a 1 percent tax on commercial healthinsurance plans. Money generated allows the state toleverage some $1.8 billion in ederal matching undsover the our-year lie o the program.

Winter/Spring 2010

9


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Tose unds not only provide or an expandedOHP, but or increased reimbursements to hospitals,as well. In essence, the agreement is an interest-reeloan rom the hospitals to the state that gets repaidin ull via the increased matching unds.

It keeps hospitals whole, Winters said, and thatis important because it was the hospitals themselveswho stepped up and oered to assist us through thismethod. I they had not made that oer, then we

would not be where we are today.

As implemented, the hospital assessment willgenerate approximately $307 million and leverage

$550 million in ederal unds during the currentbiennium; or 2011-2013, it will generate $450million in tax revenue and $635 million in ederaldollars. In total, both the hospital assessment andthe insurance tax will raise $1.02 billion in revenue,leverage $1.8 billion in ederal unds, and createor retain an estimated 3,600 jobs.

But perhaps more importantly, the agreementachieves the common goal set orth back beore thestart o the negotiations: expanding health carecoverage to more Oregonians. As a result o the

collaboration, an additional 80,000 children and35,000 low-income adults will be covered under OHP.

Teres also hope that the expanded OHP will helpease the strain on emergency departments across thestate by allowing more people to seek preventative,covered care instead o heading straight to the ER.From a big-picture view, that could also help beginto address the issue o ever-increasing premiums orcommercial health insurance purchasers.

From a moral perspective, (covering moreOregonians) would be a great accomplishment

in itsel, said Rep. Dave Hunt, D-Gladstone.But theres the economic benet as well becausetheyre not going to be using the ER or care...Te impact on all o us paying or private healthinsurance is proound.

What next?Despite the successul collaboration and the

positive outcome, no one involved in crating thelatest deal presumes that this is the end o thestory or even that this is the right way to und

OHP. I think its a reasonable solution given wherewe are, Mary Nolan said, but its hard to knowwhat our next step will be.

Its a Band-Aid or some period o time, said

Norman Gruber. You have to just be hopeul thatits going to get us through the gap.

The respose o most

states has bee primarily to

cut Medicaid udig.

Here i Orego, we did just

the opposite.

>> Bruce Goldberg, director of the OregonDepartment of Human Services

Te reality is that the current tax will sunsetin 2013, and because o ederal regulations, thetaxing opportunity has essentially been maxed out.

Additionally, the understanding has always been thatthe tax plans were temporary measures.

So what happens next?

>> KEY LEGISLATIVE FIGURESINTHEHEALTHCARECOLLABORATION

Sen. Jackie Winters (R)Salem

Speaker Dave Hunt (D)Clackamas County

Sen. Margaret Carter (R)Salem

Rep. Mary Nolan (D)Portland

Rep. Mitch Greenlick (D)Portland

Sen. Betsy Johnson (D)Scappoose

LynnHowlett

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Hospitals and other providers have longadvocated or a restoration o state unding or OHP.(Te state currently provides no general und moneyor the OHP Standard plan.) General economicmalaise makes that a tough proposition at present.

But OAHHS is planning to begin discussions thisspring to get a jump on what needs to be donecome 2013.

When we came together, we extracted the

agreement to have a discussion about a long-termunding source or health care, because it is not this,said Davidson. We are absolutely going to holdpolicymakers to that agreement.

Te association also wants to ensure that anyuture unding mechanisms are transparent and notin any way hidden rom public view.

Teres also the possibility that changes made tohealth care on a national level will impact Oregonssystem as well, including a urther expansion oMedicaid. Goldberg and Nolan voiced condencethat the tax will at least provide Oregon the bridgeit needs to make it until ederal reorms whateverthey may be are implemented.

Until then, the law stands as the short-term

solution that helped Oregon expand coverage toits poor and uninsured population while increasing

historically low payments to hospitals. It wasnt easy.Its not the end-all. But in trying economic times,hospital leadership and Oregon lawmakers madeit happen.

I really believe this was a great example ocollaboration among hospitals and legislators,Gruber said. Health care is a pretty dicey subject.Its not an easy one to deal with, but this shows you

just what can be done.

Sen. Peter Courtney (D)Salem

Rep. Ron Maurer (R)Grants Pass

Rep. Vicki Berger (R)Salem

04 05 06 07 080%

1%

2%

3%

4%

5%

6%

7%

8%

Growth iUcompesated CareAs a percetage o Gross Charges

TotalUncompensatedCare%ofGrossCharges

CharityCare%ofGrossCharges

04 05 06 07 080%5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Payer Percet oTotal Charges

Commercial%ofTotalCharges

Medicaid%ofTotalCharges

Medicare%ofTotalCharges

950,000

1,000,000

1,050,000

1,100,000

1,150,000

1,200,000

1,250,000

04 05 06 07 08

Growth I EmergecyRoom Visits

EmergencyRoomVisits

LynnHowlett

Winter/Spring 2010

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For more than a year, Oregons hospitals have been on the rontlines odiscussions around the health reorm package taking shape in Washington D.C.

Senator Ron Wyden (D-OR) is one o Congress leading health care advocates

and on the Senate Finance Committee, the chie authoring body o the

the Senate health reorm proposal. The Oregon Association o Hospitals and

Health Systems had the privilege o sitting down with Senator Wyden to

ask him some questions about the current proposals circulating Capitol Hill

and the passing o a reorm package this size.

REFORMPERSPECTIVESAn inside look with Senator Ron Wyden


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Q: How would you characterize theU.S. Senates health reorm bill?

I would call it a start. Obviously, I sought topursue a dierent approach with the Healthy

Americans Act. My approach didnt prevail,so weve sought to export as much o ourphilosophical underpinning as possible.

We incorporated the Free Choice voucherprovision in the bill. Under that provision, peoplewho spend more than 8 percent o their incomeon health care and who are ineligible or subsidieswould be able to get vouchers enabling them tobecome part o a purchasing pool getting themmore or their money and holding health insurance

companies accountable.We also secured increased reimbursement or

high-quality, efcient Medicare Advantage plans.

Oregon has the highest percentage o seniors onMedicare Advantage in the country and providershere get clobbered under regular Medicare rates,so this is very important. I was also able to winpassage o a provision that allowed states thatshow they meet coverage requirements to obtain awaiver, allowing them to develop their own path.

Tere are a number o good eatures in thisbill, including the elimination o discriminationagainst those with pre-existing illness a practicethat insurance committees have long engaged in.

Tere are also provisions Ill be pushing to changein the conerence committee and in theyears ahead.

Q: What are your concerns with theSenates health reorm bill?

I continue to believe there needs to be considerably

more competition and choice in the health caremarket. I want to help bring about the day whenevery consumer can deliver an ultimatum to their

insurance company. Te ultimatum is reat meright or Ill go elsewhere.

Much o American health care is a competition-

ree zone. We have scores o communities underthe eves o one insurer, where theres no realmarketplace. Most Americans who are luckyenough to have employer-sponsored insurancedont get any choice. Bringing consumers morechoice is at the top o my list o areas tocontinue to work on.

AmbulatoryHealth Care

ServicesHospitals

Nursing &Residential Care

Facilities

Orego Healthcare IdustryAual Average Employmet or 2008

(Data Source: OLMIS, 1/5/10)

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

42%33%

25%

Winter/Spring 2010

13


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Q: What are your thoughts abouthow the bill addresses work orce?

Considerable eort is needed to addressworkorce issues. Te ederal government canmandate anything it wants, but that doesntmean it will happen without an adequate workorce. Massachusetts showed this clearly whenit mandated a system to cover all residents, andthe rst thing it ound was the state didnt haveenough doctors and nurses to treat the population.

Some o the work orce issue concerns the needor additional resources, and some is a matter omaking better use o existing resources. Terecontinues to be a mal-distribution o providers,but all you have to do is look at the demographicsto see there will be a need or many more medicalproviders in the years ahead. Well continue to stepup the ght there.

Q: The Senate bill proposes to

increase coverage or 30 millionuninsured people. Is that sufcient?

Obviously, it leaves a substantial number oindividuals uncovered. Look at the amount o moneybeing spent $2.5 trillion last year and divide itby our population o 300 million Americans. At thatrate, you could hire a doctor to care or every seven

amilies in America and pay the doctor $250,000 ayear. I oer this as a metaphor. Te point is, we are

spending enough, but we arent spending it in the

right places.

Te Senate version o the health reorm billwould create health insurance exchanges portalsadministered by the government or a non-prot

agency through which individuals and smallbusinesses could compare health plans and purchasehealth insurance coverage.

Q: What do you want Oregons

hospitals to take away rom thesereorm packages? For example, whatare the operational changes thatwould be ideal in the wake o reorm?

Right now, the Medicare program tends to pay

providers based on volume o care rather than value or

quality o care. Te senate bill makes changes to start

to drive our spending toward value. For example, there

will be reduced payments to hospitals with high rates o

preventable hospital acquired inections. Reorm alsoestablishes a pilot program to explore the bundled

payments model under Medicare. So rather than paying

separately or each hospital stay and necessary care

ater discharge, bundled payments would set aside

a lump sum or an entire episode o care. Successul

hospitals, I believe, will see these types o reorms

and begin innovating ways to improve perormance

or example, to improve ollow-up care to reduce

complications and unnecessary hospital readmissions.

0

10,000

20,000

30,000

40,000

50,000

60,000

00 02 04 06 08

Aual Average Employmet iOrego Hospitals 2000-2008(Data Source: OLMIS, 1/5/10)

Populatio Growth i Orego

TotalPopulation PopulationAge65andOlder

0

500,000

1,000,000

1,500,000

2,000,000

2,500,0003,000,000

3,500,000

4,000,000

00 02 04 06 08

14



15/32

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Te MHA program provides the educational oundation

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Inpatient Medical Service, Legacy Health System, Portland,

and MHA Program Faculty

Q: What are the mostsalient promises andpitalls o the proposedhealth insuranceexchanges?

First o all, I have long thought

that the exchanges are really the

uture o our health care system,

which is why I think it is so

important to get them right.

Te biggest danger in creating

the exchanges, as I see it, is not

getting enough people into them

and/or ending up with risk pools

comprised o only the sickest and

most vulnerable individuals.

Tis is why I have ocused my

eorts on expanding access to

the exchanges and making them

more robust. I inserted a provision

in the bill that will allow peoplewith unaordable employer-based

insurance to take their employers

dollars with them to shop in the

exchange and am working to build on

this by making it possible or more

businesses to insure their workers in

the exchange and or their employees

to be able to shop more reely within

the exchange or coverage.

I wat to help brig about the day wheevery cosumer ca deliver a ultimatumto their isurace compay. The ultimatumis Treat me right or Ill go elsewhere.>> Senator Ron Wyden (D-OR)

O f c e o S e n a t o r R o n W y d e n

Winter/Spring 2010

15


16/32

LakeKlamath

JacksonJosephine

Curry

Coos Douglas

Deschutes

Crook

Multnomah

GilliamSherman

Jefferson

Wasco

Marion

Clackamas

HoodRiver

Lincoln

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Clatsop

Columbia

Columbia MemorialHospital

Providece

Seaside Hospital

Tillamook CoutyGeeral Hospital

Samarita north

Licol Hospital

Samarita PacifcCommuities Hospital

Peace HarborHospital

Lower UmpquaHospital

Bay AreaHospital

Coquille ValleyHospital

Souther Coos Hospital& Health Ceter

Curry GeeralHospital

TualityHealthcare

Providece newbergMedical Ceter

Willamette ValleyMedical Ceter

West ValleyHospital

Good SamaritaRegioal Medical Ceter

Sacred HeartMedical Ceter

Providece St. Vicet Medical Ceter (WA Couty)

Cedar Hills Hospital

Shriers Hospital or Childre

Orego Health & Sciece Uiversity

Legacy Good Samarita Hospital & Medical Ceter

Legacy Emauel Hospital & Health Ceter

Providece Portlad Medical Ceter

Vibra Specialty Hospital

Advetist Medical Ceter

Legacy Mout Hood Medical Ceter

Providece Hood River Memorial Hospital

Sky LakesMedical Ceter

Lake DistrictHospital

Benton

Linn

Lane

Ashlad CommuityHospital

Three RiversCommuity Hospital

Pioeer MemorialHospital (P)

St. Charles MedicalCeter Redmod

St. Charles MedicalCeter Bed

Moutai ViewHospital

Mid ColumbiaMedical Ceter

Pioeer MHospi

Providece Milwaukie Medical CeterKaiser Suyside Hospital

Legacy Meridia Park HospitalWillamette Falls Hospital

SilvertoHospital

Satiam MemorialHospital

Samarita AlbayGeeral Hospital

Samarita LebaoCommuity Hospital

McKezie-WillametteMedical Ceter

Cottage GroveCommuity Hospital

Mercy MedicalCeter

Providece MedordMedical Ceter

Rogue ValleyMedical Ceter

Salem Hospital RegioalHealth Services

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Malheur

Harney

Grant

Baker

Wallowa

Union

Umatilla

od Shepherddical Ceter St. AthoyHospital

Grad RodeHospital

St. ElizabethHealth Services

Holy RosaryMedical Ceter

Wallowa MemorialHospital

Hospital Fast Facts

2009 HOSPITAL SERVICES

343,884patientsreceivedinpatientcareat Oregons hospitals

OutpatientCareprovidedto8,990,033Oregonians

1,225,646Oregoniansreceivedcareintheirlocal Emergency Rooms

HospitalsinOregonassistedinthedeliveryo 46,714 babies last year

Morethan$1,108,508,353inuncompensated

care (the total charity care plus bad debt) wasprovided by Oregon hospitals last year.

COnTRIBUTIOnS TOOREGOnS ECOnOMY

Duringthelast3-5years,healthcareemployers in Oregon supported the economicengine in every community across the state.

Oregonhospitalsemployapproximately

55,517 people (ull and part time) and makeup 30% o the states largest employers.

Ofthestates50largestemployers,Oregon hospitals comprise 15, providingamily-wage jobs.

Oregonhospitalsareamongthetopsixindustries to project rapid job growthby 2014.

OnlysixOregonindustriesarelistedinthetop 10 o both the job growth and rapid

growth elds. Te three health care categories(ambulatory health care, hospitals andnursing and residential care) account orhal o these industries.

Whenalsoaccountingforhospitalpurchaseso goods and services rom other businesses,hospitals support one o every 10 jobs outsidethe hospital walls.

Harey DistrictHospital

Blue MoutaiHospital

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Oregons 58 community hospitals are the lastresort or many o the 639,000 Oregonians

who are without health care insurance.These hospitals are committed to a mission

o service rooted within the communitiesthey serve.

CARE FOR THE SAKEOF CARInGHospitals provide care without promise of payment

By Shelly Strom

S i l v e r t o n H o s p i t a l S i l v e r t o n O r e g o n


19/32

Teres a reason you have the blue H signs onthe highway. Tose really are important to people,said Ellen Lowe, community advocate or theOregon Association o Hospitals and Health Systems(OAHHS). Hospitals, however, are more than just the

ER and the maternity ward. Sharing the story aroundthe rest o what hospitals do provides an opportunityor hospitals to connect with a wider community.

Te notion o hospitals beneting the

communities where they operate is as old as theinstitutions themselves. Mother Joseph providesa ne example o community service, said Julierocchio, senior director o community benet andcontinuing care or the Catholic Health Association.In 1854, she led a group o ve Sisters o Providence

rom Quebec to Vancouver, WA. Tere they builtHouse o Providence, which served as an orphanageand now is an oce building known as Te Academy.

Providence Health & Services is an outgrowth o thewomens endeavors throughout the Pacic Northwest.

Community benet is part and parcel to thereason hospitals exist, said Kari Stanley, director ocommunity benet at Legacy Health. Our mission isto care or everyone, both those with insurance andthose without.

Dollar amounts tied to uncompensated care

and services known as community benet

have risen astronomically in recent years. In 2009

hospitals delivered an estimated $1 billion in care and

services that qualiy as community benet. en years

ago, Oregon hospitals provided a little more than

$150 million in care and services in the category o

community benet. Such growth is largely attributable

to providing services to people without health

insurance. As communities and the needs o people

within them have expanded, so have the serviceshospitals provide through a variety o programs.

Examples o charity care and other programs designed

to benet the community abound. Te array o ree

oerings include: fu shots, car seat installation

clinics, prenatal and general medical care, classroom

lessons in health, lectures on managing chronic

disease, librarians who can research or medically valid

inormation, health airs, transportation to and rom

medical appointments, and more.

Over the years, hospitals have evolved to denehealth beyond simply the provision o care within ourwalls, said Stanley. Our mission encompasses goodhealth or our people, our patients, our communitiesand, really, our world.

Care We Have Come to Expect...and More

In the past decade, hospitals have become moreinvolved in taking on social and economic challenges,said John King, a nationally known consultant inhealth care and ormer CEO oLegacy Health.In some cases they have the most managerial talentin the county. Tey want to put that to use beyond

their traditional health care mission. o that end,Oregon hospitals have assisted homeless people,run a amily resources center, provided oce spaceto nonprots and designed a youth employmentprogram to encourage people within groups under-represented in hospital stang toward a careerin hospitals.

I 2008, Care Va provided6,884 ree rides to ad romacilities i Silverto, Mt. Agel,

Molalla ad Woodbur,totalig early 68,000 miles.

More likely than not, everyone has partaken in

a ree program sponsored by an Oregon hospital and may not have even known it! For instance,at Southern Coos Hospital and Health Center inBandon, Ore., a drive-thru fu shot clinic is stagedannually. Te hospital puts on the event to help thecommunity by providing fu shots ree o charge.

At the same time, however, participating hospital

sta receive training in disaster preparedness.Te event takes place at an empty lot near the centero town the same place that emergency personnelwould use to provide care during a disaster.

A program operated by Legacy Health is lessvisible. Te system, which operates six hospitals anda number o clinics and labs throughout the Portland-

metro area, also provides three inormation centers.Anyone may call the center and request inormation

Winter/Spring 2010

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on a medical topic. Te service is especially valuablebecause the inormation provided is medically valid;such inormation can sometimes can be a challengeor nonproessionals to unearth. On average,the centers collectively respond to about 10,000

requests annually.

Te Silverton Hospital Network in Silverton,Ore., brings its patients to its acilities. Te program,called Care Van, serves a critical role or patients who

have transportation challenges. In 2008, Care Vanprovided 6,884 ree rides to and rom acilities inSilverton, Mt. Angel, Molalla and Woodburn, totalingnearly 68,000 miles.

Holding Themselves AccountableIn 2007, Oregons community hospitals

launched an eort to establish legislation thatwould standardize how they report on their nancialsupport o programs that provide community benet.

A purpose o the eort, which culminated in House

Bill 3290, was to illuminate just how much hospitalscontribute to meet community needs. Oregonshospitals have a good story to tell but they donthave the consistent data to tell it in a way that ismeaningul, said Kevin Earls, OAHHS vice presidento policy and advocacy. Te new law promises to

deliver clarity on the extent to how hospitals areollowing through on their mission o improving thehealth o their communities. Inormation that will begenerated on community benet programs has thepotential to break silos and unite hospitals across the

regions and the state.

Coming together and working to solve theseissues at this point in time is even more important,said Julie Manning, vice president o development

and community relations or Samaritan HealthServices in Corvallis, Ore. Being strategic aboutserving community need has never been so importantor hospitals. Demand right now is taxing theabilities o our saety net o services to ll the gap,said Manning.

Community need reached new heights in thewake o the deep economic recession that began in2008. So many more people have become uninsuredin Oregon, said Kari Stanley, rom Legacy Health.Without insurance, people delay getting care inthe earlier stages o illness. By the time they seek

treatment, they are very ill and need more and higherlevels o care.

Much o the treatment Stanley describes is tied

to medical care provided within hospital emergency

rooms. In 2008, 1.2 million Oregonians visitedhospital emergency departments. In many cases,hospitals are not compensated ully or at all orcare by people without insurance. Tis is especiallydetrimental to the nancial stability o hospitals,because care is very costly when it is provided viaemergency rooms.

o survive and continue to be able to serveanyone who walks through their doors, hospitalsneed to be on the same page in terms o community

benet reporting and standardization. Tere needs tobe a consistent way to collect, document and reportcommunity health needs and benets. Data thatwill be generated provides a strategic rameworkor addressing community needs and coordinatingcommunity benet programs, Samaritans JulieManning continues. We can ask how can we bestleverage our community benet investment..

Te potential seems powerul.

SilvertonHo

spital,Silverton,Oregon

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Tink o what we could achieve i we ocus andexpend our resources in a strategic way, Manningadds. Shouldnt we coordinate our giving based ondocumented and prioritized need?

At the same time, by allowing the public to havean even closer look at their nancials, hospitals likelywill improve community benet programs. Oncecommunity benet data becomes public, the healthneeds o a community will become clear and willallow or constructive dialogue around prioritizingcommunity benet/health needs. Te shoe willpinch at times or these institutions that dont

measure up. But at the same time, it gives them an

opportunity to improve, said consultant John King.

Being transparent is highly in tune with the worldthat were in.

By sharing their story, Oregons hospitals have a

greater chance at succeeding. I think one result will bea heightened awareness o the gravity o the nancial

situation in terms o the huge amounts o dollars

being spent as a result o so many people who dont

have health insurance, said Rosemari Davis, CEO o

Willamette Valley Medical Center.

It begs the question what is happening to the

nancial viability o hospitals and can it be continued.

Neither the nancial burden borne by hospitals

attempting to meet community need, nor the rate atwhich the burden is growing, is sustainable. (Oregonhospitals delivered $1 billion in uncompensated carein 2009. See related story, page 18.)

In order to bring clarity and substance to debatesaround how to solve a looming health care crisis,Oregon hospitals recently helped impose a new statelaw on themselves. Under the new law, known asHouse Bill 3290, hospitals must provide detailedreports on expenditures related to programs thatbenet their communities. HB3290 went into eect

in 2009.

Heretoore, hospitals have been let to their owndevices in accounting or community benet. As tax-

exempt organizations, they are required to deliver acalculable benet to the community.

Te real problem was that hospitals were

reporting in all sorts o dierent ways, saidRep. Mitch Greenlick (D-Portland). Tere always hasbeen a level o transparency, it just wasnt clear whatyou were looking at. Oregons move to standardizehospital accounting is just the latest amongapproximately 20 states that have similar rules.

Changes by the Internal Revenue Service (IRS)in recent years require hospitals to demonstratecontributions to their respective communities.Expenses that qualiy as community benet,according to the IRS and in Oregon, are:

Costs associated with medical care thatis uncompensated or charity;

Costs related to care or services availableree o charge to anyone in the community.

Costs related to marketing do not qualiyas community benet.

Te new rule provides a way to see at a nutsand bolts level the details that go into accountingaround community benet. Any time you havemore accurate, complete data it is good because it

>> HOSPITALS PROACTIVELeadership collaborates i order to help provide care to commuities

T u a l i t y H e a l t h c a r e

H i l l s b o r o

O r e g o n

Winter/Spring 2010

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enables you to make policy decisions based on solidinormation rather than assumptions, said Speaker othe House David Hunt (D-Gladstone).

Health care can be especially challenging orlawmakers to sort through. Tere has been thishuge increase in expenditures tied to communitybenet. And because there wasnt consistency inreporting on community benet, legislators had ahard time deciphering the picture, Greenlick said.With standardized reporting, legislators have achance to believe it now.

Te eort by law-makers and those in the health

care community is part o a national goal to ndsolutions to the crisis in health care that has beenbuilding or years. Were spiraling into a deep holeregarding medical costs. We have to start looking athow health care dollars are being used, said statesenator Laurie Monnes-Anderson (D-Gresham).

Having solid data on how hospitals providecommunity benet is crucial at a time like this.Te more we are able to proactively assess whathospitals are doing, the better positioned we willbe to develop the right strategies or making health

care more aordable and accessible to Oregonians,said Hunt.

In that vein, leaders rom Oregons 58 community

hospitals hatched a concept or standardizing

accounting around programs that provide community

benet. Hospital leaders looked to Oregon

Association o Hospitals and Health Systems to

assist in making a proposal to the legislature.

OAHHS vice president o policy and advocacy

Kevin Earls, representing member hospitals,collaborated with citizen groups and lawmakers toshape language or legislation on which all partiescould agree. Te eort was no small task.

It is to the credit o hospital leadership that theyall agreed, collectively that there would be a certainway o reporting community benet that allows thepublic to compare apples to apples, said Ellen Pinney,executive director o Oregon Health Action Campaign.

Standardization or reporting on accounting related tocommunity benet most o which is medical careor which hospitals are uncompensated is necessaryand overdue, Pinney said.

Work by Oregons hospitals to create theaccounting rule culminated in HB3290, which in2007 sailed through the legislature almostunanimously. HB3290 requires hospitals in 2009to start reporting on community benet to thestate. By dening certain expenses that qualiy ascommunity benet, the legislation standardizes what

hospitals already had been doing. It is just a start butalso what we need i we are going to get a handle onwhat individual hospitals contribute to address unmetcommunity health and the good they are doing,Pinney added.

Earls hopes data sets generated by the new lawadvance the issues. Hospitals oten are seen as anentity where costs and expenditures are somewhatmysterious. We want to help provide more clarityand transparency around those things, he said.

Ultimately, the story we have to tell is about howhospitals try to provide a saety net or

all Oregonians.


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> Grande Ronde HospitalLa Grande, Oregonwww.grh.org

SteppingStoneFoundationGrant

MountEmilySafeCenterGrant

NewParentingClasses ChildbirthEducationClasses

FreeChildrensClinic

> Tuality HealthcareHillsboro, Oregonwww.tuality.org

Salud!MedicalOutreach

EssentialHealthClinic,Washington County Partnership

BeeWellSummerCampforChildren FreeCholesterolandBlood-

Pressure Screening

CertiedAthleticTrainerProgramwithArea Schools

Nutrition/Diabetes Classes with Area Schools

Free/Low-CostCommunityClasses

GrassrootsHealth:FaithCommunitiesParish Nurse Program

> Good Shepherd Medical CenterHermiston, Oregonwww.gshealth.org

GoodShepherdCommunity

Health Foundation Grant CareVanComplimentaryMedical

Transportation Service

GreaterHermistonCommunityHealth Coalition

Babysitting101Class DiabetesEducationandSupportGroup

CommunityWellnessAssessments

Childbirth/NewMomClasses

> Asante Health SystemMedord, Oregonwww.asante.org

AsanteCommunityHealthEducationSeries

ChildrensDentalClinic SmullinHealthEducationCenter

ChildbirthEducation

DiabetesCareCenter PalliativeOutreach:HospiceEducation

and Volunteers

PastoralOutreach:FaithCommunityNurse Program

TheChildAdvocacyCenter

KidsHealthConnection

FrancisCheneyFamilyPlace&ThreeRiversCommunity Hospital Family House

TheBreastCancerScreeningProgram

> Providence Health & Services

Oregon Regionwww.providence.org

VietnameseVolunteerHealthPromoters

PartnersforSeniors

FeverKits SouthernOregonMethProject

FreeMammograms

SupportforSummertimeSchoolLunch Program

PartnersinHealthGrantProgram

> Silverton HospitalSilverton, Oregonwww.silvertonhospital.org

McClaineStreetClinic

CommunityOutreachClinic CommunityHealthEnhancement

Mission (CHEM)

CareVan

SchoolNursesProgram

HealthOccupationClassesandTraining

> PeaceHealthOregon Regionwww.peacehealth.org

BridgeAssistanceCharityCareProgram

UnitedWay100%AccessCoalition

PrenatalClinic&BirthCenter

VolunteersinMedicineClinic

HighSchoolSportsPhysicals HealthInformationLibrary

> Oregon Health &Science UniversityPortland, Oregonwww.ohsu.edu/xd/outreach/

WomensHealth,CancerandCardiology Screenings

BrainAwareness

OregonPoisonCenter

ScienceEducationOutreach GiveKidsASmileDayDentalCare

or Underserved Children

> Kaiser Sunnyside Medical CenterClackamas, Oregonwww.kp.org

FreeHealthScreeningsfortheAmericanHeart Associations Heart Walk

GlobalWarmingClothingDrive

CollegeScholarshipforNorthClackamasSchool District

> Cascade Healthcare Community

Central Oregonwww.cascadehealthcare.org

St.CharlesFoundation

HealthyStartProgram

SarasProject WendysWish

SoaringSprits

DEFEATCancer

KidsCenter

> Legacy HealthPortland and SW Washingtonwww.legacyhealth.org

CommunityHealthFundGrants

TraumaNursesTalkTough FreeScreenings:Glaucoma,Prostate,

Skin and Womens Health

NonprotsHousedonHospitalCampusesat No Cost

SafetyNetClinics

CaregiverServices

HighSchoolHealthcareInternships

> Salem HealthSalem, Oregonwww.salemhealth.org

HealthyHeartsEducationalSupportGroup PolkCountyFairFirstAid

TraumaNursesTalkTough SchoolClassroomSafetyEducation

WestValleyHospitalConnectionsVan Awesome3000FunRun

SalemFreeMedicalClinic

> Samaritan Health ServicesCorvallis, Oregonwww.samhealth.org

TobaccoCessationSupport

BetterBreathersWorkshops

ParishNursesProgram

LivingWellwithChronicConditions Workshops

SeniorCompanionProgram SocialAccountabilityCommunityGrants

> Adventist Medical CenterPortland, Oregonwww.adventisthealthnw.com

AdoptaFamily

PortlandAdventistCommunityServices

HealthvanProgram

HIVScreening Free/LowCostHealthScreenings

& Education

WHAT HOSPITALS ARE DOInGThis is a sampling o what Oregons 58 community hospitals are doing for their local communities.Please visit their websites to fnd out more. Also, visit www.oahhs.org/hosptials or additional hospital links.

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You only get sick in a hospital, is an oldadage Oregons hospital community is diligentlytrying to correct. Patient saety in a high-qualityacute care setting is priority one or Oregons58 community hospitals its their mission.With a strategic, proactive agenda to increaseaccountability and transparency in the hospitalcommunity, hospital members throughout the

state are collaborating on ways to improve andmaintain a culture o patient saety through best

practices and evidenced based medicine.

Building a patient saety culture in Oregonhospitals is a vital oundation to improvingquality outcomes.

Patient saety eorts will not be successulunless an organization understands and appreciatestheir own internal culture. Establishing a baselinemeasurement is critical to ully evaluating theimpact o any uture strategies. Oregon hospitalsare united in the understanding and eort neededto assess their current patient saety culture and toaddress eorts in improving culture. Te Agencyor Healthcare Research and Quality (AHRQ)recommends that hospitals complete a acility-

wide culture survey at least every three years.

Our hospitals are ocused on eliminatingsurgical complications by adopting the WorldHealth Organization (WHO) Sae Surgery Checklist.

Consumers and purchasers are demandingthat hospitals be accountable to protect themrom preventable adverse events includingsurgical complications. Oregon hospitals havecome together in 2009 to implement the WHOsae surgery checklist.

Te checklist has three parts (Sign In; Brie;and Debrie) and adds an element o teamworkto the Joint Commission Universal Protocolcurrently in use. Experiences indicate that checklistcompletion time or complex surgeries is less thanve minutes. We anticipate that use o the checklistwill decrease post-surgical complications, andtranslate to better patient outcomes and costsavings or hospitals.

PATIEnT SAFETYIS PRIORITY OnE!The hospital community has built a quality agenda rich in educational opportunitiesand events to collaborate with quality experts and share ideas across the state, regionand country. Below are some highlights o current initiatives to improve patient saety.For more inormation on Oregons quality initiatives and programs, please visitwww.oahhs.org/quality. You can also contact Diane Waldo, OAHHS director o qualityand clinical services at 503-479-6016.


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Facts About Had Hygiee

Itsperfectlynetoaskyourcaregiversandvisitors:Didyouwashorsanitizeyourhands?

Handhygienehelpstopreventthespread o inection to you, the patient.

Germsthatcauseinfectionscanbe spread in a number o ways.The most common is through hands.Hand hygiene removes germs romthe hands and helps protect YOUrom inections.

Healthcareworkerscangettheirhands clean in two ways: Washing their hands with

soap and water, or Sanitizing their hands withalcohol-based gelor oam.

Oregon Hospitals prepare or Pandemic Fluwith Hand Hygiene Education

During the all o 2009, Oregon hospitals were extremely

busy preparing or the H1N1 u pandemic. OAHHS worked

closely with the Oregon Department o Human Services(DHS) in collaboration with state emergency preparedness

coordinators to help with communication eorts.

The key message or Oregon hospital leadership was

to strongly promote & recommend H1N1 vaccine or health

care providers and consistent hand hygiene practices. To

that end, our members have been leaders in a nationally-

recognizedhandhygieneinitiativeentitled,HelpUsHelp

You.Weencouragepatientstoquestiontheircareproviders

about their hand hygiene beore administering care.

Hospitals rom across Oregon are collaborating to improve

hand hygiene compliance, based on research conducted

at the University o Pennsylvania. These compliance eorts

ultimately empower hospitalized patients and their amily

members to become active members o their care by asking

theircaregiversandvisitors,Didyouwashorsanitize

yourhands?

The CEO o Salem Health,norm Gruber, has embraced thispatiet saety iitiative by settigthe stadard or his hospital.All members o the Salem Healthmedical sta are required to view aseve miute video o the WHOsae surgery checklist that wascreated ad flmed at Salem Heath.

Our hospitals are diligetlyaddressig iectio prevetio.

Health care-associated iectios (HAIs) have receivedicreasig attetio sice the Istitute o Medicies 1999ladmark report. A HAI is defed as a iectio thatwas ot preset or icubatig i the patiet at the time oadmissio to a health care acility.

Accordig to the Ceter or Disease Cotrol, HAIs accoutor more tha 1.7 millio iectios ad aect 5-10 perceto hospitalized patiets i the Uited States.

As the atioal ocus o HAIs has itesifed, Oregohospitals have icreased their eorts to reduce HAIs.Begiig Jauary 2009, hospitals were required to reportiectios related to cetral lies (or itesive care patiets),coroary artery bypass grat surgeries ad total keereplacemet patiets. I additio, hospitals are participatigi the Multi-Drug Resistat Orgaism (MDRO) Sae Tablemeetigs ad toolkit. The MDRO toolkit helps hospitalsaddress high reliability strategies i a stadardized maertowards prevetio o HAIs.

>> INFECTION PREVENTIONINACTIONSAFETY CHECKLIST

SalemHealth,Salem,Oregon

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Oregons small and rural hospitals are the cornerstones o the communities they serve.

For many communities they are the largest employer. O Oregons 58 hospitals, two-thirds

areclassiedassmallandrural.ThiscoresectionofOregonshealthcaredeliveryhasa

unique set o challenges given the complexities o the industry. One main challenge acing

our states rural communities is the recruitment and retention o qualifed physicians.

The story oPioneer Memorial Hospital in Prineville illustrates the difcult but necessary

decision to reduce vital services when resources are not available. For more inormation on

Oregons small and rural hospitals, visit www.oahhs.org/rural.

Where Have All TheDOCTORS GOnE?By Linda Lang


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No more babies will be delivered at PioneerMemorial Hospital (PMH), Prineville. Citing aninability to replace physicians, Pioneer Memorialmade the dicult decision to close their obstetricsprogram, eective December 2009. Te closure o the

Pioneer Memorial Hospital obstetrics (OB) programsignals the growing diculty o recruiting andretaining health care providers to rural Oregon.

The ProblemDespite robust recruitment eorts, PMH was not

able to replace two o their three OB providers atertheir departure. Te recruiting diculty is not uniqueto PMH. Across the nation, many rural communitieshave trouble attracting and retaining doctors.

Rural residents deserve the same access to qualityhealth care services that their urban counterpartshave, including specialty services. Lacking providers,rural residents oten have to travel great distances toreceive care. Tis not only places an extra burden onpatients, but takes local dollars out o the communityas patients are orced to spend money elsewhere.

Te challenge o both attracting andkeeping ruralproviders oten requires very dierent eorts. Tereasons that bring doctors to practice in rural areas

might not be the same as those that keep them there.But one thing is clear it takes an entire communityto attract and retain doctors in rural areas.

Changing PhysicianDemographics

Replacement o aging and retiring physiciansposes a special challenge because o the liestyledemands and nancial realities acing youngphysicians. Current research shows that two

physicians must be hired to replace one retiringphysician because younger doctors demand a betterwork-lie balance.

One stumbling block in recruiting and retaining

physicians is the act that emale doctors whocomprise more than 50 percent o contemporarymedical school graduates are less inclined topursue ull-time medical careers. Women oten want

to start amilies and scale back their working hoursto do so. Additionally, a recent study in the Journal ofRural Health shows that emales are less likely thanmale counterparts to enter a rural practice.*

The challege o both attractigad keepig rural providersote requires very diereteorts. The reasos that brigdoctors to practice i ruralareas might ot be the same asthose that keep them there.

Another diculty in attracting doctors to ruralcommunities is the physical location o medical

schools. Physician training is typically located in urban

areas and doctors tend to stay where they are trained.

Oregon hospitals are working to improve and expand

rural training residencies. One example is the College

o Osteopathic Medicine o the Pacic Northwest,

being launched by Samaritan Health Services inpartnership with Pomona-based Western University o

Health Sciences. Tis new medical school is located in

the rural community o Lebanon.

Keeping Doctors in RuralCommunities

Data on retaining physicians is spotty, but weknow that it requires commitment o the entirecommunity to keep physicians that have beenrecruited to rural regions in place.

A number o physician surveys have beenconducted to understand why physicians leave ruralcommunities. Lack o quality education is one o themost requently cited reasons causing physiciansto leave a rural community. Physicians are concernedwith the underunding o rural school systems andtrimmed school weeks.

* Doescher MP, Ellsbury KE, Hart LG: The distribution o emale generalistphysicians in the United States. Journal o Rural Health 2000; 16(2):111-118.)

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Physicians also worry about employmentopportunities or spouses or partners. A physiciansspouse or partner must also be recruited to thecommunity. Without sucient employment optionsor spouses or partners, it is likely that physicians will

leave the community.

Physician surveys also tell us that proessionalisolation contributes to the challenge o retainingdoctors in rural areas. Rural doctors have ew i any

peers to share calls with and to discuss complex cases.Additionally, rural doctors nd access to specialtyconsultations and ongoing medical education(including grand rounds and other educationalorums) dicult without extensive travel and a majordisruption to their practice.

Addressing the challengesTere are many challenges acing rural

communities when it comes to recruiting andretaining providers, said Scott Ekblad, director,Oregon Oce o Rural Health. Both long-term

and short-term strategies are required. We need tolook at how we educate uture providers as well as theincentives oered current providers.

Initiatives in the state, including the robustdevelopment o a broadband network under theOregon Health Network (OHN) leadership, could helpconnect specialists to rural patients. Te advantagehere is that patients save time and money withoutthe worry or expense o travel. Te OHN can also

connect rural doctors to colleagues across the nationor consultations, on-call back up, and or ongoingeducation. elehealth, as enabled by the OregonHealth Network inrastructure, can solve many othe previously intractable problems in recruiting andretaining rural doctors.

Te OHN, through its network o providers, will

be able to provide high-speed connectivity to expert

care in every rural community. Wallowa MemorialHospital (WMH), a 25-bed critical access hospitallocated in rural northeastern Oregon, joined the

OHN to improve the speed in which it transmits x-ray

images, in trauma situations to radiologists at OregonHealth & Science University (OHSU). Images thatused to take hours now take only minutes to transmit.

Broadband connections will acilitate access

to colleagues and provide real-time specialtyconsultations. However, they will not solve the entireglobe o complex challenges acing todays ruralcommunities. Another approach in the works is theLocum enens Program at OHSU. Tis program,developed by the OHSU Area Health EducationCenter (AHEC), helps to alleviate the burden orequent call by placing a relie physician in thecommunity. Te Locum enens program allows ruralproviders to attend osite education and connect

with colleagues, thus addressing ongoing medicaleducation needs and proessional isolation.

Tere is no short-term x. Attracting and retaining

rural physicians requires commitment to long-term

solutions. It takes years or a community to grow its

own physician. However, research shows that growing

up rural is the most signicant predictor o whether a

doctor will stay in a rural community.ProvidenceHealth&Services-OregonRegion

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Te economic stimulus act o 2009 has provento be a game-changer or health inormation

technology, paving the way or better quality medicalcare by oering nancial incentives to doctorsand hospitals or implementing digital records orpatients medical care.

Te economic stimulus Health Inormationechnology or Economic and Clinical Health Act,or HIECH Act, sets an aggressive timetable ormedical providers to adopt technology to improvepatient care. It states that every Americans medicalprovider ought to have electronic health records

by 2015 or ace nancial penalties. Tese samedoctors and hospitals must also demonstrate theability to share key patient data among clinics andhospitals statewide.

Most experts agree the HIECH Act was animportant step toward addressing a troublingproblem or domestic medical care. In this country,physician adoption o electronic health recordslags well behind other industrialized countries.

Just 10.9 percent o U.S. hospitals have basicelectronic health record systems, according to a

2009New England Journal of Medicine articleby Ashish Jha, and just 1.5 percent currentlyhave systems likely to qualiy or the new ederalincentive payments.

Even when doctors have access to thetechnology, ew are able to digitally share it witha patients other providers a key requiremento the new ederal rules.

A growing body o research suggests that thewidespread adoption o interoperable electronichealth records could improve the quality o caredelivered to patients. Alert systems inside electronicmedical records fag problems with drug allergiesor potentially harmul drug-drug interactions, andreminders can prompt doctors to expand use opreventive care measures like cholesterol checks.Tese systems can also promote better physiciancompliance with clinical guidelines or chronicdiseases like diabetes.

HOSPITALSRACETO

ADOPTMEDICALRECORDTECHNOLOGYOregonshealthcareprovidersoutpacethenation

intheiradoptionofcomputerizedmedicalrecords,

demonstratingunwaveringcommitmenttodelivering

quality,efcientpatientcare.

Newfederalincentivesenactedin2009willfurtherbolsterOregonhealthcareprovidersongoingefforts

tousedigitalhealthrecordsandtosharekeypatient

datainwaysthatimprovepatientcareandreduces

duplicationofmedicalservices.However,theseefforts

willnotcomewithoutchalleges.

Whats in it for me,the patient?

Patiets whose medicalproviders have electroichealth records ca expect

improved care. Electroicalerts fag problems with drugallergies or potetially harmul

drug-drug iteractios,ad remiders ca promptdoctors to expad use oprevetive care measures

like cholesterol checks.

By Robin Moody

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Widespread adoption and meaningul use ointeroperable electronic health records oers thepromise o improved eciency, ewer errors, reducedredundant tests, reduction o health disparities,improved engagement o patients and amilies in

their own care and improved care coordination,said Dr. Steve Gordon, vice president and chiequality ocer or PeaceHealth Oregon. Dr. Gordonis also the chair o a state committee thats cratinga plan or statewide health inormation exchangein Oregon.

Oregons electronic health record adoption rate

among physicians is higher than the national average,

state research demonstrates. However, meeting theaggressive deadlines laid out by the ederal act will

still pose a challenge or providers. Electronic medical

records are expensive, with per-physician costs

or hardware, sotware and training hovering

around $35,000.

Teres also a major catch: I hospitals dont meetthe ederal goals or health inormation technologyadoption by 2015, their already-low Medicarepayments will drop even urther as a penalty.

I all o Oregons 58 hospitals achieve meaninguluse o electronic health records by 2013, they couldcollectively capture $236 million in ederal Medicareincentive payments and $86.4 million in Medicaidpayments over our years. Tis money will help osetthe costs o the technology. But hospitals will be

required to shoulder much o the nancial burden atthe same time theyre providing rising rates o reecare or Oregons 639,000 uninsured.

Health InformationTechnology HIT Glossary

Electronic health record:A computerized patiet medical record thatacilitates access to patiet data by cliical sta atay give locatio ad oers access to evidece-based decisio support tools or medical providers.System icludes cliical otes, automated checksor drug ad allergy iteractios ad prescriptioiormatio ad lab results, amog other data.

Health information exchange:

The capacity to electroically move digitalpatiet data across regios, commuities orhealth systems.

Health Information TechnologyOversight Council (HITOC):

Oregos state-desigated agecy, HITOCwill coordiate Oregos public ad privatestatewide eorts i electroic health recordsadoptio ad the evetual developmeto a statewide system or electroic healthiormatio exchage. The HITOC will helpOrego meet ederal requiremets so that

providers may be eligible or millios o ederalhealth iormatio techology stimulus dollars.The HITOC takes over previous eorts o theHealth Iormatio Irastructure AdvisoryCommittee (HIIAC) ad the Health IormatioSecurity & Privacy Collaborative (HISPC).

American Recovery andReinvestment Act:

A ecoomic stimulus package eacted by theU.S. Cogress i February 2009 to supportthe coutry i the wake o a major ecoomic

dowtur. The $787 billio act expadeduemploymet beets ad social welareeorts, eacted tax cuts ad boosted domesticspedig i health care, educatio ad orirastructure projects like eergy systems adroads. The Health Iormatio Techology orEcoomic ad Cliical Health Act (HITECH),cotaied withi oers up to $50 billio topromote adoptio o iteroperable electroichealth record techology.

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By Sonney Sapra,director of clinical information systems,

Tuality Healthcare Chair, OAHHS HIT-TAC

Next to patients, virtually no player has a greater stake in

the successul exchange o patient health inormation between

medical acilities than hospitals. Te ederal government

in 2009 upped the ante or the exchange o key patient

inormation. o capture ederal incentive payments and avoid

scal penalties or computerized patient records, hospitals and

doctors must be able to exchange key patient inormation.

Hospitals arent standing idly by while key decisions

about health inormation technology are made. Hospitalinormation ofcers rom around the state have ormeda Health Inormation echnology echnical AdvisoryCommittee (HI-AC) to advise the state on their healthinormation exchange policies. HI-AC meets monthly totackle questions about the architecture, governance andbusiness model or health inormation exchange. Te groupoperates under the umbrella o the Oregon Association oHospitals & Health Systems Public Policy Committee.

Oregons quasi-state agency the Heath Inormation

echnology Oversight Council, or HIOC is spearheadinghealth inormation exchange planning and implementation

and will get approximately $8.4 million in ederal dollarsand another $900,000 rom the state to achieve thesegoals. But the council must act ast; the ederal deadlineor completion o a statewide plan or health inormationexchange is July 2010.

Te hospital associations technical advisory committee

will provide crucial input throughout the planning process.Based on ederal unding requirements, we are on

an extremely aggressive timeline to develop a strategicand operational plan or health inormation exchange inOregon, said Carol Robinson, Oregons coordinator orthe Health Inormation Exchange and director o theOregon Health Inormation echnology OversightCouncil. Critical to any sustainable strategy will be input

rom health care stakeholders. Our hospital partners areessential to this planning process.

Health inormation sharing between Oregon healthcare providers working with a ully unctional electronicmedical records system could save upwards o $1.7 billionannually in health care costs, according to researchconducted by the Oregon Health Care Quality Corp. andthe Ofce or Oregon Health Policy and Research. O the

total statewide savings, $600 million can be attributed toavoidable services, and $1.1 billion to increased clinical andoperational efciencies. Employers would benet rom $6.1million in time-loss reductions.

Quality improvements are also a likely outcome, butpolicy questions must be answered or this element to besuccessul. What does better quality o care really mean?Will it be measured in terms o reduced patient wait times,or in terms o ewer unnecessary (and costly) procedureslike MRIs? Tese are very important questions that need tobe answered to dene medical outcomes.

Here at Tuality Healthcare, we are participating inthe planning eorts or a Portland-area health inormationexchange, which involves hospitals with a variety o

electronic medical record systems. Our goal is to drat aContinuity o Care Document available or patients whoseek care at any o the hospital acilities in this area.Patients will be able to show up at any o the hospitals and eventually clinics in the Portland metro area andtheir doctors will have all o the patients key inormationhandy, allowing providers to make better-inormedmedical decisions.

Among the policy questions the HI-AC has tackledare how to implement sustainable nancing or health

inormation exchange, deciding which I standardsshould be in place or eective exchange, and how HealthInormation Exchange should be expanded rom regionalhubs to a statewide ootprint.

Health Inormation Exchange is going to take a lot omoney and planning. Te goal is ambitious, and i we wantthe whole state to be under one exchange, it may be betterto start with smaller community HIEs that have alreadybeen developed or are under development.

>> HOSPITALS IN ACTIONOrego Hospitals Creatig Policy or Health Data Exchage

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www.oahhs.org

Hospital Voice | A magazine for and about Oregon Community Hospitals.

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