- routine screening
- women’s health.
1. Access to Primary
Care according to Jackson Co. Medical Society showed:
Shortage of internists -
given the current population of Jackson County, we have 28 fewer primary
care physicians than the target number, with the largest shortage in the
number of internists ( 15 fewer than target) who would generally treat
the senior population.
Several internists have left
the market because of declining reimbursements and poor quality of life
in primary care practice.
Note: In a recent change in
the availability of surgeons in the Rogue Valley, there has been a loss
of 3 neurosurgeons out of 6. As a result, the Rogue Valley Medical
Center and Providence Hospital have both been dropped in trauma center
ratings from a level 2 to level 3. They are no longer able to provide
round the clock emergency coverage for traumas and patients will have to
be sent to Eugene, Corvallis, Bend or Portland for this level of care.
Two local neurosurgeons have limited their practice to the spine because
of malpractice insurance problems and the third has left Southern Oregon
as the work was too demanding. (Mail Tribune, Sept. 5, 2004 Bill Kettler)
The overall number of doctors
who are limiting acceptance Medicare and Medicaid patients is higher in
Southern Oregon than the rest of the state.
it is estimated that at any
given time, approximately three-fourths of Jackson County’s family
practice and internal medicine physicians will accept new Medicare
patients, and only half will accept Oregon Health Plan patients,
according to the Jackson County Medical Society Director, Debra
McFadden.
the Rogue Valley Medical
Center reports that 66% of its patient revenues come from Medicare and
Medicaid.
Note: On the positive side,
there has been success in helping the needy through ten years of
cooperation among medical staff and agencies in a program named Volpact.
With it, private physicians, ( represented by the Jackson County Medical
Society), the three Jackson County hospitals (RVMC, Providence and
Ashland Community) and the safety net clinics of La Clinica del Valle
and the Community Health Centers cooperate to provide access to both
specialty consultation and non-crisis hospitalization. The Community
Health Center has opened a new replacement facility in White City on
November 1, 2004.
2. Prescription Assistance
is offered by:
an organization, as yet not
well-known, called SOMAC, Southern Oregon Medical Assistance Coalition,
which attempts to provide prescription assistance to those who most need
it.
Providence (PMMC ) has been
providing help to its patients for the last four years, including free
aid in applying for prescription assistance and it now also participates
in SOMAC.
Ashland Hospital and St.
Vincent de Paul in Medford have organized volunteers who work with low
income people who are seeking ways to get prescription drugs at low or
reduced costs. They have information and applications for the following
drug company discounts as well as obtaining Medicare discounts.
Some drug companies also
offer prescription discount program for patients who most need it.
a. Eli Lilly now is offering
a 30 day supply of any of its drugs for $12 a month to the roughly 70%
of seniors with household annual income under $24,000 under the new
Medicare program.
b. Pfizer has a similar
program for $15 a month.
c. Merck announced in
February 2004 that its prescription medicines will be free to certain
low income Medicare beneficiaries as part of a Medicare discount-card
program started in June 2004.
d. Other major drug
companies offer the free “Together RX Card” to low income Medicare
enrollees without drug coverage, giving them a discount of 20-40%. An
estimated seven million will qualify nationally. There are some fears
that the costs of the Federal program have been under-estimated ( Wall
Street Journal 1/21/04).
e. The Oregon Health
Resource Commission has a long list of sources of inexpensive, legal
medications available to the needy.
There are many web sites
pertaining to sources of less expensive drugs, and these are available
to the public ( see bibliography).
3. Frail elderly
Frail elderly According to
the 2000 Federal census, Jackson County’s population 65 years and older
comprises 16% of the population, compared with just 12.8% in the rest of
the state. 6.9% of these elderly people live below the poverty level.
The elderly need assistance in how to use and pay for prescriptions.
They also need support for “aging in place” presumably retaining their
independence.
4. Mental health
In addition to age-related
conditions, often isolation and lack of access to social support,
affordable housing and transportation lead the problems of the elderly
and the frail.
5. Dental care
is one of the five top unmet
needs. People tend to a) take care of other physical problems first, b)
have health insurance without dental coverage, and c) not understand how
poor dental health affects the rest. Medical insurance continues to be
an issue especially for small businesses and for State-funded
insurance.( see Insurance sub-group).
The other report presented at
this meeting was the “Trimmed” Report to the OCF board from Oct. 2003
prepared by Dr. Jon Gell, who has served as medical director of Rogue
Valley Medical Center and Providence Hospital. The four priority needs
for Jackson County were listed in order as:
a) substance abuse treatment
b) basic health care,
including mental and dental care, particularly lacking in this county.
c) education about health
which is difficult with the schools struggling with lack of funding.
d) coordinated services
provided either by teams of social workers visiting homes, schools, etc.
or site-based integrated service centers, offering “one-stop shopping”
for health care. There are “hidden” communities with great needs in
Jackson County, especially seniors, Hispanics and the young disabled.
Chronic poverty is often a
fact of life for people with physical disabilities and/or mental
impairment and can lessen their ability to get adequate care
Several League members have
questioned their own physicians or physician friends and found that it
is the quality of life in the Rogue Valley that keeps them here, but
obstacles were :
- a low reimbursement for
Medicare
- the no-cap situation on
malpractice suits which drives up their insurance
- the decreasing number of
internists means long work hours
- finding substitute
internists, when doctors are unavailable
Insurance Issues
This committee investigated
issues relating to medical insurance. They studied:
Medicare Recent changes in
Medicare including the law signed in December 2003 . This Act provides a
1.5% annual increase during the next two years for Medicare payment to
physicians, estimated to amount to $69 million for Oregon doctors,
according to the Oregon Medical Association.
Why are doctors in the local
area nevertheless reimbursed for Medicare and Medicaid patients at such
a low rate? A recent report on the variation in Medicare spending in
different states, made available to us by Representative Greg Walden’s
office, was written in May 2002. It represented a report to Congress by
MedPAC ( Medicare Payment Advisory Commission) given in June 2001, some
actions by Congress and a final report on May 13, 2002. MedPAC is a
non-partisan, Congressionally-chartered commission. A recent call to
Senator Wyden’s office revealed that he had tried to get an amendment
added to Medicare to ease the Oregon situation, but it did not make it
out of the conference committee. He also had been in touch with MedPAC
on this issue.
Oregon, which is regarded as
a rural state, was the 6th lowest in Medicare payments for Fiscal Year
2000. The commission found the following reasons that affect Medicare
reimbursements:
- higher payments to teaching
hospitals (Oregon has only one - OHSU, but is proposing one in Eugene)
- higher payments to
hospitals with many low-income patients, common in large urban areas
- varying costs of producing
medical care
- health status of patients
varies. As Oregon is one of the healthier states for Medicare
beneficiaries,
adjustment for this
moves it up to the 14th lowest reimbursement state
MedPAC made these
recommendations to help equalize Medicare payments among the states:
- raise the wage-index of
hospital workers, which is too low in rural areas( no teaching
hospitals)
- omit data from professional
workers in calculating the hospital wage index
- review labor share applied
to the wage index
- adjust the disproportionate
share payments to hospitals (DSH), which does not include all the care
to the
poor, including free
care
- adjust the DSH to most
rural hospitals and urban facilities with fewer than 100 beds
- adjust reimbursements
because the low volume of care in small hospitals leads to higher than
average
unit costs
- raise payments to rural
hospitals for in-patients ( large urban hospitals currently get 1.6%
more) unless
the rural hospitals
are on a special program
- replace the national cap on
Medicare payments with a set of caps, where psychiatric facilities are
concerned, and
depending on the circumstances.
Congress responded by
extending the eligibility criteria to all hospitals. By raising the cap
on the DSH add-on, the payment of most rural hospitals from 4% to 5.25%
Rural home health agencies
have a higher than average unit cost because of low volume, travel costs
and differences in the use of therapy services. Congress provided an
extra 10% payment to providers. MedPAC recommends these payments be
extended for 2 more years for thorough evaluation.
Rural hospital outpatient
care has also a higher base rate for the same reasons as noted above.
Furthermore these hospitals have limited administrative capacity and
financial reserves, so payment should be adjusted upward.
Where Oregon stands among the
states: According to 1999 statistics used in this report, the Medicare
payment index puts Oregon at 0.77 spending versus 1.00 for the US
average. In dollars this is $3829 versus the US average of $5490. When
adjusted for the health status of Medicare recipients, this changes to
Oregon $4553 versus $4868 US average.
It seems ironic that our
doctors and hospitals and medical agencies are paid less partly because
our Medicare beneficiaries are healthier. Obviously, some small progress
has been made in equalizing Medicare reimbursements geographically, but
more needs to be done.
Finally, the sub group
discovered that through a service called VolPact, the Jackson County
Medical Society arranges for free provision of care to uninsured
patients who do not qualify or apply for any of the safety net programs
mentioned above. It estimates that over $6 million in free services has
been donated over the last 8 years, a fact not generally known.
The Health Care Coalition, (HCCSO)
mentioned above, claims that in Jackson County 70% of people have
trouble with medical insurance coverage, including 20% underinsured,
13.5% uninsured. One figure puts this at nearly 26,000 people according
to the Oregon Progress Board (Mail Tribune 1/26/05) “but others figure
that the actual number is closer to 30,000 or 35,000 people.” said Peg
Crowley of Community Health Center
