League of Women Voters of Rogue Valley

Calendar of Events

Local Studies

LOCAL HEALTH CARE SURVEY 2003-2005

3. Family and Children Service, Mental Health, and Alcohol and Drug Issues

Findings on school-based clinics:

At Washington Elementary School in Medford, which is attended by many low-income children and many Hispanics, it appears that their medical care is quite good and effective advice for parents is sent out in brochures in English and/or Spanish. These include booklets to help parents decide when to go to the doctor and when to keep their child home from school.

At Jackson Elementary School and Oak Grove Elementary medical care is only available for students during the school year and is not for younger siblings. A similar situation exists at Phoenix and Talent Elementary schools.

The Kids Health Connection has Phyllis Wetzel, RN in charge, of its bilingual clinic.

Kathy Phillips, MSNRN, a nurse practitioner, runs the School health clinic at Jewett Elementary in Central Point. A health clinic at Scenic Jr. High will be moved to Hanby Jr. High in Gold Hill this spring. There is also a clinic at Crater High School.

Health services to Ashland school children are based at the Ashland Middle school, where care can be given to all Elementary and high School children.

In Eagle Point, a staff person of Community Health Center is available to provide school health services to school children.

Other Family Services:

Under-and un-insured families find health care expensive with walk-in clinics like the Medford Clinic charging $70-75 a visit, though they do accept monthly payments.

The cost of medical care is a big issue for families. The Oregon unemployment rate is the second highest in the U.S. (“The Oregonian “) Jackson Co. has 12% more poverty than the rest of Oregon and the poverty level is 15% for whites and 31% for Hispanics. According to Children First for Oregon, in Jackson Country 40-49% of children are in poverty or live in families of the working poor and in Josephine County the figures rise to 50% and over., The Rogue Valley has 13 safety net clinics, most of them school- based.

Some agencies like La Clinica del Valle and the Family Health Care Centers in Medford, Ashland and White City and the Siskiyou Community Health Centers of Josephine County, charge on a sliding scale for health care based on family income.( Interview - La Clinica, Family Health Care Center tour, phone interview with Joann Gillyatt, Siskiyou CHC). Children in School District 9 are going to benefit from the addition of a full-time nurse and two part-time bilingual outreach workers thanks to a three-year grant written by Peg Crowley, executive director of the Community Health Center. It has been funded by the Reed and Carolee Walker Fund of the Oregon Community Foundation, which supports programs for the needy.

4. Accessibility and Availability to Mammograms

The sub committee investigated how promptly a woman can have a mammogram in the Rogue Valley which at the time the study was begun was as long as 9 months to wait. At local hospitals:

The new Providence Breast Center, offers mammograms and now includes facilities for dealing with the side effects of mastectomies, bone density and associated lymph node problems. It has currently a 4 week wait list for a mammography appointment and it will soon be open extra hours a day, for at least two days a week. Digital mammograms are now available at extra cost at Providence, although Medicare reimburses the hospital at a higher rate for these. They are more efficient, quicker and more comfortable for the patient.

Ashland Hospital has a 2 week wait.

The Rogue Valley Medical Center ( Asante) opened its Women’s Imaging Center, as of October 1, 2003. It took over from Medford Radiology, which used to do mammograms, according Michelle Halfhill of Asante. The location is the same but they have added an additional machine. The wait time for an appointment is down to two months, with the possibility of getting earlier if it is an emergency.

The Three Rivers Hospital in Grants Pass, which is also an Asante Hospital, gives almost immediate mammograms, even on the same day in some cases.

There are three options for low-income women to get mammograms:

1) through a voucher system from Jackson County Health Department, which offers them for free.

2) through the Oregon Health Plan which offers them at a very low cost.

3) through the Komen Foundation funded by Soroptimist clubs, including our local ones.

With more machines of various types and longer hours of work in the local area, it appears that the wait time for getting a mammogram is now shorter than in 2002 when it was 8 to 9 months.

Survey of League Members:

This group handed out a four-question survey to League members in December, 2003 and to a different group in February, 2004 asking them to rate their personal medical care.

We asked those in February how many had Medicare coverage and 55% did. We also asked this group if their medical insurance covered any significant portion of their prescription costs and a strong majority

( 61%) said they do have such coverage.

Committee member Jean Milgram received responses from 41 members in total and the results so far indicate that in the past two years they and/or their families :

• all but one have required some health care.

• 31% have had a problem getting satisfactory medical attention.

• almost 40% have experienced a long wait for a diagnostic procedure, but with three exceptions,

those were all waits for mammograms, a problem that has recently been greatly alleviated ( above).

• 22% have had problems with medical insurance, either with getting it or with having needed services

covered.

This was not a scientific survey but the results do confirm that problems with access to needed health care are experienced by a substantial portion of a well-informed and self sufficient segment of the population of the Rogue Valley.

Health Care Coalition of Southern Oregon (HCCSO)*

HCCSO received a grant in 2001 from the Health Resources and Services Administration to complete a demographic study and define the uninsured and underinsured in Jackson and Josephine County. They concluded that more than 53,000 had health insurance plans requiring annual deductibles of $5,000 or more.

They continued in year two of the grant to convene representatives of key provider organizations to develop an integrated health services plan to address the needs of the under- and uninsured. Many of their findings echoed the ones of League of Women Voters in their study.

Additionally they noted two areas with insufficient coverage for low or moderate income persons as being dental care and lack of behavioral health services.

HCCSO listed root issues for inadequate delivery of health services as

· Money and the real cost of health care

· Uninsurance

· Lack of coordination of outside financial resources

· Fragmented data sources

· Regulatory burdens

· Lack of preventative care incentives

· End of life/futile care issues

· Consistency in provider care delivery

· Medication prescription coordination among providers and public health

· Lack of coordinated medical transport system

· Unmet needs and limited support for behavioral health

· Lack of coordinated education and service delivery for those caring for elderly family members.

* HCCSOmember representatives are: Community Health Centers, Douglas County Health & Social Services, Jackson County Health and Human Services, Josephine County Department of Health and Community Action, LaClinica del Valle, Siskiyou Community Health Center, and Umpqua Community Health Center.

HCCSO Partner representatives: Asante Health Systems, Ashland Community Hospital, Jackson County Medical Society, Mid-Rogue Independent Practice Association, Pathways to Care network and Providence medical Center

United Way Community Needs Assessment

In a needs assessment compiled in Spring, 2004, by the United Way Organization, it reported the lack of affordable medical care as the highest priority need by community members, agencies , and key leaders.

CONCLUSIONS

Although some excellent medical care is available in this area of Southern Oregon with the latest in medical technology and the best of medical staff being available for some patients, especially in a medical magnet center like Medford, there is a crisis in attracting and retaining doctors and medical staff for various reasons.

Solutions:

1) COOPERATION AMONG MEDICAL AGENCIES

Because of the increasing cost of medical care locally, any change that involves cooperation between agencies and shared use of facilities is beneficial and cost-effective. For example, the Rogue Valley Medical Center is the only hospital in the region where doctors routinely perform a procedure known as angioplasty ( heart artery dilation) which opens clogged arteries and increases the patient’s chances of surviving a heart attack, while reducing the need for cardiac surgery. The other three hospitals and emergency service agencies now send their patients to RVMC for this advanced treatment. According to Dr. Brian Gross, cardiologist, of Medford, studies in Denmark show that patients transported directly to a cardiac hospital had a death rate of 8 percent, while those who received just anti-clotting drugs at other hospital died at a rate of 13.7%. All our hospitals in the Rogue Valley are expanding and working together to make this a regional medical center which should help attract more doctors.

According to Jean Johnson of the Informational Technical Systems of the Rogue Valley Medical Center, the two Asante hospitals have already a wireless network in place, and an information system will be operative for the nurses in 2005 and by 2006, bedside computers will be in use by physicians. Also Asante has implemented a new pharmacy management system in which from the point that the pharmacist enters a medication order, there are a number of safety checks. With over 500 new drugs a year being prescribed, this is very important. The system uses bar coding to provide correct identification. This should lead to a saving in costs and medical staff.

2) ATTRACTION of MEDICAL STAFF

To attract medical staff to the area, ingenious ways of using public and private agencies to provide them with modern facilities and additional training are beginning to be used in this area. Three Rivers Community Hospital in Grants Pass, a fairly new Asante facility, has set up one year surgical residencies to attract 4th year surgical residents to help with the shortage of surgeons and in the hope that some of them will stay. Some of them already have. Communities, helped by foundations, donations and grants have built clinics in rural and small town areas to provide facilities for doctors who are willing to move here. Federal money provided by the Rural Hospital Act has been cut but hopefully will be restored, as it is much needed. (Cherryl Walker )

A recent proposal that would ease the doctor shortage in all of Oregon, including the Rogue Valley, is the creation of a satellite OHSU medical school in Eugene to train as many as 120 medical students a year and double the capacity of Oregon’s only medical school. The need is great as the number of practicing physicians has dropped from 8387 in 2002 to 8292 in 2004. There is no estimate on when the new program will begin ( Medford Tribune, 11/21/04)

3) LEGISLATION

According to Congressman Greg Walden, in an e-mail memo sent to the public 12/9/03, after the passage of the Medicare Prescription Drug and Modernization Act of 2003 ( HR1), Oregon seniors will be eligible eventually to have the first outpatient prescription drug coverage under Medicare using private insurers. There will be Medicare -approved drug discount cards, which should save seniors 10-25% off the retail price of most drugs. Also our Oregon US senators helped secure $25 billion for rural health care as part of the bill. It increases Medicare payments to rural ambulance services, as well. Finally, the measure provides a 5% bonus payment for physicians practicing in under-served areas. Cherryl Walker urged us to make our medical needs know to our legislators.

4) VOLUNTEER AID

Some suggestions to help low income patients and others get access to medical care:

Peg Crowley, Director of the Community Health Centers, has asked for volunteers to help with some of the paper work which might help in getting these patients appointments and tests. Individual League members would have to take a four hour training but their help would be invaluable as OHP clients have to sign up every six months, but may not know their children may qualify without this. Volunteers are also needed by the Community Health Centers to plan, strategize and disseminate consumer information to potential clients of the Health Plan.

La Clinica has 3 outreach workers to do this paper work, but extra bilingual help would possibly be welcome.

Another possibility is for some volunteer group, to produce a health care guide for the area, which would have to be updated regularly. For example, insurance is available for Jackson County patients in one form or another in either the Oregon Health Plan, the Family Health Insurance Assistance Program (FHIAP), Medicaid, Medicare or the Insurance Pool. However, health consumers may not be aware of their options, and may not enroll even if they are qualified. This information could be included in the guide.

It would be helpful to have a survey of the non-professional public, the low income and the elderly, people who were not represented in the Providence Community Needs Assessment and/or the Trimmed Report of the Oregon Community Foundation.

We can help and have been helping with educating the public. The Rogue Valley League of Women Voters co-sponsored a town hall meeting on May 10, 2004 focusing on the uninsured and underinsured and health information ( see above).

5) PERSONAL RESPONSIBILITY

It was the conclusion of the health survey group and echoed by HCCSO, the Forum on Covering the Uninsured and several speakers that one of the most important aspects of good health is for:

individuals to be responsible for participating in and making healthy life choices.

MEMBERS OF HEALTH CARE SURVEY COMMITTEE: Eileen Adee, Trish Bowcock, Kathleen Donham, Patty Finch, Sarah Heath, Carol Ingelson, Vicki Keeney, Mickey Ketchum, Cynthia Lora, Marlene Olson, Shiena Polehn, Nancy Swan.

SOURCES:

CALPERS newsletter, 1/04

Bates, Dr. Alan

Central Oregon Partnership, PO Box 147, Redmond, OR 97756

Children First for Oregon

Collins, Hank, Director of Jackson Co. Health Dept. 4/8/04

Community Needs Assessment, 2003 of Providence Health System

Community Health Newsletter vol. 9, # 7, Fall 2004

Congressman Greg Walden

Crowley, Peg Director Community Health Centers

Densmore, Sally president–elect of RAIFA

Douma, Dr Allen

Gross, Dr Brian, cardiologist

Financial Times, 2/11/04

Halfhill, Michelle, Public Relations, Asante Hospitals

Health Care Coalition of Southern Oregon (HCCSO)

Jackson County Statistics 2000

Jackson, Jean , Rogue Valley Medical Center, Information Technology System for Asante Health Systems 4/12/04

Mail Tribune, 9/5/04 Bill Kettler, Associated Press release, 11/21/04

Mail Tribune, 1/28/2005 Chamber looks for way to become group for health insurance

McFadden, Debra, Director, Jackson County Medical Society,

MedPAC, Medicare Payment Advisory Commission

Miller, Glenn, health care insurance specialist

Oregon Health Sciences University web site

The Oregonian, 12/16/03, 1/17/04, 1/20/04, 1/27/04, 2/5/04

Oregon Health Department

Oregon Medical Association Newsletters, Dec. 15, 2003 Vol.XXXIII and Jan. 12, 2004 Vol. XXXIV Oregon Medical Association Preliminary Report of 2003 Physician Workforce Assessment