Light reading, anyone?

Here's a summary of the House health care bill that's being debated currently. I'm still reading the fine print, but hope to have digested this thing by the weekend. One interesting note to this bill: It gives the most efficient areas in the country (i.e. OREGON) a 5% bonus payment on Medicare billing.

I love pictures

Health Care Insurance Reform is a very hot topic these days - which I think is a great thing. In order to understand the debate, I like pictures because otherwise the words bog me down in my understanding of what is going on. Here is a great synopsis of what is on the table from Nicholas Beaudrot

What health reform is and isn't....

Big developments this week with the national health reform legislation. The politics are getting fierce! But it ain't over yet and there's still good reasons to hope beyond hope that they get somewhere in Washington this year.

It's a good time to step back and analyze what this is and more importantly what it isn't.

This health care reform effort is NOT about instilling a Canadian-style, UK-style, German-style or any other nations' health care delivery system in the U.S. It IS about reforming the incredibly screwed up delivery system we already have by plugging the holes in the system where people fall through. The proposals in place include these basic elements:

* expand Medicaid to include more eligible people
* Stop private insurers from denying coverage to sick people (who can afford to pay their premiums) or "rescission" which is kicking people off their insurance roles after they become ill.
* offer high-risk insurance pools to people who are very ill who cannot afford insurance anywhere else.
* Incentivize large employers to offer health insurance to all employees and penalize those who don't
* Incentivize individuals to remain insured year-round and penalize those who don't
* Offer a public insurance pool to take care of most of the 48,000,000 people who are currently uninsured


We've tried to do this before in Oregon in the 1980s and 1990s and it was called the Oregon Health Plan. We passed legislation that expanded Medicaid (through a waiver) and offered a high-risk pool to folks with pre-existing conditions. We passed pay or play legislation for employers. But then, we repealed that legislation. We made the hard decisions in our communities about which care we would provide to people on Medicaid using our Prioritized List of health care options.

We had so-so help from the federal government with our health care experiment (some might remember that Hillary and Bill Clinton were no fans of the Oregon Health Plan)

What we learned in Oregon is that you can't reform some parts of the system without a plan for the entire system. And, in my opinion, a single state can't successfully reform health care within its borders without the federal government's help because so much of our health care system is tied up with federal laws that will either help or destroy any plans a single state makes.

So, as the Congress continues grappling with this issue I personally wish them all the best. It's been a long time coming. Oregon has been down this road. It's a tough yet necessary road. If we can't have Canadian-style health care then let's make our complex U.S. system the best it can be. God-speed lawmakers, don't weaken.

--Liz

Health Care Reform - Mid July Issue

There are two proposals on the table now, one from the Senate HELP committee and one from the House Tri-Committee. To see a really nice side-by-side evaluation of the two bills, please check out the Kaiser Family Foundation website here.

Click on Senate HELP and House Tri-Committee to see the differences.

Health Reform on a National Scale

The New York Times is doing a marvelous job outlining the key components of health reform that are coming up for debate this summer. To see the baseball-like scorecard of the different camps in the House, Senate and White House, please see their overview from last week here.

There are three plans racing towards the White House for approval currently: two in the Senate and one in the House.

The Senate Health Committee (chaired by Senator Dodd instead of Senator Kennedy) is focused on individual mandates and a public health plan. They have started drafting a plan, but details are still murky.

The Senate Finance Committee (chaired by Max Baucus and the ranking republican Charles Grassley) is leaning towards mandates with an insurance cooperative. They're looking at ways to pay for this by taxing employer-paid health benefits (in some scale), and scaling back public programs, including "Medicare payments to teaching hospitals." (This is also called GME money and I'm a little worried about what this might mean to an academic medical center.)

The House committees that are working together to draft a single plan (Ways and Means, Energy and Commerce, and Education and Labor Committees) are looking at mandates and a public insurance option. How they propose to pay for their plan is still murky, but there's been talk about sin taxes on a federal level (alcohol, cigarettes, soft drinks, etc.).

The White House wants to sign something into law by October of this year. Stay tuned as this debate unfolds and we see where our future lies.

Graduation!

Last Friday 6/13/2009, we had a very successful graduation ceremony in the Vey Auditorium. It is always a pleasure to hear about the successes of our graduates and their future plans. Our graduates are listed below:

General Psychiatry Residents
Jeanette Ardans, MD
Amela Blekic, MD
Angela Casmier, MD
Daniel Dick, MD
Leigh Hedrick, MD
Aaron Krenkel, MD

Addiction Psychiatry Fellow
Gilbert Simas, MD

Child and Adolescent Psychiatry Fellows
Joshua Dow, MD
Kimber Pezzoni, MD
Jonathan Posner, MD

Forensic Psychiatry Fellows
Stephanie Lopez, MD
Simrat Sethi, MD

Geriatric Psychiatry Fellow
David Mansoor, MD

Dr. Ardans was selected as the Resident of the Year
Drs. Zerbe and Winters received Teaching Awards
Drs. Sahana Misra and Kristen Snyder received the Distinguished Service Award

Drs. Leung and Norwood Knight-Richardson received the Chair's Award.

Congratulations to all!

In my remarks I spoke to the difficult times we have been through this year. I'd like to again express my appreciation to staff, residents, and faculty for their sacrifices on behalf of the department. Thanks to your efforts we have been able to continue the critically important work that is our and our department's responsibility and privilege.

I quoted the Oath of Amatus during my talk and some have expressed a desire to see the text which is given below:


The Oath of Amatus
by Amatus Lusitanus (1511-1568)

I swear by God the Almighty and Eternal (and by His most holy Ten Commandments given on Mount Sinai by Moses the lawgiver) that I will never in my medical practice depart from what has been handed down in good faith to us and posterity; I will never practice deception, I will never overstate or alter therapy for the sake of gain, I will always strive to benefit mankind; I will not praise or censure anyone to indulge private interests, but only when truth demands it. If I speak with falsehood, may God and His Angel Raphael punish me with Their eternal wrath and may no one henceforth place trust in me.
I will not be greedy in seeking remuneration for medical services and will treat many without accepting any fee, but with none less care. I will offer my services in equal manner to all, to Hebrews, Christians, and Muslims. Loftiness of station will not influence me and I will accord the same care to the poor as to those of exalted rank.
In prescribing drugs I will exercise moderation guided by the condition of the invalid. I will never reveal a secret entrusted in me.. Students who come to me will be regarded a though they were my daughters and sons, I will use my best efforts to instruct them in medicine and to urge them to good conduct. I will publish my medical works not to satisfy ambition, but that I might, in some measure, contribute to the furtherance of the health of mankind; I will leave to others the judgment of whether I have succeeded; such at least will always be my aim and have the foremost place in my prayers."

Cutback Clarifications from the Top

Here's more information from the executive team at OHSU:


As a member of the OSHU Leadership Team, you help implement Vision 2020 and shape the culture of OHSU. Please share this message with your staff, as appropriate.

OHSU Leadership Team members:

Though there are some signs that the worst of the global economic downturn has passed, its impacts will likely be felt at least through FY10. Many of the actions OHSU took to address the downturn must be maintained in order to continue our progress towards financial sustainability. To that end, I'm writing with reminders and clarifications on several issues as you finish budgeting and begin preparations for FY10. Please share this with your staff, as appropriate.

Hiring, salary, and one-time payments freezes. The hiring, salary and one-time payments freezes instituted in late 2008 will remain in effect in FY10. Clarifications include:
• Salaries from Grants. The freeze does apply to salaries paid from grants, in accord with Federal Cost Accounting Standards. It applies to bonuses, annual increases and merit increases, and applies to faculty and others paid from federal grants (except postdocs, noted below).
• Variable Z Productivity Component. The freeze does not pertain to the variable Z productivity component of salary for clinical faculty. The variable Z component recognizes continued individual productivity, which remains essential.
• Postdoctoral Fellow Salaries. Postdoctoral fellows – trainees and researchers – should receive pay increases based on postdoc rank. Postdoctoral researchers and trainees must be paid the same way to comply with Federal Cost Accounting Standards and NIH regulations.
Benefits notice: healthcare. As announced in May, OHSU's contributions to employee healthcare benefits will be frozen at 2009 levels during 2010. Clarifications are as follows:
• What is the change? Employees who enroll in health benefits through OHSU receive a monthly contribution from OHSU to help pay the cost of coverage they select. For calendar year 2010, OHSU's contribution amounts will be frozen at 2009 levels.
• Who does it apply to? This change affects all unclassified employees, including unclassified administrative, faculty and research employees. At the appropriate time, similar changes for ONA-represented and AFSCME-represented employees will be discussed.
• When is it effective? Calendar year 2010.
• Q&A available on the Staff News blog.
Benefits change: retirement. As announced in January, OHSU's retirement contributions to the University Pension Plan (UPP) are changing. Clarifications are as follows:
• What is the change? The contribution to the UPP Employer account will remain the same. The contribution to the Employee Account will change from 6% to 4%. This brings parity to the current levels of UPP and PERS contributions paid by OHSU.
• Who does it apply to? This change affects UPP participants who are faculty, research and unclassified administrative employees. At the appropriate time, similar changes for ONA-represented and AFSCME-represented employees will be discussed.
• When is it effective? The changes were effective Jan. 1, 2009, for unclassified new hires, and July 1, 2009, for other unclassified employees who participate in the UPP.
• Q&A available on the Staff News blog.
Clarification: pay cuts and furloughs. The Executive Leadership Team has received a number of inquiries asking whether we considered pursuing an enterprise-wide strategy of pay cuts and/or furloughs. Our approach during this economic downturn has been to provide overall reduction targets to individual units. Unit leaders have broad latitude in achieving those reductions. Furloughs should not be used for unclassified employees, because of the wage and hour implications. Managers considering furloughs for other employees should work with their Human Resources Business Partner. In general, most managers are choosing to make reductions in a way that does not impact the take-home pay of employees.

Thank you for your attention to these issues. If you have further questions, please feel free to direct them to Rick Bentzinger, Vice President of Human Resources.

Steve Stadum
Executive Vice President