Table of Contents

78th Oregon Legislative Session Overview . . . . 1-3 Legislative Dashboard...... 4-7 Legislation 2015 ...... 8-26 Selected News Coverage...... 27-54

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Acronyms Found in this Report

ABA Applied Behavior Analysis NP Certified Nurse Practitioner ACA Patient Protection and Affordable Care Act OAHHS Oregon Association of Hospitals and Health Systems ASC Ambulatory Surgery Center OBMI Oregon Board of Medical Imaging BON Oregon State Board of Nursing OEA Oregon Education Association CCO Coordinated Care Organization OHA Oregon Health Authority COHO Coalition for a Healthy Oregon OHLC Oregon Health Leadership Council COLA Cost of Living Adjustment PA Physician Assistant DCBS Department of Consumer and Business Services PERS Public Employee Retirement System DHS Department of Human Services PDMP Oregon Prescription Drug Monitoring Program HTPP Hospital Transformation Performance Program SEIU Service Employees International Union

WWW.OAHHS.ORG | ii 78th Oregon Legislative Session t 6:04 p.m. on July 6th, the 78th Session of the Oregon Legislature adjourned “Sine Die” after 155 days of work. The 90 elected members of the Oregon Legislative AssemblyA convened the 2015 Legislative Session on February 2nd amid uncertainty around the strength of the Oregon economy, concerns regarding a looming Supreme Court decision on PERS reforms adopted by the legislature in 2013 and allegations of misconduct by Governor John Kitzhaber and First Lady Cylvia Hayes. Just 11 days after the start of session, Governor Kitzhaber announced his resignation and five days later, Kate Brown was sworn-in as Oregon’s 38th Governor. While most pundits expected chaos and a rough leadership transition to ensue, Governor Brown moved quickly to solidify her leadership team and to calm the waters within the Executive Branch. The 2015 Legislative Session was marked by sharp partisan disagreement over a number of policy issues and conflict between House and Senate Leaders who differed in personality, style and approach.

2015 LEGISLATIVE REPORT | 1 78TH OREGON LEGISLATIVE SESSION Key Influences on the 2015 Legislative Session Political Imbalance History tells us that legislatures that are more evenly divided of living adjustments (COLA) benefit for state employees. The between Democrats and Republicans tend to pass less PERS decision will impact all public employers including state controversial legislation and less legislation overall. Members agencies, municipalities, fire districts and schools. The increased of both parties have to put aside the far reaching parts of their costs will require increased revenue sources or cuts to services agendas in order to accomplish the basic work involved in in order to address them. The PERS decision had a limited balancing budgets and completing work in a timely manner. impact on the 2015 budget process and will have an even more Legislatures that are controlled too much by either party lack pronounced impact on future budgets. an important balance and alternative perspective. In 2015, Democrats control the House of Representatives by a 35 to 26 Revenue Forecast and the margin, the State Senate with a commanding 18 to 12 margin Personal “Kicker” and Governor Kate Brown is also a Democrat. While across the board Democrat control didn’t eliminate conflict and On May 14th, the official state revenue forecast revealed that disagreement between the House and Senate leadership, it did estimated revenue exceeded the threshold necessary to trigger result in the passage of a number of shared policy objectives. the personal kicker at approximately $477 million. These dollars will be returned to taxpayers as a credit on their 2015 tax returns PERS Decision (an average of $248 per taxpayer). The forecast also provided lawmakers with an additional $463 million in revenue for the At the end of April, the Oregon Supreme Court overturned a 2015-2017 budget. Of the additional $463 million, at least $105 series of Public Employees Retirement System changes that were million was immediately appropriated to K-12 education based approved by the Oregon State Legislature in 2013. The decision on the commitment the legislature made to share 40% of any resulted in a loss of millions of dollars that lawmakers expected new general fund revenue expected in 2015-2017 (40% of the to use to balance future budgets. The 2013 reforms reduced the $264.5 million). PERS liability for future pension payments by $5.3 billion with a majority of the savings coming from reductions to the cost

Overarching Themes of the 78th Legislative Session Business During the 2015 Legislative Session, Democrat leadership need for critical road maintenance in large part to passage of pursued a progressive agenda focused on addressing social and a controversial low-carbon fuel standard bill within the first economic inequality under the banner of the “Fair Shot for All” two weeks of session. Negotiations started mid-session on campaign. Many of these priorities were opposed by the broader modifications to the low-carbon fuels standard that would business community including mandatory paid sick leave (SB remove the most offensive provisions and remove obstacles 454), ban the box (HB 3025), a mandatory state-run retirement to the transportation funding package. Ultimately a proposal savings plan for Oregon businesses (HB 2960) and increases was forwarded by the Senate Democrats, Republicans and the to the minimum wage (HB 2002). While efforts to increase Governor’s Office that raised 206 million ($33 million of which minimum wage failed, Democrats successfully passed the other would be bonded to create $400 million for major highway “Fair Shot” priorities. In addition, business interests failed to projects). However, significant pressure on House Democrats defeat a measure to reduce greenhouse gas emissions (SB 324) from environmental advocates, already touting the low-carbon that some believe will result in significant increases in fuel fuels standard as a major accomplishment, caused House prices due to the lack of known fuel additives necessary to meet leadership to oppose the plan. In the end, the transportation the blending requirements in the bill and the requirement that funding plan bill died in the Senate. fuel importers purchase reduction credits as an offset. Business interests also fought a host of measures designed to increase the Public Safety cost of business through taxes and fees and the elimination of A relentless number of tragic and troubling news stories business incentives through tax credits and other policies. regarding police officer conduct from around the nation had a profound impact on the perception of policing within the walls Transportation of the Oregon State Capitol during the 2015 Legislative Session. Despite apparent support for passage of a transportation This barrage of stories breathed life into bills dealing with funding package from a majority of Democrats and Republicans bias policing, deadly use of force, body-worn cameras, public in the House and Senate, the legislature failed to address the recording of police officers and grand jury recordation. While

WWW.OAHHS.ORG | 2 78TH OREGON LEGISLATIVE SESSION none of these stories originated in Oregon, the political reality K-12 Education created a very challenging environment for policing advocates. Perhaps the most intense public safety policy debate during the Lawmakers approved a K-12 Education budget of $7.255 legislative session was over implementation of Ballot Measure billion early in April, a nine percent increase from the current 91 (marijuana legalization). A combined House and Senate two-year budget. Following the positive revenue forecast in committee was appointed to address a wide range of issues May, education received an additional $105 million based on related to marijuana including changes to the Oregon Medical contingency language included in the K-12 education bill. Marijuana Act, local government authority to regulate marijuana The increases in funding put pressure on other state budgets establishments, marijuana taxation, adjustments to criminal and were still not enough to satisfy the Oregon Education penalties, access to marijuana by youth, marijuana testing and Association and other education advocates who believe the regulation of grows and establishments. The Joint Committee system is funded inadequately. Future funding of education and on the Implementation of Ballot Measure 91 reached consensus other budget priorities will be in jeopardy in future biennium near the end of session on a HB 3400, an omnibus measure that due to the impact of the recent Supreme Court ruling that was passed in both chambers with significant support. overturned PERS reforms.

Hospital Association Priorities Medicaid Funding Price Transparency Despite the disruption caused by the resignation of Governor During the 2015 Legislative Session, competing price Kitzhaber on February 18th, a Medicaid Funding Package was transparency measures pitted SB 900, a proposal submitted successfully negotiated by the end of the February and the by the Oregon Health Leadership Council against SB 891, policy measure to implement the package was passed by the a measure introduced by the Oregon State Public Interest legislature and signed by Governor Brown on March 23rd. Research Group (OSPIRG). Considered onerous and unfriendly The early resolution of the package was a departure from to consumers, SB 891 died in the Senate Healthcare Committee previous legislative sessions where the policy package and after failing to move before the first chamber deadline. Despite budget were passed at the end of session. At the beginning the failure, the debate over price transparency continued of the 2015 Session, the Senate President and House Speaker throughout the entirety of the session. SB 900, sponsored by a assigned a team of eight legislators (including both Democrats bipartisan group of legislators at the request of OHLC and the and Republicans) to meet with representatives of the Oregon Oregon Association of Hospitals and Health Systems, passed Health Leadership Council and the Oregon Association of on the final day of session as one of the final bills considered by Hospitals and Health Systems to attempt an early resolution to the legislature. The measure was passed with broad bipartisan the Medicaid funding challenge. The final agreement was very support by both the House and Senate. SB 900 calls for OHA close to the original recommendation developed by the OHLC to post to their website, state-collected data, from the existing in cooperation with the Governor. The only change requested All Payer All Claims database, to display median prices paid by legislative leadership was an increase in the extension of the for common hospital inpatient and outpatient procedures. provider tax from two to four years. The key provisions of the This website would give patients the ability to understand what final agreement included: a four year extension of the hospital the typical cost of a particular procedure would be, as paid by provider tax at the current rate of 4.3% with an additional one- insurers. SB 900 is one element in a three part initiative to help percent of tax split evenly between the Hospital Transformation consumer’s access pricing information in advance of care. The Performance Pool Program and the CCO Quality Incentive other two elements of the initiative include good faith cost Pool, repeal of the sunset on the “par/non-par” statute and a estimates from hospitals for Oregonians who are paying for continued state commitment of General Fund (with an increase their own care of for out-of-network services not covered by a of 10%) and Tobacco Tax Settlement proceeds to sustain health plan and a commitment to work with insurers to provide the program over time. Senate Bill 5526, the Oregon Health consumers with increased access to information regarding their Authority Budget, received final passage in the final days of the health coverage and out-of-pocket costs for procedures. legislative session in keeping with the negotiated agreement. The bill funds the Medicaid budget at the 3.4% per person growth rate in Oregon’s waiver agreement with the Federal Government.

2015 LEGISLATIVE REPORT | 3 LEGISLATIVE DASHBOARD Legislative Dashboard

Senate Bills

Work Group/ Bill # Relating To Results Effective Date Chapters Rulemaking SB 37 A tax credit for rural medical care. In Committee Upon Adjournment SB 71 Prescription drugs Passed January 1, 2016 Chapter 481 (2015 Laws) SB 93 The dispensing of prescription drugs. Passed January 1, 2016 Chapter 661 (2015 Laws) SB 132 Assault of health care providers In Committee Upon Adjournment SB 144 Payment for health services Passed June 10, 2015 Chapter 340 Rules (2015 Laws) SB 153 Reimbursement of primary care Passed January 1, 2016 Chapter 377 services (2015 Laws) SB 227 Use of information related to Passed January 1, 2016 Chapter 286 trauma injury (2015 Laws) SB 228 Sources of radiation; declaring an Passed July 27, 2015 Chapter 778 emergency (2015 Laws) SB 280 The regulation of medical imaging Passed June 11, 2015 Chapter 385 (2015 Laws) SB 330 Executive compensation In Committee Upon Adjournment SB 409 Noneconomic damages In Committee Upon Adjournment SB 440 Measuring the quality of health care Passed June 11, 2015 Chapter 389 Rules and appointment (2015 Laws) to a new committee SB 454 Mandatory provision of sick time Passed January 1, 2016 Chapter 537 Rules (2015 Laws) SB 465 Community mental health programs Passed July 27, 2015 Chapter 785 (2015 Laws) SB 469 Staffing of hospitals Passed Effective immediately Chapter 669 Rules and Appointments to for OHA to develop (2015 Laws) statewide advisory committee rules and select candidates to the statewide advisory board. Jan 2016 Hospital Staffing Committees in place; Jan 2017 Hospital staffing plans implemented SB 505 Influenza virus immunizations Passed January 1, 2016 Chapter 496 (2015 Laws)

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Work Group/ Bill # Relating To Results Effective Date Chapters Rulemaking SB 523 Obligations of insurers offering Passed January 1, 2016 Chapter 580 qualified health plans through a (2015 Laws) health insurance exchange SB 594 Credentialing of health care Passed January 1, 2016 Chapter 297 Oregon Common Credentialing practitioners (2015 Laws) Advisory Group SB 608 Palliative care Passed January 1, 2016 Chapter 789 Appointment Appointments within (2015 Laws) 90 days of sine die SB 665 Hospital charges In Committee Upon Adjournment SB 679 Oregon Health Authority information In Committee systems Upon Adjournment SB 710 Health records requested to obtain Passed June 10, 2015 Chapter 360 Social Security benefits (2015 Laws) SB 757 Study on Provider In Committee Incentive Programs Upon Adjournment SB 832 Integrated health care; Passed July 27, 2015 Chapter 798 declaring an emergency (2015 Laws) SB 833 Coordinated care organization Passed July 27, 2015 Chapter 799 contracts (2015 Laws) SB 835 Hospital emergency departments In Committee Upon Adjournment SB 840 Persons with chronic mental illness Passed June 16, 2015 Chapter 461 (2015 Laws) SB 874 Adrenal insufficiency Passed January 1, 2016 Chapter 501 (2015 Laws) SB 886 Building Codes Passed January 1, 2016 Chapter 678 Workgroup (2015 Laws) SB 891 The cost of health care services In Committee Workgroup Upon Adjournment SB 900 Health care price data Passed Effective immediately with the website operative by July 2016. SB 901 Insurance reimbursement Passed January 1, 2016 Chapter 588 (2015 Laws) SB 920 Protecting antibiotics for human public In Committee health; declaring an emergency Upon Adjournment SB 938 Exemption from property taxation; In Committee prescribing an effective date. Upon Adjournment SB 970 Air ambulance services in rural In Committee Interim conversations areas of this state Upon Adjournment SB 5507 Appropriations Passed July 1, 2015 Budget Notes; Report to the 2016 leg. on Mental Health and rural funding SB 5526 The financial administration of Passed July 1, 2015 Budget Notes; Report to the the Oregon Health Authority 2016 leg. on Mental Health

2015 LEGISLATIVE REPORT | 5 LEGISLATIVE DASHBOARD Legislative Dashboard House Bills Work Group/ Bill # Relating To Results Effective Date Chapters Rulemaking HB 2005 Mandatory provision of sick time In Committee Upon Adjournment HB 2022 Case management services to In Committee assist individuals discharged from Upon Adjournment facilities in transitioning to outpatient mental health treatment HB 2023 Protocols for a health care facility Passed January 1, 2016 Chapter 466 Interim conversation discharge of a patient who presented (2015 Laws) with a behavioral health crisis HB 2171 Rural Provider Tax Credits Passed October 5, 2015 – Chapter 701 Workgroup Impacting the 2016 (2015 Laws) tax year HB 2294 Health information technology; Passed June 4, 2015 Chapter 243 and declaring an emergency (2015 Laws) HB 2300 Treatments for patients with Passed Pilot project from Rules terminal diseases January 1, 2016 to January 2, 2022 HB 2304 Community benefits provided In Committee by hospitals Upon Adjournment HB 2305 Polysomnographic technologists Passed January 1, 2016 Chapter 78 (2015 Laws) HB 2306 Prescription drugs Passed June 18, 2015 Chapter 467 Rules (2015 Laws) HB 2363 Persons with mental illness Passed May 18, 2015 Chapter 81 (2015 Laws) HB 2368 Proxies for health care decisions Passed January 1, 2016 Chapter 82 (2015 Laws) HB 2395 State medical assistance program Passed March 23, 2015; Chapter 16 funding; declaring an emergency; Impacts tax collection (2015 Laws) and providing for revenue raising on October 15, 2015 that requires approval by a three- fifths majority HB 2420 Fitness to proceed Passed January 1, 2016 Chapter 130 Workgroup (2015 Laws) HB 2522 Health care for Pacific Islanders Passed July 20, 2015; Report Chapter 717 Workgroup legally residing in the United due to Legislative (2015 Laws) States under a Compact of Assembly by Free Association treaty September 15, 2016 HB 2551 CEO Attestation Passed January 1, 2016 Chapter 133 Rules (2015 Laws) HB 2570 Ambulatory surgical centers In Committee Upon Adjournment HB 2631 Safe lifting In Committee OAHHS Workplace Upon Adjournment Safety Initiative HB 2696 Administrative requirements for Passed January 1, 2016 Chapter 552 Rules coordinated care organizations (2015 Laws) HB 2796 Music therapy Passed July 1, 2015 Chapter 632 Rules (2015 Laws)

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LEGISLATIVE DASHBOARD Work Group/ Bill # Relating To Results Effective Date Chapters Rulemaking HB 2825 Services for individuals with In Committee mental illness Upon Adjournment HB 2828 A study on financing health care Passed July 1, 2015; A report Chapter 725 in this state to the Legislative (2015 Laws) Assembly in 2017 HB 2876 The practice of surgical technology; Passed June 11, 2015; DRG Chapter 373 Rules, Interim work and declaring an emergency Hosp. rural hospitals (2015 Laws) effective July 1, 2017 HB 2879 Health care; declaring an emergency Passed July 6, 2015 Chapter 649 (2015 Laws) HB 2880 Radiography Passed May 12, 2015 Chapter 62 (2015 Laws) HB 2930 Nurse practitioners Passed January 1, 2016 Chapter 63 (2015 Laws) HB 2934 Relating to access to health care Passed June 4, 2015 Chapter 256 Rules (2015 Laws) HB 2948 Disclosure of health-related Passed June 18, 2015 Chapter 473 Rules information (2015 Laws) HB 3021 Payment of insurance claims Passed January 1, 2016 Chapter 218 (2015 Laws) HB 3034 The property of nonprofit In Committee Interim conversations corporations that provide Upon Adjournment health services HB 3087 Health practitioner referrals In Committee Upon Adjournment HB 3100 Public health Passed July 20, 2015 Chapter 736 (2015 Laws) HB 3289 Physicians In Committee Upon Adjournment HB 3300 Medical assistance recipients In Committee Upon Adjournment HB 3347 Persons with mental illness Passed January 1, 2016 Chapter 433 (2015 Laws) HB 3349 Health care costs In Committee Upon Adjournment HB 3356 The primary care physician shortage In Committee Upon Adjournment HB 3357 Family medicine residency programs In Committee Upon Adjournment HB 3359 Health care providers of primary care In Committee Upon Adjournment HB 3378 Hospital discharge planning Passed January 1, 2016 Chapter 263 Rules with lay caregivers. (2015 Laws) HB 3396 Health care provider incentive Passed Effective to tax Study programs years beginning January 1, 2016; Study is repealed on January 2, 2017 HB 3427 Insurance reimbursement for In Committee health services Upon Adjournment HB 3502 Persons with mental illness; In Committee declaring an emergency Upon Adjournment

2015 LEGISLATIVE REPORT | 7 LEGISLATION 2015 Budget Budget SB 5507: Christmas Tree Bill SB 5526: OHA Budget Relating to appropriations. Relating to the financial administration of the Results: Passed Oregon Health Authority. Effective Date: July 1, 2015 Results: Passed Effective Date: July 1, 2015 SUMMARY The bill had several budget notes of importance to hospitals SUMMARY including funding for rural health transformation and community Appropriates moneys from General Fund to Oregon Health mental health statewide meetings. Authority for certain biennial expenses.

IMPORTANCE TO HOSPITALS IMPORTANCE TO HOSPITALS Budget Note: MENTAL HEALTH Budget Note: PROVIDER TAX The Oregon Health Authority shall conduct a minimum of five The budget for the Medical Assistance Programs includes community meetings in a variety of geographic locations across a consensus product developed with stakeholders, the the state. The goal of the community meetings is to capture, Governor’s Office and the Legislature. As part of the funding understand, and report to the Legislature on the experience of package, the Legislature passed HB 2395 to renew the hospital children, adolescents, and adults experiencing mental illness provider assessment with the assumption that the base rate for and their ability to access timely and appropriate medical, the provider assessment would be 5.3%. The base rate shall mental health and human services to support their success in only be adjusted during the 2015-17 and 2017-19 biennia in the community. The meetings shall not be restricted to publicly accordance with Section 2, chapter 736, Oregon Laws 2003, as financed services or individuals eligible for public benefits. amended by section 1, chapter 780, Oregon Laws 2007, section The focus will be on the entirety of the Oregon mental health 51, chapter 828, Oregon Laws 2009, section 17, chapter 867, system, both public and private. Issues to be considered should Oregon Laws 2009, section 2, chapter 608, Oregon Laws 2013 include but not be limited to: and HB 2395. The budget has made assumptions about the • Access to child and adolescent services other funds and federal funds limitations to assure the program • Boarding in hospital emergency rooms continues to operate as it has and stays within the state and • Access to housing, addiction, and recovery services federal requirements. • Family support services • Waiting periods for services Budget Note: MENTAL HEALTH The Oregon Health Authority will report to the 2016 legislative • Workforce capacity session regarding the problem of “boarding” of patients with • Affordability for non-covered individuals to access mental illness in hospital emergency departments while patients mental health services wait for a bed in an appropriate setting. The report will contain a • Coordination between behavioral health and physical thorough description of the system and process as it works now health services and why, including relevant statutes and reimbursements. It will The Oregon Health Authority shall consult and coordinate with also include data to describe the magnitude of the problem. stakeholders to plan and conduct the community meetings. Finally, the report will contain an analysis of the reasons for The Oregon Health Authority is expected to report progress and the “boarding”, such as gaps in necessary services within the findings to the appropriate legislative committees and the 2016 system, and proposals for potential solutions. Legislature. Budget Note: RURAL HOSPITALS The Oregon Health Authority shall engage in a rural hospital stakeholder process to gather input on potential transformation strategies to ensure that Oregon’s small and rural hospitals continue to be sustainable in the future. Potential transformation strategies could include grant or bridge funding, transformation pilot programs, or incentive programs to assure funding stability for hospitals and access to health care services for rural Oregonians. Based on the work with stakeholders, OHA will develop a set of recommendations. OHA shall report to the Joint Committee on Ways and Means Committee during the 2016 legislative session on any hospital assessment revenues received for the 2013-15 biennium and available for use in 2015-17. The revenue may include assumed hospital assessment revenue in the OHA 2015-17 budget or any additional hospital assessment revenue not included in the OHA budget, that could potentially be used to fund one or more of the strategies recommended, but not to exceed $10 million. The agency should include in that report any information on federal matching resources that may be available for those strategies.

WWW.OAHHS.ORG | 8 LEGISLATION 2015 Coordinated Care Organizations SB 833: CCO Contracts Relating to coordinated care organization contracts. Results: Passed Effective Date: Effective upon passage, awaiting Gov’s signature SUMMARY Requires Oregon Health Authority to give coordinated care organization at least 60 days’ advance notice of proposed amendments to contracts and payment rates. Chapter 799 (2015 Laws) Coordinated Care Organizations HB 2696: CCO Reviews Employment Issues Relating to administrative requirements for SB 454: Paid Sick Leave coordinated care organizations. Relating to mandatory provision of sick time. Results: Passed Results: Passed Effective Date: January 1, 2016 Effective Date: January 1, 2016 SUMMARY SUMMARY Specifies requirements for external quality reviews of Requires all employers to implement sick time for employees. coordinated care organizations by Oregon Health Authority. POLITICAL BACKGROUND IMPORTANCE TO HOSPITALS Implementing a statewide policy on paid sick leave was at This bill limits the auditing and information requests of the top of the Democrats and labor communities’ legislative CCO’s and their providers by OHA. The bill should reduce agenda this session. Stakeholders from both the business and administrative work. labor communities worked to find a compromise. The accrual Chapter 552 (2015 Laws) rate for sick leave will be at least one hour for every 30-hours worked, or 1 1/3 for every 40-hours worked. The enrolled bill preempts local governments from executing their own sick Employment Issues leave ordinances. Minimum increments, grace periods, usage and exemptions are all detailed and will be enforced by BOLI. SB 330: Executive Compensation Criteria The impact to hospitals is expected to be nominal; since Relating to executive compensation. most employees already accrue sick leave, or some form of personal time off. The impact to temporary or traveling nurses, Results: In Committee Upon Adjournment who receive a wage increase in lieu of personal time off, is indeterminate and will need to be clarified in BOLI rule making. SUMMARY Requires nonprofit hospital to adopt formula meeting specified IMPORTANCE TO HOSPITALS criteria for executive compensation. Hospitals should review their paid sick leave policies in light of the new requirements to ensure compliance. POLITICAL BACKGROUND Part of the SEIU’s ballot measure from 2013 aiming at reducing Chapter 537 (2015 Laws) health care costs.

IMPORTANCE TO HOSPITALS Employment Issues Although this bill failed, hospitals and health systems should be prepared for this bill to return in the future as a ballot measure HB 2005: Paid Sick Leave or otherwise. This is a prime issue for organized labor. Relating to mandatory provision of sick time. Results: In Committee Upon Adjournment SUMMARY Requires employers that employ six or more employees to implement paid sick time for employees and employers that employ fewer than six employees to implement unpaid sick time for employees.

POLITICAL BACKGROUND Paid sick leave was part of labor and Democrats’ priority agenda. See SB 454.

2015 LEGISLATIVE REPORT | 9 LEGISLATION 2015 Facility Management Health Information Technology SB 228: X-Ray Machine Fee Increases SB 679: MMIS Oversight Relating to sources of radiation. Relating to Oregon Health Authority information Results: Passed systems. Effective Date: July 27, 2015 Results: In Committee Upon Adjournment SUMMARY SUMMARY Increases fees and fee limits for registering tanning devices Creates Medicaid Management Information System Oversight and X-ray machines and issuing specific licenses for sources of Committee to monitor progress of improvements to Oregon’s radiation. mechanized claim processing system for Medicaid claims.

IMPORTANCE TO HOSPITALS Fees have not been raised in eight years. Increasing cost of Health Information Technology maintaining x-ray machines in good standing. HB 2294: Health Information - Registration fee for hospital x-ray machine from $228 to $285 - For hospital x-ray inspection from $116 to $145 Relating health information technology. For specific licenses granted by exception from $3,000 to Results: Passed $5,000 Effective Date: June 4, 2015 Chapter 778 (2015 Laws) SUMMARY Requires Oregon Health Authority (OHA) to establish the Oregon Facility Management Health Information Technology Program. Authorizes OHA to SB 886: Building Codes provide optional health information technology (HIT) services to support statewide healthcare and establish fees to cover Relating to structural codes. cost of expanding HIT services. Allows OHA to participate in or Results: Passed fund HIT partnerships or collaboratives. Establishes the Health Information Technology oversight Council (Council) under the Effective Date: January 1, 2016 Oregon Health Policy Board (OHPB), changes appointment authority from the Governor to the OHPB, and modifies the role SUMMARY of the Council to provide strategic and policy recommendations. Requires that citation or order for nonconformity with fire safety Expands OHA scope to include certain activities to support standard include information regarding source of standard and the Oregon HIT program. Clarifies procurement procedures. facts providing basis for citation or order. Requires that OHA submit annual report to the Legislative Assembly. Requires Department of Administrative Services to POLITICAL BACKGROUND procure or supervise procurement of information technology for Supported by health care facilities, opposed by the fire martials. OHA.

IMPORTANCE TO HOSPITALS POLITICAL BACKGROUND While the impact of the bill is nominal, the potential outcome of Bill sponsored by OHA; OAHHS provided a letter of support. an interim workgroup could produce a significant opportunity to have hospital facility code issues addressed. IMPORTANCE TO HOSPITALS Chapter 678 (2015 Laws) Hospitals will largely be impacted through new health IT services on the Medicaid side, which will be funded through CCO dollars and federal matching funds. Private sector health IT services will be voluntary and paid for through fees. Many members have expressed interest in the services OHA will develop under its new authority such as the provider directory and robust regional HIEs. This legislation should standardize health IT and create more alignment between state programs, offering more benefit to hospitals. The bill also changed the composition of HITOC and allows for greater hospital and health system representation on that committee. Chapter 243 (2015 Laws)

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IMPORTANCE TO HOSPITALS Health Professionals Most DRG hospitals and ASCs currently hire certified surgical technicians; this will become the standard for all hospitals HB 2305: Sleep Technologist and ASCs. Rural hospitals will begin to hire certified surgical Relating to polysomnographic technologists. technicians starting in 2017. The proponents of the bill agreed to working with rural hospitals and local community colleges in Results: Passed developing programs that will promote training and certification. Effective Date: January 1, 2016 SUMMARY Health Professionals Permits individuals who complete polysomnographic program that combines education and training program to apply for HB 2880: PAs to Perform Fluoroscopy polysomnographic technologist license. Relating to radiography. POLITICAL BACKGROUND Results: Passed The Respiratory Therapist and Polysomnographic Technologist Effective Date: May 12, 2015 Licensing Board has passed rules that make licensure much more complicated for Polysomnographic Technologist which SUMMARY make it difficult for hospitals seeking experience, especially Specifies that physician assistants may not practice fluoroscopy from other states. HB 2304 allows a person who has met the on person unless physician assistant holds certificate issued by current combined education and training prerequisites for the Board of Medical Imaging authorizing such practice. national Registered Polysomnographic Technologist to be eligible for the Board’s examination. IMPORTANCE TO HOSPITALS May apply to hospitals and systems using PA’s to do IMPORTANCE TO HOSPITALS fluoroscopy; updates to HR systems This will assist hospitals in hiring skilled sleep technologists from other states. Chapter 62 (2015 Laws) Chapter 78 (2015 Laws) Health Professionals Health Professionals HB 2930: Midwives HB 2876: Surgical Technicians Relating to nurse practitioners. Relating to the practice of surgical technology. Results: Passed Results: Passed Effective Date: January 1, 2016 Effective Date: July 1, 2016 for DRG hospitals; SUMMARY effective July 1, 2017 for rural hospitals. Requires that hospital rules granting admitting privileges to licensed, certified nurse midwife nurse practitioner meet SUMMARY specified requirements. Requires health care facilities to hire certified surgical technicians. IMPORTANCE TO HOSPITALS If a hospital authorizes an NP Midwife to practice in their POLITICAL BACKGROUND hospital, then they must be granted admitting privileges and be This was negotiated language between the proponents, a member of the medical staff with voting rights. If a hospital legislators and hospitals that delays rural requirements for two does not choose to allow an NP midwife to deliver in their years. Legislators agreed with the proponents that surgical hospital, then this does not apply and does not require that technicians needed to have a standard training program. policy to change. Chapter 373 (2015 Laws) Chapter 63 (2015 Laws)

2015 LEGISLATIVE REPORT | 11 LEGISLATION 2015 HIPAA Hospital Administration SB 710: No Charge for Copying IHI for SB 594: Common Credentialing delay SS Disability Benefits Relating to credentialing of health care practitioners. Relating to health records requested to obtain Results: Passed Social Security benefits. Effective Date: Jan 1, 2016 Results: Passed SUMMARY Effective Date: June 10, 2015 Allows for OHA to delay the implementation of the Common SUMMARY Credentialing Source. Requires state health plans, health insurers, health care providers or health care clearinghouses to provide, upon POLITICAL BACKGROUND In the wake of the Cover Oregon issues, the state implemented request, one copy of individually identifiable health information new laws around the procurement process of public contracts free of charge to individual, or to personal representative, including the need to hire a Quality Assurance vendor prior to when individual is appealing denial of Social Security disability posting an RFI. This process has delayed the implementation benefits. of the common credentialing source for the state. A bill was IMPORTANCE TO HOSPITALS necessary to move the implementation date six to 12 months out. Hospitals need to update policies to assure compliance with the requirements of the bill. IMPORTANCE TO HOSPITALS In 2013, the state passed SB 604 requiring a centralized source Chapter 360 (2015 Laws) to be used by all providers and all credentialing organizations. This bill delays the implementation of the common credentialing source, which allows for hospitals to plan and budget accordingly. Chapter 297 (2015 Laws) Hospital Administration SB 608: Palliative Council Relating to palliative care. Results: Passed Effective Date: January 1, 2016 Appointments within 90 days of sine die SUMMARY Creates Palliative Care and Quality of Life Interdisciplinary Advisory Council in Oregon Health Authority.

IMPORTANCE TO HOSPITALS There are requirements for hospitals to identify patients that Hospital Administration would benefit from palliative care. Chapter 789 (2015 Laws) SB 132: Assault of a Health Care Provider Relating to assault of health care providers. Hospital Administration Results: In Committee Upon Adjournment SB 835: Hospital Emergency Departments SUMMARY Relating to hospital emergency departments. Expands crime of assault in third degree to include physical Results: In Committee Upon Adjournment injury to health care provider in hospital. SUMMARY POLITICAL BACKGROUND Requires hospital emergency department to refer for primary This bill was proposed by Legacy Health. Although similar bills care a person who presents at emergency department but does have failed in previous sessions, this bill did garner greater not have condition requiring emergency medical services. support. The bill is likely to come back in the future.

IMPORTANCE TO HOSPITALS OAHHS is leading the Workplace Safety Initiative that will help hospitals develop best practices for preventing assaults against health care workers. Similar legislation should be expected in future sessions.

WWW.OAHHS.ORG | 12 LEGISLATION 2015 Hospital Administration Hospital Administration HB 2551: CEO Attestation HB 3087: Patient Choice Act Results: Passed Relating to health practitioner referrals. Effective Date: January 1, 2016 Results: In Committee Upon Adjournment SUMMARY SUMMARY Requires covered entities that are required to file an annual Removes requirement for Oregon Health Authority to prescribe financial statement with the Department of Consumer and rules regarding health practitioner referrals. Business Services (DCBS) to report annually on system safeguards for protecting confidentiality of personally identifiable and protected health information via a protection Hospital Administration of health information report demonstrating compliance with federal and state laws protecting individually identifiable HB 3349: Display of Charity Care Policies health information. Specifies that the report can be a letter and Relating to health care costs. outlines criteria. States the report is confidential. Requires that a health care facility submit a health information report to the Results: In Committee Upon Adjournment Oregon Health Authority (OHA) no later than 120 days following the close of each fiscal year. Requires OHA to prescribe the SUMMARY Requires hospitals and emergency departments to maintain form for submitting the report. written charity care policies meeting specified requirements. POLITICAL BACKGROUND This has been a priority bill for the Chair of House Health POLITICAL BACKGROUND Part of the SEIU’s ballot measure from 2013 to require hospitals Care for several sessions. The Chair is particularly concerned to publicly display charity care policies. with the recent breaches of personal health care information and hacks into large sources of such information. In the past, IMPORTANCE TO HOSPITALS OAHHS has opposed this effort. However, in light of the session Although this bill failed, hospitals and health systems should be politics we worked with the Chair to arrive at a compromise that prepared for this bill to return in the future as a ballot measure achieves the Chair’s goal and limits liability and redundancy. or otherwise. This is a prime issue for organized labor with the decrease in hospital charity care levels. IMPORTANCE TO HOSPITALS Requires hospital and health system CEOs to sign and submit a letter to OHA that they are confident that their facility has Hospital Administration demonstrated compliance in protecting individually identifiable health information. Additional filing requirement. Unclear HB 3378: AARP’s Care Act parameters for demonstrating compliance. Relating to hospital discharge planning with Chapter 133 (2015 Laws) lay caregivers. Hospital Administration Results: Passed Effective Date: January 1, 2016 HB 2631: Safe Lifting SUMMARY Relating to the health care workforce. Requires hospital to adopt written discharge policies. Results: In Committee Upon Adjournment POLITICAL BACKGROUND SUMMARY AARP’s national priority agenda, “Care Act”. The final version Requires hospital to implement safe patient handling program of the bill was a carefully crafted compromise that describes by February 1, 2017. a framework for discharge planning, detail will be decided by each hospital. POLITICAL BACKGROUND OAHHS and hospitals are working with SEIU and ONA on this IMPORTANCE TO HOSPITALS issue, the bill was brought as additional pressure by SEIU to Hospitals will need to revise discharge policies once the rule continue the work and keep hospitals at the table. making has taken place. Representatives on the RAC will need to assure the requirements stay very flexible so that hospitals IMPORTANCE TO HOSPITALS can determine their own details. Hospitals should continue to participate in OAHHS’ Workplace Chapter 263 (2015 Laws) Safety Initiative as well as review of best practices for lifting to protect workers.

2015 LEGISLATIVE REPORT | 13 LEGISLATION 2015 Hospital Licensure HB 2570: Ambulatory Surgical Centers Relating to ambulatory surgical centers. Results: In Committee Upon Adjournment SUMMARY Creates new category of ambulatory surgical centers for licensing purposes.

POLITICAL BACKGROUND Both the ASC Association and COHO would like to expand the hours ASCs are permitted to keep a patient. However, that is prohibited by federal law. Instead the effort will focus on a new license category of “convalescent facilities” that will in reality be adjacent to the ASC and divided by a firewall to make it legal. Currently Oregon does not permit this.

IMPORTANCE TO HOSPITALS Although this bill failed, hospitals and health systems should be prepared for this bill to return in the future. Insurance Immunizations SB 153: Nurse Practitioners and Physician Assistants SB 505: Flu Shots for Seniors Reimbursement Relating to the influenza virus. Relating to reimbursement of primary care services. Results: Passed Results: Passed Effective Date: January 1, 2016 Effective Date: January 1, 2016 SUMMARY SUMMARY Requires, from October 1 through March 1 of each year, Clarifies definition of independent practice for purpose of each hospital in this state make an offer to immunize against insurance reimbursement for services provided by licensed influenza virus to each patient of hospital who is 65 years of physician assistant or certified nurse practitioner. age or older. IMPORTANCE TO HOSPITALS POLITICAL BACKGROUND Billing offices should be aware of the new definitions and billing While hospitals have policies for offering flu vaccinations to practices. patients, this will codify that requirement for patients over 65. Chapter 377 (2015 Laws) IMPORTANCE TO HOSPITALS Implement new requirements in every hospital. Insurance Chapter 496 (2015 Laws) SB 523: Provider Protection for the 90 Grace Period Insurance Relating to obligations of insurers offering qualified health plans through a health insurance exchange. SB 144: Telemedicine Results: Passed Relating to payment for health services. Effective Date: January 1, 2016 Results: Passed Effective Date: June 10, 2015 SUMMARY Relating to obligations of insurers offering qualified health plans SUMMARY through a health insurance exchange Modifies requirements for health benefit plan coverage of telemedical health services. POLITICAL BACKGROUND Requires insurer to notify provider that the enrollee is in a grace POLITICAL BACKGROUND period when enrollee fails to pay premium for the qualified A similar bill was killed in the 2014 Session. An interim group health plan, if the provider requests information regarding negotiated the language in SB 144. coverage, eligibility or benefits. Specifies conditions that requires insurer to reimburse provider for services performed IMPORTANCE TO HOSPITALS during the grace period when coverage is terminated. Specifies Hospitals will be able to provide telemedicine services and requirements may not be waived by agreement or contract. receive payment for the services provided. Directs insurer, upon inquiries from provider, to respond that coverage is provided. Requires that a provider request the Chapter 340 (2015 Laws) information from the insurer not more than seven (7) business days before providing the service and that the insurer provides

WWW.OAHHS.ORG | 14 LEGISLATION 2015 the information to the provider no later than two (2) business Liability days after the request is made. Directs Department of Consumer and Business Services to produce written materials SB 409: Non-Economic Damages Cap Lift for consumers about paying premiums and distribute to providers upon request. Relating to noneconomic damages. Results: In Committee Upon Adjournment IMPORTANCE TO HOSPITALS Revise policies to show that an insurer must notify a provider, if SUMMARY asked, that a patient is in the three month grace period for non- Increases $500,000 limit on noneconomic damages recoverable payment of premiums. in wrongful death actions and other statutorily created causes Chapter 580 (2015 Laws) of action to $1,500,000. POLITICAL BACKGROUND Insurance This was a priority for the Oregon Trial Attorneys. SB 901: Direct Pay to Providers IMPORTANCE TO HOSPITALS Although this bill failed, hospitals and health systems should Relating to insurance reimbursement. be prepared for this bill to return in the future. The fiscal impact Results: Passed to hospitals could be substantial. The Oregon Trial Attorney Association will bring this back in 2017. Effective Date: January 1, 2016 SUMMARY Liability Requires insurer to reimburse providers directly for medical or mental health services provided to insured. HB 2300: Trial Testing POLITICAL BACKGROUND Relating to treatments for patients with terminal Part of OAHHS proactive agenda to protect the relationship diseases. between patients and their providers. Results: Passed IMPORTANCE TO HOSPITALS Effective Date: Pilot project from January 1, 2016 to Hospital billing departments will now be getting all January 2, 2022 reimbursements from insurers directly. SUMMARY Chapter 588 (2015 Laws) I Defines terms, and institutes methods by which attending physicians may refer a patient who has a terminal disease to a health care practitioner who is authorized to treat patients Insurance with investigational products not yet approved by the USDA. HB 3300: Lane County Pilot Establishes the parameters for health care practitioners and patients eligible for treatment with investigational products, Relating to medical assistance recipients. including defining the provisions for qualifying for treatment Results: In Committee Upon Adjournment and paying for treatment. Requires the physician who makes a referral, health care practitioner that administers treatment, SUMMARY and consulting physician to file record with the Oregon Health Prohibits Public Employees’ Benefit Board and Oregon Authority. Records filed by the health care practitioner that Educators Benefit Board from contracting with health care administers treatment must at least provide details that providers, directly or through third party administrator, for include adverse effects, positive outcomes, cost of treatment, payment or reimbursement of claims for health care provided and demographics. Requires OHA to: (1) Adopt rules for the to public employees residing in Lane County unless health care collection of information from physicians who makes a referral, provider accepts patients who receive medical assistance. health care practitioners that administers treatment, and consulting physicians; (2) Review, annually, a sample of records of patients who have a terminal disease and receive treatment Insurance with an investigational product; (3) Create an annual statistical report that is available to the public; and (4) Provide the annual HB 3021: Imposing Reimbursement Fees for Payment to report to the Legislative Assembly on or before February 1 of Relating to payment of insurance claims. every odd-numbered year. Results: Passed POLITICAL BACKGROUND Arizona, Colorado, Louisiana, Michigan and Missouri enacted Effective Date: January 1, 2016 Right-to-Try laws in 2014. Right-to-Try laws generally permit SUMMARY a patient to have access to an experimental drug after it has Requires insurer to offer health care provider method of passed through Phase 1 of a clinical trial, which is the initial reimbursement that does not impose fees or other charges on trial testing where a drug is given to a small group of people provider. to evaluate its safety and side effects. Right-to-Try legislation that has been developed by the Goldwater Institute states that IMPORTANCE TO HOSPITALS insurers are not required to cover the costs of the drug or other Should positively impact hospital revenue cycle by eliminating services related to its use. situations in which providers are forced to pay additional fees without prior agreement Chapter 218 (2015 Laws) 2015 LEGISLATIVE REPORT | 15 LEGISLATION 2015

IMPORTANCE TO HOSPITALS Licensing Boards In light of this bill, hospitals may want to revisit their policies regarding affiliated physicians. The bill does not require a HB 2796: Music Therapy physician to use experimental stage treatments nor does it impose any direct responsibility on the health care facility. Relating to music therapy. However, many eligible individuals will be hospital patients, Results: Passed so hospitals should be prepared to address whether an organization policy is appropriate and how to respond to Effective Date: July 1, 2015 requesting patients if the individual provider is unwilling or unable per hospital policy to comply with the patient’s request. SUMMARY Directs Health Licensing Office to issue license to practice music therapy to qualified applicants. Liability IMPORTANCE TO HOSPITALS HB 3289: Physicians as Agents of the State for While there is no direct impact to hospitals, they can now Liability Coverage include Music Therapy in their services. These services will now be reimbursed. Relating to physicians. Chapter 632 (2015 Laws) Results: In Committee Upon Adjournment SUMMARY Mental Health Provides that physician is agent of Oregon Health Authority under Oregon Tort Claims Act for purpose of medical services SB 465: Community Mental Health Commitment provided to person enrolled in Oregon Health Plan. Proceedings Relating to community mental health programs. Results: Passed Effective Date: July 27, 2015 SUMMARY Specifies duties and liabilities of community mental health program with respect to commitment proceedings initiated for individuals with mental illness.

POLITICAL BACKGROUND While OAHHS was neutral on this bill, we believe this conversation should have happened in the interim with other mental health issues. Chapter 785 (2015 Laws) Mental Health SB 832: Integrating Behavioral Health in Patient Licensing Boards Centered Primary Care Homes Relating to integrated health care. SB 280: Board of Medical Imaging Fee Increase Results: Passed Relating to the regulation of medical imaging. Effective Date: July 27, 2015 Results: Passed Effective Date: June 11, 2015 SUMMARY Requires Oregon Health Authority to prescribe by rule standards SUMMARY for integrating behavioral health services and physical health Modifies composition of Board of Medical Imaging. The bill services in patient centered primary care homes and behavioral allows for the Governor to appoint a retired physician; a health homes. chiropractic physician in good standing or an actively engaged Chapter 798 (2015 Laws) medical imaging licensee.

POLITICAL BACKGROUND The Oregon Board of Medical Imaging has had difficulty filling vacancies.

IMPORTANCE TO HOSPITALS While there is no direct impact to hospitals, rural providers are under-represented on this Board. Rural hospitals should consider nominating someone to the Board so the rural voice is heard. Chapter 385 (2015 Laws)

WWW.OAHHS.ORG | 16 LEGISLATION 2015 Mental Health Mental Health SB 840: Licensed Independent Provider HB 2022: Mental Health Discharges Relating to persons with chronic mental illness. Relating to case management services to assist Results: Passed individuals discharged from facilities in transitioning to outpatient mental health treatment. Effective Date: June 16, 2015 Results: In Committee Upon Adjournment SUMMARY Authorizes licensed independent practitioner to initiate or SUMMARY approve prehearing detention in hospital or nonhospital facility Requires hospital or provider of residential treatment that of person who is subject of civil commitment proceedings. discharges individual with mental illness to provide case management services to assist individual in transitioning to POLITICAL BACKGROUND outpatient mental health treatment. Part of OAHHS’ priority package on mental health. The allows NPs working in the ED and acute care units treating patients for IMPORTANCE TO HOSPITALS a mental illness to be able to admit and hold patients. Although this bill failed this session, the issue will return.

IMPORTANCE TO HOSPITALS This bill is permissive. It allows hospitals to implement the new Mental Health authority for NPs, but does not require it. HB 2023: Behavioral Health Discharges Chapter 461 (2015 Laws) Relating to protocols for a health care facility discharge of a patient who presented with a behavioral health crisis. Results: Passed Effective Date: January 1, 2016 SUMMARY Specifies requirements for hospital policies for discharge planning involving patient who is hospitalized for mental health treatment.

POLITICAL BACKGROUND Brought by parents of teens that commit suicide. Language was amended to fit with the requirements of the AARP Cares Act.

IMPORTANCE TO HOSPITALS Hospitals will need to revise discharge planning in accordance with specifications being worked on by OPIC and NAMI. Chapter 466 (2015 Laws) Mental Health HB 2363: Seclusion of patients Relating to persons with mental illness. Results: Passed Effective Date: May 18, 2015 SUMMARY Requires treating physician to document in clinical record any seclusion of person alleged to have mental illness who is confined in hospital or nonhospital facility.

IMPORTANCE TO HOSPITALS Hospitals should review their policies for ED and acute care units to assure they are up to date and in compliance with these requirements. Chapter 81 (2015 Laws)

2015 LEGISLATIVE REPORT | 17 LEGISLATION 2015 Mental Health Mental Health HB 2368: Health Care Proxies HB 2825: Funding for Mental Health Housing Relating to proxies for health care decisions. Relating to services for individuals with mental illness; Results: Passed declaring an emergency. Effective Date: January 1, 2016 Results: In Committee Upon Adjournment SUMMARY SUMMARY Clarifies that if a person has a valid health care directive or valid Allows Oregon Health Authority to seek out and apply for power of attorney for health care, as well as a declaration for funding for, and appropriates moneys from General Fund to pay mental health treatment, the declaration takes precedence over for, residential care for individuals with mental illness, addictions the other document. or co-occurring disorders.

IMPORTANCE TO HOSPITALS The bill is limited to those with both a physical health and Mental Health mental health advance directive. Hospitals should revise HB 2948: Protected Health Information policies if applicable. Relating to disclosure of health-related information; Chapter 82 (2015 Laws) and declaring an emergency. Mental Health Results: Passed Effective Date: June 18, 2015 HB 2420: Review of Commitment Process SUMMARY Relating to fitness to proceed. Specifies additional conditions under which protected health Results: Passed information may be disclosed by health care provider that do not subject health care provider to civil liability. Effective Date: January 1, 2016 POLITICAL BACKGROUND SUMMARY This bill “interprets” HIPAA law. Legislative Counsel assured that Requires community mental health director or designee to it does not violate or go beyond HIPAA. consult with incapacitated defendants in all criminal cases. Directs community mental health director or designee to IMPORTANCE TO HOSPITALS determine whether community restoration services are available Hospitals may need to revise policies relating to mental health and provide findings to the court. Establishes that consultation patients and their family and caregivers right to be informed of must occur prior to commitment at state hospital for restoration. aftercare, prescriptions and diagnoses during discharge. POLITICAL BACKGROUND Chapter 473 (2015 Laws) It is a requirement of our criminal justice system that the defendant understands and participates in the criminal proceedings. This requirement has several sources. ORS Mental Health 161.360 – 161.370 requires the court to suspend criminal proceedings when, as a result of mental disease or defect, HB 3347: Definition of Person with Mental Illness the defendant is unable to understand the nature of the Relating to persons with mental illness. proceedings, assist with counsel, or participate in the defense. It also authorizes the court to order treatment and commitment Results: Passed in order to restore the defendant to capacity. Effective Date: January 1, 2016 ORS 161.370 already includes a preference for community- based restoration. Commitment to the state hospital for SUMMARY restoration is only permissible when: (1) there is a finding that Expands the definition of a person with mental illness; as used the defendant is dangerous; or (2) there are no community- in civil commitment statutes. Now includes people unable or based restorative services. potentially unable to take care of their basic needs. House Bill 2420-A requires a consultation between the community mental health director and the defendant when the POLITICAL BACKGROUND court has reason to doubt the defendant’s fitness to proceed. It A priority issue for the House Majority Leader on behalf of a also requires the director to provide written findings to the court constituent. The more flexible definition, however, will help MH about whether community-based restoration is available before providers and hospitals in all parts of the state. commitment to state hospital can occur. IMPORTANCE TO HOSPITALS IMPORTANCE TO HOSPITALS Generally, this is a positive step for hospitals in being able to No impact to hospital operations. May shed light on or serve as identify appropriate sites of care for patients with long-term a future data source regarding community-based mental health needs. By expanding the universe of persons eligible for resources and gaps. civil commitment is a double edge; it could assist in placing challenging individuals but at the same time it could exacerbate Chapter 130 (2015 Laws) the State Hospital’s waitlist. Chapter 433 (2015 Laws)

WWW.OAHHS.ORG | 18 LEGISLATION 2015 Mental Health SB 5507: Christmas Tree Bill; Budget Note Relating to appropriations. Results: Passed Effective Date: Report to 2016 legislature SUMMARY The bill had several budget notes of importance to hospitals including funding for rural health transformation and community mental health statewide meetings.

IMPORTANCE TO HOSPITALS The Oregon Health Authority shall conduct a minimum of five community meetings in a variety of geographic locations across the state. The goal of the community meetings is to capture, understand, and report to the Legislature on the experience of children, adolescents, and adults experiencing mental illness and their ability to access timely and appropriate medical, mental health and human services to support their success in the community. The meetings shall not be restricted to publicly financed services or individuals eligible for public benefits. The focus will be on the entirety of the Oregon mental health system, both public and private. Issues to be considered should Mental Health include but not be limited to: • Access to child and adolescent services HB 3427: Mental Health Reimbursement Study • Boarding in hospital emergency rooms • Access to housing, addiction, and recovery services Relating to insurance reimbursement for health • Family support services services. • Waiting periods for services Results: In Committee Upon Adjournment • Workforce capacity • Affordability for non-covered individuals to access mental SUMMARY health services Creates Task Force on Mental Health Care Reimbursement to • Coordination between behavioral health and physical study and make recommendations for payment structure to health services reimburse specified mental health practitioners. The Oregon Health Authority shall consult and coordinate with stakeholders to plan and conduct the community meetings. The Oregon Health Authority is expected to report progress and Mental Health findings to the appropriate legislative committees and the 2016 Legislature. HB 3502: OAHHS’ Mental Health Bill Relating to persons with mental illness Mental Health Results: In Committee Upon Adjournment SB 5526: OHA Budget; Budget Note SUMMARY Relating to the financial administration of the Oregon Makes various changes to statutes related to treatment of individuals who are found by court to have mental illness and to Health Authority. be in need of treatment. Results: Passed POLITICAL BACKGROUND Effective Date: Report to 2016 legislature Part of OAHHS’ priority package relating to mental health. The bill was a proactive attempt to change the commitment process, and SUMMARY identify funding. The Legislature was not ready to have that level Appropriates moneys from General Fund to Oregon Health of conversation. Although the bill failed, there were two budget Authority for certain biennial expenses. notes (SB 5526 and SB 5507) regarding “boarding” in the ED/ Acute care units that is a step toward change. IMPORTANCE TO HOSPITALS The Oregon Health Authority will report to the 2016 legislative session regarding the problem of “boarding” of patients with IMPORTANCE TO HOSPITALS OPIC and internal OAHHS staff will continue to work on bring mental illness in hospital emergency departments while patients visibility to the ED/acute care system in hospitals and will wait for a bed in an appropriate setting. The report will contain a participate in any interim workgroups studying the mental thorough description of the system and process as it works now health system. and why, including relevant statutes and reimbursements. It will also include data to describe the magnitude of the problem. Finally, the report will contain an analysis of the reasons for the “boarding”, such as gaps in necessary services within the system, and proposals for potential solutions.

2015 LEGISLATIVE REPORT | 19 LEGISLATION 2015

Nursing Governor, to develop health outcome and quality measures for coordinated care organizations and plans offered by Public SB 469: Nurse Staffing Employees’ Benefit Board and Oregon Educators Benefit Board and publish data. Relating to staffing of hospitals. Results: Passed POLITICAL BACKGROUND This was a priority bill for SEIU. The bill garnered support from Effective Date: Effective immediately for OHA stakeholders through a workgroup that worked to accomplish to develop rules and select candidates to the the appropriate language. statewide advisory board. Jan 2016 Hospital Staffing IMPORTANCE TO HOSPITALS Committees in place; Jan 2017 Hospital staffing plans OAHHS will appoint one hospital representative on the new implemented committee and will be involved with reviewing any metrics proposed for use by or for hospitals and health systems. SUMMARY Makes changes to laws governing hospital nursing staff, Chapter 389 (2015 Laws) including laws setting composition of hospital nurse staffing committees and laws governing content of written hospital- wide staffing plans. The bill also outlines a timeline for OHA to audit and respond to complaint investigations and modifies law regarding use of mandatory overtime for nursing staff.

POLITICAL BACKGROUND The Oregon Nurses Association submitted legislation that was in response to organized nurses’ concerns with the current nurse staffing law. Based on political factors, ONA made the nurse staffing bill their number one priority. ONA and OAHHS agreed to negotiate a better bill that did not include staffing ratios.

IMPORTANCE TO HOSPITALS Requires hospitals to review their current nurse staffing committees and plans for compliance to the new law. Chapter 669 (2015 Laws) OHA General SB 227: Trauma Registry OHA General Relating to use of information related to trauma injury. SB 874: Adrenal Insufficiency Results: Passed Relating to adrenal insufficiency. Effective Date: January 1, 2016 Results: Passed SUMMARY Effective Date: January 1, 2016 Authorizes establishment, from information maintained in Oregon Trauma Registry, of registry of information related to SUMMARY brain injury trauma. Requires Oregon Health Authority to disseminate information to health care professionals and public related to adrenal IMPORTANCE TO HOSPITALS insufficiency. The Public Health Division will use currently submitted trauma data to study brain injuries. Existing data, no new data to be IMPORTANCE TO HOSPITALS submitted. The Public Health Division will gather information regarding treatment of adrenal insufficiency. OAHHS and other health care Chapter 286 (2015 Laws) entities will distribute the information to their members. OHA General Chapter 501 (2015 Laws) SB 440: Quality Metrics Committee OHA General Relating to measuring the quality of health care. HB 2522: Pacific Islander Results: Passed Relating to health care for Pacific Islanders legally Effective Date: June 11, 2015 residing in the United States under a Compact of Free Association treaty. SUMMARY Requires Oregon Health Policy Board to develop strategic Results: Passed plan for collection and use of health care data and to establish Effective Date: July 20, 2015. Report due to Legislative Health Plan Quality Metrics Committee, appointed by Assembly by September 15, 2016.

WWW.OAHHS.ORG | 20 LEGISLATION 2015

SUMMARY OHA General Creates Islander Health Coverage Gap Assessment Office in Oregon Health Authority to promote access to health care for HB 2934: Basic Health Plan island citizens residing in United States under Compact of Free Association. Relating to access to health care. Results: Passed POLITICAL BACKGROUND Language was changed to set up a workgroup to consider and Effective Date: June 4, 2015 study coverage for Pacific Islanders. The issue will return in 2017. SUMMARY IMPORTANCE TO HOSPITALS Requires Oregon Health Authority to convene stakeholder No impact. Potential for positive impact long-term if resulted group to provide recommendations to Legislative Assembly in implementation of a premium assistance program for concerning basic health program. Pacific Islander population not eligible for subsidies through the Exchange. POLITICAL BACKGROUND Section 1331 of the Patient Protection and Affordable Care Chapter 717 (2015 Laws) Act (ACA) gives states the option to operate a Basic Health Program (BHP) to cover certain consumers with incomes up to 200 percent of the federal poverty level (FPL) through state OHA General contracting “standard health plans,” rather than Qualified Health Plans (QHPs) offered through the Health Insurance Marketplace. HB 2828: Health Care Finance Study Extension The Oregon Legislative Assembly passed House Bill 4109 Relating to a study on financing health care in this (2014), which directed the OHA to commission an independent state. study of the costs and impacts of operating a BHP in Oregon. OHA contracted with Weekly Consulting Group and The Results: Passed Urban Institute to produce the report, which analyzed a BHP’s Effective Date: July 1, 2015. A report to the Legislative potential effects on consumers, the Oregon marketplace, state- Assembly in 2017. funded health care costs and other topics. SUMMARY IMPORTANCE TO HOSPITALS Extends, for two years, sunset of provisions requiring Oregon Although the bill itself has no impact on hospitals, it does Health Authority to study and make recommendations to continue the conversation for a Basic Health Plan in Oregon. Legislative Assembly on best option for financing health care in Chapter 256 (2015 Laws) this state.

POLITICAL BACKGROUND Pharmacy/drugs This study is an attempt at finding solutions for the cliff that is coming for Medicaid when the state portion of the expansion is SB 71: Prescription Monitoring Program increased, and/or CMS lowers the cap on provider taxes. Relating to prescription drugs. IMPORTANCE TO HOSPITALS Results: Passed Potential opportunity for alternative payment models which Effective Date: January 1, 2016 could impact how hospitals are paid and incentives regarding how hospitals are structured. SUMMARY Chapter 725 (2015 Laws) Provides that pharmacies shall electronically report to Oregon Health Authority information under prescription monitoring program not later than 72 hours after dispensing prescription drug.

IMPORTANCE TO HOSPITALS Hospitals need to update pharmacy policies to assure compliance with the requirements of the bill. Chapter 481 (2015 Laws)

2015 LEGISLATIVE REPORT | 21 LEGISLATION 2015 Pharmacy/drugs Provider Tax SB 93: 90-Day Supply HB 2395: Hospital Tax Relating to the dispensing of prescription drugs. Relating to state medical assistance program funding. Results: Passed Results: Passed Effective January 1, 2016 Effective Date: March 23, 2015; Impacts tax collection on October 15, 2015 SUMMARY Requires reimbursement for up to 90-day supply of prescription SUMMARY drug that is prescribed under certain conditions. Extends hospital assessment from September 30, 2015, to September 30, 2019. IMPORTANCE TO HOSPITALS Hospitals will want to review the prescribing practices to POLITICAL BACKGROUND comply with the law. Extension of the provider tax. Chapter 661 (2015 Laws) IMPORTANCE TO HOSPITALS Extends the hospital tax for four years. The additional 1% for Pharmacy/drugs the Hospital Transformation and Performance Program will be split evenly with CCOs. Repeals the non-par sunset. HB 2306: Drug Prescriptions Chapter 16 (2015 Laws) Relating to prescription drugs. Results: Passed Provider Tax Effective Date: June 18, 2015 SB 5526: OHA Budget SUMMARY Relating to the financial administration of the Grants explicit authority to Oregon Health Authority (OHA) Oregon Health Authority. to limit providers with regard to which medical assistance recipient may obtain prescription drugs if the recipient meets Results: Passed specific criteria including use of three or more pharmacies in Effective Date: July 1, 2015 six-month period and alteration of prescription. Authorizes OHA to conduct prospective drug utilization review, prior to payment SUMMARY for drugs for patient who has filled prescription for more than Appropriates moneys from General Fund to Oregon Health 15 drugs in preceding six-month period. Declares emergency, Authority for certain biennial expenses. effective on passage. IMPORTANCE TO HOSPITALS POLITICAL BACKGROUND The budget for the Medical Assistance Programs includes This bill was brought as an attempt to prevent the misuse of a consensus product developed with stakeholders, the pain medication. It was watered down to only apply to patients Governor’s Office and the Legislature. As part of the funding with commercial insurance. package, the Legislature passed HB 2395 to renew the hospital provider assessment with the assumption that the base rate for IMPORTANCE TO HOSPITALS the provider assessment would be 5.3%. The base rate shall Hospital prescriptions are exempt. only be adjusted during the 2015-17 and 2017-19 biennia in Chapter 467 (2015 Laws) accordance with Section 2, chapter 736, Oregon Laws 2003, as amended by section 1, chapter 780, Oregon Laws 2007, section 51, chapter 828, Oregon Laws 2009, section 17, chapter 867, Pharmacy/drugs Oregon Laws 2009, section 2, chapter 608, Oregon Laws 2013 and HB 2395. The budget has made assumptions about the HB 2879: Pharmacists to Prescribe Birth Control other funds and federal funds limitations to assure the program Relating to health care. continues to operate as it has and stays within the state and federal requirements. Results: Passed Effective Date: July 6, 2015 SUMMARY Permits pharmacists to prescribe hormonal contraceptive patches and self-administered oral hormonal contraceptives.

POLITICAL BACKGROUND Controversial; Oregon and California are the only states that currently allow this. Chapter 649 (2015 Laws)

WWW.OAHHS.ORG | 22 LEGISLATION 2015 Public Health Public Health SB 920: Prohibiting Antibiotics for Nontherapeutic HB 3100: Public Health Reform Purposes Relating to public health. Relating to protecting antibiotics for human Results: Passed public health. Effective Date: July 20, 2015 Results: In Committee Upon Adjournment SUMMARY SUMMARY Changes governmental framework for conducting public health Prohibits administration or other provision of medically activities in this state and for providing public health services to important antibiotic to food-producing animals for residents of this state. nontherapeutic purposes. IMPORTANCE TO HOSPITALS POLITICAL BACKGROUND The bill should be evaluated to assess if it effects any This was a priority bill for OSPIRG. The agriculture community relationships between counties and hospitals. The bill requires was split on the issue as was the health care community. public health to meet specified foundational capabilities Although the bill failed this session, the issue will continue to which will include assessment of hospital data and public spark national and local conversations. Hospitals should be health initiatives that implicate hospitals such as emergency prepared for this issue to come before them in the future. The preparedness and epidemic response. The exact parameters impact on hospitals will be their ability to treat diseases that are will be developed so hospitals will want to monitor and resistant to antibiotics. potentially engage with their local public health authority. IMPORTANCE TO HOSPITALS Chapter 736 (2015 Laws) This bill does not directly impact hospitals, rather it is a public health-oriented effort to prevent the emergence of antibiotic- resistant bacteria in response to overuse of antibiotics. Reimbursement Restricting unnecessary antibiotic administration in non-hospital SB 665: Hospital Rate Setting settings may provide indirect benefit through more effective use of lifesaving antibiotics in health care settings. Relating to hospital charges. Results: In Committee Upon Adjournment Public Health SUMMARY HB 2304: Community Benefits Creates Hospital Rate Commission in Oregon Health Authority to review hospital charges billed by certain hospitals and Relating to community benefits provided by hospitals. recommend to Oregon Health Authority whether to approve Results: In Committee Upon Adjournment charges as reasonable based on prescribed criteria. SUMMARY POLITICAL BACKGROUND Requires hospitals to expend 10 percent of community benefit Part of SEIU’s ballot measures from 2013 addressing price funds on public health infrastructure. setting. A few Senators believe a Public Utilities Commission, similar to Maryland’s old model, should set and regulate POLITICAL BACKGROUND hospital rates. OAHHS and commercial insurers opposed the Outgrowth of SEIU’s ballot measure from 2013 to set a approach outline in the bill as it was not inclusive, it did it reflect minimum threshold on hospitals community benefit allocations. the new model in Maryland nor did it take into account the need for a federal waiver. IMPORTANCE TO HOSPITALS Although this bill failed, hospitals and health systems should be prepared for this bill to return in the future as a ballot measure or otherwise. This is a prime issue for organized labor with the decrease in hospital charity care levels.

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Rural Tax Exempt Status SB 970: Rural Air Ambulance SB 938: Property Tax Exemption Relating to air ambulance services in rural areas Relating to exemption from property taxation; of this state. prescribing an effective date. Results: In Committee Upon Adjournment Results: In Committee Upon Adjournment SUMMARY SUMMARY Establishes Task Force on Rural Air Ambulance Services Authorizes county to adopt exemption for newly constructed or installed industrial improvements.

Rural POLITICAL BACKGROUND There was a last minute attempt by the Senate to include a SB 5507: Christmas Tree Bill legislative taskforce to look at tax exemptions for non-profit Relating to appropriations corporations. The bill failed in the House. Similar to HB 3034, County Tax Assessors want clarity in the law in how to apply Results: Passed tax exemption to the transforming health care delivery system, Effective Date: July 1, 2015; Report to 2016 W&Ms i.e. non-profit hospitals purchasing for-profit clinics. Unions committee support this change because they see hospitals charity care levels decreasing due to increased access to insurance under SUMMARY the ACA. The bill had several budget notes of importance to hospitals including funding for rural health transformation and community IMPORTANCE TO HOSPITALS mental health statewide meetings. Although this bill failed, hospitals and health systems should be prepared for this bill to return in the future. The fiscal impact to IMPORTANCE TO HOSPITALS hospitals could be substantial. The Oregon Health Authority shall engage in a rural hospital stakeholder process to gather input on potential transformation strategies to ensure that Oregon’s small and rural hospitals Tax Exempt Status continue to be sustainable in the future. Potential transformation HB 3034: Property Tax Exemption strategies could include grant or bridge funding, transformation pilot programs, or incentive programs to assure funding Relating to the property of nonprofit corporations that stability for hospitals and access to health care services for provide health services; prescribing an effective date. rural Oregonians. Based on the work with stakeholders, OHA will develop a set of recommendations. OHA shall report to Results: In Committee Upon Adjournment the Joint Committee on Ways and Means Committee during SUMMARY the 2016 legislative session on any hospital assessment Provides exemption for property of nonprofit corporation that revenues received for the 2013-15 biennium and available for provides health services occupied or used to provide health use in 2015-17. The revenue may include assumed hospital services to acutely ill patients or accident victims. assessment revenue in the OHA 2015-17 budget or any additional hospital assessment revenue not included in the OHA POLITICAL BACKGROUND budget, that could potentially be used to fund one or more of The bill was proposed by the county assessors who were the strategies recommended, but not to exceed $10 million. The seeking continuity in the interpretation of the tax exemption agency should include in that report any information on federal law. Currently, each county reviews and assesses hospitals matching resources that may be available for those strategies. and their facilities/land purchases differently. The association of assessors wanted a uniform manner in which to apply a property tax. The unions saw this bill as an opportunity to capture additional funds for counties and county services. The bill failed to move out of the House Revenue Committee. The Senate did amend SB 938 to include a legislative task force to look at the application of property taxes to non-profit corporations but that bill failed to move out of House Revenue.

IMPORTANCE TO HOSPITALS Although the bill failed to pass, the idea that hospitals’ tax exempt status should be tied to their charitable contributions will continue to surface. Hospitals should be prepared for similar concepts to be determined by the legislature or at the ballot box.

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Transparency Workforce SB 891: OSPIRG’s Price Transparency Measure SB 37: Rural Provider Tax Credits Relating to the cost of health care services. Relating to a tax credit for rural medical care. Results: In Committee Upon Adjournment Results: In Committee Upon Adjournment SUMMARY SUMMARY Requires health care facilities to publish, in manner prescribed Extends sunset for tax credit for rural medical care. by Oregon Health Authority, price data regarding health care services offered. Workforce POLITICAL BACKGROUND Priority issue for OSPIRG and Consumer Unions. Although it SB 757: Study on Effectiveness of Incentive Programs lacked support from legislators and industry, a few legislators Relating to: Appropriates moneys from General Fund did not believe that SB 900 went far enough. An interim to Oregon Department of Administrative Services for workgroup with the various stakeholders has been established to discuss the second phase of transparency. Oregon Healthcare Workforce Institute and Oregon Center for Nursing for analysis of effectiveness of IMPORTANCE TO HOSPITALS state programs designed to encourage practice of Hospitals should be aware that an interim transparency healthcare providers with underserved populations or workgroup to look at providing greater transparency on cost of health care and that the effort to move the issue forward in rural areas. will continue. Results: In Committee Upon Adjournment SUMMARY Transparency Appropriates funds for the biennium, beginning July 1, 2015, for the Oregon Healthcare Workforce Institute and Oregon Center SB 900: OAHHS’ Price Transparency for Nursing for data collection and analysis of programs to Relating to health care price data. encourage health care providers to practice with underserved populations or in rural areas. Declares an emergency, effective Results: Passed on passage. Effective Date: Effective immediately with the website POLITICAL BACKGROUND operative by July 2016. OMA priority bill. Had support of the Rural Health Association, SUMMARY OAHHS and ONA. Legislative leaders incorporated elements of Requires Oregon Health Authority to be responsible for posting the bill into HB 3396 and expanded the study to included rural to its website health care price data for inpatient and outpatient and underserved areas. hospital services. Workforce POLITICAL BACKGROUND Priority for OAHHS, OHLC and other health industry HB 2171: Rural Provider Tax Credits stakeholders. Relating to taxation Results: Passed Effective Date: October 5, 2015 impacting the 2016 tax year. SUMMARY The omnibus tax credit bill, HB 2171, did make changes to the rural provider tax credit program, effecting the long term recruitment and retention of rural providers. The changes to the programs include a tiered approach to the credit allowed based on distance from a major population center. For providers who are between 10 and 20 miles are eligible for a $3,000 tax credit; providers between 20 and 50 miles are eligible for a $4,000 tax credit; and providers more than 50 miles away are eligible for the full $5,000 tax credit. The bill retained eligibility limitations for providers who are affiliated with hospitals exceptional type C hospitals.

POLITICAL BACKGROUND The efficacy of the provider incentive programs were under political scrutiny this session. HB 2171 was the omnibus end of session tax credit bill that includes an extension of the rural medical provider tax credit for two years. However, in order

2015 LEGISLATIVE REPORT | 25 LEGISLATION 2015 to conserve tax revenue, the Committee on Joint Tax Credits, Workforce adopted a plan to reduce the amount of the credit for some providers based on geographical location. Depending on HB 3359: Expands Primary Care Loan Program practice location within a distance from a population center of 40,000 some providers will receive the whole $5000 credit while Relating to health care providers of primary care. others will receive either $4000 or $3000. The concept for the Results: In Committee Upon Adjournment tier approach was drawn arbitrarily and without data to support the change. Stakeholders were pushing for SB 37, which SUMMARY would have renewed the tax credit and SB 757 which would Expands primary care provider loan repayment program to have studied the efficacy of the program. Based on the study health care providers of primary care to medically underserved results, stakeholders were going to seek additional changes to medical assistance recipients in urban areas. the program. Instead, the legislature passed HB 3396 and the omnibus tax bill as a tool to drive the conversation about the POLITICAL BACKGROUND efficacy of the state’s provider incentive programs. Expanding provider workforce programs as well as the incentive programs had political interest this session, yet due Chapter 701 (2015 Laws) to complexity and funding issues the conversation was limited to only the incentive programs. Although these bills failed, Workforce the issue of provider shortages still remains. Hospitals and providers should be prepared to continue the conversation in HB 3356: Loans for Residency Programs developing effective and sustainable solutions. Relating to the primary care physician shortage. Results: In Committee Upon Adjournment Workforce SUMMARY HB 3396: Provider Incentive Programs Requires Oregon Health Authority to administer program to Relating to health care provider incentive programs; provide loans to hospitals for establishing new primary care declaring an emergency. residency programs. Results: Passed POLITICAL BACKGROUND Expanding provider workforce programs as well as the Effective Date: Effective to tax years beginning incentive programs had political interest this session, yet due January 1, 2016. Study is repealed on January 2, 2017. to complexity and funding issues the conversation was limited to only the incentive programs. Although these bills failed, SUMMARY HB 3396 is intended to initiate a comprehensive evaluation the issue of provider shortages still remains. Hospitals and of health care incentive programs while ensuring the stability providers should be prepared to continue the conversation in of critical programs currently serving rural and medically developing effective and sustainable solutions. underserved areas. The bill requires the Oregon Health Policy Board in the Oregon Health Authority to study the effectiveness Workforce of current financial incentives with the aim of developing recommendations to consolidate, restructure, repeal or continue HB 3357: Penalties to Hospitals if They Do Not Have existing incentive efforts to ensure that state incentive programs Residency Programs are coordinated to produce desired results; are adaptable to changes in the health care field as well as to Oregon’s changing Relating to family medicine residency programs. socio-economic landscape; and are effectively leveraging Results: In Committee Upon Adjournment federal and private funding sources. SUMMARY POLITICAL BACKGROUND Requires hospital that does not offer family medicine residency The efficacy of the provider incentive programs were under program to make payment to Area Health Education Center political scrutiny this session. Several bills were introduced program in order to defray costs of family medicine residency including a study of the programs (SB 757), tax credit renewal network created by Area Health Education Center program. (SB 37) and several other bills that addressed residency program capacity and funding. Late in session, budgetary POLITICAL BACKGROUND leaders decided to amend HB 3396 and include the study Expanding provider workforce programs as well as the elements of SB 757. By doing so, legislators were able to cut incentive programs had political interest this session, yet due the funding for the study drastically and expand the study to complexity and funding issues the conversation was limited to include rural and underserved areas. The amended bill to only the incentive programs. Although these bills failed, also sunset other incentive programs with the intent that the issue of provider shortages still remains. Hospitals and stakeholders and legislators would work in the interim to providers should be prepared to continue the conversation in develop replacement programs for the 2017 legislature. developing effective and sustainable solutions. IMPORTANCE TO HOSPITALS Provider incentive programs have been tools that hospitals have used in the recruiting and retention of rural providers. The repeal of these programs forces the health care community to really analyze the effectiveness of these tools and provide recommendations for alternatives.

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Currently, Oregon receives an “F” on the influential Catalyst for Price Transparency Payment Reform Price Transparency scorecard, and SB 900 was designed with the intention of moving Oregon toward an “A.” Oregon to create hospital According to the group, one of the most important steps to receive an “A” is to pass legislation mandating price data be shown on a website in a consumer-friendly manner. SB 900 will cost-comparison website accomplish that goal and will help move Oregon significantly up by KTVZ Central Oregon News the ranks on the scorecard. July 7, 2015 “We’ve worked hard to understand how to provide patients The Oregon Association of Hospitals and Health Systems, meaningful price information,” added Davidson. “This measure which represents Oregon’s 62 community hospitals, on Tuesday will serve as a starting point to ensure our state becomes a celebrated the passage of a bill that will set up a groundbreaking national leader in providing price information patients can use. hospital price transparency website. Oregonians will now be able to see the prices paid for common The bipartisan bill, SB 900, supported by OAHHS and other procedures at hospitals, which is an important step forward.” stakeholders, passed the Legislature on Monday and is expected The price transparency bill is an integral piece of a three- to be signed by Governor Kate Brown in coming days. pronged approach put forward by hospitals, which would allow The bill directs the state to set up a user-friendly website that Oregonians to understand health care prices in advance of care. displays median prices for the most common inpatient and Beyond the passage of the bill, OAHHS is: outpatient hospital procedures, as paid by commercial insurers, • Working with members of the Oregon Health Leadership giving Oregonians a clearer view of the cost of care. Council to build a plan that would provide insured “Senate Bill 900 gives Oregonians a new resource for patient- Oregonians with cost estimates directly from their insurer friendly price transparency,” said Andy Davidson, president and; and CEO of OAHHS. “With a broad, bipartisan coalition of • Pledging to provide good-faith estimates to out-of-network legislators and stakeholders behind the bill, Oregon should patients in advance of care. be proud that it will be leading the way in bringing price transparency to patients. “Our three-pronged approach means that whether an Oregonian has insurance or not, whether they are in-network or out, they “Oregon hospitals applaud the efforts of all those involved, from are able find out what a procedure will cost them ahead of time,” legislators, to hospitals, to health care partners and beyond. This concluded Davidson. “We needed SB 900 to ensure that all the bill, in combination with hospitals’ other price transparency pieces are there to serve Oregonians.” initiatives, will make a difference in our state.” OAHHS’ push for price transparency follows the recent launch “SB 900 will allow me to better serve my patients in my practice of a transparency website, to provide patients with user-friendly as a physician,” said Senator Alan Bates (D-Ashland). “I will be government data about the quality of care in Oregon hospitals. able to get a sense of what my referrals will mean financially to The website can be found at http://orhospitalguide.org. my patients. Price transparency in the health care sector is long overdue, and today Oregon took a big step forward. I applaud the hospitals for championing this approach and look forward to Legislature 2015: Why working with them on implementation.” “The health care system in Oregon is a national leader in many Providence CEO David ways, and today we have taken a step toward leading on price transparency,” said Senator Jeff Kruse, (R-Roseburg). “Like other Underriner backs hospital industries, health care needs to compete on price and seek to deliver the best value to its customers. SB 900 will move our price transparency state and its system in that direction and I commend all those by Elizabeth Hayes involved in this effort.” Portland Business Journal “Price transparency in Oregon got a huge boost when we passed March 26, 2015 SB 900,” said Representative John Lively, (D-Springfield). “Our Oregon lawmakers are considering two competing bills that each constituents asked for tools to manage health care expenses attempt to shed light on prices charged by Oregon hospitals. and we heard them loud and clear. In passing this bill, we have set in motion a process that will lead to a valuable source of SB 891 is supported by the Oregon State Public Interest Research information for Oregonians, which will allows them to make Group and would require health care facilities to publish informed choices about health care.” detailed pricing data, while SB 900, which is supported by the Oregon Association of Hospitals and Health Systems and

Continued on next page 2015 LEGISLATIVE REPORT | 27 SELECTED NEWS COVERAGE some insurers, would require the state to set up a website with aggregated data on median prices. Oregon bills seek price David Underriner, chair of the hospital association and CEO of Providence in Oregon, said SB 900 would set up a “consumer- transparency for medical friendly online portal.” It would also give hospitals tools to provide good-faith estimates to self-pay and out-of-network services patients. by Tara Bannow “It will help patients to have more accessible and easy to The Bend Bulletin understand information,” Underriner said. March 19, 2015 “Complexity is the enemy of the public when seeking No one argues it would be too burdensome for Wal-Mart to post information on health care procedures,” added Sen. Jeff Kruse, a prices on the products that line its aisle, so why can’t health care Republican from Roseburg and committee member. “SB 900 is providers be expected to do the same? a good first step. Sometimes it’s better not to try to eat the whole That’s a question posed by Jesse Ellis O’Brien, a health care apple in one bite.” advocate with the Oregon State Public Interest Research Group, The criticism of SB 900 is that the data wouldn’t be customizable. or OSPIRG, Foundation, a Portland-based consumer advocacy SB 891 would require real-time estimates at the point of service, group. along with a public posting of prices for the 100 most frequent “I don’t see that it’s fundamentally all that different,” he said. procedures. OSPIRG is advocating for a proposal in the Oregon Legislature, “SB 891 would provide consumers with current, accurate, Senate Bill 891, that would require licensed health care providers actionable information,” said Jesse O’Brien, OSPIRG health care in the state to post on their websites and in their facilities advocate. “SB 900 wouldn’t do that. The amount would be an charges for their most common health care services. Upon average, an historical amount.” request, they would also have to provide cost estimates to Sen. Elizabeth Steiner Hayward, a Beaverton Democrat and prospective patients. SB 891 co-sponsor, said it would allow people to take personal The measure is very similar to another before the legislature, responsibility for their wellbeing. Senate Bill 900, also aimed at price transparency. This one, “It’s all well and good to modify your lifestyle, but the other however, would take a different approach: Rather than having piece is understanding what health care costs,” Steiner Hayward providers post the information, state officials would aggregate said. “Neither as a physician nor as a consumer do I have a clue. data from insurers onto a single website. It’s completely un-transparent. It varies according to the time of As patients are saddled with higher deductibles and co- year and your health care plan.” pays on their insurance policies, transparency advocates say Steiner Hayward urged her fellow committee members not knowing what a procedure will cost ahead of time is becoming to worry too much about the specifics but to focus on the big increasingly important. That’s especially true given the dramatic picture. variation in cost depending on where you’re located and which provider you choose. An OSPIRG analysis, for example, found “Think seriously about the fact that I can walk into a grocery that a hospital in the McMinn¬ville area charged for some store and know what it will charge for laundry detergent but I services four times that of hospitals in the Portland metro, Ellis can’t walk into a doctor’s office and know what they will charge O’Brien said. me,” she said. “If the people going to that hospital could see those prices Michael Huntington, a retired physician from Corvallis, also posted in advance, they might realize they can get a much better spoke in favor: “Patients have too much skin in the game. A deal by just driving for a half an hour or whatever it is,” he said. third are at risk of losing their shirts to health care costs or even losing their skins by delaying care they should have. Patients Members of the Senate’s health care committee will debate both need more information to make choices.” bills at a March 25 hearing. Sen. Laurie Monnes Anderson, for one, would prefer that the Some research has shown that increasing price transparency bills be somehow combined. can cut health care waste, which the Institute of Medicine estimates amounts to $105 billion annually. Patients in 2012 “I only want one bill,” Monnes Anderson said at the conclusion who were given price estimates before choosing where to receive of the Senate health committee hearing on Wednesday. If one of mammograms saved an average of $220 per test, or nearly 19 the bills could “loosen up” and the other “tighten up, that would percent of the cost of the test, according to an August 2014 be great,” she said. article in Health Affairs.

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The problem is, the cost of health care can be tremendously “If Oregon could do that, I would say that would be very complex, making price transparency far from simple. impressive,” she said. Polling by the Oregon Association of Hospitals and Health From the consumer standpoint, both measures represent “ideal” Systems has shown that most importantly, those with health scenarios, Kohleriter-Perelman said. Catalyst for Payment insurance — now about 95 percent of Oregonians — want Reform prefers centralized websites, however, which make to know what they’re going to pay out of pocket after their comparison shopping simpler, she said. It also supports the use insurance carrier picks up its portion of the bill, said OAHHS of APAC data in price transparency efforts because it shows CEO Andy Davidson. what insurers actually paid compared with what hospitals charge, which is less meaningful. To that end, his organization, which represents most hospitals and health systems in Oregon, supports Senate Bill 900, which In Davidson’s mind, Senate Bill 891 is far too burdensome would require the Oregon Health Authority to organize existing for providers and doesn’t display information in a consumer- data insurers contribute to Oregon’s All Payer All Claims friendly fashion. But Ellis O’Brien said it’s important that the database, onto a new, consumer-friendly website. That database information come from providers themselves, because it will currently includes all claims paid by health insurers, but does keep the conversation between providers and patients. not publicly contain information about individual providers. “We think it will actually strengthen the doctor-patient The measure calls for the information to be broken down by relationship,” he said, “and enable consumers to start having provider, Davidson said. more meaningful, frank, upfront conversations with their health For those without insurance, Davidson said OAHHS members care providers about cost and value.” have committed to voluntarily providing good-faith estimates of what procedures are going to cost, outside of the legislation. Want to Price Shop “We felt that it was far better to do that on a voluntary basis, collectively, with broad support from the industry, than it is to have folks create a mandate to do that,” he said. for Surgery? by Lisa Balick Senate Bill 891, by contrast, would call upon licensed health KOIN 6 News care facilities to post online and in-house their contracted rates March 13, 2015 for common procedures with about 10 commercial health insurers plus Medicare, Medicaid and state-run public plans. A legislative bill would require the Oregon Health Authority The measure would apply to hospitals, health systems and to post average prices for the top 50 most common hospital community clinics, but not long-term care facilities or, in most surgeries and top 100 most common outpatient procedures in cases, individual doctor’s offices, Ellis O’Brien said. They would one spot. also have to provide upfront cost estimates to patients who asked The Oregon Association of Hospitals and Health Systems behind for them, including facility fees and physician fees. the bill would provide consumers and estimate of the average Even cost estimates from providers don’t always reflect what cost of a procedure at various hospitals, based on what an patients will pay, said Nicole Kohleriter-Perelman, director insurance company pays the hospital. of communications and special projects for the Catalyst for The measure would also require hospitals to give patients Payment Reform, a nonprofit that works to improve the without insurance an estimate for a scheduled procedure, if payment system for health services. A report her organization asked. released last month found in some cases, post-procedure costs, such as rehabilitation, can cost as much as 30 percent of the There is currently nothing to prevent a consumer from total cost. Providing an accurate cost estimate requires providers requesting that information now. to look at other costs commonly associated with procedures, Several states already have hospital transparency websites that Kohleriter-Perelman said. provide ways to compare hospital prices. But some of those don’t “It’s about being thoughtful upfront and giving the consumer factor in what insurance is often paying. as much information as possible about the care they’re likely to While many consumers are paying more with higher deductibles need for that condition so that they can really get a full picture,” now, it’s a way to shop around to price a specific procedure. It’s she said. often best to call your insurance company to find out how much Oftentimes, contracts between insurers and providers contain would be your responsibility. provisions that prevent rates from being shared, but Senate Bill The hospital pricing measure is scheduled to be heard in two 891 contains a provision that would nullify those. weeks. Such provisions, called nondisclosure clauses, have proven to be significant barriers to price transparency nationwide, Kohleriter- Perelman said.

2015 LEGISLATIVE REPORT | 29 SELECTED NEWS COVERAGE Hospital Transparency Bill Editorial: Oregonians To Shed Light On Cost need better healthcare By Aaron Nilsson KTVL Medford transparency March 11, 2015 by Editorial Board The future of healthcare in Oregon is on the brink of changing. Bend Bulletin March 11, 2015 Oregon lawmakers are discussing possible “window shopping” for healthcare. Imagine walking into a car dealership blindfolded. You have to buy a car, but you can’t know the price or the quality. Healthcare providers in Oregon said a new state website will lay out the prices for the 50 most common inpatient procedures and It would be a crazy way to shop. Consumers wouldn’t be the 100 most common outpatient procedures. informed and would be making choices that might not make much sense. Michael Bennett works for Asante as Director of Revenue Cycle and said this is a growing trend throughout the country. But in many cases, consumers have to shop that way when it comes to health care. It’s not easy to find the price. It can be He said other states are looking at options, but Oregon is unclear what insurance covers. It can be hard to learn about progressive in pushing towards it now. quality. “The value of program in Oregon is it’s a collaboration between “The current system is not transparent enough and presents hospitals and that’s not being forced on us. We are for making a moral hazard where both doctor and patient are often not things more transparent for patients and that’s a mindset here in aware of the true costs,” state Rep. Knute Buehler, R-Bend, and a Oregon,” Bennett said. doctor, told us. “This is particularly problematic when others are Bennett said this will make the administration’s burden lighter paying the bill.” and make cost information readily available for patients, letting Two bills in the Oregon Legislature attempt to improve the them know exactly which hospitals supply the information. situation. Phillip Schmidt is the Director of Public Affairs with the Oregon Senate Bill 900 would require the Oregon Health Authority to Association of Hospitals and Health Systems. post median prices for hospitals and outpatient clinics of the 50 He said once the website is up, it will serve as a basic one-stop- most common inpatient procedures and the 100 most common shop for patients so they know what they’re getting into before outpatient procedures. they go under the knife. Senate Bill 891 is slightly different. It requires each health care “If you’re in the back of an ambulance with a heart attack, you’re facility to publish the data. The prices included would be the probably not price shopping,” Schmidt said. 100 most common inpatient and 100 most common outpatient services provided in the state. And SB 891 also requires health However, if passed, the new state website will allow anyone care facilities to respond to an inquiry from a patient about a bill without life-threatening issues to do just that, shop around. in a “timely manner.” It’s unclear what timely manner means. Schmidt said healthcare is needed by everyone, so it affects The Oregon Health Authority would be given power under the everyone. bill to impose penalties on facilities that do not comply. Besides the new website, the O.A.H.H.S. said it is working on We urge the Legislature to support SB 900 over SB 891. This law two other items, work with insurers to help patients understand for pricing transparency will be a new law. If we have learned their out-of-pocket expenses, and commit Oregon’s hospitals to anything about new laws, it’s that they can cause unforeseen give a good-faith estimate to patients, upon request, for the cost problems as they try to fix problems. It’s good to go slow. of a scheduled procedure. SB 900 is a more modest approach. SB 900 will be less onerous to set up and easier to tweak to get it right.

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Second, a commitment from insurance companies to help Oregon bill could consumers with out of pocket expenses. Third, an up-front estimate from hospitals showing costs for make hospital prices people paying for their own procedures. transparent Zezula agrees with that. “I want to be able to evaluate what I can spend this money here and there if we need future services.” by Chris Willis KGW News Channel 8 Health care advocate Jesse O’Brien is with the consumer group March 11, 2015 OSPIRG, which is proposing a similar bill, SB 891. He says transparency will only help consumers. It could be a breakthrough in Oregon health care reform. “It would enable patients to have a frank conversation with their The next time you go to the doctor, how would you like to know doctor about how they could get the best value, the best bang for the price of your procedure before you get it? We usually know their buck in health care,” he said. prices of other products and services before we buy, so why not at hospitals? Senate Bill 900 has 10 sponsors in the legislature from both sides of the political aisle. It is expected to get very little opposition as Portlander Michael Rees can’t remember how much his last trip it makes its way through the legislative session. to the doctor’s cost. “The thing that ends up being discussed in my house is what the deductible is,” he said. Hospital Rates More But we’re not talking about the deductible. We want to know the total cost. How much did the hospital charge your insurance Transparent Under company? How much was that last medical procedure? Is the price the same at every hospital? Proposed Bill by KBNW Central Oregon Nobody seems to know for sure. March 10, 2015 Portlander Rhonda Zezula recently took her daughter to the The Oregon Association of Hospitals and Health Systems hospital for dehydration. Months later, she still doesn’t know (OAHHS) today announced that it has developed a new price how much it cost. transparency initiative. “Consumers need to be informed about what they’re spending This initiative has three key elements: where they’re spending it, especially when referring to emergency medicine,” she said. 1. Senate Bill 900 calls for a new state-run website displaying median prices paid for procedures at hospitals; tools for If Senate Bill 900 passes, you will know. And Oregon would be hospitals to provide good-faith estimates to self-pay and only the second state in the nation to offer this level of medical out-of-network patients; and a pledge to work with insurers transparency. to help insured patients understand their out-of-pocket The Oregon Association of Hospitals and Health Systems said expenses for care. every hospital in the state is on board. 2. The second element involves working hand-in-hand with “I think you’re going to certainly have a sense of what things insurers via the Oregon Health Leadership Council (OHLC) cost, where there’s variation in price maybe begin to ask the to help patients who have insurance to understand what questions about variations,” said Andy Davidson, President their out-of-pocket expenses will be. and CEO of the Oregon Association of Hospitals and Health 3. The last element of the OAHHS initiative is a commitment Systems. by Oregon’s hospitals to assist Oregonians who are paying There are three key elements to the transparency plan: First, a for their own care (or for out-of-network services not website that would show all median prices for common hospital covered by their health plan) in getting a good-faith procedures. estimate from any hospital for the cost of a scheduled procedure upon request. Davidson says the need for that is obvious. “I think the public doesn’t want to hear excuses anymore, they actually want the answers.”

2015 LEGISLATIVE REPORT | 31 SELECTED NEWS COVERAGE 2 Oregon bills promote Making the Cost of health care pricing Medical Procedures transparency More Transparent by Lynne Terry by OBP’s Think Out Loud The Oregonian March 9, 2013 March 9, 2013 Two bills before the legislature now would give consumers Two bills before the Oregon Legislature aim to inform greater access to pricing information from hospitals and clinics. consumers about health care pricing. Senator Steiner Hayward is sponsoring SB 891, which would require hospitals and clinics to post the cost of all procedures One bill would require extensive pricing information while the both on location and online. SB 900, supported by the Oregon other would provide patients with median prices that would not Association of Hospitals and Health Systems, requires hospitals be insurance-specific. to post the median cost for the most frequently used procedures The latter, Senate Bill 900, has 10 sponsors in the Legislature and online. the backing of the Oregon Association of Hospitals and Health GUESTS: Elizabeth Steiner Hayward: Democratic state senator Systems. It would require that the Oregon Health Authority post from NW Portland/Beaverton (District 17); Andy Davidson: median prices for the 50 most common inpatient procedures President of the Oregon Association of Hospitals and Health and the 100 most common outpatient procedures for hospitals Systems and hospital outpatient clinics. Andy Davidson, president and CEO of the Oregon hospital association, said the bill would inform patients of the cost of Hospital transparency procedures in advance. “We want to make sure that hospitals’ pricing data is accessible bills could target high- and easy to find,” Davidson said. “We know that our patients want more health care pricing information.” priced procedures by Elizabeth Hayes The organization said that as part of its backing for the bill its Portland Business Journal members would provide patients without insurance who asked March 3, 2015 an estimate of the cost of a scheduled procedure. Estimates on out-of-network costs would be provided to insured patients. Two bills introduced in the Legislature take on the opaque and often puzzling world of hospital pricing. The other proposal, Senate Bill 891, would require hospitals and health care facilities to post prices for the 100 most common While one of the bills goes much further than the other, they inpatient and the 100 most common outpatient services in both attempt to give consumers greater access to pricing data Oregon. Sponsored by Sens. Elizabeth Steiner Hayward, a from Oregon hospitals and clinics. Beaverton Democrat, and Brian Boquist, a Dallas Republican, SB 891, sponsored by Sens. Elizabeth Steiner Hayward, a SB 891 would require facilities to list charges billed to insurance Beaverton Democrat, and Brian Boquist, a Dallas Republican, companies and uninsured patients and the amount allowed requires prices to be listed at clinic locations and online, along by various payers, including Medicare and coordinated care requiring with real-time price estimates, upon request. organizations. “Just having the information out there will transform the OSPIRG Health Care Advocate Jesse O’Brien said the bill comes way health care works in the state,” said OSPIRG Health Care at a key time when Oregonians are having to dip into their Advocate Jesse O’Brien. “It’s a way to create a more level playing pockets to pay for a greater cost for medical services. “We all field, so consumers can shop around and providers can compete know that health care still costs too much,” O’Brien said. “The on price.” least we can do is make sure health care facilities post their prices, like any other business.” SB 900, which has seven sponsors in the House and Senate and is supported by the Oregon Association of Hospitals and Health SB 891 would require that health care facilities respond to a Systems, requires less detailed price data to be posted on the patient inquiry about a billed charge in a timely manner and Oregon Health Authority’s site. includes potential sanctions, including revoking a license, against facilities. “The key message here is everyone acknowledges that driving improvements in price transparency is critical,” said Robin

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Moody, the association’s vice president of public policy. “Consumers want it and it’s necessary for a healthy marketplace.” Connecticut, Oregon Oregon once had such a website, from 2007 to 2010, but the state mothballed it during the Recession, Moody said. lawmakers work on bills SB 900 would revive the site, culling price data on common to cut hospital costs inpatient and outpatient procedures from the All Payers All Claims database, “an underused asset,” Moody said. The median Proposals focus on regulating price for all health plans would be posted. ACO formation, price transparency Under the OSPIRG bill, clinics would post all negotiated prices by Ron Shinkman with everyone from Medicare and Medicaid to the largest Fierce Health Finance insurance plans. In addition, facilities would post additional March 12, 2015 fees, such as out-of-network fees. Lawmakers in Connecticut and Oregon, concerned with the Tom Holt, director of government affairs for Cambia Health continuing rise of healthcare costs, propose bills to make the Solutions (parent company of Regence Blue Cross Blue Shield of cost of delivering care more transparent. Oregon), said he doesn’t support the bill because it’s too it’s not Connecticut lawmakers are particularly concerned about what user friendly. they see as a consolidation of healthcare providers throughout “In order to derive anything useful, you would have to know the state, the New Haven Register reported. They have suggested (medical) codes,” he said. “It would impose a significant several bills to address the issue, including ones that would administrative burden on physicians and hospitals, that’s going minimum standards for the formation of accountable care to get reflected in the costs we and consumers get charged.” organizations and another that would more closely regulate deals between hospitals, as well as hospitals and medical groups. Such exhaustive price data would take up “a large spreadsheet,” but O’Brien said he would expect that with such a huge appetite A special legislative committee discovered that the share of for the data, web and app developers would likely be eager to medical spending attributed to hospital-owned physician create consumer tools for easily accessing the data. practices increased by 57 percent between 2007 and 2013, the New Haven Register reported. Holt said he supports the hospital association bill, even though the information isn’t customized for each consumer and their Those bills are on top of another piece of legislation that would particular situation and health plan (which is something that aim to cap hospital facility fees to $100. In some instances, Cambia’s HealthSparq tool does). lawmakers have discovered, some patients were charged as much as $9,500 in facility fees while undergoing cancer treatments. “It’s useful for a back-of-the-envelope look at what something is going to cost,” Holt said. “It doesn’t get to the level of detail In Oregon, the state’s leading hospital lobby has sponsored consumers might demand. It’s a great start.” several bills that would make the state the second in the country to post a wide array of prices for procedures performed at acute With more Oregonians picking up a greater portion of their care facilities, KTVZ-TV reported. It would include a state-run own health care costs in the form of high-deductible plans, it’s website that would post the prices insurers pay for care. more important than ever for consumers to be armed with this information, O’Brien said. South Carolina is one of the few states in the U.S. that has wide- ranging price transparency among its hospitals. It launched a A lack of public information about the price of health care statewide site posting price data for 60 hospitals last year. hampers competition and contributes to excessive spending, he said. The Institute of Medicine found that lack of competition “Our transparency initiative aims to assist Oregonians in and excessive price variation leads to $105 billion in waste in understanding hospital prices in advance of procedures,” Andy health care spending each year. Davidson, chief executive officer of the Oregon Association of Hospitals and Health Systems, told KTVZ-TV. “We want to Either bill would be an improvement from today. Oregon has make sure that hospitals’ pricing data is accessible and easy to received an “F” for transparency from Catalyst for Payment find. We know that our patients want more healthcare pricing Reform, a respected arbiter of price transparency in health care. information and with this initiative, Oregonians will be able Said Moody: “By taking this action, we’d be able to move to an A.” to find the data on hospital prices that will help their decision- m a k i n g .” O’Brien said the OSPIRG bill would mean that “Oregon would have the most across the board price transparency in the country.”

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In addition, OSPIRG’s Jesse O’Brien testified that making price Panel hears debate data available would allow people such as entrepreneurs to use it to create attractive and interactive websites and apps to make on health care price them consumer friendly. Katy King, from the Oregon chapter of American College of transparency Emergency Physicians, said posting prices in emergency rooms by Saerom Yoo could be a violation of a federal law that requires Medicare- Salem Statesman Journal participating hospitals to stabilize every emergency room March 25, 2015 patient. Both sides argued in favor of health care price transparency, but Any posting that could intimidate and discourage patients from their preferred path of achieving it were vastly different. seeking care could be a violation of that regulation, she said. The Senate health care committee on Wednesday heard The committee’s chairwoman, Sen. Laurie Monnes Anderson, testimony on two bills that would provide price information of D-Gresham, said at the end of the meeting that only one of the health care services to the public. bills could move on to the Senate floor, and she encouraged the two sides to come to a compromise. Senate Bill 891, pushed by OSPIRG and co-sponsored by Sen. Elizabeth Steiner Hayward, would require health care facilities “So if 891 could loosen up, or 900 could tighten up, that would to post online and on location the prices of the most common be great,” she said. inpatient and outpatient procedures, broken down by major payers. It would also require health care providers to disclose estimates for procedures on a patient’s request. It would give the Oregon Health Authority power to create rules Community Benefit to make sure the data are consistent. Senate Bill 900, which has the backing of the Oregon Our View: Like it or not, Association of Hospitals and Health Systems, would require the Oregon Health Authority to post average prices of common this sounds like progress health care procedures online, broken down by hospitals. The by Editorial Board data would come from the All Payer All Claims database. Coos Bay World Steiner Hayward, D-Beaverton, who is a family physician, said March 19, 2015 consumers need to know the potential costs of their health care We wonder if opponents to the Affordable Care Act — to take financial responsibility of their health care. Obamacare — saw this one coming. She said she has no way of telling her patients the cost of This week in Salem, Andy Davidson, the president of the services, nor does she know the cost of her own care. While Oregon Association of Hospitals and Health Systems, told The health plans can provide members with estimates, people should Associated Press that hospitals in the state are spending far less have access to that information before choosing a health plan, on uncompensated charity care since more Oregonians signed she said. up for health insurance — Obamacare. Sen. Jeff Kruse, R-Roseburg, said he preferred SB 900 because “The ACA has been so successful, and the uptick happened it is a simpler first step toward accomplishing health care price so quickly that charity care has really dropped significantly,” transparency. Health insurance carriers, such as Cambia Health Davidson said. Solutions and Kaiser Permanente, also preferred SB 900, saying they were already working on transparency tools for their The result, Davidson added, is that hospitals around the state members. will continue to spend the amount of money they used to spend on charity care to fund other public services like research, health However, proponents of SB 891 said the data need to be able screenings and education. to help patients make health care decisions, and averages from historic All Payer All Claims data do not allow that. When prices According to the Oregon Health Authority, hospitals spent can vary by multiple times depending on the procedure, median more than $400 million on charity care in 2013. All but two prices provide little value to consumers, they say. of Oregon’s hospitals are nonprofit enterprises, and those nonprofits are required to benefit the community to retain tax- “You can’t have a system that makes sense to consumers and not exempt status. provide prices because the industry says it’s too complex,” said Dr. John Santa, medical director of Consumers Union. Simply put: Fewer Oregonians needing charity; more funding for community health needs.

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Despite all the continuing debate about the ACA and the constant drumbeat from Republicans who continually promise Oregon hospitals vow they will kill the bill, this news sounds like a benefit, doesn’t it? Some of us may remember, others not, that the same debate community spending surrounded the birth of Medicare, which turns 50 this year. by Staff Medford Mail Tribune While most Americans have come to see Medicare as a given, March 18, 2015 existence of a national health care program was never assured. Through the 20th century, conservative opposition branded Oregon hospitals say they won’t reduce their spending on such medical programs as socialism and said any form of services that benefit the community, even though they’re seeing national health care would create a Soviet-style model. Even the far fewer uninsured patients. Communist Party of America opposed a proposed health care An Oregon hospital industry group said Tuesday its members bill in the 1930s. will provide free care to anyone who earns less than double the Conceived during the Cold War era, Medicare was under attack federal poverty level and is not on Medicaid. The group also said even by the American Medical Association, which viewed the that total spending on so-called “community benefit” services measure as an attack on personal freedom. AMA president, Dr. will remain at historical levels. Morris Fishbein, warned the public against “peasant medicine” Community benefit programs included services such as charity and “medical Soviets.” Ronald Reagan cut a record for the AMA care, research, health screenings and medical education. played for their “ladies auxiliaries” (doctors’ wives) in homes Hospitals are seeing a big drop in their spending on charity across America warning that the program would lead to the care since the federal overhaul gave insurance to hundreds of destruction of freedom. thousands of people who didn’t previously have it. Such fuss over a program that many Americans now feel is their birthright. Group urges Oregon Makes one wonder how Americans will feel about Obamacare in 50 years. hospitals to provide Oregon hospitals seeing free care by Tara Bannow fewer uninsured patients Bend Bulletin by KOIN 6 News March 18, 2015 March 18, 2015 Thousands of Oregonians make more than the roughly $16,200 Oregon hospitals say they won’t reduce their spending on annual threshold to qualify for Medicaid, the federal health care services that benefit the community, even though they’re seeing program for low-income individuals. But that doesn’t mean they far fewer uninsured patients. don’t have trouble making ends meet. An Oregon hospital industry group said Tuesday its members “What we know all too well is that amount of money doesn’t go will provide free care to anyone who earns less than double very far,” said Andy Davidson, president and CEO of the Oregon federal poverty level and is not on Medicaid. The group also said Association of Hospitals and Health Systems. that total spending on so-called “community benefit” services To help fill the gap, Davidson’s organization is asking its 62 will remain at historical levels. member hospitals to provide free care to all patients with Community benefit programs included services such as charity incomes less than 200 percent of the federal poverty level, about care, research, health screenings and medical education. $23,500 annually for an individual. Hospitals are seeing a big drop in their spending on charity Here in Central Oregon, St. Charles Health System already care since the federal health care overhaul gave insurance to provides free care for patients whose incomes are at or below hundreds of thousands of people who didn’t previously have it. 250 percent of the federal poverty level, or about $29,400 for an individual, so long as the care is deemed medically necessary. “It’s part of how we do business, so I don’t see this as really a change except a formal commitment to honor that,” said Jennifer Welander, St. Charles’ chief financial officer.

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Medicaid, known here as the Oregon Health Plan, expanded Davidson said he’s not aware of any other state that has in 2014 to cover individuals up to 138 percent of the federal voluntarily implemented a program that promises to treat low- poverty level in states that agreed to the expansion. The OAHHS income patients. estimates 87,000 Oregonians fall in the gap between qualifying “This is a very unique approach that we believe leads the rest of for the Medicaid expansion and the 200 percent threshold. the country in terms of really grabbing the mantle and taking St. Charles provides varying levels of financial assistance to the lead and doing this, rather than being forced into it or patients up to 400 percent of the federal poverty level, or $47,080 required to do it through state or federal legislation,” he said. “It’s a year for an individual. really about trying to do the right thing by our patients and our communities.” In recent years, Oregon hospitals have spent less money on so- called charity care, which is care provided to patients who can’t pay their bills. In the first quarter of 2010, 4.4 percent of median Oregon Hospitals to patient revenue across hospitals was spent on charity care. Over the same time in 2014, that dropped to 2.3 percent, according to Oregon Health Authority data. Provide Free Care to At St. Charles, the proportion of patient revenue spent on Families in Need Through charity care is less than the state average. At the Bend hospital, it was 1.3 percent in the first quarter of 2014, compared with 2.3 New Policy Package percent statewide. The proportion of charity care has decreased, too. In 2010, St. Charles Bend spent 4.4 percent of net patient by Kirsten Nicolaisen revenue on charity care. GoLocalPDX.com March 17, 2015 After the implementation of the Affordable Care Act, St. Charles’ charity care allocations have increasingly gone to covering a On Tuesday, The Oregon Association of Hospitals and Health portion of the cost of providing care to Oregon Health Plan, or Systems (OAHHS) announced a new ‘community benefit’ policy Medicaid, beneficiaries, Welander said. Government programs package, that will provide free care for families in need and keep such as Medicaid and Medicare do not cover the full cost of charity spending levels equal to years prior. providing care, so hospitals accept a loss when they treat those The two-part package aims to demonstrates hospitals’ patients. commitment to the communities they serve at a time when the “I would say we’re no different from other hospitals,” Welander Affordable Care Act is changing the health care landscape in said of the decline in charity care. Oregon, according to OAHHS. Many of the doctors and specialists who provide care at St. The first initiative will provide free care for families who are Charles are not employees of the health system, but rather see not Medicaid eligible, and whose income is below 200 percent patients there on a contract basis. In those situations, such as of the federal poverty level. Approximately 87,000 Oregonians in the Bend emergency room, patients who have had their bill fall into this category, and providing them with free hospital forgiven by St. Charles can still expect to receive bills from care builds on the success of Medicaid expansion, which covers individual providers, Welander said. people below 139 percent of the federal poverty level, according to OAHHS. The new OAHHS initiative also calls upon participating hospitals to ensure spending on community benefit programs, The second initiative involves hospitals keeping overall a broad array of health care services provided without the community benefit spending at or above levels from prior years. expectation of payment, remains at the same levels this year as In Oregon, “community benefit” is defined as health care- their averages over the past three years. related services that nonprofit hospitals provide without the expectation of compensation. While free care for patients who Community benefit programs include charity care, health cannot pay is dropping statewide as a result of record numbers education, health screenings, research, health professional of Oregonians obtaining insurance through the Affordable Care education and community-building activities. Act, the Oregon Association of Hospitals has committed to keep Hospitals submit their estimated spending on community community benefit spending levels equal to years past. This will benefit programs to the Oregon Health Authority. St. Charles allow hospitals to reinvest those dollars in other community Bend’s was 32.3 percent of patient revenue in 2013, compared benefit activities, according to OAHHS. with the statewide average of 20.9 percent, and up from its “Oregon’s hospitals are leading the way by enacting a set of community benefit spending of 26.5 percent in 2012. initiatives voluntarily that seek to close the coverage gap for the So far, 93 percent of OAHHS members have agreed to provide shrinking percentage of uninsured and underinsured, while free care to patients up to 200 percent of the federal poverty maintaining their significant investments in their communities level, and another 82.5 percent have agreed to keep community and in the people they serve 24/7/365,” said Andy Davidson, benefit spending in line with previous years. President and CEO of OAHHS. “Hospital and health system

WWW.OAHHS.ORG | 36 SELECTED NEWS COVERAGE leaders in Oregon are proud to play such a vital role at this about 4.5 percent of total revenue, according to data from the pivotal time in our state’s health care transformation.” Oregon Health Authority. In 2013 Oregon hospitals provided more than $1.9 billion in Compliance is voluntary for individual hospitals, but Davidson community benefit contributions to their communities, while said the guidelines were thoroughly debated internally and he providing care for 336,153 inpatients, more than 9.9 million anticipates nearly all of Oregon’s 58 hospitals will participate. outpatients, and more than 1.2 million emergency room visits, Sen. Alan Bates, D-Medford, and Rep. Mitch Greenlick, according to OAHHS. D-Portland, welcomed the announcement. Both are influential More information about Oregon’s community benefit reporting on health policy issues. program can be found online at MyOregonHospital.org. “If they don’t do these things, then of course we start questioning why they’re tax-exempt,” Bates said. “I think they’re Oregon hospitals to doing the right thing. I appreciate it and I applaud them for it.” maintain community Editorial: Charities must benefit spending prove their worth by Jonathan J. Cooper The Bend Bulletin Associated Press March 19, 2015 March 17, 2015 Reprinted in the Salem Statesman Journal, Eugene Register- Tax-exempt status should be earned. Organizations that get tax- Guard, and Klamath Falls Herald News exempt status need to do things that demonstrate they deserve it. Oregon hospitals won’t reduce spending on services that benefit St. Charles Health System is doing just that. It provides free the community, even though the facilities are spending far care for patients who are at or below 250 percent of the federal less on uncompensated charity care because more people are poverty level as long as the care is medically necessary. insured, an industry group said Tuesday. Many hospitals are benefiting now that more people are insured. The need for charity care has dropped precipitously since In Oregon, the percentage of uninsured residents dropped from President Barack Obama’s health care overhaul — the Affordable 14 percent before the Affordable Care Act to 5 percent after, Care Act, or ACA — took effect. Only 5 percent of state according to The Associated Press. residents remain uninsured, compared to 14 percent before the It means hospitals don’t have to spend as much on charity care. ACA. Oregon Health Authority data show the amount of median “The ACA has been so successful, and the uptick happened patient revenue spent on charity care has declined. It was 4.4 so quickly that charity care has really dropped significantly,” percent in the first quarter of 2010. In the first quarter of 2014, it said Andy Davidson, president of the Oregon Association of was 2.3 percent. Hospitals and Health Systems. The Oregon Association of Hospitals is calling on its members to The association said Oregon hospitals will provide free care to keep up their commitment to charity care nonetheless. low-income patients who are not on Medicaid. Many hospitals are committing to provide free care to patients Out-of-pocket costs will be paid for patients earning up to 200 with incomes of less than 200 percent of the federal poverty percent of the federal poverty level, or $48,500 for a family of level. That would be up to about $23,500 annually for an four, it said. That includes people who have low-cost insurance individual. St. Charles does slightly better, at $29,400 for an plans with high deductibles and copays, Davidson said. individual. The group said its total spending on community benefit services Compliance for Oregon’s 58 hospitals is not mandatory. It’s — which includes charity care, research, health screenings and voluntary. But nearly all of them are expected to participate. medical education — will remain at historical levels. Both at the federal level and in the state, lawmakers have All but two of Oregon’s hospitals are nonprofit organizations, questioned tax-exempt status for hospitals and other charities. requiring them to benefit the community to retain their tax- We don’t think it’s a good idea to do away with tax-exempt status exempt status. Charity care has historically been a significant as some have suggested. As others have said, it’s a lifeline, not a portion of their community benefit portfolio. loophole. If charity care spending drops, the hospitals will make up for it Nonprofit organizations do have to have a community benefit with more spending on other public services, the group said. to keep tax-exempt status. But if enough doing good isn’t being done, it would be time to strip away the exemptions. In 2013, hospitals collectively spent $405 million on charity care,

2015 LEGISLATIVE REPORT | 37 SELECTED NEWS COVERAGE The issue has come to the fore, as the Medicaid expansion Oregon hospitals agree helped reduce the rate of uninsured in Oregon to 5 percent from 14 percent before last year. That caused charity care to drop as community benefit well, by 47 percent in Oregon. At the same time, profits rose by more than 74 percent in the spending won’t drop first six months of last year, compared to the same period in by KGW News 2013, according to the report. March 17, 2015 “Hospitals look forward to input from their communities on Oregon hospitals say they won’t reduce their spending on how best to reallocate those dollars and will also be interested services that benefit the community, even though they’re seeing to evaluate the health outcomes those increased investments far fewer uninsured patients. produce,” the Hospital Association said in a statement. An Oregon hospital industry group said Tuesday its members In 2007, Oregon took steps to define and track hospital will provide free care to anyone who earns less than double community benefits. There are 11 categories in all. Most, or 58 federal poverty level and is not on Medicaid. The group also said percent goes toward unreimbursed costs from Medicare and that total spending on so-called “community benefit” services Medicaid. Charity care still accounts for 21 percent, as does will remain at historical levels. health professions education. Community benefit programs included services such as charity Hospitals agreed this spring to maintain their level of care, research, health screenings and medical education. community benefit spending even though charity care declined. Hospitals are seeing a big drop in their spending on charity But the SEIU report found some causes for concern. care since the federal health care overhaul gave insurance to In terms of grants given by hospitals, the level of disclosure hundreds of thousands of people who didn’t previously have it. about the organization and use of funds is inconsistent across the state, the report found. It also found some hospitals may be “leaning away from health and more towards advertising Advocates say nonprofit and public relations work” when it comes to what constitutes a Oregon hospitals fall community benefit. Asante gave money to the Jacksonville Britt Festival and Oregon short on charitable work Shakespearean Festival while Tuality Health helps sponsor the Oregon International Airshow, the report notes. by Elizabeth Hayes Portland Business Journal It argues that the time is ripe for this, as many hospitals are June 16, 2015 undertaking their next community health needs assessments, the basis for community benefit spending. Labor and community health advocates are calling for increased transparency and accountability related to nonprofit hospitals’ The association agreed. spending on community benefits, especially at a time when “Hospitals welcome community input and dialogue during the operating profits have risen and charity care declined. assessment and indeed rely on that input,” the association said in A white paper by the Oregon Health Equity Alliance, SEIU a statement. Local 49 and the Asian Pacific American Network of Oregon concludes that “community benefits,” which nonprofit hospitals must provide in exchange for tax exemptions, are “poorly defined and regulated.” Nurse Staffing “We must demand a return on investment for hospital community benefit programs that is transparent, measurable and effectively addresses critical health needs in our Nurses, hospitals communities, ” the report says. welcome strengthened The Oregon Association of Hospitals and Health Systems noted that statewide spending on community benefit was $1.8 billion staffing law in 2013. The association added that “hospitals are interested in increasing public understanding of their commitment to the by Tara Bannow communities they serve through these activities.” The Bend Bulletin July 9, 2015 The IRS in 1969 introduced the concept of community benefits. Adding just one more hospital patient to a nurse’s workload Rather than strictly requiring charity care, hospitals were increases by 7 percent the likelihood of a patient dying within 30 allowed to “promote the health of any broad class of persons in days of being admitted. order to qualify as nonprofit,” according to the report. WWW.OAHHS.ORG | 38 SELECTED NEWS COVERAGE That was the dire finding of a 2014 study in The Lancet, and it been spotlighted by the ONA as an example of a successful was used earlier this year by the Oregon Nurses Association to committee, said Pam Steinke, St. Charles’ chief nursing executive champion the passage of a bill to strengthen the state’s nurse and vice president of quality. staffing law. The law also creates a 12-member Nurse Staffing Advisory Board “If they’re not staffing appropriately, then patients — your loved comprised of nurses and nurse supervisors from across the state ones, your family members, your father, your mother, your that will report to the OHA on nurse staffing trends and make brother, your sister, whoever — may not get the care that they recommendations based on complaints and staffing reviews. need delivered in an appropriate manner at an appropriate time,” Steinke said she knows of local providers who want to serve on said Lynda Coats, an ONA member who has been a nurse at St. the board. Charles Bend for nearly 30 years. “I think we’d be very blessed to have somebody from this side Such arguments convinced Oregon lawmakers of the need for of the mountain at the table and not just have it be Willamette updates to the state’s existing hospital nurse staffing law, passed Valley folks,” she said. in 2001. The Legislature approved the new law in late June. The final version garnered support from the state’s hospitals Under the new law, the OHA must audit hospitals every three and nurses union, who don’t always see eye-to-eye, following a years. State officials must also initiate on-site investigations number of tweaks from its original incarnation. within 60 days of receiving complaints from hospital staff members. The law directs the agency to receive more than Staffing laws are designed to ensure patients receive enough $500,000 to perform the additional duties. attention from caregivers who have the appropriate expertise and that those caregivers are not overworked or fatigued. Steinke said she’s happy OHA will be doing more oversight, which she said has lacked in the past. Only half of the state’s Several nurses from around the state urged lawmakers to hospitals have been audited within the past decade, she said. In support the bill, divulging in letters that their hospitals don’t Central Oregon, the OHA has only performed a staffing audit on staff enough nurses in an effort to cut costs, which ultimately St. Charles Madras, Steinke said. puts patients at risk. Audits are important because they tell hospitals what they’re Vikki Hickmann, a nurse in St. Charles Bend’s emergency doing well, which provides an opportunity to celebrate those department, wrote to lawmakers that her supervisors place a things, Steinke said. They also identify areas where hospitals lot of emphasis on how quickly the nurses can move patients need to improve, she said. through, but not on whether nurses receive their breaks or whether patients are forced to wait or are not seen due to “Sometimes it’s incremental improvements, sometimes it may insufficient staffing. be a big gap,” Steinke said, “but you don’t know what you don’t know until sometimes outside eyes look at that.” “The increased stress that RNs experience when they cannot provide care they know to be necessary, the lack of rest breaks, The OHA also must now perform on-site inspections within 60 the forced use of substandard equipment and the inability to days of receiving complaints from hospital staff members. perform at a level required by hospital policy secondary to The lag time between complaints and OHA follow-up has been inadequate staffing, leads to negativity, injury, increased liability problematic for St. Charles, which the OHA investigated in and diminished patient outcomes,” she wrote. January in relation to a staffing complaint filed in December Coats said a group of emergency department nurses who work 2013 and a patient complaint filed in July 2013, Steinke said. The at St. Charles Bend recently filed a complaint to the Oregon issues in those complaints had already been addressed, she said. Health Authority alleging the hospital isn’t staffing enough “Over a two-year period, there had been a lot of changes and we nurses in the department and isn’t providing adequate break had addressed a lot of things,” Steinke said. time. “There is a lot of nurse fatigue out there,” she said. Staffing ratios struck down The bill originally attempted to make hospitals subject to OHA spokeswoman Susan Wickstrom wrote in an email that the nurse-to-patient staffing ratios if caregivers and administrators agency has received two separate but similar complaints from disagreed on the issue and asked the OHA for help. Bend’s emergency department nurses, but that it cannot make them public, nor can it reveal whether it will investigate them. Legislators dropped the ratio requirement following opposition from the Oregon Association of Hospitals and Health Systems. Details of the new law Carol Bradley, an OAHHS board member, summed up the The new rules require each hospital to establish its own nurse organization’s opposition to the ratios in written testimony to staffing committee comprised of half front-line caregivers and lawmakers. half administrators. That committee must then develop a written Prior to joining Legacy Health five years ago, where Bradley hospital-wide staffing plan and implement it by 2017. currently serves as senior vice president and chief nursing Each of St. Charles’ four hospitals already have staffing officer, she wrote that she worked in California, which until committees, and the committee serving its Bend hospital has

2015 LEGISLATIVE REPORT | 39 SELECTED NEWS COVERAGE last month had been the only state that mandated minimum must be present to form a quorum, and managers and labor nurse-to-patient ratios in hospitals since adopting its law in must vote in equal numbers. 1999. She said it forced hospitals to cut its numbers of other The committees have existed for about 15 years, but giving their support personnel, forcing nurses to take on some of the duties recommendations authority became a top priority of the Oregon previously assigned to those roles. She also said the increased Nurses Association when it became clear that many hospitals patient handoffs resulted in decreased continuity of care. were not taking them seriously, as executive director Susan King St. Charles also opposed the staffing ratio. That’s because patients told lawmakers in February: “The staffing committees have been have different levels of need depending on the illness and its ignored by hospital executives and budget makers,” King said, severity, and one-size-fits-all ratios don’t allow for individualized leaving many nurses overworked and putting patient safety at risk. care, Steinke said. The Oregon Health Authority is supposed to audit the hospitals “Nurses are an autonomous profession in which they depend for compliance with current law, but in the last reported year upon their critical thinking and clinical judgment to make only five hospitals were audited and some of the state’s largest decisions about care,” she said. “When you play it as a numbers hospitals have never been audited, including Sacred Heart game, that takes that away.” Medical Center in Springfield and Legacy Emanuel and Legacy Good Samaritan hospitals in Portland. Curiously, Kaiser While California’s law helped increase nurse staffing levels Sunnyside has been audited four times, and found to be in total in hospitals relative to those in other states, some California compliance three of those times. hospitals saw higher infection rates since the law’s passage, while others saw lower rates of patients who couldn’t be rescued The bill is headed to the Committee on Ways & Means to relative to other states, according to a 2013 study in the journal provide the health authority with additional funding to conduct Health Services Research. these audits. “We were aware of that,” said Jack Dempsey, a lobbyist for the Oregon Nurses Association. “We were ready to Massachusetts approved regulations in June that limit each nurse support getting them more money.” to no more than two patients in intensive care units, making it the second state to impose minimum staffing ratios. More than The Oregon Association of Hospitals & Health Systems dropped 10 other states have laws that address nurse staffing in hospitals, its opposition after it won a concession from the nurses’ union. but they don’t go so far as to require certain ratios. The amended version strikes language that allows the Oregon Health Authority to rely on quotas to set staffing levels if the two sides reach an impasse. Dempsey said that if an impasse does Senate Health Passes occur SB 469 calls upon them to enter mediation to reach an agreement. Bill Giving Teeth to Nurse Neither side wanted quotas. Hospital association lobbyists argued that California’s quota system was too prescriptive and Staffing Law on 5-0 Vote hampered hospitals from adjusting to meet changing needs. by Chris Gray The nurses association representatives agreed -- noting that The Lund Report Oregon’s committee approach allowed each hospital to be more April 22, 2015 flexible in determining those levels than hard-and-fast state Oregon hospitals look like they’ll be facing a tougher nurse rules. The committee approach is a way to avoid more drastic staffing law after the Senate Health Committee approved measures like state quotas, according to the nurses union. Senate Bill 469 unanimously on Monday, sending the bill to the legislative budget committee for further debate with only minor concessions to the hospital industry. Nurses Push “I think you’ve done yeoman’s work to reach an agreement,” Sen. Laurie Monnes Anderson, D-Gresham, the Health Committee Staffing Measure chairwoman, told lobbyists from the hospital association and the by Saul Hubbard state’s leading nurses’ union. “You didn’t get everything you wanted Eugene Register-Guard but that means it was a good bill because you got consensus.” Feb. 7, 2015 The legislation would bind hospitals to the recommendations of Oregon’s nurses this year are pushing to significantly toughen a hospital staffing committees, which collaboratively develop plans 2001 state law designed to ensure that hospitals around the state between management and labor for the number of nurses and provide adequate nurse staffing at their facilities. support staff needed to safely provide care in each wing of the hospital at different hours. The policy proposed by Oregon’s largest nurses’ union in Senate Bill 469 would give nurses as much say as administrators in their Staffing committees by law are composed of an equal number staffing levels and would significantly bolster the state’s ability to of nurse managers and direct-care registered nurses, with one investigate whether hospitals are complying. nurse for each specialty unit. A majority of committee members

WWW.OAHHS.ORG | 40 SELECTED NEWS COVERAGE The goal is to ensure that hospitals aren’t jeopardizing patient SB 469 would require audits care with inadequate staffing, says Sarah Baessler, a lobbyist for The union’s proposed bill, SB 469, would clarify that staffing the Oregon Nurses Association. committee recommendations are legally binding. If the “Everybody at some point is going to end up in the hospital. We committees — which have equal nurse and administrator want to ensure that they receive the best possible care,” she said. membership — reach impasse, hospitals would have to “There’s a lot of interest and momentum right now.” implement recommended national staffing ratios. Hospital representatives say they are “committed to making the The bill also would require every hospital’s compliance with current nurse staffing law effective” but that the first draft of SB staffing rules be audited every five years and would mandate 469 is overly prescriptive and seeks to fix a problem that hasn’t that nurses’ formal complaints to the state be investigated been adequately documented with hard data. within 60 days. “Hospitals are committed to the highest possible levels of safe During investigations, the bill would grant the Oregon Health and timely patient care,” said Philip Schmidt of the Oregon Authority the power to subpoena hospital administrators and Association of Hospitals and Health Systems, which represents compel hospitals to produce relevant records. all 62 hospitals in the state. There’s no cost estimate available yet on what the increase in “Staffing decisions need to balance all factors to achieve that audits and investigations would cost the state. goal,” he added in a prepared statement. “Skewing decision- SB 469 would not increase civil penalties for hospitals for making toward prescriptive requirements or putting the needs of breaking staffing rules, however, which now are limited to fines one set of stakeholders responsible for patient care above others of up to $5,000 and possible license suspension or revocation. is counterproductive.” Current staffing audit records, dating back to 2003, show that The upcoming debate in the Legislature is occurring as nurses the Oregon Health Authority has not yet levied a fine of more at PeaceHealth’s Sacred Heart Medical Center have become than $2,500 on a hospital. increasingly vocal about what they claim is chronic under- staffing, particularly at PeaceHealth’s RiverBend facility in The state also has audited Lane County hospitals on only three Springfield. occasions: McKenzie-Willamette’s Springfield hospital in 2004, PeaceHealth’s Cottage Grove Community Hospital in 2009, and According to Oregon Nurses Association data, in 2013 and 2014, RiverBend last year. The audits found no issue at McKenzie- in-house complaints filed by nurses at RiverBend made up about Willamette and two minor issues at Cottage Grove’s hospital. one-third of complaints received from all the nurses it represents The results for RiverBend have not been posted online by the at 30 hospitals across the state. Nurses at RiverBend filed 374 Oregon Health Authority yet, but Freeman said no violations complaints in 2013 and 355 in 2014. were identified. Overall, Baessler said, in-house complaints filed by nurses the SB 469 already has been scheduled for a public hearing in a ONA ¬represents have doubled since 2010. Senate committee the week after next. “Things are getting better” “Staffing is getting worse” Louella Freeman, RiverBend’s chief nursing officer, says the Sen. Laurie Monnes Anderson, a Gresham Democrat and retired hospital’s complaint numbers “don’t present a full picture” of a nurse who is sponsoring the bill, said it’s clear to her the current situation, which has improved in recent months. The complaints rules for ensuring adequate staffing levels “are not quite working.” also represent a “hodgepodge of issues” nurses may be ¬facing, not just staffing issues, she said. “Staffing in hospitals is getting worse, not better,” she said. “We should empower the (hospital) staffing committees, improve “When we’re talking to the nurses on the ground, they’re telling transparency and bolster enforcement.” us that things are getting better,” she said. “But the union is saying something different.” But she added that the issue will be “contentious” this session. Oregon’s nurse staffing law already requires that committees “We’re going to spend a lot of time on it,” she said. “I’ve had both of nurses and administrators at each individual hospital come sides in my office already.” together to craft staffing plans, and that the state audits some Rep. Bill Kennemer, an Oregon City Republican and the only hospitals for compliance every year. GOP sponsor on the bill, said hospital under-staffing “has been a But the Oregon Nurses Association says the policy hasn’t worked longstanding problem.” as intended. Some hospitals ignore the agreed-upon work plans “The sense I get is that there is a lot of variability between or simply don’t regularly convene their staffing committees, hospitals. Some (staffing committees) have great relationships. union officials said. The state’s audits and investigations are Some hospitals aren’t using them as they should,” he said. too infrequent and rarely lead to serious consequences for “Sometimes bills have an impact by their just being present, noncompliant hospitals, union officials said. not necessarily by passing. So we’ll see how far we need to pursue this.”

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PeaceHealth’s Freeman said RiverBend’s staffing committee is past year, Oregon hospitals have committed to maintain the “working well” and meeting every month for four hours. same level of community benefit. Asked about the bill, she said that SB 469 is “very prescriptive” “There’s been a dramatic drop in charity care and we’re seeing in how hospitals would have to handle staffing issues. that play out, and we’re thrilled that’s happening,” Van Pelt said. “It’s an indicator people are gaining access to the system.” “Historically, there’s been very collaboration between the nurses’ union and the hospital” on those issues, she said. “This (bill) is Financial and utilization reports for Oregon hospitals will be out outside of that collaborative process.” later this summer. Oregon Hospital Economic Economic Impact Output is $18.9 Billion by State of Reform Oregon Hospitals Pack a June 9, 2015 $19B Economic Punch Oregon community hospitals accounted for $18.9 billion in economic output in Oregon in 2013, according to a new study by Elizabeth Hayes by ECONorthwest released today by the Oregon Association of Portland Business Journal Hospitals and Health Systems (OAHHS). June 9, 2015 Nearly 60,000 Oregonians are directly employed by Oregon’s A new report pegs Oregon community hospitals’ economic community hospitals and another 52,000 jobs are directly output at $18.9 billion in 2013. associated with hospitals, showing that community hospitals The study by ECONorthwest also found nearly 60,000 are one of Oregon’s key economic engines. Those 112,000 Oregonians are directly employed by community hospitals, hospital-related jobs account for 4.9 percent of the state’s total with another 52,000 jobs directly associated with hospitals, employment. On a county-by-county basis, hospital jobs and accounting for nearly 5 percent of the state’s total employment. associated employment generally range between 3 and 6 percent of job totals–often trailing only government-supported jobs. Hospital jobs and associated employment range from between 3 percent and 6 percent on a county-by-county basis, according to “Today’s report shows the importance of Oregon’s community the report, released by the Oregon Association of Hospitals and hospitals to both the health of Oregonians and the health of Health Systems. Oregon’s economy,” said Andy Van Pelt, executive vice president of OAHHS. “Hospitals mean a great deal to their communities– “Hospitals are a big economic driver,” said Andy Van Pelt, the from urban centers like Portland to rural places like Burns. They association’s executive vice president. “For every 10 jobs we represent things like health, happiness and hope. Today’s report create in hospitals, another nine are created in the state.” shows they also represent jobs and economic stability.” Other findings: “Hospitals are major employers across urban and rural • Hospitals generated about $176.3 million in tax and fee Oregon,” said John Tapogna, president of ECONorthwest. “And, revenue for state and local jurisdictions in 2013. Including importantly, they create large numbers of middle-skill, middle- taxes from businesses that supply goods and services to wage jobs that are disappearing in other industries. Productive, hospitals, the total rises to $452.8 million. well-run hospitals are a key to the state’s economic future.” • Direct and secondary economic activity linked to hospitals Other key findings from the report include: contributed about $8.4 billion to Oregon’s Gross State • Gross State Product: The direct and secondary economic Product. activity linked to hospitals contributed approximately $8.4 • Rural hospitals play an outsize role in their communities, billion to Oregon’s Gross State Product (GSP) in 2013. with relatively higher job totals as a percent of total • State and Local Taxes: Hospitals directly generated employment. approximately $176.3 million in tax and fee revenue for “They are the lifeline many times for the economic engine in state and local jurisdictions in 2013. The State and local those communities, and it’s really important for livability to governments collected another $276.5 million in taxes from maintain a strong health care environment,” Van Pelt said. businesses that supply goods and services to hospitals. This sums to a total tax revenue of about $452.8 million. Hospitals also provided more than $1.8 billion in community benefit contributions, or services nonprofit hospitals provide “Hospitals are at the center of the economic life of the without expectation of compensation. Even with charity care communities they serve,” added Van Pelt. “As some of the largest dropping thanks to more people gaining health insurance this employers in the state, we know that many communities depend

WWW.OAHHS.ORG | 42 SELECTED NEWS COVERAGE on their hospital. With family-wage jobs, hospitals drive much of local hospital and see how it compares on everything from patient the economic engine that fuels other parts of county economies. experience to the average time spent in the emergency room. Hospitals do this while continuing to ensure that people have “Over time, more data points will be added. Including a place to go for care and treatment at any time and for any information such as how many patients are seen in a year, how reason. Hospitals are proud to serve Oregon, and this new report many babies are born in our facilities, operating margins and quantifies another way that they are integral to our state.” much more,” she said. The report found that rural hospitals play an outsized role in The website data come from the federal Centers for Medicare their communities. They are one of the steadiest sources of jobs and Medicaid Services, but some hospitals don’t report enough and have relatively higher job totals as a percent of the total data in some categories to make a useful comparison. employment in those rural counties. Hospital and hospital- supported jobs did not decline during the recession and in rural counties this was a great source of economic stability. Website Features As a function of their commitment to the health of their communities, in 2013, as tallied by the Oregon Health Authority, Oregon Hospital Data Oregon hospitals provided more than $1.8 billion in community by Saerom Yoo benefit contributions. In Oregon, “community benefit” is defined Salem Statesman Journal in statute as health care-related services that nonprofit hospitals May 27, 2015 provide without the expectation of compensation. At the same time, Oregon community hospitals provided care for 336,153 The Oregon Association of Hospitals and Health Systems inpatients, more than 9.9 million outpatients, and more than 1.2 launched a website allowing users to navigate Oregon hospital million emergency room visits. data in a user-friendly platform. “Oregon community hospitals are deeply connected with the Called the Oregon Hospital Guide, the website uses data from communities they serve,” said Van Pelt. “From the family-wage the Center for Medicare and Medicaid services to display quality jobs they provide, to the economic stability they furnish, to the metrics. The site also has a hospital compare function. community benefit they contribute, Oregon’s hospitals are vital The data include outcomes for heart attack care, emergency care, to our state.” surgical care, infection prevention and patient satisfaction. The economic impact study–commissioned by OAHHS–was The association plans to expand the data in 2016 to include conducted by ECONorthwest using state-specific data from patient utilization and hospital financial data, according to a the American Hospital Association and using the IMPLAN press release. economic modeling tool. Diane Waldo, associate vice president of quality and clinical programs for OAHHS, said in a statement that the website OregonHospitalGuide.org shows Oregon hospitals’ commitment to transparency. Oregon Hospitals Roll Hospital Tax Out Comparison Shopping Smooth Passage Expected Site for Patients for Four-Year, $1.4 Billion by Kristian Foden-Vencil OPB May 27, 2015 Hospital Tax by Chris Gray Hospitals around Oregon have gotten together to create a new The Lund Report website where patients can more effectively comparison shop. February 26, 2015 The Affordable Care Act means enormous volumes of health A four-year extension of the hospital assessment tax, which is care data are online now. But it’s difficult to find and complicated used to fund the bulk of the state Medicaid program, appears for consumers. headed for swift passage this session, without any of the partisan To simplify the process, the Oregon Association of Hospitals and theatrics that have dogged previous extensions of the tax. Health Systems has opened a new website. Senate President Peter Courtney, D-Salem, told reporters Association spokeswoman Diane Waldo said people can find their

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Wednesday morning that he expected it to move ahead months by Senate Republicans hoping to extract political quickly, and House Bill 2395 easily passed its first hurdle in the concessions from Democrats before finally voting to renew afternoon, clearing the House Health Committee unanimously. the tax. All taxes must receive the backing of 60 percent of legislators, even politically popular ones such as the hospital “We have agreement from everybody on this bill,” said Rep. assessment tax. Mitch Greenlick, the Health Care chairman. “I haven’t been told there’s any leveraging going on with this The bill now heads to the Committee on Ways & Means, where provider tax,” Courtney said. it will first have a public hearing before the Human Services subcommittee, headed by Sen. Alan Bates, D-Medford and Speaking with The Lund Report, freshman Republican and Rep. Nancy Nathanson, D-Eugene. From there, it is expected to orthopedic surgeon Rep. Knute Buehler of Bend concurred: “I quickly move through the full budget committee before a full think that will have little or no opposition from my colleagues.” House vote next month. The bill was presented to the House Health Committee by Dave The proposed $1.4 billion assessment on the revenues of the Underriner, the chief executive of Providence Health & Services Oregon’s 28 major hospitals over the next four years will be used – Oregon; Martin Taylor, the director of CareOregon, which to leverage $7.3 billion from the federal government between contracts with four CCOs to manage care for the Oregon Health July 2015 and 2019. The assessment is popular among Oregon Plan; and Kolmer. hospitals because it not only ensures funding for the Oregon Kolmer has remained in state government as Brown’s Health Plan, but the hospitals themselves are often able to take healthcare advisor, despite both his role in the development of in more money than they pay in. Cover Oregon and his close relationship to former Gov. John “The assessment is on the revenue of the hospital,” Greenlick Kitzhaber, who was railroaded out of office earlier this month explained. “The money is returned to the hospitals as a whole.” amid ethics allegations involving his fiancee, Cylvia Hayes. Greg Van Pelt, the former chief executive of Providence Health “In light of where we are in the legislative session, there is benefit & Services in Oregon and the current director of the Oregon to restoring stability, and she values the institutional knowledge Health Leadership Council, laid out the major provisions of of senior staff in specific policy areas,” Brown’s spokeswoman, the revenue package to The Lund Report before the session, Kristen Grainger, told The Lund Report in response to a highlighting the transformation fund, which in its new question about Kolmer’s continued role. conception will benefit coordinated care organizations as well as hospitals, which was conceived in the 2013 tax package. Oregon House Extends Bureaucratic delays from the federal government have kept any of that transformation money from actually compensating hospitals which have shifted away from emergency care Hospital Tax toward providing more coordinated care. In January, hospital by Peter Wong association spokesman Philip Schmidt informed The Lund Portland Tribune Report that the first allotment of dollars from the 2013 March 11, 2015 transformation pool will be disbursed in March. Oregon’s hospitals will continue to pay a tax that allows the state Gov. Kate Brown’s healthcare advisor, Sean Kolmer, explained to recoup billions in federal money to pay for health care for that 1 percent of the revenue generated from the hospital low-income people. assessment tax will go into the new transformation pool, and The Oregon House voted 56-2 on Wednesday to extend the tax half of that will be distributed to the CCOs. Since several of by four years — double the usual two-year renewal — and send the CCOs are controlled by the hospitals, much of that money House Bill 2395 to the Senate. would still likely benefit the hospital systems. Oregon has had a provider tax in some form since 2003. The Before the session, the Oregon Health Leadership Council current version has been endorsed by a coalition of groups. promoted the new assessment tax as another two-year deal, but Courtney and Greenlick worked out a longer deal, which would According to the National Conference of State Legislatures, all make the new hospital assessment last four years so that the but one state (Alaska) had similar provider taxes in 2013-14. Legislature will not have to go through the motions of passing Rep. Mitch Greenlick, D-Portland, described it as a “dream tax.” an assessment next session, as it has done in past years. “We collect the tax from hospitals, we put it up as a match for “We’ve been doing it every two years, and it’s a mess,” Courtney federal money, and then we give it back to the hospitals,” says told reporters. Not only does Courtney believe he’ll get a bye from Greenlick, chairman of the House Health Care Committee. pushing it through in 2017, he believes that the Republicans are “They have enough money to put people in Medicaid so they on board with the assessment renewal vote for 2015. have health insurance to pay for hospitalizations.” In 2013, the passage of the hospital and nursing home assessment tax (which runs through 2020) was tied up for

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The tax is projected to raise $880 million in the next two-year cycle, which starts July 1, and would recoup an estimated $2.4 Hospital tax (and billion in federal funds from Medicaid. For the 2017-19 budget cycle, the tax is projected to raise just under $1.1 billion, which Medicaid funding would recoup $2.9 billion in federal funds. Hospitals get back at least the amount they pay in provider taxes. plan) lands on Oregon The renewed tax would end Sept. 30, 2019. governor’s desk Without the tax, Oregon and other states would have trouble by Andy Giegerich paying for care for low-income people. In Oregon, that is Portland Business Journal done through the Oregon Health Plan, which under the March 23, 2015 federal Affordable Care Act was expanded to cover more low- income people. If all goes according to plan, there won’t be any change to the hospital tax in the next biennium. A Senate vote is likely soon, given that the bill has already been cleared by the Legislature’s joint budget committee. Oregon lawmakers have given the go-ahead to keeping the state’s hospital tax right where it had been, in terms of overall revenue- Rep. Jim Weidner, R-Yamhill, was one of two dissenters on the raising. vote. “This is the wrong way for us to recover money from the federal government,” he says. Both the Oregon Senate and House have approved the figures set out by Gov. John Kitzhaber before the governor resigned Feb. 13. Kitzhaber’s budget had requested the budget remain Oregon lawmakers at 4.5 percent of net patient revenue. Another chunk of the money would come from a 1 percent assessment for the Hospital approve $7.3 billion Transformation Performance Program. The tax helps fund the Oregon Health Plan, the state’s version of measure to fund Medicaid Medicaid. It also triggers a more than two-to-one match by the by Ian K. Kullgren federal government. The Oregonian/OregonLive All told, the tax is expected to generate nearly $2 billion over the underMarch 17, 2015 next biennium, along with a $5.4 billion federal match. SALEM – Lawmakers on Tuesday passed a $7.3 billion funding Kate Brown’s expected to sign the measure, introduced as House measure to pay for Oregon’s Medicaid program over the next Bill 2395. four years. Andy is the Portland Business Journal’s digital managing editor, The bill extends a $1.9 billion tax on hospitals over the next two overseeing the daily digital news operation. budget cycles. In return, the state will receive $5.4 billion in federal matching funds, which are then given to hospitals in the form of Medicaid payments. More than a million people – about a quarter of all Oregonians – Miscellaneous are enrolled in Medicaid programs. House Bill 2395 passed 29-1, with Sen. Brian Boquist, R-Dallas, Senate Votes to Require voting no. The vote was far less controversial than in 2013, when Senate Health Insurers to Send Republicans threatened to withdraw support unless Democrats agreed to deeper cuts in the Public Employees Retirement Checks to Providers, System. This time, lawmakers approved a four-year extension instead of Not Patients the usual two with bipartisan support. by Chris Gray “This is a good example of what Republicans and Democrats, The Lund Report working for Oregonians, can bring to this state,” said Sen. Alan April 17, 2015 Bates, D-Medford. The Oregon Senate passed a bill Wednesday that would require The bill now heads to Gov. Kate Brown’s desk for her signature. health insurance companies to send payments directly to the healthcare provider, and not the patient – something currently practiced by Regence BlueCross BlueShield, Lifewise Health Plan and UnitedHealthCare, and possibly other insurance companies.

2015 LEGISLATIVE REPORT | 45 SELECTED NEWS COVERAGE “Patients are being sent money directly from insurance carriers,” “It’s a real disservice not only to the hospital,” said Bunyard. “It’s Sen. Laurie Monnes Anderson, D-Gresham, told her colleagues a real disservice to patients.” before Senate Bill 901passed on a 29-1 vote without debate. No insurance company testified on the record to oppose SB 901, “This bill requires insurers to send their payments directly to the although it was amended to make clear that it did not apply to places where the service was rendered.” supplemental insurance policies from companies like Aflac, Ambulatory surgery centers have had to deal with the chaos which by design sends the checks to clients in need of extra cash, caused by insurance companies sending checks directly to often for non-medical expenses, when recovering from surgery patients for years when they haven’t had a contract with the or a hospital stay. healthcare provider. Not all insurance companies do this to SB 901 will bring Oregon in line with other states like California providers, but when it does happen, providers may never receive which already require insurers to send a check directly to the payment for their services. healthcare provider. The bill now heads to the House, where it’s The practice forces ambulatory surgery centers to track down likely to face little resistance. thousands of dollars from patients, who are often away from work because of the surgeries. Sometimes, the check goes to estranged spouses who share a policy with the patient. New Bills Highlight Hospital association lobbyist Patty O’Sullivan testified that a young woman was sent to collections after a check was sent to Holes in Oregon’s her father in New York. The woman was still covered by her father’s health insurance until she reaches 26 years old, but Mental Health Care evidently did not have a good relationship with him because by Joanna Evoniuk he cashed the check and refused to send her the money so she GoLocalPDX could pay her bill. March 23, 2015 In 2013, Alison Goldwater of Regence BlueCross BlueShield Three house bills recently introduced in the 2015 Oregon argued that the insurer sent the checks directly to patients as legislative session would create state regulations for how a way of encouraging healthcare providers to sign contracts hospitals discharge and communicate with mentally ill patients. with them, since in-network providers always receive their Supporters argue Oregon hospitals need to coordinate care money directly. better for psychiatric patients. In that session, Regence lobbyists were able to convince The push for legislation comes from Jerry Gabay, a board Monnes Anderson to support a compromise that would allow member of the Oregon National Alliance on Mental Illness. the insurer to keep sending checks to patients if they included Gabay lost his daughter to suicide in 2010, a month after she was a double signature to be signed by the patient and provider, discharged from a hospital for a mental health break down. which theoretically banks wouldn’t be able to cash with only “People are dying and there’s ample evidence to support the idea one signature. treatment goes better,” Gabay said. The compromise didn’t work. Evalyn Cole of the Spine Surgery Center in Eugene said that some patients were still cashing New Bills checks, indicating either banks were overlooking the double- House Bill 2022 applies to case management and coordinated signature or health insurers weren’t requiring one. An appeal care between systems, requiring hospitals and residential has been filed with the Insurance Division against Regence treatment facilities to help link outpatients to treatment, and after one check was allegedly found without the required involve close family or friends in the process if applicable. double-signature. A similar bill, HB 2023 would require hospitals and emergency The insurers also started barking up the wrong tree, targeting rooms to have public discharge protocols, to make sure psychiatric not just the ambulatory surgery centers, but Adventist Medical outpatients are connected with the proper support system. Center, which angered the Oregon Association of Hospitals and HB 2948 seeks to educate hospital staff on Health Insurance Health Systems into joining forces with the Oregon Ambulatory Portability and Accountability Act (HIPAA), which protects Surgery Centers this session to end the practice altogether the privacy rights of patients. Gabay said many times families with Senate Bill 901. The bill was also supported by the Oregon are not properly informed of the state of their loved ones, even Psychological Association. when HIPAA would allow doctors to share the information. Shannon Bunyard of Adventist Medical Center said that in Gabay said all three bills should help create helpful practices for one case, an insurance company sent a check to a patient who protecting and caring for the mentally ill. died, which no one could sign since they didn’t have power-of- attorney, forcing the hospital to battle for months to get paid. “These procedures happen all the time if you broke your hip or “He couldn’t pay it because he was deceased,” said Bunyard. went in for a diabetic attack,” Gabay said. “The procedures [for

WWW.OAHHS.ORG | 46 SELECTED NEWS COVERAGE psychiatric outpatients] vary widely and it often depends more on the inclination of hospital staff then on the law.” Four major healthcare Hospital professionals agree the current system for coordinating care for the mentally ill could be improved. providers work to open “This is a very important subject to us,” said Patty O’Sullivan, pscyhiatric ER in Portland a lobbyist for the Oregon Association of Hospitals and Health Systems. “We could do a better job and little more comprehensive planning. But we need somebody on the outside called ‘Unity Center for to be there and carry on.” Behavioral Health’ O’Sullivan said her organization has been working with by Maxine Bernstein supporters of the bill, to make sure the wording of the bill is fair The Oregonian/OregonLive and does not conflict with other legislation or federal regulations. February 05, 2015 Homelessness and Mental Health Care Four major healthcare providers have signed a letter of intent to The discharge procedures for the mentally ill has been a concern open a psychiatric emergency department in Legacy’s Northeast for homeless advocates for years. Portland building and call it the “Unity Center for Behavioral Health.’’ “The primary causes of homelessness is poor discharges from hospitals and jails,” Renaud said. “They don’t provide or arrange The center would provide immediate care to people suffering [support] in a way that actually works.” mental health crises and would respond to the needs identified by U.S. Department of Justice officials, said Legacy Health’s Renaud said that hospitals provide an opportunity for the behavioral health director Dr. Chris Farentinos. It would accept homeless to have access to trained staff or support, but once walk-in patients and patients arriving by ambulance. discharged, referrals by doctors are rarely followed through. Legacy Health, Adventist Health, Kaiser Permanente and And while the new bills would work to involve friends and Oregon Health Science University have agreed to move their family in the process, homeless people tend to shy away from psychiatric inpatient services to the new center at Legacy’s trusting the hospitals or bringing in people in their lives, which Holladay Park campus. The next step will be developing a joint can add to the difficulty. operating agreement detailing the management and operations “These people are often are paranoid, depressed, or crazy. The of the center. last thing they want is to get their mom involved,” Renaud said. Legacy will pay for remodeling the building, and the other providers will contribute money to operate the center, said Brain Oregon’s Mental Health Care Terrett, Legacy Health spokesman. The plan is to have it open Oregon’s was ranked as the fifth worst state in caring for adult late next year. mental illness, because of the number of cases and poor access to mental health care. Health care professionals are concerned The remodeling cost is estimated at $45 million. Legacy Health with the lack of funding and facilities. has committed $10 million in real estate value and raised another $21 million in private donations. The $14 million Suicide, often resulting from mental health, was the leading balance must be raised through the community, private cause of death for Oregonians aged 15 through 54 in 2012 and foundations and government agencies. caused more deaths than homicides, vehicular accidents and HIV/AIDS combined. Despite it’s toll, Gabay said suicide and Gov. John Kitzhaber has set aside $1 million in the Oregon Health mental health lacks the legislation and public awareness of other Authority’s budget toward the department’s psychiatric care. leading causes of death. While it’s not exactly what the Justice Department and Portland “What we’re not aware of is how much a bigger problem is police had envisioned, the center addresses a gap in care that suicide is and how to deal with it,” Gabay said. “We know we’re now has police serving as first-responders and transporting on the winning side, the question is how long it will take.” people in deep psychiatric crisis in the back of their patrol cars, Farentinos has said. Portland Mayor Charlie Hales praised the latest development. “This is a great first step,’’ Hales said. “The timing of this letter of intent couldn’t be better: It’s the first week of the 2015 legislative session, and all of these health-care providers are stepping up and joining the call to open such a facility. We are looking forward to working with everyone - the Legislature, the county,

2015 LEGISLATIVE REPORT | 47 SELECTED NEWS COVERAGE the hospitals, the CCOs (coordinated care organizations) and House Bill 3378, which advocates from AARP and the Oregon other law-enforcement agencies - to provide a level of parity for Association of Hospitals and Health System have dubbed the our residents who are in mental health crises.” Care Act, has been promoted for elderly people who need a caregiver but the policy could affect anyone. The legislation has The site is now home to the Legacy Research Institute’s labs become a model for a similar discharge policy for people with and state hospital beds. The research institute will move into a mental illness, HB 2023. building under construction next door, and the state hospital is moving its beds out by May. “When discharge planning is done well, it’s customized for that patient,” said Jessica Adamson, the lobbyist for Providence The new department would help alleviate the crowding in Health & Services, at a hearing earlier this month. regional emergency rooms, advocates said. One big incentive for the hospitals to support better discharge In the last year, nearly 10,000 patient visits to Legacy Health policies is the Affordable Care Act -- which penalizes them for hospital emergency departments were for behavioral health high readmission rates by cutting their Medicare payments, as issues. Every day, the emergency departments hold 10 to 20 Rep. Mitch Greenlick, D-Portland, reminded the committee. patients waiting for psychiatric beds, and the patients end up waiting hours to get psychiatric care, according to Farentinos. “We have a partner in the hospitals for providing quality care and preventing readmissions,” said AARP lobbyist Jon She said the average length of stay now for psychiatric patients Bartholomew. in the regular emergency departments is 16 hours, compared with two hours for those suffering physical ailments. Oregon’s healthcare transformation also keeps close track of readmissions for Medicaid patients, and the Oregon The new psychiatric ER will allow police to call an ambulance Health Authority rewards coordinated care organizations and allow emergency medics to assess a person’s needs and for keeping track of the follow-up on mental health patients take the person directly to the center. There, the patients will be who are hospitalized by offering bonus payments. The state treated immediately in a more humane, open living room-type also faces financial penalties from the Centers for Medicare setting by psychiatric experts, Farentinos said. & Medicaid if the Oregon Health Plan does not lower The center will have inpatient beds for 79 adults and 22 certain readmission rates. adolescent patients. The Care Act requires hospitals to assess patients for self-care, It’s modeled after a facility in Alameda, California. In Alameda helping them designate an in-home caregiver, and giving the County, 75 percent of the patients who arrive stay less than 23 patient and the caregiver instructions and training on doing hours, while the other 25 percent are admitted to in-patient care a treatment plan at home. “We have more work to do to help that can last as long as eight days. people plan to take care of their family and friends,” said Bill Olson, chairman of the Advocacy Coalition of Seniors and Whether Legacy could bill Medicaid for the crisis stabilization People with Disabilities. care will play a big role in whether the planned psychiatric ER becomes a reality, health care officials said. The mental health bill, House Bill 2023, is much more specific, and requires hospitals to have policies in force before The Alameda model is feasible in California because of a discharging patients treated for mental healthcare. The final Medicaid code for crisis stabilization that reimburses the policy was a consensus worked out between the hospitals, facility on an hourly basis, from a minimum of two hours to a mental health advocates and Rep. Alissa Keny-Guyer, maximum of 20 hours. D-Portland. Legacy studied the model and concluded that a reimbursement The discharge policies encourage patients to designate a rate of $100 an hour would make the psychiatric ER in Portland caregiver, assess their potential for suicide and their long-term sustainable. Alameda County’s hospital receives $109 an hour. needs. Within seven days of leaving the hospital, these patients must have an outpatient treatment scheduled. Passage Likely for Care Adult patients would designate their caregiver. For children under 14, the caregiver would be appointed either by the child’s Act for Elderly, People parent or legal guardian. For teenagers between 14 and 17, the caregiver could be appointed by the patient or the guardian. with Mental Illness The policy attracted bipartisan support from Rep. Andy Olson, by Chris Gray R-Albany and Rep. Knute Buehler, R-Bend. The chief sponsors The Lund Report are Keny-Guyer, Rep. Lew Frederick, D-Portland, and Rep. Joe April 17, 2015 Gallegos, D-Hillsboro. The House Health Committee is moving forward with two Mental health advocates testified last month that their loved bills to close a coverage gap – linking people who need special ones had fallen through the cracks when they left the hospital, assistance with information about a caregiver or supportive often with no immediate appointment or meaningful follow- person before they leave the hospital. up. The policy change appears to be one of those rare moments

WWW.OAHHS.ORG | 48 SELECTED NEWS COVERAGE where grassroots passion is leading to a new law. Mental health Those are among the findings of a 2014 AARP telephone survey activist Jerry Gabay has worked for such a change after a poor of 800 Oregon registered voters age 45 and older that was discharge plan contributed to his daughter’s suicide. entered into testimony in support of House Bill 3378, which would formally recognize unpaid family caregivers as part of a The coincidental timing of the measure brought by AARP patient’s care team. worked in the favor of mental health advocates, who have struggled for years if not decades to eliminate this critical The bill, which is scheduled for a House Committee on Health coverage gap. A second mental health priority, HB 2022, which Care work session at 1 p.m. Monday, would require hospitals requires case management for mental health patients, appears to identify and record the names of family caregivers, said Jon dead, while a third bill, HB 2948, meant to clarify federal privacy Bartholomew, director for advocacy for AARP Oregon. The laws for providers, is scheduled for a vote today. organization is the bill’s lead advocate. AARP proposed the Care Act because a growing number The bill would also require hospitals to assess family caregivers’ of in-home caregivers for the elderly do more than ability to provide post-discharge care and provide them with the traditional responsibilities like bathing or feeding. instruction or training as necessary. Bartholomew told the House Health Committee earlier this “Family caregivers are being asked these days to do a lot more in month that a study showed that three-quarters of caregivers terms of nursing-style care at home,” Bartholomew said, citing assist with medication management, often administering tasks such as managing medications, giving shots, dressing injections and intravenous drugs. wounds and cleaning catheter lines. “People are spending less Nearly half the caregivers assisted with nursing tasks for time in the hospital and more time with expectations that family multiple conditions while more than a third told AARP they caregivers will be taking care of them.” needed more training to treat wounds and other tasks. Half of all House Bill 3378 would ensure that “the family caregiver is being caregivers are unpaid as well, and lack the training they might treated as part of the care team,” Bartholomew said. receive from a home health agency. “We’re seeing a steady shift in the use of family caregivers,” Bartholomew said. “It’s one thing to be handed a sheet of paper - ‘Here’s the things you’re expected to do.’ It’s another to be walked through the There are over 460,000 unpaid caregivers in Oregon who process,” he said. “When people don’t feel as prepared, they provide care valued at over $5.5 billion annually, according to might either get the care wrong ... which leads to an infection or his testimony. a re-hospitalization - or you also might avoid doing the care.” “A good discharge plan starts before admission for elective AARP Oregon estimates that there are about 460,000 unpaid surgeries,” noted Buehler, a surgeon. family caregivers in the state. HB 3378 is also bipartisan -- attracting the support of Rep. Bill The bill’s chief sponsor is state Rep. Mitch Greenlick, Kennemer, R-Oregon City and Rep. Gene Whisnant, R-Sunriver, D-Portland, chair of the House health committee. Oregon as well as chief sponsors Greenlick and Rep. Nancy Nathanson, hospitals also have signed on to support the bill, Bartholomew D-Eugene. said, adding that at some hospitals, the policies that the bill HB 2023 passed the Health Committee unanimously on would require are already in place. Wednesday; HB 3378 is scheduled for a vote on Monday. Hospital employees might find themselves spending more time with family caregivers, Bartholomew said, “but on the other Bill would require end of the spectrum you’re going to be dealing with better health at home.” hospitals to identify “The whole point is we want to make sure that family caregivers have the tools they need to keep their loved one healthy and and assist unpaid happy,” he said. Among those who have testified in favor of the bill is west Salem family caregivers resident Bill Olson, 79, co-chair of the Advocacy Coalition by Amy Wang of Seniors and People with Disabilities. Olson and his wife The Oregonian/OregonLive were caregivers for their late son, Michael, after he suffered a April 20, 2015 traumatic brain injury in a skiing accident at age 23 in 1983. Among Oregon registered voters who are 45 or older, 50 percent House Bill 3378 will give family caregivers much-needed status with are providing or have provided unpaid care for an adult loved one. health care professionals, Olson said. “It’s basically some recognition that family and unpaid caregivers can be very, very important to the More than 40 percent say it is likely that they will provide success and to the adaptation of the patient, whether he be a blood unpaid care to an adult loved one in the future. relative or just someone that you care about.” And 86 percent support keeping family caregivers informed of medical decisions about the adult for whom they’re caring.

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Rural hospitals have a crucial role in the state’s health care, Lawmakers OK bill to making up over half of the state’s 62 hospitals and employing roughly 20 percent of the state’s hospital workforce, according to ease hospital-to-home the Oregon Association of Hospitals and Health Services. Last year, 53 percent of rural Oregon hospitals had negative transition margins, while 81 percent had margins under five percent. In KTVZ.COM recent years, the majority of hospitals with negative margins June 1, 2015 have been rural ones. From 2011 to 2013, rural hospitals made up 76.3 percent of all state hospitals with negative margins. SALEM, Ore. – The Oregon Senate has unanimously passed legislation carried by state Sen. Tim Knopp, R-Bend, aimed at Hospital Profits improving coordination and transition of patient care from the Although a hospital may end the year losing money, it doesn’t hospital to the home. mean the hospital failed to pay bills or staff. Bishop said Harney The bill passed last Wednesday on a 29-0 vote. House Bill 3378- District Hospital tries to get as close to breaking even as they A faced no opposition in the House or the Senate. can, to keep costs down for patients. The House passed the bill, carried by Rep. Mitch Greenlick, with “Personally, I have a problem with hospitals that make a ton a vote of 56-0 in late April. of money, that’s not part of our goal as health care providers,” Bishop said. HB 3378-A is also known as the Caregiver Advise, Record, Enable (CARE) Act. The CARE Act will require hospitals to Yet being financially stable can do a lot for improving a hospital adopt written discharge policies to help patients and their and its services, and making ends meet in the day-to-day caregivers transition from the hospital to the home. operations, according to Robert Duehmig, deputy director for the Oregon Office of Rural Health. Knopp said most patients do not receive a home visit by a health care professional after discharge from a hospital, and the level “It’s about trying to invest in the future, in the health care system of training for complex medical tasks doesn’t always meet the and bringing in new providers—offering the services patients needs of the family or lay caregivers. need,” Duehmig said. The principle behind the CARE Act is that family caregivers Challenges For Rural Hospitals should be considered part of the care team by medical providers. The structure and client base for rural hospitals create challenges Knopp quoted a letter from former Oregon Governor Barbra for turning profits compared to larger, urban hospitals. Larger Roberts, “As you are well aware, our current health and long- facilities can offset the costs of patients who pay with Medicare term care system relies heavily on family caregivers... who are and Medicaid through payments from private insurers, offering their love, care and generosity so those who need them according to Duehmig. Yet a majority of rural hospital patients may live with choice, dignity and independence.” tend to be older, poorer, and sicker. Knopp encouraged lawmakers to vote for HB 3378-A adding “Rural hospitals don’t have the luxury to crossover costs like that Roberts’ letter was well timed. HB 3378-A passed both urban ones,” Duehmig said. chambers and is moving to the governor’s desk to be signed into As healthcare moves towards more preventative care, and law in the coming weeks. reducing the need for primary care, it also reduces a major source of revenue for hospitals. Oregon’s Rural Hospitals Attracting hospital staff and specialists can be a challenge as well. Bishop said projected health care professional shortages Struggle to Make Profits will be felt more in rural hospitals. by Joanna Evoniuk “Recruiting the type of doctors who truly understand what rural GoLocalPDX medicine is all about is difficult, a tiny percentage will want to April 8, 2015 practice in rural communities,” Bishop said. While a majority of hospitals end the year with a profit overall, While rural hospitals may have fewer resources, they are still rural hospitals must find a way to fill a crucial role in their required to provide the same level of health care. community with fewer funds. “Finances are fairly volatile from year to year, so that appreciate “It’s really a balancing act—we can’t raise prices so high that needs to be had that rural hospitals have the same expiations it might make a huge profit, but would harm residents of the for healthcare transformation,” said Andy Van Pelt, executive county who can’t afford it,” said Jim Bishop, chief executive vice president of Oregon Association of Hospitals and Health officer at rural Harney District Hospital. “If we weren’t out here, Services. “The state needs to appreciate they have unique a lot of communities would die away.” situations.”

WWW.OAHHS.ORG | 50 SELECTED NEWS COVERAGE A Fixture in the Community “I had a single mom who was addicted to drugs and alcohol, but that helped make me a caretaker and now I can’t imagine doing Despite any limitations a rural hospital may face, they play a anything else.” crucial role in the community. “Besides being the only hospital, we are the number one employer in Harney County,” Bishop said. “We are part of the Is Oregon ready for glue that holds small communities together.” Bishop said these physicians also provide a personal connection universal health care? that is often overlooked in a larger hospital. Senators weigh the To keep rural hospitals from falling to behind on revenues, Duehmig said it is important to find ways to adapt with a matter changing health care system. by Dennis Thompson The OAHHS has been working since 2009 on a program to help Portland Business Journal reform rural health, positioning them to adapt even if they lack May 5, 2015 the size or scale of larger facilities. Oregon lawmakers are weighing whether the state should move Rural or critical-access hospitals receive some grants and extra toward universal health care for its citizens, a move that would federal funds, while the expansion of Medicaid has helped as outpace even the federal Affordable Care Act in providing well. Yet rural hospitals must still find a way to provide services medical coverage for all. with the resources they have. A key committee held a hearing Monday for Senate Bill 631, “Hopefully we won’t lose so much money we have to close— which would establish a universal, comprehensive and publicly like a lot of smaller hospitals in the south—it’s challenging,” funded health care system in Oregon. Bishop said. One of the bill’s chief sponsors, Sen.Michael Dembrow, argued that universal health care will provide residents with more Scholarship brings freedom to move between jobs and would attract more business, since companies would no longer have to provide insurance. doctors to rural Oregon “At best, what we’re going to continue to have is an expensive, Cathy Marshall complicated, patchwork system” if the state continues to provide KGW News coverage under the scheme set up by the Affordable Care Act, June 1, 2015 said Dembrow, D-Portland. ALBANY, Ore. – The state is spending millions to recruit Even though they testified for SB 631, proponents of universal medical students who will take their skills to the country. health care actually asked that Senators support a bill currently in the House — House Bill 2828, which funds research by the “People don’t understand how tough it is to get good care out Oregon Health Authority into ways the state could pay for here,” said OHSU student Margo Roemeling as she walked the health care for all citizens. grounds of her childhood home in Albany. HB 2828 currently has been referred to the Joint Ways and Means She’s one of 21 medical, dental and nursing students to receive a Committee, and so still stands a chance of passage in this session. Scholar for Healthy Oregon scholarship this year. On the other hand, SB 631 is a placeholder bill meant to create All tuition and fees are covered if students return to rural a framework for future legislation that would enact universal Oregon and practice medicine for 5 years. health care. “I never thought this was possible,” said Roemeling. “I can leave “We recognize that this bill will not move in this session, but we school without any major debt.” feel that someone working on a health care bill in future sessions Realizing rural medicine is a tough sell, state lawmakers might be interested in our intended language,” activists for allocated $2.5 million for the OHSU program. Health Care for All Oregon said in written testimony. “Students who grew up in rural areas are six times more likely SB 631 received a lot of support from many varied organizations, to want to return to those areas,” explained OHSU Vice Provost including the Oregon Center for Christian Voices. David Robinson. “The health care system in Oregon is so flawed morally and It’s what Roemeling planned all along. practically, that a major change is required. While the Affordable Care Act has provided many improvements to our current “It was not always an easy childhood for me and my four healthcare system, this healthcare system is a flawed system built siblings,” she remembered, on profits rather than the well¬being of people,” the center’s

2015 LEGISLATIVE REPORT | 51 SELECTED NEWS COVERAGE chair and vice-chair said in written testimony. “Oregon Center William Olson, vice president of finance operations for for Christian Voices asks you to support the passage of SB 631.” Providence Health & Services, said SB 665 would hamper hospitals’ ability to move away from fee-for-service models and The Main Street Alliance of Oregon, a small business owners’ nimbly respond to market demands. group, also testified in support. The bill is “inconsistent with Oregon’s health care transformation “The Main Street Alliance of Oregon strongly believes a goals and our progress to date,” Olson said. publicly funded universal healthcare system in Oregon and eventually the entire country is the only feasible and sensible Tom Holt, Cambia Health Solutions’ director of government way to provide the healthcare that every Oregon citizen both affairs, put it bluntly: “If what you wish to accomplish is to lock deserves and needs,” testified Jim Houser, co-chair of the group in the fee-for-service system in all it’s dysfunctional glory, pass and owner of Hawthorne Auto Clinic in Portland, and Mark this bill.” Kellenbeck, owner of BrainJoy LLC in Medforcd. Felisa Hagins, political director for SEIU Local 49, said the bill However, SB 631 also had its detractors. wouldn’t stifle the move to global budgeting — a method of paying for care that’s not based on each individual procedure. For her written testimony, one Oregon resident filed a copy of a 1982 pamphlet titled “Brain-Washing: A Synthesis of a Russian “We also think the global budgeting model is exactly where we Textbook on Mass Mind-Control.” want to be in the future,” she said. “We believe SB 665 puts all payers on a level playing field.” Legislature 2015: Lawmakers will tackle Regulate Oregon ticklish issue of health hospital rates? clinics and property taxes Senators consider it by Dennis Thompson by Elizabeth Hayes Portland Business Journal Portland Business Journal March 10, 2015 March 26, 2015 Hospitals will have to provide a minimum amount of Most experts agree that health care spending growth is out of charity health care to maintain their nonprofit tax status, control, outpacing growth of the overall economy. But is the cure under proposed legislation filed in the Oregon House of to regulate hospital charges? Representatives. The Oregon Senate’s Health Committee considered that question The legislation, House Bill 3034, is being promoted by Oregon’s Wednesday, at a hearing on Senate Bill 665. Hospital and county tax assessors, who have found themselves struggling to insurance executives said the idea could stifle innovation, while administer the state’s tax laws related to hospitals. labor advocates voiced their support. Hospital chains have been buying up for-profit medical clinics in “There’s been a lot of discussion about customers’ right to many communities, essentially removing those properties from choose and make economic decision about procedures,” said the tax rolls, said Randy Walruff, Multnomah County Assessor Sen. Lee Beyer, a Springfield Democrat who is sponsoring the and president of the Oregon State Association of County bill. “It’s hard to do that if you don’t know what the likely cost is Assessors. going to be.” “One day it’s a taxpaying, for-profit clinic, and the next day it’s The bill would establish a seven-member hospital rate not,” Walruff said. “There’s no clear, bright line we can follow.” commission within the Oregon Health Authority to review The new law would maintain tax-exempt status for hospitals and hospital charges. It prohibits hospitals from billing without facilities that treat “patients who are acutely ill or the victims of Oregon Health Authority approval, unless the charge is equal to accidents,” according to its language. or less than the Medicare payment rate. Medical clinics and doctors’ offices owned by a hospital chain The system is similar to one in place since 1993 in Maryland, could receive a partial exemption if the Oregon Health Authority “the only state without substantial increases in hospital costs,” judges that charity care is being provided there, and that charity Beyer said. care accounts for at least 15 percent of the gross annual patient Donna Kinzer, executive director of the Maryland Health revenue of the nonprofit hospital chain that owns the property. Services Cost Review Commission, spoke via speakerphone. That may be a tough bar to reach. Charity care has fallen to 2.5 “It’s led to limited growth of costs and a stable and predictable percent of gross hospital charges in Oregon, less than half what payment system for hospitals,” Kinzer said. it was at its peak in 2009, thanks in large part to the Medicaid expansion.

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HB 3034 is sponsored by the House Revenue Committee, but Senate Bill 144 flew through every hurdle this year by no hearing has yet been scheduled. The committee’s chair, Rep. unanimous consent but passage did not come without problems Phil Barnhart (D-Central Lane and Linn Counties), declined to last year when an effort to get a similar law passed failed after comment on the legislation, referring questions to Walruff. opposition from leading insurers and the Oregon Association of Hospitals and Health Systems. Walruff said the bill provides a necessary update to the state’s tax laws, given that the historic role of hospitals has changed. A post-season work group formed by the Telehealth Alliance of Oregon, which included insurers, hospitals and the state Office Hospitals used to be the only places where poor people could of Rural Health, was able to reach a near-consensus for the 2015 receive care, he said. With the Affordable Care Act, fewer people session, with opposition coming from only a pair of insurers need to rely on charity for health care. – Regence BlueCross BlueShield and Health Net Health Plan, “History lessons show us that hospitals and medical services which sought to delay the mandate until 2017. ended up in the charitable statute because if you had money, Assuming Gov. Kate Brown signs the bill, the law will take effect the doctors came to you. Nonprofits formed hospitals so poor in January. It does not require insurers to pay providers the same people could get the care that they couldn’t get because a doctor for a remote visit as an actual office visit; it merely requires them wouldn’t come to them,” Walruff said. to be compensated at some level, based on contract negotiations. The Oregon Association of Hospitals and Health Systems Len Bergstein, the lobbyist for the Portland-based quick-service opposes the measure, with a spokesman calling it a “backdoor clinic Zoom+, was excited at the passage of Senate Bill 144. tax on Oregon’s community hospitals to fund Oregon’s counties.” “We’ll be opening up a lot more telemedicine services,” Bergstein “In 2013, Oregon’s hospitals provided $1.9 billion in community said. “[Health plan members] will have a certain number of benefit, including providing charity care to hundreds of telemedicine visits that will be built into the plan that they buy.” thousands of Oregon’s most needy residents. Our analysis shows that this bill would force hospitals to either increase spending Because of the cost savings from telemedicine, the insurance by $2.8 billion or pay property taxes,” said OAHHS Director of plans offered by Zoom+ will have a select number of telemedical Public Affairs Philip Schmidt. visits available for members at no additional costs. “Either way, the cost of care would rise significantly. As a result, Zoom+ recently changed its name from ZoomCare; the clinic this back door property tax would be a huge blow to Oregon chain was founded in Portland in 2006 and soon spread to residents’ ability to access health care and potentially damage the Salem and Washington state. It briefly had clinics in Boise, very access we have all worked so hard to create,” Schmidt said. before leaving Idaho. Bergstein said Zoom+ has plans to expand into California. Dennis Thompson is a contributing health care reporter based in Salem. Local healthcare activist Dr. Kris Alman raised concerns that existing telemedicine technology would leave Oregon patients vulnerable to security breaches, but Bergstein said the federal Telemedicine Bill Passes HIPAA law was strict enough to make state laws that ensure cybersecurity of video-chat services unnecessary. House: Requires Payment “The penalties at the federal level force providers and insurers to make sure we are fully securing patient privacy and security,” for Videochat Healthcare he said. Zoom+ has already been offering telemedicine and by Chris Gray complying with those requirements. SB 144 just opens up the The Lund Report option for all private insurance policyholders. May 28, 2015 A sweeping telemedicine law won final passage in the House Legislature Appears Set Thursday, requiring insurance companies to pay providers for healthcare services that are delivered via secure, synchronized video chats. to Require Certification “I think you’ll see a revolution in the way that health services are for Scrub Techs delivered by this technology,” said Rep. Knute Buehler, the Bend by Chris Gray Republican and physician who’s been a champion of this very The Lund Report 21st Century approach to medicine. May 22, 2015 Oregon will join Alaska in allowing patients to receive It’s been a long time coming, but legislation looks promising that telemedicine from anywhere, improving an existing service that will require Oregon hospitals and clinics to use only certified allows for telemedical care between facilities, such as a clinic in “scrub techs” or surgical technologists. eastern Oregon and Oregon Health & Science University.

2015 LEGISLATIVE REPORT | 53 SELECTED NEWS COVERAGE House Bill 2876 requires the techs to have completed a The hospital association initially opposed the bill, with lobbyist nationally accredited education course, show training in the Patty O’Sullivan noting rural hospitals may be hard-pressed armed forces, or show they have at least two years’ experience to find scrub techs with previous training and some surgeons by July 2016. They must also achieve national certification. As preferred to “grow their own.” But she changed her mind on the with other professions, scrub techs will need eight hours of last point after speaking with Buehler, who informed her that continuing education a year to remain in good standing. some surgeons train their own people only because the techs some hospitals provide are not well-trained. Scrub techs are essential players in the operating theater, ensuring that a surgeon has all the tools at the ready. Tara Kruse, a surgical technologist at McKenzie-Willamette Hospital in Vaccinations, Medicaid Springfield, said the work has become more complicated, with the number of tools a surgeon may need rising from about 30 in 1995 to as many as 1,000 today. and the bill Pharma killed by Elizabeth Hayes The techs are charged with passing instruments, equipment or Portland Business Journal supplies; sponging or suctioning an operative site; preparing and July 10, 2015 cutting suture material; transferring fluids or drugs; handling specimens; holding retractors and other equipment; applying From the outset, the 2015 Oregon Legislative Session didn’t look electrocautery to clamps on bleeders; connecting drains to to be a game changer in terms of health policy or delivery. suction apparatus; applying dressings to closed wounds; and But the bills that passed will collectively impact millions of assisting in counting supplies and instruments, including Oregonians in big and small ways, from regulating e-cigarettes sponges and needles. to tracking toxic chemicals in toys. But even as doctors, nurses and certified nursing assistants must “Incremental progress was made on a number of fronts,” said meet a certain level of efficacy, surg techs have flown under the Jesse O’Brien, health care advocate for the Oregon State Public radar in Oregon, with no standards in place to ensure they’re Interest Research Group. “Health care consumers have a lot to qualified to do the work. be happy about, but there’s a lot to be done.” Kruse said surgical technologists had been working on such Jesse O’Brien, health care advocate for OSPIRG legislation since at least 2000, but each time failed to gain traction. They finally got the green light to improve patient Biggest hit: HB 2468 safety while demanding a level of professionalism, after working with Rep. Mitch Greenlick, D-Portland, and particularly Rep. What it does: Requires insurers to maintain a sufficient network Knute Buehler, R-Bend, who understands their role better than of providers. anyone in the Legislature. Why:“The legislative language that passed is a bit of a “He’s an orthopedist from Bend, and I think it shows his compromise, but it’s a big step in the right direction. But in the commitment for patient safety,” Kruse said. end, consumers will benefit from increased transparency and accountability, so that’s something to celebrate.” “They are really the right hand of the surgeon doing a procedure,” Buehler told his colleagues when House Bill 2876 Biggest miss: SB 891, which would have required clinics and cleared the House in late April. A vote in the Senate Health hospitals to list their prices and give real-time estimates. Committee is scheduled for Monday. Andy Van Pelt, executive vice president, Oregon The Oregon Association of Hospitals and Health Systems came Association of Hospitals and Health Systems on board with House Bill 2876 after it won an amendment that clearly delineates exceptions for rural health hospitals. Biggest hit: HBs 2395 and 5526 Such facilities -- located less than 10 miles from a city of What they do: Fund Medicaid, including a hospital provider 40,000 people -- won’t be left off the hook completely, because tax, which makes up 27 percent of the budget and translates to uncertified surgical technologists will have to go through 83 percent of the Coordinated Care Organization’s funding. training while they work, and eventually must be certified. Why:“Those together are pivotal to make health care in Oregon Don Dreese, an Army-trained scrub tech at Legacy Meridian work. We are really proud to be part of funding Medicaid. One Hospital in Tualatin, said there are only two accredited civilian of four Oregonians receive their health care through Medicaid. programs currently in Oregon, one at Mt Hood Community Without that, where are we?” College in Gresham and the other at the private Concord Career College in Portland. Part of the delay for rural areas was to Biggest miss: Solving the mental health crisis, both funding and allow for the development of educational programs outside the capacity. “We had a lot of starts, but never any meaningful or Portland metro area. concrete conclusion.”

WWW.OAHHS.ORG | 54 SELECTED NEWS COVERAGE Felisa Hagins, political director for SEIU Local 49 State Wrangles With Biggest hit: SB 474 What it does: Requires all Oregon employers to provide paid Measuring Hospital sick leave for employees. Why:“As far as being transformative to people’s personal health Performance and health of kids, this almost seems like infectious disease by Kristian Foden-Vencil control. It’s going to have a profound impact.” OPB June 27, 2015 Biggest miss: HB 3517, which would have ensured health care access for all children in Oregon. “It’s fear mongering and racism An effort to gauge the success of Oregon’s hospitals is proving that killed that bill. It’s shameful.” harder than expected, and now the state is thinking about changing the way its performance is measured. Tom Holt, director of government affairs, In order to know whether Oregon’s health care transformation Cambia Health Solutions is working, hospitals have to track their activities. One way is to Biggest hit: SB 900 measure readmissions. What it does: Requires the state to set up a website with A readmission is when someone is treated in a hospital, but has aggregated data on median prices for common health services, to return within 30 days, which could suggest the treatment paid by commercial insurers. wasn’t successful. Why:“It addresses that small part of the market, 5 percent, who But Lori Coyner of the Oregon Health Authority said sometimes don’t have any form of coverage. They ought to be able to know patients need to be readmitted for good care — and hospitals are what something’s going to cost. We thought that was a good start being penalized for it. and reasonable way to leverage information available.” “There is something called planned readmissions, and an Biggest miss: HB 2026, which made it easier for patients to example there would be cancer patients who have regular access bio-similar drugs that are essentially generic versions of admissions for getting chemotherapy,” Coyner said. “They would expensive prescription drugs. “It would help drive down costs be counted as readmissions when you’re counting all causes.” in one of the most expensive segments. Pharma killed it. They At a meeting Friday, the Oregon Health Authority’s Performance put a lot of time and effort into it. The building was full of their Metrics Committee recommended those beneficial readmissions lobbyists.” not be counted against a hospital. Sen. Elizabeth Steiner Hayward, family medicine It’s also recommending that to get incentive pay, Oregon doctor and member of the Senate Committee on hospitals have to decrease their readmission rate by 3 percent. Health Care Biggest hits: HB 3343 and SB 2879 What they do: Requires health insurers to pay for a year’s worth of birth control at a time and allows women to obtain the pill from a pharmacy, without a doctor’s prescription. Why: Eighty percent of women use hormonal contraceptives at some point in their lives. “This (SB 2879) is a really big deal. It’s a win for everybody. I think those two pieces together are significant.” Biggest miss: SB 442, which she sponsored and would have eliminated non-medical exemptions from vaccinations. However, SB 895, did pass, and it requires schools to post immunization rates. “My hope is we’ll see a reduction of our overall under immunization rate and see important conversations starting.”

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WWW.OAHHS.ORG | 56 Be Informed. Knowlegable advocates are effective advocates. Visit our website at www.ourhealthoregon.org for information on current …because Oregon’s future begins with our health. health care topics and issues. Our Health Our Community seeks to foster healthy Oregon communities by advocating on behalf of those who receive, work for, and care about health care in Oregon. Our Health, Get Involved. Our Community will serve as a place to learn about significant issues affecting the health care system and will provide tools Let’s work together to for advocates to become a vibrant and effective voice for ensure legislators have the Oregon’s health. facts to make informed decisions to better our We are committed to providing timely and accurate health care systems for information on important health care topics and issues, by patients, staff and the making available the following tools and resources: community. Connect with us on Our Core Beliefs Facebook to learn ways to get involved. P Sustainable Health Care Funding P Patient Empowerment Join us today. P Preventive Care Visit us online and add your name to the P Access to Care thousands of Oregonians P who are ready to advocate Coordinated Care for healthy communities. P Evidence-based, safe care

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Our Health Our Community is a non-profit grassroots advocacy program of the Oregon Association of Hospitals & Health Systems, seeking to foster healthy Oregon communities by advocating on behalf of those who receive, work for, and care about health care in Oregon.

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