Legislators Skeptical of Primary Care Transformation

February 16, 2011 -- Oregon’s broken healthcare system can be transformed by focusing on community-based primary care, according to doctors and advocates who testified before the House Health Care Committee February 9.

 

But Rep. Jim Weidner (R-Yamhill) dismissed the idea as an ineffective gesture “that doesn’t mean a lot” given the larger systemic issues facing Oregon’s healthcare system.

 

“Reimbursement rates are going down to doctors, who may be thinking, ‘Why should I practice here if I can get reimbursed more in Washington and not even have an income tax?’” he asked. “I wonder if we have a much larger issue that we should be looking at rather than this legislation.”

 

Weidner was referring to two measures -- House Bill 2401, which would create a statewide network of family medicine residency training programs, while House Bill 2397 would establish a primary care transformation research and training center at Oregon Health & Science University to document statewide efforts and also train people to assist medical practitioners in rural areas.

 

However, Dr. John Saultz, who chairs OHSU’s Family Medicine Department, said, “The data is close to conclusive that substantial improvements in primary care is a way to get more care to more people at a lower cost. We can incentivize more programs to open and lower the costs of operating them if we can get them to share resources.”

 

Saultz spoke about OHSU’s “offsite” training programs in Klamath Falls and Grants Pass as examples of successful family medicine residency training programs.

 

He urged legislators to consider House Bill 2401 as a way to extend these programs to “rural communities and small hospitals that depend on family physicians to provide the majority of healthcare services locally” – the patient-centered primary care home model touted nationwide as an example of the integrated healthcare system leaders are striving to create.

 

Legislators, ever wary of new initiatives with no description of the dollars involved, voiced their concerns with the legislation.

 

“Is this going to do enough to deal with the bigger-picture problem of funding graduate medical education?” asked Rep. Ben Cannon (D-Portland).

 

Saultz pointed to House Bills 2400 and 2397, which would provide more funds for loan forgiveness and repayment.

 

There’s another reason Saultz is looking to spread the wealth outside OHSU: In 1997, the federal government put a cap on the number of residency positions that can be created at a single hospital. OHSU can’t create more positions in-house, or its Medicare dollars would be revoked. However, hospitals that don’t have a residency program can do so, and become eligible for federal funding.

 

Another advantage of a statewide network, said Saultz, would be the supportive infrastructure for medical residents created by a “larger pool of people supporting training of the physicians,” as well as the cost savings potential of many programs sharing resources.

 

He cited the University of Washington’s family medicine program, which has 16 residency programs in four states, as a model for a “distributed network” that reaches underserved rural communities, shares resources across programs and provides on-the-ground support to medical students.

 

Determining the effectiveness of these efforts is a key component of House Bill 2391, also known as the “primary care transformation initiative.” Besides funding research and evaluation systems to evaluate localized primary care efforts around Oregon, it would establish an interdisciplinary continuing medical education program, run by a public-private partnership between OHSU, the Office of Rural Health and other organizations, where training would bring together nurses, physicians and mid-level providers to learn key techniques.

An existing program, the Rural Locum Tenens Cooperative, would also receive funding to expand its network of temporary providers to 10 additional sites around the state, and allow locum tenens to take on longer-term assignments (2-4 months) with loan repayment available from the National Health Service Corps.