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Strategies for better health care
By MIKE FERGUSON
Of the Baker City Herald
A new plan could lead to better, more affordable health care options for Baker City and County residents.
Building on a community forum held last November to identify perceived shortcomings in the area's health care delivery system, a group of volunteers has developed five initiatives to help plug the holes and promote healthy lifestyles.
The Community Health Improvement Partnership (CHIP) has concentrated its work in five key areas, according to co-chairs Don Hanna and Denise Ransom.
o the overuse and misuse of the emergency room at St. Elizabeth Health Services by people seeking care they could be receiving from a primary care physician. That was a factor that led to Baker County's designation as a "medically underserved area" and could lead to, among other things, higher Medicaid and Medicare reimbursements for area physicians. That, in turn, could promote the recruitment of new physicians to the area.
o support groups for cancer patients and their families, together with an effort to provide more cancer treatment especially chemotherapy locally.
o a reduction in substance abuse, particularly adults furnishing drugs and alcohol to minors.
o affordable health insurance, including a high deductible health plan that small business owners and individuals could purchase together.
o a healthy lifestyles booklet to publicize the healthy activities available in the county.
Baker County was the third community in the state selected last year for the CHIP program by Oregon Health and Science University's Office of Rural Health.
The five initiatives are based on eight health care priorities that about 90 county residents developed during an evening forum Nov. 27, 2001. After the forum, the CHIP committee surveyed area physicians and interviewed about 75 people before developing their initiatives.
The strength of the CHIP process, Ransom said, is that the initiatives were developed by area residents and not just by health care professionals.
"It's wonderful that the community helped discover what we needed," she said. "The health care professionals on our committee have a lot of knowledge, but the community input has really made people feel important."
Some of the eight priorities were combined to narrow the focus down to five areas, Ransom said.
"It's nice to be able to finally zero in on these aspects after doing a lot of the groundwork in the past year," she said. "It's going to be fun from here on out as we take care of each of these needs."
Some critical decisions remain
Now that Baker County has been designated as a medically underserved area, administrators at St. Elizabeth Health Services will have to decide whether the hospital will seek to become a Federally Qualified Health Center (FQHC) or be a partner to a Rural Health Clinic.
"The hospital is interested in pursuing (the two options)," said George Winn, St. Elizabeth's president and chief executive officer. "We're just not sure how to do it."
The rural clinic option comes with fewer federal strings attached, Hanna said. To designate St. Elizabeth as an FQHC, the hospital would have to add mental health and dental services, he said.
That's the federal stick. The carrot is a cash infusion of about $650,000 annually.
If a new rural clinic is constructed, it won't require a separate board to run it, as an FQHC would. It also wouldn't have to provide mental health and dental services.
"It would be run more or less like things are run now," Hanna said. "You just don't get the chunk of cash."
That chunk of cash would require more highly detailed reporting on patients, however, something that doctors aren't presently required to do.
"But a real advantage is that it would allow us to set market rate salaries" for health care providers," Hanna said. "It would take some of the risk out of setting up a practice in Baker County."
Part of that risk is the low level of federal reimbursement for care of Medicaid and Medicare patients. Both at the Baker Clinic and the hospital, Medicaid and Medicare reimbursement rates don't come anywhere near the actual costs of delivering health care, according to St. Elizabeth's chief financial officer, Jeff Daniels.
Medicaid the federal government program that pays for the health care of the nation's poor pays just 10 to 15 cents on every dollar billed to the program by the clinic, Daniels said.
For Medicare patients those people 65 and older the reimbursement rate at the clinic is about 35 percent, he said.
Cancer: Cancer support groups are being formed, and cancer survivors are ready to share their experiences with patients who have been recently diagnosed with cancer.
Insurance: The way to get health insurance coverage for more business owners and other self-insured individuals may be related to federal Medical Savings Accounts, according to Richard McKim, office manager at the Baker Clinic.
A high-deductible health plan could involve perhaps 100 people who would pay a set amount in advance for routine medical services. That, too, would keep patients out of the emergency room and give physicians a predictable revenue stream, he said.
"There are some viable options, but they are not easily discovered," Ransom said.
The committee working on the initiative plans to hold a forum with health professionals and health insurance experts to discuss ideas about selling lower-cost insurance to people who are uninsured, she said.
Substance abuse: Ransom said she hopes a play called "Opening Windows" can be staged locally to stimulate thinking among teen-agers on substance abuse. The play, which she says "shows vignettes of how kids can get themselves into trouble and get themselves out of trouble," would be performed by local actors.