Editorials from Oregon newspapers
The Oregonian, Dec. 29, on Oregon lawmakers' effort to overhaul health care:
The cliffhanger of the 2012 legislative session was last-minute passage of Gov. John Kitzhaber's high-concept plan to streamline but improve health care delivery to folks on the Oregon Health Plan.
The cliffhanger in 2013 won't occur in one white-knuckle moment in the Legislature, however. Instead, it will be throughout Oregon through the year, in daily tests of how well some 600,000 Oregonians on Medicaid are served as costs are contained and prevention emphasized.
It's rubber-meets-the-road time for the several coordinated care organizations, community-based networks of providers that must work within a strict budget and show gains, not losses. Each CCO must file by Jan. 15 a plan to state officials that shows how it will help weave together fragmented physical and mental health services within local service areas while showing measurable thrift and solid results for patients.
Meanwhile, hospital systems with long histories of treating Medicaid patients are in some cases still trying to figure out how more tightly controlled reimbursement practices will pencil out and how their doctors, historically accustomed to fee-for-service work, will adjust. If there isn't palpable tension over how health care transformation will work, there is in some quarters an audible drumming of the fingers.
Oregon has much riding on the effort. Only this month, a $1.9 billion pact between the U.S. government and Oregon was signed, and the deal requires that Oregon fulfill a pledge Kitzhaber made in a trip to Washington, D.C., earlier in the year: Give us the money with new flexibility in how it's spent, and Oregon will show proof of better health outcomes and reduce overall Medicaid costs at the same time.
It's the proof part where things get tricky. Oregon's plan depends not only on metering services by doctors and clinicians but in documenting how well procedures and services work and in some cases linking reimbursement to the outcomes. Did the patient get better? Did the patient have, say, fewer asthmatic episodes over a fixed period of time and avoid expensive trips to the local emergency room?
Separately, but no less pertinent: How much less is spent in the medical system as we know it by addressing causes rather than symptoms?
The potential shift in the allocation of Oregon's healthcare dollars is huge. But it is also daunting.
Norman Gruber, president and chief executive officer of Salem Health, a system comprising Salem Hospital, says: "Transforming what we've created over the last 50 years is not going to happen overnight. I'm not convinced the CCO structure changes the way people behave. What we've got going on is: Who gets what piece of the pie?" Gruber has hired a consultant who will, by Jan. 15, outline an alternative model to achieve efficiency and to motivate participating providers.
But several CCOs around Oregon report nothing less than gung-ho success going into the new year. Community physical and mental health assessments are under way in Jackson, Josephine and Curry counties — with 84 percent of primary care providers already certified and ready to work under new, evolving rules, according to Gail Hedding of the AllCare Health Plan. And Yamhill County's director of health and human services, Silas Halloran-Steiner, reports that even though his region's CCO did not form until Nov. 1, "we have a robust group engaged in transformation — it's provider-led, and our early participating providers are both independent and hospital-based."
Of all the life-and-death concerns that could engulf providers and patients, a paperwork burden looms. Record-keeping from testing CCO providers against extensive care metrics, as well as stepped-up patient tracking, could become its own beast. Yet Bruce Goldberg, director of the Oregon Health Authority, recently pledged in a webinar to "eliminate, whack, destroy, reduce the administrative services that take health care workers away from working in their communities."
We'll take him at his word. We'll also look for the governor to follow through on his commitment, cited by Sen. Betsy Johnson in her dramatic and decisive vote to support health care reform, to support tort reforms in 2013 that could help limit doctor liability.
Meanwhile, Goldberg and his crew will soon examine each CCO's draft plan of action to ensure that the right goals are served by all and that Oregon has a shot at succeeding. Already he and Kitzhaber want to bring 200,000 more Oregonians into care under the OHP, at federal expense, reducing Oregon's population of uninsured citizens by more than 30 percent.
We support that, too. But like so many things involved in overhauling an entrenched medical system, that won't happen if folks aren't rowing in the same direction and even agreeing to get a little wet along the way.
The (Bend) Bulletin, Dec. 28, on the need to disclose more information about the state's Public Employee Retirement System:
Oregon's state transparency website was designed to give citizens a clearer look at their government, and last week it got a bit better at its job. It added several links to information about its Public Employee Retirement System.
The links take readers to a variety of documents that lay out such things as how much participating government agencies owe the system and what rates they will pay in the coming year.
Though the numbers and percentages vary widely from agency to agency, the overall picture is grim.
Oregon, its cities, park districts and other units of government collectively owe PERS $16 billion. Paying off that debt will take more from government next year than it did this, a trend that may not change anytime soon.
It's no wonder, then, that PERS reform is an extremely hot topic in Salem these days.
Gov. John Kitzhaber's reform proposals, as one example, would bring close to $1 billion to the state's coffers next year, money that schools and other agencies won't see without changes.
Kitzhaber's plan would cap cost-of-living increases, tapering them off as benefits rise above $24,000 per year. Of the $865 million Kitzhaber proposes to save, fully $810 million comes from that change.
The balance would come from changing the system so that retirees who do not pay Oregon income taxes do not receive extra money given for that purpose.
Yet reform is no slam-dunk, though it is more likely to happen if Oregonians make clear to their lawmakers that reform of the system is a priority statewide.
That's where the transparency website comes in.
Unless citizens can get a handle on the system, what it is owed and who owes it, it will be difficult for them to understand what different proposals mean to them and their neighbors.
The information on the state's website makes the task of sorting things out far less difficult.
Is it perfect? No. Despite a glossary, understanding what the numbers mean can be difficult for those who find numbers confusing.
Even so, it is far better than nothing, and interested Oregonians should take time to explore it at oregon.gov/transparency.
Corvallis Gazette-Times, Dec. 27, on the idea of making school days longer:
If you want to horrify your school-age children, here's a great way to do that:
Tell them that you think their school days should be longer. In fact, tell them you like the idea of school days that start at 8 a.m. and run to 5 p.m. — give them an hour or so for lunch — and let's even set aside a few hours for additional work on Saturday mornings.
Well, cue some horrified reactions: Five states have announced plans to add at least 300 hours of learning time to the calendar in some schools starting in 2013.
It will be a significant addition to the school year in those states — Colorado, Connecticut, Massachusetts, New York and Tennessee.
To see how significant, consider this: The state of Oregon requires that high school students get a minimum of 990 hours of instructional time in each school year. (The requirements are somewhat less for middle and elementary schools.)
The cost for the experiment in the five states giving it a shot will be paid by a mix of federal, state and district funds, with the Ford Foundation and the National Center on Time & Learning also chipping in resources.
The idea behind the experiment is fairly obvious: If you keep students in schools longer, they'll do better.
Education Secretary Arne Duncan, long an advocate for expanded school days, welcomed the experiment: "I'm convinced the kind of results we'll see over the next couple of years I think will compel the country to act in a very different way."
Well, maybe. We don't think the idea of additional school hours is necessarily a bad one, but we're not sure that it's a guarantee of higher performance for schools and students.
It's not always the number of hours in a school day but the quality of the instruction that's included in each hour that really can make the difference. If you're offering mediocre instruction in a seven-hour day, just adding another hour each day won't matter.
And that doesn't even get to the issue of how Oregon would pay for any kind of expanded school day — or even if this would be our first choice to improve our schools if we stumbled across some kind of windfall for education. In fact, many state school districts now are struggling to keep their doors open even five days a week, as witnessed by the number of districts experimenting with four-day weeks.
(Speaking of which, some districts are working to maximize the number of full weeks they offer on their schedules, with the idea being that shorter school weeks often wreak havoc with teachers' educational plans. It's a good initiative, considering how those shorter weeks often increase the burden on working parents.)
If the nation continues its experiment with longer school days, though, it might well be worth taking a look at restructuring or shortening summer vacation — after all, schools spend a lot of time bringing students up to speed after the lazy days of summer. And the need for lengthy summer vacations, frankly, is a relic of those days when all hands were required to labor on the nation's farms.
Shorter summer vacations? At the least, that's the kind of proposal that could elicit a whole new batch of horrified reactions from students.