Oregonians are bursting with pride over the state's role in healthcare this year.
That's because no fewer than four state native sons will lead some of the nation's most prestigious healthcare organizations during 1998:
John King, 58, president and chief executive officer of Legacy Health System in Portland, Ore., since 1991, becomes chairman of the American Hospital Association board next month.
Peter Kohler, M.D., 59, president of Oregon Health Sciences University, becomes chairman of the Association of Academic Health Centers in September. He will help guide members along the murky boundary between their need to teach students and their need to survive by competing in the private sector.
Timothy Goldfarb, 48, director of healthcare systems at OHSU, becomes chairman of the Council of Teaching Hospitals and Health Systems, an arm of the American Association of Medical Colleges, in November.
And Thomas Reardon, M.D., 63, a general practitioner from Portland, already is chairman of the American Medical Association; his yearlong duties will conclude in June.
The situation has people wondering what it is about the state, which has just 3.2 million residents, that causes it to produce so many healthcare leaders.
Kohler says the reason is Oregon's record of innovation: "Oregon tends to attract people who are interested in finding new ways to do things instead of defending the status quo." For example, managed care arrived in Oregon earlier than in most other states. The Oregon Health Plan was the nation's first formal rationing system for Medicaid, he points out.
"Clearly, Oregon is seen as really unique in a lot of ways and ahead of the rest of the country," says Kenneth Rutledge, president of the Oregon Association of Hospitals and Health Systems. "That adds credibility to people from Oregon." Rutledge adds, however, that the timing is partly coincidence: All four have been involved previously in national health policy discussions.
The best defense . . . Anthem, an Indianapolis-based insurance giant, has come out in favor of the consumer bill of rights proposed by President Clinton's healthcare quality commission, but only as long as the provisions of the document don't become part of federal legislation.
The voluntary adoption of the bill of rights comes just weeks after the state of Connecticut joined Kentucky in suing Anthem over what the two states contend was Anthem's illegal pocketing of $780 million in charitable assets from acquisitions of Blues plans in the two states.
Ohio's attorney general also is looking into Anthem's use of assets from a Blues plan in that state.
Fortunately for the company, the bill of rights doesn't address disposition of charitable assets after not-for-profits are purchased.
Follow the money. There is a big flap brewing in Washington over sex.
No, not the imbroglios you may have read about lately. This one is over sexual abstinence.
In a strongly worded letter sent to HHS Secretary Donna Shalala, several GOP leaders are demanding an accounting of how $50 million in funds earmarked for state sexual abstinence programs is being spent.
The funds were set aside in the welfare reform bill of 1996. According to the letter, some states have used the money to set up after-school sports programs they say will keep kids out of the house and therefore promote abstinence. Other states have established sex education programs.
The Republicans intimate in the letter that the White House has been purposely allowing states to spend the money on just about anything under the guise of abstinence promotion.
There has been no response from Shalala.
1998 or 1984? When is fraud and abuse not really fraud and abuse?
In a bit of spinning that George Orwell would have appreciated, the American Hospital Association has decided that phrases like "fraud and abuse" and "billing errors" will now be called "billing disputes."
It reminds Outliers of when the AHA refused to acknowledge that last year's balanced-budget law froze Medicare hospital inpatient payments. Instead, in AHA lexicon, Congress enacted a "zero update."
In the same spirit, Outliers has a few suggestions for other euphemisms the AHA and other healthcare groups could try:
Patient dumping would seem less scary as "admission priority management."
Self-referral could be "personal procedure maximization."
Profit would sound better as "funds set aside for future community benefit."
Unbundling would be nicer as "individual pricing strategies."
And last but not least:
Fraud investigations could be "a discussion of how to correctly interpret the Medicare provider manual."
Drugs `R' Us. In Lewisburg, Tenn., patients who never asked for a drug by name are suddenly demanding the cholesterol reducer Zocor from family doctor Clay Wilson, of Lewisburg, Tenn. People with allergies ask Los Angeles physician John Brodhead for Claritin. In Dallas, psychiatrist Madhukar Trivedi is fending off depressed patients who "need" Prozac.
When the Food and Drug Administration last year relaxed rules governing TV commercials for prescription medicines, it caused a surge in such ads. That led to an increase in the number of patients demanding drugs by name. It also led to a rise in doctors' temperatures.
"What happens is that the physician not only has to defend what he's going to prescribe, but he's got to defend what he's not going to prescribe," Wilson laments.
Many doctors agree, according to a recent survey of nearly 5,000 physicians by industry researcher IMS America and the Internet service Physicians Online. Nine out of 10 doctors in the survey said the same number or more patients asked for specific brand-name drugs last year. More than 60% want drugmakers to cut back or pull the plug on TV advertising.
Doctors concede the ads appear to bring in more patients. Besides, it's the doctor, not the patient, who writes the prescription, says Brodhead, who is also an associate professor of medicine at USC University Hospital.