Spanning the State: "Perverse Incentives" by: nothstine Sun Oct 25, 2009 at 15:33:25 PM PDT

In the arcane and shifting process of health care reform, it can be pretty hard to say when anyone's scored a victory, even a small and possibly short-lived one. But that may have happened last week for Oregon and several other states where medical care is comparatively cheap and efficient: In simplest terms, the change announced Thursday would reward Medicare providers on the quality of their services rather than the volume. Since Oregon averages fewer procedures than many other state, it has received fewer Medicare dollars even though quality of care has been high. [...] Rep. Earl Blumenauer is joined by Rep. David Wu and other members of the Quality of Care Caucus to praise new language in the House health care bill that would change the way Medicare reimburses doctors and hospitals. The agreement announced Thursday would address another longstanding complaint as well -- geographic disparities that lawmakers say penalize hospitals and doctors in certain areas. With hundreds of billions of dollars at stake, it would rely on recommendations from neutral experts to drive sweeping changes. The deal calls for two expert studies on changing how Medicare pays hospitals and doctors. One would address geographic differences in payment. A second - and more crucial one - would reset how Medicare pays hospitals and doctors to reward quality, not just volume. The studies would be carried out by the Institute of Medicine, which is affiliated with the National Academies of Science. The institute's recommendations could not lead to an increase in total Medicare spending. They would be carried out unless Congress objects. Oregon's House delegation is pleased, something that hasn't always been the case in the sausage-making process: Says Earl Blumenauer: "This is a huge victory for states like Oregon that provide high quality care at lower costs. [...] These perverse incentives burden people in more efficient, low-cost regions such as Oregon, where we have had to subsidize expensive and unnecessary treatments in high cost regions" David Wu is also happy, although you have to read his statement carefully to get that: "The shift to a Medicare payment system that is based on high-value care means we will move away from the volume-based system that has exasperated geographical disparity in payments to our physicians, leading to millions of American seniors not being able to find a doctor," But the celebration will be short-lived, because now the battle advances to the next stage:  Neither Senate health care bill includes similar language, and it's not clear whether the final version will keep the Medicare reimbursement changes.   Time to Span the State. [More after the jump.]

nothstine :: Spanning the State: "Perverse Incentives"

--------------- Going organic: Oregon's Dept. of Agriculture can now certify qualifying Oregon farms as organic. The certification process has been available to Oregon farmers, for a small fee, through private entities and through Washington's state ag department, but now Oregon has become the 16th state to offer the certification as a state service. Oregon's organic farm sales jumped from around $10 million to almost $90 million between 2002 and 2007. --------------- Oregon gas prices rose a little over 6¢ this week, to $2.743 gal. Cheapest reported pump price:  $2.49/gal, at the Arco station, 18030 E Burnside St & SE 181st Ave, in Portland. Highest reported pump price:  $2.99/gal, at both the 76 station, 460 S Valley View Rd & I-5 (Exit 19) in Ashland and across the street at the Shell station, 461 S Valley View Rd & I-5 (Exit 19), also in Ashland.   Usually, when neighboring stations have a price war, doesn't the price go down?  What am I missing here? --------------- Jihad and canning: The story of the al Qaida training camp in Bly has taken a turn that's just odd: he trial of a man convicted of plotting to help recruit for al-Qaida has provided the fullest account yet of what went on a decade ago at a terrorism training camp in Oregon that never came to fruition. According to the trial record, Oussama Kassir was enraged after first arriving at the Dog Cry Ranch near Bly, about 230 miles southeast of Portland, in December 1999. He expected to be welcomed by Muslim recruits, eager to learn the ways of war. Instead, he got an Islamic leader from Seattle, a mentally impaired 18-year-old, and two women more interested in canning jars than jihad. He expected access to a weapons armory. He got one pistol and a .22-caliber rifle. Kassir recently was sentenced to life in prison for his involvement in the camp, which was intended to be an Islamic fighter training base but never fully materialized. --------------- This global warming news might make the Chamber of Commerce happy--if only they believed in global warming: According to a study by OSU and the Forest Service, rising average temperatures may lead to a productivity increase in high-elevation forests in the Pacific northwest. Unfortunately, the study predicts that the same climate trends would come at the cost of a decline in lower elevation forest growth--where the majority of the region's timber harvest is centered. Overall, forest productivity could increase about 7 percent annually in forests west of the Cascade Range and 20 percent in forests east of them under one scenario that researchers said largely reflects current trends of energy use, globalization and economic growth. However, the study did not take into account management practices, disease, insects and fire, which can affect productivity and could also be affected by climate change. "There's a lot of variability here, depending on which climate scenario turns out to be most accurate and what policy changes are made as a result," OSU professor Darius Adams said in a statement. "And there are dramatic differences in forest regions and elevations. Clearly the forest growth is likely to increase the most at higher elevations, but it's worth noting that those forests never had very high growth rates to start with." --------------- Wind shift for Oregon energy? That breeze at the back of Oregon's emerging wind-power industry might be fading: Oregon ranked second among states -- behind only Texas -- for the amount of wind power capacity installed in the third quarter, the American Wind Energy Association said today. And the state now ranks fifth for the total amount of wind power in place, with 1,659 megawatts. Texas leads the nation, with 8,797 megawatts. (One megawatt of wind power is about enough to power 200 homes.) But, despite the increased generating capacity, and the federal stimulus money supporting wind power, the manufacturing infrastructure behind it is becalmed: While the amount of wind power installed in the third quarter of this year is more than that installed in the same period of 2008, the industry association said wind turbine manufacturing is down compared with last year. And the association said the amount of wind power projects under construction right now is less than what was under way at this time last year, despite a boost from federal stimulus money. In recent years, wind power has gone from meeting about 1 percent of the Oregon's energy use to about 7 percent, according to the Oregon Department of Energy. --------------- Progress: Oregon will soon be the first state with an online Physician's Order of Life-Sustaining Treatment registry: Oregon Health and Science University officials say the purpose of the registry is to ensure that medical personnel can obtain quick and accurate information about a patient's health care wishes. Officials say a paper form submitted to the physician orders for life-sustaining treatment, or POLST, program at OHSU is converted to electronic form in a registry that paramedics and others can use to determine medical instructions when a patient is incapacitated. West Virginia and 30 other states are planning to follow suit. --------------- What's worse than a shortage of nurses? A shortage of nursing school faculty shortage of nursing school faculty to train a new generation of nurses. But Oregon has a plan, and other states have noticed: A predicted national shortage of nurses in the next decade could be made worse by a shortage of the experienced nurses who train them at community colleges and universities around the country. In response, nursing education leaders from 11 states are gathering in Portland this week to find ways to boost the number of faculty in nursing programs. The Oregon model they'll study blends the curriculum and faculty of community colleges and universities to give nursing students in two-year associate degree programs a chance to earn bachelor's degrees. The more nurses with bachelor's, the greater the number expected to go on to advanced degrees and teaching, educators say. "We really are one faculty and a common curriculum," said Christine Tanner, a professor at the Oregon Health and Science University School of Nursing. Eight community colleges have joined OHSU to create the Oregon Consortium for Nursing Education, allowing students in rural areas of the state to complete their coursework for a bachelor's while remaining in their community. --------------- The somewhat-good news: Oregon no longer is one of the four states with the highest unemployment rate in the country. Oregon's unemployment rate dropped in September to 11.5 percent from about 12 percent in August. State employment officials said last week that the number of unemployed Oregonians actually fell in September to about 211,539 people, down from 231,197 in August. They were unable to explain the drop, even though September usually sees a decline in the labor force as people go back to school. During the past 12 months, Oregon's labor force, which includes about 1.96 million people, has declined by 6,769 people. September's unemployment rate was the lowest since February's 10.7 percent, and down from a high of 12.2 percent in May. A year ago, the state's unemployment rate was 6.8 percent. The states with the lowest unemployment rates are North Dakota (4.2%), South Dakota (4.8%) and Nebraska (4.9%). -------------- Update: Do you feel lucky? Once again, Oregon will be in the cruel position of raffling off access to the Oregon Health Plan for some--but by no means all--of the 141,000 uninsured Oregonians. The good news, such as it is, is that entrants will have about a 1-in-4 shot at winning a chance to qualify for coverage in the state program.  When we tried this the first time, in early 2008, the odds of landing a chance to qualify for coverage was around 1 in 27.  So I suppose that represents progress. As I asked back then: Is this really the best we can do? --------------- Tune in to the Morning Show on KPOJ AM620 tomorrow morning between 7.30 and 8.00 to hear Carl, Christine, and Paul match wits with TJ on the weekly Spanning the State Limerick Challenge!   ---------------

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