Bill would press Lane doctors to take Medicaid patients

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SALEM, Ore. (AP) — Lane County-area legislators are trying to put the pressure on Lane County doctors to take on more low-income Oregon Health Plan-insured patients.

The move is aimed at addressing a problem created by the rapid expansion of the rolls of OHP — the state's Medicaid system — under the federal Affordable Care Act.

In Lane County, tens of thousands of low-income residents have signed up for state-funded OHP insurance, but many doctors refuse to take them on as patients because they are too busy with their existing private-insurance patients, or because OHP payment rates to doctors are too low.

Local legislators are pushing a bill to help Trillium Community Health Plan, the private, for-profit organization that runs OHP in Lane County, deal with the shortage of primary-care doctors willing to treat OHP clients.

Under House Bill 3300, which would apply exclusively in Lane County, primary care doctors would be allowed to serve public employees and teachers on state-sponsored health insurance plans only if at least 15 percent of the doctor's total patient caseload were patients insured by OHP.

Advocates say the new requirement would provide an incentive for more local doctors to open their doors to OHP patients — on whom doctors receive relatively low reimbursement rates — because they wouldn't want to lose their ability to treat the large local pool of public employees, on whom private insurance companies pay much higher rates.

Lane County's OHP population has mushroomed to almost 96,000 from 57,000 since the implementation of the federal Affordable Care Act, and Trillium has struggled to find enough primary care doctors to treat all those patients. Around 13,000 of those residents currently don't have access to primary care doctor.

The proposed fix, HB 3300, would have originally applied statewide, even though most other Oregon counties haven't faced such significant doctor shortages for OHP patients.

The proposal received little attention this session, however, and appeared set to die in mid-April, despite Trillium lobbying for the change and support from PeaceHealth, which owns and operates four hospitals in Lane County.

But it's now been revived in the House Rules Committee, which is led by House Majority Leader Val Hoyle, a Eugene Democrat. The rules committee approved the bill with little discussion on a 6-3 vote Monday, sending it to a joint House-Senate budgetary committee.

Hoyle said the policy makes more sense as a Lane-County-only "pilot project" because of the county's "critical shortage of primary care doctors." Under the amended bill, the new requirement would expire in 2020 unless the Legislature renewed it after reviewing its impact.

Asked if the bill has enough support to become law this session, Hoyle said: "It's worth consideration."

Opponents say the strategy will hurt doctors, in particular small practices that will have a harder time absorbing the cost of seeing new low-reimbursement OHP patients. Public employees and teachers, meanwhile, could potentially lose their primary care doctors if a practice declined to up its OHP patient caseload to the required 15 percent threshold.

"I have real questions about the appropriateness of this methodology," said Rep. Bill Kennemer, an Oregon City Republican who voted against HB 3300 Monday.

Others have argued that the real problem is the low amount the state pays doctors to treat OHP patients.

"Working with a stick is much more difficult than a carrot," said Rep. Cedric Hayden, a Roseburg Republican, at an April hearing on the bill.

But proponents say the problem is that some Lane County doctors refuse to see their fair share of OHP patients.

Jane Conley, an administrator at Springfield Family Physicians, said at the April hearing that OHP patients now make up 35 percent of her practice's caseload, up from 18 percent since 2013.

But other medical practices have not followed suit, she said. Because of the overall shortage of primary care doctors, "it's easy for a provider to carve out a practice that has only the best-paying (private-insurance patients) in it," she said.

Added Alan Yordy, PeaceHealth's president, said: "The system works as long as everyone shares in (serving) their respective portion of each patient type."

HB 3300 "asks the state to set some quid-pro-quo" between doctors seeing OHP patients and having access to state employees and teachers whose insurance pays the doctors at higher rates, Yordy added.

Rep. John Lively, a Springfield Democrat who sponsored the bill, said the proposed 15 percent threshold is still lower than the overall share of Lane County residents on OHP, which is between 18 and 19 percent.

Lively said he understands those who argue that if OHP paid higher rates for doctor visits and other medical activities, more doctors would be willing to take on OHP patients.

But "to up the rates, the money has to come from somewhere," he said, and the state's future health care budgets already face challenges as federal funding for them declines.

Despite the late movement in the rules committee, Lively said he still feels the bill is "a long shot."

"I'm frustrated that we haven't had more public conversations about how this approach might work," he said.


Information from: The Register-Guard,

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