HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

February 12, 2003   Hearing Room D

8:30 A.M. Tapes  25 – 26

 

MEMBERS PRESENT:            Rep. Jeff Kruse, Chair

Rep. Billy Dalto, Vice-Chair

Rep. Carolyn Tomei, Vice-Chair

Rep. Gordon Anderson

Rep. Jeff Barker

Rep. Laurie Monnes Anderson

 

MEMBER EXCUSED:            Rep. Ben Westlund

 

STAFF PRESENT:                  Sandy Thiele-Cirka, Committee Administrator

Mara McGraw, Committee Assistant

 

ISSUES HEARD:                     Informational Meeting

                                                Rural Health Overview

                                                Rural Hospital Architectural Assessment Progress Report

·         Ed Patterson, Oregon Rural Health Association

·         Don Nyberg, AIA Health Facilities Consultant

                                                Tele-Health Demonstration

·         Cathy Britain, Oregon Tele-Health Alliance

·         Ruth Giesking, St. Charles Hospital, Bend, OR

                                                Rural Health 101

·         Karen Whitaker, Director, Oregon Health and Sciences University (OHSU) Center for Rural Health

                                                Status of Rural Health Care Workforce

·         Dr. John Saultz, Director, Oregon Area Health Education Center (AHEC) Program

·         Greg Lander, Rural Emergency Service Enhancement Fund, AHEC

·         Scott Ekblad, Deputy Director, Oregon Office of Rural Health, OHSU

                                               

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

Tape 25, A

005

Chair Kruse

Calls meeting to order at 8:43 A.M.  Submits written testimony from Joel Ario, Department of Business and Consumer Services (DCBS) regarding HB 2021 (EXHIBIT A). 

INFORMATIONAL MEETING

034

Ed Patterson

Oregon Rural Health Association. Submits Small Hospital Architectural Assessment Preliminary summary (EXHIBIT B). Refers to HB 2515 (EXHIBIT C). Explains architectural assessments and small hospital needs.

103

Donald Nyberg

Consultant, AIA Architecture for Health  Presents survey results on small hospital architecture (EXHIBIT B):

  1. Seismic information.
  2. Air quality.
  3. Plumbing and Electrical code compliance.
  4. Americans with Disabilities Act (ADA) requirements.
  5. Patient care facilities

Explains structural and long range planning recommendations.

221

Rep. Anderson

Inquires on cost to replace facilities.

224

Nyberg

Presents typical costs. Estimates cost per square foot and per bed. 

242

Rep. Monnes Anderson

Questions nonprofit status of hospitals and existing funding mechanisms.

244

Patterson

Reports most of the hospitals are nonprofit. Explains bonding process for capital funding and other funding options. States need for financial profile per hospital to establish basis for bond market or to pursue federal funding.

282

Rep. Monnes Anderson

Inquires on federal options.

292

Patterson

Discusses fund planning via private sources and federal funds.  Explains Medicare fund options for critical access hospitals. 

324

Rep. Anderson

Questions federal plan to reinstitute Hill-Burton funding.

328

Patterson

Defers to Karen Whitaker. Refers to matrix (EXHBIT B), long range planning guide. Explains categorization of Type A and B hospitals. Refers to article on rural health in Oregon Business Magazine, October 2001 (EXHIBIT D).

367

Chair Kruse

Explains Medicaid Upper Limit (MUPL) funds deferred to education fund. Discusses other funding issues. 

405

Patterson

Details deferred funding.

420

Cathy Britain

Chair, Oregon Telecommunications Coordinating Council Health Care Committee, President, Oregon Tele-Health Alliance. Introduces telemedicine conference.

TAPE 26, A

011

Ruth Giesking

 

Via tele-conference from Bend, OR. Telemedicine Director, St. Charles Hospital in Burns, Oregon.

016

Bruce Brundage, M.D.

Cardiologist, Bend, Oregon. Presents via teleconference from St. Charles Hospital. Reviews telemedicine process and conducts a patient physical exam. 

062

Giesking

Places scan on screen and operates machinery enabling Dr. Brundage to view test results.

063

Brundage

Explains results to patient. Continues demonstration: electronic stethoscope (heart, lung and organ sounds are audible via telemedicine) and the high resolution camera (patient skin is visible via telemedicine).   

167

Giesking

Offers closing comments. 

176

Britain

Concludes and notes the importance of telemedicine in keeping patients in their community while offering specialty care.

193

Rep. Anderson

Inquires on cities currently using telemedicine. 

196

Britain

Explains Oregon network of telemedicine. Addresses reimbursement barriers. 

230

Karen Whitaker

Director, Office of Rural Health, OHSU. Submits overhead slide presentation (EXHBIT E). Defines ‘rural’ according to OHSU guidelines for rural health program. Reviews data on rural economy and rural health status.

351

Rep. Monnes Anderson

Inquires on rural health status related to tobacco. 

358

Whitaker

Responds on lack of research relating to tobacco use in rural communities. Discusses physician economic and workload status, Type A and B hospitals and critical access. Offers data on occupancy rates in rural versus urban hospitals.

TAPE 25, B

030

Whitaker

Continues presentation. Offers data on insurance status at discharge for patients and the average operating margin. Summarizes rural health operations, programs and legislation. 

095

Rep. Monnes Anderson

Inquires on hospital closure data. 

102

Whitaker

Explains clinics referenced are located outside of hospital area.

106

Rep. Dalto

Questions cost based medical reimbursement.

107

Whitaker

Explains reimbursement issues. 

124

Rep. Dalto

Requests clarification of cost reimbursement. 

127

Whitaker

Details new policy on cost based reimbursements.

141

Rep. Barker

Inquires on median income of rural residents.

140

Whitaker

Offers information on the calculation of median income. Explains emergency medical service funds threatened by SB 5513 and Governor’s budget. 

149

John Saultz, M.D.

Chair, Family Medicine, OHSU and Director, Oregon Area Health Education Centers (AHEC). Refers to health professionals reports titled Oregon Workforce Project published by AHEC (reference material in Legislative Library) and related database.  Discuses:

  • principle role and services provided via AHEC;
  • grants and funding sources;
  • program to recruit medical professionals to rural areas;
  • rural health research program;
  • recruitment programs directed at youth;
  • OHSU national ranking for addressing issues of rural health;
  • downturn in pursuit of medical careers; and
  • issues of training generalist practitioners versus specialists 

318

Chair Kruse

Addresses expanding scope of medical professionals.

327

Saultz

Discusses issues of nurse practitioners and physician assistants as method to expand medical professional. Reports type of health system needed in rural areas includes recruiting generalists. 

368

Rep. Anderson

Inquires on nursing recruitment issues.

378

Saultz

Explains current nursing recruitment efforts and the regionalization process in nurse training programs. Addresses a “physician-less system of care.”

423

Rep. Anderson

Inquires on training for other medical professionals. 

433

Saultz

Explains workforce training efforts and dental partnerships with trainees. 

447

Rep. Monnes Anderson

Addresses nursing shortage issue. Notes proposed legislation to increase nursing education opportunities. 

TAPE 26, B

026

Saultz

Describes OHSU efforts to train nurses. 

044

Rep. Monnes Anderson

Inquires on AHEC funding

045

Saultz

Explains past and current funding.

076

Rep. Monnes Anderson

Question General Fund leverage to federal funds.

079

Saultz

Explains local and federal fund relationship.

085

Rep. Barker

Addresses recruitment efforts  Comments on lack of training space versus lack of medical trainee applicants. 

100

Saultz

Relates issues related to status of medical applicants at OHSU. Reports economic issues, medical students and the pursuit of medical careers. Notes that applicants in rural areas are nontraditional learners.

152

Gregg Lander

Rural Emergency Service Enhancement Fund, AHEC. Explains issues related to rural emergency services (EXHIBIT F) and to diverted funds. 

247

Scott Ekblad

Deputy Director, Oregon Office of Rural Health, OHSU. Presents information on rural emergency medical service grants (EXHIBIT G).  Discusses survey of rural health agencies.  Addresses issues of recruitment relating to grant awards.  Details items purchased via grant awards. Refers to SB 5513. 

317

Chair Kruse

Comments on rural health tour during previous session. Closes informational meeting and adjourns meeting at 10:22 A.M.

EXHIBIT SUMMARY

A – Informational, written testimony, staff, 3 pp.

B – Informational, written testimony, Ed Patterson, 5 pp.

C – Informational, prepared testimony, DHS staff, 4 pp.

D – Informational, prepared testimony, Ed Patterson, 6 pp.

E – Informational, slides, Karen Whitaker, 6 pp.

F – Informational, Fact sheets, Gregg Lander, 2 pp.

G – Informational, written testimony, Scott Ekblad, 2 pp.