SENATE COMMITTEE ON HEALTH POLICY

 

 

March 07, 2005                                                                                                       Hearing Room B

1:00 P.M.                                                                                                                     Tapes  33 - 36

Corrected 9/29/2005

MEMBERS PRESENT:         Sen. Laurie Monnes Anderson, Chair

Sen. Jeff Kruse, Vice-Chair

Sen. Peter Courtney

Sen. Bill Morrisette

Rep. Chuck Riley

 

MEMBER EXCUSED:          Sen. Gary George

 

STAFF PRESENT:                 Rick Berkobien, Committee Administrator

Brittany Kenison, Committee Assistant

 

MEASURES/ISSUES HEARD:

Certificate of Need – Informational Meeting

SB 503 – Public Hearing

Healthcare Facilities Certificate of Need – Informational Meeting

 

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 33, A

003

Chair Monnes Anderson

Calls the meeting to order at 1:05 p.m.  Opens informational meeting on Certificate of Need (CON).  Introduces Tom Piper.

CERTIFICATE OF NEED – INFORMATIONAL MEETING

030

Tom Piper

Director, Missouri Certificate of Need (CON) program.  Submits and presents PowerPoint presentation on CON:  Protecting Public Interests (EXHIBIT A) and an informational handout about CON (EXHIBIT B).

040

Piper

Begins discussing topics to be covered in his presentation and history of Missouri’s CON program. 

090

Piper

Continues discussing CON program:

·         Milestones in CON

·         Chart of duration of CON regulation by state

·         Colored chart of duration of voluntary versus mandatory CON programs among the states.

·         CON matrix

144

Chair Monnes Anders

Asks Piper to read Oregon’s regulations from matrix chart.

148

Piper

Answers that it reads “swing beds.”

150

Piper

Continues discussing CON program:

·         Continues reviewing the CON matrix

·         Map for CON regulation by state

·         Map of CON changes across the nation

·         Activities to note in Missouri, Alaska

197

Rick Berkobien

Committee Administrator.  Asks to discuss Dirigo, a program in Maine.

200

Piper

Provides information about Dirigo.

210

Piper

Continues discussing CON program:

·         Activities to note: Maine, Tennessee

220

Chair Monnes Anderson

Asks why the hospital associations thought the improvements were needed in Tennessee.

223

Piper

Explains.

235

Piper

Continues discussing CON program:

·         Activities to note: Alabama

245

Chair Monnes Anderson

Asks what digital hospitals are.

246

Piper

Explains that everything is computer based. Elaborates.

260

Piper

Continues discussing CON program:

·         Activities to note: Georgia

277

Chair Monnes Anderson

Clarifies that Georgia’s CON was not to include ambulatory surgical centers and that is where the controversy was.

280

Piper

Responds.

300

Piper

Continues discussing CON program:

·         Activities to note: Virginia, Arkansas

350

Piper

Continues discussing CON program:

·         Activities to note: Florida

370

Sen. Morrisette

Asks Piper to elaborate on a “boutique hospital.”

378

Piper

Elaborates on characteristics.

395

Sen. Morrisette

Comments that the metro area in Portland, Oregon is possibly going back to the Certificate of Need program.

414

Piper

Continues discussing CON program:

·         Activities to note: Ohio

440

Berkobien

Comments on specialty hospitals in Texas and asks if they are similar to the “boutique hospitals” in Ohio.

TAPE 34, A

003

Piper

Answers question.

010

Piper

Continues discussing CON program:

·         Activities to note: Indiana, Pennsylvania, Michigan

·         American Health Planning Association (AHPA) source of CON information; national directory of health planning, policy and regulatory agencies.

055

Piper

Continues discussing CON program:

·         Report, Improving Healthcare: A Dose of Competition

070

Sen. Kruse

Asks who makes up the American Health Planning Association.

074

Piper

Answers question.

080

Piper

Continues discussing CON program:

·         Reviews report; specific certificate of need message

·         Intent of the message

·         AHPA critique of the message

130

Piper

Continues discussing CON program:

·         AHPA conclusions

·         Marketplace issues revealed

·         CON conceptual purposes

·         CON: unique regulatory concept and tool

180

Piper

Continues discussing CON program:

·         CON: unique regulatory concept and tool

·         Claims of the critics

·         What the record shows

203

Chair Monnes Anderson

Comments on increased number of ambulatory surgical centers. Asks if most states have the centers as part of their CON.

207

Piper

States that 26 of the 36 do include the centers as part of the review.

213

Chair Monnes Anderson

Asks if Missouri tracks data that shows the difference of utilization and ambulatory surgical centers versus what is used.

217

Piper

Responds yes and defers to later in the presentation.

220

Piper

Continues discussing CON program:

·         CON Realities: actual experience

245

Sen. Morrisette

Asks if there anything that can prevent centers from abandoning the community.

255

Piper

Answers how some states have to have the consent from CON before closing.  Elaborates.

295

Piper

Continues discussing CON program:

·         CON Realities: actual experience

·         Chart: non-CON versus CON states

325

Chair

Asks about specifies of the chart and if the states compared were similar.

335

Piper

Explains each state’s differences and similarities.

350

Rep. Riley

Asks for comparisons with Missouri and Ohio that were on the map but not on the chart.

360

Piper

Clarifies why they were not included.

375

Piper

Reviews charts of non-CON versus CON states.

425

Piper

Continues to review statistics comparing non-CON versus CON states.

TAPE 33, B

005

Piper

Discusses analysis on CON regulated states from a study.

020

Piper

Reviews chart on mortality, non CON versus CON states.

025

Piper

Continues discussing CON program:

·         Consequences of unrestricted healthcare competition.

045

Piper

Shares video of the “Community Hospital Viewpoint.”

095

Piper

Video continues to play on the “Community Hospital Viewpoint.”

145

Piper

Video continues to play on the “Community Hospital Viewpoint.”

185

Piper

Comments on the video.

195

Piper

Continues discussing CON program:

·         Balance regulation and competition: protect public interests

·         Contact information for American Health Promotion Association (AHPA) and for himself

225

Chair Monnes Anderson

Asks if the CON process is different between rural and urban areas.

230

Piper

Explains how other states have handled the differences and regulations implemented.

257

Sen. Morrisette

Asks if the CON program in Missouri, clarifies that the CON commission can ok centers to leave in a rural area.

270

Piper

Explains Missouri’s current regulation and provides examples.

305

Sen. Kruse

Asks how much it costs to operate a CON program and where the money would come from.

307

Piper

Provides committee with information.

320

Sen. Kruse

Comments on the no fiscal impact and believes that there should be an impact statement.

325

Chair Monnes Anderson

Closes the informational meeting on Certificate of Need and opens a public hearing on SB 503.

SB 503 – PUBLIC HEARING

330

Sen. Ben Westlund

Senate District 29.  Testifies in support of SB 503.

380

Sen. Westlund

Discusses the opposition to the bill.  Discusses the economics of the bill.

405

Sen. Morrisette

Restates previous comment about centers leaving the rural areas in Oregon.

410

Sen. Westlund

Concurs with Sen. Morrisette’s concerns and why he supports the bill.

415

Sen. Westlund

Continues to testify in support of SB 503.

TAPE 34, B

010

Sen. Westlund

Continues to testify in support of SB 503.

025

Sen. Morrisette

Asks if a Certificate Of Need (CON) program would include negotiations and how would that be handled.

035

Sen. Westlund

Answers that the bill does not address that.  Clarifies what the bill does address.

045

Sen. Kruse

Asks how the figure of a million dollar minimum was created in the bill.

050

Sen. Westlund

Offers to return information to the committee.

051

Sen. Kruse

Comments that a million dollars could be reached very easily by hospitals.

056

Sen. Westlund

Offers to work with Sen. Kruse.

063

Rick Berkobien

States that question may be answered at tonight’s public hearing on SB 503.

067

Sen. Kruse

Comments on the low threshold and that administration cost would go up.

074

Sen. Courtney

Asks how much a Computerized Axial Tomography (CAT) scan cost.

077

Sen. Westlund

Answers that it varies from one to five thousand dollars depending on the test.

082

Sen. Courtney

Re-clarifies question.  Asks how much a CAT scan machine costs.

083

Sen. Westlund

Speculates $900,000 to $1 million dollars.

084

Sen. Morrisette

Asks if there are any examples where states are concerned in lack of healthcare in a particular community and how it is addressed.

095

Piper

Notes that it would not be addressed as a CON issue.  Elaborates.

125

Sen. Westlund

Comments on issues raised on the rural areas.

130

Chair Monnes Anderson

Notes that the meeting will reconvene at 5:30 p.m.  Recesses the public hearing on SB 503 and adjourns the meeting at 2:45 p.m.

131

Chair Monnes Anderson

Reconvenes meeting at 5:33 p.m.  Opens a public hearing on SB 503.  Notes that she will testify as an proponent.

SB 503 – PUBLIC HEARING

140

Sen. Monnes Anderson

Senate District  25.  Testifies in support of SB 503.

190

Sen. Monnes Anderson

Continues to testify in support of SB 503.

240

Sen. Monnes Anderson

Continues to testify in support of SB 503.

280

Sen. Monnes Anderson

Discusses that Oregon has a Certificate of Need (CON) process.  Elaborates.

300

Sen. Monnes Anderson

Summarizes and concludes.

320

Vice-Chair Kruse

Asks where the unlicensed and un-staffed beds are.

327

Sen. Monnes Anderson

Explains that every hospital has to report this data and that the beds are unused in the hospitals.  Defers to hospital to answer specific data.

330

Vice-Chair Kruse

Asks if she has considered, or if anyone will discuss, the preparation of the data and documentation process.

338

Sen. Monnes Anderson

Answers that the setup would take a year.

340

Vice-Chair Kruse

Re-clarifies question.

346

Sen. Monnes Anderson

Answers that there may be upfront money, but that it will save money long term.

360

Sen. Frank Morse

Senate District 8.  Commends Chair for the introduction of the bills addressing healthcare costs.  Testifies in support of SB 503.

410

Sen. Morse

Continues testifying in support of SB 503.  Discusses cost drivers.

TAPE 35, A

020

Sen. Morse

Summarizes and concludes.

030

Sen. Monnes Anderson

Agrees with comments on utilization and elaborates.

040

Sen. Monnes Anderson

Comments on the focus of the “right” concerns.  Discusses cost operating margins.

070

Sen. Morrisette

Asks Sen. Morse if he thinks that there should be a CON program for ambulatory surgical centers.

072

Sen. Morse

Answers, yes and elaborates.

085

Chair Monnes Anderson

Comments on the bill effecting facilities with total projected costs of a million dollars or more. Asks if ambulatory surgical centers are less than a million dollars in total projected costs.

087

Sen. Morse

Answers that they far exceed a million dollars.

093

Sen. Courtney

Asks Sen. Morse to explain level of healthcare services being provided to public at a minimum level.

099

Sen. Morse

Asks to clarify.

100

Sen. Courtney

Re-clarifies question.

106

Sen. Morse

Answers that we should take care of people who cannot take care of themselves.  Comments on changing the culture.  Discusses healthcare that is not needed.

135

Sen. Courtney

Asks Sen. Morse what he means by “labor costs.”

136

Sen. Morse

Explains.

143

Sen. Courtney

Clarifies that Doctors are not part of labor.

144

Sen. Morse

Indicates that Doctors are part of labor costs and notes that they are paid on production.

145

Sen. Courtney

Clarifies that production means by the number of surgeries performed.

146

Sen. Morse

Affirms and adds the number of patients seen.

150

Chair Monnes Anderson

Asks if the administration has increased.

151

Sen. Morse

Answers question.

156

Sen. Courtney

Refers to ballot measures 5,11, 37 (2004).  Comments that the issue of hospital care cost must be addressed or the public will.

167

Sen. Morse

Agrees on public potential.

172

Sen. Courtney

Comments on outcome from the ballots.  Asks for comments about how public reacted to the ballot measures of 2004. .

188

Sen. Morse

Comments.

190

Sen. Courtney

Comments on public being scared and angry due to increase of healthcare.

200

Chair Monnes Anderson

Comments on the need to address the increase of healthcare costs.

212

Sen. Morse

Comments on the complexity of the issues at hand and the need to make a difference.

235

Sen. Kruse

Comments on need to address the right issues and implement appropriate programs and services.

260

Sen. Morrisette

Comments on the cost shift of people without healthcare.

280

Lynn-Marie Crider

Service Employees International Union.  Submits and presents written testimony in support of SB 503 (EXHIBIT C).

330

Crider

Continues to review testimony in support of SB 503.

380

Crider

Continues to review testimony in support of SB 503.

430

Crider

Summarizes and concludes.

TAPE 36, A

010

Maryann Holser

Citizen, Lane County.  Submits and presents written testimony in support of SB 503 (EXHIBIT D).

060

Holser

Summarizes and concludes.

075

Ellen Pinney

Oregon Health Action Campaign.  Testifies in support of SB 503.

110

Pinney

Notes concern with the bill.

125

Bruce Bishop

Oregon Association of Hospitals and Health Systems.  Submits and written presents testimony in opposition to SB 503 (EXHIBIT E).

170

Glen Cunningham

Panning Director, Silverton Hospital.  Testifies in opposition to SB 503.  Provides background on hospital and demographics of the area.

220

Cunningham

Continues discussing concerns with SB 503.

230

Chair Monnes Anderson

Asks Cunningham if the Silverton hospital is a Type A or Type B hospital.

231

Cunningham

Answers that it is a type B.

232

Chair Monnes Anderson

Asks if he is aware that type B hospitals are not exempt in SB 503.

234

Cunningham

Answers that he is aware.

235

Jim Wathen

Chief Executive Officer, Southern Coos Health District, Bandon, OR.  Submits and presents written testimony in opposition to SB 503 (EXHIBIT F).

285

Wathen

Continues to review testimony about concerns with SB 503.

335

Wathen

Summarizes and concludes.

345

Rep. Riley

Clarifies that the CON does not go far enough to address current issues.

360

Wathen

States that he does not intend that and that there are problems with the current statute.

370

Rep. Riley

Verifies that the witness would like to add ambulatory surgical centers and “boutique” hospitals.

371

Wathen

Answers, yes.

375

Bishop

Adds that it was applied to in Oregon’s CON law already.

390

Bishop

Discusses testimony from EXHIBIT E.

440

Bishop

Continues discussing opposition to SB 503.

450

Chair Monnes Anderson

Refers to Bishop’s comment about Missouri’s Certificate of Need (CON) program and that their cost still exceeds Oregon.  Asks if it is per capita and if it is because the Medicare and Medicaid reimbursement is higher than Oregon’s.

TAPE 35, B

003

Bishop

States that he does not know what their reimbursement rate is. Speculates.  Continues discussing concerns to SB 503.

050

Chair Monnes Anderson

Closes public hearing on SB 503 and opens an informational meeting on Healthcare Facilities Certificate of Need.

HEALTHCARE FACILITIES CERTIFICATE OF NEED – INFORMATIONAL MEETING

063

Tom Piper

Director, Missouri Certificate of Missouri.  Comments on public CON process in Missouri.

085

Piper

Addresses concern of cost of preparing a certificate of need application. 

120

Piper

Addresses concern of whether CON contains utilization.  Discusses optimization utilization.

130

Piper

Addresses concern if Oregon can afford healthcare the way it is today and if consumers making too many costly decisions because their healthcare is paid for from the insurance companies.  States that it is a mischaracterization to assume the public, not the doctors, are making the wrong decisions.

150

Piper

Addresses statement made that the open beds will be needed later as the baby boomers get older.  States that it is an invalid concern that does not have data to support it.

170

Piper

Addresses concern about technology increasing cost of equipment.

195

Piper

Addresses concern of regulations for a “level playing field.”

205

Piper

Addresses concern about bureaucrat burden.  Comments on public accountability.

220

Piper

Addresses concern about the of ranking of CON states.

270

Piper

Continues discussing the CON state ranking.

277

Sen. Kruse

Asks if the criteria for the application in Missouri is the same in SB 503.

279

Piper

Answers that there are a number of differences.  Elaborates.

290

Sen. Kruse

Asks is the board ever reviews applications if Piper denies them.

292

Piper

Answer question.

294

Sen. Kruse

Re-clarifies question.

298

Piper

Answers question.

303

Sen. Kruse

Asks what resources are available to get hospitals approved.

316

Piper

Clarifies that he goes through each application with hospital and makes the recommendations.  Explains that the hospital makes the decision to apply before the committee.

355

Sen. Kruse

Asks if there an appeal process.

356

Piper

Answers, yes.

357

Sen. Kruse

Asks to explain the appeal process.

358

Piper

Explains the appeal process.

370

Bruce Bishop

Oregon Association of Hospitals and Health Systems.  Refers to data in EXHIBIT E.  Elaborates.

403

Chair Monnes Anderson

States agreement that utilization has increased regarding medical services.  Refers to Cunningham’s statement about physicians being paid on utilization.  Asks witnesses to comment.

418

Glenn Cunningham

Planning Director, Silverton Hospital.  States that it was Sen. Morse who made the comment.  Comments on utilization in rural areas of Oregon.

TAPE 36, B

012

Chair Monnes Anderson

Comments on Kaiser Permanente’s efficiency.  Asks if they pay their Doctors a base salary.

017

Cunningham

Answers that he does not know.

020

Sen. Kruse

Asks if he has the ability to review what doctor’s order for tests for patients.

025

Cunningham

Explains that they do have utilization review functions.

026

Sen. Kruse

Clarifies that it would be overtime and not on a per patient basis.

029

Cunningham

Explains that they do have perspective and retrospective systems.  Elaborates.

032

Bishop

Discusses inpatient psychiatry.

050

Sen. Morrisette

Asks to discuss the level of problem with hospitals.

055

Bishop

Explains the intensity of the issue with capacity.

057

Sen. Morrisette

Asks if he has the data to support his statement.

060

Bishop

Responds that he does not and offers to return information to the committee.

061

Chair Monnes Anderson

Comments that the Oregon State Hospital Master Plan will be presented in a later meeting.

065

Sen. Morrisette

Asks about hospitals in Eugene.

070

Bishop

Responds that he does not know and offers to return information to the committee.

073

Sen. Morrisette

Comments on whether patients are committed to the Johnson Unit.

074

Bishop

Speculates that many are.

078

Piper

Comments on Bishop’s comments and concerns.  Offers to return information regarding Bishops concerns.

085

Chair Monnes Anderson

Closes informational meeting on Healthcare Facilities Certificate of Need and adjourns the meeting at 7:27 p.m.

 

 

 

EXHIBIT SUMMARY

 

A.     Certificate of Need, PowerPoint presentation, Tom Piper, 25 pp

B.     Certificate of Need, informational handout, Tom Piper, 4 pp

C.     SB 503, written testimony, Lynn-Marie Crider, 7 pp

D.    SB 503, written testimony, Maryann Holser, 4 pp

E.     SB 503, written testimony, Bruce Bishop, 14 pp

F.      SB 503, written testimony, Jim Wathen, 11 pp