Dr. Kitzhaber was clear to the audience concerning the impact of the current economic crisis on the state budget. The current situation will “require a real re-thinking of the size and scope of state governments, something that’s long overdue but something that’s not going to be very easy.” No budget, including education and health care, will be spared. There is no quick fix for a $2 billion structural revenue shortfall. “There is no secret pot of money out there with which we can solve this problem. ... We’re going to have to manage through a significantly smaller state budget in the next two years,” said Kitzhaber.
“We need to shift from ‘how do we cut $2 billion’ to ‘here’s the amount of money we know we have.’ How can we allocate that to get us through the next couple of years, protecting essential services?” said Kitzhaber.
“In the short term, we need to create a really good savings fund, modify the kicker and create a big reserve that is very tightly controlled and gives us at least some cushion to help with ups and downs.” In the long run, “public money should be spent in a way that maximizes the health of the population at large.”
“Recruiting and retaining primary care providers in rural Oregon is a challenge,” said Kerry Gonzales, ORHA President. “We have lost funding for our state loan repayment program and the deadline is looming for the Medical Malpractice Reinsurance Program. We know that this next legislative session will be very difficult in the current budget crisis, but we must continue to support these programs if we are going to reach our goals.”
State and federal health care reform will expand insurance coverage to uninsured Oregonians in both urban and rural areas. Increased coverage will create an increase in demand for providers. To cope with this demand, rural communities must redouble their efforts to attract new providers to their communities and retain those they already have. Oregon doesn’t currently produce enough providers to meet the need, and must have effective strategies to compete with other states that are vying for the same candidates.
The Oregon Legislature voted not to continue funding the Rural Health Services Loan Repayment Program during its 2009 session. The program offered loan repayment to physicians, dentists, pharmacists, nurse practitioners, and physician assistants who agree to practice in a ‘qualifying practice site.’ While never well funded, this program allowed Oregon to compete with other rural states. As those states continue to offer loan repayment, Oregon’s ability to compete falls farther and farther behind.
During the 2010 Legislative Session, the loan repayment program was transferred to the Oregon Office of Rural Health from the Oregon Student Assistance Commission. When the transfer becomes effective on July 1, 2011, the fund balance will barely be enough to meet existing obligations to award recipients. No additional loan repayment awards can be made without additional resources. Scott Ekblad, Director, Oregon Office of Rural Health said “Not being able to offer potential recruits an incentive like loan repayment severely handicaps our ability to attract providers from outside the state.”
The Medical Malpractice Reinsurance Program (MMRP) is also a key program to keep our providers in rural Oregon. Passed by the 2003 Legislature, MMRP was designed to help offset the cost of malpractice insurance. Malpractice costs are higher in Oregon than many states and must be considered when a provider is thinking of starting a practice or continuing to stay in a practice. The current program is set to expire on December 31, 2011. “Without continued support for this program or a change in our malpractice laws, we will lose many of our current rural providers,” says Ekblad. “We understand the financial situation that underlies the 2011 legislative session, but driving away rural providers, who are often the primary economic generators in their communities, just does not make sense.”
The ORHA is reviewing health care workforce proposals being developed by the Oregon Academy of Family Physicians. These proposals attempt to address the larger issues of primary care in rural Oregon. The OAFP proposals fall into the areas of:
- Recruitment:
- Loan Repayment
- GME — Graduate Medical Education
- Scholarships for Rural Scholars
- Retention
- Malpractice Premium Subsidy for Rural Providers
- Initiative for the Transformation of Primary Care
- Payment Reform
- Primary Home Payment
- New Primary Care Payment Codes
“This year’s summit is the continuation of a long conversation about the health care needs of rural Oregon,” says Kerry Gonzales, OAFP Executive Director. “We will continue to work with interested parties to make our case next session. And we really want to hear from more people in rural Oregon about how we can work together to make this happen.”