A Watershed - Oregon Medical Association

MEDICINE in Oregon
A publication of the Oregon Medical Association
Summer 2009
Policy • Community • Practice
A Watershed
Year for Health Care
OMA Passes Two Bills,
Stops Critical
Liability Measure
Volume 2, Number 3
Summer 2009
POLICY  COMMUNITY  PRACTICE
A Watershed
Year for Health Care
OMA’s work on behalf
of doctors in the legislature
By Ryan James and OMA Government Affairs Staff
Oregon Medical Association
11740 SW 68th Pkwy, Ste 100
Portland, OR 97223
(503) 619-8000 • fax (503) 619-0609
www.theOMA.org • [email protected]
12
The Politics and Medicine Issue
Also Inside
4 FROM THE PRESIDENT
MEMBERSHIP MATTERS
5 New and reinstated members
Peers: ‘Join the OMA’
8 ByTellBudYourPierce,
MD
Politics and Medicine
6 FROM THE DESK OF JO BRYSON
Reform Raises Tough Questions
10 OMA ALLIANCE
9
Some Things Never Change
12 FEATURE
A Watershed Year for Health Care
By Ryan James and OMA Government Affairs Staff
PLUS OMA’s day at the Capitol
16 IS HEALTH CARE A RIGHT?
We’re Not Ready for This Right
By Ralph Eccles, MD
PLUS The Best Recruitment...
By Jennifer Nordgaard
Upcoming events
19 SPOTLIGHT ON...
The Patient-Centered Medical Home:
Answer or Illusion?
By Glenn S. Rodriguez, MD
20 IN THE OFFICE
Technology Gives New York
Doctor a Boost with Daily Practice
By AMA Staff
Health Care Is a Right
By Rick Staggenborg, MD
21 ADVOCACY IN FOCUS
From Member Complaint to Legislation:
A Look at SB 507
18 ON MY MIND
Debt is a Political Issue
By Joy Conklin
By Moira K. Ray
23 ADVOCACY CORNER
25 IN-HOUSE COUNSEL
Changes Coming to the Health Professionals Program
By Mike Crew, JD
Compliance Process in Effect: Make Sure
You Are Being Paid Correctly
Back Page
Creative Outlets
Guarding his mistress’ shop (photo)
By Dr. Donald Froom
in Oregon
Published quarterly by
PAGE
PLUS...OMA’s Day at the Capitol
MEDICINE
Editorial Advisory Board
Carla McKelvey, Physician Editor
Monica Wehby
Peter Bernardo
Nancy Boutin
Evelyn Ford
Mike Crew (of counsel)
OMA Staff
Jo Bryson
Betsy Boyd-Flynn
Jennifer Nordgaard Ryan James
Reina O’Beck
Submissions
We welcome and encourage our members
to contribute to Medicine in Oregon.
For more information, contact
Betsy Boyd-Flynn at (503) 619-8000
or [email protected]
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Joseph Madigan
On the Cover
The Oregon State
Capitol in Salem was
constructed from 1936
to 1938, and expanded
in 1977. The Art Deco
building was placed on
the National Register of
Historic Places in 1988.
© 2009 by the Oregon Medical
Association. All rights reserved. No part
of this publication may be reproduced or
transmitted in any form by any means,
electronic or mechanical, including
photocopy, recording, any information
storage or retrieval system, without
permission from the publisher.
From the President
T
Peter A. Bernardo, MD
Politics and
Medicine
“Laws are like sausages,
it is better not to see them
being made.”
Otto von Bismarck,
1st Chancellor of the German Empire
Peter Bernardo, MD is president of the
Oregon Medical Association. He is a general
surgeon in private practice in Salem and he
has been an OMA member since 1992.
4 • Medicine in Oregon
HE OREGON MEDICAL ASSOCIATION
strives to represent the interests
of all physicians. It is not an
easy thing to do. The public, and
our elected officials, often paint
the physician community with one
broad brush. Physicians are not a
homogeneous group. Earning a
medical degree does not change your
sex, your race, or your religion. Doctors
in Oregon come from many different
cultural backgrounds; most did not
grow up and/or train here. Physicians
are also divided by specialty, urban or
rural practice setting, size of practice,
and employment. The public believes
all physicians are wealthy, but most
pediatricians and family practitioners
would argue otherwise. Physicians
are Republicans, but just as many are
Democrats and Independents.
With all of these differences, it is not
surprising that physician opinion spans
the known spectrum on any social or
political issue. Physicians definitely do
not share the same opinion on health
related matters. The debates at the
OMA House of Delegates over the last
ten years highlight this fact. In that time
period, physicians at the House have
spoken passionately about many topics
including medical marijuana, assisted
suicide, and single payer health care
models. The opinions expressed came
equally from both sides of the issue.
This presents a challenge for the OMA:
How can the association represent
the entire family of medicine? Some
physicians do not feel that the OMA
represents their interests at all. On
any single topic, that might be true.
However, I feel that physicians—and
voters—who use a single subject as a
litmus test for their political satisfaction
are doomed to be disappointed. Life
is not that simple, nor is politics that
clean. Take a broader look at the
Oregon Medical Association and
you will see just how important, and
necessary, it is for physicians and their
patients to wade into these issues.
Every two years, there are hundreds of
bills considered in the Oregon State
Legislature that involve some element
of health care. Many of the bills
relate to insurance issues or hospital
regulation. Some address physician
licensing and supervision. Others may
mandate particular treatments for a
patient, or expand the scope of practice
of non-physician providers. Patient
“advocates,” businesses, hospitals
and insurers all want to affect the
practice of medicine; often by altering
the doctor-patient relationship. They
believe they understand health care
and the practice of medicine. But they
do not—not in the way that a doctor
does. No one else has the physician’s
knowledge and experience in the
delivery of health care. Doctors must
speak from their perspective and for
their interests and the interests of their
patients, because no one else will.
Physicians have a strong political
voice through the Oregon Medical
Association. The OMA and its
government affairs team have been very
effective over the years in representing
that voice. So much so, that it is often
said that the OMA only worries about
physicians, their practices, and their
money. The business of medicine
plays out in the political arena on
a daily basis. The OMA should not
apologize for doing what it is supposed
to do: advocate for the interests and
concerns of its members. To say
that this approach is short-sighted
or selfish ignores the importance of
the physician to the community. The
vitality of a physician’s practice is a
public health issue. A healthy medical
practice environment encourages more
physicians to practice in Oregon, and
ultimately makes for better health care.
More importantly, criticism like this
overlooks much of the other work
we do. Our members are concerned
about much more than the business of
medicine. OMA staff and physicians
Joining the Circle
have always taken the lead on
important public health issues. Perhaps
the Association, and physicians in
general, have not claimed enough
credit in this area. Every community
in this state has physicians who are
actively treating the uninsured, and are
working on systems to provide them
with better care.
Physicians and the OMA have
vigorously worked on state and
national health care reform. They have
also worked hard on community health
issues. In this recent Legislative session,
OMA members testified on field
burning, smoking in cars with minors,
and providing health insurance for
all Oregon children, and supported
health insurance coverage for smoking
cessation. In the past, physicians
championed seat belt and helmet laws.
They worked on school nutrition,
physical education and childhood
obesity. The OMA has consistently
collaborated with other groups for the
health of all Oregonians, and that will
not change.
The democratic political process
demands the involvement of its citizens
on a consistent basis. It is not easy.
The political process is messy, and it is
easy for a physician to be discouraged.
There are winners and losers in the
political arena; compromises and
trade-offs. Politics is a time consuming
process, and often frustratingly slow.
Sweeping change is an uncommon
product of the political process. More
often, change, when it occurs, is
incremental.
What would our medical liability
environment in Oregon look like
if physicians had been involved in
the campaigns for our state judges,
Governor, Attorney General, and
Secretary of State? Perhaps the future
will tell us; if more physicians get
involved in political life and choose to
vote, contribute their time, and their
money. I encourage you to get to know
your elected representatives. Above all,
bring your voice to the Oregon Medical
Association.
Bismarck also said: “Politics is the art
of the possible.” More participation in
the political process makes more things
possible. 
Magazine Submission Guidelines
We welcome submissions from our members, including opinion pieces, essays about your practice, or visual art. We do not
offer payment for published work, but can provide additional copies of the magazine in which your work appears.
If you are interested in writing but do not have a clear idea or a specific topic in mind, you may wish to contact a member
of the editorial advisory board or the staff editor. They may be able to assign you a topic or make suggestions for content
we are seeking for a particular issue.
Get a sense of what is planned by viewing the editorial calendar for the year, which is kept up to date on the OMA website
at www.theOMA.org/MiO. Submission deadlines and tentative themes for each issue are as follows:
Sept. 5: Fall 2009 issue; Preparing for the Worst: Doctors, Disaster, and Public Health
Dec. 4: Winter 2010 issue; The Military & Medicine
March 5, 2010: Spring 2010 issue; Quality & Performance in Practice
June 4, 2010: Summer 2010 issue; topic TBA
Send your submissions electronically to [email protected].
Written submissions should be sent in rich text format or MS Word 2003. Any accompanying photos or illustrations can be
sent either on CD or via e-mail. Please note these must be high-resolution files, 300 dpi or higher. We have a 6MB size
limitation on e-mail we can receive. Include a brief (25 words or fewer) biographical note, including your specialty, where
you practice and (optionally) how long you have been a member of OMA. Works of visual art can be submitted either via
mailed CD or e-mail, or contact Betsy Boyd-Flynn to arrange an in-person meeting.
OMA thanks those members who have paid
their dues, and welcomes the following new
members and those who have reinstated their
membership with the OMA.
Jacob Abraham, MD
Zachary B. Adler, MD
Rebekah C. Allen, MD
Sandra J. Althaus, MD
Mary K. Alvarez, MD
William J. Arban, MD
Judah Askew, MD
Michael Shawn Axley, MD
Dianna M.E. Bardo, MD
Jennifer J. Barlow, PA
Penelope D. Barnes, MD
John R. Bates, MD
Ashley D. Batesole, PA
Katherine L. Bensching, MD
Emily Berry, MD
Falguny I. Bhavan, MD
Gregory C. Borstad, MD
Jennifer Botelho, PA-C
Jennifer L. Bowman, MD
Diana E. Brewer, PA
Lauren M. Brunner, PA
Glenn S. Buchanan, MD
Erin Butler, PA
Dan M. Byrd, MD
Mauricio A. Cabezas, MD
Clea R. Caldwell, DO
Leta T. Callahan, MD
Michelle H. Cameron, MD
Anne Margaret Carpenter
Winston D. Chamberlain, MD
Charles E. Chambers, MD
Brian T. Chan-Kai, MD
Grace Chen, MD
Poly Chen, MD
Roger Chou, MD
Cong Q. Chu, MD
Lorena L. Cline, PA
Emily L. Conley, MD
Mary M. Costantino, MD
Anita J. Dekker, MD
Lisa Grill Dodson, MD
James Patrick Dolan, MD
Machelle M. Dotson, PA-C
Ben H. Douglas, II, MD
Catherine R. Dudley, PA-C
Christina C. Duran, MD
Elizabeth N. Eckstrom, MD
Judith L. Ekstrom, MD
Sarah L. Elfering, MD
Carol Y. Endo, MD
Todd W. Engstrom, MD
Miko Enomoto, MD
S. Kathleen Esdaile, PA
Kimberly K. Felder, PA-C
Marvin D. Fickle, MD
Marian Fireman, MD
Henry B. Garrison, MD
Jordana L. Gaumond, MD
Katherine M. Gesteland, MD
Anthony K. Gomez, PA
C. Scott Graham, DO
Jessica L. Gregg, MD
Miriam Natalie
Grunkemeier, MD
Paul D. Guisler, MD
Saurabh Gupta, MD
Steven W. Guyton, MD
Matthew F. Halsey, MD
Richard S. Hamblin, PA
Amanda L. Hamilton, PA
Russell B. Harrison, MD
Liana F. Hategan, MD
Joanna L. Hatfield, MD
Daniel Helfet-Hilliker, MD
William L. Hills, MD
Daniel A. Hirselj, MD
Thomas W. Huff, MD
Scott N. Isenhath, MD
Lillian S. Iwatsuki, MD
James H. Johnson, III, PA
Ronald J. Jollo, DO
Jacob Michael Jones, MD
Robert B. Kelly, MD
Katharine J. Keranen, PA
Mark D. Kettler, MD
Akram Khan, MD
Kristy Khoury, PA-C
Adam B. King, PA
Pamela A. Kirwin
Campbell, MD
Linda R. Klein, MD
Ethan C. Korngold, MD
Larry L. Kovachevich, MD
Bradley A. Kramer, MD
Arun Kuchela, MD
Wallace Lai, MD
Katharine E. Leaning, MD
Carol Frost Lee, MD
Elizabeth A. Leon, MD
Linda Baker Lester, MD
Alfred J. Lewy, MD
Charlotte Lin, MD
Susan J. Lindemulder, MD
Kenneth Chan-Ying Liu, MD
Christopher J. Lockey, MD
Michelle L. Lotto, MD
Jon E. Lutz, MD
Annie S. Mack, MD
Elizabeth M. Macri, MD
Supriya Maddirala, MD
R. Ellen Magenis, MD
Martha E. Maier, MD
Robert A. Maricle, MD
Erik A. Martin, PA
Irene P. Martin, MD
Randall L. Martin, MD
Summer 2009 • 5
From the Desk of Jo Bryson
W
HEN WE CONVENED the editorial
board to lay out themes for
the issues in 2009, we agreed
the summer issue would be devoted
to medicine and politics. Thinking
about this connection is not unlike
pondering death and taxes. People
know these as being true certainties in
life and would rather not discuss them.
Joanne K. Bryson, CAE
Reform
Raises Tough
Questions
“You did not enter
this profession to be
bean-counters and
paper-pushers. You
entered this profession
to be healers—and
that’s what our
health care system
should let you be.”
US President Barack Obama
6 • Medicine in Oregon
Rationing health care is another
discussion most are avoiding. The
question being: is America ready to
“ration” health care to achieve reform?
With the ultimate goal of providing
everyone in America with a basic level
of access to health care, the question
of how to expand access without
increasing costs is a conversation that
is becoming more and more prevalent.
No matter what you call it, some kind
of rationing seems the most ready
answer.
Are Americans ready to give up access
to readily scheduled surgeries so that a
basic level of health care access can be
provided to everyone? Maybe, but this
cultural change would not happen over
night; it’s a change that may take years
before it occurs. Most parties in the
debate about reform would rather find
a way not to make that choice.
Our desire to avoid the topic is natural:
discussing it pulls us between our
sense of fairness, and our sense of selfpreservation. Ask a recently-diagnosed
patient with breast cancer if she would
be willing to wait four to six months
for surgery; one which would normally
be scheduled soon after the pathology
report confirmed what a routine
mammogram indicated. This patient
has good health insurance, knows her
physician well, and has had routine
mammograms for years. The physician
and patient both know that time is
cancer’s best friend, and in six months,
there is a good chance cancer would
win. Asking this patient to wait seems
unacceptable on its face.
Now, ask a women who has no
insurance, cannot afford yearly exams,
and then discovers a worrisome lump
she wouldn’t otherwise be able to have
examined, whether she’d accept that
wait in exchange for treatment at all.
For many Americans, even many with
health insurance, “rationing” such as
this would be an improvement over
what they experience today, yet it
would not come without costs to the
system.
Providing basic access to health care
for all Americans doesn’t necessarily
mean that patients will have to wait
four to six months for life-saving
surgery. Reformers are wrestling with
the question: would health care reform
result in some kind of socialized
medicine? The best case scenarios for
such systems still have significant flaws.
Canadian patients with the means to
pay have flocked to the US for years,
and are more than willing to pay for
access to life saving treatments. For
those with means, the alternative of
waiting is not an option when time is
of the essence for life or death. Is that
system more fair than ours?
Rationing of health care was one of
several topics of conversation among
physicians attending the recent Annual
Meeting of the American Medical
Association in Chicago. With health
care reform as the number one priority
of the AMA, Immediate Past President
Nancy Nielson, in addressing the
House, emphasized how committed the
AMA was to achieving reform this year
so that all Americans have affordable,
high-quality health coverage. She and
President Obama have met and both
share that common goal.
At the meeting, AMA adopted a new
policy which states that the AMA
will “support health system reform
alternatives that are consistent with
AMA principles of pluralism, freedom
of choice, freedom of practice, and
universal access for patients.”
We were honored to have President
Obama address the House of
Delegates. This was the first time a US
President had addressed the House
since Reagan in 1983.
There were several times President
Obama drew standing ovations from
the delegates. Physicians rose in unison
when Obama said, “you did not enter
this profession to be bean-counters
and paper-pushers. You entered this
profession to be healers—and that’s
what our health care system should let
you be.”
One of the largest complaints about
our current health care system is the
problem Americans with pre-existing
conditions face when trying to find
affordable health care coverage.
President Obama also drew loud
applause when he said, “That is why
we need to end the practice of denying
coverage on the basis of pre-existing
conditions. The days of cherry-picking
who to cover and who to deny—those
days are over.”
It was an especially proud moment
for the Oregon Delegation when
the President Obama spoke about a
recent meeting he had with one of our
congressional delegates. Congressman
Blumenauer, in a recent meeting with
President Obama, handed him a copy
of a special issue of Harper’s Magazine
entitled, “The Crisis in American
Medicine.” Inside were several articles
relating to soaring charges, overutilization and finding a better way
than fee-for-service to pay for medical
care. Sounds like content of any other
health affairs magazine right? Except
this one was dated October, 1960. Let’s
hope 50 years from now we are not still
facing the same challenges and have
not passed them to our children.
We are at a crucial point in history
where we have an opportunity to effect
substantial health care reform. But
as of today, it looks like its going to
be a long hard fight over health care
legislation. Senate Finance Committee
leaders delayed releasing any details of
their health care bill and the House
version is likely to be very different
from the Senate.
Polls are showing again and again that
Americans are ready for reform—as they
understand it. But do they understand
it well enough? And will a complete
overhaul of our health care system be
ready for America in four months? The
devil is in the details. And discussing
those details is sure to be a challenge.
Jason D. Mauer, MD
Shawn A. Mayer, MD
Colleen C. McCormick, MD
Kathyrn Irene McQuillan, MD
Kevin D. Merrill, MD
Bridget A. Metcalf, PA
Chris A. Metzger, MD
Christina E. Milano, MD
Judith A. Mitchell, PA
Noelle E. Montano, MD
Jennifer A. Murphy, MD
John N. Navarro, PA
Keleigh M. Nersasian, PA
Robert S. Nicol, MD
Christina M. Nicolaidis, MD
Lucy Nusrala, PA-C
Jagdeep S. Obhrai, MD
Charles C. Oh, MD
Jeremy Orcutt, DO
Matthew D. Orth, DO
Juan R. Oyarzun, MD
Eric W. Palmer, MD
Melonie Parrish, PA-C
Ami R. Patel, MD
Mark E. Pennesi, MD
Charla L. Pickett, PA
Jeffrey M. Pollock, MD
Ronald W. Powell, DO
Sarah A. Rahkola, MD
Brendan B. Ramey, MD
Rebecca Reiser, MD
Annette V. Riggs, MD
Amanda L. Risser, MD
Stefanie P. Rogers, MD
Somnath Saha, MD
Nemecia SalindongDario, MD
Faiza Salman, MD
Andrew Sargent, PA-C
William G. Schmidt, Jr, MD
Kelli R. Schmitz, MD
Aaron B. Schoenkerman, MD
Maisie Shindo, MD
Kevin R. Smith, MD
Matthew A. Smith, MD
Mindy Sobota, MD
Rebecca I. Spain, MD
Seth John Stankus, DO
Bert M. Stewart, MD
Kara J. Stirling, MD
Jennie E. Stover, MD
Kelsey G. Sullivan, PA
Harry A. Taylor, III, MD
Heather Taylor, MD
Jason A. Taylor, MD
Mark Anthony Taylor, MD
Rebecca N. Thompson, MD
Timothy J. Treible, MD
Rakhee N. Urankar, MD
Craigan T. Usher, MD
Gina M. Vaccaro, MD
Paula A. Vanderford, MD
Steven A. Wahls, MD
Eric Walsh, MD
Samuel A. Wang, MD
Denise G. Waugh, MD
Kathleen Weaver, MD
Kayleen M. Welbourn, PA
Amanda J. Wheeler, MD
Brett A. White, MD
Jacqueline C. Wilk, MD
Latasha N. Williams, MD
Jamie R. Wong, MD
Lawrence Woods, MD
John C. Wright, MD
Raghav Wusirika, MD
Zachary L. Yablon, MD
Kevin C. J. Yuen, MD
Mark E. Zeitzer, MD
Membership information is available through Beth Cherry at
(503) 619-8000 or [email protected].
Plan Your Event at the OMA’s Conference Center
Perfect for Meetings, Workshops, and Special Events
• Great location at OMA Headquarters; convenient to I-5
• Available multi-media equipment takes the hassle out of planning
• We offer expert assistance with room set-up and technological needs
• Your attendees will love the outstanding cuisine
prepared by our professional, full-service catering staff
To learn more about the conference center, contact
Ron Costa, OMA Executive Chef, at (503) 619-8000 or [email protected].
Summer
Summer 2009 • 7
Membership Matters
Tell Your Peers: ’JOIN THE OMA’
By Bud Pierce, MD
I
HAD THE GOOD FORTUNE to grow up
in a stable, hardworking, blue collar
family. In my community, physicians
were held in high esteem and were the
most respected members of society.
Early in my life I stated my intent to
“become a doctor.” I excelled in school,
and was encouraged to pursue a career
in medicine. My early work experience
as an orderly in a nursing home during
my college years convinced me to
continue my dream, and I am now a
medical hematologist/oncologist in the
prime of my career.
The Best Recruitment:
One Member, Reaching Out to Others
By Jennifer Nordgaard
D
r. John Barton, a diagnostic radiologist from Ashland and OMA delegate from Jackson
County, was at a recent House of Delegates meeting and was amazed to learn how many of
his colleagues in Ashland are not members of the Association. “Around half of the doctors on the
medical staff at Ashland Community Hospital do not belong to the OMA,” says Dr. Barton, who has
been an OMA member since 1985.
Dr. Barton wanted to change that. So, in an effort to reach out to his peers and spread the news
about all that OMA does on behalf of Oregon physicians and their patients, Dr. Barton initiated his
own “member get a member” campaign. With the help of OMA staff, he sent a letter to each nonmember physician in Ashland, along with an OMA application and membership materials. “I have
the sense that if everyone knew all that OMA does on behalf of Oregon physicians and our patients,
we would have nearly 100 percent physician membership,” says Dr. Barton.
Do you know a non-member colleague? Want to tell them why OMA membership matters to you?
Our members are the best champions for the organization! OMA staff can help you “get
a member” by providing applications and other membership materials, giving you details on
all of the various things that OMA has done for doctors and their patients, or providing a list of
non-member physicians in your area or within your specialty. Simply contact Jennifer Nordgaard,
[email protected] or Beth Cherry, [email protected], for more information and help. We’d
like to share your recruitment stories and successes in a future issue of Medicine in Oregon!
Jennifer Nordgaard is the membership coordinator at the OMA.
8 • Medicine in Oregon
Early in my medical school career,
I received an invitation to join the
AMA and the California Medical
Association. As an outsider looking
in, I was honored to join these longstanding medical associations and
have continued to be a member of the
AMA (I am a lifetime member), the
OMA, and the Marion Polk County
Medical Society. I feel honored to
have the privilege of being a member
of these medical societies, and I view
them as the embodiment of medicine
in America today. I cannot imagine not
being a member of the OMA!
Now, as always, the OMA is the best
health advocate for Oregon’s citizens
and physicians. The OMA continues
to work for health insurance for all
of our citizens, and we are very active
politically in the public health arena—as
we will only lower our health care costs
by making our citizens healthier. We
continue to oppose the expansion of
medical practice by most non-physician
practitioners, not as a means to limit
choice, but as a way to protect patients
from dangerous and incompetent
practitioners. We continue to work
to improve the working conditions
of physicians, which will require
malpractice insurance reform, a
reduction in regulatory hassles, fair
treatment of our employed physicians,
and pay adequate to prevent workforce
shortages, which are already occurring
in primary care.
The OMA is the largest physician
organization in the stage, with over
7,300 physician, medical student, and
physician assistant members. There
UPCOMING events
Coding Book Order Forms
Email [email protected] for more details.
Available Aug. 3
OMEF Grant Applications
I feel honored to have the
privilege of being a member
of these medical societies,
and I view them as
the embodiment of medicine
in America today.
I cannot imagine not being
a member of the OMA!
are, however, over 13,000 licensed
physicians in the State of Oregon. For
our organization to be all that it can
be, we need all of our physicians to
join the family of medicine by joining
the OMA!
OMA President Dr. Peter Bernardo
and I are committed to doing all
that we can do to strengthen the
effectiveness of the OMA. Toward
that end, Dr. Bernardo and I will pay
a personal visit to all of the physicians
in Marion-Polk counties who are not
currently members of the OMA and
ask them to join. We will briefly share
why we are members of the OMA,
and all that the OMA is doing for the
physicians and citizens of our state.
We’ll use the feedback we gain—even
from those who don’t want to join—
to better convince others. Wish us
luck, and I hope to report on our
successes in a future issue of Medicine
in Oregon. 
Bud Pierce is an oncologist in Salem, and a
member-at-large of the OMA Executive Committee.
Email [email protected] for more details.
Due Sept. 3
OMA Board of Trustees Meeting
Oct. 2, OMA Headquarters
OMEF Board Meeting
Oct. 3, OMA Headquarters
OMA House of Delegates
Interim Meeting/Fall Program
Oct. 3–4, OMA Headquarters
Executive Committee Meeting
Sept. 10, OMA Headquarters
Oct. 22, OMA Headquarters
Risk Management Seminars
Basic Training in
Risk Management
Sept. 16 or Oct. 24
11am–2pm, OMA Headquarters
Risk Management for
Medical Office Personnel
All seminars 12noon–4pm
Aug. 28—OMA Headquarters
Sept. 11—Ashland
Sept. 25—North Bend
Oct. 16—Eugene
Advanced Training in
Risk Management
Sept. 12—Ashland, 8–11am
Sept. 26—North Bend, 8–11 am
Oct. 14—OMA Headquarters, 8–11am
Oct. 17—Eugene, 8–11am
Oct. 24—OMA Headquarters,
7:30–10:30am
OMA Headquarters
11740 SW 68th Pkwy, Ste 100, Portland
(503) 619-8000 • www.theOMA.org
Workshops
For more information on OMA workshops, visit
www.theOMA.org/workshops.
Fall Coding Series
Oct. 28–29, OMA Headquarters
• Oct. 28: Advanced ICD-9-CM: 9am–4pm
• Oct. 29: Advanced CPT: 9am–4pm
Educational Programs
Oct. 13: Compliance Training Seminar
Oct. 27–29: Coding Series
• • • • Advanced CPT
Advanced ICD-9-CM
Modifiers
OB/GYN Specialty Coding
Nov 3: Employment Law Boot Camp
Nov. 17–18: P ractice Management
Series
TBD: A merican Recovery and
Reinvestment Act—New Privacy/
Security Provisions (Webinar)
TBD: E HR/Stimulus Package
Update (Webinar)
TBD: Contracting Series
TBD: Retirement Series
Non-OMA Events
Lane County Medical Society
Monthly Dinner Meeting
Sept. 15; Oct. 6, Hilton Eugene & Conference Center
Oregon Pathologists Association Dinner/
Membership Business Meeting
Sept. 22, OMA Headquarters
Oregon Pathologists Association
Scientific Seminar
Sept. 23, St. Vincent Medical Center,
Souther Auditorium
Oregon Geriatric Society Annual Conference
Oct. 8–11, Sunriver
Summer 2009 • 9
OMA Alliance
I
By Leanna Lindquist, President
Some Things
Never Change
The OMAA
and Medical
Legislation
N 1925, DR. A.C. KINNEY, president
of the Oregon State Medical
Society, requested that an auxiliary
be formed. He charged this new
organization to “calm the rising tide of
misunderstanding and help block the
inroads being attempted on the practice
of medicine.” In 1927 the Oregon State
Medical Society Auxiliary was born. In
1975, we became the Oregon Medical
Association Auxiliary; in 1992 the name
was changed to the Oregon Medical
Association Alliance. No matter what
our name, over the years the OMA
Alliance has been deeply involved in
many legislative battles.
The Auxiliary was active in passing
“The Basic Science Law” in 1933.
Introduced in 1931, the act was
designed to protect public health
by requiring knowledge of five
fundamental sciences in order to
practice any system or method of
healing in this state. It also penalized
practitioners for violating the act. The
new act would provide protection to
the public in a field where ignorance
should not be tolerated.
The Auxiliary sponsored House Bill
144 in 1943, which appropriated
$165,000 for the education of
handicapped children.
10 • Medicine in Oregon
THEREFORE, BE IT RESOLVED,
that the House of Delegates of the
American Medical Association
request the Women’s Auxiliary to
use every avenue possible to bring
such information to its members
and through them to the public.”
The Medical Auxiliary responded with
a comprehensive plan for state coverage
in an organized movement against
the Wagner-Murray-Dingell Bills and
the Pepper Bill, which advocated for
national health insurance. Members
of the AMA believed that the future
of medical practice was at stake. Each
Auxiliary member wrote letters to their
senators and congressmen opposing
the two bills. They recruited ten of
their friends to do the same. The bills
proposing universal health care were
ultimately defeated.
“WHEREAS, the object of the
Women’s Auxiliary is to aid the
American Medical Association in
every way requested, and
In 1949 the AMA’s National Education
Campaign produced a brochure: “It’s
Your Crusade Too!” The crusade was
in opposition to compulsory health
insurance or a government controlled
medical system. The AMA felt that
compulsory health insurance impacted
the economic welfare and freedom of
every American. The Auxiliary helped
to get out the message that it was
dangerous to think that government
had any source of income “apart from
its citizens’ own pocketbooks” with
which to finance medical services.
WHEREAS, the most urgent need
at the present time is for widespread
The “Alliance Day at the Legislature”
has been an ongoing event since 1961.
In 1945, the American Medical
Association was so concerned about
proposed legislation that would lead to
socialized medicine that their House
of Delegates adopted the following
resolution:
Leanna Lindquist, RN, is a recovery room
nurse married to past OMA President
David Lindquist, MD, of West Linn.
dissemination of knowledge
concerning the hazards of current
medical legislation,
To learn more about the OMA Alliance
visit www.theOMA.org or email Pat Webster [email protected].
Various legislators and their staff have
spoken to members about government
business. Individual members also
scheduled personal meetings with their
own legislators. In 1962 the Auxiliary
was honored at the Oregon state
capitol for cooperation and service
in recruitment of students for health
careers.
During Anna Payne’s presidency
in 1967, the auxiliary worked to
elect medicine-friendly state and
congressional candidates. Others have
followed in her footsteps. Since then,
physicians and their spouses worked to
gather over 26,000 signatures for the
Seatbelt Initiative. They answered the
call again to place the Indoor Clean
Air Act on the ballot. In Portland,
OMAA members made “get out the
vote calls” from the OMA building.
Over the past 80 years, members have
written letters and made phone calls
in favor of medical-friendly legislation.
In addition, our members have hosted
fundraisers for political candidates and
have become OMPAC members.
Auxiliary/Alliance members have
been politically involved in their
communities. They have been
mayors, served on school boards and
city councils, and volunteered on
commissions and boards. We have
a rich legacy of commitment and
volunteerism. Over its long history
the OMAA has been dedicated to
supporting the legislative efforts of the
OMA and will continue to do so in the
future. 
Correction
In the article titled “Psychiatric Care
Challenges in Oregon’s Emergency
Departments,” in the Spring 2009 issue of
Medicine in Oregon, Robin Henderson’s
credentials were incorrect.
Dr. Henderson is a licensed psychologist, and
holds a PhD. The error was not the fault of
Dr. Henderson, nor of the article’s author.
The OMA regrets any confusion caused by
the error.
Summer 2009 • 11
A Watershed
Year for Health Care
OMA’s work on behalf
of doctors in the 2009
legislative session
Looking back, the 2009 legislative session saw
a good deal of focus on health care—sweeping
reform, funding mechanisms and proposals
to improve public health and the business of
providing health care.
12 • Medicine in Oregon
The OMA maintained a strong presence in health
policy discussions throughout the 2009 legislative
session. OMA staff and volunteers provided testimony
and written comments on many policy proposals and
worked closely with legislative leadership and other key
lawmakers on behalf of Oregon physicians and their
patients. We scored victories on several important and
controversial issues.
We could not have accomplished nearly as much this
session without the advocacy work of OMA members.
Several OMA physicians, including OMA leadership
and rank-and-file members, testified before legislative
committees on critical health care bills. This year’s Day at
the Capitol was also a huge success, thanks to the more
than 80 members who converged in Salem—white coats
gleaming—to meet with their local legislators and discuss
key health care issues.
OMA Bills
The OMA proposed five bills this session that sought to
improve the business of health care in Oregon by making
relationships between health plans and physicians
more equitable and protecting patients and physicians
from unexpected costs. As these proposals raised some
objections among health plans, legislators wanted the
OMA and health plans to reach a consensus on the bills
before they were allowed to move forward. Unfortunately,
consensus could not be reached on SB 506, SB 509 or
HB 2824. These bills addressed eligibility and coverage
determinations, silent PPOs, and prompt payment of
health care claims, respectively. Lawmakers in Salem were
open to OMA’s proposals, and the Government Affairs
team will work on these bills during the interim, so they
can be revisited in the future.
OMA was able to reach agreements with health plans on
SB 507, which addresses payment to physicians during
the credentialing process, and SB 508, which deals with
the recovery of overpayments. Amendments were made
to the bills that satisfied health plan concerns, while
maintaining most of the original intent of the bills, and
the Senate passed them both unanimously. As this issue
went to press, these bills were awaiting a signature from
the Governor.
Health Care Reform,
Funding and Expansion
The biggest story of the session is the passage of a massive
health reform package and an extension and expansion
of the provider tax. The reform package, HB 2009, based
on the recommendations of the Oregon Health Fund
Board, establishes a Health Authority to take over the
functions of various existing agencies and identify ways
to improve quality and access to care while containing
cost. Other OMA-supported concepts are included in
this legislation that would create a POLST registry, a
Health Information Technology Oversight Council, an
all-payers/all-claims database, a workforce database and
other initiatives. OMA pushed legislators to include a
study of liability reform in the final package, but this
provision was not included and the issue will need to be
revisited in the interim and in future sessions.
The controversial provider tax, which was originally part of
HB 2009, proved to be the most highly-publicized issue of
the session. Originally opposed by hospitals and insurers,
the bill passed with an endorsement from OAHHS. The
bill restructures the existing tax on hospitals and health
systems that is set to expire in September, establishing a
one percent tax on health insurance premiums to fund the
expansion of health coverage to 80,000 additional children
and a floating tax rate on hospitals to add more adults to
the Oregon Health Plan.
Summer 2009 • 13
A Watershed Year
for Health Care
The tax revenue will allow Oregon to
secure around $1 billion in federal
matching funds, which will be used
to expand the Medicaid population
and increase Medicaid reimbursement
rates. The final provider tax plan aligns
with several of OMA’s health care
funding principles developed by the
Legislative and Executive committees.
Amended and
Opposed Bills
Our team in Salem also spent a good
deal of time this session working to
defeat and amend harmful legislation.
When the OMA raised concerns
about training and oversight provisions
in HB 2702 (a bill that would grant
prescribing authority to psychologists),
the Senate amended the bill to require a
work group to study implementing such
authority and make a recommendation
to the 2010 legislature.
OMA also opposed HB 2345, a
plan that would abolish a successful
impaired professionals program for
the sake of uniting several programs
under a single authority. Central to the
Health Professionals Program’s success
was its confidentiality protection for
self-referred participants (see InHouse Counsel, p. 25 ). When the
HPP’s confidentiality provisions were
compromised by an administrative law
judge decision, OMA worked to add
amendments that strengthened the
confidentiality of the new program’s
self-referral process, and ultimately
supported the bill that passed both
chambers as amended. We will
continue to work to ensure that
physicians currently in the HPP have a
smooth transition to the new program
and that self-referring physicians
continue to have access to a strong
treatment program.
14 • Medicine in Oregon
Major Victory:
Defeating 2802
OMA staff and leadership testified
against HB 2802, which would triple
the non-economic damage cap for
wrongful death claims from $500,000
to $1.5 million. Hundreds of OMA
members also contacted their Senators
in an attempt to defeat the bill on the
Senate floor. Due to constant grassroots
pressure from OMA members, HB 2802
was referred back to the Senate Rules
Committee where it died when the
Legislature adjourned sine die. This
victory means OMA members have
avoided an increase in insurance
premiums, and this will help protect
access for patients in rural areas. 
Ryan James is a Research and Projects
Specialist for the OMA.
l
o
t
i
p
a
C
e
h
t
t
Day a
09
0
February 19, 2
W
Is Health Care
HILE TAKING CLASSES at the
Harvard School of Public
Health, I was fascinated by
their motto, “The Highest Attainable
Standard of Health is One of the
Fundamental Rights of Every Human
Being.” At the time, I was working
for the Indian Health Service and
this lofty goal seemed most laudable.
However, over time I began to consider
the implications of this “right.”
Medicine was limited when Thomas
Jefferson declared “Life, Liberty and
the Pursuit of Happiness,” to be
fundamental rights guaranteed by a
just government. In light of the ability
of medicine to significantly improve
lives and the cost of medical care,
is health care therefore a right? It is
from the morbidity of preterm delivery
and thereby save billions. However, the
freedom of pregnant women to make
poor health care decisions has limited
the benefits of prenatal care. Other
choices that could save health care dollars
are similarly constrained by freedom.
Which would produce better health? The
establishment of multiple MRI centers
with free cancer screening for everyone,
or the total ban on the consumption of
all tobacco products? Larger and betterstaffed intensive care units with more
technology, or a mandatory, governmentrun exercise program for all persons age
six to sixty? Simply extending the logic of
prevention above all else, through better
access, can lead to extreme conclusions
that seem abhorrent to our national
value of individual freedom.
We’re Not Ready for This Right
By Ralph Eccles, MD
not mentioned in the Bill of Rights.
However, treaties and legislation
have established that medical care is
a right of certain people, and should
be provided by the government. Does
the existence of entitlements to some
imply that the government has a duty
to ensure the same for all?
Securing health care could well exceed
the financial capacity of the US, even
if 100% of GDP were utilized to reach
the “Highest Attainable Standard of
Health.” Public health was always considered a duty of government in civilizations who had large enough populations to make the control of contagion
necessary. In the early 20th century,
the establishment of regulations to
ensure clean water and sewage disposal
saved millions of lives; mass immunizations have saved millions more.
In like manner, at least theoretically,
a comprehensive program of prenatal
care could save thousands of children
The term health care is often interpreted
as meaning ANY medical care for the
sick, but health care should apply to
programs, institutions and activities that
improve health and prevent disease. Are
Americans willing to give up our personal freedoms to improve the health of
everyone? If health care is a right, what
other rights are we willing to give up?
Should all Americans pay for the medical
costs of diseases with a behavioral
component? What about the Americans
who choose to abuse their bodies
with substances and habits that range
from obviously harmful, like abusing
alcohol, drugs or tobacco, to behaviors
and factors that are less obvious but no
less harmful with respect to long term
health impacts—like overeating junk
food, a lack of exercise, stressful jobs or
addictive gambling? To establish health
care as a right, where these conditions
would be treated without prejudice
or eliminated through restriction of
choice, is to imply that we are willing
as a people to give up other rights. I see
that as unlikely even for those who bring
their illnesses on themselves. Even with
better interventions for these, only some
indicators get better if access improves.
In arguing that health care is not a right,
I am not saying that the present system is
the right one. The Institute of Medicine
has shown that the cost of caring for
the uninsured has increased the cost
of health care and health insurance.
Multiple studies have shown that the
administrative costs of the American
system are 5–10 times that of any other
country. Attempts to control costs thus
far have resulted in more paperwork for
physicians whether the payer is public or
private. The cost of medical care is rising
rapidly, but quality indicators (preterm
births, heart disease, life expectancy) are
actually dropping.
Providing universal health care is
laudable, but the question of how to
pay for this expansion remains. To
provide health care, we need programs
that will ensure fewer people smoke
and that more people exercise, get a
good night’s sleep, eat fresh fruits and
vegetables and deal with stress. The
cost of such programs are not usually
discussed with health reform; we know
the costs of merely caring for the sick
are high enough.
Government should help communities develop programs that will support
healthy living, but ultimately, reform of
medical care delivery and financing is
essential to reduce the impact of what
it will mean if and when we do expand
access. Focusing on health promotion
more than treating illness will improve
the health of all Oregonians. However,
the solution is going to have to come
from local, volunteer efforts at this
time. The American people are not yet
ready for the establishment of health
care as a right. 
Dr. Eccles is a family physician in Klamath Falls.
a Right?
W
HEN I WAS ASKED to write an
opinion piece on whether
health care is a right, I initially
thought that I was missing something.
As a public psychiatrist, I have always
seen it as my duty to provide service to
those in need, regardless of their ability
to pay. It is hard for me to imagine
choosing to withhold care to someone
in need of my services. I am not sure
if this means I believe access to health
care is a right; I only know that it is
right to provide access to health care.
This debate has already been rendered
moot. President Obama is on firm
ground in arguing that trying to sustain
our current system of health care
delivery is not an option. Congress
is currently considering legislation to
establish universal health care. This
has become necessary as rising health
care costs make health insurance
increasingly inaccessible to individuals
and employers. There are currently at
least 50 million uninsured Americans,
and this number is rapidly rising. The
If health care is not a right, then how
do we choose who goes without? In
our society, we have decided that the
poorest and disabled shall have care.
Those with well paid, secure jobs
currently have care, but escalating
costs increasingly deny this option
The views expressed in letters reproduced by the
Oregon Medical Association in its publications
are those of the authors alone. They neither
represent the views or opinions of the OMA or its
staff, nor do they represent OMA policy.
universal health care. It is simply not
a defensible position to continue to
regard health care as a commodity
when a disgraceful number of working
Americans are at risk of losing all that
they managed to save should they
Health Care Is a Right
By Rick Staggenborg, MD
I am not sure if this means I believe access
to health care is a right; I only know that
it is right to provide access to health care.
to a shrinking middle class, as it has
been denied to the working poor for
years. Lose your job and lose your
insurance, if you were lucky enough
to have it in the first place. This
situation cannot be blamed on fate;
rather, it results from choices that we
as a society make. Those who prefer to
describe recognizing our responsibility
to America’s less fortunate citizens as
granting them entitlements rather than
rights seem to believe that providing
for one’s own health care is a matter
of personal responsibility. If they do
not recognize the moral imperative
to help Americans who cannot help
themselves, they need to rethink their
definition of responsibility.
2
Views from
OMA Members
worldwide economic crisis
is causing Americans to lose
jobs at an alarming rate. As
long as health care access
is tied to employment, the
problem can only worsen
without reform.
The health insurance
industry recognizes this
reality and has “come to the table” to
discuss reforms for the first time. They
are motivated by recognition of the
fact that if current trends continue,
the average cost of individual health
insurance will equal average income
by 2025. Clearly, the crisis will come
long before that. If we do not intervene
now, the industry has no hope of
survival.
Most leaders, both conservative and
progressive, are concerned that the
growing number of uninsured is
immoral and incompatible with the
American tradition of caring for all of
its citizens. If we are truly a government
“of the people, by the people and for
the people” we all need to join the
debate about how we are to provide
become victims of illnesses that they
may not have the power to prevent.
It should be obvious that physicians
should be actively involved in the
debate. I am an Oregon regional contact
person for Physicians for a National
Health Plan, an organization of over
16,000 doctors who have concluded
that any economically sustainable form
of universal health coverage has to
be based on the single payer model.
This is the conclusion of every other
industrialized country in the world.
While each of these systems can be
criticized in their specifics, there is no
escaping the economic reality that we
need to have the most efficient form of
universal health care we can devise if
we are to have a health care system at
all. Even if you cling to the untenable
position of the social Darwinist who
believes that health care is not a
right, you have no choice but to add
your voice to the health care reform
movement, unless you are willing to
accept whatever system results. 
Rick Staggenborg, MD, is a psychiatrist in Bandon.
Summer 2009 • 17
On My Mind
is a
Political Issue
By Moira K. Ray
M
EDICAL SCHOOL DEBT IS the
pink elephant in the corner
of the anatomy lab. During
orientation we sign promissory notes
and discuss the surreal cost of tuition.
Yet over the course of medical school
we resign ourselves to the inevitable;
that the average medical student
graduates from OHSU with $155,000
in educational debt. Nationally,
students graduating from public
medical schools have $145,000 in debt
versus $180,000 from a private school.
More worrisome is that a quarter of
all medical students will have over
$200,000 in educational debt (this
figure includes debt from undergraduate
or other graduate programs as well as
medical school). In 2007, the average
student indebtedness increased nearly
7 percent from 2006 and cannot be
explained by inflation alone.
My fellow students and I often discuss
health care reform, future specialty
choices, or the next upcoming board
exam, but escalating debt is not a
common topic. Despite our silence,
during a continuity week off from
our third-year clinical rotations the
best attended lecture was on debt
repayment and financial planning. We
are all worried about our debt and how
it will impact our future as many of us
are just beginning marriages, dreaming
of buying a home or are starting
families.
18 • Medicine in Oregon
As my fellow students prepare to
enter their fourth year and select
their medical speciality, a vast array
of interests will play into their final
decision. The role of debt alone in
medical specialty choice has repeatedly
shown little association but it certainly
factors in when one thinks of how
much of their salary will be allocated
to repay their debt. An AAMC report
from 2007 forecast that in a worst-case
scenario, by 2033 a physician locked in
a standard 10 year repayment program
could see half of their after-tax salary
going to debt repayment. Reports like
this certainly scare students like myself.
I have always intended to go into
primary care or work with underserved
populations and know that this comes
at a cost of earning less than some of
colleagues.
However, there is hope. On June 5,
Health and Human Services Secretary
Kathleen Sebelius announced the
expansion of the National Health
Service Corps loan repayment program
as part of the American Recovery
and Reinvestment Act. Over $200
million will be available to aid medical
professionals in underserved primary
care settings who qualify to serve in the
NHSC. This could double the number
of clinicians supported by the NHSC.
While expansions of programs like
the NHSC do not erase the enormous
debt medical students accrue for their
education or lessen the rate of yearly
increase, it is a start. As the debate
over health care reform continues,
I hope medical students and young
physicians speak up as we try to find a
way to work to keep medical student
debt from its seemingly inevitable
escalation. 
Moira K. Ray is an MD/MPH candidate at
OHSU; she just finished her third year and is
preparing to enter her MPH coursework.
Resources
Steinbrook, R. 2008
Medical Student Debt—is there a limit? NEJM
359:2629-2632
Association of American Medical Colleges 2007
Medical Student Tuition and Young Physician
Indebtedness available at www.aamc.org
Spotlight On...
?
The Patient-Centered Medical Home:
Answer or Illusion
By Glenn S. Rodriguez, MD
T
HE PURPOSE OF THE Oregon Academy
of Family Physicians (OAFP) is
to enhance the daily practice of
family medicine for our members and
their patients. The current reality in
primary care, with a daily crush of
rushed visits and demands of detailed
documentation, is often far from the
practice of their dreams. The patientcentered medical home movement
offers a model for the revitalization of
family medicine. If successful, it will be
a fundamental transformation of the
delivery and funding of primary care.
physicians, Dr. Bruce McElroy and
Dr. Christine Milano, who shared
their experiences in implementing
elements of the medical home into
their practices. Four workshops
drew excellent participation from
interested physicians just starting the
medical home journey. Participants
will be united in an on-line forum for
continued learning and support. Our
Legislative Affairs Committee briefed
the members on state and federal
legislation to support the development
of medical homes.
In late 2008 the OAFP surveyed our
members about the medical home
concept. We were surprised to find
80% of respondents were familiar
with the model and interested to learn
more. The most frequent barriers to
implementing elements of the model
were “lack of time” and “no payment
for new services.” Despite these
challenges, the majority believed it
could be a viable model of care.
The OAFP Congress of Delegates
declared the development and
advancement of the patient-centered
medical home to be the top priority
for the OAFP for the next five years.
Family medicine is committed to a
leadership role in the creation of real
patient-centered medical homes. In
this work we will remain grounded in
the essential principles of excellence
in primary care: first contact, patientcentered, comprehensive and wellcoordinated patient care.
We will know success when the very best
care of our patients is rewarded. And
when we find joy in our daily work. 
Glenn Rodriguez, MD, is a family
physician in Portland.
Based on this strong interest we
launched a Medical Home Task
Force with three focus areas: research,
education and advocacy.
The research effort, chaired by Dr.
John Saultz, will start with an effort
to enumerate the practice of family
medicine in Oregon. The education
initiative began this spring with a
Practice Enhancement Forum, where
multidisciplinary leadership teams
from ten small- to mid-sized practices
came together for two days of intense
training from consultants. They
were matched with local mentors to
continue their work in their practices.
Our Annual Spring CME Conference
featured a town hall session by two
Summer 2009 • 19
In the Office
TECHNOLOGY
Gives New York Doctor a Boost with Daily Practice
Contributed by AMA Staff
W
HEN INTERNIST AND PEDIATRICIAN
Salvatore Volpe, MD, started
practicing medicine about two
decades ago, his practice’s technology
consisted of a stack of 3" square
notepads and a computer with the
power and capability of today’s $100
cell phones. But today Dr. Volpe
has an adequate data tracking and
communication system for his patients’
health information that, according
to him, has made great strides in his
practice’s administrative efficiencies.
Since implementing an electronic
health records system four years ago
and an electronic prescribing system
years prior to that, he’s noticed several
benefits surrounding the areas of
communication and patient records
management—two of the most vital
parts of a physician’s practice—to his
Staten Island, NY, solo practice.
“I don’t have to wait for test results
that I don’t need anymore, and I’m
much more efficient,” said Dr. Volpe,
president-elect of the New York State
Chapter of the Healthcare Information
and Management Systems Society and
chair of the Medical Society of the
State of New York Health Information
Task Force. “When doctors have
information at their fingertips, it
expedites patient care. Not only that, we
reduce unnecessary testing, which is both
financially and emotionally costly.”
Other benefits of health information
technology (HIT) systems include
the capabilities to electronically refer
patients, receive automated utilization
reports, and improve intra-office
communication for tasks such as
20 • Medicine in Oregon
appointment scheduling and viewing
of insurance and billing history.
While Dr. Volpe has seen several
positive returns, some have not. Cost,
time and concerns about privacy
are among the reasons why some
physicians have not yet implemented
HIT systems into their practices.
But benefiting from this type of
technology takes more than execution;
it requires careful planning at every
stage, continuous improvement and
time—something Dr. Volpe said that if
invested can bring about cost savings
for his practice and his patients.
But the benefits of EHR and
ePrescribing systems, just a few of the
many forms of HIT that physicians
are executing today, can extend far
beyond that. And for Dr. Volpe, they
have.“Now, we have an electronic trail
of everything,” Dr. Volpe said.
That trail is what’s allowed Dr. Volpe
and his staff to have access to patients’
medical and medication history
information at the point of care and a
system that facilitates enhanced clinical
decision support, automated tasking
and patient registry searches.
Dr. Volpe said patient registry
searches have proven to be lifesaving, particularly in a situation
he encountered in which a popular
prescription drug was being recalled
off the market. As soon as he caught
glimpse of an early morning CNN
report on television, he quickly
conducted an ePrescribing registry
search that listed all the names of his
patients using that particular drug.
“Three months later, health insurance
companies were contacting me to
tell me to take certain patients off
the drug, but I had already done so,”
Dr. Volpe said. “I had obtained their
names the same day of the recall in a
matter of 10 minutes.”
But sometimes such gains from
technology are much simpler. From
sending electronic prescription
requests to pharmacies so they’re ready
for pickup by the time the patient
arrives, to patient access to medical
information via portals thousands
of miles away, to reducing the risk
that hard-to-read handwriting could
lead to medical errors, HIT can help
physicians avoid countless pitfalls.
“If you can’t read the doctor’s
handwriting, that’s a preventable
event,” Dr. Volpe said. “You have
to give people the tools to make a
difference. And one of those tools is
communicating effectively.”
Visit www.ama-assn.org/go/eprescribing to
access the AMA’s online ePrescribing
learning center. This resource can help
physicians and practice managers make
informed decisions about ePrescribing
and assess this technology at their own
pace in an impartial environment.
The AMA will continue to unveil new
resources and solutions for physicians
to simplify the HIT decision-making
and implementation processes, so
bookmark the learning center Web
page and check back often. 
To join the AMA or renew your membership,
visit www.ama-assn.org or call AMA
Member Relations at (800) 262-3211.
Advocacy in Focus
From Member Complaint to Legislation
A Look at SB 507
By Joy Conklin
Low Expectations
and High Expense
Marilyn Happold-Latham, a medical
group consultant, and former
administrator of Women’s Clinic,
PC, in Portland, knows that the
lengthy amount of time it takes
most health plans to complete their
credentialing or recredentialing
to become a solo practitioner.
In order to continue to provide
services to his already established
patients, he had to go through the
credentialing and contracting processes
with all of the health plans in his
area. If this process was not completed
prior to his transition, he would not
be reimbursed for providing care to
The Problem
In 2004, OMA started to hear from physician practices regarding issues they were
having getting “credentialed” with health plans and hospitals. Credentialing—the
process used to evaluate the qualifications and practice history of physicians and
others practitioners—is time consuming, redundant and expensive and has long
been a source of frustration. The process often exceeded 60 days; practitioners
had to repeat the same process with hospitals, health plans and for licensure; and
physicians often went without health plan reimbursement until the credentialing
was completed. The complaints grew more frequent, members felt powerless, and
the OMA knew something had to be done.
processes (60 to 120 days) often
results in barriers to access for
patients. She has seen physicians
avoid scheduling patients covered by
health plans with whom they are not
yet credentialed because they know
they may not be paid.
Happold-Latham recently assisted a
physician leaving a large medical group
patients of health plans for which the
credentialing process had not been
completed. With nearly 20 health
plans in Oregon metropolitan areas,
Happold-Latham says the process
requires constant vigilance by someone
with knowledge to even know where
to start. She estimates that for this
particular physician, the process will
take almost 75 hours.
Practically all information required by
the health plans for their credentialing
has already been provided by the
physician to the state for licensure.
Jeff Baird, Administrator of Broadway
Medical Clinic, feels that the
credentialing is necessary, but the
redundancy is not. “Unfortunately,
we are repeatedly told that The
Joint Commission requires each
credentialing entity to perform its own
primary source investigation.”
James Lace, MD, chair of OMA’s
Legislative Committee and a local
pediatrician with Childhood Health
Associates of Salem adds, “Physicians
in good standing with the Oregon
Medical Board have already proven
their fitness to practice medicine
and should not be prevented from
receiving reimbursement for services
they provide during the credentialing
process.”
Committee Process at Work
OMA’s advocacy process includes
the Health Care Finance Committee
(HCFC) when health plan issues
are involved. The HCFC, chaired
by David Shute, MD, an internist
and physician consultant, consists
of practicing physicians and
health plan medical directors with
representation from PAs, IPAs and
practice managers. “HCFC members
agreed,” said Happold-Latham, a
committee member representing
practice managers, “that physicians
and their patients should not be 
Summer 2009 • 21
SB 507, cont.
penalized for slow administrative
functions.” After several discussions
and thoughtful consideration, the
HCFC recommended to the House
of Delegates (OMA’s policy-making
body) that the credentialing issues
be formally addressed. Subsequently,
OMA’s Government Affairs team and
the Legislative Committee decided to
pursue legislative action.
SB 507
Along with four other legislative
bills which focused on pressing
member issues, the OMA drafted
and introduced legislation to address
credentialing. This eventually became
Senate Bill 507. There was opposition
from the payer community to SB 507
from the beginning. Senator Laurie
Monnes Anderson, Chair of the
Senate Health Committee, assembled
representatives from the OMA and
health plans to work through the
concerns with SB 507 (and the other
22 • Medicine in Oregon
OMA bills which dealt with Silent
PPOs, eligibility and overpayment.).
After months of workgroup meetings,
discussion and negotiation, the Senate
passed SB 507 and SB 508 (addressing
overpayment). SB 507 would require,
among other things, that health
plans make credentialing decisions
within 90 days of application and
that once the decision to credential is
approved, practitioners would be paid
retroactively for services they rendered
during the credentialing process—at
least at the non-contract rate. As
this issue went to press, SB 507 was
awaiting the Governor’s signature.
OMA recognizes that other issues with
credentialing still exist. OMA participates
in the credentialing workgroup of
Oregon’s Administrative Simplification
efforts and is collaborating with hospitals,
health plans and other providers to
alleviate additional burdens to physician
practices.
Ultimately, the legislation proposed by
the OMA comes from the experiences
of its members. Dr. Lace believes SB
507 is a great example: “We drafted
legislation that pays appropriate
deference to the need for insurance
plans to vet their providers while
providing greater access to care by
allowing physicians who are qualified,
ready and able to provide services.”
Baird agrees, stating that “SB
507 allows for physicians to be
compensated for services rendered
during the credentialing process given
reasonable consideration for existing,
demonstrated medical competency.
Oregon cannot afford to have
competent physicians sitting idle, while
so many patients need care, waiting for
payers to process paperwork.” 
Joy Conklin is the Director of
Socioeconomic Affairs for the OMA.
Advocacy Corner
Compliance Process in
Blue Cross Blue Shield Settlements in Effect
MAKE SURE YOU ARE BEING PAID CORRECTLY
T
HE CLASS ACTION LAWSUITS brought
by several state and county medical
societies and physicians against
the for-profit health insurers resulted
in settlements which required the
health insurers to significantly change
the way they conduct business. The
Physicians Advocacy Institute (PAI) is
charged with enforcing the settlements
on behalf of physicians. As of April
21, 2009, all the provisions in the
Blue Cross Blue Shield Settlement
Agreement have taken effect. This
means that settling Blue Cross Blue
Shield plans:
ŒŒ May not seek overpayment recovery
beyond 18 months
ŒŒ Must use a clinically based
definition of medical necessity
ŒŒ Must adhere to most CPT© coding
rules including payment for E&M
codes appended with a 25 modifier
and payment for add-on codes
ŒŒ Must provide 90 days advance
notice of material adverse change
ŒŒ May not require physicians to
participate in all products
ŒŒ Must disclose their methodology for
determining UCR amounts
If you believe a Blue Cross Blue Shield
company (or any of the other settling
insurers) has violated a provision of the
settlement agreement, you should file
a compliance dispute by completing
the simple two page form available
on www.hmosettlements.com. There is
absolutely no cost to physicians to file
disputes.
Physicians have used the compliance
dispute process in other settlements
to collect millions of dollars. For
example, physicians collected over
$12,000,000 for previously denied
CAD mammography and myocardial
perfusion add-on codes. Physicians
have also been saved from repaying
millions of dollars in alleged
overpayments. For example, one
Florida practice saved $1.9 million
when the insurer agreed to accept
$33,000 after originally seeking to
recover over $2,000,000.
Other practices have saved hundreds
of thousands of dollars. Many
payments and savings have not reached
this magnitude but have still been
important to the individual practices
involved. For example, one Oklahoma
practice received payment of over
$9000 for previously denied modifier
59 claims. And, a New Jersey practice
saved over $13,000 when the insurer
agreed to cease all overpayment
recovery efforts.
Physicians have also successfully
used the compliance process to
enforce other rights in the settlement
agreements, including their right to
For more information, please
go to www.hmosettlements.
com, www.ama-assn.org/
go/settlements or contact
the compliance dispute
facilitators, Deborah Winegard
at [email protected]
for Blue Cross Blue Shield and
Humana disputes or Cameron
Staples at cstaples@npmlaw.
com for Anthem/WellPoint
and HealthNet disputes.
have accurate EOBs sent to patients
insured by plans in which they don’t
participate and their right not to
participate in HMO products.
In addition to the Blue Cross Blue
Shield Settlement Agreement,
settlements with Anthem/WellPoint,
HealthNet and Humana remain in
effect. 
Reprinted with permission from
Physicians Advocacy Institute, Inc.
Summer 2009 • 23
In-House Counsel
Changes Coming to the
Health Professionals Program
By Mike Crew, JD
Background
In 1989, the Oregon Legislature
enacted a bill creating a program
for addicted professionals who were
licensed by the Oregon Medical Board.
The program was generally referred
to as the “Diversion Program.” It was
to be administered by a supervisory
council made up of five to seven
members. The original program was
limited to physicians who were either
alcohol or drug addicted. In 2007,
the Oregon legislature expanded the
program to include physicians facing
mental health issues; this portion of
the program did not take effect until
January 1, 2009.
licensee is suspected of a violation of
this Chapter, other than [obtaining
or self-administering intoxicants,
drugs or controlled substances,
the habitual or excessive use of
intoxicants, drugs or controlled
substances, or violation of the federal
Controlled Substances Act].”
Simply stated, physicians understood
that if they self-referred into a
treatment program before an
investigation was commenced by
the Board, such “self-referral” would
protect them against being disciplined
for either being addicted or selfadministering drugs or intoxicants.
The Board did, however, retain the
right to discipline a “self-referred
physician” if the physician was guilty
of conduct such as diverting drugs
from patients, treating patients
while under the influence of drugs 
The original program came into
being principally through the Oregon
Medical Association’s support of the
underlying legislation. Jim Kronenberg
and other members of the OMA
testified on numerous occasions
in support of the original bill and
identified the fact that many addicted
professionals had not and would not
seek treatment unless a program was
put in place that allowed them to “selfrefer” without fear of discipline by the
Board. Thus, as a part of the original
Act, it was provided that:
“any licensee who in good faith
voluntarily participates in an
approved diversion program and
successfully completes the program
shall not be subject to disciplinary
investigation or sanctions unless the
Summer 2009 • 25
In-House Counsel
or alcohol, etc. It was generally
believed that if a physician was not
guilty of any such conduct, but was
addicted, a good faith self-referral
prior to the commencement of an
investigation would make them
“immune” from discipline, providing
that they complied with the terms
of the diversion agreement and
successfully completed the program.
These programs included a number of
conditions and, generally, were for a
minimum period of three to five years
in duration.
HB 2345-B
At the outset of the 2009 Legislative
Session, “the Governor’s Office”
introduced HB 2345, which effectively
terminated the Diversion Program
under the OMB and all other
professional licensing boards which
had similar programs, and proposed
to move them to a yet to be identified
government agency. The purported
purpose of the bill was to create a
monitoring program that did not
violate federal laws that effectively
assured the public and the licensing
boards that licensees who were
participating in diversion programs
would not violate the terms of their
diversion agreements, and should they
do so, they would be automatically
suspended from practice for a period of
not less than thirty days. The Executive
Director of the OMA, Joanne Bryson,
appeared in opposition to HB 2345
as originally written. Key points in her
testimony included:
ŒŒ The OMA would oppose the
Diversion Program being removed
from the jurisdiction of the OMB.
ŒŒ Since 1989, physicians who had
enrolled in the program had a 92%
success rate.
ŒŒ The OMA supported the Diversion
Program for addicted professionals
and would not want to see it moved
26 • Medicine in Oregon
to a government agency that did
not have any history of working
with such programs and, more
importantly, the complex issues
faced by addicted physicians.
The OMA supported the program
because of its success, as well as the fact
that it offered addicted professionals
the opportunity to self-refer and avoid
discipline where their transgression
was either due to alcoholism or
drug addiction not involving other
violations of the Medical Practices Act.
In the OMA’s view, the public interest
was best served by getting addicted
physicians into treatment programs
through the “self-referral” process.
OMA’s Change in Position
The “self-referral” provision of the
Diversion Program, in large part, was
the reason for the OMA’s original
support of the 1989 bill. The fact
that addicted professionals were
seeking treatment and successfully
participating in the diversion program
was testament to the OMA’s original
support. However, due to a recent
Administrative Law decision in a case
pending before the Board, the OMA
was required to reassess its support of
the OMB Diversion Program, and, as a
result, it withdrew its opposition to HB
2345 and supported a rewrite of the
bill which became HB 2345-B.
The Administrative Law decision
came out of a case involving Mark
Baskerville, MD. Dr. Baskerville
had self-referred into the Diversion
Program before an investigation had
been commenced. In his case, the
Board took the position that the
immunity afforded by the Diversion
Program was not binding on the Board
until he had successfully completed
his program. Dr. Baskerville’s
attorneys took the matter up with the
Administrative Law Judge who agreed
with the Board’s position.
That ruling effectively eliminated any
immunity that a self-referred physician
would have under the current
Diversion Program unless and until
he or she successfully completed the
program. Thus, if a diversion program
was for five years, at any time during
that period, the Board could discipline
the physician even though they had, in
good faith, self-referred. A number of
physicians and attorneys observed that
this effectively eliminated not only the
purpose of the self-referral provision
of the Diversion Program, but also
would predictably cause addicted
professionals not to participate. As
one physician observed, “it will cause
addicted doctors to fly under the radar
to the detriment of the public.”
It was because of the decision in
Baskerville that the OMA changed its
position on HB 2345, as it recognized
that a well-written bill would include
a self-referral provision that should
clearly allow physicians who selfreferred prior to the institution of an
investigation to avoid discipline.
The OMA’s views were made known to
the Governor’s Office and to certain
key legislators who were supporting
HB 2345. As a result, HB 2345 was
rewritten to include a provision for
self-referral [prior to commencement
of investigations] and other provisions
to protect self-referred professionals
currently in the OMB program.
Upon passage, HB 2345-B will become
effective July 1, 2010. Until then,
physicians currently participating in
OMB Diversion Program will remain
in that program and be transferred
upon the Act’s effective date. The
OMA insisted upon provisions being
placed in HB 2345-B that protected
the interests of those physicians who
are currently in the Diversion Program
through self-referrals. The new
program will be administered by the
Department of Human Services and
between the date of the Governor’s
signature upon the bill and the
effective date, DHS will be required to
enact Administrative Rules interpreting
the bill and setting forth how the
new program will function. Bryan
Boehringer, the OMA’s Director of
Government Affairs, observed that the
OMA will be a part of the discussions
with DHS relative to designing a new
diversion program and how it will be
regulated. 
Michael D. Crew is a senior partner in
Cooney & Crew, LLP, general counsel to
the Oregon Medical Association.
Summer 2009 • 27
Creative Outlets
Creative Outlets appears in each issue of Medicine in Oregon.
We encourage you to show us your creative side. Drawings,
creative writing, paintings, poetry, etc. are all welcome.
Send your “Creative Outlets” to Betsy Boyd-Flynn at [email protected].
Guarding his
mistress’ shop
By Dr. Donald Froom
Dr. Froom, an internist and
nephrologist at Providence St.
Vincent Medical Center in SW
Portland, took this photo during
the lavender harvest in Provence,
France. This and other photos
taken by Dr. Froom are on display
at St. Vincent as part of a project
combining art with traditional
medicine to treat chronically ill
patients. Dr. Froom explained
that healing images and other art
can communicate compassion
to patients without using words
and that art can provide patients
a therapeutic respite from their
illnesses. Hospitals around the
world are exploring the use of art
and music in their patient care.
MEDICINE in Oregon
Volume 2, Number 3 • Summer 2009
11740 SW 68th Pkwy
Portland, OR 97223
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