Monitoring the pulse of local health care By Mikael Krummel
If you were to sketch a triangle representing our nation’s most pressing domestic concerns, economic reform and environmental policy would likely occupy two corners of the polygon. Health care would hold down the third. Money, planet, and personal health are on nearly everybody’s mind—and that’s as true in the Eugene area as anywhere else.
What’s also true is that the major trends shaping the health care landscape across America are largely the same trends impacting Lane County: quality of care, accessibility, and cost. But similarities noted, there are also special elements in our hometown character that are molding the local health care landscape in unique—and often encouraging—ways.
Stimulating ideas
On the near horizon, we can anticipate an infusion of federal stimulus dollars into our local health care system. Access and cost are key funding targets. Scholarships, loans, and training grants should attract students into the medical field and draw more primary-care practitioners into our community. Local public health centers and clinics expect their low-income and under-insured treatment capacity to grow.
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There are also stimulus funds for expanding medical research. Dollars targeting chronic and infectious disease, biomedical treatments, and wellness strategies are expected to fit nicely with evolving research interests at the University of Oregon and in local health care organizations.
The health care portion of President Obama’s stimulus plan also focuses on information technology: promoting and adopting tools for improving electronic patient record sharing and accuracy. Most practitioners recognize that cost reductions and care improvements can both be realized through electronic information sharing. Sacred Heart is collaborating with other local providers to put a regional electronic records system in place within several years.
We are facing tough challenges with regard to flaws in our national and local health care systems, but there are many reasons to celebrate trends promoting more cost effective, accessible, and higher quality local health care. Those same trends are driving the promise of a dynamic makeover of our local economy.
Bracing for the boom
Much has been said about the impending passage of a generation of baby boomers into their senior years. Don’t look now, but that aging locomotive recently steamed into town, pulling a long train of boxcars behind.
Population forecasts for Lane County for the decade running 2005 to 2015 project a growth rate of 33 percent for the over-65 age contingent. Other age groups combined will grow only 10 percent. In raw numbers, that translates into 15,000 elderly residents added to the current 45,000―a shift portending big changes to the local health care blueprint.
According to Kay Metzger, director of Lane Senior and Disabled Services, one response to the swelling number of seniors seeking care in a climate of accelerating costs is a movement toward reduced—but appropriate—levels of patient care. Insurers, clinicians, and government all want that, she says.
Metzger also points out that Oregon is leading the trend because it has long offered seniors services geared toward independent living and other less expensive alternatives to nursing homes. “In Oregon,” says Metzger, “we have a pretty rich environment of choices.” That’s a comforting notion, given that nobody seems certain what lifestyle choices aging boomers will embrace.
Another boomer-related trend suggests seniors are postponing health care for financial reasons—which too often leads to more critical health care needs and higher costs down the line. The most promising solutions to senior health care challenges involve prevention, earlier intervention, and doses of care most appropriate to the level of need. A variety of local efforts are aimed at doing just that.
In the neighborhood
Oregon Project Independence is one notable local senior health care model. OPI offers alternatives to institutional nursing care by providing “functionally disabled” clients five hours of home-based health care services a week—simple services like back care, homemaking support, and meal delivery. OPI represents an effective strategy for dramatically reducing state-subsidized costs associated with more intensive, more costly—and often unnecessary—Medicaid services.
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Dr. Ron Stock, director of PeaceHealth’s Gerontology Institute in Eugene, suggests that residential health care for boomers might also resemble Eugene’s Cascade Manor. At Cascade, self-sufficient seniors “age in place” in individual housing units within a neighborhood that also offers assisted living, dementia care, and nursing homes for more vulnerable residents.
Stock has an impressive command of gerontology research and senior health care models. He helped create the nationally recognized clinical model at Barger Medical Clinic in Eugene, where a multidisciplinary team of case managers (geriatricians, nursing staff, social workers, dietitians, pharmacists) has extricated physicians from their usual primary care manager role. The result has been improved case coordination, better patient self-care, and reduced costs.
Another key feature of the Barger Clinic model highlights the value of customer input. Without adopting groundbreaking approaches to health care reform, like getting feedback from and engaging in dialogue with patients, changes to the system will have no practical effect. “There’s a mega trend happening here that has to happen,” Stock says with unveiled passion. “You can control costs. You can control access. You can control quality. But unless you have patient engagement, you are just rearranging chairs on the deck.”
Peace and persuasion
PeaceHealth has long been a high-revving engine driving health care changes on many local fronts. The non-profit corporation runs hospitals in Florence and Cottage Grove, the Sacred Heart Medical Center near the UO campus, numerous area medical clinics and specialty programs, Oregon Medical Labs, and the 130-member physician consortium PeaceHealth Medical Group.
But with the recent christening of Sacred Heart Regional Medical Center at RiverBend, PeaceHealth has transformed itself into an undisputed überforce driving health care services across a large region of the state. That new status comes with equally large visions of growth and opportunity.
Mel Pyne has been CEO of PeaceHealth’s Oregon region since 2005, but his knowledge of the Eugene-Springfield health care community dates back to his tenure as an administrator at McKenzie-Willamette Hospital starting in the 1980s. According to Pyne, PeaceHealth “has really been on an evolution toward more tertiary and quaternary services for 30 years.”
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“The health care cluster,” explains Pyne, “not only includes delivery of health care, but medical education, and clinical research, and spin-off life science, and high-tech economy. We’re starting to think more about synergies between health care and education. What are some partnerships that could create benefits for this economy?”
Some of those synergies clearly involve the University of Oregon and Lane Community College.
Research and training
UO professor Gary Klug, former head of the department of human physiology, says there have been ongoing discussions at UO about ways the university, the hospitals, chambers of commerce, businesses, and local governments can forge integrative health care projects. He points out that there are lots of collaborating physicians working on the UO faculty. And there are also collaborative projects in place on campus: women’s vascular health, balance in the elderly, stroke and traumatic brain injury, early childhood development, and more. “What we’re trying to do,” says Klug, “is build some kind of structure that will support these people so that research is more efficient.”
Oregon Health Sciences University, in Portland, also has a quaternary linkage with PeaceHealth. Whereas OHSU medical students have traditionally had limited training opportunities at the Sacred Heart facility near the UO campus, the new RiverBend site has opened possibilities for physician residencies and other graduate-level medical training. “It kind of lifts the whole boat,” suggests Mel Pyne, “and very likely we’ll move forward.”
Nearly a decade ago, Lane Community College planners got savvy to the anticipated effects of aging baby boomers on local health care demands. Then they scoped in on long-range goals of the local hospitals. “We realized,” says LCC president Mary Spilde, “that if McKenzie-Willamette and PeaceHealth intended to position themselves as part of a regional hub for health care, then Lane needed to ask, ‘Okay, how can we be a community resource for the health care education and health care professionals needed to support that hub?’”
The answer today is LCC’s burgeoning emphasis on health career training. The college boasts nursing degree programs, and coursework geared toward certifications in nursing assistance, respiratory care, EMT and paramedic service, medical lab technology, medical records, nutrition, and dental hygiene. The programs have strong ties to Sacred Heart, McKenzie-Willamette, and other local health care organizations.
Riding the wave
Surfing the front of the medical technology wave can be both exciting and rewarding—but also expensive. Consequently, cutting edge diagnostic and treatment technologies are mostly found in hospitals. Large institutions tend to have more money to invest in expensive high-tech devices. Our local hospitals bear witness to that.
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Awesome technologies like magnetic resonance imaging, gamma knife radiosurgery, 64-slice CTI scanning, “smart” operating suites (in-room access to technologies so that consulting surgeons, for example, in another physical location can watch or consult in real time), surgical robotics, and access to the Internet for a variety of purposes—checking drug-interaction databases, access to patient electronic medical files, prescription records, etc.—provide hospitals with competitive advantages. But in Eugene, a recent boom in specialized group practices proffering outpatient surgery represents a subtle new wrinkle in the technology trend.
“When you go down Country Club Road,” says Rob Rockstroh, director of Lane County Health & Human Services, “obviously something has switched here in the last few years.” He suggests that the groundswell of new outpatient surgery centers in Eugene means that more consumers have access to high-tech tools at lower cost. That’s because outpatient centers, he says, don’t promote overnight stays, and “don’t have the huge overhead. They aren’t running a building that was designed for use 50 years into the future.”
East meets west
It’s sometimes referred to as CAM, for complimentary and alternative medicine. It encompasses naturopathy, acupuncture, massage therapy, chiropractic care, ayurveda, tai chi, herbalism, yoga, and a long list of other nontradtional treatments and practices. In Eugene, every health care approach has its proponents.
“I don’t know what the numbers are,” admits naturopathic physician Tina Kaczor, “but the Northwest is a trend area because we have a lot of chiropractic schools, oriental medicine schools, and naturopathic medical schools.” Dacotah Splichalova, a licensed massage therapist and owner of Koru Health Center concurs. She believes the high number of local practitioners has encouraged increased use of CAM therapies in our community: “It has opened up the idea of alternative health care in general.”
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Given the view both of these women have on the volume of CAM practitioners in Eugene, it’s not so surprising that they’ve also seen recent movement toward CAM specialization. The trend reflects increasing provider sophistication, business competition, and the fact that patients are seeking out alternative treatments for some very specific concerns like diabetes, pain management, pregnancy care, allergies, post-surgery care, and cancer.
Dawn Gandalf, manager of Village Health, has a slant on another dynamic seen in patients coming to her clinic: The majority of people who come for wellness checks “are either medical refugees, where they are in a medical system that is allopathic, traditional, and they are not satisfied with the care,” says Gandalf. “Or they’ve recently been diagnosed with something and they don’t want to go the traditional route.”
To varying degrees, the upsurge in alternative care is also attributable to growing CAM acceptance in conventional medical circles. Local hospitals are endorsing established alternative treatments such as acupuncture, massage therapy, and naturopathy. And local physicians have started referring their patients to CAM practitioners, in search of greater treatment success.
“We’ve moved from doctors as gospel,” suggests Justine Michaud, a holistic health counselor at Village Health, “to asking a lot of questions, because there is a lot more information available and people are far more invested in not wanting mystery about their health and bodies.”
Strengthening the safety net
Health care reformers and advocates in our community deserve strong commendation for improving access and reducing medical costs for thousands of financially strapped residents. The efforts are paying dividends in many untold ways.
Shared leadership by local hospital administrators has fostered the development of the 100% Access Coalition, mobilizing an alliance of community partners to work on behalf of hundreds of families desperately needing affordable care. In the view of McKenzie-Willamette CEO Maurine Cate, “It’s important that we are building a model that will be embraced by the physicians and that will allow access for the greatest number of patients possible.”
The Lane County government is also an effective broker for thousands of under-insured health consumers. The county’s expanding public network of medical, dental, and mental health clinics—including White Bird, Riverstone, Looking Glass, and school-based clinics—are critical components of our health network.
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Many compassionate individuals and businesses have stepped forward with time and money in support of services for low-income clients at the Volunteers in Medicine Clinic. Similarly, PeaceHealth and its many generous benefactors have filled a huge health care service gap though remarkable financial commitments to the Bridge Assistance Program for indigent patients.
Mel Pyne, the PeaceHealth chief executive, believes change is more likely to come now due to the current economy. “There’s a strong desire to have revolutionary change,” says Pyne, with a mix of optimism and pragmatism, “but there’s big risk in trying to change this thing overnight. You know, a crisis creates opportunities that prosperity doesn’t.”
economic reform and environmental policy would likely occupy two corners of the polygon. Health care would hold down the third. Money, planet, and personal health are on nearly everybody’s mind—and that’s as true in the Eugene area as anywhere else. 
