Oregon’s health care crises will spill over into the new year – Oregon Capital Chronicle

Oregon’s health care system will kick off 2023 with a fresh start as a new director of the Oregon Health Authority takes the helm and Governor-elect Tina Kotek is sworn in.

james schroeder, currently CEO of the state’s largest Medicaid insurer, Health Share of Oregon, will serve as interim CEO effective January 10, the same day Kotek takes office and ends Governor Kate Brown’s term. He will have a lot to deal with when he replaces Patrick Allen, who was appointed by Brown, also initially on an interim basis.

Oregon faces persistent health care problems as the pandemic subsides. They include a mental health crisis, a shortage of hospital beds that is exacerbated during surges of COVID-19, influenza, or other diseases such as RSV.

There is also an ongoing health care workforce shortage affecting hospitals, access to behavioral health care and other services. Other health care and access issues continue to plague the state, such as homelessness and a lack of affordable housing.

Schroeder has a wide range of experience, from the front lines of clinics for low-income Oregonians to executive positions with large health care corporations. He led the 426,000-member Health Share Medicaid insurer and has served in senior roles at Kaiser Permanente, including vice president of safety net transformation and Medicaid chief medical officer. He also has experience as a clinician and executive in medical clinics serving Medicaid patients and played a role in founding and running the Neighborhood Health Center in the Portland area.

James Schroeder, CEO of Health Share of Oregon, the state’s largest Medicaid insurer, will become acting director of the Oregon Health Authority on January 10. (Courtesy of the Office of Governor-elect Tina Kotek)

In his new role, he will lead an agency that spends more than $17 billion a year and has 4,770 employees. The authority’s Medicaid program, which provides health care to low-income people, covers 1.4 million Oregonians, or one in three residents.

Here’s a look at the top health care issues facing Oregonians in 2022 and what’s to come:

hospitals: The pandemic exacerbated existing shortages of nurses and other healthcare workers, as professionals retired early or went to other jobs, leaving hospitals scrambling to fill vacancies.

Now, the workforce crisis continues even as fewer COVID-19 patients need to be hospitalized. Patients are being forced to wait longer in emergency rooms for hospital beds to open, and hospitals have postponed some procedures.

The nursing shortage has affected patient care, they told the Capital Chronicle. Sometimes the consequences are dire, with patients dying due to understaffing, Patrick Allen, director of the Oregon Health Authority, told a legislative committee in September.

With the triple whammy of the winter season from COVID-19, influenza and RSV, or respiratory syncytial virus, the stress in hospitals affects people of all ages. They range from the young children most susceptible to RSV to the elderly and immunocompromised individuals who face the highest risk of COVID-19 and influenza.

In the short term, hospitals have resorted to crisis care standards, which allow flexibility in tasking and scheduling and give them the ability to triage care if resources run low. The Oregon Health Authority, through a staffing contractor, has hired dozens of contract nurses to shore up pediatric units in hospitals during the trifecta of diseases.

Doernbecher Children's Hospital at Oregon Health & Science University is overflowing with patients with respiratory illnesses.  (Christine Torres Hicks/OHSU)
Doernbecher Children’s Hospital at Oregon Health and Science University, like others, is overflowing with patients with respiratory illnesses. (Christine Torres Hicks/OHSU)

But those are not permanent solutions. Lawmakers next session will hear proposals aimed at bolstering the workforce.

For example, the 15,000-member Oregon Nurses Association is supporting legislation that would have a stronger enforcement mechanism and hefty daily fines of up to $10,000 for hospitals that don’t meet minimum staffing levels. Existing state law requires hospitals to develop staffing plans, but the nurses union has said more accountability is needed.

Mental health: Oregon mental health system continues to struggle to meet the demands. Oregon State Hospital, the state mental health hospital, is facing stricter timelines under a court order to admit and care for patients who need treatment to face criminal charges. Misdemeanors can stay in the hospital for a maximum of 90 days; nonviolent felony defendants have up to six months and patients charged with violent felonies can receive treatment for one year.

The new deadlines came after a lengthy court battle because the state failed to comply with an earlier 2002 court order to admit patients within seven days after a judge found they needed treatment to help its defense.

To meet the new deadlines, Oregon State Hospital is asking lawmakers for $4.9 million for 59 new staff positions for the remainder of the biennium, which ends June 30, 2022.
But the state hospital is not the only part of the mental health system that is squeezed. County officials and prosecutors warn that the new deadlines put a strain on the county’s limited community mental health services when those patients return to their communities and still need care.

The Oregon Health Authority oversees the Oregon State Hospital in Salem. (Oregon Health Authority)

State officials acknowledge there is a shortage of beds for residential mental health programs, another issue lawmakers plan to address next session.

State legislators approved $1 billion in new funding during the 2021 session for various behavioral health programs. The state has dispersed or committed most of those funds, and it will take time to see the benefits.

Addiction: Going forward, treatment for people with addictions in Oregon will enter a new era in 2023. The state is funding measure 110 services with about $300 million in marijuana tax revenue through June 2023. Voters in 2020 approved Measure 110, decriminalizing low-level drug possession, with a view to treating addiction.

For Oregon, the state’s addiction rate stands out nationally. National reports, including this one one from Mental Health Americaconsistently rank Oregon as having the highest or one of the highest rates of people with mental health and addiction problems.

Critics have criticized the health authority, which oversees the program, for its slow deployment of money authorized by the measure. It finally shipped this summer, about a year behind schedule. At the same time, the agency approved mental health and addiction networks in each of Oregon’s 36 counties. They offer a variety of services, including health screenings, addiction treatment, and assistance in finding housing and employment.

But it will be months before they have an impact. Kotek has said that he wants the system to continue, but he has said that he will closely monitor developments.

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