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Oregon Takes First Steps Toward Reopening The State 

Gov. Kate Brown. | SHUTTERSTOCK
April 23, 2020

Gov. Kate Brown is moving towards reopening Oregon.

As a first step, she said she will allow health care providers to provide non-urgent surgeries and procedures starting May 1 if they meet certain criteria. 

The move, announced during a news conference Thursday, offers Oregonians a glimmer of hope after more than a month of restrictions amid  the state battle against the coronavirus pandemic. The decision marks a balance between the fight against the virus and the financial freefall of hospitals and clinics forced to lay off staff and trim hours due to the lack of revenue from procedures like fertility treatments, hip replacements and routine dental work.

Brown and public health officials said they believe Oregon can expand health care even though the  battle against coronavirus still rages. The state is working on plans to bolster its contact tracing efforts to track the virus and officials said they hope to boost the state’s 3,000-a-day testing capacity. 

Brown, a Minnesota native who grew up ice skating, said the move is like that first step onto a frozen pond to see if the ice can support the weight.

“We’re only stepping onto the ice carefully and cautiously one step at a time, Brown said.  “If we see a crack in the ice or find ourselves in a precarious position, then we may need to pause for a bit longer.”

Brown indicated she’s especially worried about the fate of medical facilities in rural Oregon and the threat that prolonged financial hardship could force them to close.Rural hospitals rely heavily on non-urgent surgeries and experienced steep losses.

“Halting these types of procedures has been an added strain to Oregon’s rural hospitals and providers during this crisis,” Brown said. “This order allows them to get back to providing much needed care for Oregonians across the state.”

Dr. Bruce Goldberg, a member of the Governor’s Medical Advisory Panel and former director of the Oregon Health Authority, said the panel  looked at how to safely expand services for patients and monitor the situation.

“The COVID crisis has heightened for any of us the importance of our health care workforce and our health care infrastructure in the state, particularly our rural hospitals,” Goldberg said. “Oftentimes,  rural hospitals are the only health care for many, many miles in harsh conditions.”

To start non-emergency procedures, a hospital will have to maintain a 30-day supply of personal protective equipment. A hospital also will need to have at least 20% of its beds empty. Brown halted non-urgent medical surgeries in March to preserve the state’s supply of personal protective equipment. Medical facilities can only perform half of the number of procedures they did in the past and they need to ensure social distancing in waiting rooms.

Brown indicated that  the state now has an ample supply  of personal protective equipment. She praised the efforts of companies like Nike to manufacture personal protective equipment and the efforts of the Department of Administrative Services to procure large shipments of gowns and masks.  Oregon also is set to receive a Battelle machine that allows for the safe and environmental cleaning of masks. No details were immediately available about that. 

On another front, state officials are planning a contact tracing program with about 600 workers who will reach out to residents who may have been exposed to COVID-19. Contact tracing, which involves officials identifying everyone a COVID-19 patient came into contact with and then notifying them so that they self-quarantine, for example, has helped countries like South Korea avoid a rebound of cases when people resume their normal lives.

The Oregon Health Authority is working on the plan this week, Brown said, adding that the state needs a more robust plan.  

The plan will establish qualifications of workers and likely will include laid-off health care workers, according to a health authority email obtained by The Lund Report. Hiring could start within the next week, the document said. 

Hospitals Face Slow Climb

Hospitals are not likely to snap back into operating in the black. They’ve endured $200 million in operating losses in March, according to the Oregon Association of Hospitals and Health Systems.  Experts said the  industry will need time to recover from the free fall. 

Charles Tveit, chief executive officer of Lake District Hospital in Lakeview, said hospitals will need time to restore their finances after resuming care because of the lag between providing  care and receiving payments from insurers after billing.

He said Brown’s decision will help hospitals in the long run. 

“It’s not about today,” Tveit said. “It’s about what’s going to happen in two months.”

Becky Hultberg, president and chief executive officer of the hospital association, said the expansion of health care services is a priority for the organization. The association will review the governor’s plan to resume health care services and provide feedback to the Oregon Health Authority and governor. 

“We supported the decision to pause elective procedures to preserve PPE for the COVID-19 fight, but we also understand that it’s not safe to delay some of these procedures indefinitely,” Hultberg said in a statement. “Our patients need care and we are prepared to safely resume health care services.”

Financial questions linger. The hospitals association  requested $200 million to stabilize hospitals with plummeting revenues, especially in rural areas. 

The legislative Joint Emergency Board on Thursday talked about a proposal from the governor’s office that would allow rural hospitals to access $50 million for loans to cover payroll costs during the pandemic. Under the proposal, rural hospitals would get loans from the Oregon Business Development Department. 

Lawmakers eventually tabled the proposal without action, with some expressing reservations about forcing hospitals to pay back loans that come from federal coronavirus relief funding.

“I was amazed at the surgeries that have been on hold -- hip replacements and heart bypasses,” said Senate Republican Leader Herman Baertschiger of Grants Pass. “These are essential surgeries.”

Baertschiger suggested the state provide grants to hospitals instead. 

“This loan program, it’s too complicated for them,” he said. “It’s too complicated for their financial struggles.”

Brown said Thursday she is aware of the association’s request and working on an alternative plan.

“We’re working on a different package and the details will be released soon,” Brown said, adding that the state is waiting on guidance from the federal government about how coronavirus relief funding can be used.

Hultberg, with the hospital association, said the group is encouraged by Brown's pledge to bring more assistance to hosptials.

Oregon has received $2.45 billion from the CARES Act -- the federal Coronavirus Aid, Relief, and Economic Security Act to support local and state government agencies, housing and transportation programs, child care, airports and other sectors for coronavirus-linked expenses.

State leaders expect Congress to appropriate more funding that will help Oregon as early as this week, though it’s unclear how much the state will get.

Hospitals Start Preparing

For now, hospitals are mapping out their plans to resume services.

Lisa Vance, chief executive officer of Providence Health & Services, which runs a network of Portland-area hospitals and clinics, said the company intends to be ready as much as possible on May 4. 

Providence’s surgical capacity is at 25%; the company intends to work its way up to the 50% mark allowed under Brown’s plan.

“That allows us a full week of planning and ramping up to assure we have all the ancillary services that also support our patients as they are going through the procedures,” Vance said in a statement. 

Doug Boysen, president and chief executive officer of Samaritan Health Services, said Brown’s framework will help health care providers be “thoughtful and careful when ramping up services.” Samaritan Health Services is headquartered in Corvallis and has five hospitals in Linn, Benton and Lincoln counties.

“We must remain diligent to do everything we can to protect our patients and employees,” Boysen said in an email.  

The state will monitor hospitals that resume non-urgent surgeries. Brown said the state will make adjustments as necessary if the situation worsens.

Veterinarians will need to wait longer before they can use personal protective equipment. Brown’s order does not include veterinary clinics. Brown said she is working on a different timeline to lift that restriction. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.