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A group representing family physicians is concerned that Oregon Health & Science University’s proposed acquisition of Legacy Health could make patients pay more to see their primary care doctors while failing to address a statewide shortage.
The Oregon Academy of Family Physicians raised the concerns Tuesday in a letter to the state merger oversight office that is considering whether to approve a deal that would create a major new Oregon hospital and health system powerhouse. Late last year OHSU and Legacy proposed the merger, which, if approved, would feature nine hospitals and many affiliated clinics in one health system.
Patient access to primary care in Oregon is already “precarious,” wrote Betsy Boyd-Flynn, executive director for the group of 1,800 Oregon doctors. She cited a 2022 survey of the country’s 15 biggest metropolitan areas that found Portland-area patients experience the longest wait-times for family medicine appointments, on average 44 days — more than twice the average rate among big cities and five times the wait time experienced by patients in greater Washington, D.C.
The group's input piles on to an increasingly high-profile debate over the deal. Consumer advocates as well as former Gov. John Kitzhaber and Brown University researchers have spoken out against the merger, citing studies finding that hospital consolidation elsewhere has resulted in higher prices. Nonprofits, supported by some lawmakers, have organized to oppose the deal on the grounds it would undermine health equity.
Meanwhile, after winning assurances from OHSU that the merged, publicly owned entity would protect represented employees from layoffs in the short term, some employee unions have come out in favor of the deal. So have some OHSU specialists. The Immigrant & Refugee Community Organization has come out in favor.
OHSU and Legacy have argued that the merger would be mutually beneficial in a way that benefits patients. The research university is well-capitalized and draws patients from all over the state. However, most of its operations take place at its main campus on Marquam Hill. Legacy has clinics and hospitals spread through the region, but is on financially shakier grounds.
As evidence that the deal would drive up costs, the academy’s letter cited a study recently published in the Journal of the American Medical Association that found that primary care physicians employed by hospitals charged more for the same services offered by those in independent practices.
Boyd-Flynn asked the state to request a detailed plan from OHSU on how the merged hospitals would expand primary care access to address shortages, adding that “To our knowledge, no such plan currently exists..”
She added, “Given OHSU’s role in educating medical students and family physician residents, we believe it is fair to require the parties to the merger to describe clearly how the new institution will support the institutional and community faculty who are training family physicians, and safeguard the regional capacity to do so.”
Asked about the group's concerns, Boyd-Flynn told The Lund Report that OHSU has a well-deserved national reputation as a great place to train family physicians, and “we want to make sure that is preserved.”
State officials have released numbers portraying Oregon as faring relatively well in terms of primary care access, but experts say the state has fallen behind. In terms of adults having a regular source of medical care, a 2023 national survey by the Commonwealth Fund ranked Oregon 44th among states.
Community review board meeting
The Oregon Health Authority formally launched its review of the merger application on Oct. 4, kicking off the 180-day review process evaluating impacts on health equity, cost, access working conditions and quality.
To assist in the review, state officials have named a Community Review Board that has been meeting with an eye toward recommending whether to approve the deal . The board could recommend denial, approval, or approval with conditions.
During a March 5 public hearing held by the community review board, Dr. Nathan Selden, a pediatric neurosurgeon and OHSU executive, defended the deal, saying it would improve primary care and reduce long patient wait times.
He said that after OHSU and Legacy are integrated they “will be better organized to deliver primary and community care across a larger system, which will also improve access to complex care at those very limited, specialized sites.”
Additionally, he said the merger would accelerate training of health professionals.
OHSU spokesperson Sara Hottman told The Lund Report in an email that the university is creating more training programs, including one in central Oregon for family physicians, as well as constructing a new building that will offer more hospital beds. OHSU's filing that proposes the merger states that if it is allowed to acquire Legacy it will invest money in its workforce and equipment that will improve patient access.
The review and public comment process is currently scheduled to be completed on June 18. Regulators extended the timeline earlier to have more time to review confidential documents. They could extend it again if officials need more time.
Meanwhile, a review of how the merger would affect the Legacy Foundation — which has also sparked opposition — is currently scheduled to wrap up July 19.
(Nick Budnick contributed reporting.)
