Week Six Takeaways

Date: November 19, 2024

We hope you have had an opportunity to formulate your perspective on the proposed acquisition of Legacy Health by OHSU. Last week, we offered templates for providing public comment and/or reaching out to your state representative and senator. Please visit our Get Involved page to learn how to take the next step and share your thoughts.

During preliminary review, the Oregon Health Authority received more than 120 public comment submissions. Many of those are posted on the OHSU-Legacy HCMO page. The primary concerns in public comments include the potential negative impacts on patient care related to access and equity and reduced competition due to overlapping service areas.

Here is a summary of themes and key points made in the public comments:

  • Patient care: Some comments highlight difficulties in referring patients to OHSU and worry that the merger will make it harder for patients to get the care they need, especially for Medicaid patients. There are concerns that the consolidation will lead to fewer choices for patients in their home community. 

Another concern with respect to patient access is the OHSU “command central”, a strategy whereby OHSU currently triages the high complexity (and highly reimbursed) patients to OHSU South Hospital and moves the lower complexity patients to their affiliated hospital in Hillsboro and SE Portland (Adventist). This could effectively mean that someone who lives in southwest Portland who falls and breaks their hip could be transferred to Hillsboro for care, a long drive for their loved ones. While there has been no proposal about how OHSU would address this after the Legacy combination, it is not hard to imagine how it would be conceivable that a patient who lives in Sandy who might otherwise receive a service at Legacy Mt Hood or Legacy Emanuel, may need to go to OHSU South Hospital instead based on service consolidation.” 

  • Competition: The Herfindahl-Hirschman Index analysis indicates a significant increase in market concentration, raising questions about long-term access to healthcare and potential price increases for both patients and payers.

Portlanders are lucky to enjoy a healthcare market with four large systems competing for their business and their employment. Disrupting this system with what could arguably be called a monopoly is likely to lead to higher costs for care and lower pay for healthcare workers, while disincentivizing quality of care.” 

  • Accountability: There are worries that OHSU's business model as a public corporation will negatively impact the healthcare sector if applied more broadly, and the resulting costs will not be invested in patient care but rather in a top-heavy management structure. Several comments refer to the acquisition as a corporate takeover.

As OHSU's business umbrella covers more medical/hospital organizations it limits choices for: 1) healthcare over a widening geographical area, health insurance options, and, 2) empowers OHSU without strong oversight or assurances of continuity from current physicians/surgeons.”

  • Labor: Some comments mention that the merger could further monopolize the labor market, affecting healthcare workers' job security and wages. Employees have been concerned since OHSU independently created an inequitable situation by securing additional job protections with only some unions.

Portland is a small market and healthcare employees have often worked at one or several other systems in the area before landing at one that aligns with the worker's values. This merger doesn't just remove choice of the patient/consumer, but the employee/consumer.” 

This transaction affects all of us as employees, patients, and community members. We encourage you to read the public comments and decide how you’ll get involved.

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