One nameless resident, who identifies as a transgender girl, shared issues about entry to gender-affirming care.
“The wait for these surgeries at OHSU is anywhere from two to five years, depending on the procedure. I switched to Legacy and have surgery consultations scheduled within the next month. This wouldn’t have been possible without the choice to seek care at a different hospital. I fear the merger will limit options and drive up wait times across multiple health care systems.”
Whose determination?
Numerous enter has emerged from all corners of the area, however the remaining determination rests with OHA’s Well being Care Market Oversight Program, which was established by the Oregon Legislature in 2021 to evaluate well being care enterprise offers and tackle the potential destructive impacts of well being care consolidation, in response to its web site.
OHA has the authority to approve the merger, approve it with circumstances or disapprove of it.
OHA’s evaluate started Oct. 4, however there have been pauses to permit time for each well being programs to answer requests for data, in response to OHA spokeswoman Amy Bacher.
“If a proposed transaction is disapproved or approved with conditions, this will impact the entities’ operations in Oregon,” Bacher stated.
OHA takes public feedback into consideration all through the evaluate interval, because it helps the group perceive potential impacts on the price of well being care, high quality, entry to providers and well being fairness, Bacher stated.
Washington just isn’t instantly concerned in overseeing the merger, although the Lawyer Normal’s Workplace’s Antitrust Division is conscious of the deal.
In a joint letter to OHA, 4 organizations — Oregon Nurses Affiliation; SEIU Native 49; Fundamental Rights Oregon; and the American Federation of State, County and Municipal Staff — wrote that regardless of issues about consolidation, Legacy Well being is dealing with monetary struggles, making the merger the proper transfer for sufferers throughout the metro space.
In the meantime, an opposition letter from Brown College and the American Financial Liberties Venture expressed issues that the merger may improve well being care prices with out enhancing high quality.
The 2 teams have urged OHA to dam the acquisition, warning them of the potential monopolistic penalties.
“Simply put, the math doesn’t add,” Brown College’s letter stated. “The parties claim, on the one hand, that Legacy is on the brink of collapse, while promising to deliver more of the services purportedly underlying Legacy’s financial distress: low-margin care for Medicaid patients, such as primary care and behavioral health.”
Billion-dollar merger
The mixed well being system, to be often called OHSU Well being, would embody greater than 32,000 staff throughout greater than 100 areas, together with 10 hospitals, and conduct greater than 3 million affected person visits yearly, in response to OHSU. The well being system can be the metro space’s largest employer.
OHSU stated it has dedicated $1 billion over the subsequent decade to boost major and community-based providers, primarily by way of bond financing.
On Might 30, OHSU and Legacy introduced the 2 events signed a binding, definitive settlement to merge and turn out to be OHSU Well being.
Then, on Oct. 4, OHA accepted a whole discover of the transaction. It’s conducting a 180-day complete evaluate, which is scheduled to conclude in June.
“The time frame for the final decision will depend on several factors, including the work of the community review board and any additional requests for information,” Bacher stated.
Nathan Selden, dean of the OHSU Faculty of Drugs, serves as one of many two government leaders for bringing the 2 well being programs collectively. The opposite is Legacy Well being’s chief government officer, George Brown.
After the definitive settlement was signed, OHSU launched the Transition and Integration Administration Workplace to additional plan for the mixing of OHSU and Legacy Well being.
“On day one, there won’t be any change in delivery,” Selden stated. “Going forward after day one as part of the ongoing integration, we will identify together and implement opportunities to improve patient care and fill gaps.”
However what’s going to well being providers seem like for Clark County sufferers receiving care at Legacy Salmon Creek Medical Heart, one of many area’s largest hospitals?
On the time of the August 2023 announcement, officers couldn’t instantly present specifics about potential staffing adjustments or facility impacts in Clark County.
Since then, officers from each well being programs have maintained that Clark County sufferers shouldn’t count on any adjustments in service that wouldn’t be optimistic and that there shall be no instant adjustments to worker roles.
OHSU and Legacy Well being stated they may present periodic updates because the programs work by way of the method and reply questions.
“We’re not going to disrupt the current patient care relationships that exist currently,” Selden stated. “We’re going to build from that. That’s the kind of energy, synergy and efficiency that Oregon needs from us. We’re focused on world class health care that meets the needs of our combined system.”
Legacy Well being Basis
In a separate however associated transaction, Legacy has proposed to switch its 50 % possession stake within the nonprofit PacificSource to the Legacy Well being Basis, reworking it into an impartial entity. PacificSource provides medical insurance plans to greater than 600,000 individuals in Oregon with Medicare Benefit, Medicaid and industrial protection. The proposed basis intends to promote its share of PacificSource inside the subsequent 5 to 10 years.
However that proposal defies the very that means of well being fairness, in response to an Oregon-based public engagement marketing campaign.
The Neighborhood First Marketing campaign believes any new grant sources from the OHSU and Legacy merger must be led by and for the communities that face the worst well being inequities.
Neighborhood First Marketing campaign Supervisor Luz Reyna stated the marketing campaign is merger agnostic, that means it’s not for or in opposition to the acquisition.
Nonetheless, it’s advocating for community-led governance, accountability and a dedication to fairness inside Legacy’s proposed Well being Basis.
“Legacy is proposing a foundation with only its current board members in charge. I’m very focused on uplifting the community voice,” Reyna stated. “We are running a community-based campaign to help support a public process that determines what community-led governance looks like.”
ABOUT OREGON HEALTH & SCIENCE UNIVERSITY
Variety of staff: 21,300 staff; 4,130 college students
Hospital admissions and medical clinic sufferers: 340,047
Hospital visits: 28,346
Medical clinic visits: 1,117,897
Emergency room visits (OHSU and Doernbecher Kids’s Hospital): 55,226
Day affected person/day surgical procedure visits: 42,977
Complete working income: $4.27 billion
Oregon financial affect (2019): $7.2 billion and 42,639 jobs
SOURCE: www.ohsu.edu/about/ohsu-facts
The marketing campaign has been endorsed by greater than 15 organizations throughout the Portland metro space, together with two nonprofits in Clark County: the Neighborhood Basis for Southwest Washington and the Southwest Washington Fairness Coalition.
A Seattle-based nonprofit, the Inatai Basis, has additionally expressed dismay after discovering its institutional practices have been referenced in Legacy’s utility for the muse.
“At no time has Legacy, PacificSource or OHSU contacted us, and no conversations or dialogue have taken place with this institution related to the creation of a health foundation. This feels disingenuous and undermines our trusting relationships with organizations across Oregon,” Inatai President Nichole June Maher wrote on Nov. 15.
Legacy Well being didn’t reply to questions relating to the Inatai Basis’s letter by The Columbian’s print deadline.
ABOUT Legacy Well being
Variety of staff: 14,000
Variety of sufferers served per 12 months: 2.5 million individuals throughout Vancouver, Portland and the Mid-Willamette Valley.
Working income: Within the first quarter of fiscal 12 months 2025, Legacy Well being’s working income was $709.3 million
Supply: www.beckershospitalreview.com
Last say
As a part of the evaluate course of, OHA has shaped a neighborhood evaluate board with well being care professionals, neighborhood members, sufferers of OHSU and Legacy, a enterprise proprietor and other people from precedence populations.
“The community review board will help OHA understand how a deal could affect people and communities in Oregon,” Bacher stated. “The board will also create a public space to discuss the proposed transaction and may choose to hold a public hearing, where entities can be questioned on the record.”
OHA may also assess the affect of the transaction on 4 broad value outcomes: market share, costs, spending and monetary situation, Bacher stated.
OHA’s Well being Care Market Oversight regulatory program has confronted authorized challenges. The Oregon Affiliation of Hospitals and Well being Techniques sued to dismantle it in 2022, claiming that the idea for dictating circumstances on a proposed transaction was too obscure and violated the due course of clause of the Fourteenth Modification.
The case was dismissed by a Federal District Court docket choose on Might 16.
Brown College has additionally expressed concern that the regulatory program’s capacity to impose and implement merger circumstances could also be undermined by political and trade pressures.
“Approval of the transaction by HCMO risks creating an unregulated monopoly. Crucially, this proposed acquisition is immune from review by state and federal antitrust authorities,” Brown College’s letter stated. “As has happened too often in the antitrust context, monopolies approved by the state exercise their economic power in the political arena, repealing the entities meant to regulate them.”
Come June, two of the biggest well being programs within the area may turn out to be one. However whether or not that shall be a optimistic or destructive determination for the neighborhood rests on the well being care authority.
OHSU stated it can proceed to publish details about the evaluate course of, together with responses to any requests for data from the Oregon Well being Authority, to its webpage so the neighborhood can keep knowledgeable through the evaluate course of.
For now, sufferers are inspired to remain knowledgeable, monitor potential adjustments to their well being care plans, and supply suggestions to OHSU, Legacy and regulatory our bodies because the merger progresses, OHSU stated.
“Both institutions have a deep, historic commitment to these communities,” Selden stated. “It’s one of the reasons I’m so optimistic about this integration.”