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					EXECUTIVE
SUMMARY


       As the only academic health center in Oregon, Oregon Health & Science
University (“OHSU”) provides a wide variety of unique benefits to local and state
residents, including:
•   Training for healthcare professionals who
    will serve communities throughout Oregon.           2007
Net
Economic

•   Access to high-quality healthcare services,         Impacts
in
Portland

    especially for Oregon’s sickest and most                                             

    vulnerable patients. In some cases this level
    of care is not available elsewhere in the                $2.377
billion

    state.
                                                          Net
economic
output—
•   Leading-edge research and development              activity
that
would
be
lost
to

    that results in new treatments, technologies         the
Portland
area
in
the

    and scientific knowledge.
                                                              absence
of
OHSU

•   Outreach to Oregon residents, some of
    whom might not otherwise have access to
    important health information and services.               $1.097
billion

        Oregon Health & Science University                Net
personal
income—
commissioned ECONorthwest to evaluate the              income
that
would
be
lost
to

impacts of OHSU’s activities on the                      the
Portland
area
in
the

metropolitan region (Multnomah, Washington,                 absence
of
OHSU

Clackamas and Clark counties) and on the state
as a whole. This report describes the results of
ECONorthwest’s research and analysis. It                       20,748
jobs

provides a broad qualitative overview of               Net
jobs—jobs
that
would
be

OHSU’s activities and health impacts on the             lost
to
the
Portland
area
in

community, and describes its economic impacts
                                                           the
absence
of
OHSU

for the 2007 fiscal year. All dollar amounts are
reported in 2009 dollars.
                                                             (reported
in
2009
dollars)

        OHSU’s economic impacts can be
explored by posing the following hypothetical
question: How would economic activity change
if OHSU did not exist? We consider this question in two ways: first, by examining the
gross impacts associated with OHSU’s activities regardless of the source of funds or the
reallocation of healthcare services to other providers; and second, by examining the net
economic impacts associated with OHSU’s activities based on those that are funded by
non-local sources or those that would leave the area in the absence of OHSU.
        Within this framework, the net analysis starts with the gross impacts, but excludes
the impacts that would still occur in the region in the absence of OHSU. In the case of
patient care, for example, other local providers would have (or develop) the capacity to
absorb some of the more routine care currently provided by OHSU, so that economic
activity would remain in the region and would not be included in the net impact analysis.

ECONorthwest                          November 2009                                 Page i
In contrast, services that are unique to the region and the state, such as brain neurosurgery
and medical education, would be redistributed to another state or elsewhere and, as a
result, are included in the net impact analysis.
        We also examine economic impacts in two geographic dimensions. First, we
examine the economic impacts of OHSU on the Portland metropolitan area, where they
are most direct and immediate. Second, we examine the economic impacts on the state as
a whole, which is particularly important given OHSU’s role as a statewide academic
health center.

A
BRIEF
OVERVIEW
OF
OHSU’S
ACTIVITIES


        OHSU affects both the economy and the health of the Portland area and the entire
state with its four primary activities: patient care, educational programs, research, and
outreach to the public and to healthcare providers around the state.
        OHSU’s greatest economic impacts come from its operating expenditures,
including payroll and purchases of goods and services. In support of its main activities,
OHSU adds to the economy in a variety of other ways. OHSU’s capital spending is a
major source of economic impacts. OHSU attracts students from throughout the state and
the nation, and these students contribute to the economy in the short term by spending
money on goods and services, and in the longer term when they stay and work in the
state. OHSU attracts millions of dollars in research grants and charitable contributions
that otherwise would likely not accrue to Oregon. These grants and donations help fund
operations, capital projects, and healthcare research. Research and development at OHSU
leads to new patents, technology licensing and spin-off businesses; some of these
enterprises remain local and generate economic activity.
        A brief summary of OHSU’s activities will help readers understand the basis of
the economic impact analysis. But OHSU’s activities also have many impacts that are not
easily quantifiable. Throughout this report we endeavor to describe the scope and
qualitative impacts of those activities throughout the state.

PATIENT
CARE


        The largest proportion of OHSU’s activities
involve patient care, including OHSU Hospital,                OHSU
discharged

Doernbecher Children’s Hospital, more than 80
primary and specialty care clinics, and clinical            almost
20,000
adult

outreach programs throughout the state. OHSU                inpatients
and
6,500

offers specialized healthcare services that in some         pediatric
inpatients,

cases are either not readily available, or are not           and
served
608,000

available at all at other hospitals and clinics in the      outpatients
in
2007.

state. Experts at OHSU frequently serve as
consultants to community healthcare providers
facing complex or non-routine cases, enabling




Page ii                               November 2009                         ECONorthwest
patients to stay in their own communities and allowing local doctors and hospitals to
serve them.1
        Because many of OHSU’s specialty services are not available elsewhere in
Oregon, it serves a high share of patients from outside the metro area compared to other
Portland hospitals. In 2007, 41 percent of OHSU’s adult inpatients traveled from outside
the four-county metropolitan area, compared to 13 percent at all other metro-area
hospitals. For pediatric patients, 45 percent of OHSU’s inpatients came from outside the
metropolitan area, compared to 22 percent at Emanuel Children’s Hospital (Oregon’s
only other children’s hospital) and nine percent at all other Portland-area hospitals (see
Figure 1).

            Figure 1: Share of Inpatients from Outside the Metropolitan
            Area for OHSU Compared to Other Portland Hospitals in 2007




                     Source: 2007 patient discharge data provided by OHSU.



       OHSU is a primary provider of healthcare for Oregon’s low-income households.
Because OHSU is a public entity, part of its mission is to provide healthcare to the
underserved, including Oregonians who cannot afford healthcare or who do not have
adequate insurance coverage. In addition, OHSU staff work to obtain health coverage for
Oregonians who lack insurance by working with the Oregon Health Plan and other
agencies. OHSU’s specialty physicians also provide free care to uninsured patients
through Project Access NOW, a cooperative effort that includes physicians throughout



    1
       OHSU’s outreach activities improve community health by improving access to healthcare services in
underserved areas and by disseminating health information to the public and to community healthcare
providers. OHSU operates many outpatient clinics and centers offering unique services and outreach to
residents throughout the state. OHSU also sponsors a variety of educational outreach programs, including
continuing education to healthcare professionals throughout the state and clinical rotations in underserved
areas.




ECONorthwest                                November 2009                                         Page iii
the Portland-metro area. OHSU was the first hospital in the region to achieve 100 percent
participation in this program.
        Patient revenues are the largest source of revenue for OHSU, amounting to more
than $950 million in fiscal year 2007 for both OHSU and the OHSU Medical Group. If
OHSU did not exist, other local providers would absorb some of the demand that
supports this spending. However, the state’s most complex patients likely would either
forgo the optimal level of care or go to medical centers in Seattle, California and
elsewhere. Based on an analysis of OHSU’s case mix compared to other Portland-area
hospitals using the newly-refined patient acuity coding system called MS-DRG
(Medicare Severity Diagnosis Related Groups), we estimate that 35 percent of OHSU’s
patient care revenue would be lost to the region in the absence of OHSU. This amounts to
approximately $333 million of the $950 million in total patient care revenues in fiscal
year 2007.2

EDUCATIONAL
PROGRAMS


         OHSU’s educational programs play a vital
role in training the healthcare professionals and         In
2007,
OHSU
enrolled

scientists required to meet the needs of Oregon’s          over
2,800
students
in

growing and aging population. OHSU operates
the state’s only public medical and dental
                                                           programs
around
the

schools, and also educates nurses, physician            state,
and
awarded
almost

assistants and other healthcare professionals. The         900
academic
degrees.

supply of all these professionals is highly
constrained. Combined, OHSU provides about 60
degree, certificate, and continuing education programs, many of which are not available
elsewhere in the state. OHSU also places students in clinical rotations in rural areas, both
to increase residents’ access to care and to encourage students to consider careers in
underserved areas.
       Tuition spending, which amounted to $36 million in 2007, supports the salaries of
teaching and support staff. For the net impact analysis, we assume that all revenues and
expenditures related to OHSU’s educational programs would leave Portland and the state
if OHSU did not exist. That is, in the short run, educational options in Oregon are
constrained in such a way that, in the absence of the capacity provided by OHSU,
students likely would have to leave the state to obtain the same educational services.




   2
       This total is in 2009 dollars, and includes both OHSU and OHSU’s Medical Group.


Page iv                                    November 2009                             ECONorthwest
RESEARCH

        Research at OHSU has led to many discoveries, which in some cases have been
used to develop new drugs, devices, technologies and procedures that have health related
benefits. One of the most prominent examples in recent years is the cancer drug Gleevec,
which OHSU’s Dr. Brian Druker helped to research and develop.
        In fiscal year 2007, OHSU received more
than $300 million in research funding for more
than 4,100 research projects and hundreds of                              In
2007,
OHSU

clinical trials, with nearly all of this funding                       received
more
than

coming from outside the state. As such, the
economic activity associated with research and
                                                                          $300
million
in

development represents a net economic gain to                          research
funding
for

Portland and the state. OHSU’s academic and                              more
than
4,100

clinical research activities also attract relatively                  research
projects
and

highly paid specialists to the area, and in some                       hundreds
of
clinical

cases create access to specialty services for which
                                                                      trials,
with
nearly
all

residents might otherwise have to leave the state.
                                                                     of
this
funding
coming

       Licensed technology developed through                         from
outside
the
state.

research at OHSU not only generates revenue for
the university, but also can lead to advances in
healthcare, science and biomedical technology. In
2007, researchers filed 66 patent applications and disclosed 132 new inventions.
Collaboration and innovative business partnerships facilitate the transfer of laboratory
research into marketable products that benefit the public by improving health and
healthcare practices and by contributing to economic growth.
       According to OHSU’s Technology & Research Collaborations Department,
OHSU research has led to 37 start-up companies since 2000, and 68 since the early
1970s. While not all of these companies are still in existence, 25 are now, or at some
point have been located in Oregon. Our net impact analysis includes the impacts
associated with these start-up companies. Approximately $189 million in direct spending
by these companies on payroll, goods and services is included in the model.

CAPITAL
SPENDING


        Between 2005 and 2007, OHSU spent an average of $184 million per year on
buildings, land, capital improvements and capital equipment.3 Nearly all of these
expenditures were made for facilities in the Portland area. Some of this spending leaves
the region, for example, when OHSU purchases a large piece of capital equipment from
an out-of-state manufacturer, but a majority of it benefits local contractors and workers.
Based on our analysis of OHSU’s capital expenditures, we included $132 million in the
net economic impact analysis.


   3
       OHSU audited financial statements for fiscal years 2005-07.


ECONorthwest                                November 2009                                  Page v
CHARITABLE
CONTRIBUTIONS

        OHSU receives charitable             2007
Charitable
Contributions

contributions through three
different but related entities:            Direct
contributions

        $15
million

OHSU itself, the OHSU                      OHSU
Foundation
              $74
million

Foundation, and the Doernbecher
Children’s Hospital Foundation.            Doernbecher
Foundation
       $18
million

Combined, charitable contributions         TOTAL
                     $107
million

in 2007 totaled $107 million.
Based on an analysis of the
geographic origin and designated purpose of individual contributions performed by the
OHSU Foundation staff, we assume that 84 percent of charitable contributions likely
would be sent out of state if OHSU did not exist. We assume that the remainder of these
contributions would be redistributed in the region. Therefore, the model includes
approximately $90 million of expenditures funded by charitable contributions.

OVERVIEW
OF
ECONOMIC
IMPACT
MODELING

        OHSU benefits the regional and state economies by employing and training a
large number of relatively high-wage workers; by providing high-level healthcare to
residents throughout the state; by conducting leading-edge research and developing new
technologies that generate business growth; and by spending money on capital projects
that employ local workers and businesses. In addition, OHSU brings hundreds of millions
of dollars in net new revenue into the Portland area and the state, including research
grants, Medicare, Medicaid, donations, technology licensing fees, and other outside
sources. To measure the regional and statewide impacts associated with OHSU activities,
ECONorthwest constructed economic models (called input-output models) of the
Portland and Oregon economies, and used OHSU’s expenditures as inputs into the
modeling process. Below we describe some basic concepts of economic impact
modeling.
        The total economic impact is the sum of three types of impacts: direct, indirect
and induced. Direct impacts include the output (as measured by expenditures), payroll,
and jobs directly associated with OHSU’s operations. Indirect impacts occur as OHSU or
its suppliers buy from other businesses. Induced impacts occur when workers who are
directly or indirectly affected by OHSU’s operations spend their income on goods and
services.
        The economic impacts associated with OHSU can be measured in several ways.
This report focuses on three of the most common and useful measures. Output is the
largest measure of economic activity, and represents the value of goods and services
produced. Personal income includes employee compensation, and self-employment and
small business income. Jobs consist of the number of people working full- or part-time
jobs. Finally, multipliers can be reported for output, personal income and jobs. The
multiplier helps us understand the magnitude of the linkages between a given activity and



Page vi                             November 2009                        ECONorthwest
other sectors of the economy. The larger the multiplier is, the greater the interdependence
between an activity (in this case, OHSU’s operations) and the rest of the economy.

GROSS
VS.
NET
IMPACTS

         ECONorthwest worked with OHSU staff to assemble detailed spending data for
all of OHSU’s activities, including the geographic basis of the revenues and expenditures
associated with various activities. We then identified the proportion of OHSU’s spending
that is a net gain to the region and the state (that is, spending that would not occur in the
absence of OHSU), and the proportion that likely would remain in the region and be
redistributed to other providers (and therefore is not included in the net impact analysis).
These analytical components enable us to distinguish between gross and net economic
impacts.
        Gross impacts provide an upper bound estimate of economic impacts, tracing all
the expenditures made by OHSU throughout the economy. However, as discussed above,
some proportion of the services currently provided by OHSU, primarily those related to
patient care, would still occur in the region and the state in the absence of OHSU.
Without OHSU, many of the more routine cases would be absorbed by other local
hospitals. However, the most complex cases likely would be sent to academic health
centers or large hospitals in other states, resulting in the loss of that economic activity in
Portland and in Oregon.
        While gross impacts include all economic output, income and jobs associated
with OHSU’s spending, net impacts count only the economic activity that is new or
additive to the economic region in question. In contrast to patient care, for which there
are many providers in Portland and the state, economic activity associated with education
(tuition spending, student spending, etc.), most research and significant foundation
contributions likely would not occur in the absence of OHSU, and therefore count as
additive to the Portland and state economies.

SUMMARY
OF
OHSU’S
ECONOMIC
IMPACTS


PORTLAND
AREA
IMPACTS

        Table 1 shows a summary of the gross and net impacts of OHSU’s activities in
the Portland area. The expenditures associated directly with OHSU’s activities (gross
direct output) amount to $1.601 billion, including $935 million in income, and 13,925
full- and part-time jobs. When the total downstream impacts (indirect and induced
impacts) of the initial spending are added, the total gross impacts grow to $3.644 billion
in output, including $1.724 billion in personal income and 32,561 jobs. It is important to
remember that these gross impacts are based on all OHSU expenditures, including those
that would still occur in the absence of OHSU.
      The net economic impacts—i.e., those that would not occur in the absence of
OHSU—consist of $1.038 billion in direct output, including $580 million in personal
income, and 8,617 jobs. As these expenditures circulate through the economy they


ECONorthwest                          November 2009                                   Page vii
generate a total of $2.377 billion in economic output, including $1.097 billion in personal
income, and 20,748 jobs.

      Table 1: Total Gross and Net Economic Impacts in Portland’s Economy
                                 (in 2009 dollars)
                                              PORTLAND
       Type of Impact             Direct Impacts          Total Impacts             Multiplier
       Gross Impacts
        Output                    $1,600,694,000          $3,643,549,000               2.28
        Personal Income             $935,036,000          $1,723,871,000               1.84
        Jobs                               13,925                  32,561              2.34
       Net Impacts
        Output                    $1,038,332,000          $2,376,717,000               2.29
        Personal Income             $579,926,000          $1,096,514,000               1.89
        Jobs                                8,617                  20,748              2.41

       Source: ECONorthwest IMPLAN analysis.
       Note: By definition, gross impacts will always be larger than net impacts. However, there is
       no reason to a priori expect gross impact multipliers to always be larger than net impact
       multipliers. In this analysis, the impact multipliers represent a weighted average multiplier
       across all of OHSU's activities, and the counterfactual elements that convert gross impacts
       to net impacts are applied to OHSU activities that, themselves, have smaller economic
       impact multipliers. As a result, the net impact multipliers are slightly larger than the gross
       impact multipliers.



        The net direct output circulates through the economy, adding value with each
round of spending, creating a multiplier effect. By the time the original spending leaks
out of the economy, the total net output in Portland is 2.29 times greater than the original
net direct output. Put another way, for every dollar of expenditures made by OHSU,
$1.29 of additional output is created elsewhere in the economy, for a total of $2.29 in net
output. The multiplier for personal income is 1.89, meaning that for every dollar OHSU
pays to its employees in wages and benefits, an additional $0.89 in income is created
elsewhere in the economy, for a total net impact of $1.89 in income. Similarly, the jobs
multiplier is 2.41, so for every net new job supported at OHSU, 1.41 jobs are created
throughout the rest of the economy.

STATEWIDE
IMPACTS

         Table 2 shows the economic impacts of OHSU’s operations in Oregon’s
economy. OHSU’s statewide direct expenditures (gross direct output) total $1.625
billion, including personal income of $950 million, and 14,123 jobs. These gross direct
impacts are slightly greater than the Portland gross direct impacts because they include
OHSU’s operations in LaGrande, Ashland, and other satellite locations. The total
economic activity generated by OHSU’s initial spending, including the downstream
impacts in the economy, amounts to $3.856 billion in total gross output, including $1.802
billion in personal income, and 34,614 jobs.


Page viii                                  November 2009                                  ECONorthwest
        When we consider only the net new expenditures, the direct expenditures (net
direct output) made by OHSU amount to just over $1.001 billion, including $555 million
in personal income, and 8,251 jobs. As this activity circulates through the economy
adding economic value with each round of spending, the total net impacts amount to
$2.351 billion in output, including $1.072 billion in personal income, and 20,625 jobs.

       Table 2: Total Gross and Net Economic Impacts in Oregon’s Economy
                                  (in 2009 dollars)

                                               OREGON
         Type of Impact            Direct Impacts         Total Impacts            Multiplier
         Gross Impacts
          Output                   $1,625,395,000          $3,855,706,000             2.37
          Personal Income            $949,568,000          $1,802,402,000             1.90
          Jobs                               14,123                 34,614            2.45
         Net Impacts
          Output                    $1,000,518,000          $2,350,761,000            2.35
          Personal Income             $554,981,000          $1,072,026,000            1.93
          Jobs                                 8,251                 20,625           2.50

         Source: ECONorthwest IMPLAN analysis.
         Note: By definition, gross impacts will always be larger than net impacts. However, there is
         no reason to a priori expect gross impact multipliers to always be larger than net impact
         multipliers. In this analysis, the impact multipliers represent a weighted average multiplier
         across all of OHSU's activities, and the counterfactual elements that convert gross impacts
         to net impacts are applied to OHSU activities that, themselves, have smaller economic
         impact multipliers. As a result, the net impact multipliers are slightly larger than the gross
         impact multipliers.




        On a gross basis, the statewide impacts are greater than the Portland impacts.
However, on a net basis, OHSU’s statewide economic impacts are slightly smaller than
for Portland because, by definition, spending that originates from inside the state but
outside of Portland is net new to Portland but not net new to Oregon. As discussed above,
a significant share of OHSU’s patients come from outside Portland. OHSU acts as a
magnet for healthcare in Oregon because it provides access to unique equipment and
services that are too expensive to be replicated in multiple locations throughout the state.
While OHSU supports many activities that enable rural hospitals and providers to care
for their patients in their communities, on balance there is a net transfer of economic
resources into the Portland area from elsewhere in the state. Figure 2 shows the
proportion of output that is counted as net new, and the proportion that is excluded from
the net impact model.




ECONorthwest                               November 2009                                            Page ix







        Figure 2: Comparison of Gross and Net Output for
               the Portland and Oregon Economic Impact Models

                                                                                         



                                                                                         



                                                                                         


                           Source: ECONorthwest IMPLAN analysis.






OHSU
AND
POTENTIAL
SYNERGISTIC
EFFECTS
ON
THE
ECONOMY

       In many ways, OHSU functions as a corporate headquarters within Oregon, much
like Nike and Intel on a national scale. As a headquarters, OHSU has developed strong
supply-chain relationships with local suppliers, and nearly all of its employees are local
residents. Unlike typical corporate headquarters, however, OHSU is focused specifically
on service to Oregonians, so there is no risk of it relocating its central functions and
decision makers to another state or country in pursuit of cost cutting, tax incentives, or
other enticements. This means that a large share of its activities and expenditures will
continue to benefit the local economy over the long term.
        Table 3 shows the net indirect output and jobs generated in various industry
sectors by OHSU’s operations in Portland. Various service sectors are among the top
beneficiaries of OHSU’s spending, including professional and technical services,
administrative and waste services, healthcare and social services, real estate, information,
and other types of services. These services tend to rely heavily on local labor. Together,
these sectors account for 70 percent of the total economic output and 72 percent of the
jobs generated throughout OHSU’s supply chain.




Page x                                 November 2009                        ECONorthwest
                 Table 3: Net Indirect Output and Jobs Generated by
                        OHSU Operations, by Industry Sector
                                                                 Indirect      Percent of
                             Industry Sector                       Jobs           total
              Professional and technical services                     818           22%
              Administrative and waste services                     1,443           39%
              Manufacturing                                           138            4%
              Healthcare and social services                          186            5%
              Real estate and rentals and leasing                     110            3%
              Retail trade                                            275            7%
              Construction                                            114            3%
              Information                                              48            1%
              Other Services                                           86            2%
              Agriculture, forestry, fishing and hunting              440           12%
              All other sectors                                        65            2%
              TOTAL                                                 3,723           100%

             Source: ECONorthwest IMPLAN analysis.




       In addition to its operating expenditures, over the last 3 years OHSU has spent
more than $445 million on capital and much of this went to local contractors. Similarly,
student non-tuition spending on groceries, rent, and services benefits local businesses in
much the same way.
        OHSU also supports thousands of highly skilled workers who earn higher-than-
average wages, spend money in the local and state economies, and contribute their
intellectual capital and expertise to the civic life of the region. Figure 3 shows that
90 percent of OHSU employees live in Oregon. Household spending by OHSU
employees drives induced economic impacts, and in 2007, these impacts amounted to
$557 million of economic output in the local economy, including $209 million in
personal income, and almost 5,200 jobs.

              Figure 3: Percentage of OHSU Employees by Location
                       of Residence and Employment, 2007


                                                                                              


                                                                                              





                                                           Source: OHSU payroll data.


ECONorthwest                              November 2009                                     Page xi
SUMMARY

         Oregon Health & Science University is the state’s only academic health center,
and is among the state’s largest healthcare providers, educational institutions, research
centers and employers. OHSU’s health and economic impacts are substantial, and while
its activities are centered in the Portland metropolitan area, its impacts reach throughout
the state.
       In answer to the hypothetical question that guided this study—How would
economic activity change if OHSU did not exist?—ECONorthwest estimates that in the
absence of OHSU, economic activity in Portland area would decrease by an estimated
$2.377 billion in economic output and 20,748 jobs in the Portland metropolitan.
Economic activity in Oregon would decrease by an estimated $2.351 billion in economic
output and 20,625 jobs.
        Looking toward the future, OHSU’s economic impact is poised to grow over time.
As the U.S. population ages, demand will rise for skilled healthcare providers. OHSU is
well positioned to provide these workers. For patient care, net impacts will grow if
OHSU continues to expand its ability to provide care and services that are unavailable
elsewhere in the region. OHSU’s proven ability to attract research funding and high-level
researchers, and to translate research into clinical and scientific breakthroughs and
marketable technology, promises to increase the importance of this powerful economic
driver as well.




Page xii                              November 2009                         ECONorthwest

CHAPTER
1
           INTRODUCTION
AND
BACKGROUND


        From its beginnings in 1887 as a state medical school in Portland to its current
status as a non-profit public corporation and one of the state’s largest employers, Oregon
Health & Science University (OHSU) has played an important role in the history of
Portland and Oregon. OHSU is a nationally
and internationally recognized leader in
patient care, medical education and
research. OHSU’s vision statement, at right,                   OHSU’s
Vision


reflects its unique place in Oregon.                   OHSU
will
partner
to
make

       As the only academic health center             Oregon
a
national
leader
in

in Oregon, OHSU provides a wide variety of                health
and
science

unique services that benefit individuals,            innovation
for
the
purpose
of

communities, businesses, local and state
governments, and the entire state in myriad            improving
the
health
and

ways. OHSU’s primary activities include:             well­being
of
all
Oregonians.

       •   Access to high-quality healthcare
           services, especially for Oregon’s
           sickest and most vulnerable patients. In some cases this level of care is not
           available elsewhere in the state.
       •   Training for healthcare professionals who will serve communities throughout
           Oregon.
       •   Leading-edge research and development that results in new treatments,
           technologies and scientific knowledge.
       •   Outreach to Oregon residents, some of whom might not otherwise have access
           to important health information and services.

        Together, these activities make OHSU’s role in Portland and in Oregon large and
far-reaching. In 2007, OHSU treated over 665,000 patients from the Portland area,
Oregon and the western United States; employed over 13,000 full- and part-time
employees; educated over 2,800 students; granted almost 900 degrees and certificates;
reached out to citizens throughout Oregon with its 17 community-focused institutes and
centers; received over $300 million in research funding for more than 4,100 research
projects; and attracted over $100 million in charitable contributions.
       Oregon Health & Science University commissioned ECONorthwest to evaluate
the impacts of OHSU’s activities on the metropolitan region (Multnomah, Washington,
Clackamas and Clark counties) and on the state as a whole. By undertaking this analysis,
OHSU seeks to develop a deeper understanding of its place in the economic and
healthcare picture of the Portland area and the state of Oregon. Understanding its current
impacts will help institutional leaders and state policy makers shape OHSU’s future in a
way that will be most valuable to Oregonians.




ECONorthwest                         November 2009                                   Page 1
         Universities, hospitals and other community institutions frequently use economic
impact studies to demonstrate the contributions of their activities to the regional and state
economies. Economists have developed several approaches to measure these impacts.
The most common approach, and the one used in this analysis, estimates the economic
impacts associated with the institution’s spending, as well as that of its employees,
clients, and suppliers, as it flows through the economy. The impact of OHSU goes far
beyond the economic dimension, of course, by providing residents with access to high-
quality healthcare services and a variety of other functions that are unique in the state.
This report provides an overview of the scope and qualitative nature of OHSU’s
healthcare and other activities around the state.
        OHSU’s economic impacts can be explored by posing the following hypothetical
question: How would economic activity change if OHSU did not exist? We consider this
question in two ways: first, by examining the gross impacts associated with OHSU’s
activities regardless of the source of funds or the reallocation of healthcare services to
other providers; and second, by examining the net economic impacts associated with
OHSU’s activities based on those that are funded by non-local sources or those that
would leave the area in the absence of OHSU.
        Within this framework, the net analysis starts with the gross impacts, but excludes
the impacts that would still occur in the region in the absence of OHSU. In the case of
patient care, for example, other local providers would have (or develop) the capacity to
absorb some of the more routine care currently provided by OHSU, so that economic
activity would remain in the region and would not be included in the net impact analysis.
In contrast, services that are unique to the region and the state, such as brain neurosurgery
and medical education, would be redistributed elsewhere and, as a result, are included in
the net impact analysis.
        We also examine economic impacts at two geographic dimensions. First, we
examine the economic impacts of OHSU on the Portland metropolitan area, where they
are most direct and immediate. Second, we examine the economic impacts on the state as
a whole, which is particularly important given OHSU’s role as a statewide academic
health center.
        The central question of this study leads to several others that will be considered in
this analysis, for example:
         •   In addition to providing high quality medical care, in what other ways does
             OHSU drive the local and state economies? Federally funded research, student
             tuition and related spending, clinical trials, business start-ups, and real estate
             holdings and development generated by OHSU all contribute to the economy.
         •   To what extent does OHSU serve patients outside the Portland metropolitan
             area? In the absence of OHSU, what healthcare services would no longer be
             available or accessible to Portland-area and Oregon residents?
         •   What impacts do OHSU’s educational programs have on the availability of
             healthcare in the region and the state?
       OHSU’s ability to provide top quality healthcare in Portland drives its economic
impacts. In economic terms, OHSU “exports” high quality healthcare throughout the


Page 2                                 November 2009                          ECONorthwest
Western US and beyond. All the procedures that cannot be performed at the same level of
quality—or performed at all—in Portland, Baker City, Coos Bay or Boise, Idaho generate
work for local physicians, nurses, technicians, and other staff.
        OHSU’s role as a research university further expands its impacts. Federal and
other grants bring new resources into the region, and high-level research attracts high-
paying jobs for specialists. Research discoveries lead to the licensing, development and
sales of new technologies that benefit not only the University and the local and state
economies, but the health of people around the world. These new discoveries often spur
the creation or expansion of businesses, creating new employment, new spending and
additional research funding, all of which add to the economies of the region and the state.
        This report summarizes ECONorthwest’s research and analysis related to the
impacts generated by OHSU in the Portland and throughout the state. It incorporates both
quantitative and qualitative information to describe the ways in which OHSU affects the
economy and healthcare in Portland and in Oregon. Using OHSU’s definition, Portland is
defined as Multnomah, Washington, Clackamas and Clark Counties. The statewide
analysis also includes Clark County because of its integral relationship with the Portland
economy. The analysis focuses primarily on the economic impacts generated by OHSU’s
activities in fiscal year 2006-07, although discussions related to a broader time frame will
be included throughout the report. Dollar amounts are reported in 2009 dollars.




ECONorthwest                         November 2009                                   Page 3
         

CHAPTER
2
            OHSU’S
STATEWIDE
ACTIVITIES
AND
LOCATIONS


        While the activities of Oregon Health & Science University that are primarily
focused on education, healthcare and research are centered in Portland, the university is
engaged in a broad array of activities throughout Oregon. These activities generate not
only economic impacts, but healthcare impacts as well. This chapter describes OHSU’s
activities and locations throughout the state, and their unique impact on Oregonians’
access to high-quality specialized healthcare that is, in many cases, less accessible
elsewhere in Oregon.

    2.1
       OHSU’S
ACTIVITIES

        OHSU engages in a wide variety of activities in the areas of education, research,
healthcare, and community outreach. The following section provides an overview of the
activities OHSU performs in support of its statewide role.

    2.1.1
     HEALTHCARE

         As a major academic health center, OHSU’s greatest contribution to the region
and the state may be providing comprehensive, leading-edge healthcare for the state’s
most challenging patients. In 2007, OHSU provided a wide variety of clinical and
hospital care to over 665,000 patients from Oregon, Washington, California, Idaho,
Montana, Nevada, and a host of other states and Canada. OHSU serves a diverse mix of
clients, providing interpreter services in 35 languages.
        While this section will provide an overview of the unique services offered at
OHSU, Appendix B contains detailed information submitted by department staff about
specific services and programs available at OHSU that are not available elsewhere in
Portland or in Oregon.


      2.1.1.1
       INPATIENT
SERVICES

       OHSU operates the OHSU Hospital, which serves adults, and Doernbecher
Children’s Hospital. Other large Portland-area adult inpatient healthcare providers are
Adventist Medical Center, Legacy Emanuel Hospital & Health Center, Legacy Good
Samaritan Hospital & Medical Center, Providence Portland Medical Center, Providence
St. Vincent Medical Center and Southwest Washington Medical Center. For pediatric
services, the only other children’s hospital in the state is Legacy Emanuel Children’s
Hospital.
        Among metro-area hospitals, OHSU had the second highest number of adult and
pediatric discharges (26,367), with Providence St. Vincent having the highest (33,966).
Considering the entire state, Sacred Heart Hospital in Eugene had the third highest
number of discharges (26,317). Table 4 shows a comparison of adult and pediatric
discharges at major hospitals in the one-year period between October 2006 and
September 2007.


ECONorthwest                         November 2009                                  Page 5
              Table 4: Number of Discharges at OHSU and Other Providers
                            (October 2006-September 2007)

                                                            Adult         Pediatric           Total
                                                         Discharges      Discharges        Discharges

    OHSU                                                       19,796            6,571           26,367
    Other Major Metro area Hospitals
     Adventist Medical Center                                  11,120            2,170           13,290
     Legacy Emanuel                                            11,365            7,169           18,534
     Legacy Good Samaritan                                     12,861              219           13,080
     Providence Portland                                       21,646            1,025           22,671
     Providence St. Vincent                                    31,796            2,170           33,966
     Southwest Washington Medical Center                       18,832            1,207           20,039
    Other Major Oregon Hospitals
     Sacred Heart Medical Center--Eugene                       24,637            1,680           26,317
     Salem Hospital                                            18,610            1,347           19,957
     Rogue Valley Medical Center--Medford                      12,663            1,142           13,805
     St. Charles Medical Center--Bend                          13,007            1,314           14,321
    Source: OHSU; Note: Data systems changed after September 2007 so ECONorthwest used a modified year for
   patient discharge data.



       In 2007, OHSU had the largest number of staffed beds in the state (524), with an
average daily census of 395 patients. Only Providence St. Vincent had a comparable
average daily census. Table 5 shows the capacity and occupancy of metro-area providers
and of other major hospitals in Oregon.

           Table 5: Capacity and Occupancy at OHSU and Other Providers, 2007
                                                                  Average       Average
                                                     Staffed       Daily        Length       Occupancy
                                                      Beds        Census        of Stay         Rate

     OHSU                                                524            395          5.2          75.4%

     Other Major Metro area Hospitals
      Adventist Medical Center                           252            140          4.5          55.7%
      Legacy Emanuel                                     410            294          5.8          71.7%
      Legacy Good Samaritan                              254            169          4.7          66.5%
      Providence Portland                                374            278          4.5          74.4%
      Providence St. Vincent                             473            395          4.4          83.4%
      Southwest Washington Medical Center                342             n/a         n/a             n/a

     Other Major Oregon Hospitals
      Sacred Heart Medical Center--Eugene                390            313          4.4          76.0%
      Salem Hospital                                     390            256          4.6          65.6%
      Rogue Valley Medical Center--Medford               276            183          4.4          83.4%
         St. Charles Medical Center—Bend                 226            150          3.9          66.3%

     Source: Oregon Health News. State of the State: 2008 Hospital Report. Oregon Health Forum,
     2008.



Page 6                                      November 2009                                  ECONorthwest
         Because many of the specialty services provided by OHSU’s hospitals and clinics
are not available elsewhere in Oregon, OHSU serves a greater share of high-needs
patients. OHSU routinely receives the most rare and complex cases in the region and the
state. These cases are often transferred from other hospitals or referred by community
physicians who lack the resources and expertise to provide the necessary care. An
analysis of 2007 patient data from the new, more refined MS-DRG (Medicare Severity
Diagnosis Related Groups) coding system shows that OHSU’s average case weight is 35
percent higher that other Portland-area hospitals.4 This is an indication of the relative
complexity and severity of OHSU’s caseload relative to other hospitals.
        OHSU also draws a much larger share of patients from outside the metro area
than other Portland hospitals. In 2007, 41 percent of OHSU’s adult patients traveled from
outside the metro area, compared to 13 percent at all other metro area hospitals. For
pediatric patients, 45 percent came from outside of the metro area, compared to 22
percent at Emanuel Children’s Hospital (Oregon’s only other children’s hospital) and
nine percent at all other metro area hospitals.
        Table 6 shows the origin of patients for both adult and patient discharges at
OHSU in 2007. Figure 4 displays a comparison of the share of patients from outside the
metro area that are served by Portland area hospitals.


          Table 6: Number of Inpatient Discharges at OHSU by Patient Origin,
                           (October 2006-September 2007)

                                                               2007       Percent of
               Patient Origin                               Discharges      Total
               Adult Discharges
                Portland-Metro residents                       11,546          59%
                Other Oregon residents                          6,521          33%
                Out-of-state residents (except Clark Co.)       1,619            8%
                Total                                          19,686         100%

               Pediatric Discharges
                Portland-Metro residents                        3,622          55%
                Other Oregon residents                          2,592          40%
                Out-of-state residents (except Clark Co.)         333            5%
                Total                                           6,547         100%
               Total Discharges                                26,367

                 Source: ECONorthwest analysis of OHSU data.




    4
     This is a weighted average based on the number of discharges for each MS-DRG code. OHSU’s
weighted average case weight was 1.77, compared to 1.35 at other local hospitals.


ECONorthwest                               November 2009                                   Page 7
               Figure 4: Share of Inpatients from Outside the Metro Area
                       for OHSU and Other Metro-Area Hospitals
                            (October 2006-September 2007)




                       Source: ECONorthwest analysis of OHSU data.




        In addition to treating patients who travel to Portland, specialists at OHSU often
serve as consultants to local healthcare providers, allowing patients to stay in their
communities. Traveling clinics also serve remote areas of the state to provide specialized
services not available locally.
       As one of the state’s two Level 1 Trauma Centers (the other is at Legacy
Emanuel), OHSU receives the most seriously injured patients from throughout the Pacific
Northwest, many of whom are transferred from lower level trauma centers. From July
2006 to June 2007, OHSU’s Trauma Center served 2,259 trauma patients. The OHSU
Trauma Center also is the only program in Oregon that trains trauma specialists and
supports trauma research.




Page 8                                November 2009                       ECONorthwest
  2.1.1.2




OUTPATIENT
SERVICES

                                                           OHSU
Outpatient
Clinical
Centers

          OHSU operates a number of                               
and
Institutes

  outpatient clinical centers and
                                                      •   Casey
Eye
Institute

  institutes that serve a wide range of
  patient needs, from routine care to                 •   Center
for
Health
&
Healing

  the management of complex                           •   Center
for
Women's
Health

  diseases that require
  interdisciplinary care.                             •   Child
Development
&
Rehabilitation
Center

                                                          (Specializes
in
interdisciplinary
diagnosis,

           Table 7 shows the number of                    assessment,
and
intervention
related
to

  outpatient clinic visits, outpatient                    disorders
affecting
child
development)

  surgeries and Child Development                     •   Doernbecher
Children's
Clinics

  and Rehabilitation Center (CDRC)
  visits at OHSU in fiscal year 2007.                 •   Digestive
Health
Center

  Twenty-two percent of outpatient                    •   Harold
Schnitzer
Diabetes
Health
Center

  clinic patients, 32 percent of day
                                                      •   OHSU
Knight
Cancer
Institute

  surgery patients and 47 percent of
  CDRC patients were Oregonians                       •   Family
medicine
clinics
at
Gabriel
Park,

  from outside the metro area.                            Richmond
(S.E.
Portland)
and
Scappoose





            Table 7: Number of Outpatient Visits to OHSU by Patient Origin, 2007
                              Outpatient    Percent                     Percent                Percent
Patient Origin                 Clinics      of Total       Day Stay     of Total     CDRC      of Total
Portland area residents          402,160        73%           13,964       61%       15,565        50%
Other Oregon residents           123,158        22%            7,203       32%       14,818        47%

Out-of-state residents            28,312         5%            1,567        8%           914          3%

Total                            553,630       100%           22,734      100%       31,297      100%

        Source: ECONorthwest analysis of OHSU data.


        


        2.1.2
      EDUCATION

          OHSU trains thousands of healthcare professionals each year in Portland and in
  several satellite programs that serve rural areas. OHSU offers about 60 types of degrees
  and certificates in its schools of Medicine, Dentistry, and Nursing. In 2006-07, over 2,600
  students attended OHSU programs, and OHSU granted 892 degrees and certificates.
  Table 8 shows the number of students enrolled in each school and the number of degrees
  awarded in the 2006-07 school year.




  ECONorthwest                              November 2009                                       Page 9
                     Table 8: Enrollment and Degrees Awarded in 2006-07

                                                                            Students   Degrees
                                                                            Enrolled   Awarded
               School of Dentistry
                Dental Certificate (Graduate)                                               9
                M.S. (Master of Science)                                                    4
                D.M.D. (Dental Medicine)                                                   74
                Subtotal - School of Dentistry                                   344       87
               School of Medicine
                A.A.S. (Emergency Med. Technology - Paramedic (a)                          22
                B.S. (Clinical Laboratory Science) (a)                                     23
                B.S. (Radiation Therapy)                                                    7
                Certificate in Dietetic Internship (Graduate)                              23
                Certificate in Human Investigations (Graduate)                             11
                Certificate in Biomedical Informatics (Graduate)                           14
                M.B.I. (Master of Biomedical Informatics)                                   7
                M.C.R. (Master of Clinical Research)                                        6
                M.P.A.S. (Master of Physician Assist. Studies)                             37
                M.P.H. (Master of Public Health)                                           20
                M.S. (Master of Science)                                                   15
                M.D. (Medicine)                                                           118
                Pharm.D. (Pharmacy) (b)                                                    78
                Ph.D. (Doctor of Philosophy)                                               30
                Certificate in Science & Engineering                                       22
                M.S.E. (Master of Software Engineering)                                     4
                M.S. (Master of Science)                                                   65
                Ph.D. (Doctor of Philosophy)                                                9
                Certificate (Graduate)                                                     22
                Subtotal - School of Medicine                                  1,580      511
               School of Nursing
                B.S. (Nursing)                                                            246
                Nursing Certificate (Graduate)                                              6
                M.P.H. (Master of Public Health)                                            6
                M.N. (Master of Nursing)                                                   21
                M.S. (Master of Science)                                                   11
                Ph.D. (Doctor of Philosophy)                                                4
                Subtotal - School of Nursing                                     889      294
               TOTAL                                                           2,813      892
                   Source: OHSU data
                   (a) Joint degree with Oregon Institute of Technology.
                   (b) Joint degree program with Oregon State University.
                   (c) Became a School of Medicine department in 2008.




       OHSU’s academic programs accommodate the growing demand for healthcare
professionals in many disciplines, many of which are facing shortages now and in the
foreseeable future.5 Some of OHSU’s major academic programs are not available
elsewhere in the state. The largest of these are the School of Medicine and the School of
Dentistry.


   5
       Oregon Employment Department, Occupational Information Center, March 2009.

Page 10                                       November 2009                               ECONorthwest
        While there are several nursing programs in the state, there is still a significant
shortage of capacity for nursing education. According to The Oregon Center for Nursing,
the demand for registered nurses is projected to grow steadily over the next 15 years, with
an additional 15,700 RN job openings statewide. Meanwhile, approximately 40 percent
of currently licensed RNs are expected to retire by 2025. “Oregon has a large pool of
qualified nursing school applicants, two to three times more than it has the capacity to
educate at present…In 2006, nursing schools in Oregon report[ed], on average, 6
applicants for every position.” 6
        Currently, other than OHSU, only four universities in the state offer a four-year
baccalaureate degree in nursing: Concordia University, George Fox University, Linfield-
Good Samaritan School of Nursing and the University of Portland School of Nursing. All
of these programs are located in or near the Portland area. Importantly, only OHSU offers
this degree outside the metropolitan area at its satellite campuses in LaGrande, Klamath
Falls, Ashland and Monmouth, thus helping to alleviate an even greater nursing shortage
in Oregon’s more rural areas.7 OHSU also offers co-admission to the Bachelor of Science
in Nursing program through eight community colleges throughout the state.
        Only OHSU and the University of Portland offer Master’s and Doctoral degrees
in nursing—a requirement for teaching. The shortage of nursing faculty is a key
constraint in meeting the demand for nurses in Oregon.8
       Other key academic programs at OHSU are discussed below.
       •   The College of Pharmacy, operated in partnership with Oregon State
           University, is the only such program in the state. Students in this program do
           clinical rotations at OHSU, providing students with experience in an inpatient
           setting caring for the most complex patients in the state.
       •   OHSU’s physician assistant’s program had 36 slots available for the 2007-08
           school year and 537 applicants. Oregon has one other Physician Assistant
           program, located at Pacific University in Forest Grove. This program had 42
           slots available for the 2007-08 school year, and received over 600
           applications. According to the Bureau of Labor Statistics, physician assistant
           jobs are expected to increase by 27 percent between 2006-2016.9
       •   The School of Medicine’s Department of Science & Engineering has three
           divisions: Biomedical Engineering, Biomedical Computer Science, and
           Environmental and Bio-molecular Systems. These programs are directly
           related to OHSU’s unique role in Oregon, bringing together education,
           research, and clinical and commercial advances in biomedical sciences that
           improve health and well-being in Oregon and beyond.




   6
     http://www.oregoncenterfornursing.org/shortage.php#articles, accessed February 20, 2009.
   7
     Oregon Employment Department, Occupational Information Center, March 2009.
   8
     http://www.oregoncenterfornursing.org/shortage.php#articles, accessed February 20, 2009.
   9
     U.S. Bureau of Labor Statistics, 2008-09 Occupational Outlook Handbook.

ECONorthwest                             November 2009                                          Page 11
    EDUCATIONAL
OUTREACH

       In addition to OHSU’s academic programs, the University sponsors a variety of
educational outreach programs. OHSU offers continuing education to healthcare
professionals throughout the state, which is essential for maintaining high quality care and
for continuing licensure. The University also has a wide range of educational opportunities
for K-12 students throughout the state, including classes, camps, events, lectures,
mentorships and apprenticeships.
        In some programs, OHSU students are required to complete clinical rotations in rural
areas, which not only provide students with experience in rural practice but also improve
access to care in underserved areas. Students in the Schools of Medicine, Dentistry and
Nursing performed thousands of hours of clinical rotations throughout Oregon, including
many underserved locations. Some of these community rotations are highlighted below.
   • Medical students—The Area Health Education Centers (AHEC) have been sponsoring
     rural rotations for medical students for about 16 years. Each third-year medical student
     is required to spend five weeks on a rural rotation in Family Medicine, Pediatrics or
     Internal Medicine. About 120 residents each year participate. An additional 75
     students per year perform rotations in Eugene and Bend. Research has shown that such
     programs can increase the supply of rural practitioners. “[F]amily medicine residency
     training programs that include a significant rural training component are associated
     with an increased likelihood of rural practice and retention.”10
   • Physician Assistant students—This program sponsored 326 clinical rotations in the
     2007-08 school year in a variety of specialties, amounting to almost 1,800 person-
     weeks of clinical time. Of these, 153 rotations (880 person-weeks) were performed in
     17 non-metro counties throughout Oregon.
   • Dental students—In the 2007-08 school year, 15 dental students performed 30 weeks
     of community dental rotations, amounting to 1,200 hours of direct clinical care and
     community-related activities. These rotations occurred in Burns, Grants Pass,
     Medford, Hood River, Pendleton, Prineville and McMinnville, as well as in Hillsboro
     and Portland.
   • Nursing students—At the nursing program in La Grande in the 2007-08 school year,
     62 students performed clinical rotations two to three days per week for 10 weeks in
     Ontario, John Day, Pendleton, Hermiston and Baker City. For the Portland-based
     Nurse Anesthesia program, eight students performed eight-week rotations in Josephine
     County for a total of 64 weeks of clinical time.




    10
     Gazewood, J.D., Rollins, L.K. and Galazka, S.S. (2006.) Beyond the Horizon: The Role of
Academic Health Centers in Improving the Health of Rural Communities. Academic Medicine, 81:9.


Page 12                                  November 2009                            ECONorthwest
   
2.1.3
     RESEARCH
                           OHSU
Research
Centers
and
Institutes

                                              Research
Programs
under
the
Vice­President
for

       OHSU makes important                   Research

contributions to medical science,              •    Vollum
Institute


advancing diagnosis and treatment              •    Center
for
Research
on
Occupational
&

                                                    Environmental
Toxicology
(CROET)

capabilities for some of the world’s most      •    Oregon
National
Primate
Research
Center

challenging diseases.                          •    Advanced
Imaging
Research
Center


                                               •    Center
for
Biostatistics,
Computing
&
Informatics
in

        In fiscal year 2007, OHSU                   Biology
&
Medicine

received over $300 million in research         •    Center
for
the
Study
of
Weight
Regulation
and

funding for more than 4,100 research                Associated
Disorders

                                               •    Oregon
Stem
Cell
Center

projects. Nearly all of this research          •    Vaccine
and
Gene
Therapy
Institute

funding originated from outside the state,     •    Oregon
Clinical
and
Translational
Research
Institute

making it a total net economic gain to              (OCTRI)

                                               •    Oregon
Center
for
Aging
&
Technology

Portland and Oregon.                           •    Center
for
Coastal
Margin
Observation
&
Prediction

        The wide variety of activities in     Research
Programs
within
the
School
of
Medicine

basic science research, clinical and           •    Oregon
Health
Policy
Institute


applied medical research, environmental        •    Knight
Cancer
Institute

research, biomedical engineering and           •    Dotter
Interventional
Institute

                                               •    Heart
Research
Center

medical informatics at OHSU have led to        •    Center
for
Women's
Health

the following key results:                     •    Parkinson
Center
of
Oregon

                                               •    OHSU
Epilepsy
Center

   •   In 2007, 200 clinical trials were       •    Oregon
Stroke
Center

       underway at the OHSU Cancer             •    Oregon
Hearing
Research
Center

                                               •    Multiple
Sclerosis
Center
of
Oregon

       Institute alone.                        •    Layton
Aging
&
Alzheimer's
Disease
Center

   •   OHSU generates patents from             •    Digestive
Health
Center

                                               •    Oregon
Center
for
Complementary
&
Alternative

       research discoveries, which it               Medicine
in
Neurological
Disorders

       licenses to commercial enterprises      •    Portland
Alcohol
Research
Center

       for development. In 2007,               •    One
Sky
Center

                                               •    Center
for
Evidence‐Based
Policy

       researchers filed 66 patent             •    Center
for
Policy
&
Research
in
Emergency
Medicine

       applications and disclosed              •    Oregon
Evidence‐based
Practice
Center

       132 new inventions.                     •    Methamphetamine
Abuse
Research
Center

                                               •    Children's
Psychiatric
Day
Treatment
Center

   •   Research discoveries and patents        •    Casey
Eye
Institute

                                               •    Research
Center
for
Gender‐Based
Medicine

       often lead to start-up companies             (RCGBM)

       that generate employment,               •    Molecular
Diagnostics
Center

       spending and tax revenues locally.      •    Oregon
Institute
on
Disability
&
Development

                                               •    Neuropsychiatric
Institute

   •   Collaboration and innovative            •    Center
for
Spoken
Language
Understanding

       business partnerships facilitate the    •    Center
for
Professional
Development

       transfer of laboratory research into   Research
Programs
within
the
School
of
Nursing

       marketable products that benefit        •    Center
for
Healthy
Aging

       the public by improving health and      •    Center
of
Geriatric
Nursing
Excellence

                                               •    Center
for
Health
Disparities
Research

       healthcare practices and by             •    Center
for
Research
on
Symptom
Management
in

       contributing to economic growth.             Life‐Threatening
Illness

                                               •    Intranet
Webpage
for
Research

                                              Dental
Clinical
Research
Center




ECONorthwest                         November 2009                                      Page 13
    2.1.4
       OUTREACH

        OHSU reaches out to Oregon’s citizens, including typically underserved
populations such as low-income families and rural communities, through a number of
outreach centers and programs. These programs provide a vital link to healthcare
information and services for citizens around the state. We highlight below a few of these
centers and programs.
    •    Outreach efforts disseminate              OHSU
Outreach
Centers
and
Programs

         information and promote
         public awareness about health,           • Center
for
Coastal
Margin
Observation
&

         wellness and safety issues for             Prediction

         citizens around the state.               • Center
for
Diversity
and
Multicultural
Affairs

                                                  • Center
for
Professional
Development

    •    OHSU programs provide                    • Center
for
Research
on
Occupational
and

         valuable resources for                     Environmental
Toxicology

         healthcare and other                     • Affirmative
Action
&
Equal
Opportunity

         professionals around the state,            Department

                                                  • Center
for
Ethics

         allowing them access to                  • Department
of
Public
Affairs

         continuing education,                    • News
&
Publications
Department

         information about research               • Donate
Life
Northwest

         discoveries and current best             • March
Wellness

         practices, and links to                  • Oregon
Area
Health
Education
Centers

                                                  • Oregon
Center
for
Children
and
Youth
With

         consulting resources.
                                                    Special
Health
Needs
(OCCYSHN)

    •    OHSU’s communications                    • Office
of
Rural
Health

         departments share information            • OHSU
Body
Donation
Program

                                                  • Oregon
Poison
Center

         about research and medical               • Oregon
National
Primate
Research
Center

         breakthroughs with the public            • Oregon
Rural
Practice‐based
Research

         through local, statewide,                  Network

         national and international               • Partnership
Project
(HIV/AIDS
Services)

         media and websites.                      • Science
Education
Opportunities


    •    As Oregon’s only academic
         health center, OHSU is uniquely positioned to improve quality and access for
         rural healthcare.11 Examples of OHSU’s rural outreach programs include:
             •   Students in some programs perform rotations in rural areas to help ease
                 provider shortages, to provide important training opportunities, and to
                 encourage graduates to locate in underserved areas.
             •   The Office of Rural Health addresses the unique needs and challenges
                 faced by rural areas. It helps rural communities recruit and train healthcare
                 professionals, and helps increase residents’ access to healthcare, for
                 example by establishing visiting practitioner and telemedicine programs.


    11
     Gazewood, J.D., Rollins, L.K. and Galazka, S.S. (2006.) Beyond the Horizon: The Role of
Academic Health Centers in Improving the Health of Rural Communities. Academic Medicine, 81:9.


Page 14                                  November 2009                             ECONorthwest
         •   OHSU operates four Area Health Education Centers (AHECs) outside the
             Portland metropolitan area. Serving Oregon’s four geographical quadrants,
             the centers are located in Roseburg, Bend, La Grande and Lincoln City.
             The AHEC’s mission is to:
                 o Improve the availability, continuity and quality of healthcare for
                   communities and populations in need through education.
                 o Develop distance-learning capabilities to serve health profession
                   students, resident physicians, local healthcare providers and
                   community residents.
                 o Maintain a statewide system of AHECs that link OHSU to
                   communities, healthcare facilities and healthcare professionals.
  •   The Oregon Poison Center (OPC) provides critical, often lifesaving services
      throughout Oregon and the Northwest by providing free 24-hour emergency
      phone lines and medical case management resources for individuals and
      healthcare professionals alike. According to OPC data for 2007, the Center
      received over 50,000 calls that resulted in OPC managing more than 39,000
      patients. OPC consulted directly with about 6,000 healthcare providers in cases
      where the patient was already in or on the way to an Oregon hospital. Based on
      national research, OPC estimates that their services led to the avoidance of over
      10,000 emergency department visits for a total savings of over $15 million. The
      Center also provides public and professional education, emergency planning and
      management, biochemical and radiation terrorism preparedness, and public health
      assessment and management.
  •   To share and advance clinical and scientific knowledge, many OHSU departments
      sponsor conferences that are attended by healthcare professionals throughout
      Oregon and from around the world. For example, OHSU’s Oregon Office of
      Rural Health co-sponsors the Annual Rural Health Conference that brings
      together providers, administrators, patients, activists and policy makers to address
      the challenges of healthcare in rural Oregon
  •   The Schools of Dentistry, Medicine and Nursing and the Child Development and
      Rehabilitation Center offer continuing professional education in a wide variety of
      disciplines. Education is provided in a variety of forms, including lectures,
      courses, seminars and hands-on workshops. Many continuing professional
      education programs are broadcasted or provided online so that they are accessible
      to providers throughout the state.




ECONorthwest                        November 2009                                Page 15
       2.2
 OHSU
LOCATIONS

   2.2.1
      MARQUAM
HILL

        OHSU’s main campus is located on Marquam Hill in Portland, Oregon. In 2007,
OHSU’s main campus employed more than 10,000 employees, provided instruction to
over 1,600 students, and served over half a million patients. Facilities on Marquam Hill,
which are owned by OHSU, cover 118
acres of land, comprising 36 buildings
with 3.8 million square feet of space.           “Green”
Building
Leadership
at
OHSU

Marquam Hill is OHSU’s home for the            The
Center
for
Health
&
Healing
building
and
a

following:                                     variety
of
other
“green”
projects
on
its

   •   OHSU Hospital                           campuses
have
positioned
OHSU
as
an

                                               environmental
leader
in
Oregon.
The
center

   •   Doernbecher Children’s Hospital         has
achieved
the
highest
standard
of
the
U.S.

   •   Medical, Dental and Nursing             Green
Building
Council's
Leadership
in
Energy

       Schools                                 and
Environmental
Design
(LEED)
program,

                                               making
it
Oregon's
first
LEED
platinum‐
   •   Casey Eye Institute                     certified
building
and
the
first
in
the
nation
for

   •   Patient care pavilions                  this
type
of
building.
It
is
also
the
largest

                                               environmentally
sustainable
medical
treatment

   •   Research centers and                    building
in
the
world.


       laboratories
                                               The
LEED
Green
Building
Rating
System™
is

   •   Administrative offices                  internationally
recognized
certification
system

                                               that
measures
how
well
a
building
performs

   2.2.2
      SOUTH
WATERFRONT
               across
certain
metrics,
including
energy

                                               savings,
water
efficiency,
CO2
emissions

        The South Waterfront district is       reduction,
improved
indoor
environmental

located along the Willamette River to          quality,
and
stewardship
of
resources
and

the east of Marquam Hill. The Center           sensitivity
to
their
impacts.

for Health & Healing currently is the
                                               Some
of
the
earth‐friendly
features
of
the

only OHSU facility located at the South        Center
for
Health
&
Healing
include:


Waterfront, but several more buildings
are planned for the future. The center,        •   On‐site
combined
heat
and
power
production

                                                   saves
roughly
9
million
pounds
of
CO2
per
year.

owned by OHSU, comprises 412,000               •   Stone
slabs
on
the
first
floor
store
as
much
heat

square feet of space on 16 floors,                 as
a
3,000‐gallon
water
tank.

including eight floors of medical offices,     •   Rainwater
is
used
to
flush
public
fixtures.

surgery and imaging facilities; four           •   Bio‐treatment
system
is
able
to
treat
up
to

floors dedicated to research and                   30,000
gallons
a
day.

education facilities and a future              •   Extensive
use
of
eco‐roofs.

                                               •   More
than
95%
recycle
of
construction
waste.

biomedical engineering program; and            •   More
than
50%
of
building
materials
extracted

three floors for a health and wellness             or
manufactured
locally.

center. The building meets the highest         •   Sustainably
harvested
woods
used
throughout.

standards for energy environmental             •   Photovoltaic
panels
in
sunshades
on
south
side.

design (see box on this page).                 



Page 16                              November 2009                            ECONorthwest
       The Portland Aerial Tram provides a link between the Marquam Hill campus and
the South Waterfront, carrying patients, visitors, staff and students between the two
campuses in three minutes. In 2007, the tram carried approximately 1.4 million
passengers, 38 percent more than projected for the year.12 OHSU estimates that tram will
eliminate 2 million vehicle miles per year, save 93,000 gallons of gas and reduce carbon
emissions by more than 1,000 tons.13 The South Waterfront District also is linked to the
downtown area and Portland’s transit system by bus and streetcar lines, and soon it will
be served by the light rail system.

OHSU as an Urban Development Catalyst
       In addition to their economic impacts, universities historically have played an
important role in shaping the urban development of their surrounding communities and
regions. Nowhere in Portland has this catalytic effect been more prominent than in
Portland’s South Waterfront neighborhood. In its long-term effort to accommodate
growth and provide the highest quality facilities for its patients, students and employees,
OHSU has expanded its campus to include the South Waterfront, creating the impetus for
the development of a new urban mixed-use neighborhood.
        For many years the City of Portland attempted unsuccessfully to spark
redevelopment of the 120-acre South Waterfront area. The City changed the area’s
zoning status from industrial to commercial in the 1980s in hopes of inducing more
mixed-use urban development. However, rezoning was necessary but not sufficient to
attract new urban development to the area. In 2000, the City approved an urban renewal
area for South Waterfront that enabled public financing for pivotal infrastructure
improvements and other development needs. The City also completed a framework plan
that provided greater certainty about land use patterns, building dimensions and
transportation improvements.
        In 2003, OHSU entered into a three-way agreement with a private developer and
the City of Portland to develop the central district of the South Waterfront into a mixed-
use urban neighborhood (see site plan on following page). The agreement included plans
for OHSU to develop 1.8 million square feet of research, teaching and clinical space in
the South Waterfront’s central district (approximately 33 acres located directly south of
the Ross Island Bridge) over a 15-year period. The Center for Health & Healing was the
catalyst for this plan.
       The Center for Health & Healing provided the impetus for the City to partner with
OHSU for two major infrastructure projects: the Portland Streetcar extension, which
connects the South Waterfront to downtown Portland, Portland State University, and the
mass transit system; and the Portland Aerial Tram, which provides a link between
OHSU’s Marquam Hill campus and the South Waterfront neighborhood.




   12
        Portland Aerial Tram 2007 Annual Report.
   13
        http://www.ohsu.edu/ohsuedu/about/transformation/tramefficiency.cfm


ECONorthwest                               November 2009                           Page 17
           The private developer committed to building several thousand units of mixed-
   income housing. Currently four condominium towers have been completed: Meriwether
   Towers (21 and 24 stories), the John Ross Tower (31 stories), and Atwater Place (22
   stories). Construction is nearing completion on the Ardea apartment complex (31 stories),
   and is underway on the Mirabella (see below) and the Riva on the Park apartment tower
   (22 stories). Most completed and planned buildings incorporate ground floor retail space
   to provide important amenities to the emerging neighborhood. All of these buildings are
   designed to achieve LEED certification. OHSU’s commitment and early presence in
   South Waterfront has contributed strongly to fostering this private development activity.
   Figure 5 shows the location of some of the completed and planned developments in the
   South Waterfront District.

Figure 5: Completed and Planned Developments in Portland’s South Waterfront District




                                   Riva on
                                   the Park




                                   Ardea




Source: Portland Development Commission website.



            A partnership between Pacific Retirement Services, Inc. and OHSU will bring the
   Mirabella Continuing Care Retirement Community to the South Waterfront. This
   building, scheduled to open in 2010, will house approximately 388 senior residents. Its
   proximity to the Center for Health & Healing and OHSU’s Marquam Hill campus is
   pivotal to the project. As part of its affiliation with OHSU, the facility will focus on the
   study, innovation and integration of services for seniors with the goal of improving their
   health, well-being and independence. The total project is expected to cost $221 million,
   and at its expected occupancy will provide employment for approximately 151 workers.
   It will also contain approximately 4,000 square feet of retail space.



   Page 18                                    November 2009                    ECONorthwest
        The Portland Development Commission (PDC) reports that the real market value
of the South Waterfront properties included in the Central District Development
Agreement increased by $446 million since its beginning (from the initial real market
value of $13 million in fiscal year 2006 to $459 million in fiscal year 2009.) The South
Waterfront development generated $4 million in property tax revenue in fiscal year 2008,
and $5 million in fiscal year 2009.
        PDC estimated that the first phase of the Central District development created
more than 1,000 construction jobs. In addition, the City’s commitment to building
infrastructure, including parks, the streetcar extension and the aerial tram, resulted in
expenditures of more than $84 million. The City also made investments in street
improvements in the South Waterfront Central District.
       In addition to the Central District development, OHSU was the recipient of a land
donation from the Schnitzer family of approximately 20 acres at the northern tip of the
South Waterfront. The land has been conceptually planned by OHSU as a mixed-use
campus that will house, among other building types, teaching and research facilities for
OHSU as well as Oregon University System schools (including PSU and OSU), student
and community housing, and private research facilities and corporate offices.
         OHSU’s involvement in the development of the South Waterfront neighborhood
has been pivotal to the transformation of that area from an underutilized industrial site to
a vital component of Portland’s urban landscape.

   2.2.3
      WEST
CAMPUS

        OHSU’s West campus, located in both Beaverton and Hillsboro, houses the
Oregon National Primate Research Center, the Neurological Sciences Institute, the
Department of Science and Engineering, and the Vaccine & Gene Therapy Institute. The
West Campus comprises 48 buildings on 276 acres, containing 672,196 square feet of
space. In 2007, approximately 730 staff and 240 students occupied the West Campus.

   2.2.4
      OFF­CAMPUS
FACILITIES

        OHSU houses a variety of administrative, warehouse and clinical operations in
off-campus buildings in Portland. OHSU owns Marquam Plaza and Marquam II on the
south side of downtown Portland. These buildings house administrative operations in
approximately 74,000 square feet of space. OHSU also owns a warehouse on Macadam
Street, and leases more than 400,000 square feet of space throughout the region for a
variety of uses.

   2.2.5
      COMMUNITY
MEDICAL
CLINICS

        OHSU operates five outpatient medical clinics: Outpatient Services in downtown
Portland with a variety of providers and services; Doernbecher Specialty Pediatrics in
Northwest Portland; a family medicine clinic in Southwest Portland; a family medicine
clinic in Southeast Portland; and a family medicine clinic in Scappoose.



ECONorthwest                          November 2009                                  Page 19
   2.2.6
      SATELLITE
CAMPUSES
FOR
THE
SCHOOL
OF
NURSING

        The School of Nursing offers Bachelor of Science programs in nursing (and in
some cases, advanced degrees) at college campuses in Ashland at Southern Oregon
University, in La Grande at Eastern Oregon University, in Klamath Falls at Oregon
Institute of Technology, and the newest location in Monmouth at Western Oregon
University, which opened in the fall of 2008. Space for these programs is leased from the
hosting universities.
         In 2007, approximately 255 nursing students were enrolled in these satellite
programs, compared to 202 at the Portland campus. In addition to satellite campuses,
OHSU offers an online bachelor’s degree program to place-bound students. This program
had approximately 130 students in 2007. For all Bachelor of Science nursing students in
2007, 34 percent were enrolled in Portland, 43 percent were enrolled in satellite programs
and 23 percent were in the online program. Together these programs are helping to ease
the critical nursing shortage in Oregon, particularly in the underserved rural areas of the
state.
        The School of Nursing also has formed a partnership with eight community
colleges around the state, called the Oregon Consortium for Nursing Education (OCNE),
to help students prepare for and transition to the OHSU nursing program. This program is
designed to increase access to nursing education in underserved areas and for
disadvantaged students.




Page 20                              November 2009                         ECONorthwest
         

CHAPTER
3
                 
MODELING
OHSU’S
ECONOMIC
IMPACTS


         It is widely acknowledged that universities and healthcare providers are major
economic forces in their communities. The Brookings Institution issued a report in 2008
titled, “The Local Economic Impact of ‘Eds & Meds’: How Policies to Expand
Universities and Hospitals Affect Metropolitan Economies.”14 The report highlights two
findings about the economic impacts generated by hospitals and universities that are
particularly relevant to this analysis:
    •    New income—Expanding the higher education and medical sectors brings new
         income to a metropolitan area by attracting patients and students from outside the
         area. This effect is larger for universities because students are more likely to
         travel for school than patients are for healthcare.
    •    Increased incomes—Expanding the higher education sector improves residents’
         skills, thereby increasing their earnings. Colleges and universities attract and
         retain new residents, raising the educational level and earnings of the population.
         Also, expanding the relatively high-paying medical sector is likely to drive up
         wages throughout the metropolitan area.
    •    Business growth—University research is a catalyst for creating new businesses
         and expanding existing businesses.15
        The authors conclude that expansion of these sectors creates economic benefits
for workers and business owners in other sectors, as well as state and local taxing
jurisdictions. Because OHSU is both a university and a healthcare institution, it generates
impacts across both the “eds” and “meds” sectors. OHSU is one of the largest employers
in the state, and purchases a wide variety of goods and services from businesses in
Portland and elsewhere in Oregon. OHSU also attracts spending by students and visitors
that otherwise might not occur. In addition, OHSU has fostered the development of start-
up bioscience and other companies, who will in turn employ workers and purchase a
variety of goods and services in Portland.
        The findings of this economic impact analysis are consistent with the conclusions
of the Brookings study. OHSU has significant economic impacts across a wide variety of
economic sectors. For every million dollars spent by OHSU, a greater amount of
economic activity ripples through the economy, increasing economic output, personal
income and jobs throughout the region and the state. This chapter will discuss the
methodology and data sources used to analyze this economic activity, and will present
and discuss the findings of the analysis.




    14
     Bartik, T.J. and G. Erickcek. 2008. The Local Economic Impact of “Eds & Meds”: How Policies to
Expand Universities and Hospitals Affect Metropolitan Economies. Brookings: Washington, D.C.
    15
       However, the authors point out that there is little evidence specifically regarding the role of teaching
hospitals in economic development effects.

ECONorthwest                                 November 2009                                           Page 21
3.1
 
TYPES
AND
MEASURES
OF
ECONOMIC
IMPACT

        Institutions as large as OHSU frequently use economic impact studies to
demonstrate the contributions of their activities to the state or local economy. Economists
have developed several approaches to measure the impacts. The most common approach
estimates the economic impacts associated with the university’s spending, as well as that
of its employees, students, and visitors. To this, we have added start-up bioscience
companies whose existence can be traced back to OHSU.
        Throughout this report we present three types of impacts; each is discussed below
within the context of this analysis. More detailed information about the methodology
used in this analysis is provided in Appendix A.
   •   Direct impacts include the output (as measured by expenditures), payroll, and
       jobs associated with OHSU. That is, in order to provide its services, OHSU will
       purchase a variety of goods and services and employ doctors, nurses, professors,
       researchers, technicians, administrators, and classified staff working in clerical,
       service, and maintenance positions. Together, these operating and payroll
       expenses represent the direct output of OHSU.
   •   Indirect impacts occur as businesses buy from other businesses. OHSU, for
       example, will purchase electricity, water and sewer services, construction,
       maintenance and repair services, and a host of other goods and services necessary
       to operate. The construction contractor will, in turn, purchase fuels and lease
       equipment. These purchases of goods and services by businesses from other
       businesses indirectly generate sales, jobs, and income for others.
   •   Induced impacts result from the increased income and purchasing power of
       households who are either directly or indirectly affected by OHSU. The OHSU
       doctor, for instance, will take her family to dinner or purchase clothing for her
       children. Employees for the construction contractor who repairs OHSU facilities
       will spend their income in much the same way. This spending induces sales, jobs,
       and income for workers and businesses in other sectors of the economy.
       The economic impacts associated with OHSU can be measured in several ways.
This report focuses on three of the most common and useful measures:
   •   Output is the largest measure of economic activity, and represents the value of
       goods and services produced. Output includes the value of intermediate goods
       used in production, as well as the wages and income paid to workers; rents and
       profits earned by households and businesses; and excise taxes paid to
       governments.
   •   Personal income includes both employee compensation and proprietary income.
       Employee compensation (or wages) includes workers’ wages and other benefits
       such as health and life insurance, and retirement payments. Proprietary income (or
       business income) represents the payments received by small-business owners or
       self-employed workers. Business income would include, for example, income
       received by private business owners, doctors, accountants, attorneys, etc.
   •   Jobs consist of the number of people working full- or part-time jobs.

Page 22                              November 2009                         ECONorthwest
       A multiplier is a measure of the marginal impact of an expenditure on the entire
       economy. In essence, the multiplier is a shorthand way to better understand the
       linkages between a given activity and other sectors of the economy. The larger the
       multiplier is, the greater the interdependence between an activity (in this case,
       OHSU’s operations) and the rest of the economy. It is important to understand
       that multipliers are also influenced by the definition of the economy being
       analyzed. As the size of the economic region increases, the propensity to import
       decreases, and the multiplier increases. This is one reason why national or
       regional economies typically have larger multipliers than county or local
       economies.

3.2
 SOURCES
OF
ECONOMIC
IMPACTS

        Simply citing the economic impacts that occur as a result of some activity would
produce an upper bound estimate of economic impacts. This upper bound estimate is
often referred to as a measure of the gross economic impacts. Gross economic impacts
offer a perspective on the magnitude of overall economic impacts that can be traced back
to the activity. Gross economic impacts, however, do not necessarily reflect or measure
the creation of new jobs or income.
        An analysis of the net economic impacts requires that only economic stimuli that
are new or additive to the local economy be counted. To do this, the impact analysis
would include a base case scenario that describes what would have happened in the
absence of, in this case, OHSU. In impact analysis, this base case scenario is typically
implemented by positing counterfactual arguments that only count spending that, but for
the project or activity, would not have occurred.
       OHSU’s net impact on the region and state are based on spending and activities
that would otherwise not occur but for the institution. Thus, from a net economic impact
perspective, OHSU is an exporter of medical goods and services, as well as a provider of
goods and services to Oregonians who might otherwise go out of state for medical care
(in economics, this is called “import substitution”).
        To estimate net economic impacts, ECONorthwest began by analyzing the gross
direct expenditures made by OHSU and its affiliates (e.g., staff and students), and then
developed assumptions to determine which of those expenditures would not occur if not
for the existence of OHSU. In doing this, it was important to carefully distinguish
between revenues that OHSU attracts to this region from other places versus revenues
that are locally based. When OHSU provides a service to someone outside of the area or
attracts dollars from outside of the area, all of that activity counts as a net impact—in the
absence of OHSU, that transaction would not have taken place in Portland.
       Consider the following two examples:
       •   A top OHSU researcher wins a large federal grant to conduct cancer
           research. The federal grant pays part of her salary, as well as those of a
           number of her colleagues. But for her qualifications and proposed research
           approach, a team in Massachusetts would have won the grant. This means


ECONorthwest                          November 2009                                  Page 23
           that the federal grant and the activities it supports have a net impact on the
           Portland and Oregon economies.
       •   By contrast, consider a 38-year old Portlander who needs more common
           inpatient medical services. He selects OHSU for its quality, but if OHSU had
           not been an option, he would have gone to Good Samaritan. In this example,
           his purchases at OHSU would be counted as part of OHSU’s gross impact but
           not its net impact, because they do not increase overall economic activity in
           Portland. Rather his selection simply assigns that activity to one institution or
           another.
        With this in mind, the analysis must consider which activities would cease in the
absence of OHSU and which ones would continue. Below are some major categories or
topics that are relevant in identifying net impacts.
   •   Patient care revenue. Revenue associated with patient care is the largest source
       of revenue for OHSU, amounting to more than $950 million in fiscal year 2007
       for both OHSU and the OHSU Medical Group. If OHSU did not exist, other local
       providers would absorb some of this demand. However, patients who require the
       high-level, specialized care provided by OHSU likely would either forgo the
       optimal level of care or go to medical centers in Seattle, California and elsewhere.
       For the net impact analysis, we estimate that 35 percent of OHSU’s patient care
       revenue would be lost to the region in the absence of OHSU. This amounts to
       approximately $333 million in revenue. Expenditures associated with this revenue
       are included in the model.
   •   Federal and other research funding. In fiscal year 2007, OHSU received more
       than $300 million in research funding for more than 4,100 research projects and
       hundreds of clinical trials, with nearly all of this funding coming from outside the
       state. Almost all of the expenditures associated with this revenue are included in
       the model.
   •   Charitable contributions. OHSU receives charitable contributions through three
       different but related entities: OHSU itself, the OHSU Foundation, and the
       Doernbecher Children’s Hospital Foundation. Combined, charitable contributions
       in 2007 totaled $107 million. Based on an analysis of the geographic origin and
       designated purpose of individual contributions performed by the OHSU
       Foundation staff, we assume that 84 percent of charitable contributions likely
       would be sent out of state if OHSU did not exist. We assume that the remainder of
       these contributions would be redistributed in the region. Therefore, the model
       includes approximately $90 million of expenditures funded by charitable
       contributions.
   •   Types of educational services offered. OHSU offers the only medical school and
       dental school in the state, and offers educational programs for nursing, allied
       health professions, and biomedical science and engineering. Many of these
       programs are unique to the region and the state, and they play a vital role in
       meeting the critical demand for healthcare and related services. As such, OHSU
       keeps local students in the state, brings non-local students to Oregon, and supplies
       graduates to jobs in the healthcare sector. This analysis includes all student tuition

Page 24                              November 2009                          ECONorthwest
          and other university-related spending, as well as non-university-related spending
          by students in the local economy.
   •      Start-up companies, licenses and patents. Research and development activities at
          OHSU will also spur off-site commercialization activities. These start-up
          businesses and their spending represent an important economic dimension to
          OHSU. Using an electronic survey of start-up company managers and information
          collected by OHSU, ECONorthwest identified the types of start-up companies
          and allocated their direct employment to the appropriate business sectors in the
          economic model to estimate their indirect and induced impacts elsewhere in the
          regional and state economies.
        In addition to the activities identified above, ECONorthwest also evaluated
OHSU’s role in other activities that affect the regional and state economies. As important
as these activities are, they are also much more difficult to quantify. The following
activities were not included in economic impact measures, but are discussed in this
report:
   •      Real estate holdings and development. OHSU owns and manages millions of
          square feet of real estate and influences the development of millions more. While
          OHSU is not a property tax-paying institution, it participates in the development
          of mixed-use buildings, which do generate property tax. OHSU’s development
          activities have had a catalytic impact on the quality and size of adjacent facilities,
          many of which are private and pay property and other taxes. Because the period
          of analysis for this economic impact analysis is one fiscal year (2007), the
          analysis includes the impacts of one year of capital spending by OHSU. However,
          it does not include the longer-term economic effects of real estate development.
   •      Non-medical spending by out-of-town patients and visitors. OHSU does not
          track the number of out-of-town people who accompany or visit OHSU patients,
          or to determine the origin of these visitors. Also, we assume that the spending
          patterns of patients and their visitors are significantly different from the patterns
          of traditional visitors to Portland (for example tourists, business travelers and
          convention attendees) for whom spending data are available. While visitors to
          OHSU undoubtedly have an impact on the economy from spending on hotel stays,
          restaurant meals and tourist activities, we cannot credibly estimate this spending
          so it is not included in this analysis.
   •      Conferences held by OHSU. OHSU currently does not have a comprehensive
          source of information about the number of conferences held by its school and
          departments. While these events undoubtedly create both economic and non-
          economic benefits, without information about the number and origin of
          conference attendees ECONorthwest cannot credibly estimate their impacts.
   •      Impacts of Physicians in Rural Areas. OHSU currently does not track the career
          location choices of its medical students or residents16, so we are not able to



   16
        According to Dr. Roy Magnusson, Medical Director of OHSU Hospitals and Clinics.


ECONorthwest                              November 2009                                   Page 25
       estimate the economic impacts of OHSU programs that draw physicians,
       particularly family physicians, to rural areas. However, physicians are an
       important economic driver in rural communities. To the extent that OHSU
       influences physicians to locate in rural communities, the economic benefits
       generated by those physicians are attributable to OHSU. We do not measure these
       impacts in this analysis, but they are nevertheless important to consider.

3.3
 GROSS
VS.
NET
ECONOMIC
IMPACTS

         ECONorthwest worked with OHSU staff to assemble detailed spending data for
all of OHSU’s activities, including the geographic basis of the revenues and expenditures
associated with various activities. We then identified the proportion of OHSU’s spending
that is a net gain to the region and the state (that is, spending that would not occur in the
absence of OHSU), and the proportion that likely would remain in the region and be
redistributed to other providers (and therefore is not included in the net impact analysis).
These analytical components enable us to distinguish between gross and net economic
impacts.
        Gross impacts provide an upper bound estimate of economic impacts, tracing all
the expenditures made by OHSU throughout the economy. However, as discussed above,
some proportion of the services currently provided by OHSU, primarily those related to
patient care, would still occur in the region and the state in the absence of OHSU.
Without OHSU, many of the more routine cases would be absorbed by other local
hospitals. However, the most complex cases likely would be sent to academic health
centers or large hospitals in other states, resulting in the loss of that economic activity in
Portland and in Oregon.
       While gross impacts include all economic output, income and jobs associated
with OHSU’s spending, net impacts count only the economic activity that is new or
additive to the economic region in question. In contrast to patient care, for which there
are many providers in Portland and the state, economic activity associated with the
medical school (tuition spending, student spending, etc.), most research, and significant
foundation contributions likely would not occur in the absence of OHSU, and therefore
counts as additive to the Portland and state economies.

3.4
 REGIONAL
VS.

STATEWIDE
IMPACTS

        The geographic boundary for the regional analysis is the Portland metropolitan
region, defined as the four metropolitan area counties: Multnomah, Washington, and
Clackamas counties in Oregon, and Clark County in Washington. For consistency with
our regional model, and because Clark County is an integral part of the metro area
economy, the state of Oregon model includes all of Oregon and also Clark County. This
analysis does not measure the effects of OHSU spending that accrue to non-Oregon
businesses and workers.
       From a regional perspective, any person or entity from outside the four-county
Portland metropolitan area that spends money within the region represents a net gain to


Page 26                               November 2009                           ECONorthwest
the Portland economy. However, from a statewide perspective a net gain occurs only
under two conditions:
       1. A person or entity from outside of Oregon spends money here, or
       2. If not for OHSU, a person or entity would end up spending that money in
          another state.
        For example, a patient coming from Bend to OHSU for surgery represents a
“gain” to Portland in terms of the hospital’s spending on that patient and that patient’s
spending while they are here. But that same spending represents a “loss” to Bend, so
there is no net gain to Oregon. However, if in the absence of OHSU the patient from
Bend would have to leave the state to receive this surgery, the economic activity
generated by that patient represents a net gain to the region and the state.
        OHSU’s medical and dental schools provide a different example. Without OHSU,
all potential medical and dental students would be forced to leave the state to receive
their education, representing a net economic “loss” of institutional, tuition, and student
spending for both Portland and Oregon. Also, the lost out-of-state students would no
longer generate spending. In this situation, all medical and dental students, regardless of
their geographic origin, count as a net gain for Portland and for Oregon.
         This distinction between regional and statewide impacts, and the counterfactual
assumptions used for each, can cause a counterintuitive result in some cases. OHSU acts
as a magnet within Oregon, causing a transfer of economic resources from elsewhere in
the state to the metro region. The direct regional impact of OHSU will be relatively large
at this level of analysis. However, the intrastate transfer of resources disappears in the
statewide analysis, so the statewide impact actually may be smaller than the regional
impact. This is an expected result for a primarily regional institution. Only where the
institution acts as a major national or international magnet (for example, Harvard
University or the Mayo Clinic) would the statewide impact be larger than the regional
impact. In these cases, interstate transfers are large relative to intrastate transfers.
        This counterintuitive direct effect is offset somewhat by the larger economic
multipliers that the larger state economy has as compared to the Portland economy.
Multipliers are mathematical equations that measure the linkages between some initial
activity or spending and its effect on the rest of the economy: the larger the multiplier, the
greater the linkages. The multiplier is, in effect, a measure of how many times a given
expenditure will circulate through the economy, as determined by imports, savings, and
taxes. A larger economy will have lower imports and, by definition, a larger multiplier.

3.5
 OHSU
AND
POTENTIAL
SYNERGISTIC
EFFECTS
ON
THE
ECONOMY

       In many ways, OHSU functions as a corporate headquarters within Oregon, much
like Nike and Intel on a national scale. As a headquarters, OHSU has developed strong
supply-chain relationships with local suppliers, and nearly all of its employees are local
residents. Unlike typical corporate headquarters, however, OHSU is focused specifically
on service to Oregonians, so there is no risk of it relocating its central functions and
decision makers to another state or country in pursuit of cost cutting, tax incentives, or


ECONorthwest                          November 2009                                  Page 27
other enticements. This means that a large share of its activities and expenditures will
continue to benefit the local economy over the long term.
        Table 9 shows the net indirect output and jobs generated in various industry
sectors by OHSU’s operations in Portland. Various service sectors are among the top
beneficiaries of OHSU’s spending, including professional and technical services,
administrative and waste services, healthcare and social services, real estate, information,
and other types of services. These services tend to rely heavily on local labor. Together,
these sectors account for 70 percent of the total economic output and 72 percent of the
jobs generated throughout OHSU’s supply chain.

             Table 9: Net Indirect Output and Jobs Generated by OHSU
                       Operations, by Industry Sector
                                                            Indirect   Percent of
                            Industry Sector                   Jobs        total
               Professional and technical services              818         22%
               Administrative and waste services              1,443        39%
               Manufacturing                                    138         4%
               Healthcare and social services                   186         5%
               Real estate and rentals and leasing              110         3%
               Retail trade                                     275         7%
               Construction                                     114         3%
               Information                                       48         1%
               Other Services                                    86         2%
               Agriculture, forestry, fishing and hunting       440        12%
               All other sectors                                 65         2%
               TOTAL                                          3,723       100%

               Source: ECONorthwest IMPLAN analysis using OHSU data.




       In addition to its operating expenditures, over the last 3 years OHSU has spent
more than $445 million on capital and much of this went to local contractors. Similarly,
student non-tuition spending on groceries, rent, and services benefits local businesses in
much the same way.
        OHSU also supports thousands of highly skilled workers who earn above-average
wages, spend money in the local and state economies, and contribute their intellectual
capital and expertise to the civic life of the region. Figure 6 shows that 90 percent of
OHSU employees live in Oregon. Household spending by OHSU employees drives
induced economic impacts, and in 2007, these impacts amounted to $557 million of
economic output in the local economy, including $209 million in personal income, and
almost 5,200 jobs.




Page 28                                   November 2009                          ECONorthwest

           Figure 6: Percentage of OHSU Employees by Location
                     of Residence and Employment, 2007







               Source: ECONorthwest analysis of OHSU payroll data.




       Because these synergistic effects are imbedded in the economic impact model
through expenditures in various sectors of the economy, we cannot report them
separately. However, it is important to acknowledge that as a large local enterprise (i.e.,
OHSU’s focus will always be on Oregon operations with chief administrative functions
located in Oregon), OHSU has a deep impact on the region’s economic growth and
output and.




ECONorthwest                           November 2009                                Page 29
         

CHAPTER
4
                 THE
ECONOMIC
IMPACTS
OF
OHSU


       OHSU’s economic impacts are calculated for the 2007 fiscal year,17 and are
reported in current (2009) dollars. The model traces expenditures through the economy
based on three major spending categories and one economic development category, as
shown below:18
    •    Expenditures related directly to OHSU’s activities
             o Operating expenses include payroll and expenditures on goods and
               services.
             o Capital expenditures consist of building construction and remodeling, and
               capital equipment acquisition.
             o Student expenditures consist of all non-university, non-tuition spending
               by students for living and other expenses such as rent, groceries, child
               care, personal care, haircuts, etc.
    •    Start-up company expenditures consist of estimated spending on payroll, goods
         and services by bioscience and other companies that have been formed because of
         OHSU’s activities.

        OHSU maintains detailed records of spending broken out by hundreds of types of
goods, services, payroll and capital expenditures. The highly detailed records improved
the accuracy of our estimate because each item purchased has a distinct effect on the
local and state economies. Student expenditures were calculated by combining
enrollment data with student spending data provided by the OHSU Office of Financial
Aid.19
        In addition to the three main expenditure categories related directly to OHSU’s
activities, many start-up companies can be directly linked to the research activities that
are funded or that receive laboratory space or other support at OHSU. To assess the
economic development impacts associated with these start-up companies, ECONorthwest
worked closely with OHSU to prepare and distribute an electronic survey to company
managers. This survey was then combined with data collected by OHSU and data
reported by the Oregon Employment Department, to develop inputs—industry sector and
direct employment—for our economic impact models of Portland and Oregon.
       For each expenditure category, we show the amount of direct expenditures,
explain our assumptions about what is included in the net analysis, and report the net


    17
        OHSU’s 2007 fiscal year runs from July 2006 through June 2007. In this report, 2007 refers to fiscal
year 2007 unless stated otherwise.
     18
        Spending by non-local visitors, such as family members and conference attendees, will also generate
economic impacts in the Portland-metro area and the state. OHSU does not compile visitor statistics, and
their impacts are not quantified in this report.
     19
        This impact analysis does not include student spending on tuition and other university-provided
goods and services. These expenditures represent revenue to OHSU and their inclusion would double count
their effects.

ECONorthwest                                November 2009                                         Page 31
economic impacts that result from these expenditures for both the Portland area and the
state. Then we total the impacts for all categories, showing both gross and net impacts
and the resulting multipliers of those activities for the Portland area and for Oregon.
        As explained in section 3.3 above, the gross impacts include all activity generated
by OHSU. Net impacts, on the other hand, include only those expenditures that would
likely leave the region or the state if OHSU did not exist. Many of the services offered at
OHSU are relatively routine and are available from other providers in the region. In the
absence of OHSU, these providers would have or develop the capacity to absorb much of
this demand. However, many services provided by OHSU are unique to the region and
the state, such as medical education, treatment for rare and especially complex, multi-
specialty cases, and advanced clinical and biomedical research. These activities depend
on the synergies created by an academic health center, and would be lost to the region
and the state in the absence of OHSU.

4.1

 COMPONENTS
OF
OHSU’S
ECONOMIC
IMPACTS

4.1.1
 GROSS
DIRECT
SPENDING

        Table 10 provides an overview of spending attributed to OHSU’s activities in
2007 for major expense categories including spending by OHSU and OHSU Medical
Group on operating (payroll, goods and services) and capital expenditures, as well as
non-university spending by students. Total spending in 2007 amounted to $1.552 billion
in the Portland area and $1.578 billion in Oregon.

          Table 10: Spending Associated with OHSU’s activities, FY 2007
                             (reported in 2009 dollars)

             Expenditure type                   Portland                  Oregon

             Operations                     $1,386,323,000           $1,407,434,000

             Capital                           $131,992,000            $132,227,000

             Student spending                   $33,865,000              $38,710,000

             Total                          $1,552,180,000           $1,578,371,000

       Sources: OHSU data for operating and capital expenditures and student enrollment counts.
       Notes: 1. Operating expenses based on payroll and university spending on goods and services.
       2. Capital expenses are based on a three-year average of fiscal years 2005-07.
       3. Student spending includes non-university-related spending, for example, rent and groceries.




        Detailed expenditures associated with these major expense categories, as well as
the direct employment associated with start-up companies, represent the inputs into
economic impact models of Portland and the state of Oregon. The next sections of the
report present the economic impacts associated with each of the four major OHSU
expenditure/activity groups.


Page 32                                  November 2009                                ECONorthwest
4.1.2
 DAY­TO­DAY
OPERATIONS

        The economic impacts associated with OHSU’s day-to-day operations are
attributed to OHSU’s payroll, and purchases of goods and services. In 2007, OHSU’s
operating expenses totaled $1.386 billion in Portland, and $1.407 billion in Oregon. This
spending is reported as the gross direct output from OHSU operations—measured as the
sum of OHSU’s labor and non-labor operating expenses— and is shown in the first row
of Table 11 below.
     Table 11: Gross Direct Operating Impacts of OHSU Operations in FY 2007
                             (reported in 2009 dollars)

            Gross Direct Impacts              Portland                  Oregon

            Output                         $1,386,323,000         $1,407,434,000

            Personal Income                  $875,410,000              $888,741,000

            Jobs                                    13,084                  13,224

               Source: ECONorthwest calculations using data provided by OHSU


       OHSU day-to-day operations are labor intensive. Indeed, in 2007, just over 74
percent of OHSU’s direct operating expenditures went towards payroll. In Portland,
OHSU employed 13,084 workers who received over $875 million in personal income.
Statewide, OHSU employed approximately 13,224 full- and part-time employees who
received about $889 million in personal income. These payroll and employment statistics
represent the gross direct personal income and jobs associated with OHSU’s day-to-day
operations. Table 12 provides additional details for OHSU’s full-time, part-time, and
temporary employees in Portland and in Oregon.

                   Table 12: OHSU Employment Details for FY 2007
                                                           Part-Time/
                                            Full Time       Adjunct/         Total
                                           Employees        On-Call        Number of
           Employment Location             (>0.5 FTE)      Employees       Employees
           Portland                             9,647          3,437           13,084
           Elsewhere in Oregon
            Ashland                                24              9              33
            Eugene                                 24              4              28
            Klamath Falls                           7              5              12
            La Grande                              27             23              50
            Scappoose                              11              6              17

            Total Elsewhere in Oregon              93             47             140
           Total Oregon                         9,740          3,484           13,224
               Source: OHSU. Excludes employees terminated during the 2007 fiscal year.




ECONorthwest                            November 2009                                     Page 33
         Spending by OHSU employees will generate economic impacts. (As discussed
earlier, in economic impact terminology, these impacts are called “induced impacts”.) A
consumer’s spending behavior is determined, in part, by how much money he or she has.
Low-income households spend a greater share of their incomes on housing, food, and
utilities than high-income individuals, who have more disposable income to spend on
non-essential goods and services. IMPLAN incorporates data from consumer spending
surveys, which capture the variations in purchasing patterns for seven income levels.
        Total non-payroll operating expenditures amounted to $517 million in fiscal year
2007 (for OHSU and OHSUMG). OHSU provided detailed expenditure data, with
expense categories and vendor location information, for a large sample of their non-
payroll operating expenses. To determine how OHSU spending actually impacts the local
and state economies, each line item from the operating budget was assigned to one or
more of the industrial sectors in IMPLAN models of Portland and the state of Oregon. In
total, non-payroll operating expenditures were mapped to over 200 different industry
sectors in our economic impact model. This level of detail, combined with our mapping
of payroll to different household income groups, greatly increases the reliability of the
impact model’s results.
       As shown previously in Table 11, OHSU’s operations in Portland directly
contributed $1.386 billion in spending, including $875 million in payroll, and 13,084
jobs. These represent the gross direct impacts of OHSU operations, and do not take into
consideration how spending and activity in the region would change in the absence of
OHSU. To determine the net economic impacts associated with OHSU’s operations, we
used the following assumptions to adjust gross operating expenses:
       •   Patient care revenue. This is the largest source of revenue for OHSU,
           amounting to more than $950 million in fiscal year 2007 for both OHSU and
           the OHSU Medical Group. If OHSU did not exist, other local providers would
           absorb some of the demand for this care. However, the state’s most complex
           patients likely would either forgo the optimal level of care or go to medical
           centers in Seattle, California and elsewhere. Based on an analysis of OHSU’s
           case mix compared to other Portland-area hospitals using the newly-refined
           patient acuity coding system called MS-DRG (Medicare Severity Diagnosis
           Related Groups), we estimate that 35 percent of OHSU’s patient care revenue
           would be lost to the region in the absence of OHSU. This amounts to
           approximately $333 million of the $950 million in total patient care revenues
           in fiscal year 2007.
       •   Grants. All grants revenues are included in the Portland model. The Oregon
           model includes all grant revenues except Oregon Opportunity Grants and
           other grants originating in Oregon.
       •   Tuition. All tuition revenues are included in both the Portland and Oregon
           model.
       •   State appropriations are included in the Portland model but not the Oregon
           model.




Page 34                             November 2009                        ECONorthwest
       •     Charitable contributions. OHSU receives charitable contributions through
             three separate but related entities: OHSU itself, the OHSU Foundation, and
             the Doernbecher Children’s Hospital Foundation. In fiscal year 2007, OHSU
             received $15 million in direct contributions, $74 million in contributions to
             the OHSU Foundation, and $18 million in contributions to the Doernbecher
             Children’s Hospital Foundation. Combined, charitable contributions in 2007
             totaled $107 million.

             Based on an analysis of the geographic origin and designated purpose of
             individual contributions performed by the OHSU Foundation staff, we assume
             that 84 percent of charitable contributions likely would be sent out of state if
             OHSU did not exist. We assume that the remainder of these contributions
             would be redistributed in the region, and therefore would not be counted in the
             net impacts. Based on this assumption, the model includes approximately $90
             million of expenditures funded by charitable contributions.

        Table 13 shows the net economic impacts associated with OHSU’s day-to-day
operations in 2007 using the assumptions discussed above. On a net basis, OHSU directly
contributed an estimated $824 million in output, including $520 million in personal
income, and 7,776 full- and part-time jobs to Portland in 2007 by spending money on
operations and payroll. The net direct impacts in Oregon are also significant but are
slightly smaller than those for Portland due to the assumptions about spending that would
be included in the Portland model but not in the state model.

   Table 13: Estimated Net Economic Impacts from OHSU’s FY 2007 Operations
                                (in 2009 dollars)

     Study Area /
      Type of Impact          Direct         Indirect       Induced           Total
     Portland
      Output               $823,960,000    $402,778,000    $556,883,000   $1,783,621,000
      Personal Income      $520,300,000    $158,906,000    $209,458,000    $888,663,000
      Jobs                        7,776            3,723          5,195          16,694

     Oregon
      Output               $782,557,000    $415,940,000    $578,582,000   $1,777,080,000
      Personal Income      $494,155,000    $162,744,000    $212,801,000    $869,701,000
      Jobs                        7,353            3,819          5,375          16,546

       Source: ECONorthwest using the IMPLAN modeling program



        Spending by OHSU starts a chain reaction of other spending. The indirect impacts
occur as businesses purchase from each other. In this analysis, OHSU’s purchases of
goods and services represent the first round of indirect effects. Subsequent rounds of
indirect impacts occur as vendors and suppliers purchase goods and services from other
businesses that will also need to buy goods and services. The model traces the effects of
the second and subsequent rounds of spending until all the dollars leave the economy

ECONorthwest                           November 2009                                  Page 35
(mainly through the purchase of exports). This indirect economic activity amounted to an
estimated $403 million in output, including $158 million in personal income, and 3,723
full- and part-time jobs in Portland. The indirect effects for the state are slightly larger
than those for Portland, as businesses outside the metropolitan area supply the needs of
the university.
        Spending by OHSU employees and other employees at businesses that are
indirectly linked to OHSU operations induce additional economic impacts for a wide
variety of sectors in Portland and the state. The main beneficiaries are real estate, food
and beverage stores, general merchandise stores and other retailers, eating and drinking
establishments, and medical service providers. As shown in the fourth column of Table
13, spending by OHSU employees and others generated an estimated $557 million in
output, including $209 million in personal income, and 5,195 jobs in Portland.
        In total, 2007 day-to-day operations at OHSU generated an estimated net impact
of $1.784 billion in economic output, including $889 million in personal income, and
supported 16,694 full- and part-time jobs in Portland that likely would not have occurred
without OHSU. Statewide, OHSU generated an estimated net impact of $1.777 billion in
output, including $870 million in personal income, and 13,484 jobs.

4.1.3
 CAPITAL
SPENDING

       In 2007, OHSU spent just over $144 million on the construction of buildings and
the acquisition of equipment (in 2009 dollars). Figure 7 shows OHSU’s annual capital
expenditures for 2005 through 2007. Because capital expenditures can vary significantly
from year to year, the impact analysis relies on a three-year annual average rather than on
spending for the most recent fiscal year. Accordingly, the economic impacts for 2007 are
based on approximately $184 million in capital spending.

              Figure 7: OHSU Capital Spending, FY 2005 through 2007
                            (in millions of 2009 dollars)




               Source: OHSU Audited Financial Statements



Page 36                                November 2009                        ECONorthwest
       OHSU provided detailed capital expenditures by type of product or service
purchased, including vendor locations. ECONorthwest mapped this spending to over 150
industry sectors in the economic impact model.20 Much of the capital spending by OHSU
will benefit local construction workers, special trade contactors, and suppliers of
construction equipment and services. To determine the net economic impacts associated
with OHSU’s capital expenses, we made the following adjustments:
    •    For operating revenues used to fund capital spending, we used the net revenues as
         reported in the operating impacts section of this report, which includes 35 percent
         of patient revenues.
    •    All federal grant and gift revenues used to fund capital spending were included.
    •    Bond funds, gifts and federal grants used to finance capital spending were
         included in the Portland model. These sources were also used in the Oregon
         model with the exception of Oregon Opportunity Bonds.
        The combined effects of these three assumptions will yield direct impacts that are
larger for Portland than for the state as a whole. This is because the net impacts in
Portland include capital projects financed by Oregon Opportunity Bonds while the
statewide impacts do not.
        For an institution such as OHSU, there are no direct impacts associated with
capital spending because capital expenditures generally facilitate, rather than directly
generate, output. Thus, capital expenditures enter the model as indirect impacts that work
their way through the economy. The net indirect impacts shown in Table 14 are the result
of the capital spending by OHSU, as well as the purchases of goods and services by those
firms that are supplying the capital projects. The induced impacts come from the
purchases of goods and services made by workers as they spend their income.
       In 2007, on a net basis, OHSU’s capital spending generated an estimated $184
million in output, $78 million in personal income, and 1,563 jobs in Portland in 2007.
Statewide, the impacts of OHSU’s capital spending amounted to an estimated $156
million in output, including $65 million in personal income, and 1,414 full- and part-time
jobs. Again, the statewide impacts are lower because the intrastate transfer of resources is
not counted in the state model.




    20
       Input-output models contain regional purchase coefficients (RPCs) for each industry sector to
estimate how much of commodity, on average, is available locally. The vendor information provided by
OHSU allowed us to override default RPC assumptions and identify and exclude spending that was known
to occur outside of Oregon. As a result, this information and our approach yielded a more accurate measure
of economic impacts associated with OHSU capital spending.


ECONorthwest                               November 2009                                         Page 37
            Table 14: Estimated Net Impacts from OHSU Capital Spending,
           FY 2007 Spending Based on Three Year Average (in 2009 dollars)

          Study Area /
           Type of Impact           Direct          Indirect         Induced             Total
          Portland
           Output                    N/A         $139,493,000       $45,017,000       $184,510,000
           Personal Income           N/A           $59,287,000      $18,388,000        $77,675,000
           Jobs                      N/A                  1,122              442              1,563

          Oregon
           Output                    N/A         $116,465,000       $40,003,000       $156,468,000
           Personal Income           N/A           $49,236,000      $16,158,000        $65,394,000
           Jobs                      N/A                    998              416              1,414

       Source: ECONorthwest using IMPLAN modeling system
       Note: For an institution such as OHSU, there are no direct impacts associated with capital spending
       because capital expenditures generally facilitate, rather than directly generate, output. Thus, capital
       expenditures enter the model as indirect impacts that work their way through the economy.





4.1.4
 STUDENT
SPENDING

     OHSU operates three major schools: The School of Medicine, The School of
Dentistry and The School of Nursing. These schools offer numerous educational
programs and nearly 60 different types of degrees and certificates. They attract local
students as well as students from outside the Portland area and the state.
      OHSU enrolled a total of 2,813 students during the 2007 fiscal year, with about
2,000 of these located in the Portland area and the remainder enrolled elsewhere in
Oregon or online. OHSU provides specialized instruction and internet-based instruction
to 286 students outside of Oregon. Non-tuition spending by these students is not included
in the model.
      Spending by students will generate economic activity throughout the economy. For
the balance of students, this analysis relies on spending data provided by OHSU’s
Financial Aid Office to estimate students’ non-tuition spending. OHSU’s Financial Aid
Office estimates that students will spend $1,490 per month on non-school related
expenses. Based on this amount, ECONorthwest estimates that OHSU students spent
approximately $34 million in Portland and $39 million in Oregon on living expenses in
2007. Spending on tuition and mandatory fees is not included in this category of impacts
because they serve as a source of university revenues and partially finance the goods,
services, capital, and payroll spending described previously.
      To determine the net economic impacts associated with spending by students
attending OHSU, we looked at the unique educational services offered by OHSU and
assumed that all of the students would leave Portland and the state if OHSU did not exist.
For the medical and dental schools, we made this assumption because these are the only

Page 38                                      November 2009                                ECONorthwest
such programs in the state and are likely to attract students who are highly willing to
relocate to pursue their degree. If OHSU were not here, the students in these programs
would almost certainly attend school in another state.
       For the nursing school, we considered the demand for nurses and the shortage of
supply for both teachers and program spots. OHSU is one of only two programs in the
state that offers the advanced nursing degrees required for teaching. If OHSU did not
exist in Portland, the supply of teachers and program spots would be further constrained.
While some students are place-bound and would choose a different career, and other
students would attend different nursing programs in the area, the overall shortage of spots
relative to the demand is such that if OHSU did not exist, an equivalent number of
students would be forced to leave the state to obtain a nursing degree.
      Most of the programs in the Department of Science & Engineering are aimed
toward biomedical science and technology. They depend heavily on their proximity to the
state’s only major academic and research medical center. Therefore, we assume that the
small number of students in these programs would seek similarly specialized programs in
other states if OHSU did not exist.
         Table 15 reports the economic impacts associated with non-university spending
by OHSU students. In Portland, students spent an estimated $25 million in the local
economy, creating $6 million in personal income and 271 full- and part-time jobs that
otherwise would not exist but for OHSU. The main beneficiaries of student spending are
owners of real estate, eating and drinking establishments, general merchandise and other
retailers. The direct output impacts for Portland represent approximately 73 percent of the
total student spending because some of the initial goods purchased by students are
manufactured outside of Portland, and the city captures only the transportation,
wholesale, and retail margins associated with their sale.
        As students’ spending circulates through the economy, the estimated net
economic impacts associated with that spending amount to an estimated $38 million in
output, including $11 million in personal income, and 390 jobs in Portland. Statewide,
the total net economic impacts amounted to an estimated $45 million in output, including
$14 million in personal income, and 485 full- and part-time jobs. The statewide impacts
are larger than the Portland impacts because they include spending by students in
LaGrande, Klamath Falls, Ashland and Monmouth.




ECONorthwest                         November 2009                                 Page 39
         Table 15: Estimated Net Impacts from OHSU Student Spending, FY 2007
                                     (in 2009 dollars)

          Study Area /
           Type of Impact          Direct         Indirect        Induced            Total
          Portland
           Output                $25,077,000      $6,200,000       $6,954,000      $38,231,000
           Personal Income        $6,126,000      $2,000,000       $3,128,000      $11,254,000
           Jobs                             271              48             71               390

          Oregon
           Output                $28,666,000      $7,330,000       $8,838,000      $44,834,000
           Personal Income        $7,326,000      $2,382,000       $3,935,000      $13,643,000
           Jobs                             329              61             95               485
          Source: ECONorthwest using the IMPLAN modeling system





4.1.5
 START­UP
COMPANIES

       According to OHSU’s Technology & Research Collaborations Department,
OHSU research has led to 37 start-up companies since 2000, and 68 since the early
1970s. While not all of these companies are still in existence, 25 are now or at some point
have been located in Oregon.
        ECONorthwest worked closely with OHSU staff to develop and administer an
electronic survey of start-up company officials to determine their location, industry sector
(NAICS codes), product lines, direct employment, and additional information. The
survey was sent to the 45 companies for which OHSU has email addresses, and we
received 15 responses. The survey results were added to data previously collected by
OHSU staff and, to verify the accuracy of responses as they relate to industry sectors and
direct employment, were then cross-referenced to Oregon Employment Department data
reported on their Oregon Labor Market Information Systems (“OLMIS”) website
(www.olmis.org). After removing start-up companies located in other states,
ECONorthwest then mapped the direct employment for each company to the appropriate
industry sector in the input-output models.21
         In addition, ECONorthwest assumed that OHSU was the catalyst for these start-
up companies. As such, the economic impacts associated with these start-up companies
are all net impacts. It is also important to note that the OHSU’s original survey response
rate was just over 50 percent (38 out of 67 companies), and ECONorthwest did not
estimate the number of direct hires for non-respondents. Because of this, we consider the
net economic impact results to be conservative.



    21
       Lacking additional information regarding payroll and the value of output, ECONorthwest did not
adjust the industry-specific assumptions embedded the input-output models.


Page 40                                      November 2009                            ECONorthwest
        As Table 16 shows, in 2007 start-up companies related to OHSU technology
produced an estimated $370 million in output in Portland, including $119 million in
personal income, and 2,101 jobs. These impacts increased slightly in the statewide model,
with an estimated $372 million in output in Oregon, including $123 million in personal
income, and 2,180 jobs. (The impacts are larger in the statewide model here because
there are no intrastate transfers of resources to consider.)

       Table 16: Estimated Net Economic Impacts from Start-Up Companies
                             FY 2007 (in 2009 dollars)
      Study Area /
       Type of Impact         Direct          Indirect       Induced             Total
      Portland
       Output               $189,295,000     $113,286,000   $67,774,000     $370,355,000
       Personal Income       $53,500,000      $38,129,000   $27,292,000     $118,921,000
       Jobs                            570           850            681              2,101

      Oregon
       Output               $189,295,000     $113,719,000   $69,366,000     $372,380,000

       Personal Income       $53,500,000      $41,249,000   $28,539,000     $123,288,000

       Jobs                            570           905            705              2,180

       Source: ECONorthwest/OHSU survey results and the IMPLAN modeling system





4.2
 TOTAL
GROSS
AND
NET
ECONOMIC
IMPACTS


       OHSU’s total gross and net economic impacts for all OHSU activities are shown
below for Portland and for Oregon. This includes the impacts generated by all of OHSU’s
spending on payroll, goods and services, capital, non-tuition spending by OHSU students,
and spending by start-up companies.

4.2.1
 PORTLAND
AREA
IMPACTS

        Table 17 shows a summary of the gross and net impacts of OHSU’s activities in
the Portland area. The expenditures associated directly with OHSU’s activities (gross
direct output) amount to $1.601 billion, including $935 million in income, and 13,925
full- and part-time jobs. When the total downstream impacts (indirect and induced
impacts) of the initial spending are added, the total gross impacts grow to $3.644 billion
in output, including $1.724 billion in personal income and 32,561 jobs. It is important to
remember that these gross impacts are based on all OHSU expenditures, even those that
would still occur in the absence of OHSU.
      The net economic impacts—i.e., those that would not occur in the absence of
OHSU—amount to $1.038 billion in direct output, including $580 million in personal
income, and 8,617 jobs. As these expenditures circulate through the economy they


ECONorthwest                            November 2009                                    Page 41
generate a total of $2.377 billion in economic output, including $1.097 billion in personal
income, and 20,748 jobs.

     Table 17: Total Gross and Net Economic Impacts in Portland’s Economy
                                 (in 2009 dollars)

                                              PORTLAND
          Type of Impact           Direct Impacts         Total Impacts            Multiplier
          Gross Impacts
           Output                 $1,600,694,000         $3,643,549,000               2.28
           Personal Income          $935,036,000         $1,723,871,000               1.84
           Jobs                            13,925                 32,561              2.34
          Net Impacts
           Output                 $1,038,332,000         $2,376,717,000               2.29
           Personal Income          $579,926,000         $1,096,514,000               1.89
           Jobs                              8,617                20,748              2.41

       Source: ECONorthwest IMPLAN analysis.
       Note: By definition, gross impacts will always be larger than net impacts. However, there is no
       reason to a priori expect gross impact multipliers to always be larger than net impact multipliers. In
       this analysis, the impact multipliers represent a weighted average multiplier across all of OHSU's
       activities, and the counterfactual elements that convert gross impacts to net impacts are applied to
       OHSU activities that, themselves, have smaller economic impact multipliers. As a result, the net
       impact multipliers are slightly larger than the gross impact multipliers.


        The net direct output circulates through the economy adding value with each
round of spending, creating a multiplier effect. By the time the original spending leaks
out of the economy (mainly through the purchase of imports), the total net output in
Portland is 2.29 times greater than the original net direct output. Put another way, for
every dollar of expenditures made by OHSU, $1.29 of additional output is created
elsewhere in the economy, for a total of $2.29 in net output. The multiplier for personal
income is 1.89, meaning that for every dollar OHSU pays to its employees in wages and
benefits, an additional $0.89 in income is created elsewhere in the economy, for a total
net impact of $1.89 in income. Similarly, the jobs multiplier is 2.41, so for every net new
job supported at OHSU, 1.41 jobs are created throughout the rest of the economy.


4.2.2
 STATEWIDE
IMPACTS

        Table 18 shows the gross and net economic impacts of OHSU’s operations in
Oregon’s economy. OHSU’s statewide direct expenditures (gross direct output) total
$1.625 billion, including personal income of $950 million, and 14,123 jobs. These gross
direct impacts are slightly greater than the Portland gross direct impacts because they
include OHSU’s operations in LaGrande, Ashland, and other satellite locations. The total
economic activity generated by OHSU’s initial spending, including the downstream
impacts in the economy, amounts to $3.856 billion in total gross output, including $1.802
billion in personal income, and 34,614 jobs.


Page 42                                    November 2009                                  ECONorthwest
        When we consider only the net impacts, the direct expenditures (net direct output)
made by OHSU amount to just over $1.001 billion, including $555 million in personal
income, and 8,251 jobs. As this activity circulates through the economy adding economic
value with each round of spending, the total net impacts amount to $2.351 billion in
output, including $1.072 billion in personal income, and 20,625 jobs.

      Table 18: Total Gross and Net Economic Impacts in Oregon’s Economy
                                 (in 2009 dollars)

                                                OREGON
        Type of Impact             Direct Impacts         Total Impacts             Multiplier
        Gross Impacts
         Output                    $1,625,395,000          $3,855,706,000              2.37
         Personal Income             $949,568,000          $1,802,402,000              1.90
         Jobs                               14,123                  34,614             2.45
        Net Impacts
         Output                     $1,000,518,000          $2,350,761,000             2.35
         Personal Income              $554,981,000          $1,072,026,000             1.93
         Jobs                                  8,251                 20,625            2.50

       Source: ECONorthwest IMPLAN analysis.
       Note: By definition, gross impacts will always be larger than net impacts. However, there is no
       reason to a priori expect gross impact multipliers to always be larger than net impact multipliers. In
       this analysis, the impact multipliers represent a weighted average multiplier across all of OHSU's
       activities, and the counterfactual elements that convert gross impacts to net impacts are applied to
       OHSU activities that, themselves, have smaller economic impact multipliers. As a result, the net
       impact multipliers are slightly larger than the gross impact multipliers.


        On a gross basis, the statewide impacts are greater than the Portland impacts.
However, on a net basis, OHSU’s statewide economic impacts are slightly smaller than
for Portland because, by definition, spending that originates from inside the state but
outside of Portland is net new to Portland but not net new to Oregon. As discussed above,
a significant share of OHSU’s patients come from outside Portland. OHSU acts as a
magnet for healthcare in Oregon because it provides access to unique equipment and
services that are too expensive to be replicated in multiple locations throughout the state.
While OHSU supports many activities that enable rural hospitals and providers to care
for their patients in their communities, on balance there is a net transfer of economic
resources into the Portland area from elsewhere in the state. Figure 8 shows the
proportion of output that is counted as net new, and the proportion that is excluded from
the net impact model.
        Despite larger gross impacts and smaller net impacts, the net impact multipliers
for Oregon are slightly larger than for Portland because the economy is larger. As the
definition of the economy increases, the propensity to import decreases, so the economy
capture can capture more of the economic activity before it leaks out in the form of
exports. This is one reason why national or regional economies typically have larger
multipliers than county or local economies.


ECONorthwest                               November 2009                                           Page 43
               Figure 8: Comparison of Gross and Net Output for
               the Portland and Oregon Economic Impact Models




                            Source: ECONorthwest IMPLAN analysis.




4.2.3
 TOTAL
NET
ECONOMIC
IMPACTS
BY
ACTIVITY

        Table 19 shows the total net economic impacts for both Portland and the state by
the major activity categories used in this report. OHSU’s operations clearly provide the
largest net impact on Portland and the state. Indeed, on a net basis, OHSU’s operating
expenditures accounted for approximately 75 percent of the total output impacts and 80
percent of the related job impacts in Portland and in the state.

     Table 19: Estimated Total Net Impacts, by Major Activity Group, FY 2007
                                 (in 2009 dollars)

          Study Area /                                         Personal
           Type of Spending               Output                Income       Jobs
          Portland
           Operations*                 $1,783,621,000         $888,663,000   16,694
           Capital                       $184,510,000          $77,675,000    1,563
           Student                        $38,231,000          $11,254,000     390
           Start-Up Companies            $370,355,000         $118,921,000    2,101
           Portland Total              $2,376,717,000       $1,096,514,000   20,748
          Oregon
           Operations*                 $1,777,080,000         $869,701,000   16,546
           Capital                       $156,468,000          $65,394,000    1,414
           Student                        $44,834,000          $13,643,000     485
           Start-Up Companies            $372,380,000         $123,288,000    2,180
           Oregon Total                $2,350,761,000       $1,072,026,000   20,625

              Source: ECONorthwest using the IMPLAN modeling program
              *Includes 35 percent of patient revenues.




Page 44                                 November 2009                          ECONorthwest
        Table 20 provides additional details about the total net economic impacts in
Portland by industry sector. Given the scale of OHSU’s operations and the size of its
workforce, a large proportion of the net economic impacts are captured by the healthcare
sector. However, as OHSU and its employees purchase goods and services, as
construction contractors and their employees are hired to work on new building
construction, and as start-up companies hire workers and buy operating supplies, the
economic impacts spread to all sectors of the Portland economy.
       In terms of jobs, the industry sector with the largest net job impacts is the
healthcare and social services sector (+9,257 jobs). Other sectors with relatively large job
impacts are administrative and waste services (+2,116) (jobs in primarily firms offering
employment services, services to buildings, and business support services); retail trade
(+1,557 jobs); and professional and technical services (+1,369 jobs).

    Table 20: Estimated Total Net Impacts in Portland, by Major Industry Sector
                              FY 2007 (in 2009 dollars)

                                                                       Personal
       Aggregate Industry Sector                       Output           Income        Jobs
       Agriculture, forestry, fishing & hunting       $14,186,000       $3,248,000      229
       Mining                                         $11,911,000         $923,000       32
       Utilities                                      $13,010,000       $2,402,000       14
       Construction                                  $111,348,000      $51,137,000      916
       Manufacturing                                 $307,826,000      $68,148,000      887
       Wholesale trade                                $66,467,000      $25,164,000      316
       Transportation and warehousing                 $38,409,000      $17,200,000      360
       Retail trade                                  $110,669,000      $45,665,000     1,557
       Information                                    $56,782,000      $13,756,000      199
       Finance and insurance                          $78,587,000      $24,939,000      392
       Real estate and rentals and leasing            $88,099,000      $13,994,000      488
       Professional and technical services           $207,189,000      $85,403,000     1,369
       Management of companies & enterprises          $22,083,000      $10,064,000      103
       Administrative and waste services             $107,097,000      $58,404,000     2,116
       Educational services                           $13,687,000       $6,581,000      295
       Healthcare and social services                $966,541,000     $594,498,000     9,257
       Arts, entertainment, and recreation            $12,338,000       $4,888,000      262
       Accommodations and food services               $46,626,000      $16,277,000      789
       Other services                                 $43,475,000      $17,623,000      642
       Public administration                          $60,386,000      $36,199,000      525
       Total All                                    $2,376,717,000   $1,096,514,000   20,748

       Source: ECONorthwest using the IMPLAN modeling program




ECONorthwest                                 November 2009                                     Page 45
CHAPTER
5:
            SUMMARY
AND
CONCLUSIONS


         Oregon Health & Science University is the state’s only academic health center,
and is among the state’s largest healthcare providers, educational institutions, research
centers and employers. OHSU’s health and economic impacts are substantial, and while
its activities are centered in the Portland metropolitan area, its impacts reach throughout
the state.
        OHSU provides a wide range of healthcare services, from routine healthcare to
complex multi-specialty care for the state’s sickest patients. It offers the state’s only
public medical and dental schools, and trains a wide variety of healthcare providers who
will serve the state’s growing demand for healthcare services. OHSU performs research
in many disciplines, contributing scientific discoveries to the world and bringing
hundreds of millions of dollars in research grants to the state. OHSU also plays an
important role in advancing public health by providing outreach programs for healthcare
services and health information, both in Portland area throughout the state. These services
are particularly important in the state’s underserved rural areas.
        In addition to OHSU’s impacts on health, OHSU creates economic impacts in at
least four important ways:
   1. Patient care—Patient care is the largest source of revenue for OHSU and is a
      major source of economic activity in the Portland-Metro area and in the state.
   2. Education—Educational activities at OHSU create economic impacts by
      generating tuition revenue, university spending on education related activities,
      and non-educational spending by OHSU students.
   3. Research—Research is a major source of new revenue and expenditures in the
      Portland area and the state. Research also leads to discoveries and innovations
      that OHSU licenses to start-up companies and other businesses, creating further
      economic growth.
   4. Capital spending—OHSU spends money on buildings, land, capital
      improvements and capital equipment.

        If OHSU did not exist, other providers and institutions would meet the demand
for some of the services OHSU currently provides. However, many of these services are
unique to OHSU and are related both to its status as the only academic and research
health center in the state and to its statewide role. In the absence of OHSU, the healthcare
and economic impacts of those unique services—high-level patient care, education and
research—would be shifted out of the state, and the associated revenue and spending
would not accrue to the region or the state.
       In answer to the hypothetical question that guided this study—How would
economic activity change if OHSU did not exist?—ECONorthwest estimates that in the
absence of OHSU, economic activity in Portland area would decrease by an estimated
$2.377 billion in economic output and 20,748 jobs in the Portland metropolitan.
Economic activity in Oregon would decrease by an estimated $2.351 billion in economic
output and 20,625 jobs.

ECONorthwest                          November 2009                                 Page 47
        Looking toward the future, OHSU’s economic impact is poised to grow over time.
As the U.S. population ages, demand will rise for skilled healthcare providers. OHSU is
well positioned to provide these workers. For patient care, net impacts will grow if
OHSU continues to expand its ability to provide care and services that are unavailable
elsewhere in the region. OHSU’s proven ability to attract research funding and high-level
researchers, and to translate research into clinical and scientific breakthroughs and
marketable technology, promises to increase the importance of this powerful economic
driver as well.




Page 48                             November 2009                        ECONorthwest

APPENDIX
A:

ECONOMIC
IMPACT
MODELING


        The most frequently used method to measure the economic impacts associated
with an institution such as OHSU is called input-output analysis.22 Economists use
specially constructed, regional input-output models that describe a regional economy and
the linkages between economic sectors. The most commonly used input-output modeling
software is called IMPLAN (for IMpact Analysis for PLANning).23 ECONorthwest used
IMPLAN to perform this economic impact analysis.
        The IMPLAN model enables the user to trace the effects of an activity or
expenditure as it ripples through the economy. Economic impact analysis provides
reliable estimates of both the direct impacts of the initial spending or activities and the
multiplier effects from subsequent rounds of spending.
        The model captures the following dynamic. OHSU pays a professor her monthly
salary. The professor uses some of her salary to purchase groceries. Part of that purchase
becomes the salary of the grocery clerk and also goes to a local farmer who sells produce
to the store. The grocery clerk and farmer, in turn, buy other goods and services in the
economy. With each successive round of spending, some of the purchases are made in
our economy (Portland and/or Oregon) and others leak out of it, for example to
Washington. The model traces the economic activity associated with these spending
rounds until they effectively disappear.
        In developing such an analysis, economists must take care in defining the
appropriate geographic study area, determining which expenditures are actually attributed
to the institution and which would occur even in the absence of OHSU, and
characterizing local funding sources that may or may not return to the region’s taxpayers.
Careful construction of modeling parameters and counterfactual assumptions helps to
untangle gross and net impacts and permits a more accurate rendering of the economic
impacts.




    22
       Input-output analysis was first put to practical use by Wassily Leontief in the late 1930s. He used an
input-output system to construct an empirical model of the United States economy. For his research,
Leontief was awarded the Nobel Prize in Economics in 1973.
    23
       IMPLAN was initially developed by the Forest Service of the U.S. Department of Agriculture in
cooperation with the Federal Emergency Management Agency and the Bureau of Land Management of the
U.S. Department of the Interior to assist federal agencies in their land and resource management planning.
Since 1993, IMPLAN has been developed and distributed by the Minnesota IMPLAN Group, Inc.
ECONorthwest has applied the model to a variety of public and private sector projects including, most
recently, an impact evaluation of Oregon’s system of higher education and the potential loss of federal
matching funds for long-term care services for seniors and persons with disabilities in Oregon and
Washington.

ECONorthwest                                 November 2009                                        Page A-1
APPENDIX
B:
DEPARTMENTAL
DESCRIPTIONS
OF
UNIQUE

SERVICES
PROVIDED
AT
OHSU


        This appendix is a compilation of responses to e-mails sent by Dr. Roy
Magnusson, Medical Director of OHSU Hospitals and Clinics, and Diana Gernhart,
Associate Hospital Director of Finance. The e-mail asked the recipients, most of whom
are department heads, to create a list of services that distinguish their departments from
others providers in their field. While the responses have been edited for formatting
consistency and typographical errors, the content remains unchanged. The responses are
displayed in no particular order.


Department: Psychiatry
Submitted by: George Keepers
       The following services are unavailable anywhere else in the state:
   Training programs in General, Public, Child, Geriatric, Forensics, Addictions,
       Psychosomatic medicine, Sleep medicine.
   ECT services (Kaiser does a small volume, and Dick Phillips does a few cases in
       Medford. I think Dr. Telew has stopped ECT services in Eugene.
   Vagal Nerve Stimulation for depression.
   The Intercultural Psychiatry Program and Torture Treatment Center.
   The Avel Gordly Center for Healing (the only African-American centered program in
       the state).
   State Hospital Faculty recruitment initiative—essential to providing high quality
       physicians for the state hospital system.
   The Telepsychiatry program providing essential psychiatric care to rural areas,
       prisons, the Yellowhawk reservation.
   Unique research programs in ADHD, Circadian rhythm disturbances,
       Methamphetamine addiction, and others.

Department: OMS and Hospital Dentistry
Submitted by: Leon Assael
   We are the only comprehensive hospital dental service in Oregon (just 5 on the west
      coast at USC, UCLA, UCSF, Loma Linda, and UW) serving the consultation
      needs of oncology, transplant, Ob, pediatrics, cardiology/CT surgery among
      others for the acute oral health needs tied to medical surgical problems of
      inpatients and other complex medically compromised patients.
   Our service is exceptional in the diagnosis and management of oral cancer and other
      pathologic conditions of the maxillofacial region and microsurgical repair of
      maxillofacial nerve injuries.
   Level one trauma service has full oral and maxillofacial surgery service participation.

ECONorthwest                         November 2009                                Page B-1
   Comprehensive cleft/craniofacial team and comprehensive head and neck tumor
      board.
   Residencies in oral and maxillofacial surgery and pediatric dentistry provide access to
      care for tens of thousands of children and adults.


Department: Pituitary Program
Submitted by: Maria Fleseriu
   We are the only comprehensive Pituitary Program in Oregon.
   Interdisciplinary approach, neuroendocrine testing, cavernous sinus sampling,
       transphenoidal surgery with intraoperatory MRI, and comprehensive pathology
       are all unique.


Department: Kidney Transplant Program
Submitted by: Douglas Norman
   We are one of only two kidney transplant programs in the state.
   We are the oldest kidney transplant program in the West.
   We have consistently had better than expected outcomes in both patient and graft
     survivals and these differences are statistically significant.
   We are the only kidney transplant program in the West with both patient and graft
     survivals that are statistically significantly better than expected.
   We are the only program in Oregon that provides outreach clinics for kidney
     transplant patients outside the metro Portland area (Medford, Eugene, Bend and
     Boise).
   We are the only tissue typing laboratory that provides support for solid organ
     transplantation in Oregon and we provide tissue typing for all of the solid organ
     transplant programs and bone marrow transplant programs in the state.


Department: Orthopaedics Service
Submitted by: Jung Yoo
       Orthopaedics service unique to OHSU
   Only orthopaedic oncology service in Oregon.
   Complex adult scoliosis surgery.
   Surgery for complex spine or pelvic fracture (only other is Emmanuel).
   Sports Medicine Concussion program.


Department: Hepatology
Submitted by: Scott Naugler
       What distinguishes us (OHSU Hepatology) from other hepatology in the

Page B-2                            November 2009                         ECONorthwest
community is:
   Liver transplants.
   Multi-disciplinary liver cancer program.
   Regional experts in touch with national leaders on subjects of hepatology.
   Clinical trials in viral hepatitis.


Department: Pediatric Heme-Onc Program
Submitted by: Linda Stork
        The Pediatric Heme-Onc Program At Doernbecher/OHSU is the premier center
for treatment of childhood cancer and blood disorders in OR and SW Washington.
       Services unique to our program and not available elsewhere in the state include:
   Bone Marrow Transplant Program —> 30 pediatric hematopoietic stem cell
      transplants/year.
   Comprehensive Hemophilia and Thrombosis Center (federally funded)—with a # of
      outreach clinics.
   Comprehensive Neuro-Oncology Program.
   Survivorship Program and Clinic—for long-term survivors of childhood cancer.
   Investigational Therapeutics—designated by NIH and Children’s Oncology Group as
      one of 21 national centers qualified to conduct pediatric Phase I trials.
   Bone Marrow Failure Program and Clinic.
   Adolescent & Young Adult (AYA) Program—in collaboration with medical
      oncology.
   Newborn Screening of Hemoglobinopathies—consultant for the state of Oregon.
   Pediatric Palliative Care Program—Doernbecher Bridges Program—for inpatients
      and outpatients with hospice care at home.
   Unequaled expertise in pediatric oncology and hematology—a # of peds heme-onc
      faculty are recognized as national or international experts.


Department: Harold Schnitzer Diabetes Health Center
Submitted by: Andrew Ahmann
        The Harold Schnitzer Diabetes Health Center is the only diabetes care center on
the West coast to integrate diabetes comprehensive care for both pediatrics and adults in
one center. This integration has significant advantages for transition of care into
adulthood as well as type 1 diabetes research and development of educational resources
for the center and for outreach to the region.
       The center includes all of the following in one location:
   An American Diabetes Association recognized diabetes education program
               Certified diabetes educators specializing in the needs of adults and children.


ECONorthwest                            November 2009                                    Page B-3
              Nurses.
              Nutritionists (Registered dietitians specializing in children or adult needs).
              Social Worker.
              Psychologist.
              Exercise physiologist.
   Board certified endocrinologists/diabetologists specializing in adult or child care.
   Disease specific classes for type 1 and type 2 diabetes.
   Full capabilities for the latest technology in treating type 1 diabetes.
              Insulin pumps.
              Continuous glucose sensors.
              All pumps, sensors and meters downloaded into our EMR and point of care
               Hemoglobin A1c immediately available allowing review with the patient at each
               visit.
        The diabetes center also is a leader in the region for improved diabetes care and
clinical research
   Development and administration of the Northwest Diabetes Health Summit held each
      year to explore best practices in our region and to promote cooperation in the
      region to advance diabetes care.
   Serve as one of 6 core organizations on the executive committee of the Oregon
      Diabetes Coalition.
   Research on new and innovative monitoring technology and treatment of type 1 and
      type 2 diabetes
              Insulin pump combined with insulin sensors.
              New continuous glucose sensors.
              Work to develop algorithms for an artificial pancreas.
   New research affiliations with TrialNet and the Immune Tolerance Network for
     national research on type 1 diabetes natural history and immunological
     interventions.


Department: Pediatric Infectious Diseases
Submitted by: Judith Guzman-Cottrill
   The only Pediatric HIV Clinic in the state, serving all HIV infected children and
      adolescents in Oregon and SW Washington.
   • We also follow perinatally exposed infants born to HIV+ women, until we have
      confidently ruled out HIV infection (usually until ~4 months of age).


Department: Clinical Neurophysiology
Submitted by: Barry Oken
        The Clinical Neurophysiology Dept is the only such full-service diagnostic lab in
the state (EMG, autonomic testing, EEG, and EP):

Page B-4                                November 2009                             ECONorthwest
   •   Adult and pediatric 24 hour video-EEG units including pre-surgical evaluations.
   •   Fully equipped autonomic function test lab.
   •   Highest level intraoperative neuromonitoring (all EPs including motor EPs, EEG,
       cranial nerve monitoring) including 24/7 tech and MD coverage.
   •   Urgent EEGs, including 24-hour EEGs, most commonly for possible status
       epilepticus, provided 24/7 with attending level interpretation within an hour.


Department: Movement Disorder - Neurology
Submitted by: Matt Brodsky
   In the Movement Disorder group within Neurology, we provide the state’s (and
       region’s) only comprehensive Deep Brain Stimulation program for movement
       disorders including Parkinson’s disease, dystonia and tremor.


Department: Surgical Divisions and Cancer Institute
Submitted by: Kevin Billingsley
   Comprehensive Breast Cancer Program: Only center in Oregon that allows women to
      have a comprehensive, multidisciplinary evaluation for breast cancer in one clinic
      visit. This includes Surgical oncology, radiation oncology, medical oncology,
      plastic surgery, psychosocial support, and genetic counseling.
   Colon Cancer Risk Assessment and Evaluation program: Multidisciplinary clinic for
      young patients with colon cancer or individuals at risk for the disease: includes
      surgery, GI, genetics.
   Multidisciplinary Liver Tumor Program: Only program in the region that offers a
      complete spectrum of treatment for liver cancer patients including liver
      transplantation.
   Minimally invasive liver resection program.
   Oncoplastic breast surgery.
   Minimally invasive esophageal cancer program.
   Pancreatic cancer registry, research program and multidisciplinary evaluation and
      care .
   Multidisciplinary sarcoma clinic and program (orthopedics, surgical oncology,
      radiation oncology, medical oncology).
   MultiD Thyroid clinic and program (otolaryngology, endocrinology).


Department: Pediatric Dentistry – Residency Program
Submitted by: Robert Steelman
   Training of Pediatric Dentists for the State of Oregon (only training program in the
      state).
   Comprehensive dental care to children with complex medical, developmental,


ECONorthwest                        November 2009                               Page B-5
      neurological and social needs.
   Care to handicapped children and adults.
   Training program has developed an association with DCH as well as the department
      of pediatrics.
   Referral center for dentists and physicians in Oregon/SW Washington.
   Provides education concerning oral health care to physicians, general dentists and
      other health care providers.


Department: Infections Diseases Division
Submitted by: Eileen Emori
   OINC – Orthopedic Infectious Diseases Neurosurgery Clinic (Pen Barnes)
               The combined orthopedics clinic is a multi-disciplinary clinic unique to
       Oregon where patients with complex bone and joint infections routinely have
       combined appointments with their orthopedic surgeon and ID specialist to discuss
       their care and progress.
   Transplant ID Service (Pen Barnes, Lynne Strasfeld & Graeme Forrest)
               The OHSU transplant ID group is the only dedicated ID group in Oregon
       with expertise in infections in patients with hematological malignancy, infections
       during and after bone marrow transplantation and for solid organ transplant
       recipients.
                The transplant infectious diseases service is staffed by three full time
       faculty members (Pen Barnes, Graeme Forrest, and Lynne Strasfeld) with
       expertise in the care of immunocompromised hosts with infection. Consultative
       service is provided on the inpatient & outpatient sides for recipients and potential
       recipients of solid organ transplantation, recipients of stem cell transplantation,
       and patients with hematologic malignancies. Our group of physicians works very
       closely with the respective transplant services in the care of these complex, often
       ill patients. In addition to direct patient care-related activities, our group has
       collaborated with the transplant services on protocol development & research
       studies. We have worked jointly with several of the transplant services on
       updating guidelines for prevention and treatment of infection in their particular
       patient populations. We have initiated participation in important and exciting
       clinical trials of novel anti-infectives that target infections of transplant
       recipients/immunocompromised hosts. By providing outstanding clinical
       consultative service, developing local protocols, and fostering research activity,
       the transplant infectious diseases service has helped OHSU continue to be a site
       of excellence in the care of these complex patients.
   Neurocysticercosis Clinic (John Townes)
              Patients with Cysticercosis are referred from providers in the state for
       diagnosis and treatment. Also, patients are seen who may be referred from a study



Page B-6                             November 2009                         ECONorthwest
     ID Division is doing on enhanced surveillance for Neurocysticercosis in
     collaboration with the Oregon DHS.
  Antiviral Drug Resistance in Human Cytomegalovirus – NIH Grant Funded Study
     (Sunwen Chou)
             Human cytomegalovirus infection is a serious complication of AIDS or
     organ transplantation, sometimes causing pneumonia, gastrointestinal or eye
     disease. Treatment with antiviral drugs is standard practice in transplant
     recipients, but may lead to the emergence of drug resistant virus. Our research
     program seeks to define the viral genetic mutations that confer resistance to
     antiviral drugs. For the existing drugs, many resistance mutations have been
     characterized over the past 15 years, providing the essential genetic database used
     for the rapid clinical diagnosis of drug resistance, including the level of resistance
     and cross-resistance to various drugs. For experimental drugs, the study of drug
     resistance mutations provides valuable clues as to mechanisms of drug action. We
     are currently studying the experimental drug maribavir which inhibits the viral
     kinase. Exactly how the shutoff of this kinase prevents normal viral replication is
     not well understood. A variety of viral and cellular changes appear to improve
     viral growth in the absence of its kinase. We are studying these changes because
     they could affect the therapeutic efficacy of maribavir. This research has received
     sustained support from the National Institutes of Health and the Department of
     Veterans Affairs.
  IDCRC – Infectious Diseases Clinical Research Center (Majority of ID Faculty
     Participate)
              The Infectious Diseases Clinical Research Center (IDCRC) was
     established in 2007 to foster the growth of clinical research in infectious diseases
     at OHSU. Through this entity, we have initiated and participated in multicenter
     trials of new and novel combinations of anti-infectives as well as important
     translational and observational studies. Most of the faculty in the Infectious
     Diseases Division are active participants in the IDCRC, either as principal or co-
     investigator on a study. The resources of the IDCRC include one full-time and
     one part-time research assistant, a full-time database manager, and a part-time
     administrative assistant. The IDCRC has enhanced clinical care by providing
     access to cutting edge therapies and has advanced the academic research mission
     at OHSU.
  Mycobacterial Diseases Clinic (Kevin Winthrop)
             Kevin Winthrop, MD/MPH, is a nationally-recognized expert in the
     epidemiology and management of tuberculosis and of non-tuberculous
     mycobacterial infections. In 2007, Dr. Winthrop established a Mycobacterial
     Infections Consultation Clinic within OHSU’s Infectious Diseases Clinic. Patients
     with complex or unusual manifestations of tuberculosis or non-tuberculous
     mycobacterial infections from throughout Oregon and Southern Washington are
     evaluated and treated in this clinic. This clinic provides a regional center of
     expertise for the prevention, diagnosis, and treatment of mycobacterial diseases.
     The center specializes in nontuberculous mycobacterial diseases of the chest, skin,

ECONorthwest                       November 2009                                 Page B-7
       and other organ systems, as well as difficult-to-treat tuberculosis including multi-
       drug-resistant tuberculosis.


Department: Pathology
Submitted by: Douglas Weeks
   The only full-service hematopathology, neuropathology and renal pathology labs in
      the State.
   The most sophisticated immunohistochemistry, cytogenetics and molecular diagnostic
      laboratories in the State, offering many tests that are not available anywhere else
      between Seattle and San Francisco.
   The only diagnostic electron microscopy lab in the State.


Department: Hemophilia Program
Submitted by: Michael Recht
   Hemophilia team consists of faculty in peds heme-onc, adult heme, pathology,
      epidemiology, and neuro-psychology.
   Affiliated providers in nursing, including practitioners, social work, physical therapy,
      and special education.
   Our clinical scope of practice includes caring for people with bleeding and clotting
      disorders of all ages from birth to death.
   We also have our factor distribution program that supplies outpatient clotting factor to
      our patients at greatly decreased pricing compared to the commercial world.
   We are the only federally funded hemophilia center in Oregon and regional center for
      all hemophilia centers in the Northwest, including those in Washington, Idaho,
      and Alaska.
   We do outreach clinics in Medford, Ontario, and Hermiston. We are setting up our
      first outreach clinic in Bend. We also go to Alaska twice a year for outreach
      clinics.
   We have an active clinical and basic research program with funding.
   We are involved with the state-wide Hemophilia Foundation of Oregon, the family
      advocacy group. We have a camp for children with bleeding disorders and their
      sibs yearly.


Department: Pediatric Surgery
Submitted by: Mark Silen
   We have the only training program in Pediatric Surgery in the state (in fact, one of
     only four such programs on the west coast).




Page B-8                             November 2009                         ECONorthwest
Department: Multidisciplinary Thyroid and Parathyroid Tumor Clinic
Submitted by: Linda Lester
       This is one of only a handful of such clinics in the United States and the only one
in Oregon.
       We offer the following unique services
   Multidisciplinary clinic for thyroid and parathyroid tumors including: endocrine,
      surgery, radiation oncology, nuclear medicine and medical oncology specialists.
   Our surgeons are the only ones in the region offering minimally invasive parathyroid
      surgery, including use of local anesthesia.
   Thyroid Tumor Genetic Registry.
   Phase 2 Trials for thyroid cancer chemotherapy.
   Advanced use of thyrogen stimulation in the management of patients with thyroid
      cancer.
   A dedicated radiologist specializing in neck ultrasound and a pathologist specializing
      in thyroid cancer identification.
        Together, these services allow us to provide advanced clinical care in a highly
efficient manner for patients. Our clinic is busy with patients from throughout the region
and we frequently received referrals from other academic medical centers including
Stanford and the University of Washington.


Department: Neurology
Submitted by: Dennis Bourdette
   We have the only Neurosciences Critical Care Unit in the state of Oregon, which
      provides state of the art care for neurologic and neurosurgical ICU care.
   The Oregon Stroke Center provides 24/7 care to stroke patients and 24/7 consultative
      services for the entire state of Oregon and south Washington; we are also the only
      hospital in the state of Oregon and in south Washington that provides 24/7
      interventional neuroradiology.
   We are the only hospital in the state to offer 24/7 EEG services which is necessary for
      appropriate management of status epilepticus.
   We provide state-of-the-art evaluations of patients for possible seizure surgery with
      seven CCTV EEG telemetry beds available and a neurosurgical program that is
      the only one to offer instate surgical care for epilepsy.
   We have an integrated neurology-neurosurgical program for providing deep brain
      stimulation surgery for Parkinson’s disease and essential tremor.
   We are the only hospital in the state that has two or more fellowship trained
      neurologists in the following subspecialty areas: Multiple sclerosis; Parkinson’s
      disease and movement disorders; aging and Alzheimer’s; stroke; neuromuscular
      diseases; ALS; neurocritical care; epilepsy.



ECONorthwest                         November 2009                                Page B-9
Department: Pancreatic Division
Submitted by: Brett Sheppard
   We have an advanced minimally invasive surgical program that excels in routine and
       advanced, complex and often re-do MIS procedures. We can share our
       esophagectomy and Nissen data, if you wish, as well as our robust adrenal data.
       We are in the planning stages of developing a multi-disciplinary adrenal clinic.
       We also have a simulation center that allows residents to hone their skills before
       ever getting in the OR. This and the level I surgical/endoscopic simulation center
       we are applying for will also act as a resource for other physicians in the state to
       come and practice new procedures and/or refine current ones.
   In addition we have a niche market in the surgical therapy of pancreatic diseases and
       in a particular pancreatic cancer. We offer the Oregon Pancreas Tumor Registry
       which is a voluntary registry for patients. It has a twofold purpose—one, it is a
       biospecimen repository for patient donated serum samples, pancreatic ductal fluid
       and pancreatic tissue obtained during surgery. We have already developed an
       antibody that seems to identify the earliest stages of pancreatic cancer from
       research on these donated valuable and vital biospecimens. The other purpose is
       to function as a high risk screening program for pancreatic cancer-prone families
       or individuals that are at high risk for pancreatic cancer. Also, for patients that
       have entered the registry and have died of pancreatic disease, we have the
       permission to contact family members if we develop new screening tools or have
       other information that would help decrease their risk of developing pancreatic
       cancer.


Department: Adult Comprehensive Pain Clinic
Submitted by: Jeffrey Kisch
   Adult comprehensive pain clinic that is truly multi-discipline, and includes
      procedural- oriented therapy, drug management, accupuncture, psychology, and
      physical therapy.
   Only comprehensive pediatric pain program on the West Coast.
   Anesthesia for liver tx.
   Anesthesia for Level 1 traumas (together with Emanuel).
   Simulation for training in CPR, effective intraoperative communication,
      procedures and to prepare the anesthesia provider in the management of
      uncommon emergencies.
   We are the only center in Oregon and only one of two centers west of Iowa that
      places peri-neural catheters for administration of local anesthetic in the post-
      operative period to prevent pain. This "home pain pump" program has been
      applied to patients having surgery of the upper and lower extremities and allows
      the patient to go home much quicker and with much less pain than with more
      traditional forms of pain management.
   We are the only center on the West Coast that has the ability to incorporate a


Page B-10                            November 2009                         ECONorthwest
       peripheral nerve catheter pain management program in children.


Department: Oncology
Submitted by: Brian Druker
   Only NCI-designated cancer center between Seattle and Sacramento.
   Only allogeneic stem cell transplant center between Seattle and San Francisco.
   Only adolescent and young adult cancer program in the Northwest.
   Only cancer center on the west coast performing prospective molecular genotyping of
       patient samples.
   One of eight prostate cancer programs in a Department of Defense consortium that
       allows access to numerous promising new treatments unavailable in the
       community.
   Multi-disciplinary care in numerous disease-focused areas, included breast, lung,
       colon, prostate, and sarcoma, among others.
   Patient navigators, genetic counselors, and other ancillary services that are not offered
       elsewhere.
   Numerous radiation oncology technologies (Charles Thomas will provide a list) that
       deliver more precisely targeted radiation treatments than are offered elsewhere.
   The only Pediatric Phase I unit in our region (Stacy can provide numerous other
       unique pediatric oncology offerings).
   The only fellowship trained breast and sarcoma surgeons in the region (Kevin can add
       other unique surgical services).
   The only registries for colon, pancreatic, and ovarian cancer.


Department: Diagnostic Radiology
Submitted by: Frederick Keller
   100% subspecialty reading.
   6 subspecialty certified neuroradiologists.
   3 subspecialty certified pediatric radiologists.
   Only training program between S.F. and Seattle.
   Only 256 multidetector CT scanner in the Northwest.


Department: Dotter Institute
Submitted by: Frederick Keller
   Leader in carotid stent trials.
   Oldest and most established stroke program in Oregon.
   Only center of excellence for Hereditary Hemorrhagic Telangiectasia in Northwest.
   6 CAQ certified interventional radiologists.


ECONorthwest                         November 2009                               Page B-11
   Nationally and internationally recognized leaders in interventional radiology.
   Only interventional radiology research laboratory in Northwest.


Department: MFM – Perinatal Medicine
Submitted by: Leonardo Pereira
   First trimester prenatal diagnosis (CVS).
   In utero surgery and in utero fetal blood transfusions.
   Sequential screening for detection of chromosomally abnormal pregnancies.
   Special expertise in imaging: Dopppler ultrasound, ultrasound for fetal anomalies,
       and MRI in pregnancy.


Department: Neurological Surgery
Submitted by: Kim Burchiel
      Unique services:
   Most (>90%) of the cerebrovascular surgery in the state.
   Most (>90%) of the skull base tumor surgery in the state. Essentially all vestibular
       schwannomas in Oregon.
   Dedicated pituitary tumor clinic and surgery service.
   Essentially all pituitary tumors in Oregon.
   Only site for advanced neuroendocrine evaluation-cavernous sinus sampling (a
       procedure with 100% accuracy for dx Cushing disease).
   Most (>90%) of the endovascular surgery in Oregon.
   Only adult neurooncology tumor board in state.
   Movement disorder surgery – sole provider in state.
   Only provider of Deep Brain Stimulation (DBS) surgery for movement disorders in
       Oregon.
   First DBS surgery performed outside of France (1990).
   Epilepsy surgery—sole provider in state.
   Only dedicated Neurosciences Intensive Care Unit, and Neurointensivist program.
   Most (>90%) of the trigeminal neuralgia surgery in Oregon.
   Most of the invasive pain management surgery in Oregon.
   2/3 of the Pediatric Neurosurgery in Oregon (2.0 FTE).
   Only dedicated Pediatric Neurosurgery service.
   Only Pediatric Oncology Group brain tumor center in Oregon.
   Only comprehensive interdisciplinary programs/clinics in Craniofacial disorders,
       spina bifida, and spasticity.
   Only facility offering selective dorsal rhizotomy for spasticity (CP).
   Only pediatric neurosurgery clinic in Eastern Oregon (Bend outreach clinic).

Page B-12                           November 2009                         ECONorthwest
   Only fellowship-trained pediatric neuroendoscopist.
   Only stem cell implant center for brain disorders.
   First center in US to implant purified genetically-engineered cells for neurologic
       disorder (Batten Disease).
   Only Pediatric epilepsy surgery program in Oregon.
   Predominant (almost sole source) service to Medicaid children in state.
   Only service to Shriners charity hospital for children—imporant to any hidden
       economics analysis.
   Only neurosurgery residency training program in state—by far largest source of all
       practicing neurosurgeons in Oregon—also key economic contributor.
   Only facility in state with 24/7 comprehensive stroke coverage (medical,
       interventional and surgical).


Department: Pediatric Kidney Transplant Program
Submitted by: John Barry
   • We have the only pediatric kidney transplant program in Oregon.

Department: Cancer Division
Submitted by: Tom Beer
   The only sarcoma surgery program and the only multidisciplinary sarcoma program.
   The only multidisciplinary prostate cancer program.
   The only image guided radiation therapy program for prostate cancer.
   Broadly speaking, the only clinical cancer care program that is tightly linked with a
       research and discovery program.
   The only leukemia center.
   Far and away the largest BMT program
   The only integrated digestive health center.
   The only dedicated head and neck cancer surgical team.


Department: Cancer Division
Submitted by: Gail Harper
   The only multidisciplinary Liver cancer program.
   The only BMT center that offers Allogeneic Bone Marrow Transplant.
   The only Radiation Medicine Center that offers Calypso Radiation Therapy for
      Prostate (The only image guided radiation therapy program for prostate cancer).
   The only radiation Therapy center offering SBRT (Stereotactic Body Radio Therapy).
   The only Adolescent and Young Adult Cancer program.
   The only cancer center to offer a strong Medical Genetics program incorporated into

ECONorthwest                        November 2009                              Page B-13
      multidisciplinary clinics.
   The only one-stop multidisciplinary care program with fellowship trained physician
      for breast cancer patients.
   The only Pancreas Tumor Registry.
   The only Colorectal Cancer Registry.
   The only Colorectal Cancer Assessment and Risk Evaluation Clinic.
   More cancer clinical trials (and by far the most Phase-One clinical trials) than any
      other program in the region.
   The only National Cancer Institute designated Cancer Center in the State.
   The only outpatient palliative care program.
   The only Oregon cancer program ranked in the top 50 nation-wide by US News and
      World Report.
   The only Oregon cancer program to publish more than 500 research findings each
      year.
   The only cancer program in Oregon to make world-leading advances in molecularly
      targeted therapies.
   Regional expertise for the management of Complex Bleeding Disorders.



Department: Intensive Care Unit
Submitted by: Per Thorborg
   The adult ICUs at OHSU are the place where Oregon’s most unstable patients are
        taken care of in 80 beds, some of which come from the unique programs at OHSU
        such as Transplant, specialty Neurosurgery, level 1 trauma, ortho oncology,
        ruptured AAA, neuroradiology and so on. These patients are cared for in a 24/7
        fashion by Critical Care trained and dedicated faculty and staff in closed type
        ICUs.
   It is also the main place for training of Medical Students, Residents (Surgery,
        Anesthesiology, Pulmonary Medicine, Medicine, Emergency medicine, Ob/Gyn)
        and Critical Care Fellows from Anesthesiology, Pulmonary Medicine, Medicine
        and Surgery. These ICUs have advanced organ support systems such as Balloon
        pump, VAD, BiVad, ECMO, CVVHD and regular hemodialysis.


Department: Neuroanesthesia
Submitted by: Renata Rusa
   Certain surgical procedures provided here at OHSU call for special anesthetic
      techniques, knowledge and expertise.
   Examples are:
               “Awake” craniotomy for the resection of a tumor or seizure focus.
               Use of intraoperative MRI for pituitary tumor resection.


Page B-14                              November 2009                           ECONorthwest
             Complex spine surgery with intraoperative neurophysiologic monitoring,
              including motor evoked potentials.


Department: Metabolic Clinic
Submitted by: Cary Harding
   In Oregon, the only metabolic clinic and the care of individuals with inborn errors of
       metabolism.


Department: ED Observation Unit
Submitted by: John Ma
   OHSU has the only ED observation unit for children in the state.


Department: Stroke Program
Submitted by: Wayne Clark
   Only stroke center in the Northwest with 24/7 365 Interventional acute stroke
       coverage.
   Most experienced INR cerebrovascular program in Northwest including > 1,300
       carotid stents and > 1000 aneurysm embolizations.
   Home to Oregon Stroke Center: provides 24/7 acute stroke coverage to four hospitals
       in Portland.
   Provides phone acute stroke consultative coverage for Oregon/ SW Washington 24/7
       : > 1000 calls taken 2008.
   Most successful translational stroke trial center in the nation: 270 patients enrolled in
       leading edge therapies in 2008.
   Only NW stroke center with two certified vascular neurologists.
   Only NW stroke center with five inteventional stroke specialists.
   Only NW stroke program with a neuroscience ICU.
   First stroke center in the NW to: treat a stroke patient with TPA, use thrombectomy,
       or a carotid stent.
   Oldest stroke center in the NW: established 1979.


Department: Pediatric Congenital Heart Program
Submitted by: Mark Reller
   It is the only accredited training program for pediatric cardiology in Oregon and one
        of only two programs in the Pacific NW.
   Our program has a comprehensive catheter intervention program offering the entire
        spectrum of procedures including stenting of coarctation and pulmonary artery
        stenoses and closure devices for ASD and VSD. Our program is unique in the


ECONorthwest                         November 2009                               Page B-15
      state in having 2 full time focused cath interventionalists.
   Our program has a comprehensive catheter ablation laboratory including the unique
      ability to do cryo-ablation procedures.
   We are the only Pediatric cardiac program with a comprehensive cardiac MRI
      program staffed by a pediatric cardiologist.
   We provide the only dedicated Lipid Clinic for children in Oregon.
   We have by far the most comprehensive pediatric cardiology outreach program with
      regular clinics offered in 12 cities around the state.
   We have the only pediatric cardiac surgical program staffed by pediatric perfusion
      specialists.
   Our pediatric cardiac surgical program is the only program in the state that submits
      their outcomes to the STS (Society for Thoracic Surgeons) for critical review and
      quality assessment.


Department: Rheumatology Division and Department of Ophthamology
Submitted by: Jim Rosenbaum
   The Rheumatology Division in conjunction with the Department of Ophthalmology
      has a Uveitis Service (intraocular inflammation). This clinic receives international
      referrals and is arguably the only clinic of its kind in the country with this type of
      joint rheumatology/ophthalmology expertise since uveitis often lies in the
      interface between internal medicine and ophthalmology. On the basic science
      side, the ocular inflammation research group is among the largest in the world
      studying this potential cause of blindness.


Department: Cardiology
Submitted by: Sanjiv Kaul
   Adult congenital heart disease.
   Heart transplantation, VAD, advanced heart failure.
   Heart disease in women.
   Preventive cardiology.
   Advanced Imaging.
   Advanced interventional cardiology (closure devices, mitral and aortic valvuloplasty).
   Heart disease and diabetes.


Department: Gastroenterology
Submitted by: Atif Zaman
   Comprehensive Liver Care including Liver Transplant, a Multidisciplinary Liver
     Cancer Program, and cutting edge treatment of all liver diseases (We are the only
     program in Oregon that offers such comprehensive liver care).


Page B-16                            November 2009                         ECONorthwest
   Inflammatory Bowel Disease Center.
   Comprehensive Advanced Therapeutics in Gastroenterology (Endoscopic Ultrasound,
       Mucosal Resections, Endoscopic Treatment of Barrett’s).


Department: Family Medicine
Submitted by: John Saultz
   Family medicine sponsors full time resident placements in John Day, Enterprise,
      Ontario, Reedsport, Burns, and Bend in addition to our residencies in Portland
      and Klamath Falls. The economic impact in each of these sites is at least $80K
      annually if we count only the direct patient care provided by residents minus
      practice costs. These rotations have been instrumental in lowering community
      recruiting costs by both helping to retain physicians and helping to replace them
      when they leave.
   Our residency in Klamath Falls has had a massive financial impact on Klamath Falls
      and its medical community. The residency has resulted in 7 faculty and 24
      residents working in that community that would not otherwise be there. Since
      each resident is paid about $50K and each faculty about $150K, and if we add the
      jobs created in the clinic, this is at least $10 million dollars per year of economic
      impact on that relatively small community.
   Family medicine has for many years provided the inpatient hospital care for children
      from the 5 Virginia Garcia clinics and adult medical patient from Multnomah
      County’s eight clinics. If we didn’t do this, these patients would be in local
      community hospitals with no inpatient physician to care for them. This is
      absolutely a cost shift to OHSU and improves the bottom lines of those
      community hospitals.
   OHSU family Medicine at Scappoose is the only medical practice in that town and is
      the largest medical practice in Columbia County. Without us, everyone out there
      would drive to Portland for care.
   Our department directly sponsors the SW Community Health Center in Multnomah
      Village two nights every week. This is a free clinic and serves patients who
      otherwise would have only the ED for their source of care.


Department: Child Psychiatry Division
Submitted by: Bob McKelvey
   The child psychiatry division provides rural outreach services to Coos Bay and
      Tillamook. We also provide training in child psychiatry to pediatric residents at
      OHSU and outreach training in Coos Bay to pediatricians there.


Department: Pulmonology
Submitted by: Alan Barker
   Lung transplant F/U.

ECONorthwest                         November 2009                              Page B-17
   Alpha-1 antitrypsin deficiency.
   Bronchiectasis.
   Lymphangioleiomyomatosis.
   Sarcoidosis.
   interstitial lung diseases.
   advanced lung disease such as COPD for oxygen needs.
   lung volume reduction surgery.
   difficult-to-control asthma.


Department: Casey Eye Institute—Dept of Ophthamology
Submitted by: Brent Carreau
      Ocular Pathology and Immunology Laboratories
   Casey Eye Institute houses the only eye pathology lab in the Pacific Northwest,
      processing about 1500 surgical specimens per year. The immunology lab is the
      only lab in the nation/world that evaluates samples for cancer associated
      retinopathy, evaluating 200-300 specimens per year.
      Oregon Retinal Degenerations Center (ORDC)
   The ORDC is an internationally recognized center with referrals from a six state area
      and Europe. The center is involved in clinical trials including neuroprotection,
      gene replacement and cell based therapies. Over 1500 patients are evaluated
      annually.
      Low Vision Services and Education
   In the fall of 2008, Casey sponsored a full day Low Vision Expo in Portland focusing
       on patient education and resources that are available to those experiencing vision
       loss. The Expo was free of charge and was attended by close to 1000 individuals.
      Cornea Division
   Casey has Oregon’s only cornea service with a dedicated medical contact lens
      service. Additionally, Casey’s cornea surgeons provide unique services in the
      region, including: intralase enabled keratoplasty (a form of corneal transplantation
      using a laser instead of a blade), limbal stem cell transplantations,
      keratoprostheses (artificial corneas instead of human donor corneas). Casey’s
      surgeons are the only doctors in Oregon providing pediatric corneal transplants.
      Ophthalmic and Reconstructive Plastic Surgery Division
   The Ophthalmic Plastics Division at Casey provides a number of unique services in
      the region, including enucleation of eyes of children with retinoblastoma. Other
      unique services include: optic nerve sheath fenestration (cutting a window to
      lower the pressure around the optic nerve to save vision), orbital reconstructions
      after major traumas, tumor resections and lid reconstructions.
      Elks Children’s Eye Clinic


Page B-18                           November 2009                         ECONorthwest
   The Elks Children’s Eye Clinic has provided national leadership in pediatric eye care
      for over five decades. Casey faculty played a pivotal role in developing state of
      the art treatments for Retinopathy of Prematurity (ROP), and the clinic serves as
      the only center for the treatment of ROP in Oregon and Southwest Washington.
      With the support of the Oregon State Elks Association, Casey staff and Elks
      volunteers performed statewide preschool screening. Over 2,700 preschool
      children were screened in 2007/08. The Annie E. Casey Foundation funds the
      state’s only social worker dedicated to working with families and children facing
      serious eye diseases or blindness. As a vital member of the clinic team, she is
      available to help families find resources, to advocate for their children and to
      provide emotional support and counseling during challenging times.
       Retina Division
   Casey is recognized as one of the best retina training programs in the nation, with
      over 100 applicants for two training spots. Physicians receive referrals from a
      seven-state area and care for highly unusual and serious conditions such as
      intraocular tumors, pediatric retinal disease, Retinopathy of Prematurity and rare
      hereditary retinal diseases. Casey has been the one of the leading university sites
      nationally in terms of patient participation in Diabetic Retinopathy Clinical
      Research Network. Today, Casey retinal surgeons are working on novel cell-
      based therapies including a phase one clinical trial testing the safety and efficacy
      of a gene based therapy for Lebers Congenital Amaurosis.
       Uveitis Clinic
   Three specialists staff the Uveitis Clinic, making it one of the largest Uveitis clinics
      in the world. Casey Uveitis specialists receive international referrals, seeing 1500-
      2000 patients per year. They specialize in Uveitis and other rare inflammatory eye
      diseases. Their international reputation has drawn fellows and researchers from
      around the world to train and work closely with Casey doctors in both the clinical
      and basic science settings.


Department: 24/7 Telemedicine
Submitted by: Laura Ibsen
   We provide in-house, 24 hour coverage for pediatric critical care patients, and by
     extension, for consultation for the children's hospital for codes and deterioration
     in clinical status.
   We are also the only picu participating in vps/vpicu which benchmarks nationally.


Department: Cystic Fibrosis Program
Submitted by: Michael Wall
   Cystic Fibrosis care is unique to OHSU




ECONorthwest                         November 2009                              Page B-19
Department: OB/GYN
Submitted by: Renee Edwards
   We have the first and only Oregon Ovarian Cancer Registry.
   We have the only egg/embryo freezing program for cancer patients to preserve the
       possibility of fertility following their treatment.
   a preimplantation genetic diagnosis program for genetic disorders.
   a third party (surrogate) reproduction program.
   We provide first trimester prenatal diagnosis (CVS) for genetic testing.
   in utero surgery and in utero fetal blood transfusions.
   sequential screening for detection of chromosomally abnormal pregnancies.
   We also have special expertise in antepartum imaging: Doppler ultrasound,
       ultrasound for fetal anomalies and MRI in pregnancy.
   Finally, we are far and away the largest volume Davinci laparoscopic reconstructive
       pelvic surgery group in the NW.
   We have the only Urogynecology and reconstructive pelvic surgery fellowship in the
       NW.
   We are the only group to provide a complete array of pelvic floor neurophysiologic
       testing including EMG.
   perform 3-D pelvic floor ultrasound for imaging support defects in the pelvic floor.


Department: General Internal Medicine and Geriatrics
Submitted by: Judith Bowen
   Chronic Care Demonstration project—a portion of our practice is re-designed for
      patients with chronic conditions, especially Type 2 diabetes mellitus. This
      practice has implemented the Wagner Chronic Care Model, uses a registry of
      patient outcomes to manage at the population level, and utilizes an inter-
      professional team of nurses, medical assistants, a pharmacist, a social worker, and
      both faculty and resident physicians. We collaborate with the Diabetes Education
      Center and utilize endocrinologists for consultations. Clinical process and
      outcome quality measures exceed levels published in the medical literature. This
      work is funded in part by a grant from CareOregon (successful consecutive
      renewals/funded reapplications for five years).
   The OHSU HIV Practice—This practice uses a multidisciplinary, longitudinal,
      comprehensive model of care for HIV infected adults. We offer primary care or
      consultative services to people living with HIV. Our providers are skilled in both
      the management of the HIV infection itself and its assorted infectious, metabolic,
      and psychosocial complications. We offer substance abuse counseling, psychiatric
      services and adherence counseling. Our staff offers care management and
      assistance with financial and other needed support services. We are focused on
      the quality of communication and patient satisfaction. The clinical team includes
      two general internists, one infectious diseases specialist, one psychiatrist, a


Page B-20                           November 2009                        ECONorthwest
      pharmacist with HIV therapy experience, a social worker, and medical assistants.
      The team collaborates with the Cascade AIDS Project and the regional AIDS
      Education and Training Center. This program is funded in part by Ryan White
      funds and a small grant from CareORegon. The general internists also provide
      consultative services to primary care physicians throughout Oregon.
   Group visits for Diabetes or HIV
              Patients with diabetes mellitus are invited to attend monthly physician-led group
               visits to review their own clinical data and have questions answered.
              Patients with diabetes mellitus are invited to attend nurse-led monthly group
               visits for additional education and help with self-management strategies.
              Patients with HIV/AIDs are invited to attend physician-led group visits to
               improve personal knowledge for self-management.
   Geriatrics practice—the Geriatric Consult practice is available to anyone in the state
      of Oregon (the only other such practices are in closed systems—Kaiser,
      providence, VA). We use an inter-professional team approach with Medicine,
      Nursing, Nurse Practitioners, Pharmacy, and Social Work working closely
      together to create patient-centered care plans for patients and their families.
   Medicine/Psychiatry practice—Dr. Pritham Raj is trained and board certified in
      both Internal Medicine and Psychiatry, and offers a unique service opportunity as
      a primary care provider and in consultation to others in our practice.
   Women’s Health—We have several experienced general internists who provide
      unique services for women within our practice, making it particularly convenient
      for our patients: Dr. Beth Bower places IUDs in addition to primary care services
      for adults. Dr. Katie Bensching and Dr. Bower perform endometrial biopsies. Dr.
      Betsy Haney provides consultations on osteoporosis.
   Expertise in complex care—Our faculty physician group provides primary care for
      tertiary care patients, such as those who have undergone organ transplantation,
      managing complex medication regimens and anticipating complications.
   Informatics—We have two physicians with advanced degrees in Medical
      Informatics in our practice, assisting the practice with state-of-the-art information
      management for individual patients and at the population level.
   Multiple Chronic Conditions – We have extensive experience in care management,
      both in terms of information systems and in terms of reorganizing the practice to
      train and enable care managers to enact care. We have an automated algorithm to
      assess patients for care management that is implemented, the nurse care managers
      are using tracking systems, and we are increasing appropriate referrals. This is
      one more dimension to add to our growing expertise in primary care practice re-
      design and self-management with patients who have complex care needs.


Department: Disaster Preparedness Program
Submitted by: Rob Hendrickson
       The disaster preparedness program has participated in clinical services that are
unique among hospitals in Oregon.


ECONorthwest                           November 2009                                 Page B-21
   The Regional Hospital – Regional Hospital plays a key role in notification to
      hospitals of disasters as well as coordinating hospital distribution during disasters
      in the Portland Metro Area as well as outside of this area. In addition, Regional
      Hospital plays a key role in information gathering and distribution during
      disasters.
   The Oregon Poison Center – the Oregon Poison Center plays a key role in
      distributing real-time instructions to clinicians in chemical disasters. The Poison
      Center acts as the initial incident leader in any chemical disaster in the Portland
      Metro Area or in Health Preparedness Region 1 (NW Oregon). The Oregon
      Poison Center authored the Region 1 (NW Oregon including Portland Metro
      Area) Chemical Surge Plan. In addition, the Oregon Poison Center is notified and
      participates in clinical care of ALL patients who are transported to Oregon
      hospitals after an exposure to chemicals. This role is through a contract with the
      Oregon Emergency Response System (OERS) that OERS will contact the poison
      center for ALL exposed and symptomatic patients.


Department: Transplant Services
Submitted by: Mike Seely
   OHSU has performed over 5,200 transplants and operates the oldest transplant
      program in the West, having performed its first kidney transplant in 1959. The
      kidney program remains robust to this day with better than expected outcomes for
      both patient and organ graft survival. These outcomes are viewed as statistically
      significant by the Scientific Registry for Transplant Recipients (SRTR) and are
      available at www.ustransplant.org. OHSU is the only program in Oregon that
      provides outreach clinics for kidney transplant patients outside the Portland Metro
      area (Medford, Eugene, and Boise).
   The tissue typing laboratory at OHSU provides support for solid organ transplantation
      in Oregon and provides tissue typing for all solid organ and bone marrow
      transplant programs in the state.
   OHSU, in consortium with the Portland VA Medical Center, is the sole provider of
      liver transplants in the state. OHSU’s program is in its 20th year and our outcomes
      are of the highest order. OHSU‘s team of highly qualified liver transplant
      hepatologists and transplant surgeons are committed to serving patients
      throughout the region.
   Pancreas transplantation is a unique service provided by OHSU in Oregon. Again the
      SRTR data demonstrates excellent and consistent outcomes.
   OHSU operates the only Medicare-qualified heart transplant program in the state. The
      program was established in 1985 and has performed over 500 transplants.
   Finally, OHSU houses the Pacific Northwest Transplant Bank (PNTB) which is the
      federally designated organ procurement organization serving 70 hospitals in
      Oregon, southern Washington, and southwestern Idaho. PNTB is one of 58
      organizations providing organ recovery services in the United States, regulated by
      the Centers for Medicare & Medicaid Services (CMS), a member of the Organ
      Procurement Transplant Network (OPTN), and accredited by the Association of

Page B-22                            November 2009                         ECONorthwest
       Organ Procurement Organizations (AOPO).


Department: Trauma Center
Submitted by: Martin Schreiber
        The OHSU Trauma Program is one of only two Level 1 trauma centers in Oregon.
It serves both adults and pediatric trauma patients as a tertiary care center for Oregon,
Southwest Washington, Western Idaho, and Northern California.
   The OHSU Trauma Program is the only academic Level 1 trauma center in Oregon
      and provides trauma education to hundreds of residents, nursing students, and
      allied health students throughout the region.
   The OHSU Trauma program is designated by the Oregon Department of Health and
      Human Services and is an integral part of the state-wide Oregon trauma system.
       As a Level 1 trauma center, the OHSU Trauma Program maintains the following
resources in-house 24 hours per day, 7 days per week:
   Board certified trauma surgeons.
   Board certified Emergency Medicine physicians.
   Board certified Anesthesiologists.
   Critical care nurses who respond to all trauma resuscitations and accompany the
       patient until disposition.
      Additionally, the following physicians are available to the trauma patient within
30 minutes of notification
   Board certified surgeons covering over 9 adult and pediatric subspecialty areas.
      (neurosurgery, orthopedics, plastic surgery, thoracic surgery, cardiovascular
      surgery, otolaryngology, ophthalmology, obstetrics & gynecology).
   Board certified medical specialists in over 8 adult and pediatric subspecialty areas.
      (internal medicine, neurology, endocrinology, cardiology, infectious disease,
      pulmonary medicine, nephrology, hematology).
       As a Level 1 trauma center, the hospital provides:
   Specially trained emergency, critical care, general care, and perioperative nurses.
   Physical, occupational and speech therapists with specialty training in trauma
      rehabilitation.
   Respiratory therapists with expertise in trauma care.
   Designated trauma social worker.
   Designated financial/Medicaid services worker.
   Trauma case managers.
       The OHSU Trauma Program also is a leader in the region for cutting-edge trauma
care and trauma clinical research. OHSU is a member of the prestigious multi-center NIH
sponsored Resuscitation Outcomes Consortium which studies pre-hospital care of trauma
and cardiac arrest patients. Trauma investigators from OHSU have been continuously


ECONorthwest                         November 2009                              Page B-23
funded for over a decade by the federal government. Some highlights of the research
program include:
   Seminal research on the efficacy of state-wide trauma systems.
   Improved fluid and blood product resuscitation techniques in shock.
   Rib stabilization techniques.
   Advanced dressings to stop bleeding and save lives.
   Novel research on the effects of trauma on inflammation and coagulation.
        The OHSU Trauma Program maintains a trauma registry of over 44,000 trauma
patients treated at OHSU over the past 20 years. This registry provides a rich database for
research and outcomes evaluation of trauma patients as well as a tool for evaluating
patient safety and performance improvement.


Department: Bariatric Surgery Program
Submitted by: Robert O’Rourke; Brice Wolfe
       Bariatric Surgery Program:
   The Surgical Program for Weight Loss at OHSU is the premier academic clinical
      weight loss program in the Northwest. We serve over 300 patients per year, and
      perform more than 250 operations for morbid obesity per year. We provide
      multidisciplinary care for patients with obesity and metabolic disease. Our
      surgical outcomes are significantly better than national averages, and we hold
      Center of Excellence Status from the American College of Surgeons. We also
      provide expert consultation to patients and providers at a national level.
   The program for the surgical treatment of obesity (bariatric surgery) at OHSU is a
      national leader in the conduct of research addressing the epidemic of severe
      obesity that includes Oregonians in approximately the same frequency as all
      Americans. This research problem is providing unique new information regarding
      the causes of severe obesity, the adverse health effects of obesity, and much
      detailed information regarding the pros and cons of surgical treatment of obesity.
      In the last three years this research program has brought in excess of 3 million
      dollars to OHSU. The primary source of these funds has been the National
      Institutes of Health, although private industrial contracts have also contributed.
      All of these funds have originated outside of the states of Oregon and
      Washington. These funds are infused into the local economy supporting salaries,
      supply purchases, and general support of OHSU.
   ACS COE certified program.
   Over 250 operations per year.
   Morbidity/Mortality results better than national and international standards of care.
   Multidisciplinary team approach that includes surgeons, endocrinologists,
      psychologists, nurse practitioners, nutritionists, physical therapists, all specifically
      trained in obesity and bariatric surgery.
   Outpatient and inpatient facilities and staff tailored to patients with obesity and


Page B-24                             November 2009                          ECONorthwest
       metabolic disease
   Three board-certified surgeons with experience in multiple procedures and large
       volume experiences.
   Fellowship training program that is training future leaders in bariatric surgery and
       metabolic disease.
   Vibrant local and national multidisciplinary research collaborations.
   Home of two surgeon-principal investigator-led NIH funded research efforts,
       including
              LABS, the most prestigious and largest ever multicenter bariatric surgical
               research consortium, PI: Brice Wolfe.
              Basic science research effort that is pioneering research into the molecular and
               cellular mechanisms underlying obesity and bariatric surgery, PI: Robert
               O’Rourke.
   Only comprehensive bariatric program that provides a wide range of surgical options
      and an integrated research effort to further bariatric, metabolic disease, and
      obesity-related care.
   Only bariatric program that provides easy access expert consultation for local,
      regional, and distant providers and patients.


Department: Pediatric Cardiology – Non-invasive cardiovascular
imaging
Submitted by: Mary Minette
   Our lab receives ~1100-1200 pediatric echocardiograms from regional hospitals in
      Oregon and SW Washington each year. This is a direct digital connection and
      allows us to interpret and call a physician within an hour of a study being
      performed on the outside. This service is greatly appreciated. I am thanked
      profusely on a weekly basis by these pediatricians and hospitals.



Department: OHSU Doernbecher Children’s Hopsital
Submitted by: Jan Freitas-Nichols, MN, PNP

       Background

   •   2 hospitals in Oregon that provide specialty and tertiary care for all the children in
       Oregon and SW Washington both located in Portland.
   •   Growing prevalence of obesity with co-morbidity, premature and small birth weight
       newborns.
   •   More patients surviving childhood diseases and utilizing healthcare facilities more
       frequently




ECONorthwest                            November 2009                                    Page B-25
   •   Child Health Corporation of America (CHCA) estimates these factors will result in a
       3.1% annual growth in bed days
   •   LEH planned expansion adding 21 additional beds combined with Doernbecher capacity
       will fall short of the number of pediatric beds that will be required in the state due to
       increasing prevalence of chronic conditions requiring high tech intervention and care.
   •   Critical shortage of pediatric specialists
   •   Difficult for smaller communities to recruit due to lack of critical mass

       Doernbecher - Full Service Quaternary/Tertiary Children’s Hospital

   •   Knowledge leader for children’s healthcare
   •   Only 24/7 PICU in state – trusted resource throughout the state
   •   Technology leader – cardiac MRI, interventional Cath & MRI, intra-cardiac echo,
       endoscopic neurosurgery
   •   Interdisciplinary programs provide high level evidence based practice
            o   Craniofacial, brain tumor, feeding, child development, vascular anomalies,
                cardiac, diabetes

   •   Only BMT and translational stem cell program in state
            o   Indications for BMT and stem cell transplant for disease processes beyond cancer
                is increasing annually

   •   Only renal transplant program in state
   •   Only surgical epilepsy program in state
            o   Surgical intervention decreases long term health care needs in children with
                intractable seizure disorders

   •   Quaternary cardiac program with specialists in:
            o   Non-invasive interventional cardiology, electrophysiology, heart failure,
                congenital heart surgery, cardiac intensivist, only pediatric certified lab in state

   •   Quaternary hematology/oncology programs with specialists in all children’s cancer areas
            o   Leukemia & Lymphoma, brain tumors, ophthalmologic cancers, bone

   •   Most comprehensive programs for children with special needs (CDRC)
   •   Only pediatric residency and fellowship programs in the state
            o   Over 50% of all pediatricians in state were trained at Doernbecher
            o   Fellowships in Hematology/oncology, Endocrinology, NICU, Cardiology, Peds
                Surgery, Anesthesia, Emergency

   •   Clinical outreach program brings specialty services to 13 locations throughout the state.
   •   Expanding telemedicine program provides pediatric critical care and specialty
       consultation to other hospitals outside of Portland

Page B-26                                November 2009                              ECONorthwest
    •   PANDA transport team (Doernbecher team) provides more than 80% of all pediatric and
        neonatal transports in Oregon and SW Washington
    •   Provider of the vast majority of pediatric continuing education opportunities for the state
        and throughout the state
    •   A specialty consultation resource to the entire state
            o    Over 9000 pediatric phone consultations from pediatricians and family medicine
                 physicians per year through the Doernbecher physician consult service.


Department: Oregon Poison Center
Submitted by: Sandy Giffin, RN, MS

     A long standing premise of the benefit cost ration of poison centers has been every dollar
spent on Poison Center Services saves almost 7 dollars in medical spending [Miller TR, Lestina
DC: Costs of Poisoning in the United States and savings from poison control centers: A benefit-
cost analysis. Ann Emerg Med 1997;29:239-245]. This study was largely based on data obtained
in the early 1990s. Several poison centers have conducted similar studies with similar results.

        The only poison center to close and leave an entire region without coverage was the Louisiana
        Poison Center in 1988. Louisiana's poison center handled 32,556 human exposure calls in 1987
        and handled 74% of cases at home. The year after the Louisiana Poison Center closed, the
        Alabama Poison Center took calls only from hospitals; the public was left without poison center
        access. As a consequence there were an additional 15,257 additional visits to health care facilities,
        83% of which were to Emergency Departments. The Poison Center was subsequently reopened 9
        months later. The annual cost attributable to unnecessary health care service utilization during the
        closure was estimated by be more than three times the operating cost of the poison center. [King
        WD, Palmisano PA. Poison Control Centers: Can their value be measured? S Med J 1991; 84(6):
        722-726]

    The Oregon Poison Center surveyed callers who we were able to handle their poisoning at
home without healthcare or 911 referral. When asked what they would do if they were no poison
center, they responded:

    •   Call their physician (42%)
    •   Call the ED (23%)
    •   Go to the ED (13%)
    •   Call 911 (8%)
    •   Wait and see / do nothing (6%)

    In a study by Kearney, et al, they asked health care providers what they would do if they
received a public call concerning a suspected poisoning and had no PC access. Of those
physicians who responded, they said the following:

    •   Refer to Emergency Room (59.5%)
    •   Call 911 (22.5%)
    •   Therefore 82 % would ultimately end up in the Emergency Department
    •   Give advice (19.5%) - this was in 1995, and is not current practice



ECONorthwest                                November 2009                                       Page B-27
        [Kearney TE, Olson KR, Bero LA, Heard SE, Blanc PD. Health care cost effects of
public use of a regional poison control center. West J Med 1995; 162: 499-504]

          Utilizing these results, we were able to project an analysis of the economic impact of the
Oregon Poison Center on reducing health care expenses. In 2007, the Oregon Poison Center was
able to safely manage 29,665 Oregon Poisoning Cases at home without referral to a health care
facility. According to the above survey, 42% of these callers (12459) would have contacted their
physician. Of these, (according to the Kearney study) 59.5% (7413) would be referred directly to
the ED. In addition, 22.5% of these (2803) would contact 911 for transport to the ED. Caller
responses of calling the ED (23% or 6823), going to the ED (13% or 3856) and calling 911 for
ultimate transport to ED (2372) would result in an additional ED visits, representing in a
conservative total of 20,466 additional ED visits. With a conservative estimate of $350 per visit,
this equates to $7,163,100 in health costs saved from avoided ED visits. In addition, the above
responses suggest that 6,712 of these cases would utilize the 911 system for dispatch and
transport. Utilizing an average cost of $79 per 911 call ($53,225) and $800 per transport
($5,369,365) this would result in savings of a total of $13,062,649.

         A recent presentation at the 2008 North American Congress of Clinical Toxicology
utilized a slightly different study model [Hilton J, Wahl M: Poison Centers and Medical Cost
Avoidance: Revisiting the Concept $7 Saved for Every $1 Spent]. The authors suggested an
additional increase in ED visits based on the Louisiana experience described by King and
Palmisano, as well as an increase in ambulatory/outpatient visits for poisoning based on the
National Ambulatory Medical care Survey/National Hospital Ambulatory Medical Care Survey
[Outpatient and ED Files 1997-2001]. Their study utilized updated average ED charges of $1300
and average outpatient charges of $150. Applying this same methodology to the Oregon Poison
Center cases currently managed without referral to a health care facility, would result in an
increase in ED visits (35%) of 10,383. Resulting cost savings from unnecessary ED visits,
calculated on $1300 per case would be $13,497,575. An increase in outpatient visits of 10,383 at
an average of $150 per visit would represent $1,557,412. Total savings from cost avoidance as a
result of the Oregon Poison Center, utilizing this model is estimated at $15,054,988.




Page B-28                                November 2009                             ECONorthwest

				
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