Oregon Public Broadcasting

And I’m Kristian Foden-Vencil in the Columbia River Gorge.

I decided to look at healthcare in Hood River because it’s one of about 20 counties in Oregon where Medicare costs per person are 12 percent less than Lane County.

My main question is why?

Thomas Wilhelm: “If I knew the answer to that. I think that I would be sitting at the right hand of Obama.”

Thomas Wilhelm is the medical director of the ER at Hood River Memorial. And while he doesn’t have the silver bullet for healthcare costs, he does have a few ideas about what helps to keep costs down.

First, having a healthy population helps. Many of his patients are young adults who break bones while bike-riding or windsurfing.

Thomas Wilhelm: “We’re kind of blessed in a sense that they have definable events that we can fix. As opposed to having vast populations of homeless or drug addicted populations that are sometimes hard to take care of.”

Those cases are both hard and expensive.

Wilhelm says Hood River is also a nice place to live, so there are plenty of doctors in town. That means locals get good primary care and don’t end up in the ER -- the most expensive place to be treated. 

Just like health officials in Lane County, Wilhelm says, Hood River  doesn't have the specialists needed to treat everybody.  So if someone gets in a really serious accident, they’re stabilized then sent on.

Thomas Wilhelm: “Rural hospitals aren’t going to take care of trauma patients and keep them in their facility, if they have major problems. They’re going to forward them to a major city hospital. Certainly we have an ICU here and we take care of people on ventilators. But for example if you have a stemi, a type of heart attack that is full-thickness through your heart wall. We will do our best to get you in a helicopter and send you to Portland and have that taken care of quickly.”

Those kind of patients also tend to be expensive -- because they’re usually elderly and often suffer from other problems.

The hospital can't really take credit for cost benefits that come with favorable demographics. But there are several processes the staff started in the last five years that both improve the quality of care and save money.

For example, nurse manager Tammy Milligan, says half of the elderly patients who fall and break a bone in hospital, die within a year -- because they can’t walk, their muscles atrophy, they don’t breath deeply and contract diseases like pneumonia.

Milligan says falls  happened because patients were in a strange environment and taking new medications. But not any more.

Tammy Milligan: “We went from 7.1 falls per 1000 patient days to zero, less than 1 fall per 1000 patient days. We’re very proud of that, we’re the lowest in the state.”

That one change saves money and improves care.

Technology plays a role here, too. Milligan says the hospital instituted a process of giving each patient abar-coded wristband.

Tammy Milligan: “It’s a wonderful thing when you scan a patient’s bar code and you scan a medication and an alert comes up and says, I’m sorry, this is not the right patient. This is the wrong medication. And how many times, nurses, who were at first, like this is laborious, and then they’re like, Oh, My goodness, this saved the day today. Because errors happen. We’re humans.”

So, those are a few of the reasons Hood River is among some 20 counties, by one measure, that have the lowest costs per patient in the state.

Still, a quarter of all patients that arrive here, don’t have health insurance. And that’s why the hospital’s chief financial officer, Ty Erickson, welcomes health care reform.

Ty Erickson: “We need to change. We have to change, whether we’re talking about us in Hood River or in general.”

President Obama urged Democrats in Congress Wednesday to  push ahead on health care changes  with, or without, Republican support.