Medicine

Oregon Health Plan opens door to back-pain treatment

New policy takes effect Jan. 1

By Kathleen McLaughlin, The Bulletin

Hundreds of back pain sufferers will gain access to physical therapy and a host of other treatments next year, under a change to Oregon Health Plan coverage.

As the state’s version of Medicaid, OHP will prioritize physical therapy, chiropractic and other complementary treatments over painkillers and surgery. The new policy will apply to all types of back conditions, rather than just a narrow set of patients showing signs of nerve damage, as it does now.

Many OHP members who suffer back pain have been left with no choice but to take drugs, and the policy could be contributing to Oregon’s high rate of narcotic abuse, according to the Health Evidence Review Commission, which approved the policy change in the spring.

“We were hearing really loud and clear … our current state of affairs is really stupid,” said Dr. Ariel Smits, medical director for the Health Evidence Review Commission. About 8 percent of OHP members saw a medical provider for back conditions in 2013, and over half of those patients received narcotics.

PacificSource Community Solutions, which administers OHP for Central Oregon, has at least 51,000 members in the area. PacificSource did not have information on the number of local members seeking treatment for back conditions, but if the 8 percent rate reported by HERC were applied locally, it would translate to about 4,000 patients.

Dr. Alison Little, medical director for PacificSource government programs, expects many more of those patients to get treatment when the new policy takes effect Jan. 1.

“I think it will go up a lot because the number of people who qualify under the guidelines for treatment is pretty narrow, and they’re expanding it dramatically, so I think it would certainly almost double,” Little said.

The new guidelines open the door to acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation and physical and occupational therapy.

Alpine Physical Therapy co-owner Rob Hollander sees many OHP members in the practice. Most of them are treated for ailments other than back pain, even though spine care accounts for at least half of Alpine’s work with non-Medicaid patients.

When it comes to back pain, most OHP members aren’t getting past the evaluation stage, Hollander said. “The reimbursement for Medicaid is not the best, but there’s a population that needs access to care and needs the care,” he said. “I’m psyched there’s going to be an opportunity for those patients.”

Redmond chiropractor David Herrin has turned away many OHP members, who are often referred by a nurse practitioner working in the building where he has his practice, Redmond Wellness and Chiropractic. He said it’s frustrating because he knows he can treat the symptoms they usually describe, but in the past he found billing OHP to be difficult.

Whether Herrin begins seeing OHP members will depend on the reimbursement rate, but he hopes he can. “That would be a wonderful thing,” he said.

The Oregon Health Plan will also allow patients to use yoga, massage and exercise therapy, but only if community care organizations like PacificSource can figure out how to pay for those forms of treatment.

Traditional insurers can’t accept bills from nonmedical providers, but CCOs have a pool of flexible state funds, which they can spend on their members as they see fit. “If they wanted to give you a coupon to go to an exercise trainer, they could do it,” Smits said.

PacificSource is open to the idea of paying for yoga and the like, Little said. “It would be a very unusual arrangement. We’re not opposed to exploring that.”

What works

The latest research in back pain treatment bolsters the state’s decision to throw open the door to alternative medicine.

Large, randomized trials have shown that for chronic back pain, acupuncture and chiropractic therapy are equally helpful, said Dr. Richard Deyo, professor of evidence-based medicine at Oregon Health & Science University. He served on a task force that advised the Health Evidence Review Commission. “Different people respond to different things,” he said. “The outcomes tend to be very similar, in the short term at least.”

Most people have back pain at some point in their lives, Deyo said. “The good news is that pain is going to get better over time, no matter what we do.”

A small group of those patients develop persistent pain, and the solution for them appears to be exercise therapy, combined with counseling to deal with stress and depression, Deyo said. “Stress and depression can lead to or aggravate pain,” he said. “And the pain itself can aggravate stress and depression.”

The Health Evidence Review Commission expects the new policy to be more expensive, though the cost to the state hasn’t yet been calculated. OHP members will be allowed to see one or more providers, in any combination, up to 30 times a year for back pain.

The expense of a broader range of treatments could be offset by a decline in narcotics use, Smits said. Some opioids are quite expensive.

OHP expects to pay for fewer surgeries. The new policy restricts surgery to spinal stenosis, which is a narrowing or pinching of the spinal cord, and certain types of radiating pain.

The Health Evidence Review Commission is eager to discover how the policy change will impact opioid use; exactly how that will be tracked is yet to be determined, Smits said.

In Central Oregon, a task force of doctors is already working on reducing overprescription of narcotics. Little said PacificSource will keep contributing data to that effort.

— Reporter: 541-617-7860,

kmclaughlin@bendbulletin.com

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