The Oregon Health Authority will put off landmark changes to the way the state’s Medicaid program covers treatment of back pain, which would allow patients to access physical therapy, acupuncture or other therapies, instead of relying on painkillers or surgery.
The new coverage policy was supposed to take effect Jan. 1 but now will be delayed for an undetermined amount of time, according to the OHA.
The medical director of Central Oregon’s coordinated care organization, which administers care under the Oregon Health Plan, said the delay means there will be less support for doctors who are trying to curb abuse of prescription narcotics. “It’s particularly unfortunate because of the push on opioids,” said Dr. Alison Little, medical director for PacificSource Community Solutions. “It’s a statewide initiative to get opioid use down. It would be a lot easier if we had these other therapies to direct people to.”
In a fact sheet provided by an Oregon Health Authority spokeswoman, OHA says it’s trying to come up with a way to let the entire package of guidelines on back pain take effect at the same time. “In addition, OHA will take additional time to assess the fiscal impact of these changes in order to ensure accuracy in its estimate,” the fact sheet says.
Little said the new back-pain coverage policy, which would allow OHP patients as many as 30 visits a year for alternative therapies, was expected to be more expensive, at least in the first two years. Stephanie Tripp, a health authority spokeswoman, said in an email the agency does not have cost projections that can be shared publicly.
In 2014, the Oregon Health Plan spent $9.5 million on back pain-related surgery and $4.3 million on opioid prescriptions.
The cost of Oregon Health Plan benefits is estimated early in the year and included in the state budget, but Tripp said the estimates for back-pain coverage were not created “as early as they normally would have been due to competing draws on resources.”
Tripp said the delay ties into the fact that OHA is adjusting rates for coordinated care organizations, which ended 2014 with unexpected surpluses.
“This not only includes providing CCOs with enough money to cover the changes, but also to make sure it isn’t over-inflated so that the state isn’t paying more than needed for the services provided,” Tripp said in an email.
The state has not said how much longer it will take to make the policy change effective. “We don’t know if they’re delaying it for 90 days or two years,” Little said.
The delay comes as Central Oregon health care providers have agreed to limit the daily dose of opiate drugs they prescribe. The daily limit is the equivalent of 120 milligrams of morphine. Starting in January, the limit will apply to OHP patients, but the plan is to extend it to people covered by private insurance, too.
Dr. Stephen Mann, the physician behind the voluntary limit on opiate prescribing, said it will go forward, even though doctors won’t have alternatives to offer OHP patients. “Opiates have not been found to have any benefit for mechanical back pain, so whether it is covered or not, the evidence does not support doctors prescribing it,” he said via email.
Apart from curbing opiate abuse, doctors were looking forward to offering patients new ways to deal specifically with back pain, said Mann, president and medical director of High Lakes Health Care .
“It’s clearly a 180-degree change in policy and has been quite disruptive to our community preparations for management of this common condition,” Mann said via email.
Health care providers have been talking to physical therapists, acupuncture, chiropractic and yoga therapy services on how to coordinate care of back pain, Mann said. Since the OHP guidelines won’t be implemented, he said, “These talks have wasted the time of health leaders who have many other community priorities that were set aside.”
The delay jeopardizes health care providers’ faith in projects initiated by the Health Evidence Review Commission, which approved the new guidelines in March, Mann said. “Less trust creates less robust engagement by providers, cynicism and ultimately fewer folks willing to accept OHP patients,” he said.
Under the guidelines, OHP members would be able to see one or more providers, in any combination, as many as 30 times a year. Because the cost of OHP coverage is usually assessed before lawmakers create the state budget, Little was surprised that more time was needed to determine the fiscal impact. “I had thought this was all folded into that,” she said. “They’ve been talking about this for a while.”
Coordinated care organizations have some flexibility to cover alternative pain treatments without a broad-based policy change by OHP. Little said PacificSource so far has offered behavioral support to people trying to wean themselves off opiates and is very involved in the Central Oregon Pain Standards Task Force.
— Reporter: 541-617-7860, firstname.lastname@example.org