Dr. Darryl George has a practice in Roseburg, Oregon and he has added his voice to the growing chorus of opposition to plans for force taper their Medicaid patients. The meeting is scheduled for at the Wilsonville Training Center located at SW Town Center Loop E Wilsonville, Oregon 97070.
Here are some of his thoughts.
This is all about money. “Quality of care” is used to justify their reasons for these actions. Medicare has stated that it will be “following” the CDC Guidelines, but that doesn’t mean they are cutting all their patients OFF opiates. Medicare plans to continue payments for opiates but only up to the 90 MME threshold recommended as the maximum that family practitioners and non-pain specialists should be prescribing. That means if your opiate prescription exceeds 90 MME then Medicare will pay up to that level, but anything beyond that will be paid out of your own pocket. Why doesn’t the Oregon Health Plan (OHP) adopt that type of plan? Because that means that they are still spending millions of dollars a year on chronic pain medications and visits for care that they don’t WANT to pay for anymore. OHP patients often get shorter visits to their providers than any commercial plan patients. Why? Because OHP pays so little for those visits that providers don’t want to waste more time with those patients. I see chart notes all the time that are incomplete, not properly updated with details of medications and more (despite claiming that they did “reconcile” the record), documenting one thing in one section and then basically contradicting themselves in another section, and multiple examples of “cutting and pasting” parts of previous chart notes to speed through the documentation process. That makes the visit look longer and more complete, but in reality less really occurred. Why? More documentation makes it look good to the reviewer (if they are ever really reviewed before payment), so the provider and their clinic get more money. I talk to patients all the time who say their provider hasn’t touched them in months, but almost every chart note says a physical examination was performed, some very extensive ones, so how can that be true? Medical FRAUD is rampant in Oregon and licensing boards could care less. Providers rush through their visits, cutting and pasting to support a higher billing fee. Insurance companies like OHP have decreased payments to providers to control costs. Those “savings” go on to the owners and doctors of the local CCO that has been denying care for its’ patients in the form of “bonuses.” When a provider is paid less per visit, the only solution is to see more patients in a shorter amount of time. Instead of sit-down quality time, you get fast drive-thru care with providers. Money beats quality of care almost every time.
Just to add, please note that there are two parts to the HERC meeting. The first starts at 8:00am and is the Value-based Benefits Subcommittee that will be discussing the main issues of the Chronic Pain Task Force (CPTF) findings at 8:15 and then changes to coverage for Urine Drug Testing (UDT) at 11:30. There is supposed to be public comment after each topic per their own notes on the agenda: “Note: Public comment will be taken on each topic per HERC policy at the time at which that topic is discussed.” They will take a short break between sessions at 1pm and resume at 1:30pm. That will be the formal HERC meeting where the subcommittee will present its CPTF report at 1:45 and then review the UDT recommendations at 2:30. There is supposed to be public comment time after each of those topics are discussed too. While it will be difficult for most chronic pain patients to sit through both sessions, it would be good to have people present before, during, and after both sessions.