INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT ENDS

[Guest guest]

In support of Dr. Megehee's efforts, I want to suggest that the time is

perfect for this initiative. I have never participated in managed care.

Therefore, I see many patients who want my care covered but don't have

choice. They know that there is a difference in doctors and they are getting

more sophisticated in their voting. (They also realize the hard truth that

Providence Health Plans customers are learning, that being " choice costs

more " .) This is a complex issue but I think that healthy change is imminent.

Don't forget that when Work Comp. reform hit town, the insurance companies

had promoted a campaign to suggest that health care costs were gutting the

insurance industry of not only profit but viability. It would be interesting

for someone with fast fingers (Dr. Freeman?) to assess the growth and

profitability of the insurance industry in Oregon since 1197 (that's SB1197

not the year 1197).

Customers are fairly disgusted with insurance companies saying they need to

cut costs (acess to care) while premiums keep spiralling upward.

Dr. Megehee is showing a lit of courage and sophistication. I hope we all

get behind this effort.

Dr.

on 5/18/01 4:28 PM, megehee@... at megehee@... wrote:

> RESULTS OF THE OREGON LEGISLATURE

>

> Greeting Fellow DCS,

>

>

> I'm sure you have all been waiting (eagerly, I hope) for this update

> on the initiative, and on the legislation that was based on

> the " Patient can Choose Provider " initiative.

>

> I was invited to testify to the " Health and Public Advocacy "

> Committee on Wednesday. I was joined by speakers representing the

> Opticians, the CAO, and the Dentists. The Oregon Medical Association

> decided not to testify, and there was one " dissenting " opinion from

> Keiser Permanante.

>

> Well, here is how it went. I was well treated, and my message I

> think was well received. Our lobbiest, Larry Harvey is a very

> remarkable force to be contended with. There is no question that he

> is of GREAT VALUE to the Chiropractic community. However, it is

> clear that this is not a bill that the committee members are ready to

> allow to proceed to the house floor for a vote. I have confirmed

> this information with the Speaker's office and with one of the

> committe members. However, there is no doublt whatsoever, that

> without Speaker ' support, we would have never even gotten out

> of the starting block. The committee members would much prefer that

> we work out a more " negotiated " solution with the opposition and then

> bring a new bill back for the next session with everyone giving

> support. I will leave that effort up to the CAO.

>

> Now, before we get angry about it, one of the things that I have

> learned is that it would have been HIGHLY unusual for this bill to

> get out of committee in just one year. It nearly always takes 2 or

> three tries. But here is the bottom line. This is a BIG ISSUE, and

> I don't want to wait and hope that we can get it throught the

> legislature in two years,,,I firmly believe that NOW, NOW, NOW is

> the time for action,,,,so the signature campaign is now back---up and

> running. However, you need to know about a few possible changes.

>

> THE Optometrist..

>

> Now you already know how I have felt about this group....however,

> they did come and testify FULL and COMPLETE support in front of the

> committee. Therefore, I am allowing them one last chance to make any

> changes to the initiative. If they decide to participate, it will

> mean having to re-write part of the initiative and the entire process

> will begin again.....which amounts to about a 3 month delay....

> If however, they decide to " pass " , the signature campaign could

> begin immediately. However, the legislative process may have

> revealed an imperfection in the initiative language. There is a

> minor " unclear " sentence that could be used by the opposition to

> circumnavigate the purpose of this bill should it be voted into law.

> I am re-evaluating this portion to see if there is a weakness....so

> the initiative's language may have to be changed anyway....again

> resulting in about a 3 month delay..... so stay tuned.....a decision

> regarding these issues should be made hopefully by the end of next

> week.

>

> Thank you for your continued support.... The next update will come

> out on next Friday,,,a decision will be made at that time.

>

> Sincerely,

> Mike Megehee, DC Chief Petitioner

>

>

>

>

>

[Guest guest]

Terry,

One reason that the insurance company wants the patient to choose from the

" small panel " of providers is that the company has made sure of their

qualifications, and has some contractural security that they will perform

and be available--let alone do it all for 30+% less than UCR while smiling.

This really covers the butt of the company who is contracted with some

agency to deliver health care services. If service is not delivered

according to contract in quality, and with appropriate access, legal and

political problems arise... Steve Lumsden

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT

> ENDS

>

>

> >In support of Dr. Megehee's efforts, I want to suggest that the time is

> >perfect for this initiative. I have never participated in managed care.

> >Therefore, I see many patients who want my care covered but don't have

> >choice. They know that there is a difference in doctors and they are

> getting

> >more sophisticated in their voting.

>

> This may be a question born of naivete, or perhaps just mere ignorance....

>

> Who benefits from limiting access to a small panel of providers? I just

> don't get it. If the insurance company is going to pay only so much per

> service, what does it matter who provides the service? What does it matter

> if there is an unlimited number of providers, as long as the number of

> services and cost per service remain the same?

>

> Terry

>

>

>

>

>

[Guest guest]

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT

ENDS

>Terry,

>One reason that the insurance company wants the patient to choose from the

> " small panel " of providers is that the company has made sure of their

>qualifications, and has some contractural security that they will perform

>and be available--let alone do it all for 30+% less than UCR while smiling.

>This really covers the butt of the company who is contracted with some

>agency to deliver health care services. If service is not delivered

>according to contract in quality, and with appropriate access, legal and

>political problems arise... Steve Lumsden

Yes, but.....

The insurance company could go through the same qualifying process with a

much larger number of doctors. This would seem to be especially appropriate

if one of their policy holders has a past history with a doc who is not

currently a panel member. Why should a patient who is happy with past care

be forced to switch to an unknown quantity simply because the insurance

company won't admit the doc onto their panel because they " already have

enough providers for the given area " ?

Still don't get it.

Terry

[Guest guest]

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT

> ENDS

>

>

> >Terry,

> >One reason that the insurance company wants the patient to choose from

the

> > " small panel " of providers is that the company has made sure of their

> >qualifications, and has some contractural security that they will perform

> >and be available--let alone do it all for 30+% less than UCR while

smiling.

> >This really covers the butt of the company who is contracted with some

> >agency to deliver health care services. If service is not delivered

> >according to contract in quality, and with appropriate access, legal and

> >political problems arise... Steve Lumsden

>

>

> Yes, but.....

>

> The insurance company could go through the same qualifying process with a

> much larger number of doctors. This would seem to be especially

appropriate

> if one of their policy holders has a past history with a doc who is not

> currently a panel member. Why should a patient who is happy with past care

> be forced to switch to an unknown quantity simply because the insurance

> company won't admit the doc onto their panel because they " already have

> enough providers for the given area " ?

>

> Still don't get it.

>

> Terry

>

> It all comes down to money and effort. The credentialing process must be

funded by the insurance company who doesn't understand chiropractic, likely

doesn't want to, and favors contracting with an agency who already can

verify the credentials of their panel. As long as the panel is reasonably

large enough to serve an area, and is a cost savings, then let the

negotiations begin! You do have an excellent point, and I agree in

principle(some groups have really tried to create a truly state-wide take

all-comers group), but the reality is that there is less panel control and

more risk to the agencies the larger the panel becomes. Let face it, the

more dollars that flow from a group(payor) that your are contracted with the

greater your patience and compliance. It's all about contracted

parameters(services) and doctor compliance with the contract. There's no

money in free-range wild horses, they need to at least be halter broke. The

real tragedy for chiropractic is that contracts are horribly

constipated(narrow in service options and reimbursement) and the only way to

change the scenario is to have solidarity. This state of things only exists

because we allow it to. If we continue to embrace narrow practice

parameters and enjoy technition status then that is where we're heading.

What ever happened to differential diagnosis? " shadup and moove da

bones... " I could go on for days here so I'll stop. I hope this helps.

Steve

>

[Guest guest]

Since when has a group larger than an handful ever wanted to scratch

anything more than their own itch? I truly understand Tony but the evidence

that I have seen is that they look in the mirror and forget the question.

What I have seen is that there are always a few who will do just about

anything for a few bucks. Because of that fact those on closed panels have

no choice but to participate(as they will lose a significant portion of

their practices), that is unless there is a significant group that is

willing to stand up and control the market in unionesque fashion. And that

is my plug for the CAO. Steve

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE

> EFFORT

> > ENDS

> >

> >

> > >In support of Dr. Megehee's efforts, I want to suggest that the time

> is

> > >perfect for this initiative. I have never participated in managed

> care.

> > >Therefore, I see many patients who want my care covered but don't have

> > >choice. They know that there is a difference in doctors and they are

> > getting

> > >more sophisticated in their voting.

> >

> > This may be a question born of naivete, or perhaps just mere

> ignorance....

> >

> > Who benefits from limiting access to a small panel of providers? I just

> > don't get it. If the insurance company is going to pay only so much per

> > service, what does it matter who provides the service? What does it

> matter

> > if there is an unlimited number of providers, as long as the number of

> > services and cost per service remain the same?

> >

> > Terry

> >

> >

> >

> >

> >

[Guest guest]

I like it !!

Vern Saboe

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT

> ENDS

>

>

> >In support of Dr. Megehee's efforts, I want to suggest that the time is

> >perfect for this initiative. I have never participated in managed care.

> >Therefore, I see many patients who want my care covered but don't have

> >choice. They know that there is a difference in doctors and they are

> getting

> >more sophisticated in their voting.

>

> This may be a question born of naivete, or perhaps just mere

> ignorance....

>

> Who benefits from limiting access to a small panel of providers? I just

> don't get it. If the insurance company is going to pay only so much per

> service, what does it matter who provides the service? What does it

> matter

> if there is an unlimited number of providers, as long as the number of

> services and cost per service remain the same?

>

> Terry

>

>

>

>

[Guest guest]

If I was heading up the marketing division of a managed care company I would

make sure that I was paying plenty of lip service to complementary and

alternative health care providers to pull in the new insureds (with our plan

you can see a chiropractor, acupuncturist, faith healer, etc.), while making

sure that it was incredibly difficult to access the care (very few providers

of each type [who cares about qualifications when they can't even agree

among themselves what makes one more qualified than another], and ridiculous

benefits [$300/yr for chiropractic, you pay the first $5000] so that I was

saving the higher-ups lots of dough.

It reminds me of the movie " Animal House " where the loser freshmen are all

seated together at the frat party - the minorities, the disabled, the

overweight, the poor - so that no one can say that they are excluded, but

they are just not included like anyone else. No one really wants them there.

This is the way that most insurers have seen comp and alt healthcare. What

will and is changing this is when the insurers who actually bank on these

providers to save them money turn a profit and start stealing insured lives

from the formerly profitable MD only plans.

But by allowing ourselves to be included a little bit for the past 10 years

we have encouraged insurers to take a chickenshit approach to chiropractic.

They say that they have it in their plan, but they really don't. And people

who sign up for these plans are less likely to get sufficient and quality

care then if they had no chiropractic benefit at all.

In my opinion, Chironet has been a major offender on this front. Even though

there are many fine docs who are part of the network, there are a couple of

things that stand out about the plan. The plan organizers have artificially

kept their numbers to a minimum (approximately one in nine licensees is a

member, I believe) and every DC who has done a

pro-insurer/anti-patient/anti-chiropractic IME is a member of the network.

In my opinion, this has degraded the average quality of care from Chironet,

and prevented insureds from getting chiropractic care because of the highly

restrictive panel. Patients don't want to be told that they can't see the

doc that they have seen for years when they get hurt on the job, and they

will just stick it out with the NSAIDs and ineffective advice from their

internist until the problem goes away or becomes chronic rather than see a

doc who they don't know, or worse yet told them that there was nothing wrong

with them in an IME the last time they were hurt.

Just my $0.02. As I said, there are many fine folks involved with Chironet,

and if any of them would like to chime in, I would love to hear why I am

wrong.

D Freeman

Mailing address: 2480 Liberty Street NE Suite 180

Salem, Oregon 97303

phone 503 763-3528

fax 503 763-3530

pager 888 501-7328

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE

> > EFFORT

> > > ENDS

> > >

> > >

> > > >In support of Dr. Megehee's efforts, I want to suggest that the time

> > is

> > > >perfect for this initiative. I have never participated in managed

> > care.

> > > >Therefore, I see many patients who want my care covered but don't

have

> > > >choice. They know that there is a difference in doctors and they are

> > > getting

> > > >more sophisticated in their voting.

> > >

> > > This may be a question born of naivete, or perhaps just mere

> > ignorance....

> > >

> > > Who benefits from limiting access to a small panel of providers? I

just

> > > don't get it. If the insurance company is going to pay only so much

per

> > > service, what does it matter who provides the service? What does it

> > matter

> > > if there is an unlimited number of providers, as long as the number of

> > > services and cost per service remain the same?

> > >

> > > Terry

> > >

> > >

> > >

> > >

> > >

[Guest guest]

I am confused. At one end of the spectrum, ""small panel" of providers is that the company has made sure of their qualifications" and the other end of the spectrum the insurance companies do not recognize chiropractic diplomates.

Can they have it both ways?

DeSiena

--------- Forwarded message ----------From: "Lumsden" <lumsden@...>"jhp" <jhp@...>, <megehee@...>, < >, " Abrahamson" <drscott@...>Date: Wed, 23 May 2001 12:08:47 -0700Subject: Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT ENDSMessage-ID: <000e01c0e3bb$ce92f1a0$fe3e1ad8@lumsden>References: <01c0e395$bfdc6c20$c1801ad0@default>

Re: INITIATIVE IMPORTANT UPDATE- LEGISLATURE EFFORT> ENDS>>> >Terry,> >One reason that the insurance company wants the patient to choose fromthe> >"small panel" of providers is that the company has made sure of their> >qualifications, and has some contractural security that they will perform> >and be available--let alone do it all for 30+% less than UCR whilesmiling.> >This really covers the butt of the company who is contracted with some> >agency to deliver health care services. If service is not delivered> >according to contract in quality, and with appropriate access, legal and> >political problems arise... Steve Lumsden>>> Yes, but.....>> The insurance company could go through the same qualifying process with a> much larger number of doctors. This would seem to be especiallyappropriate> if one of their policy holders has a past history with a doc who is not> currently a panel member. Why should a patient who is happy with past care> be forced to switch to an unknown quantity simply because the insurance> company won't admit the doc onto their panel because they "already have> enough providers for the given area"?>> Still don't get it.>> Terry>> It all comes down to money and effort. The credentialing process must befunded by the insurance company who doesn't understand chiropractic, likelydoesn't want to, and favors contracting with an agency who already canverify the credentials of their panel. As long as the panel is reasonablylarge enough to serve an area, and is a cost savings, then let thenegotiations begin! You do have an excellent point, and I agree inprinciple(some groups have really tried to create a truly state-wide takeall-comers group), but the reality is that there is less panel control andmore risk to the agencies the larger the panel becomes. Let face it, themore dollars that flow from a group(payor) that your are contracted with thegreater your patience and compliance. It's all about contractedparameters(services) and doctor compliance with the contract. There's nomoney in free-range wild horses, they need to at least be halter broke. Thereal tragedy for chiropractic is that contracts are horriblyconstipated(narrow in service options and reimbursement) and the only way tochange the scenario is to have solidarity. This state of things only existsbecause we allow it to. If we continue to embrace narrow practiceparameters and enjoy technition status then that is where we're heading.What ever happened to differential diagnosis? "shadup and moove dabones..." I could go on for days here so I'll stop. I hope this helps.Steve>