RE: Re: Update re. quitting managed care(long

[Guest guest]

Of note I attended a Townhall meeting of my representative, another representative from a different district and my senator. The first hour was dedicated to healthcare. Yes, things are under funded but a huge amount of focus was on rationing and utilizing what we are funding to the best possible outcome - you got it - outcomes, outcomes, outcomes - evidenced based outcomes. Our legislators are well aware of this term and what it means to solving major problems in the system. Vern has said this a zillion times , to be mindful that this is here and soon to take over - the fact is, is that it is here already and our own legislators may be the ones to educate healthcare providers and mandate it to be so.

As per the note below - giving free care may be one option but it was not even suggested by my legislators.

sharron fuchs dc

From: [mailto: ] On Behalf Of Boothby JudithSent: Friday, March 03, 2006 10:47 PMdm.bones@...; listserveSubject: Re: Update re. quitting managed care(long

:I totally agree to you statementThe profession that organizes itself to support this growing base of 'untreateds' willcapitalize on the public goodwill to it's benefit. I went to a town hall forum on health care recentlywith my state representatives Kate Brown adn DianeRosenbaum. They are concerned that the Oregon Healthplan is soon to be drastically under-funded and manypeople will be without health care. Theserepresentatives are looking for community basedsolutions to Oregon's currents health care needsbecause the money is running out. A volunter systemcould help health care to be community caring basedand not administrative and bureaucratically based.Judith BoothbyMessage: 4 Date: Fri, 3 Mar 2006 08:18:27 -0800 From: "dm.bones@..." <dm.bones@...>Subject: Re: Update re. quitting managed care(long)HI ,Thanks for this good post. Wellness is a large partof chiropractic's future. In the public's mind, we arguably lead allhealth care systems in "the natural way." Economic forces are leveragingmore personal responsibility for one's own health. What's missingis a chiropractic equivalent of dentistry's "brush your teeth every day"campaign. This may reasonably be accomplished by bringing forth asimple, accessible, effective active care protocol that we give away toeveryone. This protocol would teach the basics of working with innate(putting the mind to work in the body in order to accessparasympathetic rather than sympathetic NS) by teaching a simple and safeconscious breathing pattern. It would couple the breath training withsimple, aligned resting (open chain) postures to allow everyone thetools for recognizing chronically tight muscles and the abilityto willfully let them relax. This protocol would allow everyone, byconscious relaxation of spinal musculature, to learn how toself-mobilize VMS. They'll be able to 'get their own pops.'A second component to our professional future involvesthe ever increasing number of citizens unable to access healthcare. Each year recent history has seen it worsen nationally. Cutsthis week in Federal support have lead to a further $60 somemillion reduction in health care for Oregonians. The profession thatorganizes itself to support this growing base of 'untreateds' willcapitalize on the public goodwill to it's benefit. By providing care at afoundational level for little or no charge, chiropractic could protectitself from the avarice of cost controllers. The best thing we coulddo for ourselves is the best thing. If community docs organized a oneor two day a month "free clinic" at rotating offices, it would beimportant first steps toward community recognition of our intent. OutsideIn, which I work with in Portland, is recruiting docs to receiveone or two indigent patients per month on referral from theirclinic at the doc's office - maximal contribution for minimal effort. This seems like a workable model for other communities.These two things seem worth further investigation. I'm curious if these are lines brought up by the ICA Conference onWellness? SearsNW PortlandOn Mar 2, 2006, at 11:08 AM, cdc@... wrote:> Hey folks,I just wanted to give a little update re.my progress since> quitting CHP. Some of you may remember that Imentioned in one or two> previous posts that I recently quit CHP (as of theend of 2005) when> their new contract finally crossed my"line-in-the-sand" with its 10> dollar re-exams ans 20 dollar initial pt. examsetc. Well, I just> wanted to let you all know that whenever you quit anetwork, it is not> easy of course because your patients are beggingyou to stay and in> this case CHP was perhaps 5-7% of my total biz.Well, anwho....January> 2006 was our best month ever as far as patients/dayand then we just> beat that in February. I do not miss those Kaiserreferral patients > one> bit. The last kaiser referral pt. I saw was on like13 medications and> he wrote on his intake form that he was "in perfecthealth except for> his neck pain" (meaning all his "levels" were under> control!!!!!)....... he was referred to me for 3treatments for> 'cervicalgia' by his PCP. I tried, in my brief timewith this walking> toxic chemistry experiment, to breath some lightinto his dark> existence. I called on all of my life experienceand 9 years as a> chiro...I used the socratic method etc, but hewould have none of it.> He was a devout worshipper of the Kaiser model andjust wanted his 3> pops, which I dutifully gave him. My common-sense,rational request > for> further care was of course denied by the absolutejackasses that make> such decisions there at kaiser. I got a letter backsaying that> cervicalgia does not respond to chiropractic orsome such freakin> nonsense...I think it also mentioned that c-spineadjusting was> dangerous etc.>> I am no genius [although MENSA disagees ;-)]...butfolks, I am no> idiot...I have a Bachelors degree in mechanicalEngineering from an> Ivy-league level school and my first 3 years out ofcollege in 1985 I> made 50k/year. I did not get that degree and thatjob by being a dope.> All my friends/cohorts from school have been out ofschool 20+ years> and they ALL make 6 figures even with just the BSdegree! Most of them> work 9-5 and no extra time. Those who got mastersor went to law > school> etc. are rocking and rolling, trust me....they sendme emails from> there vacation homes in Hawaii.>> Folks: The source of almost all of the problems inour profession are> rooted in the fact that much of the chiroprofession, schools, CHPs,> docs etc. have adopted the mechanistic,reductionistic, allopathic,> pain-based, medical model. This model/paradigm , inmy opinion,> GUARANTEES that you will have mediocrity in yourworld as a> 'chiropractic physician' .....it absolutelyGUARANTEES that you will> never be recognized as more than a chiropracticTECHNICIAN. Folks on> this list-serv are every bit as smart as theguys/gals I went to> undergrad with. But many chiros are trying to besomething other than> what they should be. It is like a Zebra trying tobe a horse...it> would not work very well...the Zebra would never bea leader in the> horsey-world.>> Folks: the level of abundance and success in yourlife is directly> related to the following: "The amount ofresponsibility that you> willingly take on." (Danny Drubin said that)....> Folks, that is why my mechanical engineeringfriends from udergrad > make> 150k/year in a 9-5 office job(they are able to takeresponsibility for> multi-million dollar projects). And my collegeroom-mate makes a> million dollars per year (he is a litigator forBlackberry, taking> responsibility for a case that has billions ofdollars at stake).>> So why would we want to participate in a model that> ABSOLUTELY-FREAKIN-GUARANTEES that your ability toWILLINGLY ASSUME> RESPONSIBILITY is tremendously limited??!!??>>> You see, the quality of your life is determined bythe quality of the> questions you ask. If you are always asking'medical' questions, then> chiropractors will never have the best answer. Wewill always> look/seem/BE IMPOTENT. Why do we look impotent?Becuase we don't have> the tools (drugs and surgery and bio-tech) toanswer THEIR > questions!!!> But folks, they are asking the wrong questions. Andthe reality is,> that we actually have the right tools (our heads,hearts and hands) to> answer the RIGHT questions about health andwellness.>> This past weekend about 30-40 forward-thinkingOregon DCs joined> another 60 or so from Washington and other statesto attend the > initial> seminar of the ICA-sponsored Certified ChiropracticWellness> Practitioner program, that is being held inSeattle. In this class, I> guarantee you can learn how to ask the rightquestions. I promise you> that you can learn how to assume greaterresponsibility in helping> people to improve their health in ways that are> reasonable/true/rational and completely free of thebig-pharma morons> who rule the day. If you missed the first session,you can make it up> in Minesota or other location. Check out thecspine.org link below > and> look on calendar for april 1-2 for more info.Cheers.>>>> J. >> www.springbrookclinic.com> Springbrook Chiropractic & Natural Health Center>> www.cspine.org> Home of the Oregon Chiropractic Forums and OnlineCalendar>>__________________________________________________

[Guest guest]

On Mar 6, 2006, at 1:15 PM, Sharron Fuchs wrote:

> As per the note below - giving free care may be one option but it was

> not even suggested by my legislators.

Hi Sharron,

It's so clear that the profession will move toward a more narrowly

defined public presence in the near future, secondary to cost control

efforts by stake holders. Either we as a profession set the agenda for

standards of care, or they will be set by others for us. Good

charting, based on accepted criteria of what we are addressing, and

it's outcome for the patient, is the foundation of what we need in

order to maintain some degree of self control.

I've been working with OutsideIn, a Federally mandated health center

for homeless youth and low income patients in Portland, trying to

develop a grassroots network of volunteer docs to see one or two

patients assigned from OI each month. In this manner, a dent may be

made in the unmet health care needs of the community. The times demand

such innovative action as more and more are unable to access health

care locally (and nationally). The time is right to demonstrate how

nonmaterial or spiritual solutions can be used to address economic

problems. Any group of people who act in this regard will be able to

claim their actions as a model for others in helping. Legislators go

to the front of a parade and think they're leaders; necessity is still

the mother of invention and usually arises from the grass roots.

Sears

NW Portland

[Guest guest]

MS, I do agree with you and for you to offer your services in such a ground level area is tremendous. But for any kind of 3rd party payment we are now bound by the 'outcomes' system. Another point that came out of the meeting was that the Kaiser system now has in their electronic records system a data base that will pop up Best Practices or Evidence Based Outcomes literature for a particular diagnosis. This of course is the in house system to contain care and thus costs. There was a post recently re: further DC care not being evidenced based and neck manipulation being contraindicated. I suggest the DC or the patient ask Kaiser for the lit. that made them deny further care.

sharron fuchs dc

From: dm.bones@... [mailto:dm.bones@...] Sent: Monday, March 06, 2006 2:07 PMSharron FuchsCc: listserveSubject: Re: Re: Update re. quitting managed care(long

On Mar 6, 2006, at 1:15 PM, Sharron Fuchs wrote:

As per the note below - giving free care may be one option but it was not even suggested by my legislators.

Hi Sharron,

It's so clear that the profession will move toward a more narrowly defined public presence in the near future, secondary to cost control efforts by stake holders. Either we as a profession set the agenda for standards of care, or they will be set by others for us. Good charting, based on accepted criteria of what we are addressing, and it's outcome for the patient, is the foundation of what we need in order to maintain some degree of self control.

I've been working with OutsideIn, a Federally mandated health center for homeless youth and low income patients in Portland, trying to develop a grassroots network of volunteer docs to see one or two patients assigned from OI each month. In this manner, a dent may be made in the unmet health care needs of the community. The times demand such innovative action as more and more are unable to access health care locally (and nationally). The time is right to demonstrate how nonmaterial or spiritual solutions can be used to address economic problems. Any group of people who act in this regard will be able to claim their actions as a model for others in helping. Legislators go to the front of a parade and think they're leaders; necessity is still the mother of invention and usually arises from the grass roots.

Sears

NW Portland

[Guest guest]

On Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

> Another point that came out of the meeting was that the Kaiser system

> now has in their electronic records system a data base that will pop

> up Best Practices or Evidence Based Outcomes literature for a

> particular diagnosis. This of course is the in house system to contain

> care and thus costs

I bet all the third party carriers have data bases on all of us that

treat, broken down by diagnosis and expenses. I had a PIP patient who

was told by her insurer that, " He's a good one. " She assumed that they

knew all about my practice.

That's mainstream health care, I guess.

Sears

NW Portland

[Guest guest]

Yes, the MD at the Town hall meeting who talked about Kaiser also said that other insurance companies publish their own Best Practices or Evidence Based Outcomes and tell a Dr. that if they want to get paid by them then they will practice according to those guidelines. The other panel members of the forum and the legislators knew all about this and didn't bat an eye. I was surprised as Vern had said it was coming I just didn't realize that it actually was here. Perhaps when an insured patient comes in for care that upfront the 'guidelines' for your diagnosis be obtained from the insurance company ?

sharron fuchs dc

From: dm.bones@... [mailto:dm.bones@...] Sent: Monday, March 06, 2006 3:06 PMSharron FuchsCc: listserveSubject: Re: Re: Update re. quitting managed care(long

On Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

Another point that came out of the meeting was that the Kaiser system now has in their electronic records system a data base that will pop up Best Practices or Evidence Based Outcomes literature for a particular diagnosis. This of course is the in house system to contain care and thus costs

I bet all the third party carriers have data bases on all of us that treat, broken down by diagnosis and expenses. I had a PIP patient who was told by her insurer that, "He's a good one." She assumed that they knew all about my practice.

That's mainstream health care, I guess.

Sears

NW Portland

[Guest guest]

It’s a good thing that no one changes a dx. To get paid thus corrupting the database!

I send in dxx like cervical capsular sprain and it gets kicked back. I return it as duhhhh cervical sprain, and it soars like an eagle. A small example but worthy of consideration. Never mind that if we send in cervicogenic headache, manipulation doesn’t get reimbursed so it never gets into the database so it never gets coded as such, etc.

Same with colic, colitis, gastric reflux, CTS, TOS, etc.

Science!

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Sharron Fuchs <sharronf@...>

Date: Mon, 6 Mar 2006 15:21:54 -0800

Cc: listserve < >

Conversation: Re: Update re. quitting managed care(long

Subject: RE: Re: Update re. quitting managed care(long

Yes, the MD at the Town hall meeting who talked about Kaiser also said that other insurance companies publish their own Best Practices or Evidence Based Outcomes and tell a Dr. that if they want to get paid by them then they will practice according to those guidelines. The other panel members of the forum and the legislators knew all about this and didn't bat an eye. I was surprised as Vern had said it was coming I just didn't realize that it actually was here. Perhaps when an insured patient comes in for care that upfront the 'guidelines' for your diagnosis be obtained from the insurance company ?

sharron fuchs dc

From: dm.bones@... [mailto:dm.bones@...]

Sent: Monday, March 06, 2006 3:06 PM

Sharron Fuchs

Cc: listserve

Subject: Re: Re: Update re. quitting managed care(long

On Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

Another point that came out of the meeting was that the Kaiser system now has in their electronic records system a data base that will pop up Best Practices or Evidence Based Outcomes literature for a particular diagnosis. This of course is the in house system to contain care and thus costs

I bet all the third party carriers have data bases on all of us that treat, broken down by diagnosis and expenses. I had a PIP patient who was told by her insurer that, " He's a good one. " She assumed that they knew all about my practice.

That's mainstream health care, I guess.

Sears

NW Portland

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Bingo dude! My current front office CA used to work at OHSU at one of

their clinics...doing billing/reception/phones etc......she was not

trained formally in coding..but she and the other front desk staff were

trained that certain types of insurance like OHP, medicare and certain

private insurers etc etc had to have certain types of DXes and that lay

staff were authorized to change those DXs in the software if they

noticed that they were lacking...the provider had no knowledge of it

from what she says...and the front desk staff were taught that it was

just a small formality...no biggie. Holy cow!

In my opinion, reality does not exist in the records/database of any

insurer, private or public...but that is indeed part of the " evidence "

that drives decisions.

And it is even worse in Canada...where reality is a four letter word. I

have a chiro friend up there who participates/bills in the government

health system....they, (DCs) will only get paid if the diagnosis is

something like " uncomplicated mechanical low back pain " ....well, it

seems that every patient that has ever walked into a chiro office in BC

has uncomplicated low back pain, since that is what pays the bills.

Horrible system...and a bunch of DCS and MDs etc who look the other

way....they feel that they have gone so far down the path of

entitlement with its embedded monster beauacracy that whole thing is a

big joke.

J.

www.springbrookclinic.com

Springbrook Chiropractic & Natural Health Center

www.cspine.org

Home of the Oregon Chiropractic Forums and Online Calendar

Re: Re: Update re. quitting managed care(long

On Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

Another point that came out of the meeting was that the Kaiser system

now has in their electronic records system a data base that will pop up

Best Practices or Evidence Based Outcomes literature for a particular

diagnosis. This of course is the in house system to contain care and

thus costs

I bet all the third party carriers have data bases on all of us that

treat, broken down by diagnosis and expenses. I had a PIP patient who

was told by her insurer that, " He's a good one. " She assumed that they

knew all about my practice.

That's mainstream health care, I guess.

Sears

NW Portland

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is

to foster communication and collegiality. No personal attacks on

listserve members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print,

forward, or otherwise distribute correspondence written by another

member without his or her consent, unless all personal identifiers have

been removed.

[Guest guest]

Yes Sharron and Colleagues,

"Evidence Based Best Practices" not the CJ rule is the concern and that which we again must be pro-active. This is what the profession should currently be working on in this state in a true consensus building manner. Best Practices can allow others outside the profession to say If a particular treatment/procedure fails to have a certain "level of evidence" that treatment or procedure will not be reimbursed by third party payers. Though we may not be able to totally prevent this from occuring we can certainly try!

Also as I've said prior another aspect of "Best Practices" is that you will see that they will determine that based on the "scientific literature" this or that particular condition(s) have been supposedly shown to respond in this or that number(s) of treatments...can you say "canned treatment plans."

Part of the beauty of the CJ rule language is that it guards against canned numbers of treatments. By using "Evidence Based Outcome Assessments" First, patient self reporting instruments eg., Oswestry, Neck Disability Index for their current level of activity intolerance, VAS, numerical pain rating box, pain drawings, for their current level of pain.

Second, provider driven outcome assessments your examination findings....which may include functional radiology.....so by using serial outcome assessments each case drives itself., each patient's response time can be different, unique, and as such not canned.

Also a few years ago a sub-committee of the OBCE guidelines development deal which I and Freeman were on came up with our version of the "Ratings of the Evidence" and tied it into the current ETSDP rule language to guard against this very thing. That is someone outside the profession raising the "evidence bar" to high so that the development and use of new and exciting procedures/treatments (Les Feinberg tech? etc.,) within the profession would not be in danger. Here is our final version...now recall we wrote this more than five years ago!

Quality of the Scientific Evidence

Class I Evidence provided by on or more well-designed controlled clinical trials; or well-designed experimental studies that address reliability, validity, positive predictive value, discriminability, sensitivity and specificity.

Class II Evidence provided by one or more well-designed controlled observational clinical studies, such as case-control, cohort studies, etc., or clinically relevant basic science studies that address reliability, validity, positive predicitive value, disriminability, sensitivity, and specificity; and published in refereed journals.

Class III Evidence provided by expert opinion, descriptive studies or case reports.

Level of Field Consensus

Full agreement, over 85% consensus. Consensus, over 51%. No consensus; less than 25%.

P & U Committee's Final Recommendation

A. Established Accepted as standard in the profession.

B. Appropriate Supported by Class I, II, or III evidence and/or 51% or greater field consensus. As more evidence accumulates and more field experience gained this rating may change.

C. Investigational No Class I, II, or III evidence and less than 25% or no consensus. Evidence and consensus are insufficient to determine appropriateness, further study is warranted. Such procedures fall under Examination, Test, Substance, Device, or Procedure (ETSDP) rule pursuant to OAR 811-015-0070. As more experience and evidence accumulates this recommendation will change.

D. Inappropriate Multiple negative Class I or II evidence and no consensus, less than 25%. As more or positive evidence accumulates and higher field consensus gained this rating can change.

Hence with this document a procedure with only Class III evidence (expert opinion, descriptive studies, or case reports) should be reimbursed by third party payers....and the "Investigational" language nexus to the ETSDP OAR langauge gives us even more room to wiggle as per new and exciting procedures in the profession. The above and starting to work towards a consensus as per our profession addressing "Evidence Base Best Practices" in this state is what we need to be doing...and we need to be doing it now.

Vern Saboe

Re: Re: Update re. quitting managed care(long

On Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

Another point that came out of the meeting was that the Kaiser system now has in their electronic records system a data base that will pop up Best Practices or Evidence Based Outcomes literature for a particular diagnosis. This of course is the in house system to contain care and thus costs

I bet all the third party carriers have data bases on all of us that treat, broken down by diagnosis and expenses. I had a PIP patient who was told by her insurer that, "He's a good one." She assumed that they knew all about my practice.

That's mainstream health care, I guess.

Sears

NW Portland

[Guest guest]

This is all justification inmho for the CJ of our profession. Better to be defined by ourselves than by insurance companies or medics.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Re: Re: Update re. quitting managed care(longOn Mar 6, 2006, at 2:53 PM, Sharron Fuchs wrote:

Another point that came out of the meeting was that the Kaiser system now has in their electronic records system a data base that will pop up Best Practices or Evidence Based Outcomes literature for a particular diagnosis. This of course is the in house system to contain care and thus costs I bet all the third party carriers have data bases on all of us that treat, broken down by diagnosis and expenses. I had a PIP patient who was told by her insurer that, "He's a good one." She assumed that they knew all about my practice. That's mainstream health care, I guess. Sears NW Portland OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.