Worker's Comp and Oregon Health Services

[Guest guest]

Vern.

Since you are the expert on the rules of w/c and legislative issues, I would

like to bring up something I found out yesterday regarding w/c and Oregon Health

Systems.

Even though Oregon law allows for 18 visits over 60 days, OHS is still only

allowing 12/30 before getting further authorization. They say they have the

right to restrict treatment regardless of what Oregon law says. This doesn't

seem right, as this would be infringing on the rights of Oregon workers. I have

been going round and round with OHS this last week, and it wouldn't surprise me

if they didn't know what they were talking about with the internal 12/30 policy,

but if they are right, this circumventing the rule should be stopped.

Thanks for your hard work.

Grice, DC

Albany, OR

[Guest guest]

Yes they are right Ron...you say "This doesn't seem right, as this would be infringing on the rights of Oregon workers," well dear colleague such is the nature of managed care with their inappropriate closed panels within general health care insurance as well as Workers' Compensation. I'm on it Ron and colleagues and have already spoken with a key legislator about proposed legislation that would require the MCOs to provide at a minimum 18 visits or 60 days before the panel DC must request/pre-certify for more treatment with the MCO's all knowing iconic "Medical Director." With that said what we need, what patients/public deserve and that which they and we will achieve is a open market place/no closed panels and the clinical necessity of our treatment as well as other practice issues being based on "Patient Centered Evidence Informed Best Practices" rather than arbitrary numbers of visits or length of treatment and/or rigid evidence based treatment guidelines. I've been working for nearly three years now on this concept with officials from Colorado and Washington State as well as the ACA's "Performance Measures Workgroup" and "CCGPP Task Force" folks to that end...stay patient...truth and what is right, what is fair, will always in the end win the day we just cannot allow ourselves to become stupidly inpatient and make a political mistake....I'm on it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.Since you are the expert on the rules of w/c and legislative issues, I would like to bring up something I found out yesterday regarding w/c and Oregon Health Systems. Even though Oregon law allows for 18 visits over 60 days, OHS is still only allowing 12/30 before getting further authorization. They say they have the right to restrict treatment regardless of what Oregon law says. This doesn't seem right, as this would be infringing on the rights of Oregon workers. I have been going round and round with OHS this last week, and it wouldn't surprise me if they didn't know what they were talking about with the internal 12/30 policy, but if they are right, this circumventing the rule should be stopped.Thanks for your hard work. Grice, DCAlbany, OR

[Guest guest]

Yes they are right Ron...you say "This doesn't seem right, as this would be infringing on the rights of Oregon workers," well dear colleague such is the nature of managed care with their inappropriate closed panels within general health care insurance as well as Workers' Compensation. I'm on it Ron and colleagues and have already spoken with a key legislator about proposed legislation that would require the MCOs to provide at a minimum 18 visits or 60 days before the panel DC must request/pre-certify for more treatment with the MCO's all knowing iconic "Medical Director." With that said what we need, what patients/public deserve and that which they and we will achieve is a open market place/no closed panels and the clinical necessity of our treatment as well as other practice issues being based on "Patient Centered Evidence Informed Best Practices" rather than arbitrary numbers of visits or length of treatment and/or rigid evidence based treatment guidelines. I've been working for nearly three years now on this concept with officials from Colorado and Washington State as well as the ACA's "Performance Measures Workgroup" and "CCGPP Task Force" folks to that end...stay patient...truth and what is right, what is fair, will always in the end win the day we just cannot allow ourselves to become stupidly inpatient and make a political mistake....I'm on it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.Since you are the expert on the rules of w/c and legislative issues, I would like to bring up something I found out yesterday regarding w/c and Oregon Health Systems. Even though Oregon law allows for 18 visits over 60 days, OHS is still only allowing 12/30 before getting further authorization. They say they have the right to restrict treatment regardless of what Oregon law says. This doesn't seem right, as this would be infringing on the rights of Oregon workers. I have been going round and round with OHS this last week, and it wouldn't surprise me if they didn't know what they were talking about with the internal 12/30 policy, but if they are right, this circumventing the rule should be stopped.Thanks for your hard work. Grice, DCAlbany, OR

[Guest guest]

Ron,

Just curious, was this a patient who works at OHSU and has their brand of insurance? If so, I had a very similar thing with Mt Hood Medical Center. I treated a worker, not injured on the job, but injured in an auto accident and the employer (MHMC) would not allow or accept an 'off work' note from a Chiropractor. I doubted the patient's report of this fact and called to verify it. True! It was their policy to require the patient to be under primary care with an MD or they could have not time loss benefits no matter how clinically justified the treatment was. A hospital policy. After that and a few other problems with that hospital, I never allowed an MD to refer me to that hospital again for any procedure. The patient had no choice but to switch care from me to the MD. They subsequently -5 months later- came back to me with unresolved spine problems. I treated them. I don't blame the patient at all for transfer of care during critical stages where time loss is necessary as nothing either of us could do would change the hospital's policies. I applaud them for returning later to continue with treatment. I have been too busy with board work and our profession to make time to go back to the hospital and try to break thru that horrible policy. I wonder how many other DCs in Gresham area know about their seemingly poor public relations policies as it concerns Chiropractic?

It's worth mentioning.

Minga Guerrero DC

In a message dated 5/2/2009 10:47:48 A.M. Pacific Daylight Time, vsaboe@... writes:

Yes they are right Ron...you say "This doesn't seem right, as this would be infringing on the rights of Oregon workers," well dear colleague such is the nature of managed care with their inappropriate closed panels within general health care insurance as well as Workers' Compensation. I'm on it Ron and colleagues and have already spoken with a key legislator about proposed legislation that would require the MCOs to provide at a minimum 18 visits or 60 days before the panel DC must request/pre-certify for more treatment with the MCO's all knowing iconic "Medical Director." With that said what we need, what patients/public deserve and that which they and we will achieve is a open market place/no closed panels and the clinical necessity of our treatment as well as other practice issues being based on "Patient Centered Evidence Informed Best Practices" rather than arbitrary numbers of visits or length of treatment and/or rigid evidence based treatment guidelines. I've been working for nearly three years now on this concept with officials from Colorado and Washington State as well as the ACA's "Performance Measures Workgroup" and "CCGPP Task Force" folks to that end...stay patient...truth and what is right, what is fair, will always in the end win the day we just cannot allow ourselves to become stupidly inpatient and make a political mistake....I'm on it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.Since you are the expert on the rules of w/c and legislative issues, I would like to bring up something I found out yesterday regarding w/c and Oregon Health Systems. Even though Oregon law allows for 18 visits over 60 days, OHS is still only allowing 12/30 before getting further authorization. They say they have the right to restrict treatment regardless of what Oregon law says. This doesn't seem right, as this would be infringing on the rights of Oregon workers. I have been going round and round with OHS this last week, and it wouldn't surprise me if they didn't know what they were talking about with the internal 12/30 policy, but if they are right, this circumventing the rule should be stopped.Thanks for your hard work. Grice, DCAlbany, OR

The Average US Credit Score is 692. See Yours in Just 2 Easy Steps!

[Guest guest]

Ron,

Just curious, was this a patient who works at OHSU and has their brand of insurance? If so, I had a very similar thing with Mt Hood Medical Center. I treated a worker, not injured on the job, but injured in an auto accident and the employer (MHMC) would not allow or accept an 'off work' note from a Chiropractor. I doubted the patient's report of this fact and called to verify it. True! It was their policy to require the patient to be under primary care with an MD or they could have not time loss benefits no matter how clinically justified the treatment was. A hospital policy. After that and a few other problems with that hospital, I never allowed an MD to refer me to that hospital again for any procedure. The patient had no choice but to switch care from me to the MD. They subsequently -5 months later- came back to me with unresolved spine problems. I treated them. I don't blame the patient at all for transfer of care during critical stages where time loss is necessary as nothing either of us could do would change the hospital's policies. I applaud them for returning later to continue with treatment. I have been too busy with board work and our profession to make time to go back to the hospital and try to break thru that horrible policy. I wonder how many other DCs in Gresham area know about their seemingly poor public relations policies as it concerns Chiropractic?

It's worth mentioning.

Minga Guerrero DC

In a message dated 5/2/2009 10:47:48 A.M. Pacific Daylight Time, vsaboe@... writes:

Yes they are right Ron...you say "This doesn't seem right, as this would be infringing on the rights of Oregon workers," well dear colleague such is the nature of managed care with their inappropriate closed panels within general health care insurance as well as Workers' Compensation. I'm on it Ron and colleagues and have already spoken with a key legislator about proposed legislation that would require the MCOs to provide at a minimum 18 visits or 60 days before the panel DC must request/pre-certify for more treatment with the MCO's all knowing iconic "Medical Director." With that said what we need, what patients/public deserve and that which they and we will achieve is a open market place/no closed panels and the clinical necessity of our treatment as well as other practice issues being based on "Patient Centered Evidence Informed Best Practices" rather than arbitrary numbers of visits or length of treatment and/or rigid evidence based treatment guidelines. I've been working for nearly three years now on this concept with officials from Colorado and Washington State as well as the ACA's "Performance Measures Workgroup" and "CCGPP Task Force" folks to that end...stay patient...truth and what is right, what is fair, will always in the end win the day we just cannot allow ourselves to become stupidly inpatient and make a political mistake....I'm on it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.Since you are the expert on the rules of w/c and legislative issues, I would like to bring up something I found out yesterday regarding w/c and Oregon Health Systems. Even though Oregon law allows for 18 visits over 60 days, OHS is still only allowing 12/30 before getting further authorization. They say they have the right to restrict treatment regardless of what Oregon law says. This doesn't seem right, as this would be infringing on the rights of Oregon workers. I have been going round and round with OHS this last week, and it wouldn't surprise me if they didn't know what they were talking about with the internal 12/30 policy, but if they are right, this circumventing the rule should be stopped.Thanks for your hard work. Grice, DCAlbany, OR

The Average US Credit Score is 692. See Yours in Just 2 Easy Steps!

[Guest guest]

Minga:

I believe that is a policy of all Legacy hospitals and clinics.

I’ve had a few clients who had to get letters from MD’s before Legacy would

allow them to return to work.

Chris

T. Hill, PC

520 SW Sixth Avenue, Suite 1250

Portland, OR 97204

(503) 227-4330

chill@...

From:

[mailto: ] On Behalf Of AboWoman@...

Sent: Sunday, May 03, 2009 6:49 PM

vsaboe@...; ; rongrice@...

Subject: Re: Worker's Comp and Oregon Health Services

Ron,

Just curious, was this a patient who works at OHSU and has their

brand of insurance? If so, I had a very similar thing with Mt Hood Medical

Center. I treated a worker, not injured on the job, but injured in an auto

accident and the employer (MHMC) would not allow or accept an 'off

work' note from a Chiropractor. I doubted the patient's report of this fact and

called to verify it. True! It was their policy to require the patient to be

under primary care with an MD or they could have not time loss benefits no

matter how clinically justified the treatment was. A hospital policy. After

that and a few other problems with that hospital, I never allowed

an MD to refer me to that hospital again for any procedure. The

patient had no choice but to switch care from me to the MD. They subsequently

-5 months later- came back to me with unresolved spine problems. I treated

them. I don't blame the patient at all for transfer of care during critical

stages where time loss is necessary as nothing either of us could do would

change the hospital's policies. I applaud them for returning later to continue

with treatment. I have been too busy with board work and our profession to make

time to go back to the hospital and try to break thru that horrible policy. I

wonder how many other DCs in Gresham area know about their seemingly poor

public relations policies as it concerns Chiropractic?

It's worth mentioning.

Minga Guerrero DC

In a message dated 5/2/2009 10:47:48 A.M. Pacific Daylight Time,

vsaboe@... writes:

Yes they are right Ron...you say " This doesn't seem right, as this would be

infringing on the rights of Oregon workers, " well dear

colleague such is the nature of managed

care with their inappropriate closed panels

within general health care insurance as well as Workers' Compensation.

I'm on it Ron and colleagues and have already spoken with a key legislator

about proposed legislation that would require the MCOs to provide at a minimum

18 visits or 60 days before the panel DC must request/pre-certify for more

treatment with the MCO's all knowing iconic " Medical Director. "

With that said what we need, what patients/public deserve and that which they

and we will achieve is a open market place/no closed panels and the clinical

necessity of our treatment as well as other practice issues being based on

" Patient Centered

Evidence Informed Best Practices " rather than

arbitrary numbers of visits or length of treatment and/or rigid evidence

based treatment guidelines. I've been working for nearly three years

now on this concept with officials from Colorado and Washington State as

well as the ACA's " Performance Measures Workgroup " and " CCGPP

Task Force " folks to that end...stay patient...truth and what is right,

what is fair, will always in the end win the day we just cannot allow

ourselves to become stupidly inpatient and make a political mistake....I'm on

it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.

Since you are the expert on the rules of w/c and legislative issues, I would

like to bring up something I found out yesterday regarding w/c and Oregon

Health Systems.

Even though Oregon law allows for 18 visits over 60 days, OHS is still only

allowing 12/30 before getting further authorization. They say they have the

right to restrict treatment regardless of what Oregon law says. This doesn't

seem right, as this would be infringing on the rights of Oregon workers. I have

been going round and round with OHS this last week, and it wouldn't surprise me

if they didn't know what they were talking about with the internal 12/30

policy, but if they are right, this circumventing the rule should be stopped.

Thanks for your hard work.

Grice, DC

Albany, OR

The Average US Credit Score is 692. See

Yours in Just 2 Easy Steps!

[Guest guest]

Minga:

I believe that is a policy of all Legacy hospitals and clinics.

I’ve had a few clients who had to get letters from MD’s before Legacy would

allow them to return to work.

Chris

T. Hill, PC

520 SW Sixth Avenue, Suite 1250

Portland, OR 97204

(503) 227-4330

chill@...

From:

[mailto: ] On Behalf Of AboWoman@...

Sent: Sunday, May 03, 2009 6:49 PM

vsaboe@...; ; rongrice@...

Subject: Re: Worker's Comp and Oregon Health Services

Ron,

Just curious, was this a patient who works at OHSU and has their

brand of insurance? If so, I had a very similar thing with Mt Hood Medical

Center. I treated a worker, not injured on the job, but injured in an auto

accident and the employer (MHMC) would not allow or accept an 'off

work' note from a Chiropractor. I doubted the patient's report of this fact and

called to verify it. True! It was their policy to require the patient to be

under primary care with an MD or they could have not time loss benefits no

matter how clinically justified the treatment was. A hospital policy. After

that and a few other problems with that hospital, I never allowed

an MD to refer me to that hospital again for any procedure. The

patient had no choice but to switch care from me to the MD. They subsequently

-5 months later- came back to me with unresolved spine problems. I treated

them. I don't blame the patient at all for transfer of care during critical

stages where time loss is necessary as nothing either of us could do would

change the hospital's policies. I applaud them for returning later to continue

with treatment. I have been too busy with board work and our profession to make

time to go back to the hospital and try to break thru that horrible policy. I

wonder how many other DCs in Gresham area know about their seemingly poor

public relations policies as it concerns Chiropractic?

It's worth mentioning.

Minga Guerrero DC

In a message dated 5/2/2009 10:47:48 A.M. Pacific Daylight Time,

vsaboe@... writes:

Yes they are right Ron...you say " This doesn't seem right, as this would be

infringing on the rights of Oregon workers, " well dear

colleague such is the nature of managed

care with their inappropriate closed panels

within general health care insurance as well as Workers' Compensation.

I'm on it Ron and colleagues and have already spoken with a key legislator

about proposed legislation that would require the MCOs to provide at a minimum

18 visits or 60 days before the panel DC must request/pre-certify for more

treatment with the MCO's all knowing iconic " Medical Director. "

With that said what we need, what patients/public deserve and that which they

and we will achieve is a open market place/no closed panels and the clinical

necessity of our treatment as well as other practice issues being based on

" Patient Centered

Evidence Informed Best Practices " rather than

arbitrary numbers of visits or length of treatment and/or rigid evidence

based treatment guidelines. I've been working for nearly three years

now on this concept with officials from Colorado and Washington State as

well as the ACA's " Performance Measures Workgroup " and " CCGPP

Task Force " folks to that end...stay patient...truth and what is right,

what is fair, will always in the end win the day we just cannot allow

ourselves to become stupidly inpatient and make a political mistake....I'm on

it!

Vern Saboe

Worker's Comp and Oregon Health Services

Vern.

Since you are the expert on the rules of w/c and legislative issues, I would

like to bring up something I found out yesterday regarding w/c and Oregon

Health Systems.

Even though Oregon law allows for 18 visits over 60 days, OHS is still only

allowing 12/30 before getting further authorization. They say they have the

right to restrict treatment regardless of what Oregon law says. This doesn't

seem right, as this would be infringing on the rights of Oregon workers. I have

been going round and round with OHS this last week, and it wouldn't surprise me

if they didn't know what they were talking about with the internal 12/30

policy, but if they are right, this circumventing the rule should be stopped.

Thanks for your hard work.

Grice, DC

Albany, OR

The Average US Credit Score is 692. See

Yours in Just 2 Easy Steps!