Alternative Providers Turn to Rule-Making Process for Inclusion in CCOs

[Guest guest]

I wish we weren’t lumped into a group with the others

who are still clawing their way to acceptance. I understand a ‘group’

is stronger than standing alone but frankly I feel some of the ‘group’

pulls us down. The ‘evidence’ for some types of providers care is

lacking to the extent of incredulous hilarity.

s. fuchs dc

http://www.thelundreport.org/resource/alternative_providers_turn_to_rule_making_process_for_inclusion_in_ccos

Alternative

Providers Turn to Rule-Making Process for Inclusion in CCOs

They want to see clear definitions of terms, and guidelines on

reimbursement and provider capacity in these coordinated care organizations

By:

Waldroupe

March 15,

2012—Alternative health providers, including naturopathic doctors,

chiropractors, massage therapists and acupuncturists, are turning to the Oregon

Health Authority’s rule making process for coordinated care organizations

(CCOs) to make certain their provider groups are on board.

The state agency’s rule making process for CCOs, which is expected to be

completed within a month, spells out the rules and regulations that will govern

CCOs in a way that reflects the legislative intent of House Bill 3650 and

Senate Bill 1580, which set in motion the transformative healthcare system.

Coordinated care organizations will be comprised of patient teams that include

doctors, nurses, behavioral health providers, community health workers, and

other providers who will integrate physical, mental and dental healthcare to

the 600,000 patients on the Oregon Health Plan. The hope is that by focusing on

preventive care and reducing emergency room utilization, costs can be reduced.

CCOs are expected to become operational in August.

Alternative provider groups scored a victory when language prohibiting

discrimination against their provider groups was included in the legislation,

as well as language allowing providers to appeal decisions made by a CCO to the

Oregon Health Authority.

They were concerned that without such explicit language, they would have been

excluded.

“Our experience as alternative providers has been that when anything is

left vague…we are always eliminated or left out,” said Jan

Ferrante, the executive director of the Oregon Chiropractors Association.

That discrimination, she and others say, comes from a deep-seated bias in the

healthcare industry against alternative providers.

“[Managed care organizations]…almost categorically refuse to

credential [naturopathic doctors], for reasons ranging from they’re

governed by MDs and are unlikely to credential other providers, to their

leadership is philosophically opposed to naturopathic medicine,”

Farr, president of the Oregon Association of Naturopathic Physicians, told

legislators.

Although the non-discrimination language was an important battle to win, Farr

believes more needs to be done to integrate alternative providers into the

healthcare system.

And, she called the non-discrimination language passive, saying it “does

little” to guarantee that patients will have the same access to

naturopathic physicians and other alternative health providers. “The end

result is very, in my opinion, generic language,” Farr said.

Farr and Laverne Saboe, the lobbyist for the Oregon Chiropractors Association,

thinks there’s an opportunity during the rule-making process to create

more explicit guidelines for alternative providers in CCOs.

Saboe said the rule-making process will determine what constitutes an adequate

network of providers in a CCO, as well as provider types, qualifications and

disciplines. Farr also said the process will include defining terms such as

“provider” and “primary care provider,” and is hopeful

that these definitions will explicitly mention naturopathic doctors and other

alternative provider groups.

Another issue yet to be determined is how alternative providers will be

reimbursed. The legislation gives CCOs the ability to reimburse providers at

different levels based upon the quality of care they offer and their

performance.

Saboe doesn’t believe alternative providers will be reimbursed at a lower

rate than mainstream providers. “There are good evidence-based outcomes

assessment tools…that’s not necessarily subjective,” Saboe

said, including patient satisfaction.

Farr and others would like alternative providers to become integrated in CCOs

throughout the state. “We’ll have better luck in some communities

than we will in others,” she said.

At stake, she and others say, is whether Oregon Health Plan patients will be

able to see providers that they believe can improve their health status.

Ocker, the president of the Oregon Association of Acupuncture and Oriental

Medicine, points out that patients respond differently to medications and

therapies, making flexibility essential.

“There have to be alternative therapies,” she said. “That

gives the patient the full ability to look around and ask ‘what's

effective for me?’”

“Consumers should have access to those providers…and there should

not be such a restrictive network that it will be difficult for them to get an

appointment,” Saboe said.

Image for this story appears courtesy of

The Oregonian.

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