Provider Groups Ask for Inclusion in Coordinated Care Organizations

They think a prescriptive list of providers needs to be part of the legislation going to the Legislature in February

November 17, 2011—Not mincing words, provider groups worried they’ll be left out of the coordinated care organizations (CCOs) took their case to the Oregon Health Policy Board last week. But they came away without any assurance.

The testimony of representatives from the naturopathic community, surgery centers and preventive reproductive healthcare, both passionate and strongly worded, conveyed a collective concern about the emerging CCOs, which will coordinate the physical, mental and dental care of Oregon Health Plan patients starting next July. Their testimony focused on the importance of the care and the services they provide, and how it is relevant to Oregon Health Plan patients.

“Our concern lies in the fact that we are indeed small businesses in the healthcare arena,” said Kecia Rardin, president of the Oregon Ambulatory Surgery Center Association. “We could be left out of the CCO model.”

Surgery centers, she said, have high patient satisfaction, low infection and complication rates, and offer the same care to Medicare and Medicaid patients as outpatient hospital departments, but are only reimbursed 56 cents to the dollars.

“We’ve already figured out how to provide this care at affordable costs,” Rardin emphasized.

Preventive reproductive healthcare should be part of what these CCOs offer, said Michele Stranger Hunter, the executive director of the Oregon Foundation for Reproductive Health. She urged the policy board to “consider the long-term health needs of women living in Oregon who need access to comprehensive preventive reproductive health services such as preconception care and contraception,” adding that unintended pregnancies can “derail life plans and education goals.”

Kevin Wilson, a Hillsboro-based naturopathic physician, argued that naturopathic medicine can help reduce emergency room visits, hospital visits, prescription medication and the use of specialty medicine.

“If we have the same players, we’ll have the same outcomes, and not the transformation that we need,” Wilson said. “Include us specifically in any draft legislation. If we are not included, we will be excluded.”

“CCOs must call into service all providers,” said Laura Farr, a naturopath and the president of the Oregon Association of Naturopathic Physicians.

The members of the Oregon Health Policy Board hardly reacted to the testimony. In an interview with The Lund Report, Dr. Bruce Goldberg, director of the Oregon Health Authority, said “all feedback like this will be informing the [CCO] business plan,” but he did not go into further detail.

Dr. Chuck Hofmann, a general practitioner in Baker City, said it’s unlikely the board will be as prescriptive as the provider groups might like. “I don't know that the board wants to get so far in the grass that we’re picking one group over another group,” he said. “We don’t want to get into that battle.”

Those decisions are best left to the Legislature, Governor John Kitzhaber, and the CCOs, he thinks. But he did say that there are particular areas of healthcare that any CCO application must address—such as women’s health. “If I were drafting a proposal for a CCO, I could guarantee that my proposal would explain how I would approach and deal with women’s health issues and other health services,” Hofmann said.

Felisa Hagins, the political director of the Service Employees International Union (SEIU) Local 49, said she hasn’t made up her mind about whether the policy board should create an explicit list of provider groups. “We’ve heard it quite a bit from a whole slew of providers,” she said.

But, it might be counter-intuitive for the board, which sets broad policy, to be so detail oriented. “I do hear their concern about exclusion,” Hagins said. “[But] it could be a little bit of a slippery slope for the health board to set that list.”

The policy board is responsible for creating a business plan for the CCOs that will be presented to the Legislature in February, along with draft legislation that would allow the Oregon Health Authority to move forward with making CCOs operational throughout the state.

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Comments

Ambulatory surgical centers still don't report their infection rates, despite legislation, so how does anyone know their claim regarding low rates is true? Let's insist the state enforce the law requiring ASC's to report; it's long overdue. Naomi K. Price, consumer member Oregon Patient Safety Commission

If naturopaths want to be explicitly included, then they should have evidence showing that their treatments control blood pressure, diabetes, thyroid etc. as well as scientifically based medicine. Money is limited and pressure will be high to prove that providers are meeting yet to be determined metrics. It is not apparent to me they will be able to do that.

Treatment-caused adverse events (iatrogenic adverse events is one way this gets net-searched) make the news, including radio broadcasts in drive time. I recall hearing an M.D. say he would not want to be in a hospital without a hospitalist at his side. He advised people who cannot afford a hospitalist to have a loved one to watch procedures and understand what is going on. In Oregon, there are substantial numbers of people who go outside conventional medicine at their own expense, even when they have insurance. Some will use conventional medicine only if their chosen practitioners vouch for the conventional practitioner. Naturpaths take rigorous coursework and are licensed to practice in Oregon. N.D.'s can perform preventive-care tests that new rules ask for. Prevention, especially nutrition and lifestyle plans, are a substantial part of the scope of practice for N.D's. Many M.D.s, confident in that scope of practice, team with naturpaths to help patients with difficult health challenges. The bottleneck in primary care can and should be faced as a community, with patients involved, even if it is hard to get them to sit through long meetings for free. Few patients will want to sit through as "yet to be determined metrics" are invented. Nonetheless, they vote with their bucks, and that can be measured, as can outcomes. Outcomes for expensive chronic illnesses are of special interest if money is to be saved.