May 18th: Stand up for Spine Injections for Oregon Medicaid Patients!

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https://www.spineintervention.org/n...Interventional-Spine-Procedures-in-Oregon.htm


Happy hour and no-host bar to follow at @101N house...


On April 6, 2017, the Oregon Health Authority (OHA) will reconsider its ruling that eliminated coverage for epidural steroid injections. The OHA's Health Evidence Review Commission’s Evidence-based Guidelines Subcommittee will meet to review and discuss the initial draft coverage guidance “Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions” and revised coverage guidance “Low Back Pain: Corticosteroid Injections.”

It is critical that interventional pain physicians and their patients are in the room to make their voices heard.

The meeting takes place on April 6, 2017, from 2:00 to 5:00 p.m at the Clackamas Community College Wilsonville Training Center, Room 111-112, 29353 SW Town Center Loop E, Wilsonville, Oregon 97070.

To listen-in only (with no opportunity to comment):

Call 888-204-5984 and enter participant code 801373, or

Listen via the web by registering here

The non-corticosteroid percutaneous interventions evidence sources cited by OHA are listed on their blog. It is anticipated that the initial draft coverage guidance will be available in agenda materials and posted one week prior to the meeting.

For more information about the meeting from OHA, visit the committee’s website.

For details about SIS advocacy on coverage issues in Oregon, click here.

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Oregon is quickly sinking into the ocean...the policy makers there are a bunch of hypocritical, biased, nonsensical wanks
 
Nope, Oregon is just moving away from making iatrogenic pain a business model.

If you have invested heavily in that model - let's say by owning your own UDS lab, a fluoro/PRP scheme, and mid-levels- expect to be called out.
 
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Nope, Oregon is just moving away from making iatrogenic pain a business model.

If you have invested heavily in that model - let's say by owning your own UDS lab, a fluoro/PRP scheme, and mid-levels- expect to be called out.

You're so right. Because "iatrogenic pain" is such a successful business model in Oregon...that's where the money is.

http://registerguard.com/rg/opinion/35349362-78/investors-pocketing-cco-money.html.csp

http://registerguard.com/rg/opinion/35328292-78/reform-ccos.html.csp

http://www.mailtribune.com/news/201...on-in-reserves-bill-would-make-them-nonprofit

https://forums.studentdoctor.net/threads/most-ethical-man-ive-ever-met.1246865/
 
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Gorgeous country in the Pacific Northwest. Made some great friends during my year in Seattle.

Too bad it's so heavily populated by liberal tree huggers and unshaven lesbians who think they know more than physicians and scientists.

I will never live or work in the Pacific NW again.
 
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Gorgeous country in the Pacific Northwest. Made some great friends during my year in Seattle.

Too bad it's so heavily populated by liberal tree huggers and unshaven lesbians who think they know more than physicians and scientists.

I will never live or work in the Pacific NW again.

Maybe you can charge 100/visit for Acupuncture done in 5 min sessions by PAs. Sounds like a good business model in Oregon
 
Maybe you can charge 100/visit for Acupuncture done in 5 min sessions by PAs. Sounds like a good business model in Oregon

Do you think this whole Oregon thing is a problem strictly for the hippie northwest or do you think it will have rippling effects across the country. I know what the practical answer is, but I don't want to hear it...work in the southeast, would hate for this to happen across the board and destroy our livelihood bc of a few hippies
 
Do you think this whole Oregon thing is a problem strictly for the hippie northwest or do you think it will have rippling effects across the country. I know what the practical answer is, but I don't want to hear it...work in the southeast, would hate for this to happen across the board and destroy our livelihood bc of a few hippies

Well, Washington State Medicaid/WC stopped paying for Kypho, Stims, RF, Arthroscopic Surgery, Fusions for DDD, etc for about 5 years or so. They only pay for like a few LESIs or so.

Yet that hasn't spread throughout the country due to the Republican stance basically, so I don't see this spreading to Medicare or to many other states outside of Oregon and Washington mostly.

Haven't seen insurers or medicare stop paying for Kypho, Stims, etc.

That is why physicians need to be part of ASIPP and SIS to make sure we have collective power.

You have to remember that the liberals basically hate most specialties and want to cut them down to primary care salary numbers.

Anesthesia will NOT be safe from these people as well. They will destroy it with CRNA incursion and cutting payments.
 
Well, Washington State Medicaid/WC stopped paying for Kypho, Stims, RF, Arthroscopic Surgery, Fusions for DDD, etc for about 5 years or so. They only pay for like a few LESIs or so.

Yet that hasn't spread throughout the country due to the Republican stance basically, so I don't see this spreading to Medicare or to many other states outside of Oregon and Washington mostly.

Haven't seen insurers or medicare stop paying for Kypho, Stims, etc.

That is why physicians need to be part of ASIPP and SIS to make sure we have collective power.

You have to remember that the liberals basically hate most specialties and want to cut them down to primary care salary numbers.

Anesthesia will NOT be safe from these people as well. They will destroy it with CRNA incursion and cutting payments.

Thanks for the insight. I am anesthesia pain and left anesthesia mostly because of the CRNA issue and lack of protection in that speciality ...sad to see same thing is happening in pain. I know its happening to all specialties but it's so frustrating that both my specialties even after fellowship may be effected.
 
Well, Washington State Medicaid/WC stopped paying for Kypho, Stims, RF, Arthroscopic Surgery, Fusions for DDD, etc for about 5 years or so. They only pay for like a few LESIs or so.

Yet that hasn't spread throughout the country due to the Republican stance basically, so I don't see this spreading to Medicare or to many other states outside of Oregon and Washington mostly.

Haven't seen insurers or medicare stop paying for Kypho, Stims, etc.

That is why physicians need to be part of ASIPP and SIS to make sure we have collective power.

You have to remember that the liberals basically hate most specialties and want to cut them down to primary care salary numbers.

Anesthesia will NOT be safe from these people as well. They will destroy it with CRNA incursion and cutting payments.


Anesthesia, as a specialty has already been destroyed!
 
http://www.oregon.gov/oha/herc/CommitteeMeetingMaterials/EBGS Materials 4-6-2017.pdf

"Kim Mauer offered testimony. She read a letter from Roger Chou, lead author of the systematic review which served as a basis for the coverage guidance. Chou’s letter highlighted the finding of the review that for patients with radiculopathy, steroid injections are associated with relatively modest benefits, principally a short‐term reduction in pain after several weeks. The impact on pain is not that far out of line with other treatments for low back pain. He does not believe that pain relief should be ignored as it is important for quality of life. He said that, for patients with radiculopathy, the evidence is stronger for epidural steroid injections than for anything else. He said that surgery is the only other evidence‐based treatment for radiculopathy, so a trial of an epidural steroid injection for these patients would be a reasonable option."
 
OHA Recommends Against ESIs; Considers Draft Guidance on Percutaneous Interventions


The Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) met April 6 and referred the draft coverage guidance on Low Back Pain: Corticosteroid Injections to the Value-based Benefits Subcommittee (VbBS) and Health Evidence Review Commission (HERC) for review at their meetings May 18, 2017. Despite multiple comments submitted by SIS, the Multisociety Pain Workgroup (MPW), and others, as well as presentations made by local physicians and patients in attendance, the Coverage Guidance was approved as presented and recommends against coverage for corticosteroid injections.

The EbGS also heard public testimony from physicians on April 6 regarding the draft coverage guidance on Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions. Dr. David Sibell, SIS Instructor and Education Division member, made comments focusing on the importance of appropriate patient selection and implementation of meticulous technique for radiofrequency neurotomy, as described in the SIS Guidelines. His comments were well-received and have prompted an OHA invitation to compile materials for OHA’s EbGS consideration in preparation for discussion on this topic on June 1, 2017. SIS will work with Dr. Sibell to prepare materials for EbGS review. We will also review and prepare comments for MPW sign-on consideration regarding the draft coverage guidance.

A special note of gratitude to those who attended the meetings and made presentations: Dr. David Sibell; Dr. Kim Mauer, Comprehensive Pain Center’s Medical Director; and Dr. Sandy Christiansen, who read a statement prepared by Dr. Steven Cohen. Thanks to all the other local physicians and patients for their tireless commitment and invaluable efforts to regain coverage for interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and we will continue to advocate for patients and physicians in Oregon State.
 
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Unbelievable these idiots in Oregon and Washington state. Meanwhile I have a CRPS patient whose arm is now lost as Washington state declines SCS.
 
OHA Recommends Against ESIs; Considers Draft Guidance on Percutaneous Interventions


The Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) met April 6 and referred the draft coverage guidance on Low Back Pain: Corticosteroid Injections to the Value-based Benefits Subcommittee (VbBS) and Health Evidence Review Commission (HERC) for review at their meetings May 18, 2017. Despite multiple comments submitted by SIS, the Multisociety Pain Workgroup (MPW), and others, as well as presentations made by local physicians and patients in attendance, the Coverage Guidance was approved as presented and recommends against coverage for corticosteroid injections.

The EbGS also heard public testimony from physicians on April 6 regarding the draft coverage guidance on Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions. Dr. David Sibell, SIS Instructor and Education Division member, made comments focusing on the importance of appropriate patient selection and implementation of meticulous technique for radiofrequency neurotomy, as described in the SIS Guidelines. His comments were well-received and have prompted an OHA invitation to compile materials for OHA’s EbGS consideration in preparation for discussion on this topic on June 1, 2017. SIS will work with Dr. Sibell to prepare materials for EbGS review. We will also review and prepare comments for MPW sign-on consideration regarding the draft coverage guidance.

A special note of gratitude to those who attended the meetings and made presentations: Dr. David Sibell; Dr. Kim Mauer, Comprehensive Pain Center’s Medical Director; and Dr. Sandy Christiansen, who read a statement prepared by Dr. Steven Cohen. Thanks to all the other local physicians and patients for their tireless commitment and invaluable efforts to regain coverage for interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and we will continue to advocate for patients and physicians in Oregon State.
 
Can someone from Oregon please explain this? Insurance still covers these procedures? Any predictions for the future for other states?

No spinal injections for Medicaid people Oregon. But, please help yourself to all the tai chi, acupuncture, and chiropractic you can handle. Yes, other states will follows. As goes Oregon, so goes the rest of the nation.
 
No spinal injections for Medicaid people Oregon. But, please help yourself to all the tai chi, acupuncture, and chiropractic you can handle. Yes, other states will follows. As goes Oregon, so goes the rest of the nation.

I would assume that docs in Oregon will drop all pain patients on Medicaid then.
 
Sure.

And then they will just rely on opioids from ER and smoke recreational thc, more than they do now.


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Yeah well that is a good plan to increase the costs on the system to show the "cost effectiveness" of their methodology.

Why clean up the inevitable mess?

Drop the Medicaid unless you do acupuncture. How much do they pay for acupuncture?
 
Drop the Medicaid unless you do acupuncture. How much do they pay for acupuncture?

$20-50 if you throw in some chiropractic or osteopathic manipulation...

http://www.oregon.gov/oha/healthplan/DataReportsDocs/April 2017 Fee Schedule - PDF.pdf

97810 Acupunct w/o stimul 15 min Fac 21.76 20170101
97810 Acupunct w/o stimul 15 min Non 25.73 20170101
97811 Acupunct w/o stimul addl 15m Fac 18.03 20170101
97811 Acupunct w/o stimul addl 15m Non 19.27 20170101
97813 Acupunct w/stimul 15 min Fac 23.53 20170101
97813 Acupunct w/stimul 15 min Non 27.5 20170101
97814 Acupunct w/stimul addl 15m Fac 19.8 20170101
97814 Acupunct w/stimul addl 15m Non 21.78 20170101
98925 Osteopath manj 1-2 regions Fac 17.01 20170101
98925 Osteopath manj 1-2 regions Non 22.22 20170101
98926 Osteopath manj 3-4 regions Fac 25.55 20170101
98926 Osteopath manj 3-4 regions Non 32.25 20170101
98927 Osteopath manj 5-6 regions Fac 33.85 20170101
98927 Osteopath manj 5-6 regions Non 42.29 20170101
98928 Osteopath manj 7-8 regions Fac 42.39 20170101
98928 Osteopath manj 7-8 regions Non 51.58 20170101
98929 Osteopath manj 9-10 regions Fac 51.44 20170101
98929 Osteopath manj 9-10 regions Non 61.61 20170101
98940 Chiropract manj 1-2 regions Fac 16.07 20170101
98940 Chiropract manj 1-2 regions Non 20.04 20170101
98941 Chiropract manj 3-4 regions Fac 24.68 20170101
98941 Chiropract manj 3-4 regions Non 28.89 20170101
98942 Chiropractic manj 5 regions Fac 33.47 20170101
98942 Chiropractic manj 5 regions Non 37.69 20170101
 
$20-50 if you throw in some chiropractic or osteopathic manipulation...

http://www.oregon.gov/oha/healthplan/DataReportsDocs/April 2017 Fee Schedule - PDF.pdf

97810 Acupunct w/o stimul 15 min Fac 21.76 20170101
97810 Acupunct w/o stimul 15 min Non 25.73 20170101
97811 Acupunct w/o stimul addl 15m Fac 18.03 20170101
97811 Acupunct w/o stimul addl 15m Non 19.27 20170101
97813 Acupunct w/stimul 15 min Fac 23.53 20170101
97813 Acupunct w/stimul 15 min Non 27.5 20170101
97814 Acupunct w/stimul addl 15m Fac 19.8 20170101
97814 Acupunct w/stimul addl 15m Non 21.78 20170101
98925 Osteopath manj 1-2 regions Fac 17.01 20170101
98925 Osteopath manj 1-2 regions Non 22.22 20170101
98926 Osteopath manj 3-4 regions Fac 25.55 20170101
98926 Osteopath manj 3-4 regions Non 32.25 20170101
98927 Osteopath manj 5-6 regions Fac 33.85 20170101
98927 Osteopath manj 5-6 regions Non 42.29 20170101
98928 Osteopath manj 7-8 regions Fac 42.39 20170101
98928 Osteopath manj 7-8 regions Non 51.58 20170101
98929 Osteopath manj 9-10 regions Fac 51.44 20170101
98929 Osteopath manj 9-10 regions Non 61.61 20170101
98940 Chiropract manj 1-2 regions Fac 16.07 20170101
98940 Chiropract manj 1-2 regions Non 20.04 20170101
98941 Chiropract manj 3-4 regions Fac 24.68 20170101
98941 Chiropract manj 3-4 regions Non 28.89 20170101
98942 Chiropractic manj 5 regions Fac 33.47 20170101
98942 Chiropractic manj 5 regions Non 37.69 20170101

20 dollars for a 15 minute visit?

Unless they have literally zero overhead, I don't see how they can afford to do that.
 
Did you see that Portlandia episode where Portland succeeds from the union?

Portland secedes from U.S. on tonight's 'Portlandia'; it doesn't go well

"Have you noticed the influx of outsiders into Portland lately?" the mayor asks. He's worried that all these newcomers are "taking our jobs" and "filling up our coffee shops."

It's gotten so bad that restaurants are crowded every night. No empty tables!

"There's no room for us spontaneous boho types to roll in" and get dinner, the mayor complains.
 
The problem is not Oregon, Washington, or any other states.

The problem lies in Medicaid!

It's not a health insurance to insure necessary treatment for medical illness.

It's a welfare program, on one hand to claim federal subsidy, and on the other hand, to deny care so the left-over can be used for something else. plain and simple!

Imagine they try to do this to Medicare patients. It won't fly.
 
The problem is not Oregon, Washington, or any other states.

The problem lies in Medicaid!

It's not a health insurance to insure necessary treatment for medical illness.

It's a welfare program, on one hand to claim federal subsidy, and on the other hand, to deny care so the left-over can be used for something else. plain and simple!

Imagine they try to do this to Medicare patients. It won't fly.

Agree the problem is Medicaid. It is a joke.

The other problem is Oregon and Washington. These states are profoundly stupid thanks to the leftists in charge.
 
20 dollars for a 15 minute visit?

Unless they have literally zero overhead, I don't see how they can afford to do that.

Salaried doctors in subsidized community health centers will be the ones providing the care.
 
The problem is not Oregon, Washington, or any other states.

The problem lies in Medicaid!

It's not a health insurance to insure necessary treatment for medical illness.

It's a welfare program, on one hand to claim federal subsidy, and on the other hand, to deny care so the left-over can be used for something else. plain and simple!


Imagine they try to do this to Medicare patients. It won't fly.

Brilliantly put.
 
Keep the fight for spinal injections for Medicaid patients alive! #saveinjections

Patients on Medicaid, in the state of Oregon, no longer have access to ANY interventional spine procedures for back pain. Most patients no longer even have access to surgery and none have the option of palliative care with long-term opioid treatment. What treatments are these patients left with? The Oregon Health Authority (OHA) now recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and even yoga as the only viable treatments for back pain.

SIS and the 13 other member associations of the Multi-Society Pain Workgroup (MPW) are continuing to develop a coordinated a response to this critical oversight, but now is the time for you to act!

What you can do:
Contact your local newspaper and news stations and make your community aware of this important issue.

Let OHA know what you think. On social media mention OHA and use the hashtag #saveinjections.

Find your congressional representatives’ contact information, and demand action.

Take colleagues and patients to the next Oregon Health Authority committee meetings and provide testimony about the effectiveness of interventional spine procedures. Invite your congressional representative and the media to attend.
· Upcoming Meetings:
· May 18th: Corticosteroid Injections
Value-based Benefits Subcommittee and Health Evidence Research Commission will review proposed coverage guidance recommending AGAINST corticosteroid injections.
· June 1st: Percutaneous Interventions (Radiofrequency Neurotomy)
Evidence-based Guidelines Subcommittee will review proposed coverage guidance recommending AGAINST coverage for radiofrequency neurotomy.

Make your voice heard and be your patients’ advocate. But don't stop there. Encourage your patients to do the same. Without reasoned protest from all those affected, many of your patients will continue to be left without effective treatment options and relegated to lives plagued by chronic pain and disability.

Share your concerns and stories. Follow these suggestions for talking points for you and your patients to use in your efforts to convey the importance of regaining access to interventional spine procedures:

PHYSICIANS/HEALTH CARE PROVIDERS
1. Interventional spine procedures (injections/RFN) are critical tools in my toolbox.
Spine injections have helped hundreds/thousands of my patients regain quality of life.
These procedures are safe and effective and can help appropriately selected patients.
Share a specific patient success story.
2. Without these treatments, what are my patients left with?
Interventional spine procedures are indicated when conservative treatments have failed.
When we have procedures that can help, how can I tell my patients, experiencing terrible pain and unable to do the most basic things, that all I can offer is an Advil and yoga?
What will happen to my patients who don’t have access to interventional spine procedures that will help them improve their pain and function?
3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.
Word limit restriction on written comments: 1000 words
Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
How can we convey the value of these procedures with such restrictions on public comment?

PATIENTS
1. Share your own story or that of a friend/family member.
2. How will your life/has your life been affected if these procedures are no longer available?
3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.
Word limit restriction on written comments: 1000 words
Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
How can we convey the value of these procedures with such restrictions on public comment?

Please contact SIS if you need additional assistance or to share information about your advocacy efforts.
 
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Keep the fight for spinal injections for Medicaid patients alive! #saveinjections

Patients on Medicaid, in the state of Oregon, no longer have access to ANY interventional spine procedures for back pain. Most patients no longer even have access to surgery and none have the option of palliative care with long-term opioid treatment. What treatments are these patients left with? The Oregon Health Authority (OHA) now recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and even yoga as the only viable treatments for back pain.

SIS and the 13 other member associations of the Multi-Society Pain Workgroup (MPW) are continuing to develop a coordinated a response to this critical oversight, but now is the time for you to act!

What you can do:
Contact your local newspaper and news stations and make your community aware of this important issue.

Let OHA know what you think. On social media mention OHA and use the hashtag #saveinjections.

Find your congressional representatives’ contact information, and demand action.

Take colleagues and patients to the next Oregon Health Authority committee meetings and provide testimony about the effectiveness of interventional spine procedures. Invite your congressional representative and the media to attend.
· Upcoming Meetings:
· May 18th: Corticosteroid Injections
Value-based Benefits Subcommittee and Health Evidence Research Commission will review proposed coverage guidance recommending AGAINST corticosteroid injections.
· June 1st: Percutaneous Interventions (Radiofrequency Neurotomy)
Evidence-based Guidelines Subcommittee will review proposed coverage guidance recommending AGAINST coverage for radiofrequency neurotomy.

Make your voice heard and be your patients’ advocate. But don't stop there. Encourage your patients to do the same. Without reasoned protest from all those affected, many of your patients will continue to be left without effective treatment options and relegated to lives plagued by chronic pain and disability.

Share your concerns and stories. Follow these suggestions for talking points for you and your patients to use in your efforts to convey the importance of regaining access to interventional spine procedures:

PHYSICIANS/HEALTH CARE PROVIDERS
1. Interventional spine procedures (injections/RFN) are critical tools in my toolbox.
Spine injections have helped hundreds/thousands of my patients regain quality of life.
These procedures are safe and effective and can help appropriately selected patients.
Share a specific patient success story.
2. Without these treatments, what are my patients left with?
Interventional spine procedures are indicated when conservative treatments have failed.
When we have procedures that can help, how can I tell my patients, experiencing terrible pain and unable to do the most basic things, that all I can offer is an Advil and yoga?
What will happen to my patients who don’t have access to interventional spine procedures that will help them improve their pain and function?
3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.
Word limit restriction on written comments: 1000 words
Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
How can we convey the value of these procedures with such restrictions on public comment?

PATIENTS
1. Share your own story or that of a friend/family member.
2. How will your life/has your life been affected if these procedures are no longer available?
3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.
Word limit restriction on written comments: 1000 words
Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
How can we convey the value of these procedures with such restrictions on public comment?

Please contact SIS if you need additional assistance or to share information about your advocacy efforts.

So they aren't paying for surgery either or opioids?

Guess the patients are going to get by on Thai Chi, Yoga and Advil.

Good luck in Oregon for the Medicaid people!
 
They are basically saying if you are poor, and if you are on Medicaid, just take the pain, but be active! If you are a candidate for interventional procedure, sorry, too bad, ain't gonna happen!

I don't have fundamental problem with this approach! They have to start rationing somewhere. Frankly, how often do you see Medicaid patients get better with injection? Or how often do you see they get better at all!

What I would like to see, is Oregon as a state would get proportionally lower federal Medicaid subsidies because they are cutting out interventional pain for Medicaid population. Look if you are paying yoga instructor, accupuncturist at minimum wage to treat these patients, you don't deserve the type of federal subsidies you are getting from federal government.

Hence, I'm fully on-board with Trump to revamp federal Medicaid subsidies program.
 
http://www.oregon.gov/oha/herc/CommitteeMeetingMaterials/EBGS Materials 4-6-2017.pdf

"Kim Mauer offered testimony. She read a letter from Roger Chou, lead author of the systematic review which served as a basis for the coverage guidance. Chou’s letter highlighted the finding of the review that for patients with radiculopathy, steroid injections are associated with relatively modest benefits, principally a short‐term reduction in pain after several weeks. The impact on pain is not that far out of line with other treatments for low back pain. He does not believe that pain relief should be ignored as it is important for quality of life. He said that, for patients with radiculopathy, the evidence is stronger for epidural steroid injections than for anything else. He said that surgery is the only other evidence‐based treatment for radiculopathy, so a trial of an epidural steroid injection for these patients would be a reasonable option."

So they don't even listen to their own guy now. There's an agenda, clearly.

Instead of non-coverage, why not just make injections, opioids, etc., difficult to access?
 
Medicaid unlikely to cover back pain shots

Medicaid unlikely to cover back pain shots: Steroid injections reduce nerve inflammation

By Tara Bannow, The Bulletin, @tarabannow
Published Apr 28, 2017 at 12:09AM

Oregon’s Medicaid program doesn’t cover steroid injections for back pain, and a state commission that determines what’s covered under the program is poised to keep it that way.

The debate over whether the Oregon Health Plan should cover the injections has drawn passionate testimony from patients and physicians alike. Doctors often inject steroids into the spinal column to relieve pain in the back and legs caused by inflamed nerves. The pain often occurs when discs in the spinal column place pressure on adjacent nerves.

In order to approve coverage for the treatment, the state’s Health Evidence Review Commission would need assurance that they improve patients’ long-term and short-term function, reduce their pain and lower their need for surgery later, among other factors. So far, the commission has found little scientific evidence on most of those fronts.

But critics, including both patients and physicians, argue the commission’s process doesn’t allow enough room for patients’ experiences with the injections to shape coverage. Several patients tearfully told commission members at public hearings they wouldn’t have been able to attend without the treatments.

“If you take a normal person like me, I’m evidence,” Tracy Titus, a patient who uses the injections, said at an April 6 meeting on the subject. “I’m here. I’m here because of these injections. I can get up out of bed. I can move around. I can pick things up, something that for a while I couldn’t do.”

Doctors argue pain medicine is a unique specialty that doesn’t easily lend itself to randomized controlled trials, which — while the gold standard of scientific research — require that a set of patients receive a placebo. The HERC relies mainly on randomized controlled trials to make its coverage determinations.

“How would you tell somebody, ‘I’m going to inject your back and put saline inside or sugar water?’” said Dr. Asokumar Buvanendran, an anesthesiology professor at Rush University in Chicago. “That’s very hard to do in these clinical trials nowadays. None of my patients would agree to that.”

In this case, Buvanendran, the chairman of the American Society of Anesthesiologists’ Committee on Pain Medicine, said the results observed in clinical practice should influence the decision, as it’s such a difficult topic to study. He did not testify on the subject, but said in an interview he has been using the injections on patients for 18 years. In his experience, they relieve pain and complications are rare, he said.

The commission is recommending against coverage for steroid injections in several scenarios.

One is into the epidural space around the spinal cord in people with or without pain that extends down into the legs, otherwise known as radiculopathy or sciatica. They’re also considering providing the injections for other types of pain, such as that which originates in the facet joints and sacroiliac joints.

Dr. Cat Livingston, the HERC’s associate medical director, said in an interview she disagrees with the claim that there is inadequate medical evidence on the injections. On the contrary, she said the commission’s review included a wealth of randomized controlled trials featuring thousands of patients, but they did not show strong evidence of improved outcomes.

“There are going to be some conditions in which it’s not possible or it would be very challenging to do a randomized controlled trial,” Livingston said. “This is not one of those conditions. There are many randomized controlled trials that have been done clearly showing that there have been a lot of patients willing to participate in these.”

Dr. David Sibell, a professor in Oregon Health & Science University’s departments of anesthesiology and perioperative medicine and clinical informatics, thinks spinal injections are used too often for too many things for which there is little evidence they work.

That said, Sibell said he believes there is enough evidence to support their use to treat sciatica, which is among the indications the commission is considering.

That use is currently not recommended for coverage, although the recommendation against coverage is considered weak, whereas the recommendations against coverage in the other indications are strong.

Several private health insurers cover spinal injections, with caveats, for people who experience radiating pain, or sciatica, including Moda Health, Aetna and Cigna, according to commission documents.

Medicare also provides coverage for the injections. It pays about $160 if they take place in an office and about $91 if they take place in a medical facility, according to the American Society of Anesthesiologists.

The commission’s draft guidelines argue in part that the pain relief from the injections is temporary.

In many cases, Sibell argues, so is the pain. Many patients with sciatica feel pain for between two or three months. An injection that lasts six to eight weeks, as these do, would overlap well, he said.

“Having a treatment that helps with pain control during that period is a useful way to help people as they heal,” Sibell said.

So far, a HERC’s subcommittee has had three meetings on the subject. The full commission is scheduled to take up the issue on May 18. At that meeting, it is likely to make a decision for the Medicaid program, as well as issue a recommendation that may influence coverage by private health insurers.

The HERC has made a number of changes in recent years to its coverage for back pain issues. Last July, a new rule took effect that allows more Oregon Health Plan members with low back pain to receive services like physical therapy, chiropractic manipulation, acupuncture or, in the most serious cases, surgery.

It’s part of a broader effort statewide and nationally to decrease the number of Medicaid patients using opioid pain medications.

If injections provide a modest benefit — decreasing their pain by between 30 and 50 percent — then it prevents them from taking opioids, which should be a priority, Buvanendran said.

“I have not seen a single patient die because of injections,” he said, “but I’ve seen them die from opioids. If you can prevent this, I think it’d be a good thing.”

— Reporter: [email protected], 541-383-0304
 
Medicaid unlikely to cover back pain shots

Medicaid unlikely to cover back pain shots: Steroid injections reduce nerve inflammation

By Tara Bannow, The Bulletin, @tarabannow
Published Apr 28, 2017 at 12:09AM

Oregon’s Medicaid program doesn’t cover steroid injections for back pain, and a state commission that determines what’s covered under the program is poised to keep it that way.

The debate over whether the Oregon Health Plan should cover the injections has drawn passionate testimony from patients and physicians alike. Doctors often inject steroids into the spinal column to relieve pain in the back and legs caused by inflamed nerves. The pain often occurs when discs in the spinal column place pressure on adjacent nerves.

In order to approve coverage for the treatment, the state’s Health Evidence Review Commission would need assurance that they improve patients’ long-term and short-term function, reduce their pain and lower their need for surgery later, among other factors. So far, the commission has found little scientific evidence on most of those fronts.

But critics, including both patients and physicians, argue the commission’s process doesn’t allow enough room for patients’ experiences with the injections to shape coverage. Several patients tearfully told commission members at public hearings they wouldn’t have been able to attend without the treatments.

“If you take a normal person like me, I’m evidence,” Tracy Titus, a patient who uses the injections, said at an April 6 meeting on the subject. “I’m here. I’m here because of these injections. I can get up out of bed. I can move around. I can pick things up, something that for a while I couldn’t do.”

Doctors argue pain medicine is a unique specialty that doesn’t easily lend itself to randomized controlled trials, which — while the gold standard of scientific research — require that a set of patients receive a placebo. The HERC relies mainly on randomized controlled trials to make its coverage determinations.

“How would you tell somebody, ‘I’m going to inject your back and put saline inside or sugar water?’” said Dr. Asokumar Buvanendran, an anesthesiology professor at Rush University in Chicago. “That’s very hard to do in these clinical trials nowadays. None of my patients would agree to that.”

In this case, Buvanendran, the chairman of the American Society of Anesthesiologists’ Committee on Pain Medicine, said the results observed in clinical practice should influence the decision, as it’s such a difficult topic to study. He did not testify on the subject, but said in an interview he has been using the injections on patients for 18 years. In his experience, they relieve pain and complications are rare, he said.

The commission is recommending against coverage for steroid injections in several scenarios.

One is into the epidural space around the spinal cord in people with or without pain that extends down into the legs, otherwise known as radiculopathy or sciatica. They’re also considering providing the injections for other types of pain, such as that which originates in the facet joints and sacroiliac joints.

Dr. Cat Livingston, the HERC’s associate medical director, said in an interview she disagrees with the claim that there is inadequate medical evidence on the injections. On the contrary, she said the commission’s review included a wealth of randomized controlled trials featuring thousands of patients, but they did not show strong evidence of improved outcomes.

“There are going to be some conditions in which it’s not possible or it would be very challenging to do a randomized controlled trial,” Livingston said. “This is not one of those conditions. There are many randomized controlled trials that have been done clearly showing that there have been a lot of patients willing to participate in these.”

Dr. David Sibell, a professor in Oregon Health & Science University’s departments of anesthesiology and perioperative medicine and clinical informatics, thinks spinal injections are used too often for too many things for which there is little evidence they work.

That said, Sibell said he believes there is enough evidence to support their use to treat sciatica, which is among the indications the commission is considering.

That use is currently not recommended for coverage, although the recommendation against coverage is considered weak, whereas the recommendations against coverage in the other indications are strong.

Several private health insurers cover spinal injections, with caveats, for people who experience radiating pain, or sciatica, including Moda Health, Aetna and Cigna, according to commission documents.

Medicare also provides coverage for the injections. It pays about $160 if they take place in an office and about $91 if they take place in a medical facility, according to the American Society of Anesthesiologists.

The commission’s draft guidelines argue in part that the pain relief from the injections is temporary.

In many cases, Sibell argues, so is the pain. Many patients with sciatica feel pain for between two or three months. An injection that lasts six to eight weeks, as these do, would overlap well, he said.

“Having a treatment that helps with pain control during that period is a useful way to help people as they heal,” Sibell said.

So far, a HERC’s subcommittee has had three meetings on the subject. The full commission is scheduled to take up the issue on May 18. At that meeting, it is likely to make a decision for the Medicaid program, as well as issue a recommendation that may influence coverage by private health insurers.

The HERC has made a number of changes in recent years to its coverage for back pain issues. Last July, a new rule took effect that allows more Oregon Health Plan members with low back pain to receive services like physical therapy, chiropractic manipulation, acupuncture or, in the most serious cases, surgery.

It’s part of a broader effort statewide and nationally to decrease the number of Medicaid patients using opioid pain medications.

If injections provide a modest benefit — decreasing their pain by between 30 and 50 percent — then it prevents them from taking opioids, which should be a priority, Buvanendran said.

“I have not seen a single patient die because of injections,” he said, “but I’ve seen them die from opioids. If you can prevent this, I think it’d be a good thing.”

— Reporter: [email protected], 541-383-0304

Wait so the injections at 160 per shot provides 2 to 3 months of relief which is "temporary" for sciatica, however, acupuncture gives perm relief? How long does acupuncture last for and for how long?

Its illogical that they cover treatment modalities that offer even SHORTER term relief by that logic. Acupuncture has been proven to stop surgery as well?
 
Medicaid unlikely to cover back pain shots

Medicaid unlikely to cover back pain shots: Steroid injections reduce nerve inflammation

By Tara Bannow, The Bulletin, @tarabannow
Published Apr 28, 2017 at 12:09AM

Oregon’s Medicaid program doesn’t cover steroid injections for back pain, and a state commission that determines what’s covered under the program is poised to keep it that way.

The debate over whether the Oregon Health Plan should cover the injections has drawn passionate testimony from patients and physicians alike. Doctors often inject steroids into the spinal column to relieve pain in the back and legs caused by inflamed nerves. The pain often occurs when discs in the spinal column place pressure on adjacent nerves.

In order to approve coverage for the treatment, the state’s Health Evidence Review Commission would need assurance that they improve patients’ long-term and short-term function, reduce their pain and lower their need for surgery later, among other factors. So far, the commission has found little scientific evidence on most of those fronts.

But critics, including both patients and physicians, argue the commission’s process doesn’t allow enough room for patients’ experiences with the injections to shape coverage. Several patients tearfully told commission members at public hearings they wouldn’t have been able to attend without the treatments.

“If you take a normal person like me, I’m evidence,” Tracy Titus, a patient who uses the injections, said at an April 6 meeting on the subject. “I’m here. I’m here because of these injections. I can get up out of bed. I can move around. I can pick things up, something that for a while I couldn’t do.”

Doctors argue pain medicine is a unique specialty that doesn’t easily lend itself to randomized controlled trials, which — while the gold standard of scientific research — require that a set of patients receive a placebo. The HERC relies mainly on randomized controlled trials to make its coverage determinations.

“How would you tell somebody, ‘I’m going to inject your back and put saline inside or sugar water?’” said Dr. Asokumar Buvanendran, an anesthesiology professor at Rush University in Chicago. “That’s very hard to do in these clinical trials nowadays. None of my patients would agree to that.”

In this case, Buvanendran, the chairman of the American Society of Anesthesiologists’ Committee on Pain Medicine, said the results observed in clinical practice should influence the decision, as it’s such a difficult topic to study. He did not testify on the subject, but said in an interview he has been using the injections on patients for 18 years. In his experience, they relieve pain and complications are rare, he said.

The commission is recommending against coverage for steroid injections in several scenarios.

One is into the epidural space around the spinal cord in people with or without pain that extends down into the legs, otherwise known as radiculopathy or sciatica. They’re also considering providing the injections for other types of pain, such as that which originates in the facet joints and sacroiliac joints.

Dr. Cat Livingston, the HERC’s associate medical director, said in an interview she disagrees with the claim that there is inadequate medical evidence on the injections. On the contrary, she said the commission’s review included a wealth of randomized controlled trials featuring thousands of patients, but they did not show strong evidence of improved outcomes.

“There are going to be some conditions in which it’s not possible or it would be very challenging to do a randomized controlled trial,” Livingston said. “This is not one of those conditions. There are many randomized controlled trials that have been done clearly showing that there have been a lot of patients willing to participate in these.”

Dr. David Sibell, a professor in Oregon Health & Science University’s departments of anesthesiology and perioperative medicine and clinical informatics, thinks spinal injections are used too often for too many things for which there is little evidence they work.

That said, Sibell said he believes there is enough evidence to support their use to treat sciatica, which is among the indications the commission is considering.

That use is currently not recommended for coverage, although the recommendation against coverage is considered weak, whereas the recommendations against coverage in the other indications are strong.

Several private health insurers cover spinal injections, with caveats, for people who experience radiating pain, or sciatica, including Moda Health, Aetna and Cigna, according to commission documents.

Medicare also provides coverage for the injections. It pays about $160 if they take place in an office and about $91 if they take place in a medical facility, according to the American Society of Anesthesiologists.

The commission’s draft guidelines argue in part that the pain relief from the injections is temporary.

In many cases, Sibell argues, so is the pain. Many patients with sciatica feel pain for between two or three months. An injection that lasts six to eight weeks, as these do, would overlap well, he said.

“Having a treatment that helps with pain control during that period is a useful way to help people as they heal,” Sibell said.

So far, a HERC’s subcommittee has had three meetings on the subject. The full commission is scheduled to take up the issue on May 18. At that meeting, it is likely to make a decision for the Medicaid program, as well as issue a recommendation that may influence coverage by private health insurers.

The HERC has made a number of changes in recent years to its coverage for back pain issues. Last July, a new rule took effect that allows more Oregon Health Plan members with low back pain to receive services like physical therapy, chiropractic manipulation, acupuncture or, in the most serious cases, surgery.

It’s part of a broader effort statewide and nationally to decrease the number of Medicaid patients using opioid pain medications.

If injections provide a modest benefit — decreasing their pain by between 30 and 50 percent — then it prevents them from taking opioids, which should be a priority, Buvanendran said.

“I have not seen a single patient die because of injections,” he said, “but I’ve seen them die from opioids. If you can prevent this, I think it’d be a good thing.”

— Reporter: [email protected], 541-383-0304


http://www.oregon.gov/oha/herc/Docu...ort to Governor and Legislature, May 2015.pdf

According to this document, since at LEAST 2015, Oregon Medicaid wasn't covering most stuff already including facets, SIs, Kypho, RF, etc.

They look like they covered vertebro a little? I can't tell about SCS.
 
Medicaid unlikely to cover back pain shots

Medicaid unlikely to cover back pain shots: Steroid injections reduce nerve inflammation

By Tara Bannow, The Bulletin, @tarabannow
Published Apr 28, 2017 at 12:09AM

Oregon’s Medicaid program doesn’t cover steroid injections for back pain, and a state commission that determines what’s covered under the program is poised to keep it that way.

The debate over whether the Oregon Health Plan should cover the injections has drawn passionate testimony from patients and physicians alike. Doctors often inject steroids into the spinal column to relieve pain in the back and legs caused by inflamed nerves. The pain often occurs when discs in the spinal column place pressure on adjacent nerves.

In order to approve coverage for the treatment, the state’s Health Evidence Review Commission would need assurance that they improve patients’ long-term and short-term function, reduce their pain and lower their need for surgery later, among other factors. So far, the commission has found little scientific evidence on most of those fronts.

But critics, including both patients and physicians, argue the commission’s process doesn’t allow enough room for patients’ experiences with the injections to shape coverage. Several patients tearfully told commission members at public hearings they wouldn’t have been able to attend without the treatments.

“If you take a normal person like me, I’m evidence,” Tracy Titus, a patient who uses the injections, said at an April 6 meeting on the subject. “I’m here. I’m here because of these injections. I can get up out of bed. I can move around. I can pick things up, something that for a while I couldn’t do.”

Doctors argue pain medicine is a unique specialty that doesn’t easily lend itself to randomized controlled trials, which — while the gold standard of scientific research — require that a set of patients receive a placebo. The HERC relies mainly on randomized controlled trials to make its coverage determinations.

“How would you tell somebody, ‘I’m going to inject your back and put saline inside or sugar water?’” said Dr. Asokumar Buvanendran, an anesthesiology professor at Rush University in Chicago. “That’s very hard to do in these clinical trials nowadays. None of my patients would agree to that.”

In this case, Buvanendran, the chairman of the American Society of Anesthesiologists’ Committee on Pain Medicine, said the results observed in clinical practice should influence the decision, as it’s such a difficult topic to study. He did not testify on the subject, but said in an interview he has been using the injections on patients for 18 years. In his experience, they relieve pain and complications are rare, he said.

The commission is recommending against coverage for steroid injections in several scenarios.

One is into the epidural space around the spinal cord in people with or without pain that extends down into the legs, otherwise known as radiculopathy or sciatica. They’re also considering providing the injections for other types of pain, such as that which originates in the facet joints and sacroiliac joints.

Dr. Cat Livingston, the HERC’s associate medical director, said in an interview she disagrees with the claim that there is inadequate medical evidence on the injections. On the contrary, she said the commission’s review included a wealth of randomized controlled trials featuring thousands of patients, but they did not show strong evidence of improved outcomes.

“There are going to be some conditions in which it’s not possible or it would be very challenging to do a randomized controlled trial,” Livingston said. “This is not one of those conditions. There are many randomized controlled trials that have been done clearly showing that there have been a lot of patients willing to participate in these.”

Dr. David Sibell, a professor in Oregon Health & Science University’s departments of anesthesiology and perioperative medicine and clinical informatics, thinks spinal injections are used too often for too many things for which there is little evidence they work.

That said, Sibell said he believes there is enough evidence to support their use to treat sciatica, which is among the indications the commission is considering.

That use is currently not recommended for coverage, although the recommendation against coverage is considered weak, whereas the recommendations against coverage in the other indications are strong.

Several private health insurers cover spinal injections, with caveats, for people who experience radiating pain, or sciatica, including Moda Health, Aetna and Cigna, according to commission documents.

Medicare also provides coverage for the injections. It pays about $160 if they take place in an office and about $91 if they take place in a medical facility, according to the American Society of Anesthesiologists.

The commission’s draft guidelines argue in part that the pain relief from the injections is temporary.

In many cases, Sibell argues, so is the pain. Many patients with sciatica feel pain for between two or three months. An injection that lasts six to eight weeks, as these do, would overlap well, he said.

“Having a treatment that helps with pain control during that period is a useful way to help people as they heal,” Sibell said.

So far, a HERC’s subcommittee has had three meetings on the subject. The full commission is scheduled to take up the issue on May 18. At that meeting, it is likely to make a decision for the Medicaid program, as well as issue a recommendation that may influence coverage by private health insurers.

The HERC has made a number of changes in recent years to its coverage for back pain issues. Last July, a new rule took effect that allows more Oregon Health Plan members with low back pain to receive services like physical therapy, chiropractic manipulation, acupuncture or, in the most serious cases, surgery.

It’s part of a broader effort statewide and nationally to decrease the number of Medicaid patients using opioid pain medications.

If injections provide a modest benefit — decreasing their pain by between 30 and 50 percent — then it prevents them from taking opioids, which should be a priority, Buvanendran said.

“I have not seen a single patient die because of injections,” he said, “but I’ve seen them die from opioids. If you can prevent this, I think it’d be a good thing.”

— Reporter: [email protected], 541-383-0304

Also according to their surgical guidelines, Oregon hasn't been paying for ANY fusion surgeries since at least 2015 and will only pay for a "decompression" surgery for "moderate to severe spinal stenosis with neurogenic signs that are objectively noted".

So I don't think surgeons will be keenly taking Medicaid in Oregon outside of academic centers.
 
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