Michigan providers battle payers over palliative care
Michigan pain bill could have implications for you
When the Ann Arbor-based Michigan Council on Pain conducted a study to assess the state of pain management in Michigan, the council’s chair, Joel Saper, MD, was disturbed by what it found.
The study determined that HMOs and other managed care organizations were routinely and arbitrarily denying coverage for legitimate pain management procedures, and denying patients access to medical centers specializing in palliative care, says Saper, a neurologist and director of the Ann Arbor-based Michigan Pain and Neurological Institute.
Further, the study found that medical schools and postgraduate training programs were providing medical students with inadequate education regarding pain management. As a result, most physicians learn about pain treatment on their own, without benefit of formal data, says Saper. "They sort of do it by hunch," he says. "They give a painkiller here and a painkiller there."
Largely as a result of this lack of formal education on the subject, many physicians have taken a "cynical attitude toward the patient with pain," he adds, an attitude often reflected by payers. The existence of "sham clinics" and provider abuse in the area of pain management also has made payers wary. "You know, patients going down assembly lines of nerve blocks. Nobody managed the depression. Nobody dealt with the other needs of a patient in pain. And then when they were done collecting the money, the patient was pushed out the back door."
Such instances of provider abuse have made patients with intractable pain among the most vulnerable to being denied access to care, says Saper.
In light of the study’s findings, Saper worked with Michigan legislators to craft a pain management bill designed to rectify the problem of inadequate pain management in the state. The bill contains the following four points:
• Patients will be allowed access to centers of advanced care if they have intractable pain for six months or more and have failed to respond to treatment in their own system or community.
• Managed care plans will be forced to cover that care.
• A permanent pain commission will be established, consisting of providers and nonproviders, to monitor the quality of pain care in the state.
• The state’s system of tracking the prescription of opiates will be modified.
"Right now, we have computer tracking of all opiates, and doctors are frightened to use them to treat patients," says Saper. "We don’t want doctors to be intimidated."
Sponsors of the bill have formed an interesting coalition of supporters, in part because Michigan is home to Jack Kevorkian, MD, says Saper. Many, including the Catholic Church in Michigan, have begun to view pain care as an important opportunity to counteract the call for physician-assisted suicide. "Such large numbers of patients who have sought him have done so strictly for pain," Saper adds.
Opposition has come largely from insurance companies, but with 50 co-signers and bipartisan support in the legislature, Saper is confident the bill will pass sometime this year. If it does, Saper predicts other states will emulate Michigan’s example. "There’s no doubt that Michigan is being viewed as the state to watch," he says.
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