As of Friday, January 10, 2014
A national petition having gone viral garnering more than 600 signatures (http://chn.ge/1aua7js), highlights a concerted effort by clinicians, patients and advocates who are asking a subcommittee of the Oregon Health Authority’s Health Evidence Review Commission to allow Oregon Medicaid to cover diagnosis and treatments for fibromyalgia. Oregon is the only U.S. state that excludes Medicaid coverage of fibromyalgia.
Dr. David Russo of Hood River presented this statement Thursday to the OHA:
I’m writing in response to Oregon Health Authority/HERC Value-based Sub-Committee’s biennial review of fibromyalgia syndrome (FMS) and to offer a critique of the committee’s current priority scoring of the condition.
I am one of five pain management providers at Columbia Pain Management PC.
Grounded in a team-based physiatric (physical medicine and rehabilitation) model of care, our mission is to provide state-of-the-art comprehensive (pharmacologic, non-pharmacologic and behavioral) care to residents in rural areas suffering from acute and chronic pain conditions.
Under-served rural Oregonians are routinely referred to our Center for consultation and recommendations for the long-term management of chronic wide spread pain syndromes such as fibromyalgia.
Due to lack of awareness, limited provider-training opportunities, and/or misperceptions about the nature of fibromyalgia, it is not uncommon for us to see fibromyalgia patients who have been misdiagnosed as malingering, drug-seeking, or suffering from somatoform disorders; have been mismanaged by being inappropriately started on chronic opioid therapy; or have received duplicative and redundant medical services.
It is imperative that the committee incorporate new scientific data about the pathophysiology of FMS in order to recognize it as a serious chronic neurological disease and not a nonspecific soft tissue disorder.
The current classification still reflects an earlier understanding of FMS as a soft-tissue disorder. This has been demonstrated to be false. There is no soft tissue lesion. There is no biological marker of soft tissue inflammation or disruption.
Recent basic and translational neuroscience unequivocally demonstrates that FMS is a primary neurological disorder.
Early detection of FMS in the natural history of the disease coupled with appropriate longitudinal care prevents downstream complications such as depression, disability, and unnecessary medical care (laboratory investigation, diagnostic imaging, etc). Early detection and treatment of FMS depends upon a variety of rehabilitation interventions and lifestyle modification — just like diabetes, asthma, hypertension, bipolar/schizophrenia and other conditions classified in the same category.
Moreover, it is imperative that the committee understand that the pathophysiology of FMS is molecularly, neurologically and conceptually distinct from other common co-morbid conditions and should not rely upon happenstance to ensure that patients with fibromyalgia can access medical service for FMS via other prioritized conditions or that patient’s with FMS are merely patients with depression who “hurt all over.”
In summary, FMS is a primary chronic neurological condition that presents with diffuse wide-spread pain. Absent early detection and longitudinal monitoring, patients with FMS are at risk for development of significant secondary psychiatric and disability-related complications.
The effective treatment of FMS requires a disease management paradigm, conscientious care coordination, specific rehabilitation interventions and longitudinal surveillance in order to slow or reverse the burden of disability.
Every state Medicaid Program, except Oregon, has made FMS a covered condition for its beneficiaries. As such, I hope that the committee will take affirmative action and re-score FMS.
CPM is a regional comprehensive and interventional pain management center based in Hood River, with satellite facilities in The Dalles, and Hermiston, serving over 70,000 people in five counties bordering the Columbia River.