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“Local Chiropractor Advises Medicaid Bill”

The Eastern Ohio Chiropractic Society would like to highlight a recent article published by the Tribune Chronicle of Warren, Ohio. The article (below), featuring EOCS’s own, Dr. Patrick Ensminger, outlines the importance of a recently introduced bill that would not only help those insured by Medicaid, but also help the fight against the ongoing opioid epidemic.

WARREN — A Howland chiropractor said a bill introduced Thursday by a Franklin state representative that would increase the availability of chiropractic services for those insured through Medicaid is an effort to curb addiction-causing opioid prescriptions.

Prescribing pain medication to cover up chronic pain, rather than paying to treat the cause, is still the preferred method of operation for insurance companies — including Medicaid — according to a report compiled by the Ohio State Chiropractic Association Opioid Task Force.

Dr. Patrick Ensminger of Howland co-chairs the task force.

Chiropractic methods, when given enough time and sessions, can solve the root cause of pain, whereas commonly prescribed opioid drugs do nothing to solve the cause of pain and increase a person’s risk of becoming dependent on opioids, Ensminger said.

The task force has been working since 2017 — when the rate of accidental drug overdose deaths hit record-breaking numbers in Trumbull County and other Ohio communities — to educate and advocate for alternative approaches to pain therapy.

The efforts continue with a bill introduced by Republican state Rep. Scott Lipps of Franklin.

“There are many Medicaid recipients in our Valley and throughout Ohio. Though it’s true that the Medicaid system has taken active steps to reduce abusive opioid prescribing, studies have shown that numerous Medicaid providers continue to overprescribe and put their Medicaid patients, including children, at risk,” Ensminger said.

A U.S. Department of Health and Human Services’ Office of Inspector General study on opioid prescriptions in Ohio found 40,500 Ohio children were prescribed opioids between June 2016 and May 2017, which was the length of the federal study.

“Research shows that even using prescription opioids for legitimate purposes before high school graduation is associated with increased risk of future opioid misuse,” the report states.

The bill could save the Medicaid program in Ohio $32 to $65 million per year, if fully implemented, according to an analysis by the Ohio State Chiropractic Association, the parent organization of the task force.

“This is because chiropractic assessment begins with relatively low-cost consultation, examination and possible x-rays to confirm diagnosis and rule out dangerous red flags,” Ensminger said. “Comparatively, traditional health care frequently involves a referral for an expensive specialist evaluation or advanced and expensive imaging, such as an MRI. When the patient does not respond to medications, which are frequently ineffective, they are then assessed for back surgeries, which are enormously expensive and also frequently ineffective.”

The bill comes as other groups and organizations attempt to reduce opioid prescriptions in other ways.

In Akron, Summa Health System drastically reduced the use of opioids in surgeries at all of its hospitals as a direct result of the opioid crisis, according to a news report by Cleveland’s Fox 8.

In 2017, Summa used narcotics in 98 percent of procedures, but now that number stands at 20 percent, the report states.

“My goal is to eliminate the opiates from what we do in the operating room completely,” Dr. Thomas Mark, chairman of the anesthesiology department at Summa Health, told Fox 8.

Summa is using regional blocks with local anesthetic that can last 24 to 36 hours, a continuous peripheral nerve block that can deliver medication directly to an affected area of the body, or a combination of over-the-counter pills, therapy and a pain management approach, the news station reported.

But, there are still pharmaceutical companies promoting opioid products that specifically target and market to high-level prescribers, just as the companies did to raise the presence of drugs like OxyContin in medicine cabinets across the country, Ensminger said. Several of the companies are being sued by communities across Ohio, including Trumbull County.

The complaints claim the companies inappropriately seduced doctors into prescribing large amounts of their pills — causing addiction, deaths and expensive public responses — while hiding the addictive nature of the drugs.

Despite guidelines calling for more careful prescribing behavior from physicians, one in six Medicaid beneficiaries in Ohio in 2016 and 2017 received an opioid prescription, according to the federal report.

Before the pain pill industry took off three decades ago, medical experts were having good results managing pain with non-drug methods — like exercise, nutrition, counseling and physical therapy, Ensminger said. But the insurance companies at the time perceived the methods as more expensive than opioids and other drugs, Ensminger said.

“Our bill, when passed, will seek to eliminate major barriers that still exist toward greater Medicaid recipient use of chiropractic care. It would require Medicaid to cover all chiropractic services,” Ensminger said.

For example, Medicaid doesn’t cover the initial patient examination even though it is “absolutely necessary” to treat the patient, Ensminger said.

“In almost all cases, this is a person of very limited finances who, when told they will have to pay for the non-covered examination, is likely to give up and go to a general practitioner or the emergency room where it’s likely they will be given potentially addictive medications and scheduled for expensive specialist appointments or specialized imaging such as MRIs which greatly add to the cost of care,” Ensminger said.

The bill also would require Medicaid to reimburse chiropractors at the same rate of other physicians to encourage more of them to participate in the Medicaid network and give the insured more options, Ensminger said.

Critics say efforts to reduce opioid prescribing make it difficult for people who rely on the medication to get through their day.

While the word chiropractor is often synonymous with back pain, the doctors are not limited to treating back issues. Chiropractic solutions work on muscular, skeletal and nerve issues all over the entire body, and on injuries old and new. Chiropractors work to restore functions and reduce pain, focusing on getting the patient back to “normal,” Ensminger said.

And despite common misconceptions, chiropractors are doctors. They have the same licenses and ability to provide primary care services as a family doctor. Chiropractors can order tests and recommend other types of specialists if needed. Treatment plans vary for every individual, but patients are often seen for four to six weeks, reassessed and then continue with more or less frequent visits.

All credit to the above article goes to the Tribune Chronicle of Warren, Ohio and reporter Renee Fox – rfox@tribtoday.com.

The original posting from February 24, 2019 can be found here.