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Little, MD, MPHHISTORYCommission created in 1989 Directed to  report to the Governor a list of health services& ranked by priority, from the most important to the least important, representing the comparative benefits of each service to the entire population to be served HISTORY, cont.rCommission composed of: 5 Physicans (one D.O.) 1 Public Health Nurse 1 Social Services Worker 4 Consumer Advocates&[[ PHISTORY, cont.$f DETERMINING PLACEMENT OF A NEW OR REPRIORITIZED CONDITION/TREATMENT PAIR Proceed through steps #1-#5 until an appropriate ranking is determined. 1) Ability of Treatment to Prevent Death 2) Lifetime Cost of Treatment Per Patient (in case of ties under #1) 3) Adjustment According to Public Values (if #1 and #2 do not result in an appropriate ranking). Family Planning Services (place in 10th -15th percentile of List) Maternity and Newborn Care (place in 10th - 15th percentile) General Preventive Services (place in 20th - 25th percentile) Comfort Care (place in 35th - 40th percentile) Public Health Risk (place in 40th - 45th percentile) Self-Limiting Conditions (place in 85th - 90th percentile) Cosmetic Services (place in 90th - 95th percentile) Medical Ineffectiveness (place in 95th - 100th percentile) Early Treatment Prevents Progression to Serious Disease (place just above disease being prevented) Early Treatment Prevents Serious Complications/Future Costs (move up 50 percentile points from the ranking determined by #1 and #2 if the condition is not potentially fatal and 25 percentile points if it is a nonfatal condition) 4) Place Within Range of 5 Percentile Points from #1-#3 Based On Similarity of Organ System, Etiology, and/or Treatment Outcomes (congruency) 5) Line Placement Based on Commission Judgment (when #1- #4 do not result in appropriate ranking)PPPPPP      $PRIORITIZED LIST OF HEALTH SERVICES %% PRIORITIZED LIST OF HEALTH SERVICES APRIL 14, 2003 Diagnosis: SEVERE/MODERATE HEAD INJURY: HEMATOMA/EDEMA WITH LOSS OF CONSCIOUSNESS Treatment: MEDICAL AND SURGICAL TREATMENT ICD-9: 850.1-850.5,851.02-851.06,851.1,851.22-851.26,851.3,851.42-851.46,851.5,851.62- 851.66,851.7,851.82-851.86,851.9 CPT: 61108,61313-61316,62140-62141,62148,90471-90472,90780-90799,90901-90937,90945-92060, 92070-92353,92358-92371,92502-92508,92511-92960,92970-92977,93000-95075,95115-95999, 96100-96117,96400-97004,97010-97537,97601-97750,97799,99025,99050-99054,99058-99078, 99175,99185-99362,99374-99375,99379-99440,99499 Line: 1 Diagnosis: TYPE I DIABETES MELLITUS Treatment: MEDICAL THERAPY ICD-9: 250.01,250.03,250.11,250.13,250.21,250.23,250.31,250.33,250.61,250.63,250.91,250.93, 251.3 CPT: 90471-90472,90780-90799,90901-90937,90945-92060,92070-92353,92358-92371,92502-92508, 92511-92960,92970-92977,93000-95075,95115-95999,96100-96117,96400-97004,97010-97537, 97601-97750,97799,99025,99050-99054,99058-99078,99175,99185-99362,99374-99375,99379- 99440,99499 HCPCS: G0245-G0246,S9145 Line: 2 Diagnosis: PERITONITIS Treatment: MEDICAL AND SURGICAL TREATMENT ICD-9: 567,569.83,777.6 CPT: 10180,44120,44602,44626,49021,49040-49061,49080-49081,49420,49423-49424,90471-90472, 90780-90799,90901-90937,90945-92060,92070-92353,92358-92371,92502-92508,92511-92960, 92970-92977,93000-95075,95115-95999,96100-96117,96400-97004,97010-97537,97601-97750, 97799,99025,99050-99054,99058-99078,99175,99185-99362,99374-99375,99379-99440,99499 Line: 3"P 8ALGORITHM FOR INCORPORATING NEW TECHNOLOGY INTO THE LIST99The HSC will examine pooled data from one of the recognized sources/websites Exceptions may be made for rare diseases The HSC will consider new sources/websites as they are identified Evidence regarding the effectiveness of a treatment will be used according to the algorithm to the right: The cost of a technology will be considered according to the grading scale below, with  A representing compelling evidence for adoption,  B representing strong evidence for adoption,  C representing moderate evidence for adoption,  D representing weak evidence for adoption and  E being compelling evidence for rejection: A = more effective and cheaper than existing technology B = more effective and costs less than $25,000/LYS or QALY more than existing technology C = more effective and costs $25,000 to $125,000/LYS or QALY more than existing technology D = more effective and costs more than $125,000/LYS or QALY more than existing technology E = less or equally as effective and more costly than existing technology"Z  /      0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> $(    6p  `}  T Click to edit Master title style! !  0\Õ  `  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0(ʕ ^ `  X*  0`ϕ ^   Z*  0@ԕ ^ `  Z*H  0޽h ? 3380___PPT10.`_j Default Design 0 zr$ (  $ $ 0ܙD P   D P*   $ 0ԞD    D R*  d $ c $ ?  D $ 0D  0 D RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S $ 6dD _P  D P*   $ 6DD _  D R*  H $ 0޽h ? 3380___PPT10.)ЌZ} 0  $(  r  S x8D> D r  S P9D `   D H  0޽h ? 33___PPT10i.Pl+D=' a= @B +}  0 0 $(   r  S D `}  D r  S TD ` D H  0޽h ? 33___PPT10i.`l*O+D=' a= @B +}  0 `$(  r  S < `}   r  S x `  H  0޽h ? 33___PPT10i.#;X+D=' a= @B +}  0 @$(  r  S X!a `  a r  S 0"a ` a H  0޽h ? 33___PPT10i. y)+D=' a= @B +}  0 P$(  r  S TEa `}  a r  S La ` a H  0޽h ? 33___PPT10i.#`܈@+D=' a= @B +1  0 H@p(  r  S ya `}  a x  c $xza  a  0 ZA ?AA ?p `1  aH  0޽h ? 33___PPT10i.$plU_+D=' a= @B + 0 "((  (X ( C $   D ( S D$ 0  D ~The Work of the Health Services Commission Prioritizing Benefits; a presentation to the Citizens Health Care Working Group, in Portland, OR, September 23, 2005, by Alison S. Little, MD, MPH. )H ( 0޽h ? 3380___PPT10.)PZ 0 ,(  ,X , C $   a , S Юa$ 0  a History of the Commission: it was created in 1989; it was directed to  report to the Governor a list of health services& ranked by priority, from the most important to the least important, representing the comparative benefits of each services t the entire population to be served. There are currently 710 such ranked service items.H , 0޽h ? 3380___PPT10.)bZ 0 0(  0X 0 C $   a 0 S a$ 0  a The Commission is composed of 5 physicians (including one Doctor of Osteopathy), a public health nurse, a social services worker and four consumer advocates.H 0 0޽h ? 3380___PPT10.)Z  0 \ T 4(  4X 4 C $   aT 4 S $a$ 0z  abZ___PPT9<4 To determine the ranking of a new or reprioritized condition-treatment pair, up to five steps of an analysis are carried out until an appropriate ranking is determined: What is the ability of the treatment to prevent death? What is the lifetime cost of treatment per patient (used in cases of ties under #1) If #1 and #2 don t result in an appropriate ranking, an adjustment is made according to public values considering: Family planning services Maternity and newborn care General preventive services Comfort care Public health risk Self-limiting conditions Cosmetic services Medical ineffectieness Early treatment prevents progression to serious disease Place within range of 5 percentile points of #1-#3 based on similarity of organ system, etiology, and/or treatment outcomes Line placement based on commission judgment (when #1-#4 don t result in appropriate ranking)\" "  KH 4 0޽h ? 3380___PPT10.)p}Z 0  8(  8X 8 C $   a 8 S a$ 0  a eEach year, the list is reviewed and revised based on input from the public, advocates, and providers.[ H 8 0޽h ? 3380___PPT10.)Z 0 <(  <X < C $   a < S  a$ 0  a yThe Commission used an algorithm for incorporating new technology into the list that involves several interrelated steps.sH < 0޽h ? 3380___PPT10.)Zx] |TŹ9gc> /yW !Zl dcAjJV|z{[^+jk! 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