Mother Nature Meets The Federal Government: Exploring how the Affordable Care Act affects Naturopathic Doctors

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Most people probably don’t realize that the federal Affordable Healthcare Act (HR3590) includes provisions preventing discrimination of alternative medicine. This could have a big affect on the Naturopathic Doctors (NDs) on Maui.

“That will be the largest single event to impact our profession in years,” says Lorilee Schoenbeck–a board member of the American Association of Naturopathic Physicians (AANP)–in an article published by Bastyr University. “It’s a change our nation needs. Our health care system needs prevention-oriented, low-cost primary care that’s effective for chronic illness. There’s no profession that does that better than us.”

Hawaii is one of the 16 states that already regulates naturopathic medicine. Many NDs in the state are a part of the professional association representing licensed practitioners, the Hawaii Society of Naturopathic Physicians (HSNP). Hawaii also licenses massage therapists, acupuncturists and chiropractors in the state, all of which could all benefit from the non-discrimination clause in the new health insurance law. But at this points, there are no guarantees.

“Section 2706 of the Affordable Care Act is an inclusion law, and essentially states that insurance companies have to cover complementary and alternative care (CAM) if the practitioner is a licensed healthcare provider in their state,” says Marsha Lowery, a Maui ND and member of the HSNP. “Unfortunately this has been left up to interpretation by insurance companies and there have been many last minute changes to the ACA. Currently it only affects newly purchased plans that are in compliance with the ACA. It excludes Medicare, Medicaid (QUEST) and grandfathered plans.”

A review of the Hawaii plans available shows HMAA and HMSA are offering plans with ND coverage in some capacity. The state-offered Quest program is not covering NDs or their treatments. Kaiser has some plans that cover limited acupuncture and massage with referrals from their general practitioners. American Specialty Health has additional coverages you can buy to layer over Kaiser and HMSA that cover NDs. Some plans utilize an “in network” list of practitioners you choose from, others are more open. There are tons of variation in the system as to what’s covered, when and for how much.

Part of the problem may be consumer education. I was lost when trying to put my finger on exactly what the term “naturopathic medicine” actually means.

“Our scope is very broad, and individual practitioners may focus on a particular population of patients, or specialize in a specific treatment modality,” says Lowery. “An ND in Hawaii has the ability to order labs and imaging. We also may prescribe vitamins, supplements, herbs, hormones, and also pharmaceuticals when necessary. Treatment modalities that are used in office may include IV therapy, physical therapy, lasers, minor surgery, bodywork, counseling and adjustments to joints.”

Lowery says the new law could cover lab fees and prescribed medicines, too. Dr. Nathan Ehrlic of Ola Ha Holistic Health Clinic is also a licensed ND and an HSNP member since 1989. He says he takes a variety of private health insurance plans, motor vehicle insurance and workman’s compensation insurance as well. He treats patients for a wide range of issues, but says he specializes on regenerative medicine and sports medicine at his general practice.

“I see many patients with musculoskeletal problems of the spine and extremities,” says Ehrlic. “I utilize various types of manual therapies combined with spinal re-alignments, regenerative injection therapies, including prolotherapy such as autologous platelet and mesenchymal stem cell treatments, and peripheral regenerative nerve therapy (neural prolotherapy). I work with weight loss, detoxification, immunoptimization, diet planning, bio-identical hormone therapy. I primarily utilize botanical and nutritional therapy.”

Lowery says one of the most obvious differences between an ND and an MD is the length of time an ND will spend with a patient. A majority of her patients are women with changes in mood, hormonal issues, digestion complaints, pain and inflammation, weight gain or low energy levels. She also has pediatric patients for acute care and well-child visits.

“My initial visit with a patient is typically about an hour,” Lowery says of her practice in the Grace Health Center in Makawao. “We cover a lot during that visit, and it’s what allows me to treat the whole person and to really address the underlying cause of their problem.”

Erhlich says his patients are a mix of visitors and residents, old and young. The philosophy of naturopathic medicine and holistic arts made an impression as a premed student of a conservative medical institution. He says for him the undergrad med school work foundation of chemistry and biology fused seamlessly into the botanical and psychology training at the National College of Naturopathic Medicine in Portland.

“The Healing Power of Nature (Vis Medicatrix Naturae): this is one of the main principles of naturopathic  medicine where we as physicians believe that inherent in the patient is the ability for the body to heal itself and that, in fact, what is often thought of by conventional medicine as disease is often the expression of this principle through homeostatic processes aimed at correcting imbalances in the host physiology,” says Erhlich. “Finding and treating the true cause of pathology is then valued more than simply treating symptoms. Naturopathic physicians emphasize prevention and health optimization. We feel the best medicine is in cultivation of a healthy lifestyle.”

Naturopathic doctors are just one aspect of complementary and alternative care (CAM). There are also State of Hawaii-licensed acupuncturists, massage therapists and chiropractors that would fall under the anti-discrimination law. That leaves many other practitioners in a gray area that do not have a licensing board in the State’s Department of Commerce and Consumer Affairs Vocational Licensing Division.

Kabba Anand, the former president of the Hawaii Acupuncture Association and the only acupuncture practitioner on the Allied Medical Staff at Maui Memorial Medical Center, says the new law doesn’t affect his practice. He only accepts workers’ compensation and no-fault insurance at this time. He helps visitors and residents with symptoms associated with exposure to vog, including headache, cough, sore throat, itchy eyes, sneezing, fatigue and asthmatic symptoms. He’s also behind a proprietary blend of Chinese herbs he sells as “Vog Defense” for the past 16 years.

“According to ‘traditional’ Chinese medicine our bodies are comprised of yin and yang, which must be in balance for optimum health,” says Anand. “Qi circulates through specific channels, and can be stimulated through specific sites or points, with very fine sterile needles, in order to balance yin and yang, thus maintaining and improving health, healing and function.”

As for Reiki Master Jason Coughlin, he says he doesn’t take insurance. But Reiki isn’t a practice licensed in the state, which means it not included in the new law. An ancient Tibetan healing practice, Reiki soothes the body’s energy center with the endocrine system, also known as the chakras. He says a session lasts around an hour.

“There’s the ‘laying of hands direct in person Reiki’ but Reiki can also be sent ‘remotely,’” says Coughlin. “The universe is one big ball of energy. Everything, every molecule is touching each other. All cells are vibrating like music. Due to stress, life choices, injuries, diet etc. our energy centers can become blocked and we don’t vibrate at the right frequency we could be. We are like tuning forks. Reiki helps a person re-attain their optimum energy ‘music.’”

For Dr. Jim Roth, who runs Roth Chiropractic, the title of doctor is not taken lightly, and he says there are responsibilities that go along with his licensing process from the state. Roth feels Obama Care will allow more access to care, and his practice accepts all forms of insurance.

“We are given the responsibility and honor to diagnose conditions and are held by state law to follow the correct protocol,” says Dr. Roth. “This is what separates chiropractors from other health providers including massage therapists and acupuncturists. Results generate word-of-mouth referrals. Additionally, I ‘partner’ with the patient, allowing them to choose their best options for care. We define their goal. If it’s pain relief, we first determine if we’re the appropriate choice. If we’re not (trained to differential diagnosis), we refer to the proper health provider. If I can help, we strive to reach their goal ASAP. The key to this is a good, thorough initial exam and X-rays if necessary. Often people experience pain and ‘get a massage’ when perhaps the pain was actually a warning sign of something far more serious. This is where the general public is confused.”

This year may see a jump in naturopathic medicine, but policy watchers say it could go either way at this point. Maui practitioners are varied, confused and on the fence as to whether it will affect their business. At the national level, the naturopathic industry feels confident it’s made strides with the law.

“Insurers may not discriminate, but they certainly can dictate the number of NDs who they empanel and the scope of care they provide,” says Karen E Howard, Executive Director of the AANP, on that organization’s website. “Opportunities may continue to be tied to the tightly defined provisions for Medicare and Medicaid. Regulations could be drafted by federal employees with little or no knowledge of naturopathic medicine. Boards and Commissions could be populated by those with strong political ties vs. strong consumer ties. And yet–new doors are open and the real work of transforming our healthcare system can start! Funding bills, regulatory processes, appointments, and changes to insurance laws offer up the opportunity to influence. And influence we will.”

 

For more information on the Hawaii Society of Naturopathic Physicians (HSNP) go to hawaiind.org. For the American Association of Naturopathic Physicians (AANP) go to naturopathic.org.