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by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Harkin pushes back on HHS for broader interpretation of “non-discrimination in healthcare” – Section 2706

IUS Senator Tom Harkin has used the appropriations bill for the U.S. Department of Health and Human Services (HHS) to refute an extremely limiting HHS interpretation of the application of the “non-discrimination in healthcare” provision (Section 2706) of the Affordable Care Act. Harkin’s language, injected into page 126 of this committee report from the Senate Health Education Labor and Pensions (HELP) Committee, restates his intent in placing Section 2706 in the Affordable Care Act. This important rebuke to HHS’s position, which gutted the law, follows: Read more Round-Up >> 

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by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Policy  
Integrative Practice
Economics and Business
Academics
Research
Professions
Natural Products
People 

Policy

Harkin pushes back on HHS for broader interpretation of “non-discrimination in healthcare” – Section 2706

US Senator Tom Harkin has used the appropriations bill for the U.S. Department of Health and Human Services (HHS) to refute an extremely limiting HHS interpretation of the application of the “non-discrimination in healthcare” provision (Section 2706) of the Affordable Care Act. Harkin’s language, injected into page 126 of this committee report from the Senate Health Education Labor and Pensions (HELP) Committee, restates his intent in placing Section 2706 in the Affordable Care Act. This important rebuke to HHS’s position, which gutted the law, follow

“Provider Nondiscrimination.-Section 2706 of the ACA prohibits certain types of health plans and issuers from discriminating against any healthcare provider who is acting within the scope of that provider’s license or certification under applicable State law, when determining networks of care eligible for reimbursement. The goal of this provision is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State. The Committee is therefore concerned that the FAQ document issued by HHS, DOL, and the Department of Treasury on April 29, 2013, advises insurers that this nondiscrimination provision allows them to exclude from participation whole categories of providers operating under a State license or certification. In addition, the FAQ advises insurers that section 2706 allows discrimination in reimbursement rates based on broad ‘‘market considerations” rather than the more limited exception cited in the law for performance and quality measures. Section 2706 was intended to prohibit exactly these types of discrimination. The Committee believes that insurers should be made aware of their obligation under section 2706 before their health plans begin operating in 2014. The Committee directs HHS to work with DOL and the Department of Treasury to correct the FAQ to reflect the law and congressional intent within 30 days of enactment of this act.”

Harkin chairs the US Senate HELP Committee. The Committee Report will only have weight if the HHS appropriations bill is passed. In recent years, gridlock has left the agency operating via continuing resolution, at the previous level of funding, without passage a funding bill. A close observer with a long-time Washington, D.C. presence, Jud Richland, MPH, CEO of the American Association of Naturopathic Physicians, states that we “can point to this language as the clearest available expression yet of Congress’ intent.”

Comment
:  Many have been hoping that Harkin would weigh in on Congressional intent, given the lack of consideration, not to mention inclusion, of licensed integrative healthcare professions in essential health benefits and the development of insurance exchanges in many states. This is a good sign. Now it needs to be trumpeted.

IHPC posts briefing by former Washington insurance commissioner Deborah Senn on Section 2706
 
The Integrative Healthcare Policy Consortium (IHPC) has posted a two minute comment from former Washington State insurance commissioner Deborah Senn, JD, on the meaning of the “non-discrimination in healthcare” provision (Section 2706) of the Affordable Care Act. Senn calls the law, which goes into effect in January 2014, “groundbreaking for patients and providers in this country.” She notes that the development of insurance exchanges will substantially shape compliance. The posting was made available via the video department of Bastyr University, an IHPC Partner for Health. The IHPC also includes an FAQ on Section 2706. The useful 4-page document, developed in consultation with Senn, includes information on 14 questions. Federal policy leader in integrative health Janet Kahn, PhD, LMT, calls the video a “clear, brief and yet comprehensive on the meaning, expanse and limits of that section of the law.”

Kaiser Health News feature on Obamacare and alternative medicine stirs significant media interest

The feature by Ankita Rao for Kaiser Health News, a major resource for health policy leaders, was entitled Health Law Boosts Status of Alternative Medicine – At Least on Paper. The article focuses on Section 2706 of the Affordable Care Act and some of the poor implementation, for instance in California where chiropractors are excluded. Former Washington State Insurance Commissioner Deborah Senn is quoted as saying: “That’s just an outright violation of the law.” The article was very widely picked up, linked and re-posted.

Comment: I had a chance to be a resource for Rao and was briefly quoted. In an otherwise solid piece, I must say that I would never suggest that supportive research for integration does not yet exist, which my quote suggests. It was an interesting editorial choice to run with “alternative medicine” as the focus, rather than “integrative.” Harkin’s interpretation (see above) of 2706 would substantially support integrative care, whether through on individual’s choices or health system offerings. The value of this overall favorable piece was its location, in Kaiser Health News, which hasn’t historically shown much interest in the topic. The most recent integrative medicine-related article was coverage of the Health Affairs piece on cost savings in January 2013.

Chiropractors announce positive steps toward VA residency, expansion of VA services, and an opening with Medicare

On July 25, 2013, the American Chiropractic Association (ACA) informed members that the U.S. Senate Veterans Affairs Committee included provisions of the Chiropractic Care Available to All Veterans Act (S.422) in an omnibus bill. This new language would expand the availability of chiropractic services to more U.S. Department of Veterans Affairs (VA) medical centers. The next day the organization notified members that the VA “has released a request for proposals to establish a chiropractic residency program at VA medical facilities.” According to the notice, the program will support up to six residencies for chiropractic physicians at VA medical centers around the country. It will also expand partnerships between VA centers and local chiropractic schools.

In addition, the chiropractic organization announced on July 12, 2013 a long-sought opening by Medicare of consideration of potential coverage of evaluation and management (E&M) by chiropractors. The agency covers chiropractic care for limited conditions, but only for the procedure rather than the E&M that are routine care provided by doctors of chiropractic. The organization plans to work with seniors and the Chiropractic Summit to respond to Medicare’s related queries.

Comment: Each are terrific steps for that profession, its academic organizations, and the health of the Veterans, many of whom suffer from pain conditions. Credit the ACA and the Association of Chiropractic Colleges for their perseverance in informing Congress about the benefits of inclusion. Here’s hoping that S.422 stays in the omnibus bill. Meantime, good for the ACA to have found a way to get Medicare to begin to appreciate that chiropractors are not merely mechanical modalities but rather professionals with broader value to human health, including E&M services that are important to patient care. It’s a step toward interprofessional respect for the agency.


Integrative Practice

From Google Alerts: Links to Integrative Medicine in Health Systems and Communities from July 2013

This monthly report from the Integrator includes 17 segments from Google Alerts on integrative medicine developments in health systems plus 12 from the community, for July 6, 2013-July 28, 2013. These came via requests for “integrative medicine,” “integrative oncology,” “alternative medicine” and “complementary and alternative medicine.” The most significant media pick-up during the month was the Kaiser Health News feature, although the focus was on “alternative medicine” rather than “integrative medicine.” Here is the MedPage link, WebMD and here the Denver Post, for instance. The Bravenet publication based on a study of integrative pain was also widely picked-up (see here and here and here, among others). Meantime, Paul Offit, MD’s anti-CAIM book continues to pick up significant media, including this in the Washington Post and this rejoinder in the LA Times from the Council for Responsible Nutrition.


 Economics and Business

 
Dean Ornish, MD links with Healthways to promote his pioneering integrative heart health program

Dean Ornish, MD, whose research showed that an integrative health program could reverse atherosclerosis, has inked a deal with Healthways to promote the program internationally. A July 23, 2013 release announced that the “largest global provider of well-being solutions” has exclusive rights to promoting the Ornish program. In January 2011, Medicare began covering “Dr. Dean Ornish’s Program for Reversing Heart Disease” under a new benefit category, “intensive cardiac rehabilitation.” This was the first time that Medicare covered an integrative medicine program. The release states that “Ornish’s programs, combined with Healthways’ well-being improvement platform, will enable the Company to comprehensively leverage proven lifestyle behavior change programs that serve the purpose of preventing, treating and reversing certain chronic diseases.

Comment: Few will recall that Ornish once inked another such deal, a dozen years ago, with Highmark Blue Cross Blue Shield via its visionary health a wellness leader, Anna Silberman and its subsidiary Lifestyle Advantage.  Highmark believed then, as did Ornish, that Medicare coverage of the program was just around the corner, when it was yet years away. The question of the day will remain whether hospitals will rapidly embrace a program that, if successful, will run down revenues on one of their major income producers: heart disease. Silberman found a discouragingly few parties interested a decade ago. Healthways boasts the relationship prominently on its site.

Health creation? Former CEO of a Henry Ford Hospital takes over as CEO of Cancer Treatment Centers of America

The former CEO of Henry Ford Hospital in West Bloomfield, MI, Gerard Van Grinsven, is now the CEO of Cancer Treatment Centers of America. Van Grinsven joined Detroit-based Henry Ford Health System in 2006 to oversee the launch of the West Bloomfield hospital, which opened in March 2009. Before that, he was an executive with the Ritz-Carlton Hotel Co, the customer-focus of which led him to bring alternative treatments into the hospital. He succeeds Stephen Bonner, president and CEO since 1999, who will assume the new role of executive chairman. CTCA pioneered inpatient integrative treatment via a program that began with nutritional interventions and expanded substantially after the firm began contracting with naturopathic physicians. Timothy Birdsall, ND has been the lead integrative medicine leader for CTCA.

Comment: Integrator columnist Taylor Walsh forwarded this news with this note: “If you are not familiar with Van Grinsven, you will want to view the video of him explaining how he created — wait for it — a health-creating hospital in West Bloomfield, which opened in 2009. It is astonishing and inspiring. Said he in 2010: ‘We said that we will be a community center for well being. What does that mean? It means we create an environment that healthy people actually want to come to our facility and partake in activities and programs that help them stay healthy.’ He forced alt med therapies into the wellness center because ‘my customers wanted it.’ If he is half as inventive with CTCA as he was with West Bloomfield, at worst the paradigm will be turned upside down.” The You Tube video is here.

RAND group reports expert panel recommendations on economic analysis of complementary, alternative, and integrative medicine

Well-known health services researchers on complementary and integrative medicine Ian Coulter, PhD and Patricia Herman, PhD, ND, have published a paper entitled Economic analysis of complementary, alternative, and integrative medicine (CAIM): considerations raised by an expert panel. The paper reflects findings of an international panel convened by the RAND Corporation, with which they are associated, in 2011. The team identified 7 “major themes that are particularly salient for determining the economics of CAIM.” These include clarifying the target audience, and looking at overall outcomes and costs rather than disease-specific outcomes and costs, given the whole person approach. They conclude: “The business case for CAIM depends on economic analysis and standard methods for conducting such economic evaluations exist. The challenge for CAIM lies in appropriately applying these methods. The deliberations of this panel provide a list of factors to be considered in meeting that challenge.” The PDF is here.

Comment: This follows Herman’s more substantial work, via the Samueli Institute, Evaluating the Economics of Complementary and Integrative Medicine.  

Medical tourism in Portland, Oregon? Tribune says “Global patients, wellness tourists seek out city’s naturopaths”

In a twist on a global theme, the Portland Tribune has published a feature entitled “Need treatment, will travel: Global patients, wellness tourists seek out city’s naturopaths.”  The piece focuses on the specialized treatment in naturopathic cardiology provided through the Center for Natural Medicine, founded 30 years ago by Martin Milner, MA, LMT, ND. It then turns to specialized treatments by other physicians such as “fecal transplant” and hormone therapy. The author of Medical Tourism, John Connell is quoted: “Maybe the ultimate phase in medical tourism will be when medical tourists come from places like India for naturopathic medicine in the U.S.”

Comment: Notably, as reported in the July 2013 Integrator Round-up, Milner’s clinic, a teaching center affiliated with National College of Natural Medicine, was recognized as a Tier II medical home in that state.

Academics

Chiropractic accrediting agency calls for public comments on residency standards

The Council on Chiropractic Education (CCE) is requesting submission of public comment for the 14 page Draft Residency Program Standards. The standards from the U.S. Department of Education-recognized agency will be reviewed during CCE’s annual meeting in January 2014. Comments must be sent by Sept. 30, 2013.

Comment
: The work on standards is undoubtedly linked to the interest of the Veterans’ Administration in establishing chiropractic residencies, noted under policy, above.

Consortium announces Patty Wilder as new executive director, replacing Janet Polli

In a July 13, 2013 message to members, Ben Kligler, MD, MPH, chair, and Margaret Chesney, PhD, vice-chair, of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) announced “with mixed emotions” that the consortium’s executive director of four years, Janet Polli, is “transitioning” out as she works on her MBA. Polli is credited with being “particularly instrumental in the Consortium’s very important strategic planning process and has guided us as the membership of the Consortium grew by over 33%.” Serving as interim executive director is Patty Wilder. Wilder’s background includes more than 35 years of experience in the nonprofit sector. Wilder is said to have “a long interest and passion around integrative medicine and is a Spring Forest Qi Gong practitioner.”


Research

Bravenet’s positive outcomes of prospective study on integrative pain treatment published

The network of integrative medicine clinics called BraveNet has published a prospective observational study on integrative medicine treatment approaches for pain. The “non-randomized, open-label observational evaluation” was conducted over six months, at nine clinical sites. The findings on the open access article via BMC Complementary and Alternative Medicine, led by Donald Abrams, MD, related to the 252 of 409 participants initially enrolled who completed all follow-up visits during the 6 month evaluation. The integrative treatment significantly decreased pain severity and “produced improvements in mood, stress, quality of life, fatigue, sleep and well-being.” In addition, mean 25-hydroxyvitamin D levels increased. They concluded that “among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures.” The participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain.
 
Comment: The report is timely for the re-opening of an exploration of non-pharmacological approaches to pain by the Joint Commission which was urged by the Consortium of Academic Health Centers for Integrative Medicine, with which most Bravenet members are affiliated. It would be nice to know what happened to the other 157 individuals who did not complete.

NIH NCCAM announces David Shurtleff, as new deputy director

In a July 23, 2013 blog post, NIH National Center for Complementary and Alternative Medicine (NCCAM) director Josie Briggs, MD announced that David Shurtleff, PhD, has joined NCCAM staff as deputy director. Stated Briggs: “In this capacity, he will partner with me in directing the Center’s scientific, programmatic, and administrative endeavors. During Dr. Shurtleff’s initial period of tenure, he will share the Deputy Director position with Jack Killen, M.D. ” Shurtleff comes to NCCAM following previous roles at the National Institute on Drug Abuse (NIDA) and a period as director of Basic Neuroscience and Behavioral Research at NIDA. Adds Briggs: “NCCAM and NIDA share a strong interest in improving the management of chronic pain and reducing prescription drug abuse, and his background in these areas will strengthen our partnership with NIDA on these important areas of public health concern.” Shurtleff’s doctorate is in experimental psychology.

Comment: The NCCAM pattern of choosing leadership from within, and subsequently educating them about the field for which they will lead exploration, rather than choosing from the integrative medicine field, and up-training them to the NIH culture, continues. (See my open letter to Briggs on her appointment: Oops They Did It Again.) Bottom line, a person who has devoted his or her career to reductive thinking is not likely to fully understand wholism, whether in practice or research modeling. Shurtleff’s behavioral health background is hopeful. Vamos a ver. We’ll see.

Professions

National association for AOM announces goals in $3-million drive to support 2013-2016 strategic plan

Denise Graham, the relatively new executive director of the American Association for Acupuncture and Oriental Medicine, has hit the ground running. In a July 23, 2013 letter to members entitled “The Future of Acupuncture Needs Your Help,” Graham described a $3,130,000 Action Fund drive targeting 3 purposes: obtain licensure in the remaining unlicensed states to allow the practice of acupuncture and Oriental medicine (AOM); pursue coverage for AOM services under federal programs; and “educate third-party payers and healthcare providers on the qualifications and requirements to practice acupuncture (e.g., dry-needling).” The letter supports the announcement of an AAAOM 2013-2016 strategic plan by AAAOM president Michael Jabbour, MS, LAc. The “three core goals” are to “1) Advance the profession, 2) Advocate for the profession, and 3) Grow our AAAOM membership.” Graham’s letter, which urged monthly contributions of $20 to $100 from all members, was framed by urgency: “As a medical profession we need to act NOW to make sure we have a future.” Funds are anticipated to be used to hire lobbyists, (provide) legal services and consultants.

Comment: Credit the Jabbour-Graham team for going large with their ask. Here’s hoping some significant corporate and individual donors can boost what the membership will choose to contribute. It’s a lofty goal.

Naturopathic physicians’ association announces new PR message: Natural Medicine. Real Solutions

The American Association of Naturopathic Physicians (AANP) has announced a new cut-line to market the profession: Natural Medicine. Real Solutions. The announcement followed a process which included contracting with an outside marketing firm that extensively interviewed and surveyed prior to making its recommendations. The new tag-line replaces Physicians Who Listen.

Comment: Taglines are the most challenging of group processes. Everyone has an opinion. Leaving it to the professionals doesn’t always work. I am told that the first choice of the firm was chucked before this was announced. My judgement is that this tagline reflects professional insecurity. Even as regular medicine is taking its baby steps toward being involved with health, here is a profession that celebrates its engagement with health creation in patients that is seeking to associate itself with medicine rather than its leadership arena, health. I was interviewed by the marketing firm and recommended a phrase adopted from work by the profession in a 1987-89 process: Treating Disease by Restoring Health. (See the present version here: 1987-1989 Definitions of Naturopathic Medicine process.) That about says it. Then again, it may be meaningless or confusing to consumers. Alas, I am among the non-professionals who is easy with an opinion.

Natural Products

United Natural Products Alliance reaches out to practitioner groups as partner organizations

The United Natural Products Alliance (UNPA), led by attorney, lobbyist and organizer Loren Israelson, has announced a new set of partners. Among these are the Personalized Lifestyle Medicine Institute founded by Jeffrey Bland, PhD and the American Association of Naturopathic Physicians. The UNPA presents these partnerships, sealed with formal agreements, as a means of advancing the UNPA strategic plan. The organization calls itself “an international alliance of forward-looking companies dedicated to providing consumers with natural health products of superior quality, benefit and reliability.”

Comment
: I began to think that the UNPA had new directions up its sleeve when it lured a co-founder of the LOHAS movement and former Innovision vice-president Frank Lampe from his communications role with the American Herbal Products Association to a vice president position. Wonder what’s next?

AHPA publishes second edition of Botanical Safety Handbook online

One of the first significant early projects of the American Herbal Products Association (AHPA) was the publication of its Botanical Safety Handbook. The field needed to address safety issues leveled against herbs. Now the second edition is available online. Called an “essential tool for anyone who manufactures, recommends, or uses herbal products,” the text provides safety information on nearly 600 species of herbs and data compiled from clinical trials, pharmacological and toxicological studies, medical case reports, and historical texts. AHPA noted in its June 20, 2013 release that in the text classification systems are used to indicate the safety of each listed species and the potential for the species to interact with drugs.

People

Integrative doctor Melinda Ring, MD selected as one of Chicago’s 100 most influential women

The director of Northwestern Integrative Medicine, Melinda Ring, MD, was named one of Chicago’s 100 most influential women by Today’s Chicago Women. Ring was recognized for her work as medical director at Northwestern Integrative Medicine and as director of the integrative medicine curriculum at Feinberg School of Medicine. In her roles at Northwestern, Ring oversees the clinical outpatient and inpatient programs, as well as medical student and resident education in integrative medicine. Said Ring of the honor: “It is also deeply satisfying for me to see this recognition of integrative medicine and the value it places on considering the full range of physical, emotional, mental and spiritual influences that affect a person’s health.” Ring is co-chair of the upcoming International Congress for Clinicians in Complementary and Integrative Medicine.

Comment: Nice to see one of the new leaders of the Consortium of Academic Health Centers for Integrative Medicine – Ring has served on the Steering Committee and as co-chair of the Clinical Working Group – awarded.

Health freedom warrior Clinton Miller dies at 91

Beth Clay, the former NIH staffer and Washington D.C. lobbyist, sent a notice that her mentor Clinton Miller died on July 24, 2013. Miller is known as a fighter for “health freedom.” In a eulogy posted here, Clay describes how Miller and his wife moved to Washington, D.C. in the early 1990s to lobby for access to alternative therapies. She credits the then leader of the National Health Federation with leading “the passage of the Proxmire Amendment that blocked the Food and Drug Administration’s arbitrary limiting of vitamin potency and set the stage for the Dietary Supplement Health and Education Act of 1994.” Miller subsequently worked with the Sunshine Health Freedom Foundation.

Comment: When Clay sent the notice I immediately replied to her that I have not been pleased with Miller’s association with efforts to protect individuals whose version of health freedom includes announcing themselves as doctors in a field of medicine (naturopathy) with no more than mail-order training. His organizations have fought to stop licensing of naturopathic doctors. That being said, his work in the early 1990s was important, and, while I never personally liked the utter polarizing that characterizes much of the NHF work, there was a time some decades ago when it was among the only dissident voices in a US health care which was in need of dissent. Miller championed choice. That alone is a fine legacy.

AANP announces 2013 awards: Clark, Gazella, Anderson, Brinkman, Marinelli, Ayush Herbs

The American Association of Naturopathic Physicians (AANP) presented its annual awards at its conference on July 13, 2013 in Keystone, Colo. Physician of the Year was presented to Denise Clark, ND, who as president of the Colorado Association of Naturopathic Doctors led a successful campaign for regulation. Karolyn Gazella, publisher of the Natural Medicine Journal, the official journal of the AANP, was presented with this year’s Champion Award which goes to a non-ND. Gazella has 22 years of publishing in the field of natural medicine. Others honored were Rick Brinkman, ND (President’s Award); Ayush Herbs, led by Virender Sodhi, ND (Corporation of the Year); Paul Anderson, ND (the VIS Award, which acknowledges a person who represents the VIS, the healing power of nature); and Rick Marinelli, ND, MAOM, posthumously awarded the Benedict Lust Award, a lifetime career achievement award intended to acknowledge extraordinary naturopathic physicians.

Comment: The assembled members of the profession celebrated Clark’s accomplishment repeatedly during the week, despite its status as regulation rather than licensing. I was particularly pleased to see Marinelli, who was a close friend and colleague, honored. I had a chance to collaborate with him in work with an Institute of Medicine committee on pain where he proved an influential voice, even as his cancer treatment overtook his ability to participate. His contribution was perhaps the most pronounced of any single naturopathic physician in any federal policy arena to date.

Ethnobotanist Rosita Arvigo, DN lectures for the American Holistic Medical Association

I report this piece to call attention to a remarkable contributor to herbalism in the Western hemisphere. The American Holistic Medical Association recently announced that Rosita Arvigo, DN will be lecturing on 25 medicinal botanicals from the Midwest. The naprapathic doctor is best known for her center in Belize where she has worked as educator, cultivator and community organizer around medicinal plants and healing since 1981. Arvigo has also been a National Cancer Institute field assistant. The lecture for the AHMA will be held in Bloomfield Hills, Michigan on August 25, 2013.

Comment: I had a chance to visit with Arvigo in her center in Belize in 1991. It was only while there that I learned how deeply her work penetrated not just herbal education but into community organizing around use, gathering and preparation of herbs. Truly a remarkable life and legacy, still expanding!