December 2012 John Weeks Integrator Round-up covering the topics of:  Policy; Employers & Costs, Integrative Clinics & Services; Education;
Professions and Organizations and People

Essential benefits: New York Times reports chiropractors included in most states, acupuncturists in six

A feature in the New York Times entitled Interest Groups Push to Fill Margins of Health Coverage reports that chiropractors appear to be included in “most” of the two dozen states that have announced their essential health benefits (EHB) packages while licensed acupunctirists are in six. The article begins with reference to the organizing efforts of the American Chiropractic Association (ACA) and the American Association of Acupuncture and Oriental Medicine (AAAOM). The six states where acupuncture made the grade are California, Washington, Maryland and New Mexico, with Nevada and Alaska expected to follow. Jeannie Kang, LAc, a past AAAOM president characterized the wins in the six states as “huge” since their profession couldn’t afford “a million dollar lobbying effort.” John Faldareau, vice president for governmental affairs for the ACA is quoted as saying: “We’ve been in constant contact with our state chapters, just telling them, ‘Look, you’ve got to get in the room.” Coverage is typically for much less than these practitioners’ scope of practices. For instance, Washington state reportedly covers just 12 visits for acupuncture and 10 visits for chiropractors.

Comment: First, congrats to these associations for showing up. The article’s framing is interesting. It might have been called “Chiropractors and Acupuncturists Fight for Scraps After Large Interest Groups Divey up Coverage Pie.” The article in this Round-up on the cost savings from CAM users using the MEPs data, below, suggests that if these practitioners were less marginalized and more at the core of essential health benefit planning that there may be a larger pie to divey up.   


Integrative medicine in accountable care: report from Oregon naturopathic physician Bill Walter, ND

Bill Walter, ND of  Golden Apple Healthcare has been on a quiet campaign for months to create a place for naturopathic doctors and other complementary and alternative healthcare services in the emerging payment and delivery model called coordinated care organizations (CCO) in his home base of Lane County, Oregon. The county includes the liberal university town of Eugene and its working class sister city of Springfield. Walter’s participation in care delivery as a naturopathic physician has been supported by a handful of medical leaders in the local community health clinic system.

In a report here in the Integrator on his efforts, Walter shared that he has also been integrated into two of the CCO’s committees. These were established to explore “transformation” in care delivery. One relates to behavioral health and primary care integration and the other to chronic pain/opiate reform. The latter committee also includes another naturopathic doctor, Miriam Mazure-Mitchell ND, MS who also sits on the board of the Pain Society of Oregon. In the report Walter notes that naturopathic physicians are not presently credentialed, but the CCO’s clinical advisory panel (CAP) will soon make determinations about which services and providers to cover. A naturopathic doctor who is also a midwife been credentialed to provide births in an Eastern Oregon CCO. Walter credits the Oregon Association of Naturopathic Physicians for its support.

Comment: Over the last few months, Walter documented his stepwise engagement with the web of connection he and colleagues have spun through this commendable work. From the list of committees and meetings he attends, the fellow clearly needs to be cloned. The cloning is not just for his profession but for others, around the country, where accountable care organizations in various forms are taking shape. Walter concluded a recent missive from the field on this optimistic note about his own profession in his home county: “We’re getting rumblings that some major specialty groups from the hospital are interested in creating wellness centers and ND partnerships. Gastro and cardiology are now starting to refer to NDs. If we pull this off right, we’ll have NDs peppered throughout the [conventional] healthcare landscape in Lane County in the next 5-10 years. May be overly optimistic but there’s a lot of buzz for what we’re doing.” I am reminded of two phrases from my dabbling in the I Ching in my early 20s. First, “it furthers one to cross the great water.” This is perhaps the Integrator slogan. The second blunt charge, worthy of Polonius’ maxims: “Perseverance furthers.” As the ACA’s Falardeau says in the article above: “Look, you’ve got to get in the room.”


Holistic medical doctors collaborate as NDs cross 25,000 signature threshold in petition to the White House

Getting the attention of the federal government when a profession is only licensed in 16 states can be challenging. That is the situation of the naturopathic medical profession as it seeks inclusion in federal work force planning on primary care, and access to programs that support service for rural, Indian health and underserved communities. A lone naturopathic doctor in Portland, Oregon, Shawn Soska, ND, LAc decided to petition the new Obama administration via for inclusion of the naturopathic profession in such federal programs. The target was 25,000 signatures by December 7, 2012, enough to guarantee that someone from the White House would pay attention. This goal from the profession of 4,500 practitioners is roughly equivalent to a campaign among the some 800,000 medical doctors to gather 4,000,000 signatures. Though the campaign did not begin through the profession’s organizations, individuals, institutions and the professional organizations eventually picked up the campaign. I sent a push via the Integrator list when the number was at 19,100.

Notably, early on December 5, 2012, the American Holistic Medical Association (AHMA) followed up with a resend of the Integrator blast. They led with a cover note from AHMA president Molly Roberts, MD. She urged AHMA’s predominantly medical doctor membership to consider helping “our allies who are naturopathic doctors.” Late on December 5th, the campaign went over the top. Nearly 400 of the holistic medical doctors appear to have responded. Some may have sent on to their own lists. Apprised of the AHMA initiative, AANP executive director Jud Richland, MPH, MPA sent an e-note of thanks to the AHMA leadership. Richland’s included this: “It was like watching election returns last night as things sped toward 25K. We’re going to take maximum advantage of this. It’s a great boost to naturopathic medicine. Thanks again!”  

Comment: Who knows what this may mean? As Rand Corporation and Samueli Institute researcher Ian Coulter, PhD has said of the many contributions of the naturopathic profession to the integrative health movement: “They are fighting above their weight class.” Empowering the NDs with success in this drive gives them  an additional boost. Kudos to the collaborative support from the holistic medical doctors. Now Richland and the AANP: Go make something of it!