Over the last 10 years, the naturopathic profession has experienced major advances and significant challenges. Some are unique to our profession; others we share with all holistically minded professionals as we take our places in American health care.
Everywhere, there is evidence that health care is in need of radical healing. One of our movement’s biggest challenges is that we lack evidence to show the cost savings of our approaches. We believe we have answers to many of health care’s ills, both clinical and financial. In the coming years, we must prove it.
The naturopathic community has seen admirable growth in the number of energetic young people emerging from our schools in the last decade. But lack of insurance reimbursement and lack of funding for residency training have restricted further integration of NDs and NMDs into the healthcare continuum. Several key states passed licensure laws in the last decade, but still, only 15 states license naturopaths. Clearly, there’s work to do!
I was pleased that the 2010 Patient Protection and Affordable Care Act (aka Health Care Reform bill), included provisions pertaining to licensed CAM and integrative practitioners. It remains to be seen whether they will be implemented in ways that truly enable our professions to benefit the public.
The American Medical Association remains a major source of obstruction. It’s Scope of Practice Partnership must cease its divisive, exclusionary efforts, and work with other healthcare professionals to improve access to a variety of willing practitioners who deliver affordable, effective care. This is what the American people really want.
Let’s face it: health care reform will be excruciatingly slow, with continued huge costs to those excluded from the status quo as well as those who do the excluding, although they might not recognize it. As a society we all suffer from the continued lack of rational, effective and equitable healthcare. Still, there have been some very positive steps forward in the last decade. Here are a few game-changers worth celebrating:
The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM): Convened in July 1999 at the Fetzer Institute, by representatives from 8 conventional medical schools, CAHCIM works to expand the field of integrative medicine by supporting chancellors in their advocacy, fostering collaboration, and developing an influential, expandable working community of leaders to articulate a new paradigm that truly integrates the best of allopathic, mind-body and other non-allopathic approaches. Since January 2002, the Consortium’s membership has climbed from 11 to 44 member centers. Working groups have met on a monthly basis, advancing medical school curricula, establishing research standards and integrating alternative treatments into clinical care.
The Integrated Healthcare Policy Consortium (IHPC): The IHPC evolved from the very successful National Policy Dialogue to Advance Integrated Health Care (NPD) at Georgetown University in 2001. NPD convened representatives of over 50 stakeholder groups committed to advancing integrated care, including federal agencies; members of Congress from both parties; leaders in conventional, complementary and alternative health care; and representatives from payers. The goal was to create a voice of consensus, free of divisive interdisciplinary disagreements, that could speak to Congress. IHPC was created to ensure that the NPD’s agenda would be carried out. Nearly a decade later, it remains an interdisciplinary and non-partisan voice of consensus on the Hill.
The Academic Consortium of Complementary and Alternative Health Centers (ACCAHC): As the IHPC continued its work, it became clear that real integrated care would require changes in the education of all healthcare practitioners. In 2005, IHPC convened the National Education Dialogue (NED), an unprecedented group of over 70 educators from nursing, conventional medicine and all regulated CAM professions to discuss best practices in collaboration and cross-disciplinary curriculum development. This dialog provided impetus for formation of ACCAHC. With representatives from the accrediting bodies and councils of colleges in all regulated and emerging CAM disciplines, ACCAHC provides a forum for information exchange and collaboration across the disciplines.
Licensure of Naturopathic Physicians in California: In September 2003, California became the 13th state to license naturopaths. Despite many years of resistance by the California Medical Association and other groups, the California Naturopathic Doctors Association mounted a successful legislative campaign, overcoming nearly insurmountable odds to provide access to naturopathic physicians in the nation’s most populous state This opened opportunities for many naturopathic graduates to quickly establish sustainable practices in California. There are currently 367 naturopathic doctors licensed by California.
Patient Protection and Affordable Care Act of 2010: The healthcare overhaul contains language that will likely shape policy on integrative practices for years. CAM practitioners and practices are included in sections related to: non-discrimination; workforce planning; community medical homes; wellness, prevention and health promotion; individualized wellness plans; comparative effectiveness research; and birthing services. The non-discrimination provision that takes effect in 2014 has the most far-reaching potential. It states:
“A group health plan and a health insurance issuer….shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation...Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
The bill does not require insurers to contract with all willing and licensed practitioners, and it leaves them plenty of “discretion” as to how much they will pay various practitioner groups. But it does prohibit them from categorically discriminating against particular practitioners solely based on their degrees.
This is hardly a guarantee of a brighter future for naturopathic and holistic medicine. But the fact that lawmakers felt obliged to reckon with our professions in the national reform plan reflects the prodigious growth of our field. Perhaps that is the most significant and hopeful development of all.
Michael Traub, ND, DHANP, FABNO is past-president of the American Association of Naturopathic Physicians. He is member of the Board of Directors of the Integrated Healthcare Policy Consortium, and President of the Hawai’i Consortium for Integrative Healthcare.