How the Affordable Care Act Influences Naturopathic Medicine
Disclaimer: I don’t usually pay a lot of attention to politics or the news (possibly to my shame), but since I am a doctor I figured I’d better do some research on the subject. This is not intended to be inflammatory in either direction; I’m merely trying to present the facts. (If you do want my $0.02, though, I posted it in the last paragraph.)
The Affordable Care Act in a Nutshell
The bulk of the Affordable Care Act (aka “Obamacare”) will take effect in 2014, at which point some 44 million currently uninsured Americans will receive coverage. Additionally, insurance companies will no longer be able to deny coverage for preexisting illnesses, and children will be able to remain on their parents’ policies until 26 years of age. The federal law also expands Medicaid coverage, although individual states have the ability to opt out of this expansion.
How They Plan to Pay For it
Obviously, this will be expensive. The money to cover those 44 million will have to come from other new policy holders, which means that everyone who can afford to do so will be required to purchase health insurance with a certain breadth of coverage. All non-exempt Americans who choose not to purchase such coverage will be subject to a tax penalty.
What This Means for CAM (Complementary Alternative Medicine) — Including NMDs
Insurance Companies will give provider groups (aka Accountable Care Organizations) a certain amount of money to care for a certain number of people, and they have to stay within that amount. This encourages preventive care: if those people stay healthy, the ACOs can pocket the money. If they overspend, that money comes out of their own pockets. This means demand will increase for preventative care.
Section 2706 of the Affordable Care Act prohibits discrimination of coverage against licensed health care practitioners regardless of the type. This may mean that suddenly naturopathic physicians (as well as other types of licensed CAM providers) will be covered by insurance in the 16 states and District of Columbia where naturopathic physicians are currently licensed. However, this section will still be up for interpretation in individual states.
New Research Approaches
One of the primary arguments against CAM treatments is the paucity of double-blind, placebo controlled trials demonstrating their efficacy. There are several reasons why such trials are scarce, but one is that the design of most studies rarely takes the whole patient into account (for if they do, it destroys the ability to interpret any benefit or harm as due to a single variable).
The Affordable Care Act, however, will also introduce a new Patient-Centered Outcomes Research Institute (PCORI) to fund research that tracks how treatments affect individual patients. The PCORI will compare treatments and overall outcomes data over time, rather than tracking a single intervention while controlling for all others.
I think PCORI sounds like a potentially good idea. I very much support the model of “evidence based medicine,” but it is quite difficult to design double-blind, placebo controlled trials for integrative treatment approaches. This institute may help to bridge that gap.
I’m on the fence about whether it’s a good idea for naturopathic physicians to accept insurance, though, even if we had the option. On one hand, it would make our services much more widely available, which is undoubtedly a good thing. The emphasis on preventive medicine is certainly lacking thus far in our health care system, and I believe it is sorely needed.
On the other hand, insurance reimbursement is notoriously low, and that is one main reason why conventional doctor visits tend to be so brief. A key difference between naturopathic medicine and conventional medicine is the amount of time we spent with our patients, enabling us to identify and address root issues that our conventional counterparts simply don’t have the time to uncover. My new patient visits are an hour long, follow ups are half an hour, and my new patient paperwork is a very comprehensive nine pages. This enables me to see how various symptoms might be related. Underlying causes of illness don’t usually present themselves in the first five minutes. Longer visits also enable me to build trusting relationships with my patients, which I believe is invaluable, and often greatly assists us both in identifying the most effective treatment approaches. If naturopathic physicians were similarly relegated to very short patient visits just to cover overhead, I am concerned that patient care would suffer.
What’s your $0.02? Post it below!