Affordable Care Act and Access to Integrative Medicine–What Does it Really Mean?

This post was written by Glenn Sabin

Well, that depends on who you ask.  Those within the integrative healthcare field and the disbelieving skeptics alike, offer quite divergent views.

This post focuses on the Affordable Care Act’s impact on health consumers currently using or hoping to incorporate integrative medicine practitioners and services into their care.  It does not attempt to decipher the short- or long-term economic impact of the Affordable Care Act on this country.  Nor does it explore the cost-effectiveness of integrative medicine delivery.  I will largely leave that to the health economists and prognosticators, but do offer this: the long-term economic affect cannot be good.  The ACA does not trumpet in a new payment paradigm—a reimbursement model that economically incentivizes good health outcomes over the provision of high margin procedures, services or products.  So we are still heading toward eventual insolvency or, minimally, healthcare reform part II over the next few years.

So How Will the ACA Affect Consumer Access to Integrative Medicine Services? 

For consumers receiving integrative services from providers working outside of the payer system—those not participating with insurance companies—very little may change for the time being.  These providers receive cash for services and may or may not provide their patients with super bills.  Super bill essentially comprise a list of line item services with accompanying CPT codes that make it easier for clients to get reimbursed from their insurance company as out-of-network services.  Clearly, getting out-of-network coverage for covered integrative services is still better than going fully out-of-pocket each visit.

Conversely, for insured patients utilizing services like acupuncture, chiropractic, naturopathy and massage therapy, the future looks brighter.  There is built-in anti-discrimination language in the ACA that specifically speaks to covering licensed and credentialed practitioners in these fields.  Over time this should make integrative medicine services more accessible for those insured—and not just those with so-called Cadillac health plans.

What Others are Saying

John Weeks from Academic Consortium for Complementary and Alternative Health Care and The Integrator Blog posits that the ACA is a game-changer for integrative medicine.  On the eve of the Supreme Court vote, Weeks describes the “powerful elements of historic conclusion in areas of workforce planning, payment, delivery, research and health promotion”, with emphasis on the anti-discrimination clause for credentialed integrative practitioners, and in the context of Patient Center Medical Homes.

The Integrated Healthcare Policy Consortium (IHPC) is the main lobbying champion for integrative healthcare delivery.  IHPC has worked hard to ensure that the practitioner anti-discrimination language in the ACA has stayed firmly in place and that the Prevention and Public Health Investment Fund is protected.  (Many people don’t realize that in February $5B of the total $15B—a full third—of the Prevention Fund was cut and redirected to fill the gap in the payroll tax fund, and to avoid a 27% cut in physician Medicare reimbursements.)   On hearing the Supreme Court’s decision, IHPC policy adviser Dr. Janet Kahn had this say: “This is great news for the American people and for the integrated healthcare community….  Perhaps the best news is that a law that is designed to move us from thinking about medical interventions to thinking about health promotion and maintenance is allowed to move forward.”

The folks at The Alliance for Public Healthargue that the ACA is horrible for integrative medicine and will force consumers to purchase government approved health plans that will all but eliminate high deductible polices and doom health saving accounts (HSAs).

Erik Goldman from Holistic Primary Care—News for Health & Healing had this to say when contacted by FON: “It [ACA] really doesn’t provide much fiscal support for holistic services.  The health insurance industry has made a miserable hash out of conventional medicine—which already has a reductionist, treat-the-numbers, protocol-driven mindset. One can reasonably expect that this effect will be even worse on holistic/functional/integrative medicine because insurance plan thinking is quite antithetical to holistic, individualized, health-oriented thinking.

Many health consumers today purchase high deductible “catastrophic” plans and use their HSA accounts to pay out-of-pocket for integrative medicine services.

Over at Science-Based Medicine, attorney Jann Bellamy ponders the ACA and its possible implications on state laws that currently mandate coverage of some integrative medicine services for private insurance plans.  Bellamy postulates that the ACA has the “potential of putting a significant dent in this forced coverage of pseudo-scientific health care” based on how Health and Human Services may come to define “essential health benefits” in the context of CAM (complementary and alternative medicine).

I believe the ACA, while far from perfect, provides meaningful progress to ensure patient access to integrative healthcare services from licensed practitioners through a non-discriminatory insurance payer system.

Who do you think has it right and what are your thoughts?  Please leave a comment.

 

 

 

 

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Jul 19, 2012 · Comment (4)

   

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3 comments · Add Yours

Based on my limited understanding of the PPACA, under the model of Accountable Care Organizations (ACOs), integrative holistic practitoners can be members of the ACO and deliver care to the patient as part of the healing team, should the patient decide to utilize those services.

I have postulated that an integrative medicine group practice could form their own ACO and partner with more traditional providers as well. I don’t get the sense that the PPACA excludes integrative medicine and in fact, major universities (e.g. University of Utah, Duke University) and insurance companies seem to be embracing the holistic concept of wellness vs. the traditional model of disease treatment, from a mind, body, spirit perspective.

Whether integrative medicine practices get to participate in the new healthcare paradigm will no doubt depend upon credentialing and evidence based outcomes provided by the practice over time. What was considered “woowoo” 20 years ago is not embraced by conservative healthcare institutions: e.g. healing touch, reiki, therapeutic music practitioners, chiropractors, Feldenkreis, etc.

I’ll be interested in other’s perspectives and experience.

Reply

As the Executive Director of a holistic health non-profit organization, I’m finding it hard to get a foothold among the organizations that are forming ACO’s, due to the intense work that the initial quality standards and large administrative overhead these groups take on. Physician groups seem to want to know if acupuncture, for instance, can not only pay for itself in reduced health care spending by patients, but if it will offer additional savings. We’re trying to develop pilot projects with insurers or physician groups to assess what kind of health savings can be shown.

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I think that generally, as with most issues that are (or become) political—fwiw I can only speak for the US here—the levels of discouragement most of us (ie “the public”, broadly speaking) experience is a hindrance. Going by just personal experience, the amount of willpower and self-direction required to find an integrative doctor seems almost impractical much of the time. A lot of this ironically probably has a lot to do with my health/medical history—most doctors call it “ADHD”, I’m not sure it’s that simple (“reductionary”?) I am very sluggish ever since I was a child, it’s like I’m a car with no “gas pedal”, the ignition has to be extrinsic or it’s just not there. I’ve been in therapy for chronic(ally mis-/under-diagnosed) anxiety issues, and it seems without the anxiety I’ve got nothing. Antidepressants (>a decade’s worth) either didn’t help or exacerbated the problem: until recently after I had to basically be my own lawyer to go off them, I was apathetic towards my own chronic apathy, “meh who cares, better this than a psych ward!!” However it was becoming at least equally impairing. And I think by now there are long-term effects that are confounding everything.

Being sluggish and apathetic isn’t simply reducible to “chronic depression” when anything I’ve done (been prescribed) to help “depression” has made it worse.

People are losing faith. Ultimately the success of the ACA likely depends largely on whether it reverses some of the discouragement we seem to have accumulated collectively. I definitely am struggling with intrinsic motivation, but I think to a degree we all are and it’s only apparent in people who are most strongly affected by the setbacks (for comparison, a tough economy is a huge disincentive for someone whose days begin with getting out of been seeming forced, walking from one room to another causing lightheadedness and momentary vision loss because I’m trying to eat more to keep my weight up in a normal range…etc…trying to express these things without sounding victimizing…)

I guess by “personal experience” I’m mostly saying I see most of my own struggles reflected in much of society, just perhaps to a lesser extent (perhaps greater in dirre situations like people who are homeless and without care, and possibly very ill/dying…seems to come down to the same issue really, lack of resources and/or means to obtain them; perhaps due to the illness itself) but it’s everywhere. I think to fix a system that we deem broken, we have to work both in it and above it. Politicians can’t really do all that for us. At least not by now, there are too many of us being personally affected. “Rome wasn’t built in a day”, cliche but relevant here.

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