A number of questions may be on the minds of most American AOM practitioners regarding the recently passed health care reform bill. What impact does this have on the AOM profession? Is wellness adequately addressed? Can our government effectively manage health care in the United States? The list goes on. Controversy and misinformation regarding this bill from "death panels" to "free health care for illegal immigrants" have overshadowed rational discussion of health care reform.
The law will generate 159 new offices, agencies and programs over the next several years, some of them worth noting here. The Interagency Working Group on Health Care Quality involves representatives from 24 agencies including the NIH and FDA under the leadership of the Department of Health and Human Services (HHS).1 This landmark effort will open lines of communication among researchers and clinicians where there is usually a gap of a decade from test tube to treatment table. The President will establish an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health that will include integrative health practitioners.2 The Patient-Centered Outcomes Research Institute will be a nonprofit organization identifying research priorities that include "the potential for new evidence to improve patient health, well-being and quality of care."3 There will also be a "grant program to promote small business wellness programs."4 Additionally, there will be seven agencies set up to specifically to address various aspects of women's health. This is a step in the right direction.
The exact definition of "integrative health practitioner" is still being debated. Naturopaths, homeopaths and AOM practitioners involved in this debate believe that only MDs will hold this title in the future. The Integrated Healthcare Policy Consortium (IHPC) has been quietly influencing the language contained in the bill since its conception. The IHPC's mission has been to "direct the national health care agenda toward a health-oriented, integrated system, ensuring all people access to the full range of safe and regulated conventional, complementary, and alternative health care professionals." It believes that Americans should have real choice about their health care, which includes access to CAM professionals. Since being voted onto their Board of Directors in the fall of 2009, I have been very impressed with their past accomplishments and future goals.
The IHPC played an important role in four key areas in the new legislation, which are: nondiscrimination language; expanded definition of health care workforce; comparative effectiveness research; and the National Council on Prevention, Health Promotion and Public Health.
What will this non-discrimination provision accomplish? This will make it illegal for insurers, group health plans and health care cooperatives to discriminate against a class of health care providers based on their license, (i.e., payment based on CPT code only). More importantly, it is the first time the CAM professions have pierced the Employee Retirement Income Security Act (ERISA) shield, therefore making licensed CAM professions' services accessible to millions of Americans on federal, private and ERISA plans. States have traditionally been tasked with regulating insurance plans, however, when insurance plans changed to become ERISA plans, the state laws that protected patients' freedom of choice statutes and mandated benefit laws were no longer applicable.
Health Care Workforce
One of the key elements of the bill is the definition of "health care workforce" and the inclusion of acupuncturists/DOMs/OMDs in this definition. It is important to note that acupuncture/Oriental medicine/TCM is not mentioned once in this law, and the language was a great source of controversy among legislators, but survived in the final version: "The term 'health care workforce' includes all health care providers with direct patient care and support responsibilities, such as physicians, nurses...licensed complementary and alternative medicine providers, integrative health practitioners, public health professionals, and any other health professional that the Comptroller General of the United States determines appropriate."
It's imperative to emphasize that we are not under any obligation to be preferred providers on government policies. It is our choice to participate.
Comparative Effectiveness Research
As you are well aware, the gold standard for research in the health care industry has been randomized controlled trials as well as double-blind placebo controlled studies. Comparative Effectiveness Research (CER) allows acupuncture to be compared with a variety of approaches such as standard care, spinal manipulation or deep tissue massage. This type of research may also include a cost analysis to find not only the least harmful and most effective modality, but also the one that is most affordable to the consumer in order to lower overall health care costs. For example, findings show that "patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes."5 The CER can clarify what modalities and treatments will provide the best value in our health care delivery system. In 2009, $1.1 billion of President Obama's stimulus package was earmarked for this effort.6
National Council on Prevention, Health Promotion and Public Health
This groundbreaking initiative contains a number of steps toward a healthier America:
- Developing a national prevention, health promotion, public health and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States
- Providing recommendations to the President and Congress concerning the most pressing health issues confronting the United States and changes in federal policy to achieve national wellness, health promotion and public health goals, including the reduction of tobacco use, sedentary behavior and poor nutrition
- Considering and proposing evidence-based models, policies and innovative approaches for the promotion of transformative models of prevention, integrative health and public health at individual and community levels across the United States.7
Since AOM is a highly evolved system of preventive medicine and health promotion, it will dovetail nicely with the efforts of the national council.
The IHPC has been working on Capitol Hill since its inception in 2002. During 2009-2010, IHPC's work became more apparent to the public through the creation of its online action network and because the work bore tangible results in the health care reform bill. As committees are formed and programs developed, Board members of IHPC will be working closely with legislators to promote an integrated health care that is based on therapies in addition to the conventional treatments utilizing drugs and surgery.
As an example, the IHPC has formally requested that the NCCAM call for a consensus conference on integrated treatments for chronic back pain. This initiative is currently in process. Other high priorities include working with the HHS on the mandated creation of the National Council on Prevention, Health Promotion and Public Health, ensuring that CAM and integrated health care approaches are included in the growing field of comparative effectiveness research, and conducting educational briefings on Capitol Hill to help legislators consider how best to re-orient our health care system toward a clearer understanding of health and wellness and more focus in health promotion.
The American public has expressed concern about the cost of a government-run health care system. The HHS contracted the RAND Corporation to write a policy brief entitled Analysis of the Patient Protection and Affordable Health Care Act, which concluded: "We found that, if enacted as passed, the legislation would decrease the number of uninsured in 2019 from 53 million to 25 million, would increase national health care spending by 2% between 2014 and 2019, and would result in a net benefit to those who become newly insured. Bear in mind that this 2% increase represents government spending, not premiums paid for by American citizens."8
In a recent article entitled "Health care overhaul won't stop premium increases," published in the Los Angeles Times, Noam N. Levey wrote, "Public outrage over double-digit rate hikes for health insurance may have helped push President Obama's health care overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future ... Stepping up regulation doesn't promise to be easy. Insurance companies in Maine and Massachusetts have sued state regulators who tried to block rate increases."9
It's hard to speculate exactly what the impact will be on our profession based on what's currently written in the bill, with the exception that all insurance plans will be written to provide acupuncture benefits. Time will tell what the newly passed law's effect will be on the American health care system and specifically on our profession.
However, it is not a matter or time alone. It is also a matter of proactive work on our part. Wondering how you can become more informed and involved? Go to www.ihpc.info, click on the action tab at the top of the page and sign up to become a member of the IHPC's online action network. This network gives CAM and integrated health care providers, and patients an opportunity to have a direct voice in policy-making by sending targeted communications to legislators and others on Capitol Hill. In the past round of health care reform, the IHPC's network sent thousands of letters to specific legislators.
When you sign up, you will receive e-mails periodically from the IHPC, sometimes inviting you to send an e-mail to your legislators on particular issues, sometimes gathering information from you about your policy priorities to help guide the IHPC's Board in decision-making, and sometimes asking you for a small donation to keep this effort going. Each individual action is voluntary. Signing up commits you to nothing other than receiving the e-mails, and you can unsubscribe from that at any time. Get involved. Your future depends on it.
- Senate Bill HR 3590, p. 688
- ibid, p. 1117
- ibid, p. 1619
- ibid, p. 2285
- Committee on Comparative Effectiveness Research Prioritization. Initial National Priorities for Comparative Effectiveness Research. Washington, DC: National Academies Press, p. 30.
- Senate Bill HR 3590, pp. 1115-6
- Ringel JS, Girosi F, Cordova A, et al. Analysis of the Patient Protection and Affordable Care Act (H.R. 3590). Santa Monica, Calif.: RAND Corporation.
- Levey, NN. Health care overhaul won't stop premium increases. Apr 13, 2010, Los Angeles Times.
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