Provider Nondiscrimination Update

My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care providers is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of  the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

New Study Distinguishes Specific and Nonspecific Effects of Acupuncture

This is a very clarifying study for those who follow the controversy about specific vs. nonspecific effects of acupuncture. It strongly counters the claim that nonspecific effects are the whole story and that therefore one can insert needles at random and achieve effects equal to classical acupuncture. Conceptually, this also relates to the specific and nonspecific effects of manual therapies including spinal manipulation.

The full text is available here: http://www.hindawi.com/journals/ecam/2013/427265/

Karner M, Brazkiewicz F, Remppis A, et al. Objectifying Specific and Nonspecific Effects of Acupuncture: A Double-Blinded Randomised Trial in Osteoarthritis of the Knee. Evidence-Based Complementary and Alternative Medicine. 2013;2013:7.

Abstract: Acupuncture was recently shown to be effective in the treatment of knee osteoarthritis. However, controversy persists whether the observed effects are specic to acupuncture or merely nonspecifc consequences of needling. Therefore, the objective of this study is to determine the efficacy of different acupuncture treatment modalities. Materials and Methods. We compared between three different forms of acupuncture in a prospective randomised trial with a novel double-blinded study design. One-hundred and sixteen patients aged from 35 to 82 with osteoarthritis of the knee were enrolled in three study centres. Interventions were individualised classical/ modern semistandardised acupuncture and non-specifc needling. Blinded outcome assessment comprised knee flexibility and changes in pain according to the WOMAC score. Results and Discussion. Improvement in knee flexibility was significantly higher after classical Chinese acupuncture (10.3 degrees; 95% CI 8.9 to 11.7) as compared to modern acupuncture (4.7 degrees; 3.6 to 5.8). All methods achieved pain relief, with a patient response rate of 48 percent for non-specific needling, 64 percent for modern acupuncture, and 73 percent for classical acupuncture. Conclusion. This trial establishes a novel study design enabling double blinding in acupuncture studies. The data suggest a specific effect of acupuncture in knee mobility and both non-specific and specific effects of needling in pain relief.

Mindfulness Training for Marines

The military is pragmatic — if something works, they will use it whether it’s conventional or alternative. Over time, the evidence-based alternatives become the norm.

While preparing for overseas deployment with the U.S. Marines late last year, Staff Sgt. Nathan Hampton participated in a series of training exercises held at Camp Pendleton, Calif., designed to make him a more effective serviceman.

There were weapons qualifications. Grueling physical workouts. High-stress squad counterinsurgency drills, held in an elaborate ersatz village designed to mirror the sights, sounds and smells of a remote mountain settlement in Afghanistan.

There also were weekly meditation classes — including one in which Sgt. Hampton and his squad mates were asked to sit motionless in a chair and focus on the point of contact between their feet and the floor.

“A lot of people thought it would be a waste of time,” he said. “Why are we sitting around a classroom doing their weird meditative stuff?

“But over time, I felt more relaxed. I slept better. Physically, I noticed that I wasn’t tense all the time. It helps you think more clearly and decisively in stressful situations. There was a benefit.”

That benefit is the impetus behind Mindfulness-based Mind Fitness Training (“M-Fit”), a fledgling military initiative that teaches service members the secular meditative practice of mindfulness in order to bolster their emotional health and improve their mental performance under the stress and strain of war.

Designed by former U.S. Army captain and current Georgetown University professor Elizabeth Stanley, M-Fit draws on a growing body of scientific research indicating that regular meditation alleviates depression, boosts memory and the immune system, shrinks the part of the brain that controls fear and grows the areas of the brain responsible for memory and emotional regulation.

h/t The Schwartz Report

 

 

CFO Magazine Urges Fortune 500 Firms to Explore Cost Savings Via Alternative and Integrative Medicine

A fine article by John Weeks at Huffington Post, well worth reading in its entirety.

CFO Magazine would seem an unlikely source of cheerleading for more inclusion of complementary and integrative medicine practices and providers into U.S. health care delivery. Yet the magazine that targets chief financial officers (CFOs) of Fortune 500 firms has been shaking those pom poms in recent months.

There is a smart economic alignment that connects these stakeholders at the economic hip. They may even be a perfect marriage, as one writer recently put it.

An October CFO Playbook on Health Care Cost Management webinar featured the medical doctor who chairs the most significant lobbying group for integrative health care, the Integrative Healthcare Policy Consortium. The presentation from Leonard Wisneski, M.D., was assertively titled “Integrative Medicine: The Future of Health Care Delivery.” Wisneski, a former medical officer for a large employer, urged extensive piloting of integrative approaches for their cost-saving possibilities.

Early efforts to integrate complementary and alternative medicine therapies and practitioners with conventional delivery — later called integrative medicine — taught us a hard lesson. Hospitals weren’t going to make money with “CAM” the way they do with high-priced services like interventional cardiology.

Rather, the big money in complementary and integrative medicine fields and their preventive and health promoting focus that CFO Magazine’s McCann notes is not in churning services. It is in saving money by limiting services. Use of lucrative interventional cardiology services may be reduced. Hospital business models typically don’t like this. Employer business models do.

The Supreme Court Speaks, Health Reform Continues

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

Supplements, Especially Those for Bodybuilding and Weight Loss, Linked to Liver Disease

Today’s MedPage includes a report on a study linking supplement use to liver damage.

A few comments…

I find it revealing that the study’s authors report a long list of drug company conflicts of interest and that “supplements” are to a large extent lumped into one overall category, which has the effect of creating a generalized anti-supplement narrative.

That said, the fact that bodybuilding and weight loss supplements seem to be the main culprits appears to be an important finding.

It would be most helpful to find out exactly which supplements we’re talking about. But all we’ve got at this point is an abstract from a poster presentation at a digestive diseases conference.

I will be interested to see if this results in a flurry of anti-supplement stories in major media in the coming days, despite the lack of publicly available data to analyze the findings and respond to the clearly anti-supplement narrative.

If certain supplements are dangerous, that’s definitely worth publicizing. But to tar all supplements with the same brush is disingenuous at best.

Congressional Committee Calls Chiropractic “Key Benefit” Within DoD Health Care System, Urges Pay Equity System

Over the past decade and a half, chiropractic has increasingly become an integral part of the health care systems serving America’s active duty military and its veterans. DCs now work at 45 VA hospitals and outpatient facilities as well as 60 Department of Defense treatment centers.

This news release from the American Chiropractic Association just arrived:

Congressional Committee Calls Chiropractic “Key Benefit” Within DoD Health Care System, Urges Pay Equity System      

Arlington, Va.- Members of the House Armed Services Committee have approved the inclusion of a strong, pro-chiropractic directive in their official committee report accompanying the FY 2013 National Defense Authorization Act. The committee language asserts that services provided by doctors of chiropractic (DCs) for our nation’s men and women in uniform is of “high quality” and has become a “key” benefit within the military health care system. Read relevant pages from the committee report here.

According to the American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC), the language is significant for several reasons. “What we have here–and this is very important–is an official statement from one of the House’s oversight committees with authority over the Pentagon that directly links the services of DCs to the treatment of conditions experienced as a result of combat operations. This is a huge validation that chiropractic services are of significant, direct value to a combat fighting force,” said ACA President Keith Overland, DC.

Equally significant, the thrust of the language is aimed at ensuring that DCs within the military achieve “pay equality” and appropriate “job classifications” that are on par with other health care providers with similar training, education and scopes of practice. Regarding that language, Dr. Overland noted, “Our advocacy efforts have not only been aimed at getting DCs into federal health care programs such as the DoD’s, and expanding their presence there, but they also have been aimed at ensuring that DCs are provided with appropriate status, authority, salaries and other benefits equal to those enjoyed by comparable-level providers. This is a major step forward in this advocacy process. It demonstrates that Congress is not just interested in simple DC inclusion, but inclusion in the right way which fully recognizes the status, training and professional capabilities of a DC. Part of the ACA’s mission is to level the playing field down to every last detail.”

Inclusion of the language follows a bi-partisan letter sent last year to the Assistant Secretary of Defense for Health Affairs, signed by 15 members of the House Armed Services Committee, requesting the Department of Defense take action to correct the wage rate disparity experienced by doctors of chiropractic within the DoD. Full congressional action on the Defense Authorization bill that includes the House committee language has not yet taken place, but enactment is expected later this year, according to ACA officials, and will be a positive indicator that Congress continues to support a robust chiropractic program within the Department of Defense.

“The Association of Chiropractic Colleges is gratified that the extensive education and training that doctors of chiropractic receive has been recognized and that appropriate compensation is vital,” said ACC President Dr. Richard Brassard. Dr. Overland added, “I want to thank House Armed Services Committee Chairman Buck McKeon, Ranking Member Adam Smith and especially Congressmen Mike Rogers of Alabama and Dave Loebsack of Iowa for moving this issue forward.”

For further information on chiropractic inclusion in the military, or to learn more about ACA’s ongoing legislative efforts, go to ACA’s Advocacy webpage at www.ACAToday.org

 

Medical Doctors Teaching Nutrition

Hopefully this is a sign of good things to come.

David Eisenberg, MD, is director of the complementary and alternative medicine program at Harvard Medical School and a long-time leader in the field.

From the Well Blog at the New York Times:

This isn’t neurosurgery,” Dr. Eisenberg said as he whacked a garlic clove with the cleaver. “This is hearty, affordable, cravenly delicious food.”

The son of a Brooklyn baker, Dr. Eisenberg is the founder and chief officiant of “Healthy Kitchens/Healthy Lives,” an “‘interfaith marriage,” as he calls it, among physicians, public health researchers and distinguished chefs that seeks to tear down the firewall between “healthy” and “ crave-able” cuisine. Although physicians are on the front lines of the nation’s diabetes and obesity crises, many graduate from medical school with little knowledge of nutrition, let alone cooking….

To Dr. Eisenberg, flavor is a health issue. Now in its eighth year, the sold-out event is in the vanguard of a major shift in attitude among a young generation of medical professionals who grew up with farmers’ markets. Their ranks include students at the Baylor College of Medicine in Houston, who have hired a chef to teach cooking skills, and a doctor in suburban Chicago who was so inspired by “Healthy Kitchens/Healthy Lives” that he went home and installed a demonstration kitchen in his medical office.

 

 

 

Congressman Tim Ryan on Mindfulness Meditation

An excellent story from the Washington Post.

In “A Mindful Nation,” published last week, Ryan details his travels across the country, to schools and companies and research facilities, documenting how mindfulness is relieving stress, improving performance and showing potential to reduce health-care costs. It is a prescription, he says, that can help the nation better deal with the constant barrage of information that the Internet age delivers.

“I think when you realize that U.S. Marines are using this that it’s already in the mainstream of our culture,” he says. “It’s a real technique that has real usefulness that has been scientifically documented. . . . Why wouldn’t we have this as part of our health-care program to prevent high levels of stress that cause heart disease and ulcers and Type 2 diabetes and everything else?”

The whole article is well worth reading.

h/t The Schwartz Report 

 

 

 

Homebirth Midwives: Better Outcomes, Moving Toward Broader Acceptance

From John Weeks in the Huffington Post, positive news from out west:

“Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.”

The speaker was Jeff Thompson, M.D., MPH, chief medical officer of the state of Washington’s Medicaid program. He spoke in a taped interview for Symposium 2012 — Certified Professional Midwives and Midwifery Educators: Contributing to a New Era in Maternity Care. The gathering took place at Warrenton, Va.’s Airlie Center on March 18, 2012.

Thompson, a member of the National Advisory Council for Healthcare Research and Quality, works in the state with the most evidence-based exploration of the value and risks associated with direct-entry, licensed, non-nurse, midwives. His state’s heightened interest began with a state requirement in 1996 that health plans cover midwives. Washington, like 11 other states, presently also covers midwives via Medicaid.

If the certified professional midwives (CPMs) get their way in Congress, CPM services will be reimbursed by Medicaid in all 26 states where CPMs are licensed. Passage would significantly expand access to low-income women across the country. The Access to Certified Professional Midwives Act was introduced in the U.S. House of Representatives in 2011 by Congresswoman Chellie Pingree (D-ME). Passage would energize a slight bump in home births captured in recent data from the Centers for Disease Control.