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Professions & Politics: Organizations, Developments, Legislation in Integrated Health Care PDF Print E-mail
Written by John Weeks   

Professions and Politics: Possible AMA Scope of Practice Strategy, DCs Viewed Positively in Washington Post, DC and ND on Washington Tech Assessment Committee, Reflections of AANP's Guiltinan, Indiana Regulates Massage, Role of Tibetan Medicine

Summary: This is an occasional look at professional action related to integrated care. A possible American Medical Association legislative strategy related to the restrictive Scope of Practice Partnership against other disciplines noted ... Work of the American Chiropractic Association supported the development of a favorable piece in the Washington Post ... Naturopathic leader Jane Guiltinan, ND, president of the American Association of Naturopathic Physicians itemizes accomplishments and unfinished business in a term near to completion ... Indiana becomes the 38th state to regulate massage therapists ... Clinician and writer Eliot Tokar explores a role for Tibetan medicine in the Western world ... Washington State establishes an integrated clinical group to assess healthcare technologies and inform coverage decisions ...
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1.   Possible AMA Scope of Practice Partnership Strategy: "Manage" Scope Issues for Legislators

Possible SOPP strategy?
Some who have been waiting for the other boot to fall after the American Medical Association announced its Scope of Practice Partnership  (AMA SOPP) in spring of 2006 are wondering if an emerging state legislative strategy on scope may have the AMA's hand-prints on it. The strategy is to pass legislation which would require all scope-related issues to first be vetted through a new scope of practice review committee. Parties with pro and con views on the change would have representation on the committee. The committee would make a report to the legislature. The catch is that the proposals typically suggest that the process be housed within the state medical board, which is controlled by MDs. Can one expect fairness from any single profession? Images of foxes and hen houses come to mind. 

The strategy has appeared in multiple states. In Oregon, according to a legislative report from the Oregon Naturopathic Physicians Association (OANP) to its members,  
SB 717 "attempted to create a review committee to assess any proposed changes to scope of practice for all healthcare professions prior to the next legislative session." The OANP and others successfully raised concerns with language in the original bill which "authorized the Board of Medical Examiners to convene the review committee." The OANP also was concerned with the politics suggested by language which "would have required the committee to consider evidence-based research in the assessment." The bill died in committee but the issue is expected to come back. The Oregon Nurses Association (ONA) was also following the issue closely. Their analysis is here.

Comment: That there is a debates over the extent to which this is a quiet AMA SOPP strategy or a legitimate legislative concern is evident in Oregon and particularly with the ONA's positioning. The primary sponsor of the bill in Oregon is a nurse, Laurie Monnes-Anderson. The ONA defends her work on SB 717
with this language:
"Senator Laurie Monnes-Anderson is responding to a concern raised by some legislators about health profession scope of practice issues. Many of Oregon’s legislators feel they know too little about these issues. And they also believe there’s no way to acquire objective information."
Legislators are being hit with many exotic scope issues. Meantime, the American Nurses Association is the lead agency in the Coalition for Patients Rights which was organized to oppose the AMA SOPP.  Thanks to Kevin Wilson, ND, for alerting me to the bill.

2.   ACA Publicizes Washington Post Story Blessing Chiropractic

Praising coverage
The July 17, 2007 health section of the Washington Post featured an article
entitled “Mainstream Makes Adjustments.” A note to members from the American Chiropractic Association, which worked on the story, stated that one of the most powerful comments in the story is from William Lauerman, MD, the chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital. Lauerman is quoted as saying: “I’m an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic.” Lauerman later gives a nod to chiropractic's use in not only acute conditions: “I'm more of a believer for acute problems like short-term back pain, although I know [chiropractic] can be helpful for some cases of more-chronic conditions.” The article focuses on the personal experiences of patient and writer Buzz McClain, who, following three unsuccessful spinal surgeries was referred to a chiropractor by his neurologist.

Comment: A complementary practitioner colleague who read the article notes that it is "classic" that the referral came after 3 surgeries. The concept of therapeutic order, of trying the least invasive approach first, remains a too-rare topic in the integration dialogue.

3.    Massage Therapists Gain 38th State in Indiana, See Internal Disputes Etched in Statute

In early May, with the passage of SB 320, the State of Indiana became the 38th, plus the district of Columbia, to regulate massage therapy. The certification bill will establish an Indiana State Massage Therapy Board with five members: 3 massage therapists and two members of the public. In an interesting note, the law stipulates that not more than one massage therapist member appointed to the board may belong to the same professional massage therapy association and at least one members must not be a member of any association.
Comment: The internecine, intramural battles in the massage field between different association appear to have passed over into willed ignorance. Membership in an association is typically a way a professional learns things. Perhaps the law should have mandated that at least one board member will have never spoken to another massage therapist. This would introduce a concept of immaculate conception into political appointments. Odd.

4.   Reflections of an Association President: Outgoing AANP President Jane Guiltinan, ND

I was recently informally in touch with Jane Guiltinan, ND, regarding the President's Reception at the August convention of the American Association of Naturopathic Physicians. Guiltinan, a colleague since 1985, is AANP president. She will be hosting the reception for her final year this year. I asked how she felt about her term leading national organization representing the 4,500 practitioners in her emerging and ambitious field. Naturopathic doctors are now licensed in 14 states.
AANP president Guiltinan
Guiltinan replied via email in great honesty. I asked her if I could share her comments, believing that the passion in what she wrote would ring true for any numbers of leaders of grossly-underfunded and passionate leaders of diverse discipline. She said yes, and said she'd like to add some "balancing" comments. Here is her soliloquy:
“My term ends December 31, will be on the board one more year after that as past president.  It's a lot of work, 15-20 volunteer hours a week, mostly very positive but occasionally feels like you can't get anything right as you hear more from the unhappy campers than you do from the happy ones.  I feel generally good about my term, but wish more could have been accomplished like 50 states licensed, residencies for every ND grad, 90% of eligible ND's as members, more new schools, better malpractice options, access and equity for ND's in the reimbursement world, real integration, standards of care, more cost and clinical evidence for our medicine, better tools for our grads to succeed out in the big bad world, increased public awareness of naturopathic medicine, etc. etc, etc.”
Guiltinan got back to me with more of what she has accomplished and what has given pleasure:
"I also think that in spite of our relatively small size and budget, the AANP has done a great job of leveraging resources to accomplish many things.  Examples include leadership training for state affiliate associations that have tremendously increased their capacity and effectiveness; enhanced member benefits; initiation of a public awareness campaign; support for demonstration projects like (member) Bernie Noe's award winning corporate wellness program and the development of the school WELLth program; relationship building with groups such as the National Foundation of Women Legislators, the AHMA, the AHNA, the Coalition to Preserve DSHEA, the Coalition for Patient Rights, and the Collaborative for Healthcare and the Environment; advocacy on the federal level through our lobbyist, our 5th annual federal lobby day attended by over 85 AANP members; representation on the AMA/CPT Health Care Professionals Advisory Committee; and finally, increased staffing and infrastructure in our office in Washington DC that has resulted in improved customer service for both members and the public, as well as our capacity to get things done. Membership numbers have increased annually for the last several years, and are exceeding our projections for this year.  Indeed, there is much to be done, but there are also many accomplishments to celebrate."
Tokar - a pluralistic vision
Comment: An interesting sweet, short description that captures the life energy not only inside the AANP, but any number of professional organizations in the natural healthcare fields. Clearly, Guiltinan’s successor will have no trouble finding focal areas for work.

5.   Role of Tibetan Medicine in Western Systems Explored

Tibetan medicine practitioner and activist Eliot Tokar has recently published a document entitled "Preservation and Progress: Using Tibetan Medicine as a Model to Define a Progressive Role for Traditional Asian Medicine in Modern Healthcare" has just been published in Asian Medicine Tradition and Modernity, the journal of the International Association of the Study of Traditional Asian Medicine. Tokar believes that Tibetan medicine provides some clues about a pluralistic method for integrating Asian therapies into medical and public health practices. Tokar explores "the proper interaction between traditional Asian medical systems (e.g., Tibetan medicine) and biomedicine?" A link to the article, available as a PDF is at Tokar's site is here.

6.   Washington State Integrates Technology Assessment for Coverage Decisions

Image Small signs of integration: Lori Bielinski, executive director and lobbyist for the Washington State Chiropractic Association (WSCA) sent a note that the Washington State Health Care Authority has established an integrated team of 11 clinicians to inform its
Health Technology Assessment Committee. The committee will evaluate the evidence surrounding diverse treatments in order to inform insurance coverage decisions. The committee's first three health technologies to be reviewed are lumbar fusion and discography, pediatric bariatic surgery, and upright/positional MRI. By statute, the committee includes 6 practicing physicians and 5 other practicing licensed health professionals "who use health technology in their scope of practice." Included on the committee, following lobbying by the WSCA and the Washington Association of Naturopathic Physicians, are Carson E. Odegard, DC, MPH and Michelle Simon, PhD, ND.

Comment: Like the integration of licensed natural healthcare professionals into the
AMA/CPT Health Care Professionals Advisory Committee, noted above (which also has a chiropractor and an acupuncture Oriental medicine representative, along with the ND), this is inclusion just outside the inner, economic sanctum of healthcare. That said, those writing the statute made clear with their 6 MDs, 5 others make-up that MDs, unified, could quell any non-MD uprising.

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