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The DeFacto Federal CAM-IM Agenda - Part 1 PDF Print E-mail
Written by John Weeks   

Special Report: The De-Facto 2006 Federal Agenda for CAM and Integrative Medicine


Part I: Federal Action of Five CAM and IM Disciplines

Below:
  • Conventional Academic Consortium: Practice-Based Research Network
    Image
    US Capitol Building

  • Chiropractors Focus on VA, DoD Inclusion

  • Acupuncture: Medicare and Federal Employee Benefits

  • Massage Therapists Keep "Ear to Ground," Focus on State Issues

  • Naturopathic Physicians Organize, Push Indian Health Services Inclusion


Overview and a perspective: 
Long-timers in the distinct complementary, alternative, holistic, natural products and now integrative medicine fields, will recall numerous initiatives which envisioned uniting these fields to move federal
healthcare policy. 

Wouldn't there be power in numbers? Isn't there a philosophic common ground which links these parties? Don't all endorse a move toward a system which is not reactive and end-stage oriented, but instead applies itself to the front end of care? Aren't all these fields health promoting, education-oriented, patient centered, limiting the overuse of problematic pharmaceuticals and high cost and sometimes unnecessary surgeries and their adverse effects? Couldn't we make more headway if we worked together?


The years pass. With a few exceptions - particulary the work of the Integrated Healthcare Policy Consortium - such energy and intention has rarely coalesced. The 109th Congress and the federal agencies in the Beltway are not presently dealing with a single piece of legislation or departmental action, much less a healthcare platform, which has wide backing from these diverse parties.

Image In this IBN&R Special Report, we approach the idea of a CAM-IM agenda from a different perspective. Rather than asking where interests are united, we ask:

  • With what federal actions are the diverse parties to integrated care individually engaged?
  • Are these individual agendas something that you -- and you as a member of your discipline or interest -- can support? 
  • Put differently: Will success in these initiatives enhance our ability to realize our visions of integrated health care?
  • Finally: Might there be value in each of the involved fields cross-endorsing the action area of the others?

Highlights of the DeFacto Agenda

For this Part 1 of this Special Report, the IBN&R interviewed leaders of five leading CAM and IM fields to determine their priority activities. Here are top priorities on which each discipline is working.

  • Chiropractic - Focus on continuing with the pilots of chiropractic in the Veterans' Administration and of Department of Defense initiatives.
  • Integrative medicine - Seek funding for a practice-based research network involving the IM members of the Consortium of Academic Health Centers for Integrative Medicine.
  • Acupuncture and Oriental medicine -- Continue efforts to gain a place for AOM practitioners in Medicare and federal employees benefits.
  • Naturopathic medicine - Secure inclusion of NDs as included providers in Indian Health Services.
  • Massage therapy - Continue focus on state licensing with federal work defined by participation in the Integrated Healthcare Policy Consortium.

Disciplines do not, typically, support agendas of others unless there is something in it for
Image
Make-up of the 109th Copngress
them. Why would NDs support legislation to get AOM providers into Medicare when NDs are not presently included?  Why would chiropractors, who might feel that they too would benefit from federal funding of a practice-based research network, support the agenda of the IM doctors? Why would IM doctors lend their credit to the agendas of any of the CAM disciplines? And why would massage therapists, presently without a specific Congressional initiative, care about advancing the other fields?

Affirmative answers to these questions can only come if the IM and CAM disciplines decide that their visions of integrated healthcare would be promoted by the gains of the others. This begs a larger question: Can we transform healthcare if we don't transform the way disciplines relate to each other?

Columnist Paul Krugman ("The Health Care Crisis and What to Do About It," New York Review of Books, March 23, 2006) recently called "fragmentation" the "key problem" in the US healthcare sytem. Perhaps practicing more connectivity between disciplines at the policy level may begin to create more coherence through which a reformed health system can be constructed.


Conventional Academic Consortium: Still Clarifying Goals

The Consortium of Academic Health Centers for Integrative Medicine, an organization of 30 conventional academic health centers, has a new working group on policy. This initiative is co-directed by Paul Vick, a government relations expert at Duke University, a consortium member. Image

Vick told IBN&R that the Consortium's exact agenda is not fully set. (Consortium chair Susan Folkman, PhD underscored in an IBN&R interview  that the Consortium's federal priorities had not yet been set.) Vick cites two general directions. One is "around issues of funding." This includes supporting the budget for NIH NCCAM and pursuing other agency opportunities for funding the Consortium's priorities. Vick states that a focal point of the work is securing funding to develop a practice-baed research network among interested Consortium members. Vick notes that there was "report language in the (U.S. Senate) appropriations bill" which encourages support of PBRN networks.

Vick states that a second general area is "issues around reimbursement, particularly Medicare and Medicaid," for integrative services. Vick, while aware of the recent decision by the Centers for Medicare and Medicaid Services regarding cardiac rehab services (see CMS Boosts Multidisciplinary Cardiac Rehab Services), is "not clear what utility it may have" for Consortium members.

Image
Paul Vick, CAHCIM Policy Co-Chair
Vick, a seasoned lobbyist, notes that asking members of Congress to "support the recommendations of the White House Commission on CAM Policy is on the agenda of the Consortium for possible consideration as a priority. Asked about possible efforts to re-invigorate the recently dormant Congressional Complementary and Alternative Medicine Caucus, Vick told IBN&R: "The value of any caucus is that it shows an expression of interest by members in a given field -- with the ultimate value coming by having legislative initiatives that you get the caucus to support." No agenda has yet been clarified and brought to this focal point for Congressional activity.

Consortium federal acion, when clearly defined, may be expected to be supported, to an extent at least, by the government affairs departments of others of the Consortium's 30-member academic health centers.

Chiropractic Agenda Focuses on VA, DoD Inclusion

The chiropractic profession is unique among the professions considered here for the size of its focused lobbying team. Government affairs for the American Chiropractic Association includes 4.5 professional staff, plus legal counsel, according to new executive director Kevin Corcoran. The ACA frequently works closely with the Association of Chiropractic Colleges, which brings its own lobbying team to specific initiatives.

State of Emergency Declared

Work includes both proactive and defensive campaigns. An example of the latter is a fight against S.B. 1955, the Health Insurance Marketplace Modernization and Affordability Act.   The bill, according to a March 27, 2006 ACA release, "would prove disastrous to chiropractors and their patients" through "gutting state protection laws." The ACA, which has declared a profession-wide "state of emergency" to fight the measure, recently focused its federal lobby day on opposition to S.B.Image 1955. Over 500 ACA members participated. The chiropractors currently have some form of mandated insurance coverage in 45 states. Says Corcoran: "We're rolling out our grassroots on this one."

(Note: IBN&R recently received information that the Washington Association of Naturopathic Physicians whose members are included in all of the State's health plans through the 1995 "every category of provider" legislation, has also alerted  its members to oppose the Act.)

On the pro-active side, Corcoran notes that there are presently 53 Department of Defense bases in which chiropractors are on duty and delivering chiropractic care. The ACA and ACC have exercised vigilance in pushing the DoD to comply with a federal requirement to include chiropractors. Last September, a report of the US General Accounting Office took the DoD to task for its slow implementation. In early 2006, 11 Air Force bases, the DoD division where implementation had been slowest, added chiropractic services.

Also following legislation passed via the ACA-ACC coalition, chiropractors are now on staff in 30 Veterans' Administration facilities -- of the 150 potential sites. The ACC is looking at potential Congressional action to "urge them" to more rapidly expand implementation. Gaining access has frequently met with resistance, despite the Congressional act.

The chiropractors have found a similar pattern of reluctant implementation in their demonstration project to include chiropractors in loan repayment programs of the US Bureau of Primary Health Care. States Corcoran: "Two-million dollars were granted to fund 40 positions. Only 6 were paid for." The goal, again, is to make the agency abide by Congressional intent, and eventually make chiropractic participation permanent.

Asked about working in coalition with other CAM-IM interests, Corcoran states: "We  see places where we can work together, but chiropractors will be reluctant to be viewed as 'alternative.' Being 'alternative' is to be alternative to the first tier."

Acupuncture Initiatives: Medicare and Federal Employee Benefits

Will Morris, LAc, president of the American Association of Oriental Medicine (AAOM) figures that a basic presence in Washington, DC, would cost the association $75,000-$150,000 per year.Image The AAOM, which represents the nation's licensed AOM practitioners, hasn't yet been able to fund that work. Morris hopes that this time will be coming soon.

Meantime, the leading acupuncture-related federal initiative remains a bill to include AOM practitioners as accepted providers in Medicare and federal employee health benefits. Known as the "Hinchey Bill" after Congressman Maurice Hinchey (D-NY), the bill has been introduced in each Congress since 1993. Called the Federal Acupuncture Coverage Act (HR 818),
the bill picked up 49 sponsors in 2005, just below the top performance of 57 during the 108th Congress. The bills has yet to have had a hearing, according to Morris. A Senate version has never been
Image
Will Morris, LAc, AAOM Pres
introduced. Taking the lead on the bill for AAOM is their legislative affairs committee chair Lloyd Wright, LAc, DNBAO. "It's been on a back burner for a couple of years but I am going to push on it," Wright pledges.

Morris, the AAOM president, notes two other areas of national involvement for his organization. One is continued participation as part of a consortium of nine national organizations to develop a "Proposed Regulatory Model for Traditional Medicines." This work includes developing an effective adverse-response reporting system.

The second area noted by Morris is to work with the Accreditation Commission for Acupuncture and Oriental Medicine and diverse organizations inside the acupuncture field to clarify standards which will shift basic acupuncture training toward an entry-level doctorate. ACAOM has called for public comments after issuing its final report.

Massage Therapists Keep "Ear to Ground" But Focus on State Issues

Liz Lucas, executive director of the American Massage Therapy Association, is blunt about her association's  federal interests: "The subject of a lobbyist in DC just doesn't come up." The organization, which has led the spread of massage licensing in the past 15 years onto 37 states, has recently taken on a professional staff person to support state efforts. The focus, for now, is on "cleaning up laws for portablility purposes."Image

The organization, however, wants to "keep its ear to the ground" federally, states Lucas. For that purpose, AMTA chose to make a multi-year grant of $5000 a year to support the work of the Integrated Health Care Policy Consortium (IHPC) to stimulate collaborative national work. Lucas is a member of the IHPC's Advisory Committee. Says Lucas: "We've used them as a channel onto what is going on in federal initiatives." (The IHPC's priorities will be covered in Part 2 of this Special Report.)

Naturopathic Physicians Organize, Key on Indian Health Services

The American Association of Naturopathic Physicians (AANP), like the AAOM, has not yet assembled the funds to mount a full-time Congressional lobbying effort. But the DC-based association's executive director, Karen Howard, notes that a part of her time, plus that of a part-time
Image
Karen Howard, AANP Exec
lobbyist, are helping them in an array of activities which are laying the ground for a higher profile role. Howard also serves as the executive director of the profession's Association of Accredited Naturopathic Medical Colleges, a consortium of six recognized North American naturopathic programs.

Internal organizing work by the AANP has included:

  • the institution of an annual Congressional lobbying day for the profession, which will have its 4th gathering this May
  • establishment of bi-annual meetings of the leadership of all of the profession's leading institutions to agree on shared priorities.

The chief federal effort has been seeking inclusion in the Indian Health Services (IHS) as covered provider category. In 2005, Congressman J.D. Hayworth (R-Az)  successfully included  naturopathic doctors in the  House version of the IHS re-authorizaton bill. ImageHayworth's involvement grew from activity with local tribal groups in Arizona by the Scottsdale, Arizona-based Southwest College of Naturpopathic Medicine. Howard explains that inclusion would allow graduates into the IHS's loan repayment programs and students into scholarship programs. Such inclusion has yet to pick up a Senate sponsor.

The AANP/AANMC has not been involved in working with, or through the Congressional CAM Caucus. Says Howard: "I am not sure that one particular Congressional caucus can serve as the conduit for our agenda -- even the CAM caucus. Our message as a profession cuts across a myriad of issues and participation as one part of a larger alternative medical community is not the appropriate venue for defining what naturopathic medicine has to offer." She sees the profession working with and through other caucuses, naming the Disability Caucus as one of particular interest. The AANP also anticipates involvement with "activity around the Dietary Supplement Health and Education Act" (DSHEA). "We believe that the full implementation of DSHEA is in the interest of our patients," explains Howard.

Among other areas of interest noted by Howard are Department of Defense, disaster relief and homeland security issues. The profession is also active "in a variety of Department of Education issues" regarding the standing of the profession's educational institutions and degrees.


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