How Health Care Reform Affects Alternative Medicine Still Unclear

Tue, May 10, 2011

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KMUW / Briana O’Higgins

As full implementation of the Federal Patient Protection and Affordable Care Act – or health reform - inches closer, health professionals are figuring out the changing system and their changing roles. This includes Kansas physicians and practitioners of complementary and alternative medicine, also known as CAM. For some of them the current bill will present opportunities, but challenges can’t be ruled out at the state and national level.

In a small room in a strip mall office in Derby, Activator Chiropractor Dr. Mindy Ewert is manipulating the spine of her intern, Stephanie Meyers. As a chiropractor, Dr. Ewert started studying chiropractic after shadowing a variety of doctors.

Ewert: I just thought it would be fun to see what a chiropractor does, and I was sold the first day.

Ewert says she was drawn to the natural and preventive elements of chiropractic, a hallmark of complementary and alternative medicine that also includes acupuncture, homeopathy, naturopathy, herbalism and some others.

Chiropractic is a practice of muscular skeletal manipulation, that Ewert says many people think is just for neck and back problems.

Ewert: We do work a lot on your spine and your back; the bigger reason that we do that is because of the nervous system. That is what controls ultimately everything in your body and the fate of your health, and we want to make sure that there is no structural stress on that system.

Chiropractic has come a long way since Kansas became the first state to license the practice in 1913, with major strides made in the last couple decades. Dr. Daniel Redwood is a professor of chiropractic at Cleveland Chiropractic College in Overland Park.

Redwood: When I first started exploring chiropractic as a possible career, and I am talking about the mid to late 1970s, there were at that time no, and I mean zero, randomized control trials on spinal manipulation, which is basically the primary method that chiropractors use.

Chiropractic’s inclusion into mainstream medicine has been slow. Dr. Redwood remembers lobbying Washington as a young doctor in 1980. He and others were asking for chiropractic inclusion on health teams serving both active duty military and veterans. At the time he says he felt like it was a pipe dream - never to happen in his lifetime. But he was wrong.

Around the turn of the 21st century laws were passed, one signed by president Clinton, the other signed by president George W. Bush, which included chiropractic in active military care and VA care.

Chiropractic is licensed in all 50 states and is covered by some insurance companies.

There have been hundreds of random controlled trials and there are several scholarly journals dedicated to the subject. Redwood says there are many millions of people in the US and across the world that have been helped by chiropractors, the majority of them seeking care for low back pain.

Redwood: I don’t think it is really in dispute at this point among informed scientist and informed policy makers that it is clinically effective. I would say that it’s proven, and they use the term proven.

Chiropractic is growing, along with many other areas of complementary and alternative medicine. Redwood says it is partly due to dissatisfaction.

Redwood: On a one-by-one two-by-two basis until you have millions. Dissatisfaction from results from conventional medical care, and that is a piece of it. There is another piece of it that has to do with congruence with a philosophical outlook with a desire to live more in harmony with nature, for example, to do things that emphasize more natural approaches, fewer synthetic approaches.

A natural approach is exactly what is offered at Wichita’s Riordan Clinic, a nutrition-based health facility.

The Riordan clinic has staff of 40 including two medical doctors and a naturopathic doctor, a license provided by only 16 states, one being Kansas. Dr. Jennifer Kaumeyer is the Riordan Clinic’s naturopathic doctor. She says at the clinic they focus more on health, not disease management.

Kaumeyer: So we really work at trying to bring the body back to health, rather than just managing symptoms and diseases. We have a lot of things in what we call the black bag. We have a lot more options, especially nutritional therapies, IV therapy and things like that.

Just like with chiropractic, natural healing has grown in the last decades. Riordan’s director of operations, Donna Kramme, says when she started in 1980 they were seeing patients who had already exhausted their options in traditional western medicine.

Kramme: And then they were like I am going to go here, this is it. And that is great, we will see those patients all day long and that is fine. But you know the kind of patients we want to see say, “I want something different, I want to find out the real cause of the problem and let’s go in and change that. Lets make a difference.”

And those people seem to be the ones coming these days.

Currently most patients of the Riordan Clinic pay cash at their time of service. And chiropractor Mindy Ewert, says most of hers do, too. That is because insurance companies do not have to pay for services provided by CAM practitioners like chiropractors and naturopaths, and if they do pay there are often many restrictions.

Ewert: We have so many people dictating how we practice and chiropractic is a different kind of entity. You know they can no more say how we do our job then we could tell them how to do theirs, so there is a bit of a problem with that. With health reform that could be a little bit of a different situation, if more people have coverage for chiropractic. So we are hoping that will open a whole lot more avenues to see people get that care.

Redwood: There are a few things included in the law, first and foremost section 2706, which is the non-discrimination clause which basically says that it is illegal, starting in 2014, for insurance companies to discriminate against categories of practitioners who are practitioners who are practicing within their legal scope of practice.

This is big in all 50 states for chiropractors, in 44 states for acupuncturists, though not Kansas, and in 16 states for naturopaths, including Kansas.

Redwood: Now how that plays out exactly in the states, because that is where a lot of the action is right now…we have to be eternally vigilant at this point. We have to make sure there isn’t, that there aren’t policies set up at the state level that neuter the wonderful non-discrimination law. It is a moment of great opportunity, and it is probably cliché at this point, but the Chinese character for crisis is danger and opportunity and it is a moment for both.

At the Riordan Clinic, Donna Kramme says they are open to finding their way within the new law, but still a few years from the 2014 full implementation date, they are sitting back to see what happens.

Kramme: We have no idea what to expect, but it could be very good for us and the whole medical community in general if they stick to some of the things that they are talking about. But like I say, basically with insurance you end up paying all the premiums all the time, and it is great. You need insurance, don’t get me wrong. But you kind of need to look for insurance, my personal opinion, kind of in a catastrophe policy you know, get a larger deductible and kind of invest a little by keeping yourself healthier so you don’t end up with those dreaded diseases.

Whether the Riordan Clinic decides to contract with insurance companies or not, if health reform goes forward as written, naturopaths and chiropractors in Kansas and a handful of other CAM practitioners nationwide will be able to enter the world of health insurance, with all its perks and its pitfalls.