November 16, 2012 -- Naturopathic doctors are “cautiously optimistic” that they will have a place within Oregon’s coordinated care organizations (CCOs) after officials threatened to cut them out of the primary-care system and seemingly ignore non-discrimination language in Senate Bill 1509.
The problem was highlighted in a September 19 article that appeared in The Lund Report -- “Naturopaths Left Behind in New Coordinated Care Organizations” – after which the state began requiring CCOs to process the bills from naturopaths for 90 days, starting November 1. In the meantime, officials are attempting to resolve the problem.
In fact, the Oregon Health Authority has pledged to work with a group of Oregon Health Plan patients who could lose access to their naturopaths after this 90 day window. The problem occurred after several CCOs were unwilling to accept naturopaths on their panel of providers.
If CCOs continue to exclude naturopaths, these patients will have the ability to be placed on an open card – outside of the managed care system. For more information, download this fact sheet from the Oregon Health Plan. Naturopaths have offered more information based on their understanding of the situation at the Oregon Association of Naturopaths website.
“We’re not as worried now that people are going to lose access,” said Laura Farr, executive director of the Oregon Association of Naturopathic Physicians. “Excising patients of naturopathic doctors will continue to be able to see their providers, at least for the foreseeable future.”
But this temporary solution provides little solace for Ellen Reva and many other patients in her type of situation. Reva, 24, who is currently about six months pregnant, sees naturopathic Dr. Katherine Zieman in Gresham.
Before CCOs came into play, women in their last trimester were eligible for an open card that would cover their naturopath. That’s not the case any longer, although women who were receiving state-funded naturopathic care can seek an excemption. Reva, who’s not a member of the Oregon Health Plan, would have had to have been on the plan before Nov. 1 to be eligible to have her naturopahic care covered under the current rules. She prefers seeing Zieman, who’s been with her since the beginning of her pregnancy in June, and tests her blood, weight, and listens to the fetus’ heart -- practices common among maternity doctors.
“I prefer naturopathic care because in a hospital you’re just the next person in line, and I’d like to get more emotional support and more time with my doctor,” said Reva. “If I had to go to a hospital, I’d feel like I had no choice in the matter and I was being forced by the state to go there.”
Reva, 24, works at a check-cashing company and paid about $190 out-of-pocket for her first visit to Zieman, but estimates that her payments so far have totaled less than $500, still “a burden” for a family living below the poverty line.
“It’s much cheaper that a hospital, so I don’t know why they don’t want to cover it,” she said.
She and her husband, Andrey, 25, married in April, when she moved from Missouri and rented an apartment in the Portland area. They feel that “hospitals treat pregnancy like a disease,” an attitude they plan to avoid if at all possible.
“Those uniforms scare me, and Dr. Zieman’s really down to earth,” Reva said. “People have been giving birth naturally for ages, and some people might consider the hospital more civilized, but I consider a hospital to be a place where you go if you’re sick.”
Negotiations continue with CCOs
The state’s reprieve came after the Association of Naturopathic Physicians delivered over 2,000 petition signatures to the governor’s office on October 30 demanding that “patients need access to every type of provider licensed by the state.”
Farr is hoping that naturopathic doctors don’t have to go to the Legislature for a permanent solution since lawmakers already included the nondiscrimination language in the bill creating CCOs. “We think that the governor’s office will help implement those rules,” she said. Officials in the governor’s office did not return calls for comment.
On November 15, the naturopaths’ association began distributing a White Paper on naturopathic primary care in Oregon. This has been prepared to address concerns or questions, and to offer criteria and a pathway to utilize naturopathic doctors.
Although some health plans show no signs of budging from the position of cutting out naturopaths, but Farr described a meeting last week with CareOregon as “very positive.” CareOregon plans to draft some criteria for credentialing naturopaths as primary care providers, and promised Farr that the health plan would get their feedback before finalizing those criteria.
Also, The Yamhill Coordinated Care Organization seems to be taking steps toward figuring out how to work with naturopaths. Its clinical advisory council met last Friday morning and had a lengthy discussion with a naturopath from McMinnville.
“Again, no formal decisions made, but positive signals,” Farr said.
CCOs leaders and state officials have told The Lund Report that their goal is to make sure all the providers who are become part of their network meet “basic standards of care” and that legislators would consider rules clarifying the role of naturopaths when they meet in December.
Jason Black, who’s a naturopath along with his wife, Jessica, says CCOs have false ideas about the role of their profession. Since January, the couple has treated 600 patients on the Oregon Health Plan.
“They really don’t understand what we do or what our training is,” he said. “Their misunderstanding is that we just don’t know how to treat chronic cases that need a referral. I understand where the concerns are coming from, but the questions, such as whether we were board certified, which of course we are, were just ignorant and insulting.”
His wife, Jessica, believes the current situation is now much more promising: “There’s a great need to have multiple types of primary care physicians, and we can help fill that void of patients having access to care. We work out of two different counties and most rural counties don’t have enough providers to see all of their patients. We’re seeing quite a number of patients where there’s limited primary care, so they’re thinking, ‘what are we going to do without these folks are accepting new patients?”
Another case study
Jessica Black has provided primary care for Kim Walton and her children, who used to live in Yamhill County. Walton’s oldest is now 5, and she started feeling “comfortable” immediately seeing Black when her infant daughter was only days old.
“She was tiny and very colicky, and Dr. Black provided lots of options to help me out with how to care for her,” Walton said.
Then Walton had some complications during her second pregnancy, which resulted in an emergency C-section at Oregon Health & Science University, followed by a two-week stay in the neo-natal intensive care unit. Her days-old son had a posterior urethral valve, which compromised his kidneys, and doctors told her that his kidneys would most likely need a transplant before he was 18.
Black remembers when she was in the intensive care unit being able to ask her what advice she needed.
“Using the imagery and urinary testing that any other type of doctor would use, we were able to track his progress to seeing it head bit by bit to more normal,” Black said.
But it was not just a “wait and see” method that she said another doctor might use when considering a kidney replacement. Black was using various non-toxic boosters of kidney function, including homeopathic and herbal medicines.
“When we came home, she saw us every week, and provided excellent care,” Walton said. “She embraced methods both natural and traditional mainstream to treat him very proactively. Now my son is almost 2, and his health is almost perfect. I believe it was a result of her care that he is so healthy now.”
After Walton moved, the Oregon Health Plan would not allow her to keep an open card so her children could continue seeing Black. She believes naturopaths should be fully involved in the new CCOs because they’re truly focused “on prevention and improving care.”
“Since then, I have not taken my kids to their new primary-care provider under the new coordinated care organization, and have tried to scrape together some money when they need to go to the doctor to see Dr. Black instead,” Walton said. “She knows them all, and I don’t want to have to start fresh with a new primary-care provider, especially with my son, with his past problems. “
The Blacks believe no one should find themselves in Waltons’ situation.
“We have so many more options, but we excel in those chronic conditions where we thyroid, asthma in children, gastrointestinal complaints and chronic pain,” Jessica Black said.
Jason Black specializes in the pain-management side and said a naturopath can “promote healing” of Crohn’s and colitis diseases of the intestine and prevent painful flair-ups.
“We have not only been able to get people’s pain managed so that they can start de-toxing,” he said. “We really focus on how people respond to the stresses in their lives and what the sources of those are.”
He also sees hope in the common ground between naturopaths and other physicians.
“I want to take away the fallacy that we can’t all work together to improve patient outcomes,” he said. “This whole transformation is about increasing the use of preventive measures, and there’s a lot that naturopaths have to offer there, so it could be a win-win. Patients really appreciate having their health care managed with preventive medicine.”