OANP’s BIG TENT
Thursday, November 15, 2018
Posted by: Jeff Clark | Legislative Committee Chair
Naturopathic doctors are an independent lot. We have many diverging opinions and ways to practice. That independence is one of the many things I personally love about our medicine and our profession. So many treatment choices and one shared ideal above all others. Individualized care. Some topics are controversial enough to seriously divide us. Some have gone so far as to state that because of one or more issues, OANP "doesn't represent their views" or "doesn't share their voice."
If you find that you feel that OANP doesn’t represent you on any specific issue, you might have misunderstood just why OANP exists and why it is much more than any single issue.
OANP’S CORE MISSION
1. Our right to exist. You would think after being licensed in Oregon since 1927, this shouldn't be much of a concern. Think again. Both Florida and Nevada for example, used to be licensed states and had their licensing laws revoked in 1959 and 1987 through the aggressive efforts of proponents of conventional medicine.
Over the years OANP has had to fend off multiple attempts to dissolve the Oregon Board of Naturopathic Medicine and fold it under other regulatory bodies that oversee tattoo artists, and nutritionists.
I have had it intimated to me personally by an insurance executive that we might just be lucky to still be practicing at all. He was implying that “they” have the power to take that away from us if we get too “uppity.” My involvement with OANP is why that didn’t, and doesn’t rattle me. We can never let our defense down. The menace is real, and our best ongoing defense is the continual advancement of our profession.
2. Scope of practice. Oregon has possibly the strongest ND scope of practice in the nation. We need to always be surveying the landscape and stand ready to defend what we are legally able to do. Here is a brief look at the work that has been done by OANP to protect and expand this over the last decade:
- In 2009 we added a comprehensive drug formulary that allows us to prescribe and de-prescribe every medication used in primary care.
- In 2015 we fixed a law in Oregon that specifically prohibited NDs from calling ourselves “specialists” as part of the credentialing bill.
- In 2015 we fended off an attempt to exclude NDs from being able to sign off on philosophical and medical exemptions for vaccinations.
- In 2017 we cleaned up a bundle of laws and subsequent rules that were ambiguous regarding ND practice, and therefore excluded us. These exclusions by omission accumulated over a long time.
- In 2018 we have added the authority to return student athletes to play after a concussion.
All it takes is a law here or there, saying NDs “shall not” do this or that, to prohibit some of the most lucrative practices of our most financially successful doctors.
We need OANP to be forever monitoring our state’s legislative and regulatory landscape. To not ever be caught by surprise. Ready to mount a vigorous defense of our scope of practice.
CURRENT ADVANCEMENT FOCUS
1. Insurance barriers to patient access. This is one of our two battle fronts with insurers. Some NDs have chosen, and have become successful at a cash only practice. I think everyone envies that freedom! 97% of Oregonians have some form of comprehensive health insurance and strongly prefer to utilize it. Only about 10% of our state’s patient population is able to pay for their care without utilizing insurance. That leaves 90% who have no access when ND care is cash only. I want to believe every successful ND wishes for every other ND to also be successful. If we fix health insurance, the entire profession will increase its reach in helping all the people around us, rich and poor alike. Having NDs who do take insurance, and especially OHP, increases our relevancy to Oregon’s policy efforts to get health care to all of its citizens. Participation in insurance plans by at least some NDs entrenches the entire ND profession, supporting our core mission.
The number one reason NDs need to always be included within the state's definition of “primary care” is barriers to patient access. No one is saying every ND in the state MUST be a fully burdened primary care provider. We need to support those who take it on. They are serving OANP’s core mission. OANP members and leadership need to always be serving on state committees related to health care. The colleagues who have served our profession this way deserve a lot of gratitude from the rest of us. We need to be forever encouraging each other to step up. These roles are voluntary. There is a lot of personal time and attention invested so we, you, can have a seat at the tables where decisions are being made that include, exclude, and otherwise affect all NDs.
2. Fair payments from insurers for our services. Private insurance pay parity is the biggest legislative lift OANP has taken on since our initial licensing law in 1927. OANP was formed in 1909. It took 18 years to achieve licensure in Oregon! We are charging ahead with insurance pay parity in 2019.
There is an enormous amount of exasperation about insurance pay parity among NDs who find themselves dependent on patients who are dependent on 3rd party payers. As a profession we have struggled economically, and have lost too many naturopathic doctors in this state over the years unable to make a living. Those doctors either moved away, or for them, rightfully chose gainful employment in another field. Most of us are still not making what we deserve, or need. It is our biggest problem as a profession today. It has come to my attention that there is some misdirected blame towards OANP for taking so long to address this problem.
I must protest that we have very much been working on this difficult problem long before now. Everything I have personally been a part of since joining the OANP board, has been focused on this very problem. Our failed lawsuit against Health Net initiated in 2015 was specifically about pay parity and removing patient barriers. In retrospect the lawsuit was a false start.
Here we have a federal law, the ACA, declaring insurance companies and plans shall not discriminate against any provider working within their scope of practice. Shall not discriminate including payments for services.
No one in government was, and as of yet, has been willing to write rules. No one has stepped up to enforce this law. Federal judges can interpret laws and absolutely enforce them. We found a way to go after that with the lawsuit. After a lot of sweat and tears, we got thrown out of court. Not on the merits of our case, rather a technicality the insurers dragged out, that still leaves me stunned. We could not show sufficient patient financial harm because none of the doctors involved required their patient to pay them the full price for the denied service. Do we have heart? Yes, to a fault. Are we quitters? No.
In 2015 we did some reimbursement investigations through friendly conventional offices. That effort revealed just how bad our relative pay differential is. It wasn't until 2018 and $3,500 of OANP membership dues spent to buy a data query -- that we are finally able to produce irrefutable evidence of our insurance pay disparity problem.
OANP is right now in the strongest position we have ever been to prevail with a private insurance pay parity bill at the Oregon legislature. It is time, and all of our hard work has lead up to this point. If you are a licensed ND practicing in the state of Oregon, there is a need for you to belong to OANP along with the rest of us. We won’t last long as a profession if we all choose one by one to go it alone.
The work of OANP is never done. Our ND tent is big enough to include you too. We need everyone’s support and commitment to stand together in common cause.
If you can, please renew your OANP membership or join today! https://www.oanp.org/page/Join
Jeff Clark, ND
OANP Legislative Chair