By Glenn Sabin
Well, that depends on who you ask. Those within the integrative healthcare field and the disbelieving skeptics alike, offer quite divergent views.
This post focuses on the Affordable Care Act’s impact on health consumers currently using or hoping to incorporate integrative medicine practitioners and services into their care. It does not attempt to decipher the short- or long-term economic impact of the Affordable Care Act on this country. Nor does it explore the cost-effectiveness of integrative medicine delivery. I will largely leave that to the health economists and prognosticators, but do offer this: the long-term economic affect cannot be good. The ACA does not trumpet in a new payment paradigm—a reimbursement model that economically incentivizes good health outcomes over the provision of high margin procedures, services or products. So we are still heading toward eventual insolvency or, minimally, healthcare reform part II over the next few years.
So How Will the ACA Affect Consumer Access to Integrative Medicine Services?
For consumers receiving integrative services from providers working outside of the payer system—those not participating with insurance companies—very little may change for the time being. These providers receive cash for services and may or may not provide their patients with super bills. Super bill essentially comprise a list of line item services with accompanying CPT codes that make it easier for clients to get reimbursed from their insurance company as out-of-network services. Clearly, getting out-of-network coverage for covered integrative services is still better than going fully out-of-pocket each visit.
Conversely, for insured patients utilizing services like acupuncture, chiropractic, naturopathy and massage therapy, the future looks brighter. There is built-in anti-discrimination language in the ACA that specifically speaks to covering licensed and credentialed practitioners in these fields. Over time this should make integrative medicine services more accessible for those insured—and not just those with so-called Cadillac health plans.
What Others are Saying
John Weeks from Academic Consortium for Complementary and Alternative Health Care and The Integrator Blog posits that the ACA is a game-changer for integrative medicine. On the eve of the Supreme Court vote, Weeks describes the “powerful elements of historic conclusion in areas of workforce planning, payment, delivery, research and health promotion”, with emphasis on the anti-discrimination clause for credentialed integrative practitioners, and in the context of Patient Center Medical Homes.
The Integrated Healthcare Policy Consortium (IHPC) is the main lobbying champion for integrative healthcare delivery. IHPC has worked hard to ensure that the practitioner anti-discrimination language in the ACA has stayed firmly in place and that the Prevention and Public Health Investment Fund is protected. (Many people don’t realize that in February $5B of the total $15B—a full third—of the Prevention Fund was cut and redirected to fill the gap in the payroll tax fund, and to avoid a 27% cut in physician Medicare reimbursements.) On hearing the Supreme Court’s decision, IHPC policy adviser Dr. Janet Kahn had this say: “This is great news for the American people and for the integrated healthcare community…. Perhaps the best news is that a law that is designed to move us from thinking about medical interventions to thinking about health promotion and maintenance is allowed to move forward.”
The folks at The Alliance for Public Healthargue that the ACA is horrible for integrative medicine and will force consumers to purchase government approved health plans that will all but eliminate high deductible polices and doom health saving accounts (HSAs).
Erik Goldman from Holistic Primary Care—News for Health & Healing had this to say when contacted by FON: “It [ACA] really doesn’t provide much fiscal support for holistic services. The health insurance industry has made a miserable hash out of conventional medicine—which already has a reductionist, treat-the-numbers, protocol-driven mindset. One can reasonably expect that this effect will be even worse on holistic/functional/integrative medicine because insurance plan thinking is quite antithetical to holistic, individualized, health-oriented thinking.
Many health consumers today purchase high deductible “catastrophic” plans and use their HSA accounts to pay out-of-pocket for integrative medicine services.
Over at Science-Based Medicine, attorney Jann Bellamy ponders the ACA and its possible implications on state laws that currently mandate coverage of some integrative medicine services for private insurance plans. Bellamy postulates that the ACA has the “potential of putting a significant dent in this forced coverage of pseudo-scientific health care” based on how Health and Human Services may come to define “essential health benefits” in the context of CAM (complementary and alternative medicine).
The ACA, while far from perfect, provides meaningful progress to ensure patient access to integrative healthcare services from licensed practitioners through a non-discriminatory insurance payer system.
FON: The Business of Integrative Health + Medicine
30-MIN COMPLIMENTARY BUSINESS DEVELOPMENT CONSULT