Dr. Faust’s Testimony before the Department of Health & Human Services

United States Department of Health & Human Services

Testimony before the National Committee on Vital and Health Statistics

Subcommittee on Standards and Security Regarding Coding for Naturopathic Medical Services

January 29, 2003

Paul Faust, N.D.
Chesapeake Natural Health Center

Chairman Cohn, Vice Chairman Blair and members of the Subcommittee, thank you for the opportunity to address you this morning. As background, I am a naturopathic physician in private practice in Towson, Maryland. I am also the Vice-President of the Maryland Association of Naturopathic Physicians and a member of The American Association of Naturopathic Physicians. I have presented lectures on the philosophy and practice of naturopathic medicine at Johns Hopkins University and the University of Maryland School of Medicine.

This submission discusses coding for naturopathic medical services in Maryland which is representative of a majority of states that do not regulate or license the practice of naturopathic medicine. I plan to cover the following key areas: certification, coding and barriers to implementation, insurance coverage and reimbursement, and greater parity for greater healthcare.

Certification:

I am a licensed naturopathic physician in the state of Washington. However, I am not a licensed physician in the state of Maryland since this state does not currently offer licensure for naturopathic physicians. Therefore, I am unable to contract with insurance carriers in Maryland or submit for third-party payment, and my patients are not able to receive insurance reimbursement for my services. In addition, they must incur additional healthcare costs because I am unable to order routine laboratory tests (as in the State of Washington).  This results in my patients paying for office visits to a conventional provider for this purpose.

Coding and Barriers to Implementation:

I do not provide any ICD-9 or Current Procedural Terminology (CPT) codes for my naturopathic services since these collectively might imply providing a medical diagnosis and practicing medicine. And, I am unsure whether I risk state censure by utilizing these codes. In contrast, the use of CPT codes in Washington and other licensed states is necessary.  The confusion and potential legal risk due to providing naturopathic services in a state which has not defined a license for naturopathic physicians causes me great distress and uncertainty due to the potential for liability.

I do carry professional liability insurance for my services and limit my practice to the scope of my education, training, and Washington State license. In addition, I voluntarily restrict the scope of my practice even further to exclude the following services which I am authorized to provide in the State of Washington. For example,  physical exams such as breast, pelvic, and rectal; prescriptions for barrier contraceptive devices; intramuscular nutrient administration; ordering and interpreting diagnostic procedures such as clinical lab tests, ultrasound, x-ray, and electrocardiogram; minor surgery; and pharmaceutical drug prescription (as per the granted drug formulary).

These restrictions to my scope of practice degrade the quality of naturopathic care available and increase the overall healthcare cost to the average consumer. Authority to practice has real impact on access to and delivery of naturopathic medical services.  My patients want to be able to choose from both conventional and naturopathic medical services and they want assurances that practitioners are qualified.

Insurance Coverage and Reimbursement:

For billing purposes, I provide an invoice for naturopathic consultations based on the length of time for the appointment. My fees for service are paid out-of-pocket by the consumer even though most of my patients have health insurance for conventional healthcare.

Coverage of and reimbursement for most health care services are linked to a provider’s ability to furnish services legally within the scope of their practice. This legal authority to practice is given by the State in which services are provided. Even if insurers are interested in covering safe, cost-effective naturopathic interventions, they cannot do so unless there are properly licensed practitioners in a State.

State laws that establish professional standing protect the public by ensuring that covered health benefits are provided by qualified practitioners whose services should meet recognized standards of care. In the absence of such laws, health insurers would be at increased risk of liability if an adverse event occurred.  Naturopathic physicians qualified to furnish safe, beneficial services for which insurance companies are willing to pay should have the ability to practice legally in their State — just as conventional practitioners do today. Today’s healthcare system should not be prejudiced toward any philosophy of health care, but give equitable consideration to safe and efficacious interventions for both conventional health care and naturopathic medical services.

Greater Parity for Greater Healthcare:

I am very interested in the collaboration and integration of naturopathic medical services with conventional healthcare providers.  I frequently co-manage care with other licensed healthcare providers including medical doctors, osteopathic doctors, chiropractors, acupuncturists, and counselors when it is to the benefit of the patient. However, this does present some challenges since licensed providers may not make official referrals within the current Maryland healthcare system. I receive many unofficial referrals from conventional physicians, and even have many physicians and their families as patients. I also regularly train conventional physicians in the philosophy and principles of naturopathic medicine by having them observe and participate in the services provided in my practice. In addition, I provide preceptorships for naturopathic medical students from the four accredited naturopathic schools in the United States, and I also provide elective training in CAM practices for fourth-year medical students from the University of Maryland School of Medicine.

I have tried several times to establish an integrated health center in Maryland with conventional medical doctors; however, the professional license for medical doctors in Maryland prohibits them from sharing patient care with unlicensed providers. I have also been invited by the Director of the Complementary Center for Healing at the University of Maryland School of Medicine to join their clinical faculty at Kernan Hospital. Unfortunately, we have not been able to proceed since we are unsure how to code or bill for my services within the existing, conventional system. In the health care industry, partnerships are becoming increasingly more common and essential for delivering integrated health care for today’s consumers. Good health care requires teamwork among patients, health care practitioners, regulatory bodies, and health insurance providers. The absence of licensing for naturopathic physicians in all states is an obstacle to inclusion in the mainstream health care system and prohibits the integration of naturopathic medical services into conventional healthcare.

Currently, there are less than 10 naturopathic physicians in the State of Maryland who are members of The American Association of Naturopathic Physicians, graduates of a naturopathic medical college accredited by the Council on Naturopathic Medical Education (CNME), and have passed the Naturopathic Physician’s Licensing Examination (NPLEX). I am aware of several other individuals who use the title N.D., Naturopathic Doctor, or Naturopathic Physician in this state who have not met these requirements and may have simply purchased a degree or certificate from an organization with no requirement that students must meet professional educational standards and have supervised, clinical training. These two categories represent significant differences in level and types of training, yet most consumers in this state are unaware of the difference.

Establishing legal authority for naturopathic physicians to practice in unlicensed states such as Maryland through mandatory licensure, which prohibits the practice of a profession without a license, ultimately protects the public from the inappropriate practice of healthcare. Licensure also provides opportunities for appropriately trained and qualified health practitioners to offer the full range of services in which they are educated, trained, and certified by a recognized standard body.

In addition there are many other significant barriers to public access to naturopathic medical services in Maryland, such as:

• The distribution and availability of local naturopaths
• regulation and credentialing
• policies concerning coverage and reimbursement, and
• disparity in the existing health care delivery system

Equally important, since naturopathic medical practices and products are not covered by health insurance programs in unlicensed states, is that access often has been limited to those with higher discretionary income.

In closing, we need to have uniform licensure and regulation of naturopathic physicians for the public’s safety and to ensure equal access to healthcare. Every person has the right to choose freely among safe and effective care or approaches, as well as among qualified practitioners who are accountable for their claims and actions and responsive to the person’s need.

I hope that this information is helpful to the Subcommittee in its deliberations and recommendations to the Secretary, and I thank you for the invitation to submit testimony.

Paul Faust, N.D.
Chesapeake Natural Health Center