Naturopaths now covered by Medicaid in Washington

Naturopaths now covered by Medicaid in Washington

Naturopathic doctors, that is, naturopaths who go to four-year naturopathic "medical"schools, want to become licensed in all 50 states with the same scope of practice as a primary care physician.  Their education and training falls far short of that of an M.D. or D.O. family practice physician.  But because their education system is accredited by a private agency created by, and operated by, naturopaths, no independent body has ever evaluated their education and training. Thus, for now, they can get away from claiming they are capable of practicing as PCPs, but only a minority of the 18 states where they are licensed or registered have bought into their claims.  

Another goal is insurance coverage for their services.  Naturopaths pinned their hopes on Section 2607 of the Affordable Care Act, which prohibits "discrimination" by insurers against any provider licensed by a state.  However, the Department of Health and Human Services has not required any insurer to include naturopaths as providers, although final regulations have not been issued.  They've been trying to get covered as Medicare providers too but have failed in that endeavor.

Washington just became the third state (along with Vermont and Oregon) to cover naturopathic services as Medicaid providers.  Medicaid is the state-run, but federally financed, health care program for low-income residents, and it is up to the individual states to decide what services the state will pay for.  

KOMOnews.com announced this entry into the Medicaid provider field in an AP report which duly repeated the claim that naturopaths stand at the ready to fill the shortage in primary care physicians supposedly looming by increased demand created by the ACA.  The news story also featured the requisite anecdote of the happy naturopathic patient thrilled by naturopathic services.  In this case,the patient is actually a toddler who qualifies for Medicaid and it is his parents who are thrilled. The toddler doesn't have any choice. One day, I suppose, a reporter will actually include facts about deficiencies in naturopathic education and training or the relationship between seeing a naturopathic doctor and increased risk of acquiring a vaccine-preventable disease. (I had to wonder whether the cute little guy in the photo accompanying the news story was vaccinated.)  The vaccination stats actually came from Washington insurance records, for goodness sake.  But I've yet to see a news story about naturopaths that didn't simply repeat the party line, complete with anecdote.  Nothing new here.   

In the toddler's case, his "naturopathic pediatrician" is Stacy Bowker, ND, of Snohomish County Holistic Medicine, who's taken on "eight to 10" new Medicaid patients since the start of the year. That is about two a month, not excactly a stampede. 

Here's what we learn from her website.  To her credit, she reccommends the CDC's website and the pertussis (whooping cough) vaccine.  But a few nuggets of science is no cure for pseudoscience. The website also recommends homeopathic remedies over  acetaminophen as well as Dr. Bob Sears' books on the "alternative" vaccination schedule, based on the baseless idea that "too many too soon" can harm your child.  The practice offers "liver detox" to "improve overall health" and rid the body of "toxins" as well as IV vitamin infusions. They sell dietary supplements to patients, a terrible conflict of interest that is not permitted by medical ethics. Smoking cessation featuring acupuncture and dietary supplements is offered as well, even thought neither has any good evidence of effectiveness.

Dr. Bowker does not have hospital privileges at any hospital.  This means she cannot admit her patients to any hospital, so they will be left to their own devices when faced with an emergency or need for hospitalization. And if you choose her as your baby's "pediatrician," she won't be able to examine the baby at the hospital.  

Medicaid patients can be complex.  Here, for example, are the top 10 reasons for hosptal readmission (in terms of cost) for Medicaid patients: 

1. Septicemia (except in labor) 
2. Schizophrenia and other psychotic disorders 
3. Mood disorders 
4. Congestive heart failure (nonhypertensive) 
5. Diabetes mellitus with complications 
6. Chronic obstructive pulmonary disease and bronchiectasis 
7. Alcohol-related disorders
8. Other complications of pregnancy 
9. Substance-related disorders
10. Early or threatened labor 

Managing these is nor for the faint of heart, nor the untrained. Liver detoxification, homeopathic remedies, dietary supplements and acupuncture aren't going to do the patient with scepticemia any good.  But failure to promtly recognize that a patient is suffering from, or may be at risk for, scepticemia, may well kill him. And there's where hospital-based training, as well as sufficient education, can make a huge difference.  Scepticemia patients don't need "wellness."  They need a hospital.

Points of Interest 5/25/2014
Infinite Variations