Oregon, of the 18 states that allow naturopaths to legally practice at all, is the only state that grants naturopaths the same scope of practice as a primary care physician MD or DO. The state also mandates that naturopaths be credentialed as PCPs by insurers. (Again, it is the only state to do so.) Obviously concerned about the inadequate education and training of naturopaths, insurers naturally sought to impose additional requirements on naturopaths before credentialing them by, for example, saying naturopaths must do a three-year residency, just like MDs and DOs who want to be PCPs.
Naturopaths don't like having standards imposed on them. They prefer to practice the sort evidence-free, no-standard-of care way they are taught in naturopathy school. A few years ago, Oregon's Medicaid program simply wanted naturopaths to practice evidence-based medicine. Who could argue with evidence-based medicine? Naturopaths, that's who. They went running to their friends in the state legislature to oppose the Medicaid program's eminently reasonable, cost-saving action.
Now, Oregon naturopaths are back at the statehouse seeking special privileges again.They want the legislature to declare by fiat that they can practice primary care with the same expertise as MDs and DOs by making those extra credentialing requirements illegal.
Current law says that insurers can require naturopaths to meet their requirements to be credentialed as a PCP. House Bill 3400 would prohibit those requirements from including anything other than meeting the current minimum education requirements for licensing (four years of school and passing the NPLEX) and being licensed by the state. The bill also says that
- "An insurer may establish additional quality standards for credentialing naturopathic physicians that are based solely on the standards that the insurer uses for the credentialing of other health care practitioners."
- "An insurer may not require a naturopathic physician to complete additional training for credentialing."
The two provisions are somewhat contradictory when it comes to residencies. If an insurer requires MDs and DOs to have completed a residency, then isn't requiring a naturopath to do the same "based solely on the standards" used for other health care practitioners? Or, is a residency the equivalent of requiring the naturopath to "complete additional training?" If the latter is true, insurers will be required to credential naturopaths who come to them straight out of naturopathy school without the three-year residency required of family practice physicians and internists.
Whatever the answer to that question, naturopathic education and training are inadequate to the task of serving as a patient's primary care physician. It's a subject we've covered many times over on Science-Based Medicine and here at the Society for Science-Based Medicine. For a comprehensive one-stop-shopping look at naturopathic education, training and practice, there's no better source than Naturopathic Diaries.
HB 3400 was introduced by Rep. Sheri Malstrom, of Beaverton, whose biography describes her as a public health nurse. Rep. Malstrom must be wholly unaware of how virulently anti-vaccination naturopaths are. We can only assume she would never support this bill if she knew the truth.
Many naturopathic diagnostic methods and practices are rejected by insurers. For example, look at Aetna's list of alternative and complementary practices it will not cover because of lack of evidence of efficacy. Many of them are standard naturopathic modalities: applied kinesiology, aromatherapy, bioidentical hormones, chelation, colonic irrigation, craniosacral therapy, hydrogen peroxide therapy, live blood cell analysis, megavitamin therapy, and reiki, to name but a few.
One insurer, University Health Alliance (UHA) in Hawaii, actually reviewed three years of clinical documents associated with every claim for naturopathic services. (Hawaii has an insurance mandate pending; UHA's testimony starts on page 9.)
"UHA's coders and physicians have studied the claims and clinical records and worked to reconcile these with standard CPT manual criteria and the Hawaii statutory definition of medical necessity. In addition, appropriate use criteria from a variety of sources have been used in determining whether tests or treatments have been safe, timely, efficient, patient centered, effective and equitable."
The result of UHA's exhaustive review?
"In general, our experience with Naturopaths has not been clinically favorable. . . In view of our three years' worth of evaluation, UHA does not believe that this is safe or effective care and, therefore, does not favor legislation which will serve to embed naturopathic medicine in a standard health insurance plan."
(For the record, the healthcare giant Kaiser Permanente also opposes Hawaii's naturopathic insurance mandate bill.)
Oregon has piled one bad judgment on another. It licensed naturopaths in the first place, gave them a broad scope of practice, forced insurers to cover their services and, finally, mandated that they be credentialed as primary care providers. Now, with HB 3400, the Oregon legislature is about to take away the insurers' last line of defense against naturopathic incompetency.