Feeling the pinch
WAIKOLOA VILLAGE — As the shortage of traditional doctors continues at hospitals and health centers around the Big Island, a different option is now more easily accessible through health care: naturopathic physicians.
In July, Hawaii Medical Service Association signed an agreement with the Hawaii Society of Naturopathic Physicians allowing patients to choose a naturopathic doctor as their primary care physician for the first time on their HMO plan.
Next month, Naturopathic Medicine Week will be celebrated Oct. 10-16, where physicians will share more about their safe, effective and now affordable care with residents and policymakers at individual open houses and events.
Shanon Sidell, a naturopathic physician based in Waikoloa Village, has had her practice there for five years.
“HMSA is doing a pilot project adding naturopathic doctors in network,” she said. “We’ve worked very hard through HSNP and American Association of Naturopathic Physicians to get insurance coverage. With Obamacare — or the Affordable Care Act — there is a nondiscrimination clause that if you are a licensable health care provider you can work within your scope and you cannot be discriminated against by insurance companies. Here in Hawaii, we have HMSA, University Health Alliance, Hawaii Medical Assurance Association and Kaiser, and though some steps have been made to comply there are still more steps needed by all to come into full compliance.”
On July 1, HMSA added the first naturopathic doctor to its primary care provider network.
“We’re excited to be the first Hawaii health plan to add a naturopath to our primary care provider network,” said Elisa Yadao, HMSA’s senior vice president, consumer experience. “The program is still active. We’re calling it a pilot program because it gives us the opportunity to make modifications and improvements to the program.”
She continued, “PPO members can also see a naturopath outside of HMSA’s network, and we’ll reimburse them for services that are covered by their health plan, the same way we would any out-of-network provider. We currently have more than 50 naturopaths who provide services to HMSA members. Primary care providers play an especially important role in making sure our members get the right care at the right time. We’re committed to working with any of these physicians who would like to join our primary care provider network and plan to provide approval status updates to our naturopathic community by January 2017.”
Doctors hope the system can become more efficient in time.
“It’s a new category and they will allow me to bill them and the patient gets reimbursed at whatever percentage their plan allows for out-of-network providers. It was a great step to help people who have insurance get access and have options, but for every one patient hour, I spend 2-3 hours in admin work in the office,” Sidell said. “I feel very strongly that I want to serve my community to who has insurance. I know some doctors have gone to a noninsurance model but I couldn’t do that to my community so I’m trying to find a way to work within that.”
Local politicians have been champions in support of naturopathic medicine over the years.
“Sen. Roz Baker has been really supportive of preventative medicine and in helping expand and solidify our scope of practice, and get it codified within the legislature,” Sidell said.
On other fronts, U.S. Rep. Tulsi Gabbard has long been known for her efforts on behalf of veterans. As a result, Sidell has seen her naturopathic practice expand after becoming vendorized by the Veterans Association two years ago.
“About 30 percent of my practice are now veterans,” she said. “I love working with them. They’re seeking alternatives to the opiates. They don’t want to be addicted, they want to manage their pain — physical, mental and emotional. The VA has been trying to provide them more access to naturopathic options. If a veteran lives more than 20-ish miles away from one of the VA facilities they can be seen by a non-employee of the VA. I’m in that middle ground.”
In the last few months, AANP conducted a third party veterans’ survey.
“Sixty-four percent said they wanted natural approaches and non-opioid therapies before drugs and surgery,” Sidell said. “In the second question, 73 percent said if they had an in-house naturopathic doctor employed by the VA, they would like to see them first for preventative, non-prescription, holistic, natural means. We are actively working with the VA now to see if they can do a pilot with an ND on staff, and what it does to the quality of life, disease prevention over years and cost.”
Naturopathic doctors are also looking for ways to help more kupuna.
“A letter that reps. Pocan and Pingree sent to the Center for Medicare and Medicaid Innovation has been circulating this month in the House of Representatives, encouraging a study or pilot project that would include naturopathic physicians in preventative health care for seniors through Medicare and Medicaid,” Sidell said. “It focuses on increasing senior’s access to integrative preventative cardiovascular care and other related diseases. It will now go to the director of CMMI and he will decide what to do with it.”
Rachelle Moore, a Waikoloa resident, started using naturopathic treatment three years ago and returned this spring for help with a new ailment.
“I was suffering from what I thought was inflammation of the thigh muscle,” she said. “I’m over 70 and it was hurting badly and I couldn’t walk. I went to a regular doctor but nothing was really diminishing the pain or inflammation, so I talked to Dr. Sidell and we decided to try acupuncture. She gave me a really good educational background from a holistic standpoint so I could understand it and this immediately put me at ease. I’ve had several sessions now and it’s the only treatment I’ve had success with. What sets her apart from other doctors is she really educates you and after an assessment she says, ‘let’s choose the treatment together.’”
Sidell added, “Lifestyle counseling is a big piece, helping people unravel what’s holding them back. They come to me seeking some type of relief and I help them to find their own decisions about what they want to change.”