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Institute for Natural Medicine Primary Care Task Force

Monday, September 14, 2020   (0 Comments)
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Written by: Hannah Gordon, ND, RN, INM Primary Care Task Force


The INSTITUTE FOR NATURAL MEDICINE PRIMARY CARE TASK FORCE (INM) launched in October 2018 with the mission of spearheading outreach to rural and underserved clinics and health service providers including opportunities for integration with naturopathic doctors in primary care roles in Oregon and Washington State. Our vision includes improved health outcomes for rural and underserved populations and an expanded Washington and Oregon State primary care workforce through the addition of naturopathic doctors. Alongside our vision and mission, we promote naturopathic doctors as a viable solution to help answer the primary care provider shortages in community clinics.

As spoken of during last month’s article, the benefits of including naturopathic doctors (NDs) at CHCs or FQHCs include having a provider trained on how to safely prescribe botanicals, nutritional supplements, and pharmaceuticals alongside one another while also including a provider type that may retain a group of patients that may be referred or seek integrative medicine outside of the clinic. Referrals that could be kept in house include but not limited to non-pharmaceutical approaches to acute or chronic pain, consultation on herbal medicines, integrative medicine approaches for myriad of diagnoses, and integrative medicine consultations between providers.

Non pharmaceutical approaches to acute and chronic pain management are in the forefront of the medical conversation at this time. A recent statement and update from the Integrative Health Policy Consortium in July 20201 includes the urgency around expanding and including integrative health therapies to assist in the opioid crisis. Having an increase in tools to address myriad of diagnoses as well as an opportunity to improve health outcomes by assisting in pain reduction for patients by including an ND as part of your organization, may be of interest.

Naturopathic Doctors have been trained in multiple physical medicine modalities especially as pertains to non pharmaceutical approaches to pain alleviation and management. These modalities include high velocity low amplitude adjustments, therapeutic massage and fascial work, and hydrotherapy/physiotherapy. A common coding example would be an E&M code (99213) with an OMT code for the HVLA adjustment. There is no prior authorization required for OMT and the adjustment can be completed within the timeframe of the already scheduled visit as the adjustment itself takes 5 minutes. Most insurance companies pay out $20-35 per OMT code while Medicaid averages $40 (this is in addition to the billed office visit).

Many NDs do extra courses and certifications that would offer additional non pharmaceutical approaches to pain management which include muscle energy stretching, visceral manipulation, craniosacral therapy, Kinesio taping, Activator, constitutional hydrotherapy. NDs are also educated on multiple counseling techniques including motivational interviewing.

Additionally, there are NDs who have also obtained their LAc, (acupuncture license), which is covered by insurance for multiple diagnoses. An example of this for low back pain is that 12 sessions are allowed within 90 days and up to 20 sessions/year if there is demonstrated benefit from treatment. For L&I complaints, insurance allows for 12 visits maximum per claim for acupuncture. Having an ND, LAc as part of your clinic to help with acute or chronic pain as well as L&I claims may be beneficial for your organization.

Though NDs are not covered by Medicare specifically, Medicare Advantage does include NDs for 12 visits per year for diagnoses of pain. NDs are credentialed with Medicaid in Washington and Oregon and are trained in and use the same CPT and ICD-10 codes as other providers.

NDs are qualified for wrap-around payments through HRSA and are eligible for the Washington Health Professionals Loan Repayment Program (HPLRP).

Acute and chronic pain alleviation and management takes a collaborative effort to improve the health outcomes of our nation’s population and including an additional provider type like a naturopathic doctor may be of interest to your organization.

If you would like more information or would like to connect with the INM Primary Care Task Force, email Hannah Gordon, ND, RN at ndpcpjobs@naturemed.org.






1. House Appropriations Committee Support IHPC Priorities. Statement from the Integrative Health Policy Consortium. Integrative Health Policy Consortium. 14th of July, 2020, http://www.ihpc.org/news/





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