2010 trends accroding to Entrepreneur Magazine

This doesn't highlight alternative care directly, but does give hope for the market share preventive care is taking. Keep on keepin' on!

From 10 (an 1/2) to watch, December 2009 issue of Entrepreneur Magazine:

#8: Health and Wellness
Healthcare reform, aging baby boomers, more emphasis on preventive care -- all of these things and more are fueling growth in health and wellness businesses. Healthcare and social assistance topped the industry growth charts this year, according to the U.S. Census Bureau, with second quarter revenue of $452.5 billion, up 3 percent from the previous quarter.

Home care was the No. 1 growing industry from 2004 to 2009, averaging yearly increases of more than 7 percent, according to IbisWorld. In-home care already employs a staggering 1.33 million people, and revenue is expected to grow beyond $72 billion by 2011.

And whatever form the government's healthcare act finally takes, it is likely to boost the number of consumers for health services.

Preventive care continues to thrive too. In fact, people are more likely to go to the gym during a down economy, according to a recent survey by the International Health, Racquet and Sportsclub Association. Total health club industry revenue last year topped $19 billion, the association reports.

Boomer Fitness, based in San Carlos, Calif., is capitalizing on that generation's obsession with staying healthy and youthful.

"Our generation isn't about sitting around and getting old," says founder Arleen Cauchi. "We're about being active, enjoying life." - K.O.

PEBB covers NDs but not their services...?!?

The Public Employee Benefits Board has become a "self-insured" employer and is using Providence to administer its plan. Under the new plan NDs are covered (as they have been) but the actual services that Providence will pay for have been severely limited. Despite recent gains in the legislature through SB 327 which gained full prescription rights for NDs, they have decided they will not pay for any prescriptions written by NDs, even though they have the same basic education as MDs and DOs. It appears that all the plan will pay for is talking to the doctor, though that is subject to a test of "medical necessity." If you have PEBB insurance coverage, don't plan on getting your naturopathic care covered, but do contract your insurance provider to express you disappointment.

The actual handbook reads as follows:

Effective January 1st, coverage for naturopathic services will exclude the following things:

- Prescription of pharmaceuticals (whether prescription or over-the-counter) and surgery or invasive therapeutic procedures

- Immunizations, vaccinations, injectables, and intravenous infusions (does not include venipuncture for the purpose of obtaining blood samples for laboratory studies)

- Topical and oral drugs, pharmaceuticals, intravenous administered treatments, minor surgery.

- Vaccines or vaccination services, homeopathic products, botanical medicine products

- Dietary and nutritional supplements, including vitamins, minerals, herbs, herbals and herbal products, injectable supplements and injection services, or other similar products

- Natural childbirth services

OBNE Meeting, Sept 28, 2009

The Board Recently wrapped up their most recent meeting on Sept 28, 2009. The next meeting will be December 7th. They usually wrap up the Executive (closed) session about 10 am, sometimes later.

All board members were present.

I. The Non-ND Investigations: These descriptions are based on my own notes and do NOT represent the facts on the record with the OBNE nor any official communication from OBNE. Also, the chair of the board speaks rather quickly and I am sure I missed some information. Contact the board for exact minutes if you need them.

N09-05-12N Mollo: Dismissed with Letter of Concern
A gentleman in Grants Pass was suspected of practicing naturopathic medicine without a license at "New Hope for Health." He was found via a listing which described him as an MD, a listing he did not know existed. Mr. Mollo was formerly licensed in California after attending a school who's accreditation is not accepted by the OBNE. He was also part of the licensing era that allowed NDs to use the term Dr. even w/o the standard ND education, and was grandfathered into the new system which requires this education. The key part of the decision was whether or not he was diagnosing his clients. The OBNE investigator determined that he is not diagnosing but only selling supplements to old patients and perhaps doing some "nutritional counseling" which is not practicing naturopathic medicine.

N08-089-22N Casey: "A routine problem"
Casey is a woman who in the Portland area who failed to pass her ND boards but practices under her LMT license. She is listed as a Dr. on her website and Clackamas County referred the case to OBNE. Investigation continues.

N09-09-10N Hurliman: Dismissed with Letter of Concern
A patient of an unlicensed ND was referred to a dentist for removal of his/her amalgam fillings. The "ND" practiced in Las Vegas over 10 years ago where a license is not required, and had heavy metal testing done for this patient. She is now retired but still in contact with the patient. "ND" vehemently denies telling her patient to have his/her fillings removed. Only one old listing is intact.

N06-06-05N Delphini: Update
Civil Penalty was assessed for practicing veterinary medicine. Notices were sent by OBNE, the Vet Board, and the Medical Board (for acupuncture). Case has been sent to collections, Delhpini has moved to Texas, though the board suspects she'll try to come back.

N09-09-19N Chamberlain: Initiated investigation
Health Co-op is providing cancer treatment without a license.

II. ND Investigations: Names nor case description is given.
N09-08-16: Dismissed
N09-06-13: Dismissed
N09-05-10: Discipline Notice Sent

III. Administrative Rule Changes
850-030-0195, 850-033-0230, 850-040-0210, Increase in CE hours, Adopted with minor revisions.
850-30-035, Fee increase to cover prescription monitoring authority, $25/licensee. ADOPTED
860-0225 and 850-060-0226 - Formulary amendments, proposed rule making initiated. Final rules to be adopted at the December meeting.

IV. Miscellaneous
a. Natural Childbirth Discussion tabled for next meeting
b. Sharon Fuchs brought a complaint and general concern for out-of-hospital deliveries. She believes that VBACs should never be done out of hospital because of the risk of uterine rupture, and that even minor risk patients should not be able to do out-of-hospital deliveries. She is also looking for clear transport guidelines for midwives' patients.
C. Sarah Ohgushi will be joining the board in December
d. For those who had issues with getting their fingerprints through the background check process, the board is initiating a temporary license process that will allow certain applicants to get through. Call the board for more information about your case.
e. Bee venom therapy is not an ND licensed process if administered by bees and not by injection.

A word from the AANP regarding NDs and Health Care Reform

News From The Office
A Naturopathic Remedy For Health Care Reform
By Karen Howard

With the health care debate at a fever pitch, there is no time like the present for our naturopathic community to unite in voice and action. I am often asked what one person, one doctor, one professional organization can do to impact this Beowulf of an epic legislative battle.

My answer is thus. Stay alert, stay positioned, be nimble in your views and your response. There is no doubt that enactment of insurance reform is treating a symptom of this disease-based system. And yet, you often remind me that alleviating symptoms is often required in order to get to the underlying cause of illness. Here are some key data points for the journey to passage:

In order to keep the government running, Congress must either complete work on 8 more appropriations bills or enact a Continuing Resolution by September 30.

In the Senate, two massive bills from the Senate HELP Committee and the Finance Committee must be finalized and reconciled. Add in three more bills from the House. Time is running out for this year’s session.

The Governors have much at stake. Negotiations around the inevitable expansion of Medicaid beneficiaries, and state costs, the implication for existing state mandates and the inclusion of licensed providers (including NDs), not to mention a new push for Governor’s to enact Tort Reform legislation are critical to passage.

The process for passage, and the ability for the Democrats to maintain the right number of votes, will result in some amazing and complicated parliamentary process and voter confusion.

Inclusion of NDs in any final bill hinges on Senator Ted Kennedy’s replacement, Senator Tom Harkin the new Chair of the Senate HELP Committee and strong advocate for our issues. Sen. Harkin is still working to include ALL licensed providers in whatever the program becomes.

AANP is advocating daily (write your Member of Congress today), updating regularly (click here to find out the latest on our federal legislative efforts [member's only page]), and pursuing every option to expansion of naturopathic medicine through loan repayment programs, student scholarship opportunities, the future “technical amendment” opportunities that will rapidly appear. Congress has initiated a process for achieving wellness.

I ask that you support that process today, tomorrow and for as long as it takes to make the system whole. Our grandchildren’s grandchildren are depending on us.

Senator Monnes-Anderson reminds NDs to make sure they're at the health reform table, or they may go hungry.

First of all, congratulations to NCNM for opening the largest natural medicine clinic in Portland; you can read all about it here. It was a lovely opening and the speakers were inspiring, however none so much as Senator Monnes-Anderson who was a champion for the ND Formulary Bill (SB 327) this past session and even continues her efforts post-session.

Two statements by the Senator really spoke to me. First, she reminded NDs that the only way her profession, nursing, has been able to achieve the political clout it maintains is by joining together and supporting their professional organizations and lobbyists. Political power is not gained by simply doing a good job, it requires you to "play the game." My mother used to tell me I had to learn to play the game and I hated the idea of that, but I think she may be right, especially in some circumstances. NDs, you need to support and join the OANP and you need to keep up with the political workings of your profession. Your long-term success depends on it.

Second, she admonished NDs that the landscape of health care is changing dramatically as our nation, Congress and Obama pushes for reform. Change is coming in a big way. NDs stand to become THE source of primary care physicians, but if NDs are not at this "table," they will be sent to bed hungry. There will not be another opportunity quite like this one and it needs to be capitalized on if NDs are going to have a place in our health care system.

For some this is not why they got into medicine, and when your medicine has been invalidated or worse for generations, it is daunting to put yourself out there and demand parity in the system. Shake it off and buck up buttercup, it's now or never! Get in touch with Laura Farr at the OANP and ask how you can help. Get in touch with the AANP and ask how you can help. Now is the time. Our nation needs you and they just don't know it yet.

See you on the front lines!

Looking for free advice?

Check out the Portland Small Business Fair this Saturday, Sept 19th, from 8:45am till 4:30pm at the convention center.

A list of the workshops can be found at: http://www.portlandonline.com/smallbusinessfair/

I'll be attending for ideas and networking... see you there!

More information on micro or ideal medical practices

Many names, the same idea: low overhead and high-quality care. NDs have always done it, MDs are looking to reclaim it. Here are two more articles about Doctor's retaking their business and their ability to truly care for their patients.

The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship by L. Gordon Moore, MD, and John H. Wasson, MD

Is a micro-practice in your future? by Philippa Kennealy

Have an opinion? Please share!

7 Strategies for Creating a More Efficient Practice, brought to you by Dr. Lynn Ho

Though this is written by an MD, it is applicable to any provider billing insurance and working on a small-office budget. Enjoy!

7 Strategies for Creating a More Efficient Practice

http://www.aafp.org/fpm/20070900/27seve.html

Simple, low-cost technologies and strategic outsourcing have helped this solo physician practice efficiently, even without any staff.

Lynn Ho, MD

I opened a solo family medicine practice in Rhode Island in October of 2004. It's an ultra-solo, no-staff ideal medical practice, also known as a micro practice. Low overhead allows me to see fewer patients per day and spend more time with them, but it also requires that I optimize efficiency in order to accomplish all of the administrative tasks on my own.

Before opening my solo practice, I worked as a salaried family doctor for more than 13 years in an environment where I was completely sheltered from the practice management aspect of medicine. Although I wondered whether I would be able to manage the challenges of running my own practice, I was inspired to make the leap after reading about Dr. Gordon Moore's ideal micro practice in Family Practice Management1,2 and watching a colleague of mine set up a similar practice that has prospered.

The start-up process was relatively easy: I applied for insurance provider numbers, rented some office space, incorporated myself, bought used office equipment from a retiring physician, created a practice Web site (http://nkfp.familydoctors.net) via Medfusion (http://www.medfusion.net) and placed an advertisement in the local newspaper.

Believing that technology is a key to efficient practice management, I also decided to purchase an electronic health record (EHR) system (Amazing Charts; http://www.amazingcharts.com) and billing software (EZClaim; http://www.ezclaim.com) that interfaced with my EHR. (Total cost for hardware and software at the time of purchase was less than $4,000.) To supplement my income while I developed my practice, I found a part-time job for 12 hours a week at a college health service. Then, in October 2004, I opened the door to my office with a few patients (fewer than 10) who followed me from my previous practice.

Hook, line and sinker, I had swallowed the ideal medical practice bait. I was and remain convinced that ideal medical practices can deliver what patients want and need through the medium of a sustainable and enjoyable practice setting for physicians. However, at the 18-month mark of my new practice, I noticed that although my practice engaged me and provided a level of professional satisfaction that my previous employment had not, I was spending way too much time on my work. I was routinely bringing home billing and notes that had not been finished and phone messages that had not been attended to. Burnout was imminent.

It was clear I needed to fix a number of key workflow processes to achieve greater efficiency in my practice.

Seven interventions

From June to December of 2006, I tested and implemented a number of solutions to hone my office efficiency. Through this process, I discovered one of the most delightful aspects of a micro practice: its responsiveness to change. When I decide to change something, it simply gets done. No one needs to be convinced or trained. The results are immediate and dramatic.

I've listed below the changes that were the most helpful in my workflow redesign:

1. Offer online appointment booking. I use http://www.appointmentquest.com for $14.75 per month. Now, when patients want to make an appointment, they simply go to my Web site and follow the prompts. I am gradually training my patients to use the system as I see them, or while they are on the phone with me. After I go through the steps with them once, they realize it is easy, efficient and convenient, and they take over. It saves them and me lots of phone time.

2. Delegate history-taking to patients. In September 2006, I started using Instant Medical History (http://www.medicalhistory.com), which allows patients to enter their own history into their chart. I use both a Web-based version that patients can complete from home and an office-based version that patients can complete in the waiting room. To implement this, I had to rearrange my office and set up a desktop computer for patient use, but it was worth the effort. More than 80 percent of my patients participate. The system has many benefits. It produces a more complete note than I would have, which allows me to bill at a higher level than I might otherwise be able to; saves me time; helps patients think about the reason(s) for their visit before they see me; keeps churning out histories of the same quality even at the end of the day when I am fatigued; has made obsolete all the paper rating scales I used to use to evaluate patients' pain, depression, etc.; and helps me finish the note in the exam room. Plus, at $50 a month, it's much cheaper than a nurse or medical assistant. (For more information on this topic, see "Improving Care With an Automated Patient History," FPM, July/August 2007.)

3. Use free tools to measure how you're doing. How's Your Health? (http://www.howsyourhealth.org) is a free online tool that collects patient-entered data regarding their health status and their perceptions of the care they have received, and it provides a summary to the patient and to the doctor. I can even export the data electronically into DocSite (http://www.docsite.com), a Web-based patient registry that helps me track and manage patients' chronic, complex and preventive health needs. Patients can complete the HowsYourHealth.org survey at home or on the computer in my waiting room. It gives me an instant practice database that helps me identify my patients' needs and measure how I'm doing.

4. Use e-mail to convey laboratory and X-ray results to patients. E-mailing provides a written record to the patient, is fast (particularly if you use templates) and is free, assuming you already have e-mail set up in your practice. I also use Updox document management software (http://www.updox.com), which allows me to attach items such as lab orders, prescriptions and even Web pages and save the information to the patient's EHR file as I'm sending the e-mail.

This approach is much more efficient than traditional communication methods. Conveying results by mail is neither fast nor free. Calling patients with their lab results often sets you up for, "Oh, by the way, doctor, I wanted to ask you about [insert any new problem]," which can consume your time.

5. Don't be afraid to let the answering machine pick up. During office hours, my message machine states, "I am currently with a patient or otherwise unable to get to the phone; please leave a message and I will call you back as soon as I can." Interrupting the work I am currently engaged in is highly inefficient, whereas handling messages at a time of my choosing is much more effective. Because I return calls promptly, patients don't object.

6. Use electronic billing. Electronic billing through a clearinghouse is easier and faster than paper billing, and the clearinghouse scrubs my claims and identifies those with problems. (I use EClaims, http://www.eclaims.com, which costs about $65 per month after setup.) The "easy" rejections can be fixed in a day or two, as opposed to disappearing into my accounts receivables. Electronic billing also provides proof of the date of submission, which I didn't have with my paper system, and electronic remittance advice, which makes it easier to produce the explanation of benefits in question when arguing with insurance companies about payments.

7. Hire a poster/biller. I gave up on the pure ultra-solo/no-hired-help model, mostly because I hate posting and billing. Successful physicians seem to know how to play to their strengths, and billing is simply not one of mine. I now pay a medical biller approximately $100 every one to two weeks to argue with insurance companies about claim rejections, submit claims to patients' secondary insurers and produce patient statements, and I find it liberating.

How's it working?

While my practice is by no means perfectly efficient, the above changes have made my practice sustainable over the long haul. The pace, the quality of my work, the reward of running my own practice and the capacity for making lasting and significant changes within my practice are addictive. I would never go back to the high-patient-volume, high-overhead model.

Dr. Ho's technological repertoire

Amazing Charts http://www.amazingcharts.com	Electronic health record
Appointment Quest http://www.appointmentquest.com	Online appointment scheduling
DocSite http://www.docsite.com	Online patient registry
Eclaims http://www.eclaims.com	Electronic claims clearinghouse
EZClaim http://www.ezclaim.com	Billing software
How's Your Health? http://www.howsyourhealth.org	Online health survey tool
Instant Medical History http://www.medicalhistory.com	Documentation tool
Medfusion http://www.medfusion.net	Web site creation
Updox http://www.updox.com	Document management system

Even if you are not planning to open your own micro practice, many of the above changes in workflow and processes are applicable to any practice setting. For example, you may want to explore online scheduling, patient-entered histories or e-mail-based results reporting.

For those interested in practice transformation via the ideal medical practice model, join the online discussion group "practiceimprovement1" at http://www.groups.yahoo.com. It will connect you with like-minded physicians and give you information on how to nudge, nurture and shape your practice as it evolves to its truly "ideal" form.

a tool for gathering patient data

Dr. Ho encourages her patients to complete a free online health survey at HowsYourHealth.org, which generates a health summary (shown here) and helps her manage patients' preventive and chronic care needs.

Send comments to fpmedit@aafp.org.

1. Moore LG. Going solo: making the leap. Fam Pract Manag. February 2002:29-32.

2. Moore LG. Going solo: one doc, one room, one year later. Fam Pract Manag. March 2002:25-29.

About the Author

Dr. Ho is a solo family physician in North Kingstown, R.I. Author disclosure: nothing to disclose.

OBNE Meeting, Aug 3, 2009

I was unfortunately late to this meeting because they started earlier than usual.

I was not present for the disciplinary presentations.

Continuing Education Discussion:

There was considerable discussion about how to word OAR 850-40-210. When a final version is provided I'll link it to the site.

SB 355: Fees for being able to prescribe pain meds. All active licensees will be required to pay a $25 annual fee to help pay for the Pain Management Program, which will provide more oversight of pain med prescribing. Apparently this exists in more than 30 states, but Oregon’s new program is the best.

Formulary Meeting Summary:

SB 327 Passed and was signed by the Governor! This is HUGE. OBNE has been working on this legislation for several sessions and many years. This says a lot about how far we’ve come, but more about how hard the board and OANP has worked to promote the profession. This should change a lot for NDs in Oregon, and eventually the US.

With the removal of restrictions (starting Jan 1, 2010), NDs will have prescription power for all meds they can safely prescribe, except that extra education will be required to prescribe chemotherapy meds, and anti-psychotics.

The Formulary council intends to include all of the drugs in the US P&F, all FDA approved substances, all drugs included in the Drug Facts and Compendium, the AAHFS, or any comparable and authoritative source.

OAR 850-060-226 (dividing drugs by ND classification) was removed from the ND OARs, and OAR 850-060-225 was clarified to better reflect the change. The question arose of what role the formulary will take on now.

Legislative update:

HB 2009 which create a Healthcare Authority Board/ Health Policy Board has apparently passed. This is one of Senator Greenlick’s measures. The Board would like to sugest and ND join to keep the ND voice alive in this board. The fear is that it will try to become and “umbrella” organization for all health-care boards which is disapproved by OBNE.

Next Meeting: Sept 28^th, 2009.

Public Comment:

Vanessa Esteves is involved in a committee to try to achieve parity for NDs in traditional medical settings: hospitals, integrative clinics, community health clinics, etc. Now that SB 327 has passed, putting NDs on par with MD primary care providers, it’s time NDs were welcomed in these settings, should they choose to apply for employment there. This is also key for banks. Apparently, banks are more likely to loan NDs on par with aestheticians rather than MDs in order to build their business. This affects the amount of money NDs can borrow as well as the terms and conditions of such borrowing. If you are interested in getting involved in the effort to achieve equality in this manner, contact Vanessa info@dresteves.com.

OBNE Public Meeting, June 1 2009

My apologies for the late posting of this meeting. Some of the business is now somewhat outdated, but my summary is here nonetheless. I am not an official minute keeper, so please note that there may be an occasional error as I do not have the opportunity to double check this with the board.

Opening Business: Minutes of previous meeting approved, typos corrected,approved addition of OAR 850-060-225 and 226: Formulary Compendium and classifications.

Non-ND/ND investigations: The public is not meant to know who these people are, only a small degree of the circumstances. If an investigation leads to formal discipline, only then will the person names become public.

09-00-ON-1: Complaint regarding and advertisement of ND services where the ND had left the business. They were notified and addressed the problem promptly and the board dismissed the complaint as simple oversight. Dismissed with no action.

N08-09-20N: Closed case, overlapped with the medical board.

N09-05-11N: Other board licensee was selling supplements and diagnosing medical issues, investigation open

N09-05-12N: individual claiming to be an ND selling supplements. Investigation open.

09-02-04, 05, and 06: issued proposed discipline

08-08-18A: issued proposed discipline

09-00-ON1: Motion to close with no action

08-09-11N : Motion to close with no action

Bill Report:

SB 131: The Governor signed SB 131 changing the name of the Board from the Oregon Board of Naturopathic Examiners to the Oregon Board of Naturopathic Medicine. Look our for the OBNM this January!

SB 132: At this time was awaiting a vote on the House floor to increase the civil penalty maximum amount to $5000. This civil penalty amount is used by the Board to discipline licensees. (This was signed by G. Kulongoski on June 18)

SB 327A: This is the monumental bill that allows NDs to prescribe in accordance with their training rather than according to drug structure. At this time was passed by the Senate, 22-7, and awaiting a vote on the House floor. The initial bill was an exclusionary bill, meaning that it was going to be a short list of medications NDs couldn’t prescribe. Though Pharmacists and Nurses supported this, DOs and the OMB protested and requested an inclusionary bill as a compromise. This was adopted in the end, so a lengthy list is being compiled of all the drugs NDs can prescribe rather than a very short, simple list of all the drugs NDs can’t prescribe. (G. Kulongoski signed this into law June 18th!!!)

The Formulary council will tentatively be meeting September 11^th, for those interested in weighing in on this process.

Continuing Education discussion:

A doctor/professor at NCNM proposed increasing the CE requirements to relate to and likely exceed those of MDs in Oregon. The goal is for Oregon to be a leader in the country as a state of quality alternative medical care. Additionally, it was brought up that by 2014 all practitioners will be required to use electronic medical records. There was a considerable discussion about how much to increase the hours by and across how many years. The Board was sensitive to the concerns that it would be cost-prohibitive to new practitioners and looked into options to make it easier. The recommendations will be transformed into rules for the next meeting.

Ended up with:

35 Hours Next year

50 hours the following and thereafter

No restrictions on subject areas, except 3 must be in ethics

10 hours must be “in person.” Virtual presence is not “in person.”

Help! I hate this Contract I signed!

First of all, this is not legal advice, it is practical advice. If you want me to review a specific contract, let me know! Before you do, however, take these thoughts into consideration. Lawyers and dispute resolution get expensive very quickly. Knowing your options can save time and money.

Why are you unhappy with the contract? What would it take for you to be happy with the contract again? It seemed like a good deal at the time, what has changed?

Read it over. How much will it cost you to get out of the contract according to its terms? If there is no ability to terminate the contract for a fee or after giving notice, how much is the contract worth if you were to pay it up front? (i.e., if you are stuck in a rental agreement, how many more months do you owe rent? # months x $ rent = $ amount). Can you afford that?

How much can you afford to spend to get out of the contract?

Can someone else step in your shoes? Would that work for you and the person you are contracted with? How long do you think it will take to find that person?

Would the person you're contracted with be willing to work with you to amend the contract?

If you break the contract will you sever a valuable relationship?

What will happen to the relationship when you say "I'll have my lawyer call you"?


Before stepping into a new contractual relationship make sure you can afford to meet the terms of both contracts while you are trying to move on. Life gets expensive fast when you are tied to two agreements.

Good luck! And again, if you would like help reading and understanding a contract you are looking to sign or that you have already signed, feel free to give me a call or an email.

I know I need to communicate with my elected representative, but how?

This is a Democracy kids, everyone has a voice! Don't forget to use yours!

Check out this list of 10 helpful tips to assist you in communicating with your elected official. The article was originally published by the our Washington Acupuncture and Oriental Medicine Association. I've updated for Oregon.

http://www.waoma.org/members/getpolitical.cfm

If you don't make your voice heard…who will?

In the spirit of promoting direct action we encourage all those interested in promoting alternative medicine in Oregon to contact the legislature with concerns and ideas by offering the following links to easily identifying who your representatives are and how to contact them with your input. Prompting our legislative representatives directly on how we want them to represent us is an effective way to do this. The internet makes the ideal of a representative government more of a reality by facilitating fast and easy communication, we need only to take the time to use! Locate your representative by your address:

http://www.leg.state.or.us/findlegsltr/

Once you've found your representative, pick a topic you care about that affects your community and put it in writing! Even better, go to Salem or Washington, D.C. to have a meeting with your representative, and take your friends and neighbors for added effect. Do keep in mind that our legislators in Salem are in session right now. They probably won't have much in the way of free time, so if you don't get an appointment, write a letter. And if you do, expect it to be short, and don't be late!


10 Tips To A Productive Meeting With Your Legislator

Make an appointment. The best way to contact your legislator can vary depending on whether the Legislature is in session or out of session.

During session, use their Salem phone number or e-mail. Out of session, for issues, or meeting and educating, the same, except that sometimes a legislator will have a district office. That information is usually on the Salem voice mail. For campaign related contacts, use their campaign contact information only. Do not use their Salem contact numbers.

Know your goal. For alternative medicine practitioners, an excellent goal would be to educate legislators on the important role you play in the health care delivery system. Give them examples of the cost effective care that you provide. Also, speak to them about the importance of retaining every category of provider.

Remember that legislators are people too. There is an incredible bias in our society against "politicians." But what defines a politician? It's just someone who has decided that they care enough about what's happening to run for office. The vast majority take their responsibility very seriously and want to make a difference. Approaching them from that perspective will yield the best results.

Be prepared as best as possible, and then, if a legislator has a question you don't know how to answer, just simply say you don't, and you'll get back to them. Part of being prepared is knowing something about the legislator, what party are they a member of, how long have been in office, what's their background, etc.

Be aware of time constraints. During a session, appointments are approximately 15 minutes. During the interim, they can be about an hour. It's a great advantage to meet during the interim, especially initially.

Listen carefully, speak thoughtfully. If you find something to disagree about, be polite. You can still be a good advocate for your position and be "smart" about how you deliver your message. You don't want to burn a bridge. Sometimes legislators need some education so that they understand the significance of an issue.

Know that if you're meeting with a legislator who is up for election, you can expect to be asked to help with their campaign, or make a contribution. Think through your answer ahead of time.

After the meeting send a thank you note. Not only is it a good way to say "thank you," but it's also a chance to restate some of the points you wanted to emphasize, or follow up on questions that you didn't have the answer for earlier.

OBNE Public Meeting, April 6

Today I headed over to the public meeting of OBNE (the Oregon Board of Naturopathic Examiners). A few of the highlights are listed below, and minutes to this (and all other public meetings) can be found at http://www.oregon.gov/OBNE/BOARD.shtml

I. Legislative Updates: Thinking the meeting started later I missed the legislative update. However, SB 327 which "modernizes" the ND formulary was being voted on in the Senate today and will likely go to the house soon. Make sure to contact your representative if you have an opinion about this bill, or even better, if you have personal experience with the formulary. Read the text of the bill here if you are interested. More comments from Holistic Health Law to come.

II. To increase or not to increase ND CME hour requirements... That is the question.
In order to set the national bar for ND quality the board is considering raising the number of required CE hours from 25 to 30 or 35. This discussion involved the weighing of many factors and all agreed that the issue was not urgent and could be brought up at the next meeting on June 1, 2009. A few of the major considerations are improving the ethics education of NDs, how to make sure new practitioners can afford to get the credits, the administrative costs of approving CE courses, and the ability of NDs to take increased hours in on-line CE courses. As the meetings are public after 10:30 am or so anyone may come to voice his or her opinion on the matter. Emails can also be sent to the board to communicate an opinion.

III. Miscellaneous scope of practice issues:
a) Vasectomies will likely be considered within the scope of an NDs practice because they should be considered minor surgery.

b) Lipolysis will also likely be considered within the scope of an NDs practice because it is likewise considered a minor surgery.

c) Assisted suicide is NOT within an NDs scope of practice or even close.

d) Employee-provided IV therapy: An ND raised the question of whether or not s/he can hire and train employees to administer IV therapy and kelation therapy. The board asserts that so long as the employee is under "direct supervision" this is permitted. "Direct Supervision" is defined by OAR 850-010-0005 (3). ”Direct Supervision” means that a licensed Naturopathic physician is physically present in the clinic, is monitoring and directly responsible for activities of supervised person, and is available to intervene if necessary.

e) More investigation is required to address two additional questions regarding, first, POLST, and second, ND provision of special education assessment.

The meeting ended approximately 1:30 pm.

Will a focus on healthy, organic food lead to a focus on alternative medicine?

Michelle Obama is promoting healthy eating for all Americans, including avoiding processed foods and eating fresh, local produce. Could this lead our svelte First Lady to bring alternative medicine into the limelight as well? Only time will tell, though it might not hurt to do some letter writing to your representatives in Congress.

Michelle Obama’s Agenda Includes Healthful Eating

By RACHEL L. SWARNS

Published: March 10, 2009

"THE television cameras were rolling, the journalists were scribbling and the first lady, Michelle Obama, was standing in a soup kitchen rhapsodizing about steamed broccoli. And homemade mushroom risotto. And freshly baked apple-carrot muffins. Mrs. Obama was praising the menu last week at Miriam’s Kitchen, a nonprofit drop-in center serving this city’s homeless. And she seized the moment to urge Americans to provide fresh, unprocessed and locally grown foods to their families and to the neediest in their communities." See the article for more.

A whirlwind of activity

Holistic Health Law has undergone quite the makeover in the last few months.
I have a new office space in the Ford Building in SE Portland (2505 SE 11th Ave, Ste 220, Portland, OR 97202) that I am happy to welcome clients to. The feng shui isn't perfect yet, but I'm working on it.

New Website!

Check out Holistic Health Law's new website...

www.holistic-health-law.com.

A legal tidbit: Health Savings Accounts

A Health Savings Account (HSA) coupled with a high deductible health insurance plan is one way to cover the cost of your medical expenditures. This is potentially a good plan for an individual who is concerned about the high cost of unexpected emergencies but spends his or her health care dollars on services not covered by insurance contracts, such as a variety of holistic health care treatments. The way an HSA works is that you can contribute a portion of your income tax free to a specific trust account. The money in this account can only be used for medical expenses. In order to have an HSA you are required to have a high-deductible health insurance plan. This structure was designed to make it more affordable for individuals to have catastrophic health coverage as well as develop incentives for those individuals to save money to spend on preventative care. It was also designed to reduce employers’ cost of insuring their employees.

As a community that frequently operates outside of the constraints of insurance, it seems obvious that natural health practitioners would want to explore health savings accounts to help defray the cost of their own medical care as well as the medical care of their employees. This memo is meant to give you an overview of the basic requirements of a Health Savings Account. If you have an Archer MSA or a Medicare Advantage MSA the rules are a bit different. If you have any further questions please refer to the IRS publication 969 (found at www.irs.gov) or send me an email at lucy.forsten@gmail.com.

The basic idea behind a Health Savings Account (HSA) is that you or your employer can contribute a portion of your income to your HSA and you will not pay income tax on the money, either when you save it or when you spend it. In order to have an HSA you must be eligible and you must set up your account with a qualified HSA trustee (this includes a number of major banks).

Are you qualified?
To be qualified for an HSA you must meet the following criteria.

1. You must be covered under a high deductible health plan. To be a “high deductible health plan” in 2009 your minimum annual deductible must be at least $1150 for a single plan and $2300 for a family plan. *Note that if you are self-employed the cost of your medical and dental insurance may be deductible. Consult a tax professional to determine if you qualify.*

2. You may not have other health coverage, with some exceptions. You may have coverage for a specific disease or illness, accidents, disability, hospitalization (with a fixed amount per day or other time period), dental care, vision care, long-term care, or personal liability protection.

3. You cannot be enrolled in Medicare. There are special rules regarding those who may have had HSAs and who are enrolled in Medicare, as well as special rules regarding the Medicare Advantage MSA.

4. You cannot be claimed as a dependent on someone else’s tax return. (They would be the holders of the HSA if you are a dependent)

What can the money in my HSA pay for?

The money in your HSA can pay for your qualified medical expenses, as defined by the IRS. Unlike your average insurance plan, almost every legitimate health care expenditure is included in the IRS’ definition of a “qualified medical expense.” You should consult a tax professional or IRS publication 502 if you have a question regarding a specific expenditure.

You use your HSA to cover not only your own medical care, but also that of your spouse and any of your dependent children or adults.

How much can I contribute tax free?

How much you can contribute depends on the type of high deductible health plan coverage you have, your age, and when in the year you become an eligible individual (and when you become an ineligible individual). For 2009, if you are eligible for the full year and have a self-only coverage you can contribute up to $3,000; if you have family coverage you can contribute up to $5,800. If you are not eligible for a full year (regardless of when you begin), your contribution is limited. Also, anyone can contribute to your HSA, you, your employer, your spouse and your dependents may all make income-tax free contributions.

Mission Statement

Lucy C. Forsten founded Holistic Health Law in order to follow her dream of maintaining a law practice that supports and advocates for natural medicine practitioners in Oregon as they work to shift the health and the perceptions of health across the state and around the world. Her services include business development work such as contract drafting and review (insurance contracts, employment contracts, leases, partnerships, LLCs, and others), legislative advocacy, and representation in the case of fee disputes or disciplinary notices.

She is also available for simple reassurance. A quick phone call to an attorney who understands your business can calm your fears and help you take those preventative, proactive steps for the health of your business that you so often encourage your patients to take for themselves.