Health and Human Services: 030129p1

Testimony Before the NCVHS subcommittee on Standards andSecurity Regarding Coding for Naturopathic Medical Services1/29/03Konrad Kail, P.A., N.D.Director Southwest College Research InstituteTempe, AZ(602) 363-9237kkail@cox.net

I would like to thank the Chairman and members of the subcommitteefor the opportunity to bring testimony before you. I am a naturopathicphysician and have a family practice in Phoenix, Arizona. I am amember of the Advisory Council to the NIH National Center for Complementary and Alternative Medicine. I am also the liaison to theCancer Advisory Panel for Complementary and Alternative Medicineat the National Institutes of Health. I am involved in several multi-specialty health networks and co-manage patients with conventionalphysicians. I am here on behalf of the American Association of Naturopathic Medical Colleges (located here in Washington D.C.) andthe Southwest College of Naturopathic Medicine and Health Scienceslocated in Tempe, Arizona.This submission discusses the training, licensure, practice andinsurance reimbursement of naturopathic physicians. Naturopathicphysicians provide primary care for patients of all ages. We utilizeconventional diagnostic techniques including physical examination,laboratory evaluation, diagnostic imaging and pathologic diagnosis.Assessment may include determination of nutritional status and toxicburden. Additionally, the patient's mental, emotional, social andspiritual status is evaluated.Traditional naturopathic therapeutics include lifestyle interventions,the prescription of natural medicines of animal, mineral and plantorigin, therapeutic diet, homeopathy, physical modalities andcounseling. Naturopathic physicians are also trained to provide inoffice minor surgical procedures, administer vaccinations andprescribe a range of drugs. We refer for evaluation and management

by specialists, using the same criteria as conventional primary careproviders. Naturopathic physicians meet public health requirementsand in utilizing a primary care model, work with a multi-specialtyreferral network of other providers. A natural evolution of naturopathic care models has resulted in the emergence of integratedclinics that include the full gamut of licensed provider types (ND, MD,DO, DC, LAc, ARNP, LM, …).Naturopathic principles of care and philosophy serve as the bases for naturopathic practice and guide the practitioner in utilizing the leastinvasive, most efficacious and cost effective level of intervention.The goals of care include direct patient management, education inself-care, disease prevention and health promotion throughrestoration of normal physiology to the greatest extent possible.Evaluation and management, as well as procedure codes, ideallydescribe the actual service provided. It is hoped that anunderstanding of how naturopathic physicians practice will aid in thecode development process undertaken here by the committee.

Naturopathic Medicine

Naturopathic Medicine is a unique and distinct system of health carethat emphasizes the use of prevention and natural therapeutics. Thedoctors who practice naturopathic medicine, called

naturopathic physicians

(NDs), are trained to serve as primary care generalpractitioners who are experts in the prevention, diagnosis,management, and naturopathic treatment of both acute and chronichealth conditions.In the United States, the naturopathic profession's infrastructure isbased on accredited educational institutions, professional licensing bya growing number of states, national standards of practice and care,peer review, and an ongoing commitment to state-of-the-art scientificresearch. Modern American naturopathic physicians receiveextensive training in and use therapies that are primarily natural andnontoxic, including clinical nutrition, homeopathy, botanical medicine,hydrotherapy, physical medicine, and counseling. Many NDs have

additional training and certification in acupuncture and naturalchildbirth. Naturopathic physicians practice medicine as primaryhealth care providers and are increasingly acknowledged as leadersin bringing about progressive changes in the nation's medical system.Without exception, all laws that have licensed naturopathic physicians(both historically and currently) establish educational standards thatare recognized as the highest available when the laws were enacted.Naturopathic physicians are trained at accredited, four-year, post-graduate, residential naturopathic medical programs. Today, thehighest educational standard available for the naturopathic professionis graduation from a four-year, residential naturopathic medicalschool that has been accredited by the Council on NaturopathicMedical Education.The traditionally regulated scope of practice for a licensed naturopathhas remained consistent since the profession’s founding in the early1900’s although some changes have been made to reflect societalchanges and scientific advances. The naturopathic physician’s scopeof practice continues to include diagnosis and treatment of patientsby using light, air, water (hydrotherapy), botanical medicine,homeopathy, clinical nutrition, physical medicine, and lifestylecounseling.Naturopathic medicine is defined by its fundamental principles.Methods and modalities are selected and applied based upon theseprinciples in relationship to the individual needs of each patient.Diagnostic and therapeutic methods are selected from varioussources and systems, and will continue to evolve with the progress of knowledge.The earliest doctors and healers worked with herbs, foods, water,fasting, and tissue manipulation - gentle treatments that do notobscure the body's own healing powers. Today's naturopathicphysicians continue to use these therapies as their main tools and toadvocate a healthy dose of primary prevention. In addition, NDsconduct and make practical use of the latest biochemical research