Natural Health & Workers Compensation

1. Natural Health & Workers Compensation Safe, Effective, and Less Costly Minnesota Natural HealthLegal Reform Project

2. History of Work Comp and Natural Health in MN • In the 2008 Worker’s Compensation Bill, a provision was included which prohibits the payment of services rendered to injured workers by unlicensed healthcare providers in Minnesota.  This provision is found in Minnesota Statute 176.135, subd 1b.  Minnesota Natural HealthLegal Reform Project

3. History of Work Comp and Natural Health in MN • This change in 2008 has been presented by the Minnesota Department of Labor and Industry (DLI) as a “reform".  • No evidence has been shown that there was any abuse of the system.  • In short, this "reform" is a solution looking for a problem.   Minnesota Natural HealthLegal Reform Project

4. What is Natural Health? • Natural health encompasses the use of a variety of modalities that, when used properly, enhances the body’s innate healing abilities. • Frequently natural health products cannot be patented because they are found in nature. • Natural Health does not aim to “cure disease”. It aims to heal the person. Minnesota Natural HealthLegal Reform Project

5. What is Natural Health? • Natural health modalities tend to be more traditional. • Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. --World Health Organization. Minnesota Natural HealthLegal Reform Project

6. What is Medicine? • Any substance or substances used in treating disease or illness. • The art or science of restoring or preserving health or physical condition, as by means of drugs, surgical operations or appliances, or manipulations. --Random House Dictionary 2010 Minnesota Natural HealthLegal Reform Project

7. What is Medicine? • The word “medicine” comes from the Latin word “medicinus” which means “of a doctor”. • The Medicine Show was a “traveling show meant to attract a crowd so that patent medicine could be sold to them.” American English, 1938--Online Etymology Dictionary Minnesota Natural HealthLegal Reform Project

8. Natural Health…. • Treats people, not disease. • It is not a disease management system. • Is usually not patented or patentable. • Is not usually offered by MD’s. • Is the preferred phrase, rather than Alternative Medicine. Minnesota Natural HealthLegal Reform Project

9. History of MN Natural Health • The Minnesota Natural Health Legal Reform Project (MNHLRP) was founded in 1997 in response to an unprecedented number of actions against natural health practitioners. • There were no claims of harm, so this was not done to protect the public. • In 2000, MN passed the Health Care Freedom of Access Bill—Statute 146A. Minnesota Natural HealthLegal Reform Project

10. History • Current regulation on licensed practitioners makes it nearly impossible for them to hire or refer to Statute 146A practitioners. • They can, but in doing so, they risk an investigation by the medical board. Minnesota Natural HealthLegal Reform Project

11. History • How does all this affect injured workers? • MNHLRP and WCAC • Minnesota Statute 176.135, subd 1b prohibits work comp insurance payment of 146A practitioners who help injured workers. This was passed in 2008. • There is an exception for those who are employed by a licensed practitioner. Minnesota Natural HealthLegal Reform Project

12. History • Because of the nature of the WCAC, MNHLRP could not get it removed from the Work Comp Bill in 2008. • The legislature repealed the provision in 2009 and 2010. • The Governor vetoed it in 2009 and threatened a veto of the omnibus bill to which it was attached in 2010. Minnesota Natural HealthLegal Reform Project

13. MN Statute 214 • Subd. 2.Criteria for regulation. The legislature declares that no regulation shall be imposed upon any occupation unless required for the safety and well being of the citizens of the state. In evaluating whether an occupation shall be regulated, the following factors shall be considered: Minnesota Natural HealthLegal Reform Project

14. MN Statute 214 • (1) whether the unregulated practice of an occupation may harm or endanger the health, safety and welfare of citizens of the state and whether the potential for harm is recognizable and not remote…. • (3) whether the citizens of this state are or may be effectively protected by other means Minnesota Natural HealthLegal Reform Project

15. Is It Safe? • The FDA has refused to do studies on the safety of Natural Health modalities. • Other countries have, however. • A study in Australia showed the risks of various human activities relative to 1 in a million odds of crashing on a single flight of a Boeing 747. Minnesota Natural HealthLegal Reform Project

16. Is It Safe? • A person is less likely to die from administration of Natural Health modalities than from a lightning strike. • It actually showed up as negative risk. • Work place accidents had the third highest society and personal risk. • Preventable Adverse Drugs was second highest and Preventable medical injuries was the highest risk. Minnesota Natural HealthLegal Reform Project

17. Is It Safe? • A Canadian study showed the relative risk of dying in Canada from various causes compared to being killed on a Boeing 747 flight. • The only thing less risky than Natural Health Modalities was being struck by a meteorite. • Natural Health had a rating of Negative Risk. Minnesota Natural HealthLegal Reform Project

18. Is It Safe? • Very High Level of Risk includes Preventable Medical Injuries, Preventable Adverse Drug Reactions, and Smoking. • High Level of Risk includes Adverse Drug Reactions, Motorcycle accidents, farm work. • Moderate Level of Risk includes Workplace accidents, homicide, accidental falls. Minnesota Natural HealthLegal Reform Project

19. Is It Safe? • Low Level of Risk includes School Bus Accidents, Fire, Forces of Nature, Tuberculosis. • Ultra Low to Very Low Level of Risk includes Railway/Pedestrian accidents, Commercial Airliners, Electrocution. Minnesota Natural HealthLegal Reform Project

20. Who Wants Natural Health? • "I can't think of any major city where these kinds of services are not offered now. In some states or geographic areas it may be more difficult to find, but it's not absent. There are small and single practices everywhere, as well as major institutions like Cleveland Clinic or the Mayo Clinic. The demand has been almost entirely consumer driven." • Kenneth R. Pelletier, PhD, MD, Clinical Professor of Medicine at the University of Maryland School of Medicine (UMMC) and the University of Arizona School of Medicine Minnesota Natural HealthLegal Reform Project

21. Who Wants Natural Health? • Natural Health is the fastest growing segment of the health care industry with over 83 million Americans spending over $34 billion annually. • A majority of it is out of pocket. • The number of visits to Natural Health providers exceeded those to primary physicians by over 200 million in 2002. Minnesota Natural HealthLegal Reform Project

22. Who Wants Natural Health? • 38% of the public has used some natural health modality. • Nearly double that rate—76%--of doctors and nurses have used a natural health therapy, according to a study conducted by the Penny George Institute for Health and Healing with the Allina Health System. • This holds true even when removing vitamins and supplements from the responses. Minnesota Natural HealthLegal Reform Project

23. Natural Health Modalities • When you think of Natural Health, it can encompass any number of modalities. • Most are so safe that licensing is not required. • Some are practiced by licensed professionals, but most licensed professionals risk running afoul of the medical board if they do practice them. Minnesota Natural HealthLegal Reform Project

24. Qualifications to Practice • Statute 146A requires practitioners to give their clients a Bill of Rights. • This document includes a disclosure notice containing background on their training. • Most people should and do ask about qualifications before “hiring” a practitioner. Minnesota Natural HealthLegal Reform Project

25. Qualifications to Practice • Buyer Beware applies to licensed practitioners as well. • Licensing doesn’t guarantee high quality, it guarantees minimal quality. • DLI discussed a pilot project utilizing more effective MD’s. • It is up to the insurance companies to mandate qualifications, not the state. Minnesota Natural HealthLegal Reform Project

26. Scope of Practice • Some have expressed concern that there is no scope of practice for unlicensed practitioners. • Statute 146A is a safe harbor law, which requires that the practitioners stay within the harbor of safe practices. They are not allowed to engage in any unsafe practices, such as drugs and surgery. • 146A practitioners have been and continue to be covered by Fraud Laws. Minnesota Natural HealthLegal Reform Project

27. What About Fraud? • Research on incidences of insurance fraud show that having a license and a standard of care has not stopped anyone from engaging in fraudulent practices. • Most often involves double or triple billing insurance companies, giving unnecessary treatment, not giving treatment claimed. • No information was uncovered about unlicensed natural health practitioners engaging in such fraudulent practices. Minnesota Natural HealthLegal Reform Project

28. No Benefit to 146A Practitioners • There was no evidence that anyone had even used a 146A practitioner. • Most practitioners can’t afford to wait until they receive payment from an insurance company. • If someone submitted a claim, it would likely be on a reimbursement basis and the practitioner would be unaware of it. Minnesota Natural HealthLegal Reform Project

29. Homeopathy • A form of Natural Health care that uses minute substances from plant, animal and mineral kingdoms to stimulate the body to heal itself. • The substances are prepared in a special way called potentizing which makes them safe and effective. • Works on the principal of Like Cures Like. • Has been around for over 200 years. Minnesota Natural HealthLegal Reform Project

30. Naturopathy • A system or method of treating disease that employs no surgery or synthetic drugs but uses special diets, herbs, vitamins, massage, etc., to assist the natural healing processes. • It could include homeopathy, supplements, acupuncture, nutrition, etc. Minnesota Natural HealthLegal Reform Project

31. Naturopathy • Some naturopaths have gone to a four year school. In Minnesota they are referred to as Registered Doctors of Naturopathic Medicine. (RDNM) • Others have gotten their training from a variety of sources over the years and are considered Traditional Naturopaths. Minnesota Natural HealthLegal Reform Project

32. Massage Therapy • Therapeutic massage involves the manipulation of the soft tissue structures of the body to prevent and alleviate pain, discomfort, muscle spasm, and stress; and, to promote health and wellness.  • Massage therapy improves functioning of the circulatory, lymphatic, muscular, skeletal, and nervous systems and may improve the rate at which the body recovers from injury and illness.  Minnesota Natural HealthLegal Reform Project

33. Rolfing • Also known as Structural Integration. • Rolfing assists the structure of the body by reorganizing the fascia. • It recognizes that the body is a system of seamless networks of tissues rather than a collection of separate parts. Minnesota Natural HealthLegal Reform Project

34. Rolfing • Research has demonstrated that Rolfing creates a more efficient use of the muscles, allows the body to conserve energy, and creates more economical and refined patterns of movement. • Research also shows that Rolfing significantly reduces chronic stress and changes in the body structure. • Research also showed that Rolfing enhances neurological functioning. Minnesota Natural HealthLegal Reform Project

35. Aromatherapy • Humans have the capacity to distinguish 10,000 different smells. • In dealing with patients who have lost the sense of smell, doctors have found that a life without fragrance can lead to high incidence of psychiatric problems such as anxiety and depression. Minnesota Natural HealthLegal Reform Project

36. Aromatherapy • The nose is the portal for the chemicals that are found naturally in many substances to be introduced into the body. • Other forms of medicine also use the olfactory method of delivering the medicine. • Some essential oils can also work by being absorbed through the skin. Minnesota Natural HealthLegal Reform Project

37. Aromatherapy • A fragrance company in Japan conducted studies to determine the effects of smell on people. • They have pumped different fragrances in an area where a number of keyboard entry operators were stationed and monitored the number of mistakes made as a function of the smell in the air. Minnesota Natural HealthLegal Reform Project

38. Aromatherapy • When exposed to lavender oil fragrance (a relaxant), the keyboard typing errors dropped 20 percent. • When exposed to jasmine (an uplifting fragrance), the errors dropped 33 percent • When exposed to lemon fragrance (a sharp, refreshing stimulant), the errors fell by a whopping 54 percent! Minnesota Natural HealthLegal Reform Project

39. The Ultimate Wellness Center • Established by Becker Furniture World owner Doug Huseby. • Wellness clinics • Injury Clinics • In Wellness clinic or Mobile Minnesota Natural HealthLegal Reform Project

40. Injury Clinics • Over the course of Five years, Ultimate Wellness has developed protocols for helping to heal injuries, particularly back injuries. • They include modalities that are used by professional sports teams to get their elite athletes back on the field. • Spinal Decompression, Microcurrent Therapy, Cold Laser Therapy, Muscle Stimulation and UltraSound. Minnesota Natural HealthLegal Reform Project

41. Work Comp Case #1 • Kyle came into UWC for an injury that occurred while working. She slipped on a patch of ice and came to the clinic with constant pain in the left hip and low back area. He received 1 treatment of advanced nerve/muscle therapy and reported that had far less tension and felt completely better. Minnesota Natural HealthLegal Reform Project

42. Case #1 • Initial Case: Days Lost: 5Medical Costs: $3,500.00 • Final Claim Resolution:Days Lost: 1Medical Costs $175.00 Minnesota Natural HealthLegal Reform Project

43. Case #2 • Henry came to the UWC after slipping on stairs while carrying some boxes at work. He hurt his mid and low back. The pain was 10 of 10, was constant and nothing provided any relief. • After treatment, his back pain was only present 30% of the time and was a 3 of 10. Minnesota Natural HealthLegal Reform Project

44. Case #2 • At that point Henry went back to work functioning fully but still had some aches and pains. • Within a month and a half, he reported no pain, and that he felt better than he had pre-injury. Minnesota Natural HealthLegal Reform Project

45. Case #2 • Initial Case:Lost days: TTO 21 days, TPO 30 daysMedical: $12,000. • Final Claim Resolution:Lost days: TTO 4 days, TPO 13 daysMedical: $865. Minnesota Natural HealthLegal Reform Project

46. Starkey Labs • 15 years ago, Starkey had 1.3 million dollars annually in Work Comp Claims, mostly CTS. • They brought Rolfers to the company to work on the 17 people who had been diagnosed with Carpal Tunnel Syndrome (CTS). Minnesota Natural HealthLegal Reform Project

47. Starkey Labs • Since implementing the on-site Rolfing program, Starkey has gone from $150,000/mo in Work Comp Claims to $58,000/year in Work Comp Claims. • Starkey pays $80,000/year for the two part time, on-site Rolfers. • Their work comp expenses are ½ the national benchmark for light electronic assembly. • $345,000/year is considered good nationally. Minnesota Natural HealthLegal Reform Project

48. Starkey Labs • Starkey’s MOD rate is 55. Most companies can’t get lower than 70. • VP of Human Resources, Larry Miller, estimates that they have saved $10 - $20 million dollars since introduction of the program. • Today Rolfing is part of the culture at Starkey. • There was never a corporate edict. • Any employee can get Rolfed. Minnesota Natural HealthLegal Reform Project

49. Starkey Labs • Unexpected Benefits of the Rolfing Program • Their cost per hire is 50% of the national average. They have a higher retention rate and it is easier to recruit employees. • There is no antagonism between employers and employees as it regards work related injuries. Minnesota Natural HealthLegal Reform Project

50. Starkey Labs • In 2010, DLI established the Governor’s Award for innovation in Work Comp. • Starkey Labs won this award. • How can the state reward such innovation and then tell its workers that unless they work for a company willing to pay for it, such as Starkey, this award winning therapy is not an option for them? Minnesota Natural HealthLegal Reform Project