John Weeks’ Integrative Medicine, Complementary Alternative Medicine and Health Round-up #54: April 2012 


Duke integrative medicine moves to insurance model

In a change from past practice, on March 15, 2012, Duke Integrative Medicine began accepting insurance “for all physician consultations and many health psychology services.” Duke’s director Adam Perlman, MD, MPH states: “We are tremendously excited to be able to make our services available to more people than ever, now that we are enrolled in the insurance plans of most of the people who live in the Triangle and beyond.” The program’s statement about the change describes the patient process:

“A physician consultation at the [integrative medicine] center is a comprehensive evaluation by an expert Duke physician who is trained in conventional and complementary medicine.  It offers a complete assessment of a patient’s physical, emotional, and spiritual health during which the physician takes the time to listen to and understand a patient’s health concerns and goals.  The physician works in partnership with the patient and his/her other physicians to create a plan including the very best treatments available that aims to optimize health and well-being. [Italics added.] At the time of any appointment, the patient has full use of all of the Duke Integrative Medicine facility including spa, whirlpool, sauna, steam room, library, meditation spaces, walking labyrinth, and more.”

Comment: It is no surprise that this change came after the arrival of Perlman. He recently transited to Duke from the integrative medicine program at the University of Medicine and Dentistry of New Jersey, a public university serving an under-served population. Another change that may yet come as Perlman’s stamp goes on the program is away from the physician dominance displayed in the language in this announcement. The program has 7 MDs and some 30 other providers. These include massage therapists, acupuncturists, mental health counselors, health coaches, yoga teachers, exercise therapists, mindfulness educators). One would never know this diversity exists, or that these representatives of distinct disciplines were even present, from this language: “The physician works in partnership with his/her other physicians …” Are the MD physicians not in partnership with the others? Is that not worth noting? Perlman, a past chair of the Consortium of Academic Health Centers for Integrative Medicine, is known to be an exceptional collaborator and advocate for respectful relationships between integrative medicine and licensed CAM providers. He may need to give an in-service to his colleagues on respectful language.

Portland, Oregon’s managed CAM business announces high patient satisfaction, suggestions of cost savings

The CHP Group (CHP) of Portland, Oregon announced March 12, 2012 that it is “thrilled” to release outcomes of its 2011 patient satisfaction survey. CHP looks at patient experience of chiropractors and acupuncturists and naturopathic doctors and others through questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) developed by the US Agency for Healthcare Research and Quality. The CHP Group also adds additional questions developed internally by the firm to explore cost and quality issues in the integration dialogue. On the basic CAHPS, the firm’s overall score for 2011 was 96%, consistent with its outcomes since 2000, according to the release. In addition, the CHP-developed questions found that:

  • 98% of respondents replied “always” or “usually” to the question “Has the treatment or recommendation you received from this provider helped you?”
  • 82% answered “usually” or “always” to: “Has the treatment or recommendation you have received reduced your use of prescription drugs?”
  • 92% of respondents answered “usually” or “always” to: “Has the treatment or recommendation you received reduced your use of other medical care for this problem?”

States Michell Hay, CEO of The CHP Group: “We are well aware of the high-quality of care our network providers render to their patients, but it is gratifying to see patients acknowledge the beneficial outcomes of the quality care they received.” 

Comment: I find it astonishing that the prejudice or corrupt incentives of the present system limit affirmative exploration of the patient experience behind these data. Are patient perceptions so belittled that a finding that 82% perceived experience of decrease in drug use is discounted and unexplored? Do they judge worthless that 92% of these human beings said they reduced medical costs elsewhere through services of CHP’s CAM networks? All integrative practitioners who do any kind of outcomes work should gather these data from these 3 questions. Why don’t the employer, payer or research communities find these findings worth exploration? My default answer is that it does not serve the dominant school of medicine to affirm the value of another discipline. Am I missing something?