John Weeks’ Integrative Medicine, Complementary Alternative Medicine and Health Round-up #54: April 2012
Washington State pushes to double Medicaid home births: disruptive innovation of the first order
“Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.” The speaker was Jeff Thompson, M.D., MPH, chief medical officer of the state of Washington’s Medicaid program. He spoke in a taped interview for Symposium 2012 — Certified Professional Midwives and Midwifery Educators: Contributing to a New Era in Maternity Care. Thompson proceeded to layout how his state has determined that home birth essentially meets the Triple Aim evidence Trifecta of satisfaction, effectiveness and cost savings. In his state, Medicaid payments to licensed midwives for uncomplicated vaginal birth runs $2,500. Payment for birth center births is $5,000 and doubles again to $10,000 for those performed inside of hospitals. The cost doesn’t touch additional savings from reducing the rate of often over-used medical interventions such as epidurals and inductions of labor. And there’s the rub. An obstetrician presenter noted that the #1 surgery performed in hospitals is C-section, the #1 one diagnostic-related group (DRG) in hospitals nationally is birth and that the #2 two surgery in hospitals is hysterectomy, often associated with birth. He summed up: “Birth keeps the lights on in hospitals.”
Comment: See this Huffington Post article for more. I contributed after attending the Symposium. The posting had generated over 630 Facebook shares, 2,200 “likes” and some 90 comments as of April 3. (See the comment stream.) Can we have true healthcare reform without moving birth out of the hospital and back into our communities – either in birth centers or homes, where normal birth belongs? What could be more radical, or positively disruptive of the present harmful economic preference of US healthcare for hospital services?
New addictions guidelines includes CAM
A March 12, 2012 press release from Portland, Oregon-based CHP Group reports that complementary and alternative medicine (CAM) is included in a new evidence-based clinical guideline that was recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is part of the US Department of Health and Human Services. The guidelines is entitled “Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders.” It is published as Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. The guideline focused on people with chronic pain and a history of substance abuse.
The CHP Group, which provides managed CAM services to employers, insurers and managed care organizations (see Insurance, this Round-up), was connected to the study via CHP co-founder and medical director Chuck Simpson, DC, a TIP panel member. The CHP release notes that many patients look for non-drug, non-surgical treatments offered by licensed CAM providers: “The evidence shows how often these treatments are sought out and used. One study revealed that over 40% of pain patients treated with opioids also used some form of CAM. (Fleming S, Rabago DP, Mundt MP, et al. CAM therapies among primary care patients using opioid therapy. BMC Complement Altern Med 2007;7:15.)”
Comments from SAMHSA consensus panel member Chuck Simpson, DC, vice president and medical director of CHP Group: I asked Simpson for his view of the place of CAM in the guideline. He wrote:
“That CAM was considered at all is a step forward [in my humble opinion]. The consensus panel was not particularly CAM-savvy, or CAM advocates. So the discussions centered around the reality of CAM use in chronic pain populations (it’s very prevalent) and the evidence for CAM in chronic pain (it’s thin) but conventional medicine approaches to chronic pain and this population in particular are similarly shy on evidence of effectiveness. And the evidence of the down-sides to Rx pain treatment in this population is robust (e.g drug diversion, non-compliance, addiction, lack of efficacy).
“I think that point was made. I was drafted for the consensus panel because of my publication in an issue of PMR Clinics of North America a couple of years ago. It was a great experience. While not related it’s interesting to see that NCCAM has increasingly focused on pain and CAM. Will this TIP revolutionize treatment of chronic pain in people with substance abuse issues? Not sure. But it is a small step. At this point in my path along CAM integration, I’ll appreciate any step in the right direction”.
Holistic Primary Care convenes e-forum of holistic practitioners on the ACA’s individual mandate
During the week of the Supreme Court hearings on the constitutionality of the Affordable Care Act (ACA), Erik Goldman, editor of Holistic Primary Care, queried a few hundred of his mainly MD/DO subscribers for their perspectives as holistic practitioners on the individual mandate in the ACA. Some are compiled here at Practitioners Sound off on Healthcare Reform Hearings. Goldman summarizes that, while most see a need for fundamental healthcare reform: “It seems the holistic community has little love for the ACA or the individual mandate. Many respondents say the plan fails to address the main drivers of the country’s health crisis, and does little to foster a meaningful shift toward holistic care. Further, since many practice outside of insurance, they are leery of any reform plan that keeps insurance companies in the Catbird seat.” Goldman reports that 90% of respondents (total respondents not noted) believe the act would be declared unconstitutional. In a March 30, 2012 call for additional perspectives, he summarized themes in early returns as:
- A mandate forcing people to purchase insurance is morally wrong and economically questionable.
- Being against the ACA is not synonymous with being against health care reform.
- Elimination of 3rd party payors and restoration of direct relationships between patients and practitioners is the true corrective for the system.
- Holistic & integrative modalities have tremendous potential for cost savings and for improving health outcomes—if only they were given a fair chance.
- Partisan politics & the influence of corporate special interests have corrupted the process, making meaningful large-scale reform difficult if not impossible.
To participate, email Holistic Primary Care at: Opinion@holisticprimarycare.net and share what you think about the individual mandate.
Comment: The holistic medicine movement is all over the map politically. Back in the 1960s-1980s, the alignment of the FDA and FTC with the “health fraud” movement, and the general support of big government for big medicine created a powerful anti-government sentiment among many “alternative medicine” providers. Liberal Democrats like Henry Waxman focused on regulating the natural products industry, alienating others. Meantime, politicians on the right, like Dan Burton and Orrin Hatch, often supported “alternative medicine” and “health freedom” as consumer choice and opposed government regulation of the industry. Other politicians on the left, like Tom Harkin, began pushing integrative medicine as a part of systemic reform toward a wellness focus. Harkin and his colleagues inlaid integrative practice and complementary and alternative medicine in the ACA. Presently, Republicans are presently refusing to co-sponsor a bill to cover Medicaid payments for home birth (a choice issue, one way you look at it) because to do so would imply support for Big Government and Medicaid itself. Political leanings of the field are anything but monolithic.
I personally support the ACA. This is on one hand quite personal. I have had a health condition that would have had very crappy economic consequences for our family had we not had good health insurance. I wouldn’t wish lack of coverage on anyone. So I can hold my nose to a lot of other aspects of the law that i don’t much like to extend insurance protection to other human beings and their families.
I also support the present reform as the best option in a nation that didn’t have the good sense to go for single payer. (Do comparative outcomes with other nations mean nothing? Of course, the politics of evidence, in the U.S. is basically nothing more than the evidence of politics.) Finally, I support the law out of professional self-interest and related personal pleasure. Language inlaid in the Affordable Care Act, noted above, put licensed complementary and alternative professions or some variant of integrative practice, integrative practitioners and licensed members of integrative practice professions into federal policy for the first time. It is a pleasure after 28 years of working from a position of significant disenfranchisement to now be working on reform with a footholds on the inside. Complex stuff, for our fields as for the nation itself. It will be interesting to see what Goldman’s survey will find.
Alyssa Wostrel named executive director of the Integrated Healthcare Policy Consortium
The leading multidisciplinary organization lobbying for advancement of integrative healthcare at the federal level, the multidisciplinary Integrated Healthcare Policy Consortium (IHPC), has announced that Alyssa Wostrel, MBA, DIHOM will be its new executive director. The release notes that Wostrel brings to the job more than a decade of experience in marketing and organizational leadership positions within the natural products industry. The release notes that Wostrel “is skilled in development and fundraising, including as Chair of the fundraising committee for the American Medical College of Homeopathy, where she focused on cause-related marketing at both the community and national level.” She remains actively involved as a Board member. States Wostel: “My for-profit career offered rewarding work, but I also wanted a deeper purpose. So, I’m excited to bring more visibility and awareness to IHPC’s groundbreaking accomplishments in the legislative arena of integrative healthcare.” Wostrel succeeds former IHPC Executive Director, Janet R Kahn, PhD who remains involved as IHPC’s Senior Associate. IHPC states that the organization and it Partners for Health represent more than 250,000 licensed integrative health care providers including medical doctors, naturopathic physicians, acupuncturists, chiropractors, massage therapists, professional midwives, and homeopathic practitioners.
Comment: Here’s hoping that Wostrel will have the tenacity, creativity and fundraising chops to allow IHPC to fulfill on its promise for integrative health care.