Input sought on “Tier 1 Pilots” and definition of Patient Centered Outcomes Research, by September 2, 2011 The Patient Centered Outcomes Research Institute (PCORI), established under the Obama Pelosi Affordable Care Act, references complementary and alternative medicine as a

Input sought on “Tier 1 Pilots” and definition of Patient Centered Outcomes Research, by September 2, 2011 

The Patient Centered Outcomes Research Institute (PCORI), established under the Obama-Pelosi Affordable Care Act, references complementary and alternative medicine as a subject area. Integrative practitioner researcher Christine Goertz, DC, PhD was named to PCORI’s Board of Governors. Now PCORI has circulated a draft definition of “patient centered outcomes research on which it seeks public comment. Goertz shares with the Integrator that PCORI is also seeking input of their Tier 1 Pilot Projects. Adi Haramati, PhD, chair of the International Research Congress on Integrative Medicine and Health sent notice of the opportunity to participate with this comment:

“The national focus on comparative effectiveness research (CER) is a golden opportunity for the field of integrative medicine and health. This will play out in the focus on health outcomes research (and the need for refined research methods) and in the imperative to educate health professionals to be research literate and be able to utilize this information in their practice. The 2012 International Research Congress on Integrative Medicine and Health (May 15-18, 2012 in Portland) has 2 impressive speakers lined up to address CER (Sean Tunis, CEO of the Center for Medical Technology Policy, and Michael Lauer, Dir of Cardiovascular Diseases, NHLBI at NIH).  Although they come from very conventional medical positions, they clearly understand the broader implications related to CAM and Integrative Medicine.”


Submit input on the definition through this link. Submit input on the Tier 1 Pilot Projects through this link.

: The potential for the integrative practice community in the comparative effectiveness arena is to directly address a central claim of many integrative practitioners. Many assert, without much organized evidence, that their approach is better and/or more cost effective compared to usual treatment. Yet I have heard that the only outcomes to be compared via PCORI are between approaches which already have a significant evidence base. Since most real world integrative practices haven’t such preliminary research, this could rule out the most significant public health value in comparing integrative practices with usual care. The present definition does not, in itself, seem to preclude such studies. The consumer focus the PCORI Methodology Committee followed would seem also to keep the door open. Input from anyone, again, is open. Take a look and give your input. See the Guiding Principles in the Definition Rationale. (Thanks to Carlo Calabrese, ND, MPH and Haramati for alerting me to these developments.) 


Natural products bill seeks to expand HSA payments for supplements


The Family Retirement and Health Investment Act of 2011 (HR 2010, S 1098) would allow US citizens to use their Flexible Spending Arrangement and Health Saving Account (HSA) dollars on dietary supplements and meal replacement products. The bill, backed by Congressman Eric Paulsen and Senator Orrin Hatch 9R-UT), is promoted by the Natural Products Association (NPA). However, in a letter for support sent to its list on July 29, 2011, the NPA shared that they did not believe that the bill would separately pass through the legislative process but could be added as an amendment to another bill that was moving through the process.  As of July 29th, NPA had generated over 2000 support letters.

NCCAM-funded team examines possible roles of complementary practitioners in Accountable Care Organizations
A team of NCCAM-funded health services researchers recently published a substantive editorial in the Journal of Alternative and Complementary and Medicine entitled CAM Practitioners and Accountable Care Organizations (ACO): The Train is Leaving the Station.  The authors, led by Mathew Davis, DC, MPH and sometimes Integrator-contributor James Wheedon, DC, take the position that “this is a critical time for the U.S. health care system and an important time for CAM professions to consider how they might fit into an ACO era.” The writers estimate that the “relatively large CAM workforce” amounts to roughly 180,000 licensed CAM practitioners. These will assume one of 3 positions in ACOs: exclusion, partial inclusion or “full participation.” The latter would include meaningful roles in incentive payments via ACA “shared savings” programs. The writers propose areas of potential cost savings from CAM inclusion, noting that the pain-related services with which CAM practitioners are frequently involved make up a good deal of conventional primary care. Ultimately, the authors call for collaboration among CAM professions:

“As policymakers, payers, and stakeholders come together to discuss ACOs, the authors believe CAM professions will have a louder voice as one large group. There are a diverse number of professional organizations both within and across CAM professions that united could influence adoption of CAM into national health care reform efforts such as ACOs. Conversely, should CAM professional organizations continue to act individually, increased competition between CAM professions.”


Comment: The Affordable Care Act in Section 5101 states that health care workforce plans shall include licensed CAM disciplines. However, Section 3502 on patient-centered medical homes was less assertive. The teams in these homes, according to Congress’ language, “may” include chiropractors and members of other licensed CAM disciplines. Credit this team for bringing this issue of how these practitioners “may” be used to the fore. I like and agree with their call for united action. Multidisciplinary vessel for such collaborative work that are noted in the article include the Integrated Healthcare Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care. The authors conclude with a note of urgency: ” … should CAM practitioners and professions fail to get involved in the discussion now, they may not have the opportunity later.”


Homebirth Midwives involved in multiple CMS and Berwick activities
The MAMA (Midwives And Mothers in Action) Campaign reported 3 significant activities related to the Centers for Medicare and Medicaid Services (CMS) on July 26, 2011. First, Mary Lawlor, CPM, the executive director of the Certified Professional Midwives, was invited by CMS administrator Don Berwick, MD to represent the MAMA Coalition at a June 2nd CMS symposium for 40 national health care leaders. The focus was on limiting cost for perinatal caer. MAMA underscored that CPMs were at the table. A week later, MAMA representatives and Jeff Thompson, MD, chief medical officer for Washington State, had a private meeting with Berwick. Their agenda: 1) urge that CMS focus resources on the needs of the majority of childbearing women and infants who are low-risk; 2) increase access to CPMs and birth centers to assure appropriate care for this population that too often suffers the consequences of inappropriate interventions; and, 3) include CPMs and birth centers in performance measurement, data reporting and payment reform initiatives. MAMA also reported that, following their work, the “CMS State Plan Amendment template, containing implementation guidance to state Medicaid offices, specifies that Medicaid reimbursement of birth center provider fees applies to CPMs.”


Comment: Never underestimate the power of a midwife on a political mission. Hours and hours of participation with the most elemental of human activities somehow infuses the typical “how a bill becomes a law” with a distinct birth canal push.