Check out these stories from the February edition of John Weeks’ Integrator Round-up.
Costs and Cost Effectiveness
George Institute/Allina inpatient initiative reports $2000 savings per patient in integrative care program
In an interview with Natural Medicine Journal, Lori Knutson, RN, BC-HN, executive director of the Penny George Institute reports that a preliminary analysis has found that the inpatient integrative care initiative is saving $2000 per patient per hospital stay for patients at Abbott Northwestern Hospital, part of the Allina system. Knutson adds that this includes administrative costs. Her report followed a question from NMJ publisher Karolyn Gazella in which she asks whether the initiative, with over 60,000 inpatient visit since 2004, can legitimately be considered a model for the nation, a statement in the Integrator when Knutson was honored among the Top 10 for 2009. Knutson noted that to be rolled out as a model, the hospital’s positive clinical outcomes will not suffice: “[Becoming a model] goes to the financial piece. This is where you get the ear of legislators.” Knutson notes that a critical need in offering these data is to have “the comparative effectiveness research and health services funding to support the research and tell the story.” Knutson believes that the value of Allina as a model rests on an integrated approach to policy
Comment: Gazella’s 20 minute interview is a nice synopsis of this significant initiative which is significant both for offering outcomes on an integrative approach to care and also for outlining what Knutson call an “integrated approach” to policy change. Here’s hoping that research funders of all kinds will see the potential value in this model and make sure appropriate funding is in the hands of the George Institute, and any similar models, to look at this every way we can.
Duke Prospective Health reports annualized $2200 per employee per year savings from integrative approach
The personalized, prospective healthcare model tested at Duke Prospective Health in the Duke University Medical System is showing significant benefits in lowering employee costs according to a report referenced in a recent JAMA column, Improving Health by Taking it Personally, written by Ralph Snyderman, MD and Michaela Dinan, BS (JAMA. 2010;303(4):363-364). The approach to patient care includes a health risk assessment, setting of personal health goals, health coaches, primary care providers and some disease management services. A report on the Duke site referenced in the column shares these outcomes:
“During the first two years of Prospective Health, individuals in the high-risk group, people who o typically have the highest medical costs, had a 3.5 percent decrease in medical costs. This saved hundreds of thousands dollars in expenses for the health insurance plans paid for by Duke and employee premiums.
“Ironically, because reimbursement
“Duke has also seen reductions in the number of emergency room visits and the length of hospital stays during the first two years of the program. Such indicators are helping Duke keep its medical costs, and thus its premiums for health insurance, well below national and regional trends. For example, last year, Duke’s average health care cost per employee was $5,298, compared to the national average of $7,498, according to Hewitt Associates, a Human Resources consulting firm.”
Snyderman and Dinan used the JAMA column to push insurance reform: “Personalized, prospective approaches to health will not be attainable without reimbursement reform to support them.” They noted a problem with reimbursement in an earlier pilot. In that case, with 117 patients with congestive heart failure, $8571 per patient in costs were avoided. They note: “Ironically, because reimbursement compensates in-hospital patient care at a higher level than outpatient services, the health system realized a financial disadvantage, and the program proved economically unsustainable.
Comment: The key elements of the Duke model of care are well integrated into the best integrative practices, whether integrative medical, functional, naturopathic, chiropractic, TCM or holistic nursing. If we are to “attain” these approaches for most of the population, the onus is on those who do so to generate outcomes as Duke Progressive Health has accomplished. And this puts the onus on our research community to wake up to this need, ask the right questions and make the funding available.
NIH Office of Dietary Supplements mounts workshop on economic analysis of nutrition interventions
“Despite the rapid escalation of healthcare costs, research into healthcare economic solutions has not taken center stage.” So runs the copy in an announcement of a February 23-24, 2010 workshop that will be sponsored by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS), the National Center for Complementary and Alternative Medicine (NCCAM), the National Cancer Institute (NCI), and the National Institute of Nursing Research (NINR). The event will focus on Economic Analysis of Nutrition Interventions. The workshop will look at methods, research and policy issues. The NIH is soliciting comments. If interested in commenting or attending, contact Mike Bykowski at firstname.lastname@example.org or 301-670-0270.
Comments: Integrator columnist Mike Levin with Health Business Strategies has continuously brought the theme of these potential savings to my attention over the past decade. One sample: Columnist Levin: $24-Billion Savings through Supplement Interventions Says Lewin Group. It is good to see the theme of cost savings via nutritional interventions, long a part of the claims of integrative practitioners, receiving this focused attention. Here is a hope that the methods discussion will include using dietary supplements as part of a whole practice intervention, as urged by the Council for Responsible Nutrition. (Thanks to Douglas “Duffy” MacKay, ND, CRN’s vice president for scientific and regulatory affairs, for bringing this event to my attention.)
MD academics urge NCCAM to fund CAM researchers in 2011-2015 strategic plan
In an unusual twist on typical guild politics, a consortium of MD academic and nurse educators make a priority of promoting support for licensed complementary and alternative healthcare researchers and partnerships between CAM and conventional schools in the 2011-2015 strategic plan of the NIH National Center for Complementary and Alternative Medicine. In a statement released to the Integrator, the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) included 3 priorities which CAHCIM is stressing in dialogues with NIH NCCAM director Josephine Briggs, MD. The third of the priorities is:
“We feel strongly that continued support for the training of researchers at CAM institutions should be a high priority for NCCAM, and that the current model of partnerships between academic medical centers and CAM schools to support this type of training and infrastructure development for the CAM schools is an excellent model.”
The remainder of the CAHCIM position is included in an article that also details the positions of the Council for Responsible Nutrution, a powerful dietary supplement association, and the American Massage Therapy Association, the leading 501c6 professional organization representing that field.
Comment: The leadership of CAHCIM, which has 44 North American medical schools as its members, has repeatedly reached out to connect with colleagues in the licensed complementary and alternative professions, including at the reception noted here and a 2005 change in its own definition noted here. It is particularly meaningful that they should stick their necks out when it comes to priorities for NCCAM’s dispensing of the funds off of which many of the CAHCIM members live. This is a remarkable example of not doing business as usual. They are breaking with past dis-integrative patterns by elevating integration of colleagues who may, given the historic guild biases of NCCAM, be at risk. Kudos.
“Licensed integrative practitioners” included in CER portion of Senate reform bill
An additional significant place where integrative practitioners gained an explicit foothold in Congressional action relative to health reform is in the comparative effectiveness research (CER) language in HR 3590, the Patient Protection and Affordable Healthcare Act. Gretchen DuBeau, executive director of the Alliance for Natural Health-USA shared with the Integrator that her association worked closely with US Senators Kent Conrad and Barbara Mikulski to secure the inclusion. Page 1628 of states that the Board of Governors of the new CER institute would include in its members a “state-licensed integrative health care practitioner.” In addition, an Expert Advisory Panel would include, “as appropriate, experts in integrative health and primary prevention strategies.” The proposed language of the section is available here.
Comment: That the reform bill may not be moving should not take away the steps that integrative practice has gained in recognition this year. be nice to see some of this passed in smaller chunks, with this inclusion intact. Thanks to ANH-USA for their work on this.
AHRQ recognizes NDs as “primary care” for purposes of practice based research network
The certificate received by the Naturopathic Physicians Research Network (NPRN) was a formality, following an application and a dialogue. The heading reads: “AHRQ PBRN Resource Network.” Translated from the acronyms, this phrase means: “Agency for Healthcare Research and Quality Practice Based Research Network Resource Network.” Beneath this the language reads: “This certificate is awarded to the Naturopathic Physicians Research Network,” and further: “This acknowledges the 2010 registration with the AHRQ PBRN Resource Center as a primary care Practice-Based Research Network.” The certificate was received by Carlo Calabrese, ND, MPH at the Helfgott Research Institute associated with the National College of Natural Medicine. Calabrese, a former member of the National Advisory Council on Complementary and Alternative Medicine, is heading up a profession-wide initiative in naturopathic medicine to begin using a PBRN, and eventually electronic medical records, to capture outcomes of naturopathic practices. Acceptance of the NPRN required the primary care recognition and now allows the new network access to resources necessary for it to fulfill on its mission. Calabrese has advocated an effectiveness approach to the analysis of the whole practice of naturopathic medicine since his MPH thesis in the early 1990s.
Comment: The good news for the naturopathic profession here is two-fold. First, of course, is the recognition of the NPRN by AHRQ. But inside of this is the recognition, by this federal agency, of naturopathic physicians as primary care providers. The profession will likely build on this in other state and federal initiatives.
Mikulski promotes integrative healthcare as core principle in healthcare reform
A constituent writes a note to a US Senator on healthcare reform legislation. In the generic response letter the elected official notes her “four principles of health care reform” which are part of the proposed Patient Protection and Affordable Healthcare Act. The first three principles are quite familiar to all followers of the Democratic side of the debate: universal healthcare, strengthening Medicare and ending exclusion based on pre-existing conditions. But the 4th has some surprising language:
” … emphasizing quality, prevention and integrative health to save lives and save money.”
This was the experience of sometimes Integrator contributor Taylor Walsh, a constituent of US Senator Barbara Mikulski (D-MD) when he heard back from Mikulski on a letter he wrote in late January 2010.
Comment: Notice the link with “quality” and “prevention.” That’s good company and just where advocates would like integrative practice to be positions. The other side of the phrase is A-list also, as far as healthcare rhetoric goes: “”save lives” and “save money.” Here’s to an NCCAM agenda which will help us explore the preventive and money saving aspects of this integrative care.
AMA Scope of Practice Partnership (AMA SOPP) strategy to slow and kill scope expansions
The AMA News ran a January 18, 2010 story in which the writer began by introducing the AMA’s successes in beating back scope expansions of naturopathic doctors, chiropractors, midwives and others. These were noted among the 300 scope related pieces of legislation the AMA tracked in 2009. (See this story for list of 30 integrative practice-related scope efforts of interest to the AMA.) The AMA’s new strategy for slowing or halting such expansions is to ask legislatures to establish “scope of practice review panels.” The AMA, which argues that its interest are in patient protection. has developed model legislation to create these panels. The article notes that the AMA also lost a few in 2009, and is increasingly seeing court challenges. The article links to six related AMA news articles. (Thanks to Elaine Zablocki for calling the article to my attention.)
Comment: The classic soft legislative strategy to kill an initiative is to it to death. The creation of a special panel is this soft strategy raised to its highest manifestation. Think Roberta Flack: Killing me softly, with this panel/stopping my whole life, with his words …
AANP reports “horrifically flawed” AMA SOPP paper on the naturopathic profession
Meantime, the American Association of Naturopathic Physicians (AANP) shared with their members some of the language with which the AMA is opposing the expansion of the naturopathic profession. Executive director Karen Howard writes that “naturopathic medicine was recently named one of 10 professions to be profiled by the AMA.” Interestingly, the AMA provided to the AANP a copy of as white paper on their presentation prior to release. Howard called it “horrifically flawed in its interpretation and conclusions.” She cites the September 2009 AMA draft:
“Not only does naturopaths’ insistence on practicing on the fringe of modern medicine produce providers of questionable medical competence through an educational system fraught with scientific inaccuracies and omission of even the most basicS established medical principles, it also propagates the unfortunate result of patient care that is devoid of current, evidenced-based medically accepted concepts.”
Howard shared that her organization’s response “was to offer a detailed analysis of errors, omissions and inaccuracies – and to suggest the AMA rethink its assertion that restricting access to qualified providers serves to protect patient safety.” She adds: “It is a divisive campaign that has marshaled the resources of millions of practitioners in all 50 states.” The AANP has joined the Coalition for Patient Rights, represents 37 Associations opposed to the AMA SOPP. Howard serves in CPR’s leadership.
ACA joins Texas chiropractors in battle with Texas MDs and AMA on scope issue
An area the AMA news story noted as a growing battle zone on scope is the courts. A January 14, 2010 note to members from the American Chiropractic Association (ACA) reports that the ACA is formally getting involved in one such case. The case regards a the rights of chiropractors to perform needle electromyography (EMG) and spinal manipulation under anesthesia (MUA), and moer importantly, to diagnose. The case was filed in September 2006 by the Texas Medical Association (TMA) fagainst the Texas Board of Chiropractic Examiners (TBCE), with the Texas Chirioprctic Association (TCA) actively involved. A part of the suit challenges the legality of licensed DCs in Texas “to render a diagnosis as a part of their scope of practice,” according to the ACA statement. The ACA reports that on November 24, 2009 action in which Judge Stephen Yelenosky “ruled that both procedures are outside the scope of practice for doctors of chiropractic in Texas.” (See TMA account here.) The judge also opened questions relative to diagnosis. The TMA claims that if the statute is viewed to “permit particular rules of diagnosis (this would) would impermissibly allow the TBCE to authorize the practice of medicine.”E$xpert testimony will be heard. ” The ACA allocated $10,000 from the National Chiropractic Legal Action Fund (NCLAF) to support the board and the Texas chiropractors effort to combat the lawsuit.
Widely published survey find medical school students “supportive of CAM”
A widely published survey, led by UCLA professor Michael Goldstein, PhD, concludes that, as the ABC news account put it, “most medical students think that knowledge of complementary and alternative medicine could help Western doctors do a better job.” Of respondents, 74% believe that a blend of conventional and CAM would be “better than either approach by itself.” A similar percent (77%) thought patients would benefit if their conventional codctors knew more about CAM. The findings were based on a 30 questrion survey sent to 126 medical schools and published online Jan. 20 in Evidence-based Complementary and Alternative Medicine. A low response rate limits the value of the conclusion. The survey was funded with support from NIH NCCAM.
Major look at integration in January 2010 Hospitalist
The January 2010 issue of the Hospitalist includes a feature entitled Growth Spurt: Complementary and Alternative Medicine Use Doubles. The balanced overview touches on key points: data on growth of integration, challenges in researching multi-factorial approaches, adverse effects policies, and more. Among those featured is University of Wisconsin medical school integrative medicine leader David Rakel, MD. (Thanks to Mathew Taylor, PhD, PT, for bringing it to my attention.)
Masters in Clinical Nutrition online via New York Chiropractic College
Seneca Falls, New York-based New York Chiropractic College will begin delivering its Master of Science in Applied Clinical Nutrition (MSACN) program online in September 2010. The distance learning program gained the approval of the New York State Education Department in January. NYCC, a multidisciplinary institution which also houses the Finger Lakes School of Acupuncture and Oriental Medicine, presents the online nutrition program as preparing graduates for employment “in a variety of settings including private practice, integrative practice with other professionals, research, and industry consulting.” The program “emphasizes an integrative and natural healthcare approach” that “enables practitioners to expand existing practices, offer more comprehensive treatment, and augment their professional success through interventions that incorporate diet, exercise, nutritional supplementation, and life style modifications.” While designed for practicing chiropractors and chiropractic students, the programs “will also be available to all other qualified healthcare professionals (i.e., nurses, medical physicians, dentists, etc.).” Anna Kelles, PhD, director of NYCC’s School of Applied Clinical Nutrition at NYCC: “We’re looking to teach healthcare practitioners who want to enhance their credentials and expand their practices by incorporating nutrition to address a myriad of health conditions.”
Mayo program and essential oils, acupressure and Qi gong certificates at Anoka-Ramsey Community College
A recent e-note from Brent Bauer, MD to participants in the complementary and integrative medicine program at Mayo Clinic informed recipients of new certificate programs in essential oils, acupressure and Qi gong. The courses are offered via the Integrative Health & Healing programs at the Anoka-Ramsey Community College (ARCC). The ARCC site lists 9 classes, plus the 3 certificate programs. The ARCC program is also involved in a Holistic Healing Conference on February 25, 2010. The community college’s statement of purpose is to “offer a variety of courses and programs designed for individuals and healthcare professional who are interested in natural, holistic and integrative health and healing practices.”
Comment: This news item is notable both as a sign of the kind of resources professionals at an integrative center such as Mayo are being sent and as an example of program a community college is offering.
Tai Sophia Institute begins 5 new certificate programs to help educate “the wellness workforce of the future”
On January 19, 2010, the Tai Sophia Institute (TSI) announced that 5 new graduate certificate programs were approved by the Maryland Higher Education Commission’s (MHEC). The 5 certificates are: Health Coaching, Herbal Studies, Medical Herbalism, Transformative Leadership, and Wellness Coaching. president and co-founder Robert Duggan, MA, MAc, positioned the programs as useful in the nation’s move toward a greater wellness orientation: “Through our newly expanded offerings, Tai Sophia is educating the wellness workforce of the future and empowering individuals with sustainable, wellness-based practices.” The programs target professionals who are seeking to expand their competencies and range of services as well as individuals who are simply wishing “to apply new skills to their communities, their families and themselves.” The release states that “health and wellness coaching are considered to be among the top, cutting-edge health-care careers for the next decade.” Details on the programs are each accessible here.
Comment: These certificates continue a wellness-focus on which TSI, and Duggan in particular, have taken an outspoken lead for decades in this integrative practice dialogue. The certificates appear to not only grant tools for the practitioner’s tool-chest but also keep the eye on the prize of wellness and health.
Natural Doctors International and Acupuncturists Without Borders respond to Haitian crisis
The rapid response to Haitian needs of integrative and functional medicine leader Mark Hyman, MD, featured on 60 Minutes and his French-speaking spouse and father-in-law, both MDs, was only the most visible of responses from the community to this disaster. Integrative practice groups have been mounting various responses. Natural Doctors International partnered with Haitian-American Sabine Thomas, ND, an NIH funded researcher for a relief effort which will begin February 28, 2010. All of the major North American professional and educational organizations are backing the effort which is described on this Facebook page. Those interested are urged to contact email@example.com
Meantime, Acupuncturists Without Borders (AWB) sent its first exploratory team to Haiti on February 3, 2010. A report on the AWB site notes that Diana Fried, AWB Executive Director, and Julia Raneri, AWB Haiti Operations Manager and a [National Acupuncture Detoxification Association] registered trainer, will be going on a private plane with a group of doctors to the Dominican Republic and going by truck from there to Haiti. The group uses a group acupuncture setting and protocols. AWB is working on a logistics plan for setting up repeat groups. The site notes that something over $10,000 had been donated by February 1, 2010.
Corporate citizenship of Standard Process as it achieves $100-million in annual sales
Standard Process announced on January 13, 2010 that its sales reached $100-million for the first time in 2009. The firm has over 270 employees in a plan that now covers 260,000 square feet. The release notes that Charlie DuBois, the president of the family-owned firm, was named person of the year for 2009 by Dynamic Chiropractic. A query regarding the corporate contributions from the former Integrator sponsor produced a remarkable list. The response noted that Standard Process “continued its mission by supporting those who embraced the whole food philosophy and strived to strengthen the connection chiropractic and nutrition.
- Co-sponsored campaigns to solicit patient support for chiropractic inclusion in health care reform.
- Support of universities and schools, often focusing on advancing nutrition education ($1,000,000 over 5 years to Parker Chiropractic College; $550,000 over 6 years to Cleveland Chiropractic College; $400,000 over 4 yeto Texas Chiropractic College; and )$150,000 committed to Southern California University of Health Sciences)
- Scholarship support including $100,000 over 10 years to Life Chiropractic College West and Student American Chiropractic Association (SACA) scholarships.
- Major sponsorship of numerous chiropractic conferences.
While the firm’s focus has been on the chiropractic profession, from time to time Standard Process invests more broadly in the integrative practice arena. Examples are:
- Whole Food Nutrition Scholarship for a naturopathic medical student, via the Institute for Natural Medicine (INM)
- Major sponsorship of the American College for the Advancement of Medicine conference
- Multi-year support of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care.
DuBois has also served as a board member for several organizations, as has Standard Process’ director of research and development, nutrition research David Barnes, PhD. Standard Process views these commitments as “laying the foundation for the future of nutritional health care.”
More Top 10: Massage and naturopathic organizations publish 2009 lists, Integrator looks at the decade
A Top 10 list can be an insight into a profession’s perspectives on the evolving universe. The American Massage Therapy Association (AMTA) published its top 10 news AMTA stories for 2009, an informative list which includes: publication of position papers on massage/pain and massage/hospice care; expanded relations with the NIH NCCAMl substantially increased support (to $500,000, of research through the Massage Therapy Foundation; and passage of two new laws (Michigan and Montana) taking the number of states with licensing to 43. The Association of Accredited Naturopathic Medical College published a Top 10 CAM News Stories for 2009. The noted developments in integrative cancer, expansions of scope in Canada and then included a nod to conventional colleagues at the Arizona Center for Integrative Medicine. For those interested in reflecting over the decade that was, the AMTA also published top stories of the decade. I also took a look at the 2000-2009 emergence of integrative practice in the Integrator (A Short History in the Form of a Top 10 for the Decade in Integrative Medicine).
Comment: After the battering of the so-called healthcare reform debate, these Top 10 lists remind us of that significant gains are being made in expanding access to integrative services even as one may be feeling hopeless about the political direction of health care nationally.
Yale mounts second conference, Briggs to keynote; anti-NCCAM blogger Novella to participate
The Yale Research Symposium on Complementary and Integrative Medicine will be held on March 4, 2010 with NIH NCCAM director Josephine Briggs, MD as keynote speaker. NCCAM antagonist Steven Novella, MD will also participate. Topics to be included in the packed day-long event are: An Integrative Approach to Cancer: The Biology of Lifestyle Interventions and Cancer Survival; Evidence and Plausibility in the Context of CAM Research and Clinical Practice; Recent Research in Traditional Chinese Medicine, Herbal Medicine, Nutrition, and Mind-Body Medicine; Acupuncture for Pregnancy-Related Conditions; The Impact of Dietary Protein on Bone Turnover; Psychological Stress and Sudden Cardiac Death; Mindfulness Training as Treatment for Addictions; Exploration of a Chinese Herbal Formula as Adjuvant Therapy for Patients Under Chemotherapy; A Stress Reduction Curriculum for Medical Residents; and Measuring Barriers to Meditation Practice. The 2009 conference more than sold out.
Comment: Yale integrative medicine is distinctive in that one of the more outspoken opponents of CAM and NCCAM, Steven Novella, MD, has his home base there as a clinical neurologist in the medical school. Novella is on an end-of-day panel with Yale IM founder David Katz, MD, MPH in a “Moderated Discussion on Evidence and Plausibility in the Context of CAM Research and Clinical Practice.” Should be interesting.
Brief notes on conferences, in order of their arrival
- Integrated Healthcare Symposium, February 25-27, 2010, is 95% sold out, according to a late january notice from the sponsors. The conference has a remarkable diverse group of 25 collaborating partner organizations.
- American Association for Acupuncture and Oriental Medicine, April 8-11, 2010 at the Hyatt Regency in Albuquerque, New Mexico will feature special workshops related to AOM and pregnancy and fertility.
- The 30th annual conference of the American Holistic Nurses Association will be held in Colorado Springs June 3-6, 2010. The theme is Re-Visioning Environment.
- The 5th Biennial Symposium of Integrative Medicine Professionals in the Land of Enchantment (SIMPLE) is scheduled for October 10-13, 2010 at the Albuquerque Marriott, 2101 Louisiana Blvd., NE, Albuquerque, New Mexico.
- The American Association of Naturopathic Physicians annual conference will be held in Portland, Oregon, August 11-15, 2010.
- The American Massage Therapy Association will hold its annual conference in Minneapolis, Minnesota, September 22-25, 2010.
- The International Association of Yoga Therapist will present the Symposium on Yoga Research, October 1-3, 2010 at the Himalayan Institute headquarters near Honesdale, Pennsylvania.
Susan “Demie” Stathopoulos selected as Pathways to Wellness’ new Executive Director
Susan “Demie” Stathopoulos will join Pathways to Wellness as executive director. She was formerly at Canyon Ranch where she ran a significant integrative health practice including a variety of health practitioners. Stathopolus has a background in social work and then earned a Master’s degree in business from the MIT Sloan School of Management. Kristen Porter, Pathways current executive director, will remain at Pathways in the newly created role of director of integrative medicine. Porter will focus on the development and growth of Pathways’ clinical capabilities.
Send your news to firstname.lastname@example.org
for inclusion in a future Round-up.
The Integrator is made possible through the generosity of:
NCMIC, Alternative Medicine Integration Group, Inner Harmony Group, Institute for Health and Productivity Management, IntegrativePractitioner.com, Integrative Healthcare Symposium and readers who choose to voluntarily contribute. Thank you all.