The April 2010 edition of John Weeks' Integrator Round-up
Integrative practice stakeholders on perceived gains, losses from the healthcare overhaul
Later this month, the Integrator will publish a Special Report on the Obama-backed and Pelosi-driven healthcare overhaul legislation and its impacts on integrative practices. Meantime, here are some links to what integrative practice stakeholders are saying:
- Natural Products Association: See Healthcare reform to Impact CAM, Supplements.
- American Chiropractic Association: March 21 press release.
- American Association of Naturopathic Physicians: Healthcare Reform Becomes Law- What Now?
- American Association of Acupuncture and Oriental Medicine: HR 3590: How it Benefits the AOM Profession, with strong nod to the Integrated Healthcare Policy Consortium, of which they are a member.
- American Herbal Products Association: CAM, Supplement Provisions Survive in Health Reform Bill.
- MAMA Campaign (Certified Professional Midwives): Healthcare Reform Passes - A Victory for Mothers and Babies
- Integrated Healthcare Policy Consortium: Influential in the non-discrimination language and placement on integrative practices in workforce language and elsewhere, IHPC has not sent any release at this time.
- Alliance for Natural Health: Let’s Not Forget the Good News About How We Changed the Bill When It Was Being Drafted Last Year
Comment: Whatever one thinks about the legislation that passed, there is no question that all of the licensed integrative practice disciplines are more specifically in the game than they have ever been in the past. If these professions connect the dots between the various levels of inclusion in workforce planning, comparative effectiveness research, wellness and health promotion, medical homes, community health teams and the critical non-discrimination clause, a constellation clearly emerges of a new presence for integrative practice in federal US healthcare policy. More soon.
Berwick, speaker at IOM Summit on Integrative Medicine, to be asked by Obama to direct CMS
A March 27, 2010 article in the New York Times indicates that Barack Obama plans to appoint Donald Berwick, MD, MPP, FRCP, as director of the Centers for Medicare and Medicaid Services. Berwick is the founder and director of the influential Harvard-based Institute for Health Improvement, through which he led the 100,000 Lives Campaign to clean up medical errors in US hospitals. Berwick considers himself an "extremist" advocate for patient-centered care, partly based on his own troubling experience with the system as a patient. Some have challenged Berwick for the CMS position based on his lack of experience in running a large agency. Others highly laud Obama for his choice. Berwick was among the presenters at the February 25-27, 2009 Institute of Medicine (IOM) National Summit on Integrative Medicine and the Health of the Public.
Comment: This potential appointment is extraordinarily on target. Anyone who supports patient-centered care and integrative practices would be smart to do all they can to make sure the appointment is not held up. Consider, merely from the integrative practice community, that he not only showed up for the IOM Summit, he also made a significant, thoughtful contribution. Here are the "Principles for Integrative Medicine" Berwick offered attendees.
Berwick's Principles for Integrative Medicine
- Place the patient at the center.
- Individualize care.
- Welcome family and loved ones.
- Maximize healing influences within care.
- Maximize healing influences outside of care.
- Rely on sophisticated, disciplined evidence.
- Use all relevant capacities - waste nothing.
- Connect helping influences with each other.
Berwick is quoted in the report on the IOM meeting as concluding this way: "The sources of suffering are in separateness and the remedy is in remembering that we are all in this together. Integration, if it is to thrive, is the name of a duty to contribute what we can to a troubled and suffering planet." This is wisdom, a rare treat in a leader of a huge bureaucracy. The United States will be lucky to have him in this critical moment.
George Institute/Allina Hospital publishes outcomes on patients who receive integrative, inpatient care
A study conducted by Jeffrey Dusek, PhD, and including a top-notch team of Michael Finch, PhD, Gregory Plotnikoff, MD and Lori Knutson, RN, BS-HN examined the results of integrative inpatient care on 1837 patients. Of these, 66% had never before used integrative services they received. The researchers are all part of the inpatient care team of the Penny George Institute for Health and Healing that is part of Allina Hospitals and Clinics. Results were published in the Journal of Patient Safety as "The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hospital." Here is the conclusion:
"The formal provision of inpatient integrative medicine had a significant impact on pain scores for hospitalized patients, reducing self-reported pain by more than 50%, without placing patients at increased risk of adverse effects. This was true in all 6 settings. Age, previous use of complementary therapies, and sex did not affect results. Future research must define the appropriate dose of the intervention, the duration of the relief, and the identification of patients most likely to respond to these nonpharmacological treatments. Additionally, future research using the electronic health record will allow quantification of any reduction in total costs, pain medication usage, and adverse events."
Following a query from the Integrator, Knutson confirmed that this is the patient population on which the team has estimated there was a $2000 average savings per patient which Knutson had previously reported. The savings were linked to decreased length of stay.
Comment: The robust George Institute inpatient initiative, which has delivered over 60,000 inpatient integrative visits, would optimally have a full-time staff of a half-dozen researchers and support staff continuously slicing and dicing that experience. It is clearly the most significant demonstration opportunity in the country, if yet limited in its service offerings. This is one of the best settings to help answer the question US Senator Tom Harkin posed to NCCAM when he charged NIH NCCAM in 1998, in Section C of the NCCAM mandate, to "study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States." To this point, this focal interest of the Senator and his colleagues has been poorly engaged at NCCAM. Here's hoping that the NCCAM advisory council and staff will place fulfilling on this charge near the center of NCCAM's investment in the 2011-2015 strategic plan in development.
Healthpoint, formerly Community Health Centers of King County, continues with integrative services in new facility; Breed featured in interview
In 1996, Community Health Centers of King County, now Healthpoint, began the first government-funded integrative services program in the United States. The widely reported initiative, under the direction of CEO Tom Trompeter, MHA, chose to continue offering the services after the subsidy expired. The homepage begins with this unusual descriptor: "Welcome to HealthPoint. We provide medical and dental care, as well as complementary and alternative services, at 12 King County locations." Healthpoint stayed this course when it recently moved its Kenmore clinic into a new facility in Bothell, Washington. There, employee Christopher Crumm, ND, LAc offers both naturopathic medical and acupuncture services each Wednesday. (He also works 3 days a week at Healthpoint's Eastside Redmond facility.) Cindy Breed, ND, Healthpoint's "lead provider for Natural Medicine program" is the subject of the audio interview in the March 2010 issue of Natural Medicine Journal. Breed is affiliate clinical faculty and residency director for the Bastyr University Residency Program which HealthPoint also supports. Employed natural health practitioners are on staff in all 8 clinical facilities.
Comment: Credit Trompeter for holding the vision and maintaining the model through a tremendous roller-coaster of budget cycles and funding challenges for all community clinics. Breed, interestingly, has also been there since the beginning. Let's hope the services are still there after the current, crushing cycle of funding retraction.
International homeopathic team meets with NCCAM: Nancy Gahles, DC reports
Top homeopathy researchers recently met with NIH NCCAM leadership to explore NCCAM's relationship with the field. The meeting was organized by Nancy Gahles, DC, CCH, RS Hom(NA), president of the