Policy PCORI Changes Language to Include Integrative, Complementary and Alternative Medicine ProvidersThe Board of Governors of the Patient Centered Outcomes Research institute (PCORI) has listened to public input and made a series of responsive changes to their draft “National Priorities
PCORI Changes Language to Include Integrative, Complementary and Alternative Medicine Providers
The Board of Governors of the Patient-Centered Outcomes Research institute (PCORI) has listened to public input and made a series of responsive changes to their draft “National Priorities for Research and Research Agenda.” Page 6 of their publication entitled “Major Themes from Public Comments on the Draft National Priorities for Research and Research Agenda and PCORI Response” notes that the public “recommends that PCORI study new and expanded roles for allied health professionals.” PCORI then shares language in their section on “Improving Health Systems” which now includes “integrative healthcare providers, complementary and alternative medicine providers” in the list of allied health practitioners adding: “Research that compares the effectiveness on patient outcomes of alternative strategies to composition of health care teams through alternative workforce deployment models including care collaboration and team based care approaches.” A more through Integrator look at these and other changes that are positiuve for whole person approaches is here.
Comment: First, it’s great to see PCORI acting with such conscious responsiveness. Inside the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), my day job, we have the view that, at this point in time in U.S. health care, if integrative healthcare providers, complementary and alternative medicine providers are not explicitly included, as PCORI now does, they are likely yet to be excluded. This need is not ideal health care. It is realpolitik. Thanks to all who, responding to an Integrator push (Patient-Centered Outcomes Research Institute draft plan comment period ends March 15: No CAM-IM presently noted) or for other reasons, made such comments in any of PCORI’s comment periods. Healthcare writer Elaine Zablocki was among these. You were heard.
Recent news on the diabetes front underscores the wisdom of PCORI’s change. When Group Health Cooperative allowed patients with non-insulin dependent diabetes to have access to “adjunctive naturopathic care” from a network of naturopathic physicians, the outcomes proved beneficial on an array of fronts. Following up on pilots such as this work, led by Ryan Bradley, ND, MPH, Dan Cherkin, PhD and others, would appear to be rich ground for PCORI funding.
Kahn: Prevention Fund under 6th attack by Republicans
Janet Kahn, PhD, a member of the Advisory Group on Prevention, Health Promotion and Integrative and Public Health to the National Prevention, Health Promotion, and Public Health Council provided a list of the series of attacks the Prevention Fund has take from Republican antagonists. The Fund, established as part of the Affordable Care Act, is now threatened through the most recent of these gutting measures.
4/25/12 – Rep. Judy Biggert, on behalf of House Republicans, introduced the Interest Rate Reduction Act (HR 4628), which would delay the increase in federal Stafford Direct Stafford Loan rates, offset by repealing the Prevention and Public Health Fund.
4/25/12 – The House Energy & Commerce Committee advanced a budget reconciliation measure (Proposed Matters for Inclusion in Reconciliation Recommendations), which includes elimination of the Prevention and Public Health Fund. The title was approved by a committee vote of 30-22 (party line). Several Democratic members, including Capps and Matsui, offered amendments to cut the provision.
2/22/12 – The Middle Class Tax Relief and Job Creation Act (HR 3630) became law, extending the payroll tax cut, unemployment benefits, and physician payment updates (“doc fix”), offset by a $6.25 billion cut to the Prevention and Public Health Fund.
9/29/11 – The Labor-HHS FY2012 Appropriations bill offered by House LHHS Chairman Rehberg rescinded funding for the Prevention Fund for FY12.
4/13/11 – Legislation to repeal the Prevention and Public Health Fund (H.R. 1217, introduced by Rep. Joseph Pitts) passed the House on a vote of 236 – 183. The bill did not pass Senate.
1/19/11- H.R.2 – Legislation entitled “Repealing the Job-Killing Health Care Law Act” (H.R. 2, introduced by Rep. Eric Cantor) passed the House on a vote of 245 – 189. It did not pass the Senate. This bill repealed the entire Patient Protection and Affordable Care Act (including the Prevention and Public Health Fund) and the Health Care and Education Affordability Reconciliation Act, which together comprise the landmark health care reform that was signed into law by President Obama in March 2010.
9/14/10 – The Senate defeated an amendment offered by Sen. Johanns that would offset the costs of repealing a 1099 tax reporting requirement by eliminating the Prevention Fund.
The American Public Health Association’s letter-writing campaign to preserve the fund is available via this link.
Comment: As a parent of a student with loans, and another on the way, this pitting of a national prevention strategy against prevention of ignorance and limited job potential for hundreds of thousands of young adults is Machiavellian ugly. Not investing in prevention and health promotion is akin to denying global warming. Republican readers of this blog: can you defend these actions?
Integrative oncologist Donald Abrams, MD takes public position for legalization of marijuana
Integrative medical oncologist Donald Abrams, MD, with the UCSF Osher Center, is an outspoken advocate for legalizing marijuana. In an April 10 Boston Herald article, Doc urges Bay State to decriminalize marijuana, Abrams is quoted as bluntly telling the reporter: “It’s a flower. Get a grip. It’s part of nature. It should be available at sports events instead of alcohol. There’d be less violence.” Abrams, chief of hematology/oncology at San Francisco General Hospital, was headed to Boston to lecture at the Dana-Farber Cancer Institute when he took a moment to lecture the reporter on Massachusetts’ marijuana policy: “Cannabis has been a natural medicine for thousands of years. It’s an analgesic, it’s anti-inflammatory.” Abrams is a past-president of the Society for Integrative Oncology and a leader of the Bravewell Clinical Network.
Comment: There is a worried line of political reasoning that says if you are already in one field that is not fully accepted, such as integrative medicine, you’re a damn fool to attach yourself to another that is also marginalized by many, such as marijuana legalization. I love the disregard Abrams shows in standing up for what he believes, instead of kowtowing to some notion of political savvy. Go Don! Personally, I never inhaled.
CAM educator consortium ACCAHC to represent integrative health in the 3 year IOM Global Forum on Innovation in Health Professional Education
The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) announced on in an April 13, 2012 release that it has become a founding sponsor of the Institute of Medicine (IOM) Global Forum on Innovation in Health Professional Education. According to the release, IOM established the forum to:
” … help operationalize recommendations from two significant reports produced in the centennial year of the Flexner Report that both revolutionized and polarized health professional education after its publication in 1910. The Lancet Commission’s Educating Health Professionals for a New Century (2010) and the IOM/Robert Wood Johnson Report on The Future of Nursing (2010) each stressed inter-professionalism, team care and the importance of educating professionals for leadership and as change agents The Lancet Commission also focused on the globalization of healthcare and the need to better integrate health professional education with primary care, healthcare delivery and community and public health.”
ACCAHC, a consortium of 16 principally education-oriented organizations centered in the 5 licensed CAM disciplines, plans to “will urge whole person, integrative, health and wellness-focused explorations” during the 3 year forum. ACCAHC found an unnamed donor to support the organization’s participation with over 30 other medical organizations including the councils of colleges for medicine, nursing, dentistry, pharmacy and public health. States Elizabeth A. (Liza) Goldblatt, PhD, MPA/HA, ACCAHC chair and ACCAHC member on the IOM committee: “ACCAHC is excited to bring our core values of whole person, wellness-focused, patient-centered, integrative practices to this Global Forum with our academic colleagues from other disciplines and other nations.” After its commitment to join, ACCAHC received a $30,000 philanthropic grant to support the participation. Goldblatt’s alternate will be ACCAHC executive director John Weeks. This is ACCAHC’s third significant engagement with on IOM initiative.
Comment: This is a very exciting involvement, personally of course, and for integrative health ideas as we embark on the 100 years after the Flexner century. The ACCAHC disciplines will have a lot to learn from their colleagues. We also believe we have some important content to bring to the table. In a discussion before the ACCAHC board made this huge commitment to sponsor – another $30,000 is yet needed to support costs – one member said: “Wouldn’t the best innovation be to graduate professionals who focus on wellness, on getting people healthy, and helping them stay healthy.” What a bodacious thought! Then again, what Flexner recommended was way outside the box of health professional education in his time. Who wants to enter the 22nd Century wondering if we ever get over being merely reactive in our healthcare treatment?
The Global Forum will develop two, 2-day forums each year from 2012-2014 on topics on innovation in health professional education. Some may be particularly of interest for the integrative community. Each will be an exceptional networking opportunity. Mark the dates for the 2012 forums (August 28-29, November 29-30) and sign-up here for the IOM for updates on content.
Surveyed acupuncturists back educational requirements for experience in integrated environments and team-care
The preliminary report of the 2012 Annual Survey by the American Association of Acupuncture and Oriental Medicine found 76% agreed with the statement that “AOM training should be required to include clinical training in settings such as community clinics and/or hospitals.” Of AAAOM members who responded, the percent responding affirmatively was higher, at just over 80%. Similarly, 65%/73% agreed that “AOM training should be required to include clinical training on a team with other medical professionals.” Notably, respondents also agreed (73%/81%) with this statement: “Accreditation standards for AOM programs should be consistent with standards for other healthcare professions, such as Physician Assistant, Nursing, Chiropractic, Naturopathy and Physical Therapy.” The findings were marred by a response rate of just 7%.
Comment: Credit the AAAOM with trying to reach the entire profession. The professional association partnered with both the Council of Colleges of Acupuncture and Oriental Medicine and the National Certification Commission for Acupuncture and Oriental Medicine to mail to 18,000 licensed acupuncturists and 5,000 students. The chief focus of the survey was the profession’s controversial move toward establishing a First Professional Doctorate (FPD). Findings on this topic are also available. The low response rate was likely due to AAAOM asking respondents to read two complex documents on the FPD before responding.
Meantime, the findings noted above suggest a profession whose involved leaders see their future less in silos and solo practices and increasingly in teams and multidisciplinary practices. The high percent seeking to align accreditation standards with other allied health fields suggests a recognition of the value of acquiring shared language.
National Business Coalition on Health CEO offers 10 suggestions for integrative care players approaching the employer market
When Gerry Clum, DC, the head of the Octagon Institute at Life University, a mainly chiropractic institution, invited National Business Coalition on Health (NBCH) CEO Andy Webber to speak at Octagon’s mid-April health policy conference, he made a request. He asked Webber to lay out some tips for the chiropractors and other integrative health professionals in the room on how to best work with employers. Webber took Clum seriously and offered a Top 10 list. I asked him for his slides. Here is Webber’s list.
1.Prioritize the employer community as a critical customer.
2.Aim high with employer outreach (i.e. C-suite level).
3.Internalize and always relate your message to the employer community’s broad goals and strategies.
4.Build partnerships and integrate chiropractic services into employer/worksite based health management strategies, e.g. onsite clinics, disease management initiatives, health promotion programs.
5.Build partnerships and integrate chiropractic services into emerging population health delivery models, particularly ACOs and patient-centered medical homes (e.g. Community Health Teams as specified in Section 3502 of ACA legislation).
6.Help design and support new provider payment models, e.g. bundled and global payments, shared risk.
7.Help design and support value based benefit design models, e.g. lowering co-pays for high value services, provider steerage.
8.Understand that employers, as their customers, can influence health plan strategies in value-based products.
9.Demonstrate chiropractic’s value by more published data and research (i.e. Choundhry and Milstein study). Include productivity metrics in impact analyses – this will significantly boost potential ROI.
10. Always work with an employer-led health coalition if one exists and supports community-based health/health care initiatives.
Comment: A great deal here, from on high. Insert your field for chiropractic. Take it in, people. This should be required meditation material for all in integrative health who want these approaches and practices to eventually have more meaning in U.S. health care. NCCAM, if you are listening, please note #9. NBCH is the “real world” that one would hope the real world focus of the strategic plan might wish to engage.
What the naturopathic doctors sought on their Washington, D.C. Lobby Day
An organizing pitch to turn out members to an early May 2012 Lobby Day in the nation’s capital succinctly laid out the present federal policy wish list of the American Association of Naturopathic Physicians (AANP). The letter, from AANP governmental affairs chair Lorilee Schoenbeck, ND, began with her call to action: “Our nation’s health care is at a crossroads. The choice is between maintaining the status quo of unsustainable, high-cost interventions that happen too late, or the creation of a true Health Care System that embodies early primary care, prevention and addresses the root causes of illness. America has a choice to remain invested in pharmaceutical and corporate interests in the delivery of what is considered to be medicine or to move toward empowering people with the knowledge and tools that connect them with their natural environment, the earth, their spirit, their food and their hearts.” The starting place for NDs was represented in their identified “asks” for those participating in Congressional visits. These are: inclusion in United States Department of Health and Human Services programs, and similar inclusion as Department of Veterans Affairs’ approved providers.
Comment: Pardon the long prelude from Schoenbeck. Sometimes it is just music to hear what it is one is all about.
Transition in leadership at the American Holistic Nurses Association
Jeanne Crawford, MPH, a key force in holistic nursing as executive director of the American Holistic Nurses Association (AHNA), has stepped down “after 8 years of dedicated service” according to a note from the association. Her interim replacement is Terri Roberts who for 23 years served as executive director of the Kansas State Nurses Association (KSNA), The Kansas Nurse, a refereed journal, and the Editor of a legislative newsletter that was published weekly during the Kansas legislative session each year. She has worked as a healthcare consultant with a variety of non-profit, institutional and individual clients on policy and quality initiatives.
Comment: During Crawford’s term as executive director, the AHNA took the powerful step of creating a board certification in holistic nursing that gained recognition for the field from the American Nurses Association. The number of board certified holistic nurses has grown steadily. Yet the field has largely been inward-turning, providing a newsletter and conference to support its members. It will be interesting to see, if Roberts sticks around, whether her legislative leanings might begin to move the field to have more of a voice in health affairs.
CAM/Integrative Medicine Panel At The Yale Healthcare 2012 Conference
“Nurses and public health professionals have often been in the vanguard of advocating for more effective and humanistic healthcare. This tradition was once again in evidence in April at Yale University’s Healthcare Conference 2012. The annual conference is a joint effort between Yale’s School of Management, School of Medicine, School of Nursing, and School of Public Health.
“This year a group of students led by Christine Brubaker (Nursing) and Rebecca Ng (Public Health) produced a breakout session entitled ‘Massage or Morphine? The Role of Integrative Medicine in Modern Healthcare.’ The panel leaders were Eliot Tokar, an internationally recognized doctor of traditional Tibetan medicine, writer and lecturer, and Ather Ali, a naturopathic doctor and Associate Research Scientist at the Yale School of Medicine. The panel and attendees — which included both students and a diversity of healthcare industry professionals — discussed topics such as the effectiveness of integrative medicine (IM) and CAM therapies in delivering quality healthcare services to patients; the significance of promoting medical pluralism in the US; IM and CAM’s ability to contribute to healthcare innovation, cost containment and chronic disease management; appropriate training pathways for CAM professionals; the implications of the Patient Protection and Affordable Care Act and protocols for evaluating the applicability and effectiveness of CAM and IM approaches in disease prevention and treatment.
“Following the conference breakout session Dr. Tokar was invited to the Yale School of Nursing to conduct a workshop with students on the topic of How Can Nurses Work Effectively To Define And Achieve Progress In Expanding Medical Education And The Quality Of Clinical Practice.”
Massage Therapy Foundation develops useful evidence tool-bar
The Massage Therapy Foundation has developed a nifty toolbar to help massage educators, in particular, but also clinicians and students, to ready access to evidence and other resources that will help with teaching. The tool offers live literature searches from an array of databases, plus anatomical images and other teaching and clinical aids. This is another in a series of MTF projects that have sought to enrich scientific literacy in the massage field.
Comment: The MTF deserves an award for sheer functionality in the massage field. Under current president Ruth Werner as under past-president Diana Thompson, LMP, the organization has consecutively delivered tremendous value to the massage field. Credit the American Massage Therapy Association (AMTA) for substantially funding it for many years. Here’s hoping the AMTA will find ways to continue to do so.
Multidisciplinary coaching group announces websites, next steps toward educational standards, credentialing
The National Consortium for Credentialing Health & Wellness Coaches (NCCHWC) issued an update in April on work that commenced with a summit in September 2010 to set educational standards and credentialing requirements for health coaching. The group lists 18 “stakeholders” including the American Chiropractic Association, American Board of Integrative Holistic Medicine, American Association of Diabetes Educators, ACCAHC and diverse coaching organizations. NCCHWC is incorporating as a non-profit entity and shares its project plan. Next steps are mundane but critical for establishing legitimacy: complete a job analysis, training and education curriculum analysis (DACUM process), survey health and wellness coaches, and ensure that each task follows best practices to avoid bias and partisanship.
Meantime, a “coaching research project team” is developing a multi-site collaborative coaching research agenda. NCCHWC will then hold a second Summit to define the way forward to national standards and credentialing. They invite more participants. The note was signed by a leadership team of: Dick Cotton, MS, American College of Sports Medicine; Karen Lawson, MD, University of Minnesota; Margaret Moore, MBA, Wellcoaches Corporation & Institute of Coaching; and Ruth Wolever, PhD, Duke Integrative Medicine.
Comment: My view of coaching, and this work in particular, is that if you have skin in the integrative health game, then you have skin in this one. If you think your discipline “already coaches,” I urge you to take a look at the modern arts and sciences of health coaching and see if you haven’t something to learn. If we’ve lost track of prioritizing assisting people in moving toward wellness, then we’ve failed to keep our eye on the prize. It’s a fine group, with great intentions, doing necessary work. Check them out.
Philanthropist-backed Casey health Institute to feature integrative medicine in a PCMH model; medical director sought
In 2010, Betty Casey, a philanthropist in the nation’s Beltway with an interest in integrative medicine, charged David Fogel, MD with coming up with an integrative model to place in a large building she owned. She had funds enough to support an significant exploration of models. In a write-up by long-time integrative medicine leader Alan Dumoff, JD, MSW, a consultant to the project, Dumoff ticks off key elements Fogel, MD and his spouse, Ilana Bar-Levay, MD selected in announcing the Casey Health Institute (CHI). Among these are shared medical appointments and a significant focus on collaboration and team care. This is built around a covey of functional medicine doctors, licensed acupuncturists, massage therapist, integrative nurses and others. The potential for CHI to be a significant national model is due to the choice to imbed this in a patient centered medical home (PCMH) structure. CHI could influence developments across the country as the PCMH model expands. There is a position open for a top-notch medical director. The job description at the bottom of Dumoff’s article.
Comment: This is exciting business. Now what medical doctor will drop everything to step into this influential, experimental medical director role?
Group acupuncture at Cleveland Clinic’s integrative center highlighted
The community acupuncture movement that grew out of a working class neighborhood in Northeast Portland, Oregon is making its way into academic medicine. An article in the Cleveland Plain Dealer features a program begun last October by acupuncturist Jamie Starkey, LAc at the Cleveland Clinic’s Center for Integrative Medicine in Lyndhurst. A six week pilot in which Starkey saw between 2-13 patient each week convinced Michael Roizen, MD, the clinic’s chief wellness officer and Tanya Edwards, MD, medical director for the center, to go ahead with the program. The pilot began using 10 recliners in an employee meditation room space.
Comment: Notably, to me, the reporter focused on a patient who was finding success with acupuncture for a number suffer from xerostomia. I can vouch for the value, in the group acupuncture format. I receiving treatment via Jordan VanVoast, LAc at the Communichi community acupuncture clinic in Seattle.
Briefly noted developments related to health system integrative medicine clinics
Here are some brief notes on developments in health system-based integrative clinics and initiatives:
- Northwestern Integrative Medicine re-posted information about its philanthropy program here. The page describes a series of funds to net diverse donor interests.
- Integrative medicine doctors at the University of Wisconsin will have a new home in a small part of $241-million facility expansion.
- The Simms-Mann UCLA Center for Integrative Oncology at UCLA’s Jonsson Comprehensive Cancer Center was among the beneficiaries of a $400,000 Lance Armstrong Foundation grant via Aspen’s Pillars4Life.
- A Baltimore Examiner article declared the University of Maryland integrative medicine’s first health conference a success. Some 500 turned out for an event featuring Andy Weil, MD.
- Weil and another principal at University of Arizona Center for Integrative Medicine Tieraona Lowdog, MD have engaged a relationship with product manufacturer Innate Response for what they call the “first seasonal therapeutic program.”
- Kentucky-based St. Elizabeth’s Healthcare has opened a new integrative oncology program in Crestview Hills offering an array of integrative services.
- Family Practice News published a piece on research carried out at the Women’s Heart Center at Cedars Sinai Hospital that found acupuncture to improve heart rate variability in CHD.
- The University of Wisconsin Program in Integrative Medicine has updated their publicly available GERD module.
- New Jersey’s Raritan Bay Medical Center had an open house for its integrative medicine center.
- A CNN Money article notes that Susan and Henry Samueli, backers of the Susan Samueli Center at UC irvine, are among 12 more billionaires that have signed onto the Gate-Buffet pledge to give away at least 50% of their wealth in their lifetimes.
- Cincinnati’s TriHealth Integrative Health & Medicine has added acupuncturist Diane Kloecker LAc, MSOM, Dipl.OM to their team.
Charlie DuBois, Standard Process’ president, granted honorary Doctor of Humane Letters
New York Chiropractic College granted Standard Process’ president Charles DuBois a Doctor of Humane Letters at its April 2012 graduation ceremony. It was only the second such degree granted by NYCC in its 90-year history. The release from the school noted that the American Chiropractic Association earlier named DuBois Humanitarian of the Year. In an address to students, DuBois urged then to “treat employees as you would your family, and treat your patients as you would your parents.”
Comment: Cynics may note that Standard Process is a huge donor to the chiropractic field, including NYCC. Insider cynics will raise an eyebrow with the knowledge that my own professional work, including the Integrator itself, have benefited from Standard Process’ donations. Yet I report this because the quote from DuBois is not empty. His firm has more than once been honored as a top place to work in Wisconsin. The employee health promotion program has likewise been honored. The firm has also been recognized as an contributor to its community of Palmyra. And for whatever self-interested reasons, the dollars that Standard Process has given to NYCC and other institutions and initiatives in the field of chiropractic have created tremendous opportunities to enhance practices for thousands of chiropractors and the treatment received by tens of thousands of patients. Few executives make such commitments to any field. This honorary degree was earned. Congratulations, Dr. DuBois.
Robert Downey, Jr received award from YoSan University for advocacy of acupuncture
In a March 2012 ceremony in Malibu, California, actor Robert Downey Jr was honored for his advocacy of traditional Chinese medicine and martial arts by Yo San University of Traditional Chinese Medicine’s founders Daoshing Ni and Mao Shing Ni. Yo San granted Downey the Robert Graham Visionary Award in an event that included a live auction to benefit programs at the university. An short article in Acupuncture Today quotes Dr. Mao Shing Ni explaining the award: “What he has done as a spokesperson for Chinese medicine and from the perspective of where he was health wise to where he is today, it has been very positive for him and that is why he is here to support our event.”
E-Letter in response to a past articles
Tai Sophia Institute vice president Judy Broida, PhD on the institution’s move toward university status
In the April 2012 Integrator Round-up I reported steps take at Tai Sophia Institute toward becoming a university then wondered about whether the Institute could keep its distinctive focus on wellness. Tai Sophia vice president Judy Broida, PhD, vice president, responded:
“After reading your blog comment about Tai Sophia’s proposed move to a university, I wanted to respond. Having worked at many universities, private and public, small and large, highly prestigious and some not so, I can assure you that as long as I and the new leadership are here, Tai Sophia will not ‘regress to the mean’ of universities and will always retain its roots. It is what makes us special and all of us here commit to a future for Tai Sophia that is based on its values-driven foundation, its self-care, and transformational philosophy.
“We are all deeply passionate about birthing and growing a health care model that uses the best of the allopathic approaches integrated with the ‘alternative’ or ‘complementary,’ both ancient and contemporary approaches for the benefit of delivering a personalized, natural, and optimal approach for the patient. We believe that it is possible to unite our ‘healing presence’ approach with both innovative approaches to higher education, research, scholarship, and service to create a unique university that is poised to develop future leaders who will be at the forefront of reforming the delivery of health care.”
Comment: It is challenging, in the words of my colleague Pamela Snider, ND, to “operationalize the vis” (the vis medicatrix naturae or the healing poswer of nature). Keeping a wellness focus is as much a challenge. Constant reminders, affirmations, may be useful. Are we on track? Good to have Broida speaking this commitment publicly for the Tai Sophia