Foundation for Chiropractic Progress publishes a white paper on chiropractors in patient centered medical homes The Foundation for Chiropractic Progress (F4CP) has jumped into a n emerging debate with a white paper entitled The Role of Chiropractic Care in the
The Foundation for Chiropractic Progress (F4CP) has jumped into a n emerging debate with a white paper entitled The Role of Chiropractic Care in the Patient Centered Medical Home (PCMH). F4CP considers the work a call for action. The authors of the 26-page report were a joint DC/MD team. They quickly focused on key clinical areas for collaboration: back pain, neck pain and headaches. (Notably, in the first 2 of these areas chiropractic ranked higher than conventional care in the recent Consumer Reports survey.) The white paper succinctly summarizes the considerable positive data for chiropractic. Cost effectiveness data developed through Integrator sponsor Alternative Medicine Integration Group is featured.
The authors underscore how the provider incentive fees in PCMH payment models suggest value in inclusion of chiropractors: “The inclusion of DCs in PCMHs represents an opportunity to transfer significant care components into the hands of a provider group with a unique focus and a unique skill set.” On the key issue of guidance of the PCMH, the authors generally accept the position that an MD or DO would lead the PCMH team. (They also offer ideas relative to primary care DC-led models in Appendix A. Places in statute and practice where chiropractors are considered primary care physicians noted.) The integrated Clinical Advisory Council to the white paper makes suggestions on appropriate care pathways.
Comment: Section 3502 of the Affordable Care Act notes the PCMHs “may” use “doctors of chiropractic, licensed complementary and alternative medicine practitioners.” Proactive work like this white paper will be required to turn the “may” into “will.” This F4CP project is an example for the other integrative practice disciplines.
The National Consortium for Credentialing Health & Wellness Coaches has published an update on the group’s progress. This comes roughly a year after a September 2010 health coach summit meeting in Massachusetts. The Consortium’s executive team, elected in May 2011, includes integrative medicine leaders Karen Lawson, MD (University of Minnesota) and Ruth Wolever, PhD (Duke Integrative Medicine). The others are Michael Burke, PhD (Mayo Clinic), Margaret Moore, MBA (Harvard Institute of Coaching) and Dick Cotton, MS (American College of Sports Medicine). The 12-page document reviews the action at the founding meeting and steps taken in committee work asnd by the executive since. Key tasks are developing a Job Task Analysis, developing training standards, identifying “structural options for certification” and raising money. The reports lists 73 Supporting Organizations. Other individuals and organizations are invited to participate.
“Sort of a ‘hat trick’ as they say in hockey.” Those words completed a brief note from John Kepner, MBA, executive director of the International Association of Toga Therapists (IAYT). I had congratulated him on the recent news that IAYT’s September 23-25, 2011 Symposium on Yoga Research, engaged with Kripalu Center for Yoga and Health, had received a $30,000 conference grant from the NIH National Center for Complementary and Alternative Medicine. Kepner and his team had reason to be jubilant. The past year saw long labor of the organization to step up into the healthcare scene score big 3 times. The first was acceptance of The International Journal of Yoga Therapists by PubMed. The second was the release of the Draft Proposed Education Standard for the Training of Yoga Therapists. The NCCAM grant completed the hat trick.
Comment: As over the past decade yoga seeped into a willing American culture like water finding parched ground, the IAYT has grown into it’s role as the field’s intellectual guide. This trio of accomplishments is not just a hat trick for the organization. These are markers on our culture’s path toward better health. Good for us!
How can one sort out conflicting findings from various surveys on practice methods, income and student loan debt for members of the acupuncture and Oriental medicine (AOM) discipline? Steven Stumpf, EdD and a team attempt to do this in the Summer 2011 issue of the American Acupuncturist, the official journal of the American Association of Acupuncture and Oriental Medicine.
Stumph’s group worked off 4 surveys. These were from: the Community Acupuncture Network (CAN), 12-month out graduates of an unnamed leader AOM school, a forum of Balance Method acupuncturists (BM-described as pain specialists) and the National Certification Commission for Acupuncture and Oriental Medicine. The authors describe the value of their project this way : “The independent surveys analyzed here demonstrate that interest exists in identifying certain factors that might influence economic success among distinct groups of acupuncturists.” Overall comparison of gross income (before expenses)found:
“The BM cohort had the highest monthly mean ($7,784) and median ($5,000) income figures among the three groups. CAN posted the next highest monthly mean ($6,236) and median ($4,796) income figures. The [recent graduate] cohort reported the lowest mean ($4,354) and median ($1,500) income figures, which might be expected given they have been in practice no more than 12 months. Sale of herbs and “other items” appears to contribute between 5% and 10% to revenue where asked. The average fee for BM and G09 cohorts was $63 and $53, respectively, and $21 for CAN.”
Key work pattern and patient visits behind these findings were:
- Visits “The numbers of patient visits ranged widely. The BM group averaged 179% more patient visits than the [recent graduate] group, but CAN saw 229% more patient visits than BM. The [recent graduate] cohort worked the least number of weekly hours. … The BM group had no more than approximately ten visits per week but reported the highest income and fees. The CAN group reported 70 visits per week, earning nearly the same income as the BM group, but had the lowest fees by far. The [recent graduate group] reported the lowest income and the fewest weekly visits, even with fees more than double those of CAN. The G09 group also held that the largest student loan debt adds a new factor to consider when creating a formula for success.”
- Debt “The [recent graduate] reported average student loan debt at graduation for that class was $88,545. The follow up survey data showed the median, or the point where half of the respondents fall, was $95,000 … The BM median student loan debt was $40,000 with reported average income of (roughly) $93,000 and median of $60,000. Student loan debt appears to have grown exponentially for new graduates.”
The authors opine that 30 hours may be the standard for “full time” practice among acupuncturists. They also posit that “it is plausible a bimodal distribution exists wherein a large contingent of LAcs earn [gross income of] less than $20,000 and wherein another sizable contingent earn between $40,000 and $60,000.”
Comment: The data comparison works favorably for the relatively young CAN movement. Mightn’t a new graduate think like this: “If I am going to be struggling with income, why not at least see more patients while I am doing so.” The CAN income numbers also look relatively good. Some follow-up questions: To the extent that there is a “bimodal distribution,” to what degree is the schism linked to years in practice? Are new graduates ascending into higher income? And where are dedicated CAN doctors after 5 years relative to those with more the typical one-to-three treatment room office set-up? Stumph is clearly carving a position as the workforce expert for the acupuncture and Oriental medicine profession. As such, he may be tapped by US government when this field is fully integrated into workforce planning as was mandated in Section 5101 of the Affordable Care Act.