April 2014 John Weeks Integrator Round-Up
April 14, 2014
by John Weeks, Publisher/Editor of The Integrator Blog News & Reports VA's integrative pain initiative shows early positives in limiting opioid dependency The US Veteran's Administration recently sent a media release announcing that VA Initiative Shows Early Promise in Reducing Use of Opioids for Chronic Pain. The article notes that the comprehensive initiative includes "an emphasis on patient education, close patient monitoring with frequent feedback and Complementary and Alternative Medicine practices like acupuncture." Robert Petzel, VA’s Under Secretary for Health is quoted: “The Opioid Safety Initiative is an example of VHA’s personalized, proactive and patient-centered approach to health care. We are also using a full-range of support treatments for Veterans, including Complementary and Alternative Medicine. We are delivering health care with the patient’s long-term personal health goals at the forefront.” by John Weeks, Publisher/Editor of The Integrator Blog News & Reports Policy Organizations Integrative Centers Academia Professions Resources Miscellaneous People Policy VA's integrative pain initiative shows early positives in limiting opioid dependency The US Veteran's Administration recently sent a media release announcing that VA Initiative Shows Early Promise in Reducing Use of Opioids for Chronic Pain. The article notes that the comprehensive initiative includes "an emphasis on patient education, close patient monitoring with frequent feedback and Complementary and Alternative Medicine practices like acupuncture." Robert Petzel, VA’s Under Secretary for Health is quoted: “The Opioid Safety Initiative is an example of VHA’s personalized, proactive and patient-centered approach to health care. We are also using a full-range of support treatments for Veterans, including Complementary and Alternative Medicine. We are delivering health care with the patient’s long-term personal health goals at the forefront.” The program includes a pain monitoring app. Comment: This is evidence that, as integrative health policy leader Janet Kahn, PhD has suggested, the military may be the change agent for patient-centered policy on integrative health and medicine even as the AIDS activists changed FDA approval timelines to better reflect the interests of the individuals the agency is to serve. (Thanks to Jud Richland, MPH for the heads-up on this story.) Is a major threat to integrative medicine practice rolling south and west from Nova Scotia's medical board? Chris Foley, MD, a long-time leader of both health system-based and community-based integrative centers sent an alert about a new Policy and Guidelines on Complementary and Alternative Therapies. The paper was issued by the Council of College of Physicians and Surgeons of Nova Scotia. The 3-page guideline requires "ethical physicians" to:
- Carry out appropriate and conventional examinations and investigations in order to establish a diagnosis and basis for treatment;
- Prescribe or recommend an effective and proven therapy not delayed or supplanted by the choice of a complementary or alternative treatment;
- Not expose patients to any undue risk from a complementary or alternative therapy; Not misrepresent the safety or efficacy of any therapy or procedure, whether conventional or unconventional;
- Not exploit the emotions, vulnerability, or finances of patients for personal gain or gratification;
- Respect the autonomy of patients in choosing from available treatment options.
Kahn/IHPC report-Chesney: I think the presentations built well. I was the set-up person, using material from the IOM Report "Shorter Lives, Poorer Health" to identify what the crisis is; distinguish between the contributions of prevention and those of health promotion/health creation; also the needed synergy between integrative health care and integrative health policy. Margaret Chesney, PhD, chair of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and integrative medicine leader at UCSF Osher Center, explained IM/IHC and used heart disease exquisitely to illustrate the problem, and the difference between usual care and integrative care. She illustrated the growth of IM/IHC through the increase from 8 to 57 centers in CAHCIM between 1999 and today; and the comparable growth in number of hospitals offering integrative healthcare services. She offered good cost data, including Ornish's work on both heart disease and prostate cancer - the latter showing telomere growth which is hugely important. The Kahn/IHPC report continues-Baechler: "Courtney Baechler, MD, MS, a cardiologist, and Chief Wellness Officer & Vice President, Penny George Institute for Health and Healing, Allina Health, presented on Allina's growth from 2003-present. She gave the audience a good picture of the size and complexity of the Allina system; the decision to move from a single site - the Penny George Institute of Health and Healing - to ultimately seeking to integrate all 13 hospitals. The range of things Allina is doing - in-patient and outpatient, community-based programs, etc. is impressive - as is their data. Across these presentations people saw examples of IM/IHC in relation to chronic pain, heart disease, cancer, spinal fusion, and more. And the problem identified in the first presentation - that the US has been getting a horrible return on investment when it comes to health care $$ spent, was well-answered with a look at Allina's and Ornish's cost data. Kahn/IHPC report concludes - Wisneski: Finally Len Wisneski, MD, IHPC's chair and faculty member at Georgetown University, George Washington University and University of Colorado, capped the presentations by focusing on the common sense of IHC, the importance of 2706 and use of the full healthcare workforce, importance of supporting the two active bills bringing IHC into the VA and DOD, and on IMPriME and the importance of training physicians for these times and this kind of team work, especially knowing when to refer to other kinds of providers."Comment: Kudos to the Integrative Healthcare Policy Consortium for the time, energy and expense of organizing this meeting, and to the contributions of Chesney and Baechler and their respective organizations. For all the talk of health reform and "transforming" the medical industry toward health, very few in this community ever set foot in the nation's Capitol where the lever's get pulled that make new directions possible. Who knows which staffer in IHPC’s briefing room might add just the right language in a bill? Notably, Kahn reports that she and Wisneski also pointed out to the staffers that as federal employees, they may be among the first Americans to benefit from Section 2706, as Blue Cross Blue Shield included in their pamphlet to federal employee plan participants that "we now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA)." Doctors of chiropractic and naturopathic medicine on National Quality Forum The quasi-governmental National Quality Forum has a good deal of clout in the emergence of the new system for medicine. The organization sets standards by which quality will be measured, and compared, between plans and systems. The American Association of Naturopathic Physicians recently chose to join the NQF and, according to CEO Jud Richland, MPH, “successfully nominated Christian Dodge, ND, to serve on the Musculoskeletal Measures Standing Committee.” (To a query, Richland noted that there is also a chiropractor on the committee, John Ventura, DC, via NQF member the American Chiropractic Association.) Richland notes that the AANP has another nomination in for a second committee. “Our goal in joining NQF is obviously to influence the health system to place greater emphasis on whole person care and integrative medicine,” explains Richland, adding: “We know that what gets measured gets done, and NQF is the most influential organization in determining what gets measured.” Richland states that the AANP “certainly anticipates placing AANP members on a number of the measure development committees in the future.” Comment: Inside the Academic Consortium for Complementary and Alternative Health Care, with which I work, we talk about the value in placing key representatives “of the values, practices and disciplines associated with integrative health and medicine” in every important healthcare dialogue. Kudos go to the AANP, and to the ACA, for having the foresight to be involved in this significant process. back to top Organizations American Academy of Pain Management calls on insurers to cover integrative approaches as part of multidisciplinary, team approach to chronic pain American Academy of Pain Medicine has issued a release entitled Pain Physicians Say Insurance Coverage Falls Short. The media notice followed passage of a position paper entitled Minimum Insurance Benefits for Patients with Chronic Pain at the organization's 2014 annual meeting. The paper "called on insurance payers to provide adequate coverage for interdisciplinary pain care, including physical therapy, massage, yoga, acupuncture and other alternative therapies." The perspective lambastes a reductive approach to coverage that increases opioid dependency: “Patients with persistent, ongoing pain experience endemic barriers to care, many related to non-existent or insufficient insurance coverage and reimbursement for evidence and consensus based therapies. The result is a reductionist approach to pain management whereby the default treatments are prescription (often opioids) and procedural." Here is the key statement: "In all tiers of the healthcare system, from the uninsured to those on public and private plans, coverage is needed for comprehensive, interdisciplinary modalities of treatment like CBT [cognitive behavioral therapy], physical therapy, stress management, rehabilitation, complimentary [sic] and integrative therapies (CIM) and alternative therapies and medications that are known to be effective and safer than usual care. At minimum, all payers should provide three months coverage for an interdisciplinary integrative pain evaluation and treatment program for people with pain that is severe enough to warrant ongoing therapy that has failed or is not expected to respond to first-line therapies and that is not expected to resolve in the foreseeable future." Comment: The fit of this call for reimbursement change with the findings from the early VA work to limit dependence on opioids could not be better. Notably - and unfortunately - the paper does not specifically address the benefits that could flow from a broad interpretation of the Non-Discrimination in Health Care provision, Section 2706, of the Affordable Care Act. (See Sections on CAM and Integrative Health in the Affordable Care Act-HR 3590.) American Academy of Neurology issues guidelines for CAM and multiple sclerosis - cannabis high on list The American Academy of Neurology has issued a guideline on "CAM" and multiple sclerosis in which only cannabis is high enough on the team's scale to merit a recommendation. The March 24, 2014 release was entitled "Guideline: Medical Marijuana in Pill Form or Oral Spray May Ease Some MS Symptoms; Little Evidence Other Complementary or Alternative Therapies Work." An AAN Patient Summary notes "weak evidence" that supports use of Gingko Biloba, reflexology and magnetic therapy. This AAN page guides one to evidence and conclusions. The AAN has engaged a significant outreach effort to promote its new guideline. IN-CAM Research Network announces 10th Anniversary Research Symposium: The Next Wave The theme of the 2014 IN-CAM Research Symposium is "The Next Wave of Complementary & Integrative Medicine Research." The meeting will take place Nov 6-8, 2014 in Calgary, Alberta. Keynote talks will be offered by Dr. Rogers Prize-winner Sunita Vohra, MD, Georgetown-based IM-educator, Aviad Haramati, PhD, Rand Corporation cost-effectiveness expert Patricia Herman, PhD, ND, and University of Saskatchewan complementary medicine research leader Michael Epstein, PhD. Abstract submission deadline is June 30, 2014. IN-CAM's current acting director is Ania Kania-Richmond. Comment: This Canadian network has done exceptional work in its decade of existence. We have nothing like it in the United States. The organization's co-founders and co-advisors Heather Boon, PharmD, and Marja Verhoef, PhD are international leaders in highlighting the need to expand our abilities and capacity to research whole practices and whole systems. One sample: Boon is among those on a panel that will be a "soap-box" on research methods at the International Research Congress on Integrative Medicine and Health. The IN-CAM Outcomes Database is a gift to all interested in coming to understand the value of these practices and disciplines in the real world. An early congrats on 10 years! Massage Therapy Foundation engages research project with Samueli Institute The Massage Therapy Foundation (MTF) has selected the Samueli Institute to lead an exploration of the impact of massage therapy on chronic pain, and "to identify gaps in knowledge that can help direct future research" according to this release. To begin the work, the two organizations convened a round table discussion with leaders and subject matter experts in both massage and pain management in February 2014. The goal was to formulate a clear research question, namely: "What is the state of the science regarding the impact of massage therapy on function for those experiencing pain?" The project will also "develop criteria that will be beneficial for use in future research articles for integrative medicine." The project is funded by the Massage Therapy Foundation with the ongoing support of the American Massage Therapy Association. American Public Health Association's "CAM" group changes name The co-director of the special interest group concerned with "CAM" within the American Public Health Association (APHA), Beth Sommers, LAc, PhD, has shared with the Integrator that the group, which has been called the Alternative and Complementary Health Practices group since being formed in 1994 has "officially changed our name." The change came through a vote among members. The winner: "Integrative, Complementary and Traditional Health Practices." States Sommers: "It's a mouthful, but our name expressed the comprehensive and global reach of our work. We use the term ‘health practices' to signify the importance of self-care and self-help strategies as well the use of practitioner-based interventions." Comment: In the move for "good medicine" - that is inclusive, respectful, and multidisciplinary our language must be continually re-adjusted. This looks an enduring handle. AHA, hospital transformation and leadership from the CEO of Hospital Corporation of America: health creation? The cover story in the American Hospital Association's Hospitals and Health Networks flagship magazine showed Jonathan Perlin, PhD, MD, CEO of Hospital Corporation of America (HCA) in pin-stripe suit, maroon power tie against a silvery-glass backdrop that evokes the fine interiors of high end hospitals. The title: "Toward a Healthier Tomorrow." Perlin, the chair-elect for the organization is characterized as welcoming "a powerful, positive, transformation of health care in America." Inside the feature, a subsection is entitled “From Sick Care to Health Care." Perlin speaks of how hospitals "have been honed to focus on sick care," adding: "It is a tough transition, but we have to learn how to move from sick care to health care." Then: “I'm not sure that any of us - big system; small, rural hospital; academic health center; government; or private sector - fully understands or knows the recipe." He believes the AHA can be a powerful convener for making the change. Comment: First, it is a good thing that hospital leaders are distinguishing the two types of care. The humility - "I am not sure any of us fully understands or knows the recipe" - echoes the perspective of Don Berwick, MD when he called recently for a move toward "health creation" as the focus of the industry. Perrin's bio is intriguing, pairing leadership of the for-profit behemoth HCA with a leading role in the Veteran's Administration’s transformation during the heyday of its early reform under the visionary leadership of Kenneth Kizer, MD. Notably, the same issue of H&HN included a feature on the money saving value in better linking medicine to mental health care (Mind+Matter=Health Care's New Math). These are birth tremors. The truly tough thing for hospitals is that we need to shrink them, in favor of outpatient models. Can Perlin and the AHA lead that? Still, this move away from merely “sick care” is an opportunity for leadership from integrative health and medicine. back to top Integrative Centers From Google Alerts: links to integrative medicine in health systems and communities -March 2014 This typically monthly Integrator feature reflects a quick capture of highlights from the multitude for links that flow in daily via Google Alerts for "integrative medicine," "complementary and alternative medicine" and "alternative medicine." While my focus is on integrative medicine in health systems, the later search term nets developments from around the world that I began to share for November 2013. Here are 15 selections related to hospitals and medical organization in integrative medicine and 8 from the community, for March 2013. Chiropractor on integrative practice at the Casey Health Institute's patient-centered medical home The headline in the Dynamic Chiropractic article is Collaboration for a Cause: Blurring disciplinary lines to benefit the patient: the new model of truly integrative health care. The article is by Sarah Potthoff, DC, the first chiropractor in the ambitious Casey Health Institute, founded in Gaithersburg, Maryland, in 2013. CHI has, besides primary care medical doctors, practitioners of chiropractic, psychology, acupuncture, naturopathic medicine, massage therapy, yoga, meditation, and Reiki “to achieve their vision of truly integrative health care,” as Potthoff writes. She describes how collaboration is fostered at CHI, offers three case studies of interprofessional collaboration, and then gives some guidance to her chiropractic colleagues on qualities that will help them get involved in integrated environments. Comment: This is a great little insider's view of a rare but emerging environment of an integrative patient-centered medical home. Notably for the chiropractic field, the most "preferred future" in a recent study of the field by the Institute for Alternative Futures, Chiropractic 2025: - Institute for Alternative Futures, is one in which a growing percentage of chiropractors are pro-actively part of PCMH and integrated care teams. Attorney Michael Cohen offers insights into "fee-splitting" business strategies in integrative centers Michael Cohen, has published a useful article entitled "Fee-splitting 101 for Medical Doctors, Chiropractors, Acupuncturists and Others." The topic regards the common practice in integrative environments of offering new practitioners a cut or split of any new revenues he or she generates as a portion, or all, of their compensation package. In his thorough accounting, Cohen notes, among other things, that "kickbacks and fee-splitting are related." He clarifies: "A 'kickback' involves the payment to or from a physician in exchange for a referral, while 'fee-splitting' involves splitting the physician's fee to the patient between the physician and a third-party." The posting is particularly valuable with the 7 links to related Cohen posts. Comment: Michael Cohen, formerly at the Harvard Osher Center, is a practitioner and thought leader in the field, as well as an attorney. If you are engaged in such business practices, especially in California, grab a read! Guarneri's Pacific Pearl La Jolla officially opens May 10 with top naturopathic doctors in key clinical roles The website for Pacific Pearl La Jolla greets one with "Guarneri Integrative Health Inc", after clinic founder and former interventional cardiologist Mimi Guarneri, MD. Pacific Pearl features a multidisciplinary team including two other medical doctors, two chiropractors, a massage therapist, and three naturopathic physicians who were formerly leading the Bastyr San Diego campus: Moira Fitzpatrick, PhD, ND, Erica Oberg, ND, MPH and Ryan Bradley, ND, MPH. Guarneri, who founded the Scripps Center for Integrative Medicine, where she worked for 15 years, also serves, according to her bio, as the founder and director of the Taylor Academy for Integrative Medicine and Research. The official opening is May 10, 2014. back to top Academia UCLArts and Healing advances leadership in the creative arts/health connection with series of grants and strategic collaborations An organization under the umbrella of the integrative medicine consortia at UCLA, UCLArts & Healing, has recently announced a series of initiatives propelling its work in multiple directions:
- A grant from the Boone Foundation to develop a training program for delivery of "Dance for All", a therapeutic movement and yoga-based program for adolescents and adults with developmental disabilities.
- Completion of the organization's first UCLA undergraduate course on 'Maximizing the Social and Emotional Benefits of Arts Education' (Art&Arc 101, here) through the Visual and Performing Arts Education program within the UCLA School of the Arts and Architecture.
- Kaiser Permanente Educational Theatre, which serves the entire Southern CA region, is offering a workshop of UCLArts & Healing's nationally known program, Beat the Odds: Social and Emotional Skill Building Delivered in a Framework of rumming,to follow their assembly entitled, "Drummin' Up Peace," on conflict management.
- A local municipal connection is applying for a State of California Department of Education grant to bring various UCLArts & Healing programs to youth and families in its new comprehensive health and resource center for underserved populations.
- An active collaboration with the Jewish Family Service in which the agency sets up the UCLArts & Healing program and offers it in another part of Los Angeles, with the JFS covering all costs.