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(Another Kind of) Integration in Georgia - Yoga, TCM, Mindfulness Plus at Athens Regional Medical PDF Print E-mail
Written by John Weeks   

(Another Kind of) Integration in Georgia - Yoga, Mindfulness, TCM and Functional Medicine at Athens Regional Medical Center

Summary: Richard Panico, MD, contacted the Integrator in response to a call for information on Yoga therapy in mainstream health systems. The interview which followed, about Panico's work in Georgia's Athens Regional Medical Center, revealed that this southern health system is quietly including an array of complementary and integrative approaches, including functional medicine, Yoga therapy, mindfulness, and acupuncture and Oriental medicine. Growth is stepwise, with services reaching over 2000 individuals in the second quarter of 2006. This article is partly backed by an Integrator sponsorship from the International Association of Yoga Therapists on the Future of Yoga Therapy.

Richard Panico, MD, ARMC MBI leader and long-time Yoga practitioner and teacher
The steps toward building an integrative medicine program at Athens Regional Medical Center (ARMC) in northeastern Georgia follow the book - as much as there can be said to be a by-the-book strategy for integrative medicine business development. Especially in the southern portion of the United States, never a hot-bed for integrated health care.

The game plan went like this First, find a respected medical leader with an interest in complementary and integrative medicine. Richard Panico, MD,
filled the bill. Before taking on the Athens job, Panico, a psychiatrist by training, had been a medical director of a large Georgia health system. He had a Yoga practice that dates back to 1968, and an interest in integrated care that would lead to training in through the Institute for Functional Medicine founded by Jeffery Bland, PhD.

Services at the ARMC
Mind Body Institute

Clinical Services

Functional medicine
("Health evaluations")
Massage Therapy
Mindfulness Meditation
(Mind Body Stress Reduction)
Healing Touch

Community Programs

Programs for Health
(Bridges to Health)
Meditation Group

As he began his work, Panico respected the importance of relationships: "I spent the first two years doing politics." This included formal feasibility work with what Panico considered the principal stakeholders -  physicians, other health care providers, and consumers. Working with the University of Gerogia Department of Health Promotions and Behavior, Panico's group mailed over 13,000 questionnaires. His team held a half-dozen focus groups.

The consumer interest was there. But would area physicians support the concept? Panico
developed a physician advisory board. He included members who were not complementary medicine advocates.
Of the 400 medical doctors in the system, Panico estimates that "85% were solidly behind us doing something - as long as it was evidence-based and physician-run." He adds: "Our CEO was an MPH from Yale who understood the concept of health. He gave us space, rent, utilities and staff with the expectation that we would need to break even in three years." (More on this, in a moment.)

A Mind-Body Spin-off of MBSR Programs

Interestingly, the integrative operation - with a wide array of services - has moved ahead as a Mind-Body Institute, rather than as an "integrative medicine clinic". The evidence-base for mind-body supported this approach, according to Panico. He specifically notes the contribution of the meta-analysis produced by John Astin, PhD and others, in 2003
Imagewhich showed the value of mind-body medicine for an array of conditions, including depression, reduction of pain, emotional functioning and limiting fatigue.

However, Panico discovered that neither the eight week cycle or the $250 price point of the typical Mind Body Stress Reduction (MBSR) program worked with Athens' "university town, stable but low-ball economy." Panico developed a six week program at roughly half the cost which he calls Bridges to Health which has proved to fit the population better.

An Expansive View of Yoga as a Core Service

The International Association of Yoga Therapists (IAYT) is a sponsor of an Integrator series on the Future of Yoga Therapy. This article began as a part of that series.
Panico's passion for the value of Yoga therapy has led to a "whole spectrum" of uses. Individuals with mobility problems receive chair Yoga. A "gentle Yoga" class is another alternative. He ticks off the kinds of health problems Yoga has served: "Strokes, severe fibromyalgia, severe fatigue states, cardio vascular problems ..." 

Given the diversity of health conditions with which ARMC's Yoga teachers and therapists work, Panico developed a two-level process for selection. First, he required that they all be Registered Yoga Teachers (RYT) through the Yoga Alliance. Interested therapists then needed to "first take classes (at Athens Regional), then instruct here, so we could watch them teach." The teachers selected are key: "Our best teachers keep 95% to 100% of those who sign up and the worst have a 45% drop-out rate."

Outcomes have remained key to building the programs inside the system. The Athens team has twice given poster sessions at the annual conference of the American Public Health Association and at the annual research conference of the Center for Mindfulness. A report has been accepted October 2006 issue of the International Journal of Yoga Therapy, the publication of the International Association of Yoga Therapists.
The internal studies use various publicly-available measuring tools (Beck depression scale, Beck Anxiety Scale, the Rand 36, a public domain version of the SF-36, Freiberg Mindfulness Inventory, others). 

Panico notes that results are limited as outcomes research ("we have no controls") but that they are valuable "in reassuring patients and reassuring physicians who refer to us." He summarizes: "We are (to this point) delivering these programs to a relatively homogenous population. The outcomes are impressive for those who complete our programs."


"We are delivering
these programs to a
relatively homogenous
population of

"The outcomes are
impressive for those
who complete."

- Richard Panico, MD

The structure of the service delivery for Yoga is based on everyone first taking a basic class at their level. (These are therapeutic, gentle, or level 1 at Athens Regional.) "Everyone who completes a six-week introductory class," says Panico, "can then buy a punchcard for an additional six or twelve classes." The cost is $60 for each six week session.  Participants can then take classes as they choose at their level of practice.

Other Departments Come Knocking

As news of the program spread, both through formal outcomes and word of mouth, various departments began to approach the Mind Body Institute to explore better integration of services. Examples are the ARMC physical therapy department and the pulmonary, diabetes and cardio-vascular rehabilitation programs. Panico notes that physical therapists (PTs) initially had "huge issues" with Yoga therapy. He and his group responded by doing Yoga in-services with the physical therapy department. Interest built and PTs "have become our biggest fans."

How about psychologists - did they see any threat to the mind-portion of traditional Yoga's mind-body work, or from the multi-week mindfulness programs? Panico estimates that 1/3 of the area psychologists "refer to us pretty regularly." He thoughtfully approaches
Laura Simpson, ARMC massage therapist
the program's positioning: "I talk about being an adjunct to their clinical practices. I say 'watch your practice grow.'" He adds: "I have gone to great pains to be a servant to all the practitioners."

New Serices, Philanthropy, Payment, Break-Even, and Next Steps

In time, Panico's own functional medicine practice has grown. In 2003, an acupuncturist, William Skelton, D.Ac, joined the MBI staff. His patient slots quickly filled.

The ARMC Mind Body Institute's diverse programs are now reaching 500-700 people per month - and topped 2000 people served in the second quarter of 2006. Revenues are growing, to $20,000-$30,000 a month, says Panico. Though a little behind the 3-year schedule for getting into the black asked by the system's CEO, says Panico, "we are sneaking up on break even."
William Skelton, ARMC's TCM provider

Thus far neither donations nor insurance have played a role in their business model. Panico notes that, the Mind Body Institute has found it "hard to have access to what's called the (ARMC) foundation."  However, he notes that the MBI has "the greenlight" to begin fundraising.

They decided early on to not participate in third-party payment. Says Panico: "We found out that early on that insurance was a nightmare. We couldn't fit into the categories and most things were contested. So we went to cash only." He reflects: "I think it is limiting who comes. (The Mind Body Institute) isn't available to everybody, and if it's not available to everybody, it's not the medicine of the future."

Ronnie Sutherlan, CHTP, Athens healing touch therapist
"I think (lack of
insurance) is limiting
who comes. (MBI) isn't
available to everybody.

"If it's not available
to everybody, it's not the
medicine of the future."

I asked Panico why chiropractic is not part of the MBI service offerings. His response showed the practical resignation commonly found in integrated care clinics based in conventional hospitals and health systems: "It's not been because I don't think it's valuable. It's that in the medical community it would have been controversial and might have derailed the whole thing." There are signs of a thaw, but Panico thinks the potential chiropractic is not in the near term.

He lays out his clinical-economic strategy:
"My goal is to do really good clinical work. We need to get the place financially secure so we're off the radar. (ARMC) is a big center for providing indigent care. They're struggling to stay alive with their core responsibilities. When we're on solid footing (with the Mind Body Institute), we can shake the bushes again."

Panico laughs, aware of another history of integration, a few short decades ago: "I don't want anybody burning a caduceus on my front lawn."

Note:  This article is published without review from Dr. Panico, who is on a sabbatical. My apologies for any mistakes or misrepresentations.

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