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Organizational Action at a Glance: AAOM, Bravewell, CAHCIM, IHPC, ACCAHC, AANP, AMTA ... PDF Print E-mail
Written by John Weeks   

Organizational Action at a Glance: AAOM, Bravewell, CAHCIM, ACCAHC, ACA, AANP, AMTA, plus ...

Summary: "Integration" is enhanced by awareness of the priorities of the "other" with which one is, or may be, involved. This irregular Integrator feature is a look at strategic actions of some leading organizations with a stake in creating a better integrated healthcare system.

Issue #2 of the Integrator included an article on the Defacto CAM-IM Federal Agenda. The article explored the federal initiatives of diverse groups involved in advancing integrated care. This article looks more broadly at current priorities of organizations which represent significant stakeholders in the healthcare integration effort.

American Association of Oriental Medicine (AAOM) and AOM Alliance

Image Under the leadership of president Will Morris, LAc, DAOM, MEd, and executive director Rebekah Christensen, the AAOM is showing significant new energy and comfort in reaching out and collaborating with other organizations. AAOM, which is promoting an exploration of a plan to shift the basic AOM education toward an entry-level doctorate, recently joined the Coalition for Patient Rights (CPR) and is establishing a partnership of national and state AOM organizations to coordinate their activity relative to the AMA's Scope of Practice Partnership (AMA SOPP). Morris, who is also the president of the Academy of Oriental Medicine of Austin AOMA), has also recently, as both an AOMA an AAOM representative, begun participating in the multi-disciplinary National Education Dialogue to Advance Integrated Healthcare. and has supported a multi-disciplinary exploration of competencies based on the Pew Commission work.

ImageMeantime, Michael McCoy recently stepped down as the executive director of the AOM Alliance. This acupuncture organization, which has worked to represent the entire acupuncture community - from acu-detox technicians to LAcs to MD-acupuncturists - appears to be in a re-thinking phase under the direction of president Leslie McGee, LAc.

Comment: The AAOM's move to connect with other organizations appears to be strongly supported by its constituency, if a recent poll in Acupuncture Today is to be believed. The poll asked readers the following:
"How important is it to network with other alternative health care providers, including chiropractors, massage therapists and naturopathic doctors?" Of 205 respondents as of October 8, 2006, 73% (150) marked "very important," 14% (28) "somewhat important", and another 5% (10) "important". Only 8% thought such action was not important.

Interesting that AOM respondents to the poll - who a colleague has dubbed the "Hobbits of integration" for their strong tendency to stay inside their own language and culture - should so strongly endorse networking with others.


Bravewell Collaborative

Image The Bravewell Collaborative, a national organization of philanthropists in integrative medicine, announced in its October 2006 newsletter that its third Bravewell awards night, November 8, 2007, will honor what it calls "The Pioneers" in the field: Larry Dossey, MD, James Gordon, MD, Jon Kabat-Zinn, PhD, Rachel Remen, MD and Andrew Weil, MD. The newsletter also noted that the set of academic health center-affiliated clinics Bravewell has explored to gain information on best practices, has now been organized as the Bravewell Clinical Network, a practice-based research network (PBRN). Brian Berman, MD, the 2005 Bravewell awardee, will direct this network. The PBRN's creation should allow them to apply for a recently announced NIH National Center for Complementary and Alternative Medicine health services research program which will be awarded only to existing primary care networks. Bravewell also notes that its The New Medicine television special which was first aired last spring will be a part of a PBS series to begin this fall called "The Remaking of American Medicine."

Comment
Kabat-Zinn's "PhD" marks a breakthrough of a non-medical doctor into Bravewell's mono-focus on the MD part of the integration mix. I believe that the Bravewell's work is fundamentally good, but the organization's strategic decision to focus on MDs, which reinforces the MD perception of sole ownership of health care, sends an unfortunate, reductive, Pavlovian message which reinforces medicine's imbalance. The "Pioneers" who produced this movement, who are leading it now, and who the consumer seeks for care, are a very diverse lot. 

Consortium of Academic Health Centers for Integrative Medicine (CAHCIM)

Image This US-Canada Consortium has added four members to its ranks to now reach a total of 36 institutional members. The new centers are associated with the University of Colorado, Yale University, University of Vermont and Stanford University. To be a member, the institution must both have integrative activity in at least two of the three basic areas of academic focus - education, clinical, research - and support at the Dean's level, or above. Funded principally by Bravewell during its first five years, CAHCIM is presently engaged in a drive for $2500 dues from each member school. The Integrator was told by its co-chair for its Education Working Group, Vic Sierpina, MD, an Integrator advisor, that the schools are ante-ing in. CAHCIM chair Susan Folkman, PhD, adds that "members are indeed stepping up to fulfill their obligation."

Folkman also told the Integrator that CAHCIM has made a proposal to the Bravewell Collaborative "for continued support of the Consortium’s infrastructure." CAHCIM has been one of Bravewell's strategic investments. She adds: "We are grateful for Bravewell’s support of our infrastructure over the first five years, and we are hopeful that their valuable support will continue in the coming years." 

Comment:
Congrats to CAHCIM, presently led by chair Susan Folkman, PhD, and vice chair Mary Jo Kreitzer, PhD, RN, for their successful move to dues support and the respect that underlies these contributions.

A little side-note, regarding non-MDs and CAHCIM. The one non-MD who will be acknowledged by Bravewell as an integrative medicine pioneer in 2007, Kabat-Zinn, happens to have been the fellow who provided the seminal, academic energy, from his University of Massachusetts base, to begin organizing CAHCIM. Both Folkman and Kreitzer are non-MDs, as was CAHCIM's founding vice chair, Adi Haramati, PhD. Only the founding chair, Berman, was an MD among this quintuplet of "pioneering" leaders of this MD-focused organization. Theories, anyone?


Academic Consortium for Complementary and Alternative Health Care (ACCAHC)

ACCAHC, a younger consortium, founded in 2004 through the Integrated Health Care Policy Consortium (IHPC) as part of the National Education Dialogue process, and through a grant from Lucy Gonda, is also moving into a dues-based budgeting process. Under the leadership of Reed Phillips, PhD, DC, chair, and Pamela Snider, ND, executive director, ACCAHC is in the process of moving from a project of the IHPC to becoming a separate
Image
Reed Phillips, PhD, DC, ACCAHC chair
501c3 organization by 2008. (ACCAHC intends to continue have a partner relationship with IHPC, a 501c4 organization, particularly on policy issues.)  ACCAHC is showing positive initial signs of generating dues support from the core set of associations of colleges, accrediting agencies and certifying bodies from the distinctly licensed CAM professions which represent the organization's base. The dues structure is $1000 to $5000, depending on the budget of the organization. ACCAHC also recently gained approval from all its members to join the Coalition for Patient Rights, to counter the AMA SOPP.

Comment: Snider's dedication - largely volunteer this year - has been filling the shortfall in core ACCAHC funding that opened when Gonda chose to end not just her ACCAHC support but her foundation activity. A strong executive team are working on projects and organizational development. Anybody know a philanthropist or two with the vision to see the value of having not just MD-IM educators linked but also educators in the CAM professions?, How about having both sets routinely linked together, gaining better understanding of each other, bettering their education and research capacity, and offering a more organized voice in the integration process? Write to and I'll steer you to Snider and Phillips.

American Chiropractic Association (ACA)

Image The ACA's ongoing campaign to gain deeper integration into healthcare benefits of military personnel gained another foothold late last month. A provision in HR 5122, the National Defense Authorization Act for FY 2007, requires a study, due March 2008, "on providing chiropractic care to all members and former members of the Armed Forces, their families and reservists." The ACA release also notes that a gain last year, in which Congress directed the Air Force to place a doctor of chiropractic in 11 new bases, has not yet been acted upon. Chiropractic care is presently available in 42 medical facilities in the military health system.

The ACA has turned to its grassroots network on a series of moves related to Medicare payments which, if not changed, will cut fees by 13.1%. Of these, 5.1% represents a cut to all Medicare providers under a complex Sustainable Growth Rate (SGR) formula. The other 8% is an adjustment due to a five-year review of the Relative Value Units (RVUs) which govern Medicare payments. Because the system is "budget neutral," a decision (71 Fed. Reg. 37170) to increase payments to primary care providers means that, according to an ACA notice, "doctors of chiropractic, many allied health professionals, and some medical doctors will see dramatic decreases" in Medicare payments. The ACA is working with "the rest of the Medicare provider community" to support two members of Congress who are trying to find Congressional funding on the SGR shortfall. 
On the RVU-based shift, the ACA's protective strategy is for a one-year delay and a study.

Comment:  Chiropractic's limbo position in the integration dialogue is nowhere more evident than their smart and aggressive political work. In one moment, they are members of the "Medicare provider community." At the same time, they are allied with other allied health as founding members of the Coalition for Patient Rights, oppositing the AMA SOPP. Meantime, they are providing, through their academic arm, the Association of Chiropractic Colleges, significant leadership in ACCAHC. Beyond skilled, opportunistic partnerships, this neither in nor out status remains a part of the profession's self-identity challenge.



American Association of Naturopathic Physicians (AANP)

ImageThe AANP, representing graduates of programs that are represented by the Association of Accredited Naturopathic Medical Colleges, has continuously faced challenges from individuals who call themselves "naturopathic doctors" but whose education is typically mail-order and whose "certification" is from an organization that has not, historically, required testing. (Pay a fee, get a big certificate to hang on your wall and some initials behind your name.) In a recent AANP E-News, the AANP noted that problems related to this otehr set of individuals are requiring the AANP to take action against two of the organization's former state associations. The affiliation of the Missouri Association of Naturopathic Physicians was suspended when the group promoted licensing did not require candidates to be graduates of programs accredited by an agency recognized by the US Department of Education. A suspension of bylaws and an overthrow of the leadership of the Idaho Association of Naturopathic Physicians by individuals who do not meet the AANP standard has also led to a suspension of that association's affiliation. The AANP and its associates are working with Idaho officials to assure that individuals who do not meet federally-recognized standards are not covertly granted licenses.

Meantime, faced with the AMA's June 2006 Resolution to seek to stop licensing of naturopathic doctors as a field of medicine - part of the AMA SOPP - the AANP has joined the Coalition for Patient Rights.

Comment: The Stealer's Wheel song, "Stuck in the Middle with You" may well be the theme song for the AANP. Remember the lyric:

Clowns to the left of me,

Jokers to the right, here I am,

Stuck in the middle with you.


Only nobody is joking. The context is this: the AANP is pushing for licensing in 50 states - up from the present 14. Individuals and businesses associated with those who do not meet the federally-recognized standard for ND education have, as a best estimate, spent hundreds of thousands of dollars to stop the expansion of licensing. Why? So they and their business clients can keep on hanging up their "naturopathic doctor" shingles without meeting any sort of decent standard. So they are, effectively, in collaboration, if not collusion - there is speculation but no proof on this count - with the AMA's SOPP goals.

(Personally, were I charged with running the AMA SOPP's campaign against ND licensing, I'd definitely be meeting with this other group which shared my goals. Strange bedfellows, indeed. The AMA, claiming it is trying to protect the public from the harm from "licensed naturopathic physicians" fosters a situation in which mail-order degreed individuals present themselves to the public as "naturopathic doctors.")

Adding insult to these injuries, the AANP is not always finding friends where you would think they would be. For instance, a brief scan this last week showed at least two websites of conventional Consortium (CAHCIM) programs empowering the poorly-educated clowns in this scenario. One CAHCIM program allowed a clinical faculty member, who is also an acupuncturist, to wear the "ND" despite his never having met the standard of the AANP-represented NDs who are participating in the integration dialogue, seeking and receiving NIH grants, and etc. Another CAHCIM center advertises the national meeting of these mail-ordered "doctors."

Here is a simple request to integration's MD and other CAM associates who have set and met standards in their own fields: Credential any 'ND" that walks through your door. Or do you think that a person should be calling his or her self a "naturopathic doctor" without meeting the nation's accepted standard? Better put: Do unto others as you would have them do unto you.

American Massage Therapy Association (AMTA)

ImageThe AMTA anticipates 1200 members and 100 exhibitors at its national meeting which is to be held October 11-14 in Atlanta. For the first time, this year, the conference will also host the AMTA Council of Schools Teachers Conference. AMTA, which has conducted an annual consumer survey on massage use for a half-dozen years will shortly release its 2006 version, in conjunction with its National Massage Therapy Awareness Week, October 22-28. The organization's national policy efforts continue to be through the Integrated Healthcare Policy Consortium, and ACCAHC, each of which have received important, formative support from the organization.

Additional Note: The Integrator will shortly run a feature on the Integrated Healthcare Policy Consortium, a five-year-old effort which continues to emerge, under the leadership of Sheila Quinn, board chair, and Janet Kahn, PhD, executive director, as a significant, uniting voice for the disparate players in the integrated healthcare world.

Disclosure notes: I serve in the volunteer leadership of both IHPC and ACCAHC and, until December 2006, as the founding director of NED. (The latter has been in a largely unpaid capacity this year.) In addition, some of my best friends and closest colleagues are in the leadership of most of the rest of these organizations. Finally, my work from 1983-1993 to help set standards in the naturopathic profession still energizes my commentary on their regulatory issues.

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