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Integrative Medicine and Integrated Health Care Round-up: June 16-30, 2008 PDF Print E-mail
Written by John Weeks   

Integrative Medicine and Integrated Health Care Round-up: June 16-30, 2008

Summary: Kaiser Permanente models natural pharmacy in managed care ... American Acupuncture Council offers acu-coding book ... Successful Massage Envy franchise operation purchased by huge Indian conglomerate with strong wellness interest ... URAC developing accreditation standards for wellness programs - comment period now ... Details on the AMA's Scope of Practice Partnership campaign against expanding scopes of other disciplines: NDs and midwives taking heat ... Healthcare advisers for presidential campaigns have loose links to integrative practice movement .. IOM puts annual waste in US health care at over $1,000,000,000,000 (that's one trillion wasted, or a lot of what might have been fully-reimbursed integrative care) ... A few words about Penny Simkin, a quiet hero of empowering healthcare, plus more
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This is the 3rd of an ongoing "Round-up" feature in which I attempt to capture, in short notes, some of the top developments which took place in the previous 2 weeks (or which finally arrived on my desk for action). Readers are a good part of my news service. Send me good information. Robust developments, here.

Payment/Managed Care

herbs, managed care, management
Modeling herb and dietary supplement management for payers
Kaiser Northwest Permanente's Management of Herbs and Supplements

Integratiing Herbs and Supplements in Manged Care: A Pharmacy Perspective is an excellent resource on the subject, detailing "a comprehensive and systematic approach to managing and stocking herbal supplements that can serve as a model for other conventional and managed care organizations." The article, by
Charles Elder, MD, et al, recently published in the Permanente Journal/Summer 2008. (Elder is also a top whole systems researcher.) The authors raise questions about product quality, then note that they decided to go with a line from National Vitamin Company's Nature's Blend.  Kaiser chose to back the article with a side bar by Tierona Low Dog, MD, the chair of the United States Pharmacopeia Dietary Supplements Information Expert Panel. The article includes a fascinating chart which whoses what supplements are stocked across 5 Kaiser regions. Only 3 are in all 5: St. John's wort, Glucosamine chondroitin and Gingko Biloba. A total of 14 are stocked in at least one region. Top seller in Kaiser NW Permanente is Omega 3, with 3729 bottles sold in a 12 month period to their 470,00 members, not yet a major presence. Great stuff - take a look. Kaiser's work - particularly in the Northwest and Northern California regions -  in many forms of complementary and alternative health care integration has been perhaps the most thoughtful among an managed care organization. (Thanks to Chuck Simpson, DC, for linking me to the article.)

wellness, accreditation
Developing standards for wellness programs
Malpractice Insurer Publishes Useful Coding Book

American Acupuncture Council (AAC), the leading provider of malpractice insurance to licensed acupuncturists, recently unveiled AcuCode 2008, its "Acupuncture Guide to Coding for Insurance Billing: Diagnosis and Procedure." An introduction to the new edition states that content includes specific guides from major insurers (Aetna, Blue Cross, CIGNA) on their requirements, treatment guidelines from California and Colorado, "updated information on E&M codes and their most common usage for acupuncture, and CPT modifiers.
The 30 page manual walks one through specific codes for various conditions. This is likely an exceptional resources fior anyone working to get third-party payment for acupuncture services. AAC is a major backer of the AAAOM and is credited with important assistance in ending the rift between two national acupuncture associations in 2006-2007.  Copies can be orders at 800-562-3335.

coding, reimbursement, acupuncture
Pamphlet offers insights into acupuncture coding
Public comment asked for accreditation measures for wellness programs

On June, 24, 2008, URAC, a leading accrediting agency, announced in a release that it has "convened an expert advisory group for creation of accreditation standards and measures for wellness programs." The move to create Comprehensive Wellness Accreditation was reportedly made in response to employers’ requests for quality standards and measures for both comprehensive and focused wellness programs. The more than 50 advisory committee members include employers, health plans, public benefits organizations, health care professional associations, health care providers and wellness promotion companies. The CAM-identified players at the table include American Specialty Health and Healthways (American Whole Health). The deadline for public comment is Aug. 7, 2008.


Franchise success story purchased by wellness conglomerate
Massage Envy Purchased by Huge, Indian Conglomerate

On May 13, 2008, Veria, a wellness conglomerate, acquired Massage Envy, the rapidly growing, franchise-based massage firm.  Veria, described in their release as "a growing natural health and wellness company," is part of the Essel Group of companies, a multi-billion-dollar consortium encompassing television networks, cable systems, satellite communications, entertainment enterprises, and one of the world's largest packaging companies. Subhash Chandra, Chairman of the Essel Group and founder of Veria, commented that "Veria is committed to supporting consumers' growing interest in a natural wellness lifestyle. Massage is an essential part of a healthy lifestyle, and Massage Envy brings the benefits of massage to thousands more Americans every month by making it convenient and affordable.
We are proud to welcome Massage Envy to the Essel family." Massage Envy, founded in 2002, currently has 420 clinics nationwide, up from 265 when the Integrator covered its exploding business in September 2007. (See $90-Million Massage Envy Turns to Employee Benefits Market, Seprtember 8, 2007.) Former CEO John Leonesio will step down from his position but stay on as a director of Veria.

Revolution Health, the entrance into the health zone of AOL founder Stephen Case, has taken a hit. The Integrator received a notice of downsizing and a work query from a former writer there who is part of a significant cuts that are said to be deep and wide ...


AMA sopp
More insights into AMA efforts
More on the AMA Resolutions Against Other Disciplines

A report to members of the Coalition for Patients Rights from members of the nurses associations who observed the AMA House of Delegates casts additional light on June 2008 flurry of AMA hostile resolutions again other disciplines. (See
AMA SOPP Escalates Campaign Against Nurses, Chiropractors, Naturopaths, Midwives and Others, June 22, 2008.) Apparently the naturopathic physicians were the particular subject of ire as "MD-wannabees" in the heated debate over Resolution 232 (formerly 303). The ultimate form of Resolution 232, which seeks legislation which would declare it a felony for non-MD/DO to use the physician title passed on a 2/1 vote. Opposition was raised against moving this into the judicial system. Non-MDs were derided not only as "wannabes" but as "surrogates" as "dabblers" as "encroachers" and as likely to inflict "grievous harm, bordering on homicide ... The observers also clarified that the anti-midwifery resolutions (204 and 239) targeted certified midwives rather than nurse midwives. There was no indication that the nurses stood up for their home-birth oriented colleagues. 

: Interestingly, the typical standard for training of certified midwives, in terms of total birth observations and managements, is typically more than double that of nurse midwives. This is not acknowledged in the nurses' report. As such, the nurses appear to be dissing the direct-entry midwives in the same way that the MDs are dissing the doctor of nursing programs. Nevermind, also, that where midwifery and homebirth is well-integrated into birth practices, the safety and health outcomes are far better than typical OB care in the US. That said, kudos to the nurses for organizing this coalition and keeping their members informed.

Massage law in Colorado, Briggs at AAAOM, NDs Expand Coalition Thinking

On June 2, Colorado Governor Bill Ritter signed SB 08-219 that made his state the 39th to regulate massage therapists, according to an article in Massage Today ...  Josephine Briggs, MD, the new director of NIH NCCAM will be a featured speaker at the October meeting of the American Association of Acupuncture and Oriental Medicine ...  Bill Benda, MD and the American Association of Naturopathic Physicians (AANP) will continue bringing leaders of different associations together at their annual conference August 13-16 at the Arizona Biltmore. As reported here, the American Holistic Medical Association (AHMA) has invited its members to participate as part of that organization's 30th year celebration. On August 14, Benda will host a panel with leaders of AANP, AHMA, American Holistic Nurses Association, American College for the Advancement of Medicine, Natural Products Association, Consortium of Academic Health Centers for Integrative Medicine, and the Academic Consortium for Complementary and Alternative Health Care. The title: "Practicing Partnership, Integration for the 21st Century" ...


acupuncture, stress, group,
Serving Red cross workers inside our borders
HerbDay, Acupuncture w/o Borders, Natural Doctors International

October 11, 2008 will be the 3rd annual HerbDay.
The HerbDay Coalition is comprised of five national nonprofit organizations: American Botanical Council (ABC), American Herbalists Guild (AHG), American Herbal Pharmacopoeia (AHP), American Herbal Products Association (AHPA) and United Plant Savers (UpS) ... Acupuncturists Without Borders announced in a July 1, 2008 E-newsletter that they now have a team on the ground in Iowa doing stress-relieving community acupuncture. Red Cross workers reportedly invited them in. Kirk Moulton, LAc, a co-founder of the original American Whole Health clinic in Chicago, is leading the team ... Natural Doctors International has announced that it will host its 11th, 12th and 13th "Brigades" this summer. The 1980s, retro-sounding service-learning programs bring volunteer medical workers to NDI's clinical operation on the Nicaraguan island of Ometepe. Besides providing care, Brigade participants engage learning about the international economy, and have the opportunity to experience a homestay with a local family. Each brigade brings 10-15 students and practitioners. NDI provided over 4500 clinic visits last years ...

Health Politics & Reform

Healthcare advisers to presidential campaigns - loose links to CAM/IM

The Health Care Blog has published a succinct list of key informants on healthcare policy for the two presidential candidates. The list and bios are available here. Of note are two Harvard professors who have been at least tangentially involved with the integrative care field. Consumer-health advocate and biz school professor Regina Hertzlinger is listed as a McCain adviser, and professor of economic David Cutler advises Obama. Herzlinger advised now defunct Wellspace and is on the national Advisory Board for the Corporate Health Improvement Program. led by Integrator adviser Kenneth Pelletier, PhD, MD (hc). Cutler's connection was is more attenuated, through dialogue with Harvard integrative medicine leader David Eisenberg, MD on assessing the economic impact of complementary and integrative therapies.

IOM blasts $1-trillion of waste
IOM Puts "Waste" in Health Care at up to 50% - over $1,000,000,000,000/year

I recently read the exceptional Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, by Shannon Brownlee, at the recommendation of my journalist colleague Elaine Zablocki.  The book makes a powerful care that the elephant in the room of the healthcare reform debate is waste, and harmful waste at that.  (See my Integrative Practitioner Online column Does Hospital Care Need a Public Health Warning Label?) I recentlly learned that the Institute of Medicine formally weighed in on this in a February 6, 2008 article in JAMA entitled "From Waste to Value in Health Care" (Vol 299, No 5). The key statement: "Waste accounts for 30% to 50% of health care spending." In a $2.3 trillion system, this means over $1-trillion is waste. And, as Brownlee points out, the overtreatment, on the whole, is not only waste but creates negative health outcomes. Now, what if we instead "wasted" a fraction of that wasted trillion to reimburse any individual on a massage, an acupuncture treatment,
a chiropractic adjustment a group visit, a yoga class, or an integrative or naturopathic consult ...? Co-authors of the article include Samantha Chao, MPH, who is managing the National Summit on Integrative Medicine, as well as former US Secretary of the Treasury Paul O'Neill.


homebirth, natural childbirth, integrative medicine
Author Penny Simkin - guiet leadership in empowering care
Honoring Penny Simkin: Natural Childbirth Activist, Author, Educator and Instrument of Health Reform

A quiet, powerful force in the effort to bring quality, empowerment and reason to childbirth in the US was honored in the March 23, 2008 issue of Pacific Northwest, the Sunday magazine of the Seattle Times. Entitled Labor of Love: Penny Simkin helps women deliver, the 9-page feature takes one into the Simkin living room where literally thousands of Seattle-area parents learned the art of an empowering birth. Simkin's wisdom has also reached thousands through her Birth Partner: Everything You Need to Know to Help a Woman through Childbirth.  My spouse and I are among those who had the opportunity to be graced by her warmth, humor and wisdom as we headed into the childbirth process with our first. (See Integrator article
Father's Day: Reflections on My Firstborn's Homebirth as Alignment with Healthcare Reform, June 18, 2007.)

Comment: My observation is that
"integrative medicine" and "complementary and alternative medicine" have not very well incorporate natural childbirth and homebirth into what they routinely advocate. Simkin and others like her (including the midwives noted above in this article) are small counter voices to a birth movement about which researcher and author Michael Klein, MD, states in the Seattle Times article: "To say its medicalized is an understatement. It's industrialized." Then he adds: "Somehow Penny remains optimistic."

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