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Shore Health System: ExploringCAM-IM's Economic Value in Nurse Retention PDF Print E-mail
Written by John Weeks   

Shore Health System: Exploring CAM-IM's Economic Value in Nurse Retention

Shore Health System, Eastern Shore, Maryland
A first level of establishing value for CAM-IM inside a hospital is to show that the people who use the CAM-IM services are as pleased with these forms of care as the research suggests they will be. But such satisfaction is a necessary but not sufficient basis for deeper integration. To be fully present and valued at healthcare's table, one's services must be viewed as an economic contributor. This has proved challenging for CAM-IM.

David Mercier, LAc,
"clinical acupuncture specialist" - who effectively serves as director of integrative medicine - for the Maryland-based Shore Health System - has succeeded in developing a program at the Shore Health Center for Integative Medicine which has captured the
Shore Health Center
for Integrative Medicine:
At a Glance

 Location    Stand-alone 
 Salaried (Mercier)
.5 admin,
.5 clinical
Contract staff  8
 FTE equivalent
 Patients per month 300
 Inpatient Reiki
Years in operation
Bottom line

   with caveats  
system's attention for its very high patient-satisfaction on the Press Ganey scoring system used by many hospitals nationwide. He is now considering an unusual strategic direction - help in nurse retention - which may also implant the center as an important contributor to the hospital's bottom line.  

In 7 of 8 testing periods
with the widely-
Press Ganey survey, Shore's
department ranked
higher than all other
departments -- most recently
an overall 98.5
average score.

The five-year-old, stand-alone Center is part of a system which serves a population base of 135,000 on Maryland's eastern shore. The system includes two hospitals and a range of other facilities such as primary care, rehab and a cancer center. The Center's services focus on acupuncture and massage, and sometimes include limited Yoga, tai chi and Mind Body Stress Reduction. (The Center has also developed an award-winning, inpatient Reiki program which will be the subject of a future IBN&R article.)

No medical doctors or other conventional providers are onsite at the Center. Mercier, with a 50-50 administration/patient care split in his time, is the chief salaried staff person. He notes that "after five years of struggle, the Center is now breaking even." He shares, however, that in this accounting the cost column does not include rent or building maintenance, which are covered by the hospital.

Shore Integrative Medicine Scores on the Press Ganey Patient Survey

Overall, Integrative Medicine


Overall, Acupuncture


Overall, Massage


Overall, (Conventional) Medical Practice

David Mercier, LAc
While breakeven has been a long-term struggle, showing that patients are pleased with the care they received came quickly. States Mercier: "Our services have ranked the highest of any of the departments in the (Shore) system in 7 of the 8 rating periods for which we have been scored."

Each scoring has been by the widely-utilized
Press Ganey system. This patient surveymeasures roughly three dozen characteristics of the patient experience. These range from facility cleanliness, to the skills pf providers, sensitivities of the providers, and the likelihood of referring other people to the facility. In fact, in outcomes shared with IBN&R, the "Overall Service Rating" for the Shore Center for Integrative Medicine averaged 98.5 on a 100 scale. This compares to a typical rating in the high 80s for conventional medical services.

How CAM-IM Can Have an Economic Impact on Hospitals and Health Systems?

Shore has been pleased with these outcomes. Mercier notes that, to the health system, the Shore Center for Integrative Medicine "adds value to its image." Then he adds: "But from a business perspective, there is really little the integrative medicine center can do to add to the bottom line." He explains: "Even if fully booked" - and the Center is approaching that status - "our percentage of the total hospital revenues would be miniscule."

Mercier concludes that there are chiefly two strategies for creating a more forceful impact for CAM-IM in the system. The first would be to work to more deeply integrate the

  How can the IM program
r economically when,
even fully-
booked, the
Center's percent
of total
hospital revenues

remains miniscule?
services into hospital inpatient services. To understand this option, Mercier engaged "a little informal survey" of other integrative programs around the country. He concluded that none had significant in-patient penetration: "No one seems to be doing anything comprehensive." He sees the problem structurally: "A hospital system has a highly integrated architecture. The modules of diagnosis, procedures, supplies and billing all interface with a high degree of specificity. Putting CAM into that architecture, while not impossible, is a considerable challenge." He chose not to focus his limited time and energy there.

A second area is proving more intriguing to Mercier. What if integrative medicine focuses not only on service to the surrounding community but also on contributing to "the quality of life of the employees." Mercier views the receptor sites within the system's wellness programs, and even its employee benefits package, as more open to a CAM-IM infusion. And the bullseye in his thinking is the toughest personnel challenge in hospital care today -- the hiring and retention of nurses.

CAM-IM: A Role in Hiring and Retention of Nurses?

The shortage of nurses is the big workforce mismanagement story in US healthcare planning. According to data from compiled reports on the website of the American Association of Colleges of Nursing:

  • Roughly 75% of hospital vacancies are for nurses.
  • US Department of Labor has called nursing the top profession for job growth through 2012, with over 1-million new nurses needed. (For reference, we have a total of roughly 770,000 medical doctors in the entire system.)
  • In long-term care facilities alone, there are 100,000 open slots for nurses on any given day. These facilities pay $4-billion a year in recruitment and training.
  • A survey found that nurses "see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%)."
  • The nursing shortage is viewed by 52% of doctors and 65% of the public as linked to medical errors. (See related IBN&R article on medical errors.)

Bottom line: According to estimates, the full, direct and indirect "turn-over" costs (not including costs, both financial and clinical, related to medical errors caused by shortages and the use of temporary nurses when are less familiar with system protocols) for a Registered Nurse, are typically estimated at $50,000 to $85,000 per nurse. This is a estimated annual national cost of $9.75 billiion dollars. For a 400 bed hospital, such costs are estimated as reaching $800,000 a year. Mercier figures that this is a good place to focus integration efforts for his team at Shore: "If we can help them retain just a few nurses, we can have an important economic impact."

The direction is yet new for the Shore IM team. States Mercier: "This is our line of inquiry. It's a strategy. There's a lot we think we can do. " But at this time the effort is yet "an idea with its feelers out." He has found a good deal of interest: "
The chief nursing officer likes the idea." He has found informal support. But implementation of a focused strategy, if it comes, will not likely take place until later this year.
Comment:  In the early days of integration, most of us thought the center of activity would be in exploring the benefits to health systems through better clinical care. Experience first taught us that health systems typically viewed integration, first, as beneficial to the PR Department. Now, here, we see the potential for benefits in Human Resources. The Department of Medicine is not yet the domain of principal inquiry.

In this nurse-retention
strategy, CAM-IM
services gain
an economic
without challenging
the system's
status quo.
With a seat at the
economic table, perhaps
dialogue can deepen.

A survey of integrative medicine leaders undertaken as part of the second Integrative Medicine Industry Leadership Summit suggests a potential reason for this lack of medical penetration. Asked which of five top stakeholders in health care were viewed as having the highest "alignment of (economic) interest" with integrative medicine, hospitals and health systems ranked near the bottom. Only 18% marked it #1 or #2. [These positions were claimed by "consumers" (95%) and "employers" (42%).(See related article on employer interests.)] "Hospitals and health systems" ranked near the bottom, with HMOs and insurers.

CAM-IM services, with their preventive and health-creating focus, may have as their optimal global impact on health care the reduction in need for pharmaceuticals, procedures, surgeries and hospitalizations. To the extent that this is so, we see a strong mis-alignment with the capital-intensive, tertiary care economic center of health systems today - regardless of the system's expressed mission. The safe-money bet on the tug-of-war between mission and money in a healthcare system still goes with the established investment practices. 

The direction Mercier and the Shore team are considering is an intriguing one, in this light. CAM-IM services can potentially gain an economic alignment with the broader system without deeply challenging the status quo in the way medical investment is prioritized. With such a seat at the system's economic table, perhaps the dialogue can deepen.

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