Summary: AMA specialists seek continued discrimination against integrative practitioners in effort to repeal Section 2706 of healthcare overhaul ... Ornish program receives penultimate boost toward full coverage from CMS/Medicare ... AANP proposes a definition of "integrative practitioner" to shape federal policy post reform .. Integrator publishes resource on the mentions of CAM/IM in the healthcare overhaul law ... Notes on the overhaul's impact on health psychologists and LAcs from Bastyr University ... Brief comment/update on the Integrative Medicine Clinic of Santa Rosa ... Medical schools begin offering tenure to integrative medicine leaders ... College links with integrative medicine clinic to offer certificate course for "patient navigators" ... Duke's Integrative Health Coach program booked solid, certification program begins soon ... NCCAM begins publishing priorities for the 2011-2015 strategic plan, holds session on CAM and behavioral change ... Botanical sales up in 2009 to over $5-billion .. Survey finds MD knowledge of herbs remains low ... Standard Process honored for commitment to advancing integrative medicine ... Bravewell publishes 50 page booklet on integrative medicine ... Helfgott's Tippens reports socio-demographic data on clients of community acupuncture model .. Fall 2010 American Public Health Association conference will include 16 segments on alternative healthcare practices and chiropractic ... Integrative medicine featured in Minnesota Monthly and group visits in the Denver Post ... Micozzi's pioneering Fundamentals of Complementary & Integrative Medicine textbook in 4th edition with forward from former JAMA editor George Lundberg ... Mark Hyman, MD takes role as chair of the Institute for Functional Medicine ... Integrative behavioral health leader Joseph DeNucci announces new retreat center ...

Policy

Proposed resolution urges stepped-up campaign to maintain discrimination against other professions

AMA Specialists Promote Repeal of Non-Discrimination Toward Licensed Integrative Practitioners, Others, in Section 2706 of Healthcare Reform Bill

The ink was hardly dry on the landmark Non-Discrimination in Health Care provision (Section 2706) of the Obama-Pelosi healthcare overhaul, the Patient Protection and Healthcare Affordability Act, and MD specialists are pushing its repeal. Anesthesiologists and ophthalmologists have asked the AMA to initiate a lobbying campaign at the executive, Congressional and grassroots levels so the Section 2706 of the 2010 law, scheduled to come into effect in 2014, never does. The request is framed as part of the AMA's ongoing Scope of Practice Partnership against other professions. Section 2706 is healthcare reform's most significant inclusiveness measure for DCs, NDs, LAcs, massage therapists and licensed midwives. Section 2706, if not repealed, could open consumer choice to these practitioners to tens of millions of US residents. In the name of patient protection, the two AMA specialty societies are acting against their direct competitors, nurse anesthetists and optometrists, but taking out integrative practitioners with them. A look at the language in the proposed resolution as it will go to the AMA House of Delegates in June 2010 is available here.

Is it all about the money?

Comment: I had the opportunity at the research conference of the Massage Therapy Foundation to be on a policy panel on May 13, 2010 with Deborah Senn, the former Washington State insurance commissioner. Senn is widely credited with saving a 1995 state statute that was, effectively, a "non-discrimination" law in Washington State legislature. Senn repeatedly battled back the courtroom and lobbying efforts of insurers for repeal. She and I spoke of the likely battle ahead over Section 2706, just 10 days before the campaign of the two AMA specialty societies, noted above, came to light. Get involved, friends, if you want to see this language stay in the law. Two coalitions that are likely to be involved are the Integrated Healthcare Policy Consortium and the Coalition for Patients Rights. To gain a sense of the potential battle ahead, the AMA's "grassroots" anesthesiologists average $311,600 to $446,994 of income per year and their "grassroots" ophthalmologists average $349,766. Redwood grasses, I guess.

Close to coverage of Ornish program

CMS/Medicare takes huge step toward routinely covering Ornish's integrative cardiac program  

Following 16 years of lobbying and a major federal pilot project, the Centers for Medicare and Medicaid Services (CMS) is on the brink of routinely covering the revolutionary integrative medicine program developed by Dean Ornish, MD and the Preventive Medicine Research Institute to reverse coronary artery disease. One May 14, 2010, the agency published a Proposed Decision Memo which states that:

"The Ornish Program for Reversing Heart Disease meets the intensive cardiac rehabilitation (ICR) program requirements set forth by Congress in §1861(eee)(4)(A) of the Social Security Act and in our regulations at 42 C.F.R. §410.49(c) and, as such, should be added to the list of approved ICR programs."

Ornish: 16 year campaign may find success

The decision memo requested final public comment on the action, a 30 day period. Ornish mentions the action in his Huffington Post blog on May 15, 2010. Ornish writes:

Comment: Ornish has shown tremendous perseverance on this work. Integrative medicine leader Lee Lipsenthal, MD, who was involved for years with the Ornish team, sent news of the action to the Integrator with this comment: "This is the first time that a healthy lifestyle program including yoga and veggie diet will be covered as a treatment option from the government." Here's hoping there are no glitches in the final comment period.

ND organization offers definition in its own image

AANP makes stab at defining "integrative practitioner" for federal policy makers

A key focus of the May 2010 annual lobby-day of the American Association of Naturopathic Physicians was on

"An Integrative Health Care Practitioner, acting within the scope of that provider's license or certification under applicable State law, addresses the underlying causal factors associated with chronic disease; improves individual health and increases individual capacity to engage in activities of daily living through lifestyle change, including strategies relating to diet, exercise, smoking cessation, and stress reduction; and provides patient-centered care that:

A. addresses personal health needs;

1. uses a multidimensional approach to encourage patients to improve their own wellness through lifestyle changes and the use of scientifically based therapies and outcomes based treatments that facilitate the inherent ability of the human body to maintain and restore optimal health; and
2. utilizes clearly defined standards to determine when the implementation of wellness and health promotion activities will be useful for each patient based on the diet, exercise habits, individual health history, and family health history of the patient."

Comment: While I like this definition of a practitioner, it is too ND-centric for the law. I would urge an understanding of the bill language that is broad and that clearly includes, for instance, licensed massage therapists, chiropractors, acupuncture and Oriental medicine practitioners and midwives. (I don't mention integrative medical doctors and holistic nurses as MDs and nurses are already included in the relevant sections of the law.) Each of these other professions would need to stretch in various ways to meet this naturopathic-centric definition of integrative practitioner. Mean time, the AANP's focus on elevating the wellness-orientation of integrative practitioners is worth noting. We often say that all of these fields share that focus.

Special report meant as a reference resource for federal political action

Integrator report details 7 sections in the federal healthcare overhaul law that expand inclusion of integrative practices

Comment: Fascinating that the concept of "integrative practices" and "licensed integrative practitioners" did not exist in federal law until this law in 2010. It is worth a moment of reflection on how far this movement has come, even if slower than any of us might want. And, for those of you who participate in US politics through contributing to elected officials, I include photos of those elected officials who appear to have had the most impact: Harkin, Mikulski, Sanders, Conrad and  Cantwell for specific sections; and Obama and ultimately Pelosi for shouldering the legislation into law.

Courtney: Regulations will shape meaning of non-discrimination

Analysis of healthcare overhaul for health psychologists and acupuncturists

The e-newsletter from Bastyr University for May 27, 2010 includes a useful look at the impact of the Patient Protection and Affordable Healthcare Act on health psychologists and licensed acupuncturists. The health psychology component leans heavily on perspectives from the American Psychological Association. The article celebrates the potential for more mind-body integration in various components of the law. Chief concerns regard the breadth of the panels of psychologists with whom insurers will choose to work and whether licensed mental health counselors will be included. The section on acupuncturists focuses on insurance coverage under Section 2706, Non-Discrimination in in Health Care.

Comment: Clearly, with the likelihood of an AMA campaign to gut Section 2706 (see Battle On: MD Specialists Promote Repeal of Non-Discrimination Vs Integrative Practitioners, Others), a variety of hands besides insurers may be on deck trying to stir this ship.

Academic Integrative Care

Kemper: One of 6 tenured integrative medicine leaders featured

Explore features 5 integrative medicine academics  granted tenure

An article in the May 2010 issue of Explore marks a form of arrival of integrative medicine in U.S. academic health centers. Entitled University Professors Awarded Tenure for Integrative Medicine Accomplishments, the piece includes short synopses of the now tenured academic careers of Victor Sierpina, MD (U Texas), David Rakel, MD (U Wisconsin), Brian Berman, MD (U Maryland), Kathi Kemper, MD, MPH (Wake Forest) and Brent Bauer, MD (Mayo). Each offers some analysis of major contributing factors to their success in achieving this recognition. Comments from Kemper capture the gist of the communication from the others:

“It was the extramural funding and the publication record rather than my particular topics [of research] that led Wake Forest to offer me a position as professor and within a few years, extend tenure as well ... Department chairs and administrators look for faculty who can generate revenue to support the academic enterprise. Leaders also need to be assured that faculty contribute to the morale and teamwork of the overall institution.”

12 practitioner center

Update: Integrative Medicine Clinic of Santa Rosa

Pam Koppel, LCSW, a clinical associate of the Integrative Medical Clinic of Santa Rosa, was in touch regarding the Patient Navigator Certificate Program described in this Round-up. I asked Koppel for an update on the clinic, founded 10 years ago by Robert Dozer, MD and Ellen Barnett, MD, MPH. The clinic has roughly a dozen practitioners and includes a concierge component. Koppel reports:

"The clinic is still going (www.imcsr.com) and has been running smoothly for a long time now. About 4 years ago we changed it from an employee model (not working) to a model where the practitioners rent space and buy services. That is working well. I can't say that Bob & Ellen are making big money from it but it is working well enough. There has been a steady group of about 12 practitioners there for about 6 years, some longer and some a bit shorter. I don't work for the clinic much anymore, but I still run the practitioner team activities - weekly patient care conferences, bi-monthly team meetings, and I do new patient intakes via phone as well. And yes, it is still integrative and the group continues to explore and struggle with what integration really is. Even after 10 years, it clearly is not an easy thing to do, and part of the reason it has been determined a navigator can play an important role in making integration happen, as practitioners tend to be mostly focused on their own modality."

Koppel: Developer of navigator program

Sonoma State University teams with integrative medicine clinic to offer Patient Navigator Certificate Program

Duke's integrative health coach professional training sessions selling out; certification to start in July 2010

A visitor to the Integrative Health Coach Professional Training Program web page at Duke Integrative Medicine will discover that the program, begun in late 2008, is finding significant interest. This program is part of a growing Duke initiative that also includes a certification course that starts July 2010. The $4500 basic program, featuring four

is sold-out at 40 participants for all three 2010 sessions.

McCabe: Lead role in Duke's health coach program

According to senior program coordinator Kathy McCabe,

Research

Rolling out strategic plan

NCCAM moving toward clarity on 2011-1015 strategic plan: chronic pain and natural products highlighted

Testimony to Congress and two white papers recently published by the NIH National Center for Complementary and Alternative Medicine are setting the first formal clarity for the first strategic plan under director Josephine Briggs, MD. In Briggs' testimony to Congress to support a $132-million request for NCCAM for fiscal year 2011 (3% increase), she turns Congress attention in two directions: first chronic pain and then natural products. In addition, NCCAM has just closed a comment period on two white papers on the strategic plan. The first is Principles Guiding CAM Natural Product Research and Development. The second focuses on one region and type of chronic pain: Better Strategies for Management of Back Pain.  In support of the second agenda, the NIH hosted a May 10-11, 2010 workshop on Deconstructing Low Back Pain. At the end of March, NCCAM held a March 26, 2010 Think Tank on Natural Products. Natural products were also the subject, with mind-body medicine, of the December 8, 2009 10th Anniversary Research Symposium.

Comment: On May 7, shortly after the May 2010 Round-up was published, NCCAM sent a note about the two white papers, stating that a comment period would last from May 10-24. Unfortunately, the Integrator publication schedule did not allow me to include timely notification of the comment period. Perhaps I should have gone ahead with a special mailing. Apologies to those of you who might have responded.

Additional Note: I was pleased to see that NCCAM is engaging a special focus on behavior change June 3, 2010 just prior to the 39th meeting of the National Advisory Council on Complementary and Alternative Medicine. Entitled "Gaps and Opportunities in Health Behavior Research," the day-long strategic planning session begins with a series of short presentations and concludes with an exploration entitled "Improving Healthy Behavior: What is the Role of CAM?" Hopefully the segment will engage the more focused, practical question of improving healthy behavior -the role of the CAM/integrative practitioner. That's the topic that will most assist agencies in how to implement programs related to integrative practices in healthcare reform.

Natural Products

American Botanical Council report 5% growth in herbal supplement sales in 2009 to over $5-billion

Sales of herbs in the U.S. grew by nearly 5% in 2009 to just over $5-billion according to a May 7, 2010 report from the not-for-profit American Botanical Council. Most growth was seen in sales via mainstream retail outlets, such as drugstores. In these categories, sales soared 14th from 2008. ABC's Mark Blumenthal comments: "In the most economically difficult market in over 70 years, when almost all consumer goods experienced a drop in sales, consumers voted strongly with scarcer dollars for herbal dietary supplements." The report found that:

• 5 top-selling via health and natural food channel: aloe, flaxseed oil, wheat grass and barley grass, açaí, and turmeric.

• 5 top-selling via food, drug, and mass market channel: cranberry, soy, saw palmetto, garlic, and echinacea. (The rankings do not include herb combination products.)

Products firm honored for donations and for workplace as employer

Standard Process honored with Corporate Vision Award from ACAM; recognized as a top work place in home state
 
The American College for Advancement in Medicine (ACAM) has awarded Standard Process with its highest honor, the ACAM Corporate Vision Award. The award to the Palmyra, Wisconsin firm was made at ACAM's Spring 2010 Education Summit held in San Diego, April 21-25, 2010. Charles DuBois, president of Standard Process commented in a press release: "Like ACAM, we are dedicated to optimizing health and wellness. Together we are committed to a single vision: a time when all health care professionals are working in the best interest of the patient by combining conventional care with alternative solutions to obtain optimal results and health."

Comment: My own work has benefited doubly from Standard Process' generosity. The firm helped launch the Integrator, coming on as the second sponsor and maintaining support for a 2-year period, thank you! In addition, beginning in 2007, the firm has supported staff costs relative to the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care, with which I am involved. I was pleased to see this recognition of Standard's investments. Notably, the firm was also honored May 24, 2010 as a 'Top 100 Workplace" by the Milwaulkie Journal Sentinel with particular kudos for its wages and benefits.

"Despite the small number of responders, the results of the survey have notable majorities: 71.8% responded that they believe the public has a misplaced faith in herbal medicines, 84.1% do not believe herbal medicine is well regulated, and 62.8% said they did not provide general herbal medicine information to their patients. Furthermore, 75.5% of respondents believe that doctors are poorly informed about herbal medicines while 46.6% admitted to being poorly informed themselves. Of the 21.3% who responded that they wouldn’t seek more information about an herbal medicine their patient was taking, 60% said they were unsure where to seek such information. Overall, 50% said they’d use Google or similar Internet tools if they were to seek such information."

Philanthropy

Bravewell publishes 50-page booklet on integrative medicine

The Bravewell collaborative of philanthropists for integrative medicine has published a handsome, 50-page booklet entitled Integrative Medicine: Improving Health Care for Patients and Health Care Delivery for Providers and Payors. The short description from Bravewell states that the booklet:

" ... explains what integrative medicine is and how it can help transform our health care system. It summarizes the evidence presented at the Institute of Medicine's 2009 Summit on Integrative Medicine and the Health of the Public and answers the question: What is health? The report also discusses the need for health care that addresses the whole person, the connection between lifestyles and health, the importance of the doctor patient-relationship and the need to embrace complexity and connection in both care and research.In addition, it contains patients stories from Duke Integrative Medicine, Scripps Center for Integrative Medicine, UCSF Osher Center for Integrative Medicine, and The Alliance Institute for Integrative Medicine.

 


Public Health & the Underserved

Tippens: Exploring group acupuncture clientele

Helgott's Tippens reports first data on socio-demographics of community acupuncture network clientele

Those observing the growth of the Community Acupuncture Network and movement for low-cost, community room services will be interested in data that are emerging from an ongoing analysis led by Kim Tippens, ND, MPH, a post-doctoral fellow at the Helfgott Institute associated with the National College of Natural Medicine. At the April 2010 meeting of the Symposium for Portland Area Researchers in CAM (SPARC), Tippens presented a poster with some of the demographics of the users of the acupuncture services at the mothership of the CAN movement, Portland, Oregon-based Working Class Acupuncture, co-founded by Lisa Rohleder, LAc. Clients choose to pay between $15-$40 per visit. In a sample of 478 clients, Tippens found that

" ... primarily white (87%) and female (72%); 25% of respondents are uninsured, 29% are unemployed, and 77% have an annual household income of less than $55,000; 69% completed a college degree or higher level of education. The majority (87%) of WCA clients used acupuncture for a specific health problem. More than half (55%) of respondents reported that acupuncture had helped their condition and 90% reported being 'very satisfied' with the treatment they had received at [Working Class Acupuncture]."

"The 77% below 55K/23% above is about what I would have guessed. We draw folks from all income categories. We haven't tracked payment categories for quite a while, but the last time we did, I think about 50% paid $15, and about 10% each paid $20, $25, $30, and $35. I would estimate another 5-10% are people with whom we have 'special arrangements': temporarily paying nothing because they lost their jobs, paying $5 because they have very low fixed incomes, paying less than $15 because they are coming every day for treatment for something acute, etc."

Comment: The portrait that emerges from Tippens' socio-demographic data is of a user population that, while well-educated, is solidly in the so-called working poor/middle class range. Members of any household with family income of less than $55,000 are likely to have trouble paying for a series of acupuncture treatments at $65-$125 per needling. Ten visits at $15 is $150 and doable for most; at $75 each, the cost is simply prohibitive for many.

American Public Health Association

APHA conference to feature 11 segments from alternative heath special interest group, 5 from chiropractic section

The early announcement from the American Public Health Association on their 138th annual conference, November 1-6, 2010 notes 11 segments for their Alternative and Complementary Health Practice Special Interest Group. The co-chairs of the group are Richard Harvey, PhD, from San Francisco State University and Beth Sommers, LAc, MPH. Program leads for the 2010 conferece content are Harvard-based Anne Doherty-Gilman, MPH and massage therapist and researcher Karen Boulanger. The conference will also include 5 sections from the more established Chiropractic Section of the APHA led by Paul Doherty, DC. Information on the conference is available here.

Comment: Staff model organizations such as Kaiser Permanente and Group Health Cooperative have been leaders in using the group model over the last decade. (See related Integrator article with a former Group Health MD entitled Holistic Leader Kjersten Gmeiner, MD on the Fit of "Group Visits" with Holistic Medicine.) Nice that typical insurers and physician groups are figuring out ways to create the same incentive structure to support payment for these services. Groups are an area in which integrative practice, by its philosophy of patient-empowerment, could be providing leadership.

200,000 subscribers to newsletter

Jackson & Coker report to physicians focuses on spirituality and medicine

The May issue of the Jackson & Coker Industry Report from the medical staffing consulting firm focuses on spirituality and medicine via an editorial, a Special Report and a reprint of a feature on the subject from Christina Pushaklski, MD, MS, the head of the spirituality and health program at George Washington University. The editors share that

The electronic Jackson & Coker report currently reaches 200,000 on their list.


Publications

Micozzi's Fundamentals: Into 4th edition

Micozzi's update on Fundamentals, the original integrative medicine textbook now in a 4th edition with Lundberg's forward

." The forward is called "Your 'Good Medicine' Guide to CAM,"


People

Hyman: Stepoping into lead role at IFM

Mark Hyman, MD take on role as chair for the Institute for Functional Medicine

Integrative medicine clinician, author and policy influencer Mark Hyman, MD has become chair of the Institute for Functional Medicine. Hyman shared the news with his Ultrawellness list on May 19, 2010 with this commentary:

"Through education, research and strategic partnerships and policy change we can facilitate the transformation of medicine based on new science that allows us to treat the underlying causes of chronic disease ... Our first goal is to scale our educational model to train health care providers in the medicine of the future. We are at a moment in medical history that requires a new way of thinking to successfully address our global epidemic of chronic disease. Practitioners need a new set of lenses to interpret and act on clinical information.  Functional Medicine provides those lenses, a new way of seeing the epidemic of chronic disease based on underlying causes, and treatments based on restoring balance within dysfunctional biological systems and networks.  It focuses on treating the whole system, not just the symptoms.  Applied in practice, Functional medicine can more effectively prevent, treat and often cure chronic conditions, at lower cost, failed by our current paradigm."

DeNucci: Opening retreat center in Colorado

Joseph DeNucci opens retreat center for "

Comment: DeNucci is a relatively unsung influencer in the emergence of the integrative medicine field. He was among the very first who united personal practice and commitment with significant business skills. A long-time yoga instructor and meditator, DeNucci was also a turn-around artist for inpatient behavioral health facilities and then a holistic behavioral health program developer.

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