Is alternative medicine in your future?

Rehab practices see a natural mind-body connection

Perhaps more than any other specialty, orthopedic practices and hospitals with rehabilitation facilities see the alternative medicine field as an arena ripe for expansion. Although only a few managed care organizations have added alternative care reimbursement to their benefit packages, many facilities are setting up alternative care treatments in anticipation of future payer coverage or to take advantage of patient willingness to pay for treatments out of their own pockets.

"One of the areas where we're seeing more demand is for alternative or complementary medical services. Consumers have said they want those services. Payers will find a way to pay for part of it," says Janell Moerer, administrator of marketing and development at HealthSouth Mid-America Rehabilitation Hospital in Overland Park, KS.

Alternative or complementary medicine is a natural adjunct to a rehabilitation program that already focuses on healing the whole person instead of just the illness, points out Rick Leskowitz, MD, consulting psychiatrist to the pain management program at Spaulding Rehabilitation Hospital in Boston. "The whole-person approach is second nature in rehab. It's easy to move from that point of view to the mind-body approach. Alternative medicine has great potential because the emphasis on rehabilitation is on improving function, and so many alternative approaches harness the awareness of the person through the function of their body," he explains.

"We were constantly bombarded by patients and other professionals who had an interest in something other than the traditional medical model of care. The old traditional models are not meeting all of people's needs any longer," explains Rebecca Gudorf, MS, MSA, director of the Mind-Body Medical Institute at St. Joseph's Hospital in South Bend, IN.

St. Joseph's pain center has been using the mind-body approach to successfully treat chronic pain for many years. The same approach will work for other patients, Gudorf says.

"A large percentage of patient visits to a doctor are for stress-related problems or by the `worried well.' Pharmaceuticals, surgery, or other traditional medical interventions don't meet the needs of these patients," Gudorf says.

St. Joseph's spent more than a year researching mind-body medicine, looking at clinical issues, quality issues, and community needs, and visiting numerous sites and conferences around the country. The hospital decided to affiliate with Harvard's Boston-based Mind-Body Medical Institute in spring 1997.

"We all felt that this affiliation was the strongest way we could go. We felt comfortable that we were keeping our patients' safety in mind and that Harvard has the credibility," Gudorf says.

The medical center began with cardiac rehab and has plans to transform other programs to take a mind-body approach in its treatment protocols.

"By its very nature, rehab has already had a multidisciplinary approach. We are truly integrating body, mind, and spirit as part of the standard way care is offered," Gudorf says.

Sentara, a multihospital health care system based in Norfolk, VA, is considering adding alternative medicine to its programs, says Debra Flores, director of rehabilitation services for Sentara Bayside, Leigh, and Norfolk General Hospitals.

`The climate is right' for alternative care

Flores set the wheels in motion after researching alternative medicine in graduate school. One of her surveys of physicians showed that a high percentage of respondents had prescribed alternative approaches ranging from massage therapy and chiropractic services to prayer.

"I got a 90% response rate from the survey, and the majority wanted to see our preliminary results. The climate is right to start talking about alternative services," she explains.

After trying alternative therapies in both its inpatient and outpatient pain programs, Spaulding Rehabilitation Hospital is setting up a holistic therapy program for all diagnoses. That program will have a clinical focus, but also will teach people the concepts involved in mind-body coordination and life energy cultivation and management, Leskowitz says. For the inpatient program, payers pay a package rate. For outpatients, some of the offerings will have to be self-pay because insurance doesn't cover some alternative approaches.

Some Pennsylvania payers are approving such alternative modalities as massage therapy, acu puncture, biofeedback, or chiropractic care for pain management, says Virginia Wagner, vice president for ambulatory services at Chester County Hospital in Westchester, PA.

That hospital is developing a task force to look at options to provide alternative medicine along with traditional rehabilitation, Wagner says. "It will likely come under the umbrella of wellness and prevention. We want it to be a viable option, should patients want to choose it. It won't replace our traditional diagnostics."

Although she doesn't anticipate starting an alternative program for 18 months or more, Mid-America's Moerer has started to research the subject with an eye to satisfying the consumer and meeting payer needs.

Already Mid-America has formed an alliance with a chiropractic group to meet payer demands for chiropractic services.