Practice adds alternative care to service mix

Expansion a big hit with patients

Increased consumer demand for alternative care treatments such as acupuncture and massage therapy has received widespread coverage in the press, but the jury is still out regarding how the supposed boom affects the day-to-day operations of the average family physician. If your group practice is toying with joining rather than fighting the alternative care boom, you may be interested in the experiences of a Boston multispecialty group that has made alternative services available to its patients.

Harvard Vanguard Medical Associates, a multispecialty group that has an exclusive relationship with the prestigious Harvard Pilgrim Health Plan, is testing the waters in alternative care, with much success. Since November, the group has leased office space in its Cambridge clinic to alternative providers who offer acupuncture, chiropractic care, and massage therapy, says Richard Weisblatt, PhD, medical director of Harvard Vanguard's Cambridge office.

The alternative providers are not on staff at Harvard Vanguard, Weisblatt stresses, but offer care to the practice's patients at a 20% discount. Because Harvard Pilgrim does not offer alternative care as part of its benefit package, members pay for alternative care out of their own pockets.

The alternative care connection to Harvard Vanguard is not entirely hands-off. Although there are no referral requirements because alternative care is not a covered service, the alternative care providers work collaboratively with the practice's internal medicine department. The alternative providers keep separate medical records for the Harvard Vanguard patients, and they release these records to the patient's primary care physician with the patient's permission, Weisblatt says (so far, all patients have granted permission). The alternative providers have held two group sessions with internal medicine physicians on staff to review cases.

Harvard Vanguard addressed some physician concerns in two ways. First, it developed educational materials for its clinicians to help them understand the three alternative care modalities involved. "We're just in the process of developing these to help physicians learn what they [the alternative care providers] offer and whether there is any [clinical] research to support it," Weisblatt says. "This is so our physicians can have an educated conversation with their patients about the subject."

The second way Harvard Vanguard increased physician buy-in is by screening the alternative providers it leased office space to. The group chose acupuncture, chiropractic care, and massage therapy because these three modalities of care face some degree of regulation, Weisblatt says. Both acupuncture and chiropractic care are accredited by the state, while massage therapists have to register in towns where they practice.

The practice developed a request for proposal for alternative care providers. The RFP required graduation from an accredited college for the care discipline, proof of licensure, and proof of malpractice insurance. Staff physicians also had the opportunity to recommend alternative care providers to send a copy of the RFP to. Finally, Harvard Vanguard went through an extensive interviewing process with the alternative care candidates, in which a number of staff physicians participated. "We looked for communications skills, motivation, and the ability to work with our physicians," Weisblatt says.

Less than six months after the providers started seeing their first Harvard Vanguard patients, the group has decided to continue offering the service. Patient satisfaction has been high, Weisblatt says. "We had to double the number of acupuncture sessions being offered [per week], and then double them again. We've also had to double the number of chiropractic sessions," he says.

In addition, internal medical physicians on staff at Harvard Vanguard are now more likely to ask patients if they have seen an alternative care provider, opening up patient dialogue on the subject. Studies have shown that over 80% of patients who see alternative care providers do not inform their primary care physician of this, Weisblatt says.

Harvard Vanguard hopes to get more information on the quality assurance angle of alternative care through its participation in a research study being conducted at the practice by David Eisenberg, MD, of the Deaconess Center for Alternative Medicine Research in Boston. "Just getting people to talk to each other about the subject [of alternative medicine] has already been a big plus," Weisblatt says.