MDs shouldn't fight alternative care boom
MDs shouldn't fight alternative care boom
Our patients' approach to medical care is undergoing drastic changes, and we as physicians have to change with the times. The latest example of this trend is the increasingly popular use of alternative medicine as a potential cure for everything from cancer to low back pain.
In my opinion, we can't crawl in bed, pull the covers over our eyes, and pretend the problem will go away if we just try even harder to improve. It's time to educate ourselves on the specifics of alternative medicine so that we can answer patient questions about the efficacy of these treatments and how they complement a care program.
Before offering suggestions on how to do this, I'd like to clarify my definition of alternative medicine: the practice of chiropractic, naturopathy, acupuncture, hypnosis, meditation, behavior modification, Oriental medicine, and massage.
What alternative care also represents, frankly, is a serious competitor for our patient base. Alternative medicine is care that a large number of our patients seek, with or without our knowledge. Deepak Chopra, MD, and Andrew Weil, MD, both have books on the best seller list that advocate for alternative and complementary therapies. A 1993 New England Journal of Medicine study demonstrated that one-third of all Americans had used nontraditional treatments. The same study estimated that Americans are spending an estimated $13.7 billion on alternative care annually. Seventy percent of HMO survey respondents surveyed in this same study reported an increase in requests for alternative care therapies from their members.
Although most alternative care consumers have so far willingly paid for this care out of their own pockets, many are now beginning to look to their health insurers to help shoulder the payment burden. Some health plans are eagerly agreeing to pay for alternative medicine therapeutic interventions in an attempt to differentiate their plan from their competitors and to secure a larger market share.
So where do we as "traditional medical caregivers" fit in?
There are several things we can do right away to integrate the alternative care our patients seek into a care program we coordinate. My theory is that it is better to have an open dialogue with your patients who are seeking out these kinds of treatments, and to understand how it can complement or conflict with other care and treatment we are providing. Instead of scoffing at alternative care, it is important for physicians to learn to incorporate it into the overall care management process. In these days where both primary care and specialist physician reimbursement is increasingly determined by patient satisfaction, patients are generally more satisfied with providers who do not have a rigid prejudice against some form of therapy that the patient thinks is in his or her best interest.
Becoming alternative care-literate
It is important for practicing physicians, medical directors, and office managers to become familiar with the alternative therapy milieu so you and your staff can respond to patient questions. Even though the majority of Western-trained physicians are not well-schooled in alternative medicine, many are going "back to school" to learn hypnosis, acupuncture, homeopathy, and other alternative therapeutic regimens.
In an effort to educate practicing physicians and HMOs regarding alternative medicine, many workshops are being developed for use throughout the county. One such organization I am familiar with is the Kansas University Medical Center in Kansas City, KS. Topics for some workshops include:
· how to develop a quality approach to credentialing alternative medicine providers;
· how to integrate the practice of acupuncture in a primary care practice;
· understanding managed care regulatory issues for alternative and complementary health care;
· understanding the guidelines for provider inclusion or exclusion to deliver care.
In addition, there are courses regarding packaging benefits for alternative medicine services and measuring outcomes and quality assurance in managed care alternative medicine delivery sites. There presentations are often given now at medical society annual educational meetings on understanding the potentials and perils of merging alternative and western medical therapies. These workshops usually have a high attendance rate.
On the other hand, becoming better educated on the subject does not mean you have to agree with its use in every case. As care managers, primary care physicians will face the same dilemma in trying to maintain appropriate use and protect against overuse of those alternative therapeutic modalities that are inappropriate in terms of type or length of treatment.
After becoming educated about the various alternative medicine modalities, find out who the good practitioners of the different modalities are in your market and develop a working or professional relationship - in person.
In addition, as physicians and hospitals move to form provider-sponsored organizations to contract directly with their Medicare patients, they will have to make decisions typically left to HMOs. Those decisions revolve around benefits coverage and pricing, marketing strategies, network recruitment, credentialing, and contracting with alternative medicine providers.
In many states, physicians seeking to integrate alternative care into their practices have the law on their side. Alaska, Washington, and North Carolina have passed freedom of practice statutes, allowing physicians the freedom to practice alternative forms of medicine without fear of loss of licensure or retribution from their state medical boards.
Science is beginning to back up the swing toward alternative care. There are now clinical studies that support the use of alternative therapies for their role in cost-effective patient care. One of the most notable was a study that demonstrated that for low back pain, chiropractic care was more cost-effective than physical therapy, surgery, or other modalities, and had similar or better results for pain control.
Certainly, there is a need for more controlled studies regarding the benefits of alternative medicine therapeutics. But it is possible to seek more clinical data without deriding the alternative care profession if this is a road one of your patients has decided to travel.
Recently in the Journal of the American Medical Association, an article written by a seventh-grader in conjunction with her nurse mother called into question the benefits of therapeutic touch. Healthy debate is good for the profession, but be careful. Hunkering down with an "attitude" about alternative medicine will do ourselves and our patients little good.
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