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A "Sleeping
Giant" Awakens in Chicago
by Keith M. Sarich Once upon a time, it may have been considered lethargic, or even maybe in a deep sleep, but there is no doubt that Complementary / Alternative Medicine (CAM) appears to be awakening and ready to run with the healthcare industry. Perhaps it's that old adage, "being in the right place at the right time." A greater possibility is that we now know how incredibly important patient / "client" satisfaction is in health care delivery. Whatever the case, the bottom line is, "Give the client what they want or they'll go someplace else!" Complementary, Alternative, Holistic, Natural, World... What ever we may call it, many prefer to use 'CAM'. The strength of this often-fragmented, often-misunderstood 'form' of health care delivery system can only be viewed as incredible and growing. Since CAM refers to a broad segment of "non-traditional" health care delivery, it can include a myriad of treatment modalities, including Chiropractic (considered a complement), Acupuncture, Massage Therapy, Homeopathic and Botanical / Herbal applications. You say you want proof, some facts and figures? Utilization went up from 33.8% of the American public in 1990 to well over 50% in 1998. There were 427 million CAM visits in 1990, and that number increases to over 629 million in 1997, a 47.3% increase in just seven years! Spending for CAM therapies, including nutritional and botanical / herbal supplements in 1998, totaled $18 billion OUT-OF-POCKET! Overall CAM patient satisfaction rates are greater than 75%. And if that's not enough, perhaps this is the clincher. Current CAM visits far outnumber visits to any and all primary care physicians 2.1:1. CAM appears ready to become fully integrated into mainstream allopathic medicine on a much greater level then previously seen. But what is the reason for such growth? There are several, among them the Balanced Budget Act, PPS, low patient satisfaction rates in managed care and intense competition between health care organizations. CAM's strong points are superb patient satisfaction rates using one or more CAM therapies, greater compliance and a strong alliance with a preventative health care philosophy. The popularity of CAM therapies has been and is growing nationwide. In a question of which of the CAM therapies is the most popular, the prize would have to go to chiropractic therapy. Reasons include being well accepted, having a long history of actually working, being considered a true compliment, as well as receiving a high rate of reimbursement on the financial end. The other therapies - such as acupuncture, massage, and nutritional - are close behind chiropractic, and gaining ground. However, these therapies are facing some challenges. Most reimbursement is still out of pocket, especially in the Midwest. Managed-care on both coasts reimburse for these therapies with greater frequency, however the going is still slow in the Chicago area. Despite the challenges, CAM is definitely gaining strength in the Chicago area. Integration with 'traditional' health care delivery systems (allopathic) is increasing as hospitals and health systems recognize the need to offer a wider range of services. With differentiation of service lines critical for organizational survival, CAM is becoming a bona-fide choice for integration. Just a few short years ago CAM would have had a very slim chance of integrating with allopathic medicine, but it seems that in this case, timing is everything. As the popularity of CAM continues to grow in the greater Chicagoland area, several health care organizations have begun integration at some level. The many hospitals and health care organizations either directly or indirectly affiliated with CAM activities include Northwestern Community Medical Group, Ltd., Illinois Masonic Medical Center, ('Strong Spirit'), Ravenswood Hospital Medical Center and Advocate Lutheran General Hospital. Many others are currently investigating CAM integration, as growing numbers of patients are demanding a greater choice in 'alternatives' to traditional allopathic medicine. To accommodate the rapidly growing interest in CAM as a profession, a number of educational choices exist in the Chicago area. In the field of chiropractic therapy, the National College of Chiropractic in Lombard offers a wide range of courses, including coursework in acupuncture for the chiropractic student. There are many superb choices for the student of massage therapy, which truly has undergone a renaissance in terms of popularity. These include The Chicago School of Massage Therapy, The Wellness and Massage Training Institute and the newest addition, The Soma Institute. The acupuncture field, in which the Department of Labor projects a 110% growth in demand over the next five years, is well represented by the Midwest School for Oriental Medicine, with locations in Chicago and Racine, Wisconsin. A new concept for training allopathic physicians in the essentials of CAM therapies is available at The Institute for Integrated Medicine at Sawyer College in Northwest Indiana. Educational choices will grow as CAM gains popularity with patients and allopathic providers alike. On the system level, new players are emerging to integrate CAM as a affinity, or value-added service available through HMO's. Alternative Medicine Inc., a Highland Park, Illinois IPA, bills itself as an Independent Physician Organization which fully integrates CAM and mainstream western medicine. In this model, chiropractic physicians are used as the primary care provider (PCP), credentialed by Blue Cross HMO Illinois to 'meet the same high standards (NCQA) as all other primary care physician M.D.'s'. Optimum Health, Inc., a Chicago-based CAM network, has recently begun development of its own network. A 'stand-alone' option offers the patient access to a network of CAM providers in the greater Chicagoland area, including acupuncture, chiropractic, massage therapy, nutritional counseling, yoga (mind-body), and naprapathy (correction of structural imbalances). The patient pays the provider a discounted fee from usual and customary charges. According to Matt Malpede, Optimum's Chief Executive Officer, 'we want to establish ourselves as a network that truly offers a lot of choices.' Integration of this model is expected to occur with local HMO's in the near future. Even though the future of
CAM looks promising, it is not the complete 'savior' of health care.
Many obstacles still exist for CAM to be widely accepted in the medical
field. Among them is the issue of gaining more credibility through
comprehensive studies and scientific trails to determine efficacy.
Issues also include consideration of a 'crosswalk' version of CPT codes
and protocols regarding the unique state and national licensing
requirements of specific CAM providers, and the development of standards
regarding protocols in the CAM setting and documentation of outcomes
measures. The list goes on and on. However, perhaps the
greatest strength of CAM can be summarized by describing three things it
does very well. First and foremost, is significantly increases
patient compliance and satisfaction. Second when implemented
properly, it can be a revenue-generator for the organization. And
finally, when introduced into an organization, it tremendously
strengthens the continuum of care. Look for CAM to continue its
rapid development in Chicago as traditional medicine embraces perhaps
two of the most important aspects of health care delivery, choice and
access. Mr. Sarich is the President of KMS Associates, a consulting firm working exclusively in complementary and alternative medicine. Institute for Integrated
Medicine at Sawyer College Sources |