Is there alternative medicine in your future?
Patients are demanding new forms of rehab
If they haven’t already, your rehab patients soon may demand acupuncture, massage therapy, therapeutic touch, or relaxation response along with more traditional therapies.
"One of the areas where we’re seeing more and 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. (For detailed information on Spaulding’s chronic pain program, see story, p. 42.)
"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.
Wave of change is coming
If your rehab facility isn’t already exploring alternative medicine, it may be time to get on the bandwagon. Consider these facts:
1. A 1993 study published in the New England Journal of Medicine showed that 34% of respondents to a survey used alternative therapies during the previous 12 months. The vast majority (89%) sought alternative therapies without the recommendation of their medical doctors.
2. The same study reported that Americans spend an estimated $13.7 billion a year of their own money on alternative medicine treatments when insurers refuse to pay.
3. Harvard Medical School in Boston has set up a Mind-Body Medical Institute to study a wide range of alternative therapy approaches.
4. The National Institutes of Health established an Office of Alternative Medicine (OAM) in 1992 under a Congressional mandate to "facilitate the evaluation of alternative medical treatment modalities" to determine their effectiveness. The OAM budget has increased from $2 million in 1992 to $12 million in 1997.
"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 ot 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.
Putting patient needs in mind
St. Joseph’s pain center has been using the mind-body approach to successfully treat chronic pain for many years and felt the same approach would 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.
After more than a year of researching mind-body medicine; looking at clinical issues, quality issues, and community needs; and visiting numerous sites and conferences around the country, the hospital affiliated 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 treatment protocol. (For details, see p. 41.)
"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 multi-hospital health care system with headquarters 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.
Flores set the wheels in motion after researching alternative medicine in graduate school. One survey 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, Spauld-ing 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, acupuncture, 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.
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