Complementary and Alternative Medicine in US Hospitals

Sita Ananth, MHA, Samueli Institute

Presentation for:

GIH CAM Funders Network

July 14, 2011

© 2011 Samueli Institute

Com

mon

CA

M P

ract

ices

What do we know about CAM use? • 2007 CDC report – 4 out of

10 adults surveyed used some form of CAM

• One in 9 children• Up from 30% in 2002• Number of visits was 697

million- 60% more than all primary care physician office visits combined

• $12-$19 billion spent on providers- total $34 - $40 billion on services and products combined

One question: Are there organized hospital services or formal arrangements to providers that provide care or treatment not based solely on traditional western allopathic medical teachings as instructed in most U.S. medical schools?  Includes any of the following: acupuncture, chiropractic, homeopathy, diet and lifestyle changes, herbal medicine, massage therapy, etc.

American Hospital Association Annual Survey of Hospitals

Trend: Growing from 8% in 1998 to 21% in 2010

2007 CAM Survey of Hospitals• Subsidiary of the

American Hospital Association

• An education, publishing and data company providing healthcare leaders with resources to achieve their organizational and personal goals

• Bi-annual survey started in 2003

Survey specifics• Mailed to 6349 hospitals in AHA’s database (includes

public hospitals, VA and military facilities)• Option to complete online or on paper• Total of 748 responses – response rate was 12%• Of those responding 280 hospitals (or 37.4%) said they

offered CAM• Survey was divided into 4 key areas: Location and Types

of Services; Finances and Reimbursement; Planning and Staffing; Research and Evaluation

Geographic Distribution of CAM hospital programs

Region 914%

Region 89%

Region 69%

Region 75%

Region 53%

Region 215%

Region 317%

Region 111%

Region 417%

Hospital Characteristics

• Primarily urban - 72%• 52% in medium hospitals (100-299

beds)

Reasons for offering CAM

Patient Demand

Clinical Effectiveness

Reflects organizational mission

Attracts new patients

0 10 20 30 40 50 60 70 80 90

Percentage of Respondents

Criteria used to select CAM therapies

• Patient demand – 79%• Evidence based – 72%• Practitioner availability 62%

Services offered- Outpatient

Five most common outpatient modalities offered :

Massage 54%

Acupuncture 35%

Meditation 25%

Relaxation therapy 27%

Services offered- Inpatient

• Pet Therapy 46%• Massage Therapy 40%• Music/Art Therapy 31% • Guided Imagery 20%

Services offered, contd.

• Smoking cessation offered - 51%

• Nutritional counseling - 49%

• Herbs or supplements in hospital pharmacy -13%

Comparison of hospital services with consumer demand

Brain Berman, MD, University of Maryland School of Medicine

Therapy AHA Rank Eisenberg Survey Rank

Massage 1 3Stress Management 2 Not RankedYoga 3 Not RankedRelaxation Techniques 4 1Pastoral Counseling 5 5Acupuncture 6 16

Support for initiating CAM program

How patients access CAM services

Self Referral Physician ReferralNurse Referral Other

80%77%

51%

17%

How patients pay for CAM services

Patient Self Pay

Third Party Reimbursement

No charge

Workers' compensation

0 10 20 30 40 50 60 70 80

Percentage of Respondents

Program start-up costs

Break even expectation

Staffing

• Medical Director – 29%• 33% no direct physician involvement• 19% had physicians on staff• Average number of FTE’s = 2.0

Planning

Metrics used to evaluate CAM programs

Patien

t Sati

sfacti

on

Volume

Qualit

y

Health

Outc

omes

Reven

ue

Budge

t

Safety

Profit

Mark

et Sha

re

Other

86%

55%

48%

39% 38%36%

30%

23%

7%5%

Major Obstacles

• Budgetary constraints – 70% • Physician Resistance – 41%• Lack of evidence based research – 35%

Reasons for discontinuing the CAM program

Challenges and Opportunities

• Cost effectiveness – mind/body medicine is one of the most cost effective interventions

• Chronic care – aging population with chronic conditions

• Physician champion

Challenges and Opportunities

• Physician resistance – several types:

- competitive threat to their income - those who claim lack of data or research- another unknown to deal with- bad experience

Milt Hammerly, MD, director of Integrative Medicine, Catholic Health Initiatives

Challenges and Opportunities … cont.

• Integrate into an existing program – example : headache clinic – first in line of “last resort”

• Patient safety – very safe with few side effects

Challenges

• Money! Money! Money!• Access• True integration –not silo-ed• Safety – concealed from

physician; drug/herb interactions; quality

• Mis-placed incentives

Models

• Consultatory• Primary care• Fitness center• Virtual• Spa

Dr Don Novey, Center for Complementary Medicine, Advocate Medical Group

Recommendations

• Education, education, education!• Studies reported in mainstream

medical journals – JAMA, NEJM or others

• Success with patients and sharing results with referring clinicians

• Building referral base