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Chronicles of Health Creation: RAND Report Begs New Look at Integrative Medicine and Health Professionals in the Triple Aim Era

Excerpted from Huffington Post
John Weeks

A recent report from the RAND Corporation describes how regular medicine reduced complementary and alternative medicine professionals to “thing” status — as “modalities” — in the first years of the integrative medicine era.

The title of the report is “Complementary and Alternative Medicine: Professions or Modalities?” The discussions among policy makers, practitioners and delivery system leaders synthesized in the 75-page document beg a more significant question: Does the emergence of values-based medicine urge a major re-think regarding the potential contributions of these professionals?

The case statement by RAND’s Patricia Herman, ND, PhD and Ian Coulter, PhD begins with a blunt irony. “One of the hallmarks of complementary and alternative medicine (CAM) is treatment of the whole person.” Yet in the fee-for-service procedure and production orientation of the medical industry, licensed practitioners of chiropractic, acupuncture and Oriental medicine, and naturopathic medicine were typically stripped of this core value — treating the whole person — before being put to any use.

Regular medicine’s dominant influence when “CAM” integration by medical delivery organizations began in the mid-1990s was the industrial value of service production. Mayo Clinic’s director of innovation captures this concisely when he recently spoke of medicine’s historic focus on “producing” services rather than on “creating health.”

In such an industrial setting, a chiropractor became a thing to be use sparingly. Chiropractor = spinal manipulation for low back pain.

A precedent for this boiling down of a chiropractor’s potential value in human health to thing status was set for chiropractors decades earlier in Medicare. In that even more intransigent fee-for-service era, only adjustment of the spine for low back pain made the grade. Unremunerated was the time that a chiropractor spends in evaluation and management. Most of the chiropractic professional’s education and practice rights were dumped overboard. No value was placed on a chiropractor’s counseling of patients on diet, lifestyle, dietary supplements, or ergonomics, for instance.

Getting into Medicare at all back then was a victory for the field. But a consequence of this limited economic relationship was the rack ’em and crack ’em – as fast as possible method of treatment. Produce!

 

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