Complementary and Alternative Medicine in US Hospitals Sita Ananth, MHA, Samueli Institute Presentation for: GIH CAM Funders Network July 14, 2011 © 2011 Samueli Institute

Common CAM Practices

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 9 14% Region 8 9% Region 6 9% Region 7 5% Region 5 3% Region 2 15% Region 3 17% Region 1 11% Region 4 17%

Hospital Characteristics Primarily urban - 72% 52% in medium hospitals ( beds)

Reasons for offering CAM

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 TherapyAHA RankEisenberg Survey Rank Massage 13 Stress Management 2Not Ranked Yoga 3Not Ranked Relaxation Techniques 41 Pastoral Counseling 55 Acupuncture 616

Support for initiating CAM program

How patients access CAM services 80% 77% 51% 17%

How patients pay for CAM services

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

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