As the acupuncture and Oriental medicine (AOM) profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate." The expansion of integrative health and wellness offerings within, and outside, the traditional health care systems is increasing. The growing focus on the Triple Aim, and actually measuring population health, experience of care, and per capita cost are requiring that AOM be part of the solution. There is a growing need for AOM graduates to work within health care systems and be at the table for the discussions.
The difficulty for the schools and organizations that form the foundation of the AOM profession is that many are not well informed of the weight of integrative medicine that faces the AOM profession, how to participate in the discussions or who the players are. The Council of Colleges for Acupuncture and Oriental Medicine recently held it's biannual meeting November 10-12, 2015 in Annapolis, Maryland and provided a healthy discussion and respected guest speakers on integrative medicine. Len Wisneski, MD, Chair of the Integrative Healthcare Policy Consortium (IHPC) and Courtney Jordan Baechler, MD, Chief Wellness Officer and Vice President of Penny George Health and Healing at Allina Health informed the members of the significant work happening nationally, and within Allina, demonstrating the upswing in acupuncture and Oriental medicine across the nation.
Dr. Baechler launched the presentation with an introduction of the impressive history of the Penny George Institute, formed in 2003, and now the largest integrative health care program in the country that is integrated within a health system. Their mission is to combine leading medical practice with ancient healing wisdom, to optimize health and wellness in the whole person – body, mind and spirit. Allina Health serves Minnesota and western Wisconsin with 13 hospitals and 60 clinics. They provide inpatient and outpatient services with the following team of providers and services:
The presentation was capped with the broad overview of challenges facing health care from Dr. Len Wisneski, Chair of the Integrative Healthcare Policy Consortium. The challenges we see with population health of unsustainable expenditures, insufficient primary care providers, uninsured patients, unhealthy behaviors and weak socioeconomic conditions are leading to shorter lives and poorer health. The fact that the chronic diseases affecting a large percentage of Americans can be helped with simple, low-cost health promotion and prevention is not being lost among many policy leaders in the nation.
The Integrative Healthcare Policy Consortium is a coalition of healthcare organizations, clinicians, patients and educators that advocates for public policy that ensures all Americans access to safe, high quality, integrative, whole person healthcare. IHPC includes naturopathic doctors, chiropractors, acupuncturists, nurse practitioners, nurses, midwives, nutritionists, massage therapists, medical doctors and osteopathic doctors and was responsible for several inclusions of integrative health and prevention in the Affordable Care Act (ACA 2706, 3502, 4001, 4206, 5101, 6301, Wisneski, 2015). The recent publication "Integrative Health and Medicine: Today's Answer to Affordable Healthcare" (Oberg, Guarnari, Herman, Walsh, and Wostrel, 2015) provides clear evidence for the inclusion of AOM as part of the Triple Aim.
Not only has the American Academy of Medical Colleges increased their accountability of integrative medicine within mainstream medical colleges, but the ACAOM standards for the first-professional doctorate also frame the need for interprofessional collaboration and education.
In addition to revised accreditation standards emphasizing interprofessional collaboration, the recent Joint Commission ruling on revisions to pain management standards (PC.01.02.07) state: "The identification and management of pain is an important component of patient-centered care. Patients can expect that their health care providers will involve in their assessment and management of pain. Both pharmacological and nonpharmacological strategies have a role in the management of pain." Nonpharmacological strategies could include physical modalities (acupuncture, chiropractic, osteopathic manupulative therapies, massage theraoy, physical therapy), relaxation therapy, and cognitive behavioral therapy.
With the growing emphasis on measuring the Triple Aim and more states including language from the ACA for health care coverage, the need for practitioners continues to grow as seen in the recent MA [R] HB 930: An Act relative to the practice of acupuncture: "Establishes a commission on acupuncture and wellness. The commission acupuncture and wellness shall make an investigation and comprehensive study of the potential for better integrated use of acupuncture services to expand access, reduce health care costs, and provide improved quality of care to Massachusetts residents. All individual or group accident and health insurance policies and health service contracts delivered, issued or renewed by an insurer or nonprofit health service corporation which provide benefits to individual subscribers and members within the commonwealth or to all group members having a principal place of employment within the commonwealth shall provide benefits for acupuncture and oriental medicine based diagnosis and treatment in the areas of pain management, post-traumatic stress disorder, substance abuse treatment, and nausea. Notwithstanding any general or special law to the contrary, no third party payer of health care services shall differentiate reimbursement rates for acupuncture services by provider type. Only licensed acupuncturists or medical doctors shall be reimbursed for acupuncture services." http://cqrcengage.com/painmanagement/legislation
The future is bright for the AOM profession that will need to find ways to integrate with other health care providers and systems. Even with the many positive trends with acupuncture, Wisneski states there are still some challenges needing to be worked out such as:
It's clear these challenges are being taken on by many of us in the profession and other leaders are recognizing the need for change also. As Ken Paulus, CEO Allina said, "We've been in the business of treating diseases and we do it well. Now, for the first time ever, the payment will change to keeping people healthy."
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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