After a stress-reduction technique known as Reiki was introduced at Portsmouth (N.H.) Regional Hospital, one physician worried that it would “release the devil.” Others wrote “no Reiki” in patient charts. And the nurse who initiated the practice at the hospital was dubbed “Voodoo Queen” by a neurosurgeon.
But times have changed dramatically, as alternative care programs like Reiki have gained acceptance in the general public and in certain health care circles. “[Reiki’s] not a big deal anymore,” says Ana Drexler, R.N., director of integrative services and palliative care at Portsmouth and the nurse dubbed a voodoo queen. What started in 1999 as an offering of Reiki only to patients preoperatively to reduce anxiety has spread to now being available hospitalwide to patients, their visitors and hospital staff, Drexler says. “[Doctors] appreciate it, and they don’t call me the voodoo queen.
A growing number of hospitals are adding complementary or integrative therapies to their menu of services. One reason for the growth is the rise of consumerism in health care. “As patients want this, providers are being forced to help deliver some of these services,” says Andrew Ziskind, M.D., a senior vice president at Premier Academic Alliance.
Another factor is growing acceptance among clinicians of various nonconventional therapies as an adjunct to traditional medicine, he says.
In addition to Reiki, complementary therapies include acupuncture, massage therapy, deep breathing exercises, meditation, guided imagery and yoga.
Service models vary measurably. Some hospitals create comprehensive outpatient integrative medicine centers, others weave specific complementary services into inpatient care, and some offer a combination of outpatient and inpatient services.
The Financial Picture of Alternative Health Spending
Amount people spend on:
Complementary practitioners $14.7 billion
Natural product supplements $12.8 billion
Self-care approaches $2.7 billion
Total $30.2 billion
Regardless of the model, the reimbursement possibilities for integrative and complementary medicine are tough, Ziskind says. Insurers increasingly cover acupuncture, and they’re warming to massage therapy. But less-substantiated practices generally are not covered. Patients pay for them out of pocket, typically for therapies in outpatient settings; or the hospital offers them free of charge, commonly for therapies provided to inpatients.
Comprehensive outpatient centers often feature spa-like facilities with high operating costs. “The economics don’t necessarily align, especially in a high-cost environment,” Ziskind notes. Oftentimes, these centers are financed with the help of a philanthropy, he says.
On the inpatient side, hospitals hope that the complementary therapies cover or mitigate the cost of their delivery by shortening patients’ lengths of stay or reducing their need for pain medication, while improving the care experience.
Creating a healing environment
At Portsmouth Regional, Drexler sees the Reiki energy-healing technique as a supportive service that decreases patients’ anxiety. Relaxation is therapeutic because it lowers levels of the stress hormone cortisol, opens up the blood vessels and boosts the immune response, she says. Portsmouth hasn’t compared lengths of stay, pain medication use or patient satisfaction among inpatients who have received Reiki therapy with those who haven’t.
A voluntary survey given to surgical patients receiving Reiki asks them to rate their anxiety and pain before and after their procedure. Patients almost universally report a marked decrease in both, Drexler says.
Any hospital considering going down a similar complementary medicine path should keep its focus on the patient experience, Drexler advises.
“You have to have those people who are passionate to go for it,” she adds. “You have to have administration who is going to support it.”
People are beginning to be more accountable for their health and, at the same time, some consumers are growing skeptical of pharmaceutical medications, thanks in part to commercials that list myriad negative side effects, Drexler says.
“The time is right now because your public is looking for it,” she says. “I don’t think it’s as hard a sell to administration anymore because of that.”
- An estimated 59 million U.S. residents ages 4 and older had at least one expenditure for some type of complementary health approach in 2012.
- The average individual out-of-pocket expenditure was $433 for visits to a complementary practitioner, $368 for natural product supplements and $257 for self-care approaches.
- Spending increased with income. Average individual out-of-pocket expenditure for complementary health approaches was $435 for people with family incomes less than $25,000 and $590 for people with family incomes of $100,000 or more.
Integrative care physicians combine traditional medicine with complementary therapies, which is attractive to patients who are unfamiliar with nontraditional medicine and for physicians with an interest in providing it. “It’s a beautiful way to practice medicine because I’m not restricted by conventional or alternative; I use whatever works,” says Leslie Mendoza Temple, M.D., director of the integrative medicine program at NorthShore University Health System, a four-hospital, suburban Chicago network. “I start with the substances associated with the least toxicity and then move up from there if we’re not getting results,” Temple says.
Complementary therapies don’t work for every patient and every condition, she notes. “You have to still be very cognizant of and be really good at your conventional medicine,” she says.
Reimbursement issues are significant
Most complementary therapies are not covered by insurance, and the NorthShore integrative medicine practice only accepts Medicare and an HMO plan. The physicians and complementary care practitioners are NorthShore employees. Patients pay for their care out of pocket and then bill their insurance provider. New patient visits are an hour long and follow-up meetings are 30 minutes. “You really can’t do that and take insurance and stay financially afloat,” Temple says.
The lack of insurance coverage for most complementary therapies worries Temple because it tiers off access by income. She chairs the policy working group for the Academic Consortium for Integrative Medicine & Health, a group of 60 academic medical centers and affiliates. Her panel is studying how to influence policy to increase access to care.
The integrative medicine team also is trying to make it easier for people to access care in the community. Through a 2011 grant of an undisclosed amount from the Oberweiler Foundation, the program offers free acupuncture at Evanston Township High School, to young adults at NorthShore’s Deerfield Behavioral Health, and at Glenview’s Park Center for pediatric patients meeting financial criteria.
Without the grant, “patients would have to be pulled out of school, and their parents are working one or two jobs,” Temple says. “So we went to where the kids are.”
Reaching outside the hospital
The two-hospital Lourdes Health System based in Camden, N.J., has offered complementary services since 1986, and now runs Lourdes Institute of Wholistic Studies, where people can earn certification in such practices as holistic massage, yoga, reflexology, herbal medicine and aromatherapy. The institute arose from the belief that Lourdes “had an obligation to help others further the mission of integrating care,” explains Colleen Kendrick, director of community health and wellness for the system. As part of their education, students do inpatient rotations.
By the numbers: Out-of-pocket spending on complementary health
- Adult, practitioner visits: $14.1 billion (46.7%)
- Adult, nonvitamin, nonmineral dietary supplements: $12.0 billion (39.7%)
- Adult, other approaches: $2.2 billion (7.3%)
- Children, nonvitamin, nonmineral dietary supplements: $0.8 billion (2.6%)
- Children, practitioner visits: $0.6 billion (2.0%)
- Children, other approaches: $0.5 billion (1.7%)
Source: National Center for Health Statistics, “Expenditures on Complementary Health Approaches: United States, 2012,” June 22, 2016
The Lourdes strategy is to offer therapies patients couldn’t get elsewhere, says Mark Nessel, the system’s executive vice president and chief operating officer. “We don’t want to be retail,” he says. “We want to look just at specialized needs.”
As is the case with many providers, complementary medicine program financials are a challenge at Lourdes, which doesn’t rely on philanthropic funding. “We’re really trying to provide these services and get reimbursed just enough to cover the cost,” Nessel says.
Cost constraints and the push to provide care in the community spurred Lourdes to begin looking for partners with shared interest in wellness and complementary therapies. The result was a partnership with Cherry Hill (N.J.) Health & Racquet Club.
The arrangement means Lourdes can offer patients access to classes in exercises, such as yoga and tai chi, without renting space, while the club gains new members. The partnership especially benefits patients with physical limitations, Kendrick says. A fibromyalgia patient with musculoskeletal pain, for example, might not be able to take a standard yoga class. “We’re able to take our yoga instructor who is highly trained in managing folks with chronic conditions and have her work with them right at Cherry Hill,” Kendrick says.
Despite today’s financial pressures, Kendrick is bullish about complementary medicine’s future.
“As we start to see the development of ACOs and we see care move from volume-based care to value-based care, we’re going to be looking for more ways to keep people well,” Kendrick says. “I would be shocked if in the next five years we aren’t having a bit of a different discussion about the adoption of some of these modalities.”
Read on for how Portsmouth, NorthShore and Lourdes have structured their complementary and alternative medicine offerings.
Terminology: What’s what?
Alternative medicine: A non-mainstream practice used in place of conventional medicine.
Complementary medicine: A non-mainstream practice used in conjunction with conventional medicine.
Integrative medicine: Conventional and complementary approaches used together in a coordinated way.