resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
January, 2014, Vol. 14, Issue 01
Economic Evaluation of CAM/CIM Practices
By Massage Therapy Foundation Contributor
Contributed by MK Brennan MS, RN, LMBT; Jolie Haun, PhD EdS, LMT, April Neufeld, BS, LMT
In this month's review, the Massage Therapy Foundation's writing group selected a study done in 2012 that evaluates the economy of Complementary and Alternative Medicine (CAM), also referred to as Complementary and Integrative Medicine (CIM).This review is timely given the non-discrimination section of the Affordable Care Act is set to go into effect on January 1, 2014. Section 2706 provides a possibility for insurance reimbursement for massage therapy: "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law."
The objective of the review done by Herman et al., was to establish the value of complementary and integrative therapies within the health reform context. Numerous sources including PubMed, CINAHL, AMED, Psych Info, Web of Science and EMBASE, were searched for information published between 2001 and 2010. The Cochrane complementary and alternative medical group was used for determining the criteria for studies and all of the sources reporting economic outcomes were reviewed with the terms "integrative," "integrated" and "collaborative" medicine added to the search. Three hundred, thirty-eight (338) economic evaluations were identified and 204 of those were published between 2001 and 2010. One hundred, fourteen (114) of the 204 were full economic evaluations with 90% of those being studies of single therapies. Only one study compared usual care to usual care with access to CIM practitioners.
Surveys done in 1990, 1997 and 2007 show estimated out of pocket expenditures of $14 billion, $27 billion and $34 billion for CAM to treat principal medical conditions. This indicates an increase in the use of CAM for healthcare and the willingness of individuals to pay for it. The cost-effectiveness of CAM use, however, has not been well defined. As the authors explain, "Economic evaluations allow costs to be included, alongside data on safety and effectiveness, in healthcare policy decisions. As healthcare costs rise, the availability of these economic evaluations becomes increasingly important to the formulation of disease management strategies which are both clinically effective and financially responsible." This type of evaluation provides massage therapists and other CAM practitioners information that is valuable when meeting with conventional healthcare providers, insurance providers, policy makers, consumers and other stakeholders.
Articles were categorized as full or partial economic reviews. A full evaluation compared the costs, as well as the outcomes, of two or more therapeutic treatments for the same population. A partial evaluation was one that focused on cost-identification or cost-comparison. The authors used the 35-item British Medical Journal checklist to capture components of internal validity and transferability of information. They "also chose five quality criteria by which to identify a subset of full economic evaluations to highlight as being of most interest to policy makers." These include a comparison of CAM to usual and customary care; use of at least one recognized perspective such as hospital or third-party payer; randomized control studies or non-randomized ones that are adjusted to address baseline differences; a measured outcome unless the study was a modeling one that used the data from previously published studies; a sensitivity analysis since assumptions made can factor into uncertainties in economic evaluations.
Items reviewed from the studies that met the above criteria included: "treatment and study duration, primary clinical and economic outcome measures, the setting in which treatment took place, study design and sample size, the type and perspective (i.e., the point of view used to define costs) of the economic analysis, and incremental cost effectiveness of the CIM alternative compared to usual care."
Results of the analysis are mixed. Thirty-one of the full economic studies were considered a higher-quality than the others because they met all five of the study criteria. These indicate potential cost effectiveness and even cost savings across a number of CIM therapies and populations. "Of the 56 comparisons made in the higher-quality studies, 16 (29%) show a health improvement with cost savings for the CIM therapy versus usual care. Study quality of the cost-utility analyses (CUAs) of CIM was generally comparable to that seen in CUAs across all medicine according to several measures, and the quality of the cost-saving studies was slightly, but not significantly, lower than those showing cost increases (85% vs 88%, p=0.460)."
Other studies reviewed provide information for specific practices and/or settings. For example, cost savings were seen with acupuncture for breech presentations in pregnant women and also for low back pain. Other cost savings were found with some supplements, naturopathic care, Tai Chi and manual therapy.
The methods used in this article are comprehensive and applied multiple measures of study quality in the review of the articles. However, the authors recognize some study limitations, including: 1. The reviewers not blinded to journals and article authors; and 2. Publication bias was not assessed. However, the authors suggest for the purposes of this review, it is not clear if either of these limitations is relevant.
This report and those like it are valuable to those interested in making a case for the inclusion of CAM in healthcare settings or insurance reimbursement as well as consumer awareness. As the use of CAM increases and policies change to increase reimbursement of CAM care, economical evaluations of this type are needed to determine the use and cost effectiveness of CAM in the healthcare setting.
To learn more about the economic impact of CAM, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search Pub Med for CAM/CIM cost analysis studies.
Click here for more information about Massage Therapy Foundation Contributor.
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