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Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
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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