Complementary and Alternative Medicine: Professions or Modalities?
Oct 2, 2015
Practitioners Face Many Policy Hurdles to Finding Their Place in Mainstream Medicine
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Complementary and alternative medicine (CAM) practitioners such as chiropractors and acupuncturists are almost unique among health professionals in that, although they are legally recognized as members of professions, and some can provide primary care, Medicare and most private insurers treat them primarily as purveyors of a limited set of procedures.
While conventional doctors belong to health care systems, CAM practitioners usually do not, and their services are treated as "add-on" or second-tier services that conventional doctors could also offer their patients. As a result, integrating CAM practitioners into primary care — which has a shortage of providers — is rarely considered in health policy or research. Furthermore, CAM practitioners cannot seek reimbursement from insurers for many services they are trained to perform and so cannot practice to the full extent of their capabilities, which for chiropractors might include giving full physical examinations or writing prescriptions.
In addition to undermining the intent of various states' laws that establish CAM practitioners as licensed health professionals, limiting CAM professionals' scope of practice has significant policy implications for patients, the CAM professions, and health care in general. Complementary and Alternative Medicines: Professions or Modalities? examines the landscape for four types of CAM practitioners with the strongest claim on established professional status: chiropractic, acupuncture and Oriental medicine, naturopathic medicine, and massage therapy. The study examines various policies that apply to CAM, the research literature, and the results from two panel discussions — one of CAM experts and the other of health care decisionmakers.
There are a number of health-related policies where designation as a profession versus a procedure or modality has an impact. Often, these policies prevent patients from accessing CAM practitioners, even when the treatment they provide may promise the best outcomes. These include:
One key solution to helping CAM professionals practice to the full extent of their training and capabilities involves integrative care — that is, including, as appropriate, practitioners of CAM on the team of doctors, nurse practitioners, and physician's assistants that has traditionally been responsible for a patient's care. Because CAM and non-CAM providers often perform in siloes, care does not necessarily address conditions in an integrative or coordinated manner. Integrative teams would provide not just medical care, or care for a particular episode, but also wellness care, prevention, and support for lifetime health. Integrative care may be the future of health care, so advancing CAM in this way addresses the rapidly emerging future rather than the present state of the industry.
A number of specific regulations and coding issues act as obstacles and may even preclude integrative care teams that include CAM in mainstream settings. During the panel discussions, the experts considered the following:
A number of issues for the CAM professions also need to be addressed to move the health care system to successful integrative care. These recommendations include the following:
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