Alternative Care Gets Less Fringey

As in any treatment decision, Bauer recommends weighing the effectiveness of an alternative therapy against its potential to cause harm. He uses the example of chelation, the practice of injecting a manmade amino acid called EDTA (ethylenediaminetetraacetic acid) into the bloodstream to treat heart disease. “The idea is, it scavenges fat globules off of artery walls,” Bauer says. But so far, studies have not shown a benefit, and he worries about potential harm. A National Institutes of Health trial is underway now on that procedure, according to Bauer, and he would wait for those results before recommending chelation to a patient.

Show Me the Study

Research centers like the Mayo Clinic, Abbott Northwestern, and the University of Minnesota are all working to expand the clinical literature on complementary and alternative therapies. They’re motivated by more than a desire to educate patients and care providers. Abbott, for example, is collaborating with the Samueli Institute, a nonprofit group in Washington, D.C., to measure whether alternative therapies decrease the use of pain medication and the length of hospital stays, which would directly affect Abbott’s profitability.

“Insurers are not paying for these [alternative therapies] in the hospital,” Knutson says. (Currently, philanthropy, like that of the Georges, is footing the bill.) “So we’re trying to help the hospital see that if these services help reduce costs, it’s definitely a good return on investment.”

Knutson has reason to be optimistic about a continued increase in the use of alternative treatments in mainstream medical settings. Abbott’s outpatient integrative-treatment center, which the hospital opened in 2004, is already “bursting at the seams,” she says. Its 500 weekly visitors flock to providers like the registered nurse–healing coach, the psychologist, and the nutritionist, and draw on services such as acupuncture, herbal-supplement consultations, classes in yoga and tai chi, as well as a retail store with products that support those services.

Insurers do reimburse for many of these outpatient visits, which aren’t coded into the insurance industry’s infrastructure of “diagnostic related groups”—medical procedures and acceptable costs and activities associated with them—the way inpatient care is. “We can bill for acupuncture, nutrition therapy, and the psychologist,” Knutson says. Over the past two years, “reimbursement has increased by 60 percent,” and she expects more procedures to be reimbursed in the relatively near term.

Abbott is by far the country’s largest provider of integrative care in a hospital setting, according to Knutson. As a result, she says, research partners including Harvard Medical School are looking to do studies with Abbott Northwestern.

Results from Abbott’s collaborative study with the Sam-ueli Institute should begin to be published in major medical journals in the next 12 to 18 months, Knutson says. Hard data will drive acceptance of complementary medicine by insurers and the addition of alternative therapies to their inpatient reimbursement regimens, she believes. Now that’s integration.