CAMLAW: Complementary and Alternative Medicine Law Blog : Complementary, Alternative, & Integrative Medicine Law, Regulation, Ethics & Policy (Alternative and Complementary Medicine, Medical Spa Information, Holistic Health Attorney, and Legal Resources)

CAM is used by religious professionals:

Complementary alternative medicine practices used by religious professionals.

J Health Care Chaplain. 2010 Jul;16(3):172-82

Authors: Jankowski KR, Silton NR, Galek K, Montonye MG

Religious professionals completed an online survey of their use of health related practices currently known as complementary and alternative medicine (CAM). They indicated how often they engaged in these practices and how often they had used these practices when helping other people. The majority of religious professionals used at least one of the practices when alone and when helping other people. The most frequently used practices were meditation and deep breathing exercises used both when alone and when helping others. Female respondents were more likely to use these practices on their own and when helping others than were males, and older respondents were more likely to use multiple CAM practices than their younger counterparts. Other Faith/Humanists used the most CAM practices when alone and Jewish respondents used the fewest. In general, religious professionals used fewer practices when helping others than they used for themselves. Limitations of this study and suggestions for future studies for examining CAM practices among religious professionals are discussed.

Alliance urges use of ABC over CPT codes for legally compliant billing and coding of medical technologies involving alternative and complementary medicine:

The world of medicine is run by billing codes. Every hospital, doctor, and practitioner who accepts insurance or Medicare uses billing codes so they can be reimbursed. But where are the codes for integrative and alternative medical services?  Our Action Alert to the DHS this week asks for the incorporation of these integrative codes.

Healthcare codes describe medical, surgical, and diagnostic services, remedies, and supply items provided to patients. They are designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, payers (insurance, managed care, Medicare, Medicaid, etc.).

The code set copyrighted and maintained by the American Medical Association is called the Current Procedural Terminology (CPT) code. In 1983, an agreement between the HCFA (the government’s Health Care Financing Administration, which is under the Department of Health and Human Services) and the AMA made the CPT the sole coding system that could be used for billing Medicare. This monopoly completely squeezes out alternative and integrative medical practitioners.

The AMA’s codes are for treatments by conventional medical doctors, in allopathic medical care systems. There are no codes for complementary and alternative medicine (CAM) because the AMA doesn’t deal in that type of medicine; for them to create CAM codes would in fact be a conflict of interest.

There is a competing system that can fill those gaps: the ABC codes—a system of 4,400 new codes specifically designed for those 4,300,000 non-MD practitioners working in professions such as nursing, behavioral health, alternative medicine, ethnic and minority care, midwifery, and spiritual care. They are important for a number of reasons:

• they are HIPAA-compliant (HIPAA is the Health Insurance Portability and Accountability Act; passed by Congress in 1996, it allows for people to transfer and continue their health insurance coverage when they change or lose their jobs, mandates industry-wide standards for healthcare information on electronic billing, and requires the protection and confidential handling of protected health information);
• they can be used by both licensed and non-licensed healthcare practitioners on standard claim forms;
• they complement existing code systems used in the allopathic setting;
• they accurately document the care patients receive, covering a vast range of healthcare practices; and
• they fulfill requirements imposed by both state medical boards and payers.

Widespread use of ABC codes is desperately needed so alternative medical providers can be fairly compensated for the services they provide, and can document and quantify the safety and efficacy of their treatments.

However, the AMA’s coding system is being spread across the board—and physicians are charged to use it, even though only 15–19% of practicing physicians are AMA members. And it’s a huge business. The AMA’s own website says, “The AMA is a successful business entity that generates approximately two-thirds of its annual $230 million operating budget from non-dues sources”—which includes the hefty fees to use the CPT codes.

In 1997, the US Court of Appeals, Ninth Circuit, ruled that the AMA’s exclusivity agreement with HCFA for using CPT “gave the AMA a substantial and unfair advantage over its competitors” and “constituted a misuse of the copyright by the AMA.” The court did not address whether the AMA’s conditions and high prices for a licensee’s use of the CPT code constituted violations of anti-trust law as well.

In 2001, when he was Senate Minority Leader, Trent Lott (D–MS) asked the Department of Health and Human Services to clarify the exclusivity arrangement it had with the AMA’s coding system. In response, the HHS approved a two year pilot project using the ABC codes. The pilot project was an amazing success, providing stunning statistics in a report showing the need for a revised billing code system—one that would include billing codes for ALL health practitioners.

According to ABC Coding Solutions, which developed the ABC codes, the AMA is now open to other coding systems, and ABC codes can work with CPT and provide supplemental information for billing, but the government has been unwilling to implement any changes that would have a greater effect on the healthcare billing system. Our Action Alert to the DHS this week asks for the incorporation of these integrative codes.

As we pointed out last week, doctors often have their hands tied by healthcare regulations. A doctor can be charged with a crime for billing an “unnecessary” treatment to the government or a private insurance company, because the CPT codes often do not allow for non-traditional services. This makes it difficult for doctors to bill their services accurately and puts them at risk of running afoul of government regulations.

There are several ways for an integrative doctor to reduce this risk. One is to not participate in any government program or accept private insurance.  Another is to avoid using the CPT codes and instead substitute the ABC codes—ABC will automatically convert its code to the AMA’s code for such billing purposes. This makes the treatment more likely to be covered, and it will therefore be harder to say that it is “unnecessary.” This can be  especially useful for an integrative clinic that is part of a hospital system that requires the AMA’s code.

Tai Chi keeps you young:

Tai Chi Boosts Efficacy of Antidepressant Therapy in Older Adults

July 25, 2010 – Adding an abbreviated version of Tai Chi to antidepressant therapy with escitalopram improved resilience, quality of life, and cognitive function in adults with major depression 60 years and older, according to a new research conducted by the David Geffen School of Medicine at the University of California, Los Angeles.
“Fewer than half of elderly depressed patients respond to first-line antidepressant pharmacotherapy,” said Helen Lavretsky, MD, when talking about her research. “There is some information in the literature about the benefits of Tai Chi in older adults, but this relates to their balance and their physical functioning. We wanted to see whether Tai Chi would be helpful in improving depression.”

The study recruited 112 adults with major depression and treated them with 10 mg of escitalopram daily for 6 weeks. The 70 subjects who partially responded to escitalopram continued to receive 10 mg of escitalopram per day. In addition, they were randomly assigned to receive either 10 weeks of Tai chi Chih for 2 hours a week or to a lecture on health education for 2 hours a week. “Tai chi Chih is a shortened form of Tai Chi that has only 20 movements and is easier to remember over the course of 10 weeks,” Dr. Lavretsky explained.

Most of the patients (62%) were women, and their mean age was 70 years. The patients were evaluated for depression, anxiety, resilience, health-related quality of life, psychomotor speed, and cognition.

Both Tai Chi and health education patients showed similar improvement in the severity of depression, with mean Hamilton Rating Scale for Depression scores of 6.0 in both groups, Dr. Lavretsky reported. However, subjects in the Tai Chi group showed significantly greater improvement in resilience than did subjects in the health education group. The Tai Chi group also had better health-related quality of life. “Patients who were in the Tai Chi arm had a greater resilience to stress, and I thought the improvement in cognitive measures, such as memory and executive function measures, with Tai Chi was particularly impressive,” Dr. Lavretsky said in an interview.

“I’m in Los Angeles, so people tend to like alternative medicine interventions,” she added. “The limiting measure was the degree of arthritis that patients had. The patients who were in the education group liked that intervention, too, but it was very interesting to me to see that this gentle form of exercise had these superior results. Even C-reactive protein levels in the Tai Chi group were improved.”

This study was funded by the National Center for Complementary and Alternative Medicine. It has been presented at the American Psychiatric Association’s Annual Meeting in May and then at the New Clinical Drug Evaluation Unit (NCDEU) 50th Anniversary Meeting in June.

More CAM law news:

Bastyr University of Kenmore is the recent recipient, along with Fred Hutchinson Cancer Research Center in Seattle, of a $3.1 million grant for the study of complementary and integrative care for breast cancer. The grant, awarded by the National Institutes of Health (NIH) and National Center for Complementary and Alternative Medicine (NCCAM), will officially fund a project titled “Breast Cancer Integrative Oncology: Prospective Matched Controlled Outcomes Study.”

CAM use in Canada studied.....Purpose: To conduct a systematic review of reasons for and sociodemographic and disease characteristics associated with complementary and alternative medicine (CAM) use in cancer patients. Methods: Eligible studies were identified by searching the following databases: Alt Health Watch, AMED, CINAHL, CancerLit, PremMEDLINE, MEDLINE, Pub-Med, Ingenta, EMBASE, and Health Star, as well as reference lists in review articles. Only English-language articles published between 1994 and 2004 were included. Search terms included CAM and oncology/cancer , decision making and CAM and oncology/cancer , treatment decision making and CAM and oncology/cancer , and health care choices and CAM and oncology/cancer . Results: Fifty-two eligible studies were identified and summarized. These studies were conducted in 14 different countries, with the largest number of studies being completed in the United States (34.6%). A therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope were the most commonly cited reasons for using CAM. Age, socioeconomic status, and gender were the dominant characteristics associated with CAM use. Conclusion: Reasons for and characteristics associated with CAM use among cancer patients have been studied extensively. Future CAM research among cancer patients should focus on identifying decision-making processes and building theoretical decision-making models. These can be used in the development of decisional aids for patients when confronted with the choice to use CAM as part of their cancer treatment.

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Michael H. Cohen is an attorney providing business legal advice to green entrepreneurs and companies, and health care law advice to businesses and physicians, acupuncturists, naturopaths, homeopaths and others in the holistic health, wellness, and green industries. As a founding attorney of the Global Vision Law Group, he represents businesses poised for vertical lift, whose leaders are conscious, intuitive, and committed to shaping a better world. Michael also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists, dietary supplement and cosmetics companies, and businesses with bio-energy and other technologies and medical devices. Michael offers the Entrepreneur’s Legal Toolkit as a series of legal guides to businesses. The first legal e-book deals with Contract Essentials, giving legal tips every business needs to negotiate its legal agreements; the second addresses legal issues faced by multi-level marketing companies and individuals involved in multilevel marketing and direct sales; and the third one so far is a HIPAA Regulations and Privacy Manual at far less the cost than it would take for an attorney to prepare.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services. 

Read reviews of Michael’s work on the Complementary Complementary and Alternative Medicine Law Blog. And visit the Flat Rate Legal Services page for information on legal services offered at a flat rate or project fee (such as incorporation for entrepreneurs, review and drafting of business contracts, trademark, and health law services for CAM providers and others).

Michael’s clientele  through the Global Vision Law Group includes businesses not only in California, New York, Maryland, Massachusetts, Washington, D.C., and other U.S. states, but also abroad. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about laws and legal issues for entrepreneurs and new enterprises that are seeking legal advice, contact the Global Vision Law Group today.