Credentialing CAM Providers

It's important to remember that a variety of personnel may be offering CAM services: physicians; allied health providers (such as nurses); and CAM providers (such as acupuncturists).

Physicians typically get privileges as members of the hospital staff; such privileges will need to be modified to add specified CAM therapies. This may be heavily contested or negotiated with the hospital's medical executive committee.

The task may be slightly easier with allied health providers, who may have their own departmental committees to review scope of services allowable within the hospital. Allied health providers have a narrower scope of practice than physicians, and one typically set forth in a statute and any explanatory regulations or interpretive cases. You can find a lot of detail about licensure and scope of practice in Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives, and in Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, van Rompay MI, Cooper, RA. Credentialing complementary and alternative medical providers. Ann Intern Med; 2002;137:965-973.

Some CAM providers may already be operating within the hospital system--for example, there may be an acupuncturist within the pain unit of an affiliated hospital within a larger, complex system. Credentialing criteria for this provider can serve as a model for others in an integrative care unit.

The article on Credentialing referenced above offers good information about steps involved in credentialing CAM providers. The abstract reads: "Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations. The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies."

Another helpful resource will be a forthcoming book funded by the National Library of Medicine, in which Mary Ruggie, PhD (a professor at Harvard's Kennedy School of Government) and I interviewed over twenty-five integrative care centers across the U.S. about strategies they used to overcome social and legal obstacles to integrative care. We summarized some of these strategies and our findings in Cohen MH, Ruggie M. Integrating complementary and alternative medical therapies in conventional medical settings: legal quandaries and potential policy models. Cinn L Rev 2004;72:2:671-729. A large part of the article focuses on credentialing struggles within the integrative care unit; look for a forthcoming Part 2 to this article soon.

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