Saturday, July 27, 2019

Lunchtime Listen Recommendation: The VA Whole Health Program

keywords: Veterans' Health Administration (VHA), U.S. Department of Veterans' Affairs (VA), acupuncturists, the new "whole health" program

The VA Staffing Position for Acupuncturists
Acupuncturists are being hired as a unique staffing position into the U.S. VHA system as part of their whole health programs.  See the "VA Staffing Code" blogpost for more information.

What is the Whole Health program at the VA?
I recommend watching this presentation of Dr. Tracy Gaudet's work with this field-forwarding initiative to learn more. Dr. Gaudet's lecture here is the NIH's Stephen E. Strauss Distinguished Lecture, given November 29th, 2018, "Transforming Veteran's Health Care: The Whole Health System". 

The Academic Collaborative of Integrative Health hosted a webinar series that included a presentation (6.13.2019) on the VA's Whole Health model, "VA's Whole Health System: What can be learned and applied to your practice?" by Kavitha Reddy, MD, and Lauri Phillips, RDN, LD. More information, including how to download slides can be found at the ACIH landing page for this presentation.

For more about the Lunchtime Listen Recommendations series, learn more at this webpage and check out the related YouTube playlist.

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

The CHRONIC Care Act: A Health Policy Focused on Addressing Social Determinants of Health

keywords: Centers for Medicaid and Medicare Services (CMS), Medicaid, Medicare, federally qualified health centers (FQHC), Medicare Advantage plans, health policy in the United States, social determinants of health (SDOH), patient-centered medical home (PCMH), accountable care organizations (ACA)

themes: evidence-based health care, addressing social determinants of health (SDOH) to decrease societal health care costs, addressing SDOH to improve individual health outcomes, public health, health policy

Community News on U.S. Health Policy, Research, and Measuring Patient-Centered Outcomes (Metrics): Medicare the CHRONIC Care Act

You know how hit or miss, depending on your region, the Medicare Advantage plans are on covering acupuncture the past couple years? Ever wonder why the Advantage plans have more variability than standard Medicare? This article from JAMA that touches a bit on Medicare Advantage plan flexibility and the 2018 CHRONIC Care Act helped me better understand this and how it has impacted coverage of acupuncture services.

Medicare Advantage programs (not to be confused with regular Medicare) are allowed to be innovative.  In fact, you may have noticed several programs are leading the way on innovation and coverage of integrative health services and other wellness-promoting and function-promoting services.

Some of this innovation is in response to recent federal health policy initiatives to address social determinants of health (SDOH) in patients and patient populations with chronic health conditions.

The following July 2019 study, "Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act" looked at how these insurance companies were responding to the Medicare incentive from innovative ideas to limits.

acronym of "CHRONIC" stands for: "Creating High-quality Results and Outcomes Necessary to Improve Chronic care" aka the "CHRONIC Care Act of 2018"

Connection to Integrative Health (IH)
The IH paradigm looks at a person as a garden, as part of a larger system that includes their environment and community. Some Medicare/Medicaid advantage programs have begun covering IH care, including services provided by acupuncturists as related to its large evidence base demonstrating improved health outcomes. Medicare Advantage program patients can receive care at private practice clinics or hospital-based outpatient clinics.

Why This Policy Change and Its Implementation is Important
According to the paper, “The passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act in 2018 allows Medicare Advantage (MA) plans, which enroll more than one-third of Medicare beneficiaries, greater flexibility to address members╩╝ social determinants of health (SDOH) through supplemental benefits.”
“To provide more benefits to address SDOH, MA plans may learn from the experience of other payment models in expanding their service offerings. While, to our knowledge, there is no evidence to date of how MA plans can better address SDOH, flexibility has existed to address SDOH and other patient needs in patient-centered medical homes, 36 accountable care organizations (ACOs),10,37-41 and Medicaid Managed Care. 42-44" [emphasis added]

Challenges these companies have when they are innovating new patient care coverage plans that address social determinants of health

  1. finding strong evidence base for types of clinical care or procedures that show improved patient outcomes 
  2. finding evidence base for cost-effectiveness 
  3. finding partners who can provide these evidence-based services
  4. getting clear guidance from CMS about what is permitted

"In particular, ACOs may face many of the same challenges as MA plans as they begin to take on more capitated risk, i.e., the need for a strong evidence base that addressing SDOH may improve patient outcomes and reduce costs, the ability to find partners who can provide these services, and clear guidance from CMS about what is permitted.39"
"In a 2014 qualitative study (38) of ACO perspectives on SDOH, ACOs, similar to MA plans, were interested in expanding these types of benefits but did not always know how." [emphasis added]
"The Hennepin model, (41) in which a Medicaid Managed Care agency partners with a hospital, a community health center, and the county department of health to better coordinate services, is often seen as a successful example of how organizations can address SDOH through community partnerships."
"The past successes of Medicaid Managed Care in addressing SDOH may be an even more relevant example to MA plans on how an insurer can best address these concerns.(10)” [emphasis added]
Citation: JAMA Netw Open.2019;2(7): e196923. doi:10.1001/jamanetworkopen.2019.6923 

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

More Documentation and Coding Resources

keywords: documentation, charting, coding, CPT, E/M, and modifiers, licensed acupuncturist, east Asian medicine practitioners, integrative health

Here are some new resources for reviewing documentation and coding standards in the profession

Documentation and Coding Review Video with Sam Collins, DC of the American Acupuncture Council Information Network, dated May 15th, 2019:

Coding and Use of Modifiers with Evaluation and Management (E/M) codes
  • Article by Sam Collins, DC in the May 2019 edition of Acupuncture Today, volume 20, issue 05.  "The Most Common Modifier for Acupuncture Claims".
  • Summary of content: 
    • An insurance company can deny a claim if you do not code your work to their standard. The common denial issue he discusses in this issue is choosing and using the correct modifier with your E/M code.
    • Types of modifiers he covers in this article include: level 1 modifiers, modifier 25, and modifier 59.  There is also the special case GP modifier that is common in the VHA program that covers acupuncture services by some vetted community providers, "Veterans Choice".
  • source: article by Sam Collins, DC in the May 2019 edition of Acupuncture Today, volume 20, issue 05.  "The Most Common Modifier for Acupuncture Claims". Link to the digital edition of this article. And the webpage version of the article on Acupuncture Today.

Related Blogposts on Documentation include

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

Friday, July 26, 2019

Research Thursdays: Oncology

key words:  research literacy, acupuncture and oncology, integrative oncology, sharing related research in the field, research in integrative health; integrative survivorship, oncology and insomnia, program examples, oncology work and compassion fatigue

Acupuncture in Oncology

Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter with focus on Oncology

At the Hospital-practice Handbook Project, we encourage practitioners to cultivate mentor-relationships and practice research literacy

This is a work in progress. last updated 9.5.2019.

Community Survey 

Oncology Acupuncture Community News
  • New webpage from the Advocate Aurora Integrative Health program in oncology (program)
  • research--oncology and insomnia.  New paper from Memorial Sloan-Kettering on insomnia in cancer patients
    • Both cognitive behavioral therapy and acupuncture had clinical effectiveness in treating severity of insomnia and had sustained benefits for 20 weeks. It was the first comparative effectiveness study for this clinical research query.
    • Sheila N Garland, Sharon X Xie, Kate DuHamel, Ting Bao, Qing Li, Frances K Barg, Sarah Song, Philip Kantoff, Philip Gehrman, Jun J Mao, Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial, JNCI: Journal of the National Cancer Institute.
  • Integrative Survivorship programs for life after cancer (program)
    • "Implementing an Integrative Survivorship Program at a Comprehensive Cancer Center: A Multimodal Approach to Life After Cancer”, is a JACM free-access article.  The study: “describes the development of an integrative survivorship program at an urban National Cancer Institute-designated comprehensive cancer center with three closely linked components: a Survivorship Clinic with dedicated staff, a network of Support Services including Wellness, and an Integrative Medicine Program.”
    • Integrative health providers included in this program noted as: nutritionist and acupuncturist. Integrative health programs included: yoga, mindfulness, Healing Touch, and Reiki, and psychosocial oncology.
  • February 2019 National Cancer Institute (NCI) and National Institute of Health (NIH) conference, "The National Cancer Institute NIH Report" by Dr. Jennifer Stone, published in Meridians: Journal of Acupuncture and Oriental Medicine (now the Journal of American Society of Acupuncturists).

Related Community Survey
  • How Do You Define Success in an Integrative Oncology Program? 
    • At this time a large % of acupuncturists working in hospitals are working in oncology programs.  
    • Goal: learn about the current standards and metrics for integrative oncology programs, focus on the work of licensed acupuncturists
    • How will this info be used? 
      • Continue discussion in the community about the following topics: using metrics in clinical care, finding relevant metrics for your work, how integrative oncology programs are being set up, maintained, and grown
      • when enough information, I will publish a blogpost summary 
      • follow up interview potential about specific programs for those interested in participating, part of the "issues in hospital practice" community webinar/interview series.  Go to this post for more about this special Project series.  

Related Interviews
coming soon...

Related Blogposts
More resources on Integrative Oncology Recommended by the Community
Research Articles

"Compassion fatigue is a phenomenon in which witnessing high levels of suffering and death over time may lead to reduced capacity and interest in being empathetic to the suffering of others. Not surprisingly, compassion fatigue may contribute to burnout and secondary traumatic stress. Because they deal with cancer, oncologists are particularly susceptible to this phenomenon. 
"To understand compassion fatigue, Dr. Rony Laor-Maayany surveyed 74 oncologists in Israel using the Professional Quality of Life Questionnaire (PRoQOL) and the Texas Revised Inventory of Grief (TRIG)-Present Scale. Surprisingly, they found no association between exposure to suffering and death and compassion fatigue. Rather, it was grief and sense of failure that predicted compassion fatigue, burnout, and secondary traumatic stress. Altogether, the authors suggest that the subjective experience elicited by the exposure, e.g. grief, may be more important than the exposure itself. This provides insight into potential interventions focusing on perceptions and experiences to prevent compassion fatigue and consequent burnout."

  • a

For more on the topic of research
  • follow the tag/label in this blog for "research literacy"

Monthly research summary blogposts

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us
for "research and metrics Thursdays" on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

Saturday, July 6, 2019

Basics of Being an Employee in a Healthcare System: Focus on Performance Management, a Wisdom-Share Series with Sondra Abanto, MBA

keywords and phrases: hospital employee, being an employee, basics of being a health care professional in a U.S. health care system, clinician employee, employee acupuncturist, integrative health employee, basics of performance management for the professional health care employee; interview series, special topic; milspouses Megan and Sondra share wisdom for the integrative health community :)

Wisdom-Share Interview Series with Sondra Abanto, MBA

updated July 2019
This interview series is coming to you from the corner of Courage and Commitment.  After 5 years of military PCS moves, our (Sondra and Megan's) worlds are overlapping again.  So, let's take advantage of it!

This is a relaxed interview series where Megan interviews Sondra about the basics of what to expect when you are an employee in a medium to large organization, with emphasis on health care organizations and asides about working as an integrative health care clinician within the system.  We talk about what to expect in an ideal situation from parameters to resources.

This is a series of interviews we (Megan and Sondra) recorded in winter and spring 2019 where Sondra covers the following topics related to performance management:

  1. employee orientation process basics (onboarding)
  2. performance plans
  3. mentorship
  4. team communication
  5. career path mapping

This series is intended for the acupuncturist or related integrative health care professional working (or interested in working) in hospital-based practice in the U.S., whether the civilian sector or the federal sector of employment.  However, we go over basics that apply to any health care professional employee in the system.

Sondra Abanto, MBA, has significant experience in both civilian and federal sectors on program and performance management (metrics) who has also trained as an MSA (acupuncture) student.

As of summer 2019, the sessions have finished recording and will be going to the video editor. If you are interested in this interview series, sign up on the landing page email list and you'll be notified when the recordings and related materials are published. Go here to sign up.

We are still looking for sponsors for this series, if you or your organization is interested in sponsoring this series (partially or fully), please let us know via the website contact page very soon as the finished videos will start going to the video editor in summer 2019.

Sponsorship would help with the following:  creating recordings, editing recordings, creating transcripts, creating pdfs related to each session.

You can also provide feedback on the series and what you would like to see more of at the website contact page.

I am looking forward to hearing from you!
Megan Kingsley Gale, MSAOM

Founder and Facilitator of The Hospital practice Handbook Project for Acupuncturists and their Hospital Sponsors