Hospital Association Report Finds More use of Alternatives, But There are Questions

Summary: 37% of hospitals offered some form of complementary and alternative medicine in 2007, up from 26% in 2005. This is the marquis finding from the recently published Summary of Results of the Complementary and Alternative Medicine Survey of Hospitals from the American Hospital Association/Health Forum. However, a low response rate raises questions about the extent to which the trend line is positive. In addition, inclusion of many key modalities in hospitals that offer CAM in outpatient services is actually down. Here are data and analysis from this always useful pulse on the uptake of non-conventional therapies into US hospitals. Credit AHA/Health Forum and Sita Ananth, MHA, the lead author.

AHA-Health Forum 2008 Report: 37% of Hospitals Have Some Complementary and Alternative Medicine

Summary: 37% of hospitals
offered some form of complementary and alternative medicine in 2007, up
from 26% in 2005. This is the marquis finding from the recently published Summary of
Results of the Complementary and Alternative Medicine Survey of
Hospitals
from the American Hospital Association/Health Forum. However, a

low response rate raises questions about the extent to which the trend line is positive. In addition, inclusion of many key modalities in hospitals
that offer CAM in outpatient services is actually down.
Here are data and analysis from this always useful pulse on the uptake of non-conventional therapies into US hospitals. Credit AHA/Health Forum and Sita Ananth, MHA, the lead author.


Send your comments to
johnweeks@theintegratorblog.com
for inclusion in a future Integrator.

The Report and data sets from the AHA/Health Forum
can be purchased here.


Image

A subsidiary of the American Hospital Association

The marquis finding in the 3rd Biannual Complementary and Alternative Medicine (CAM) Survey of Hospitals from the American Hospital Association/Health Forum is
that the
percentage of hospitals with at least some CAM services jumped to 37.4%

from 26.5% in 2005.  This movement is up from 7.7% in 1999, the first year the AHA included a question on CAM in one of its surveys. Yet a closer look at the findings suggest that a straight-line
projection of continuing growth in hospital inclusion may be misleading.
Here is a data-view from the 748 respondents (12% response rate) with some comparisons to data in an Integrator report from AHA/Health Forum’s 2005 survey plus some analysis and commentary. 


_____________________________________________


Hospital Inclusion of CAM: 2005 versus 2007

From the AHA-Health Forum Surveys in 2005 & 2007


Date of survey
2005
  2007
 
Project leaders

Sita Ananth, MHA;
William Martin, PsyD,

MPH, MA

 
Sita Ananth, MHA;
 
Samueli Institute

Surveyed &
responses
 

6347 hospitals;
1394 respondents
21% response rate

   
6,439 hospitals;
748 respondents;
12% response rate

Offer some CAM

370 hospitals;
26.5% of respondent

   
280 hospitals;
37.4 % of respondents

 
Of the 370 respondents with
CAM programs
   
Of the 280
respondents with
CAM programs

 
Location  of
services

Hospital-based
Wellness-Fitness Center (37%)
Hospital-based
CAM Center (15%)
Off-Oite CAM Center (11%)
Other (59%)

 
Hospital-based
Wellness-Fitness Center (24%)
Hospital-based

CAM Center (15%)
Off-site CAM Center (10%)
Other (74%)

 

Top Out-Patient
Modalities


Massage (71%)
Tai Chi/Yoga/Qi Gong (47%)

Relaxation (43%)
Acupuncture (39%)
Guided Imagery (32%)
Therapeutic Touch (30%)

   
Massage (54%)
Acupuncture (35%)
Relaxation (27%)
Meditation (25%)
Guided Imagery (24%)

Biofeedback (21%)

Top In-Patient
Modalities
 
Massage (37%)
Music Therapy (27%)
,
Therapeutic Touch (25%)
Guided Imagery (22%)

Relaxation (20%)
Acupuncture (12%)

 
Pet therapy (46%)
Massage (40%)

Music/art therapy (31%)
Guided imagery (20%)
Then, each at 18%:
Acupuncture, relaxation
training, Reiki and
therapeutic touch

 
Top 3 Reasons
to Offer CAM

Patient Demand (87%)
Mission (63%)
Clinical Effectiveness (61%)

   
Patient Demand (84%)

Clinical Effectiveness (61%)
Mission (57%)

 
Top Payment Methods

 
Self pay (81%)
3rd party (37%)
   
Self pay (71%)

3rd party (39%)
No charge (38%)


Top 2 Challenges


Budgetary expertise (67%),
physician resistance (46%)
 
Budgetary constraints (70%)
physician resistance (41%)

Typical Hospital Outlay

< $200,000 (86%),


$200-$500,000 (8%),

> $500,000 (6%)

   
< $200,000 (86%),

$200-$500,000 (10%),

> $500,000 (4%)


Top metrics
for measuring

program outcomes 


Patient satisfaction,
volume, budget,

quality

   
Patient satisfaction (86%),
volume (55%), quality (44%),



_____________________________________________


Analysis: The lower response rate in
2007 (12%) as compared to 2005 (21%) creates the awkward reality that
the marquis finding of an increased percentage of hospitals with some
CAM (37.4% versus 26.5%) is based on responses from significantly fewer hospitals (748 in 2007 versus 1394 in 2005).

   
The apparently robust
increase in the percentage
of hospitals with some CAM –

37.4% versus 26.5% –
may not be real.


 

One might assume that hospitals with CAM
would be most likely to
respond. So what explains this fall off in participation?  Bottom line:
any conclusions about what is going on in 6,439 hospitals based on
responses from this very
small fraction (12%) seems especially questionable. The apparently
robust increase in the percentage of hospitals with some CAM
(37.4% in 2007 versus 26.5% in 2005) may not be real.

Image

Report leader Sita Ananth, MHA

Other patterns in the data also question whether hospital interest in
CAM is significantly growing. In the out-patient environment, the
level of inclusion of the next 4 most prominent modalities in those with CAM programs is
actually in decline. These 4 are acupuncture and 3 mind-body modalities: therapeutic touch,
guided imagery and relaxation therapy. The in-patient story is mixed, with some inclusion up and some down-trending. Even if a higher percentage of hospitals are offering CAM, we may assume that they are offering less robust programs.

Nor do these data suggest that inclusion will trend upward at a
significant pace in the years ahead. Just 11% of participating hospitals that do not offer CAM are
planning to begin to offer any CAM by an average of 18 months from the
late 2007 date of the survey. In hospitals with existing programs, the infrastructure for growth also appears to be
wanting. Of those with CAM programs, over 50% do not have CAM in the
hospital’s overall strategic plan. Of the CAM programs, 70% don’t have a
strategic plan. If you don’t know where you want to go, how are you going to get there? Only a third of the programs periodically report to the hospital’s Board.

   
  A parallel shrinkage in the levels

of inclusion of specific therapies
in outpatient settings is also

evident. Even if a higher %
of hospitals is offering CAM,
we may assume that they are

offering less robust programs.

One good sign is that “physician resistance” is somewhat lower as a reason for not offering CAM (41% in 2007 versus 46% in 2005).  Yet the report quotes Integrator adviser Milt Hammerly, MD

describing new forms of physician resistance that have emerged. One is
that the “tolerance for change” of any sort has been tested in health
system physicians. CAM may be viewed as yet another tiresome, top-down system
initiative. System change challenges have created a climate in which
many physicians simply don’t want to try anything new. Hammerly asserts that still others may view CAM as a competitive threat.


_____________________________________________


Hospital Inclusion of CAM: Some Additional Findings

From the Health Forum 2007 Complementary
and Alternative Medicine Survey of Hospitals

Reasons for
discontinuing

CAM programs

    
Poor financial performance (55%)

Re-prioritized hospital initiatives (40%)
Lack of community interest (35%)
Inability to break even (30%)
Lack of medical staff support (30%)
General cuts to nonessential programs (25%)
 


CAM program
relationships
with the medical

staff

  Excellent/high referrals (16%)
Good/moderate referrals (40%)
Mediocra/limited referrals (32%)

Poor/few referrals (12%)


Break even
expectation


One year (6%)
Two years (14%)
Three years (24%)
Not expected to break even (56%)

_____________________________________________

Comments: First, I thank Sita
Ananth, MHA for her long-time work with Health
Forum and AHA. The field has benefited greatly. I hope that AHA/Health
Forum will again survey the hospitals in 2009, despite Anath’s move to
the Samueli Institute, where she directs the Knowledge Center in the Institute’s Optimal Health Environments initiative.
(A number of Ananth’s co-workers at Samueli Institute also contributed
to the present report.) The AHA’s David Allen for made the report
available for analysis this year.

Is this sober and even somewhat bleak analysis accurate on what these
data say about actual movement in hospital behavior relative to CAM? Might
hospital-based integration be stalled, rather than advancing? I think these data
urge us to consider this analysis to be closer to the mark than what may be
suggested by the marquis finding of “37% of hospitals offer CAM” which
has shaped the media accounts. Your comments and perspectives are welcome. 

The Report and data sets from the AHA/Health Forum

can be purchased here.


Send your comments to
johnweeks@theintegratorblog.com
for inclusion in a future Integrator.


Send your comments to
johnweeks@theintegratorblog.com

for inclusion in a future Your Comments Forum.
John Weeks Written by John Weeks

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