The integrative medicine practice by Marc H. Sencer, MD

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It’s important to know the ins and outs of an integrated practice before you decide if it’s right for you. Integrative medicine is a popular topic in the healthcare industry. As a chiropractor, you are in a unique position to expand this wing of your practice. Integrative medicine is the blending of traditional allopathic medicine with alternative, holistic therapies. The integrative approach emphasizes the mind-body connection and treats the patient as a whole rather than simply as a collection of symptoms.

While this approach is inherently non-surgical, integrative physicians recognize that surgery and medications can be necessary. The difference
between the integrative surgeon and his or her counterpart is that the integrative doctor uses holistic therapies in conjunction with surgery to speed healing, limit pain, and get the best possible result for the patient. Integrative practices incorporate many alternative treatments, varying
by specialty and the preferences of the practitioner. Some of the most common are: nutrition and supplements, acupuncture and Chinese herbal medicine, yoga, meditation and deep breathing exercises, hypnosis and guided imagery techniques, biofeedback, and biofield therapies such as
qigong and reiki.

While many complementary and alternative medicine (CAM) practitioners utilize these therapies, it’s the use of both traditional and complementary therapies that sets the integrative medicine practice apart. Integrative medicine emphasizes early diagnosis and prevention. And nutrition and nutritional supplements play a key role. If disease has already been diagnosed, the goal is to slow down or reverse the disease process.

This can mean recognizing the importance of the mind-body connection and treating the patient as a whole person.Stress reduction and an understanding of the patient’s lifestyle is important. Skeptics should be aware that major trials are being conducted at teaching centers that focus on the benefits of supplements such as coenzyme Q10 in slowing the disease progression of chronic neurological conditions such as Alzheimer’s, Parkinson’s, and multiple sclerosis (MS). Other studies focus on the effect of integrative techniques on surgical outcomes and healing time. Integrative medicine is being used by a number of medical specialties to treat a variety of conditions. In gastroenterology, relaxation and biofeedback techniques, as well as diet, are used to treat irritable bowel syndrome. Oncologists are increasingly turning to CAM to ease pain, reduce stress, and support the traditional therapies being used for cancer patients.

Psychiatrists have a long history of using integrative techniques, and the field of integrative cardiology is rapidly growing. While the focus in cardiology is on prevention, many integrative cardiologists are surgeons who practice cardiac surgery or interventional cardiology and use complementary medicine as an adjunct.

Getting started
Here are a few things to consider if you are creating or expanding an integrative practice:
If you’re interested in starting an integrated practice, you will need a medical doctor to collaborate with, either in the practice or outside. Often, the patient’s family doctor will be happy to coordinate care with you.

While you may be trained to do some complementary therapies in addition to chiropractic, some services such as biofeedback, reiki, and hypnosis may need to be done by another practitioner.

Ideally, you should have these people in your practice rather than sending the patient out. This makes it easier for you to coordinate their integrative care.

No discussion of integrative care would be complete without discussing reimbursement. There will be reimbursement for the traditional allopathic treatments. The integrative cardiologist will still be paid for his echo-cardiograms. Insurance coverage for most complementary therapies, however, is spotty. Some payers pay for biofeedback, acupuncture, and medical hypnosis. There are also codes for counseling and psychotherapy that may be used for some services. But many of the complementary tests and treatments will not be covered.

Your staff will have to verify insurance carefully and provide financial counseling for your patients.

One caveat:

Avoid billing complementary services as something else.
For example: Do not bill IV chelation therapy as IV nutrition.

The good news on the reimbursement front is that some employee plans are paying for complementary services, and patients are increasingly seeking out and paying cash for these services.

The nutritional supplement industry is a multi-billion-dollar per year business — and it’s growing.

You can create a multi-specialty, multi-provider integrative practice with all of the services under one roof, or you can start on a smaller scale by expanding the alternative services you currently provide and emphasizing more collaboration with MDs.

Either way, integrative medicine will provide you with intellectual challenge, more treatment options for your patients, and increased cash flow and profits.

marc-h-sensor-head-shotMARC H. SENCER, MD, is the president of MDs for DCs,which provides intensive one-on-one training, medical staffing, and ongoing practice management support to chiropractic integrated practices. He can be reached at 800-916-1462 or through www.mdsfordcs.com.

Test yourself
Check your knowledge about integrative practices with this true or false quiz.

[ ] 1. Dr. Smith practices acupuncture and Chinese medicine. Since these are considered alternative medicine treatments, Dr. Smith is practicing integrative medicine.

[ ] 2. You run an integrative medicine practice with an MD partner. For a simple back pain patient, you should not take a detailed personal and lifestyle history because it is unnecessary and intrusive to the patient.

[ ] 3. Reiki and bio-energy field treatments are being studied at major medical research centers.

[ ] 4. Coenzyme Q10 may slow the progression of neurode-generative diseases like Parkinson’s and Alzheimer’s.

Answers
Nos. 3 and 4 are true.
Nos. 1 and 2 are false.
Dr. Smith is an alternative medicine provider, but since he does not combine alternative medicine with traditional allopathic medicine he is not an integrative physician.
Careful attention to the patient’s lifestyle and how that affects his or her illness is one of the hallmarks of integrative medicine. It’s an integral part of seeing the patient as a whole person and not just as a collection of symptoms.