Complementary and Alternative Medicine Management Forms and Guidelines - Book Review

AORN Journal, Dec, 2002 by Michelle M. De Lima

By Michelle Bowman and G. Frank Lewis 2001, 13 sections $259, loose-leaf binder

Complementary and alternative medicine (CAM) can be used to augment traditional medical modalities. Patient demand for varied health care choices has led health care disciplines to explore viable options in alternative medicine. This manual provides an excellent guideline for health care organizations serious about integrating CAM treatment programs into their facilities. It uses a model implemented at Longmont United Hospital, Colo.

This manual will assist the facility seeking to integrate CAM by providing fundamental guidelines and examples of paperwork needed to implement a CAM program. It discusses internal requirements, such as policy, protocols, and forms for documentation, and compliance with national standards, such as Joint Commission on Accreditation of Healthcare Organizations' requirements.

The manual is divided into 10 chapters, each containing corresponding forms, and three appendices. Included is a CD-ROM that contains all of the forms, which provides an easy method to begin formulating facility-specific policies, procedures, and documentation. The manual begins by outlining the types of CAM therapies available, including massage, music, acupuncture, meditation, nutrition, herbal medicine, therapeutic touch, yoga, tai chi, osteopathic, chiropractic, and homeopathic. Implementation problems are discussed, including lack of research, gaining physician acceptance, financing concerns, education, and finding staff members and space to practice.

Chapter three discusses formulating a model to implement a CAM program. It explains how to use business strategies to establish and maintain revenue so the program remains viable. Organizational methods are compared, models of practice are discussed, and flow charts are provided. Chapter four outlines procuring approval for a CAM program and starting the program. Steps include obtaining internal support, determining community interest, appointing an advisory committee, presenting a CAM proposal, and initiating the program. A good place to initiate CAM treatment is in the obstetrics department. The authors advise beginning small, such as with massage therapy and nutritional support, and building on those successes.

Chapter five discusses implementing a CAM program and reimbursement issues. A strong business infrastructure must be established. Parameters to consider include the type of program to implement, for profit versus nonprofit, provider compensation, reimbursement, equipment, space requirements, modality mix, governance, and ancillary services. Developing the financial structure also must be considered. At the present time, most insurance companies will not cover CAM because of the lack of proven return on investment, scientific evidence, and research. Strategies for reimbursement include discounted fee-for-service, self pay, managed care, and billing.

Chapter six provides recommendations for staffing a CAM unit. The authors suggest surveying the community to see which practitioners are in highest demand. Certified professionals, existing hospital staff members, interns, volunteers, students, contractors, and referrals to outside practitioners are options to consider. The authors advise hiring CAM practitioners proficient in several disciplines. Job descriptions and competency validation forms are located at the end of the chapter.

Chapter seven provides an overview of patient care protocols and documentation. It covers legal responsibilities, continuity of care, standards, and professional functions. State and professional guidelines must be adhered to, and explicit protocols must exist for unlicensed CAM practitioners. Documentation should be thorough and concise.

Chapter eight discusses marketing a CAM program. It gives suggestions for marketing strategies, such as involving the media, holding special events, giving gift certificates, sponsoring national speakers, providing education programs, publishing testimonials, and targeting specific groups. It is important to be honest in marketing because patient trust is essential if the program is to be viable.

Chapter nine discusses the importance of continually evaluating the program and performing annual evaluations. Chapter 10 delves into lessons learned at Longmont United Hospital and preventing common mistakes. Several appendices include recommendations for suggested CAM documentation forms and contact information necessary to successfully operate a CAM program. This manual provides a good framework for instituting a CAM department in a hospital setting. Any facility seriously considering implementing a CAM program will benefit from the information found here.

This book is available from Aspen Publishers, Inc, 200 Orchard Ridge Dr, Suite 200, Gaithersburg, MD, 20878; http://www.aspenpublishers.com.

MICHELLE M. DE LIMA
RN, BSN, CNOR
ASSISTANT SECTION MANAGER--OR
MEDICAL CENTER OF LOUISIANA
AT NEW ORLEANS