SENTARA WILL SOON OFFER DISCOUNTS FOR SOME TYPES OF ALTERNATIVE MEDICINE

Published: November 25, 2000
Section: FRONT, page A1
Source:    LIZ SZABO THE VIRGINIAN-PILOT
© 2000- Landmark Communications Inc.

When Richard Paradiso arrived at his doctor's Virginia Beach office recently, he was bent over with pain and leaning heavily on two canes. When he left an hour later, he said, he was carrying the canes under his arm.

Paradiso's lower-back pain, which has plagued him for 30 years, hadn't disappeared entirely. And it still resurfaces periodically. But his physician found a way to ease pain that hadn't been helped by prescription drugs. His doctor used acupuncture, a Chinese medical technique that has been practiced for at least 2,000 years. Dr. Jesse Broome, an M.D. who specializes in internal medicine, updated the practice by using hair-thin disposable needles that are individually wrapped and sterilized.

``I'm a believer in alternative medicine,'' said Paradiso, 66. ``I had tried everything. I'd tried chiropractic. But acupuncture seems the best. I'm just a little disappointed that health insurance won't pick it up.''

That may soon change.

Insurers are moving closer toward recognizing - and perhaps even reimbursing - unconventional therapies whose merits have been proven in scientific studies.

Sentara Health Management, for example, will begin a new program Jan. 1 that gives customers discounts on alternative medicine. Patients who visit professionals in the Sentara network can receive up to 25 percent off in fees for three kinds of alternative medicine: chiropractic, massage therapy and acupuncture.

``Members told us they want access to complementary and alternative medicines, and that's what this discount program provides them,'' said Michael Dudley, president of Sentara Health Management, which oversees Sentara and Optima insurance plans.

Sentara is the latest of about 30 health insurance companies to join a complementary medical discount program in the past two years, said John Weeks, the Seattle-based publisher of an online newsletter about payment delivery for alternative medicine. The trend indicates the medical community's growing recognition of alternative therapies, Weeks said.

``It's almost like a pilot program,'' said Dr. David Maizel, executive medical director for Sentara Medical Group. ``We want to get a handle on the demand for this. We don't really know. We also see this as a research opportunity to compare alternative and traditional health-care treatments in terms of their cost effectiveness.''

The discount program is also a savvy move to capture at least part of a booming market, Weeks said.

Growing numbers of insurers want to experiment with alternative medicines just enough to please their customers, but not enough to offend doctors who remain skeptical, Weeks said.

``What Sentara is doing is definitely within the dominant trend nationally,'' said Weeks. ``It's the classic `toe in the water.' It's like a quarantine. It says, `We'll include you, but we'll put a fence around you so you're not involved in what we think of as real medicine.' ''

A study published in the Journal of the American Medical Association found that only about 40 percent of alternative therapies are covered by insurance. Chiropractic has been covered by Medicare for several years and, in some states, Medicaid.

The trend toward greater acceptance of alternative healing - often known as integrative medicine - is an enormous shift. For years, physicians generally regarded procedures like chiropractic or acupuncture as a waste of time at best, or dangerous fraud at worst.

Their patients, however, have increasingly embraced alternative care.

Eighty million Americans routinely use alternative treatment, spending $27 billion a year of their own money. That's as much as people pay out-of-pocket for all physician services, and far more than their share of hospitalization costs.

Fees for alternative care vary widely, depending on the treatment.

Massages often cost about $60 an hour. Initial visits to chiropractors, which typically involve X-rays and extensive examinations, can cost more than $200, said Daniel Shaye-Pickell, a doctor of chiropractric and acupuncturist from Williamsburg. Because chiropractors and acupuncturists use hands-on treatments, patients usually need to visit these practitioners more often than a primary care physician. Follow-up visits can range from $35 to $105 a session.

Many alternative practitioners in Hampton Roads said they're pleased that an insurance company would take their work seriously.

``They have to do it. We're moving so much into the mainstream that to ignore it (alternative medicine) isn't a choice,'' Shaye-Pickell said.

Dr. Cherril-Ann Thorpe, an M.D. at New Vision Health & Wellness in Virginia Beach who specializes in nutrition and herbal remedies, also welcomes Sentara's decision.

``It's great they're going to finally recognize the need for alternative medicine,'' Thorpe said. ``In my own practice, we stopped filling out insurance forms for patients a year ago because insurance companies weren't reimbursing. Cost is a real barrier for people.''

Other local hospital systems have taken steps in the same direction as Sentara.

In February, Bon Secours Hampton Roads began offering heart attack patients lessons on meditation in combination with education about nutrition, exercise and stress management. The program is affiliated with the Mind/Body Medical Institute, which was founded by a Harvard University doctor and now has 15 branches across the country.

The new programs, offered at Bon Secours' three local hospitals, have proven popular. The hospitals enroll about 60 people at any given time, with about 20 new patients signing up each month, said Bon Secours spokeswoman Lynne Zultanky.

Providing insurance coverage for such programs would make them even more accessible, she said.

Insurers deny access to the programs to at least seven people a month, Zultanky said. Many other potential patients probably never even bother to try getting reimbursed for the programs, whose costs can range from $60 for a simple four-week course to $2,600 for an intensive 12-week class.

By offering complementary medicines, many health-care executives hope not just to please their customers, but reduce future medical costs, said Jennifer Boynton Smith, director of Bon Secours' Mind/Body Medical Institute.

Complementary therapies sometimes add to a patient's total health-care bill, she said. Heart attack survivors who sign up for meditation classes still need to see their regular cardiologists, for example. In the long run, however, doctors hope that wellness programs that teach people to retrain their responses to stress will help to prevent future heart attacks and save the patient money.

Sentara's business partner in its new program, American Specialty Health Networks, works with many of the nation's largest insurance companies, Weeks said. The network recruits physicians who are willing to offer discounts in exchange for being included in a list given out to Sentara's customers - a potentially useful form of advertising.

Sentara's costs for such a partnership are minimal, Weeks said. And discount programs usually lose money for the company that sets up the network.

But establishing a network of providers makes it easier for insurers to look toward full reimbursement, Weeks said. Large, self-insured companies - that decide for themselves which benefits to offer their employees - may decide they'd like to begin covering alternative therapies.

That's when health networks can begin to really make money, Weeks said.

Paradiso's doctor, Broome, is pleased that the medical establishment is recognizing the benefits of specialties like his. Traditional medicine, after all, wasn't able to alleviate Paradiso's back pain. And Western medicine can't explain why Paradiso, who's also recovering from a bone fracture in his ankle, has begun feeling a lot of pain in his toe.

Chinese medicine, however, helped Broome recognize that the pain in Paradiso's toe lies along the same energy pathway, or meridian, as the injury to his ankle. So Broome has been using acupuncture and very light electric currents to ease Paradiso's pain.

But Broome also knows his limitations.

``Acupuncture can help with depression,'' he said, ``but I probably won't use it for depression because I know from a medical standpoint that medicines are just so much more effective. Acupuncture would work, but it would take longer and it would take so many treatments that it might not be cost-effective.''

Dr. Cynthia Romero, a Virginia Beach family practitioner, raises concerns about another kind of alternative treatment: herbal remedies. Like any other drugs, she said, they can have risky side effects.

The plant black cohosh has been found to contain natural estrogens and is used by some menopausal women as an alternative to hormone replacement therapy. But estrogens also pose a risk of blood clots, Romero said. And they can be dangerous for women with a family history of estrogen-sensitive cancers, like that of the breast.

Romero said many doctors are frustrated that their patients don't disclose which alternative therapies they're using. Research has shown that only about 40 percent of those using alternative remedies tell their physicians.

``You ask a patient if she's on any other medication and she says `No,' but she could be taking five different chemicals,'' Romero said. ``There's a misperception that if something is sold over the counter, it's not really medicine.''

Recognizing the benefits of alternative medicine will help the health-care industry win the trust of patients, said Shaye-Pickell, the Williamsburg chiropractor. People who treat themselves also may be safer if they seek help from certified and licensed professionals.

``Doctors have been so ignorant of this that patients are going outside and getting it themselves from herb stores,'' he said. ``But doctors are willing to make referrals now because of medical journals. And doctors themselves are becoming patients.''

Description of illustration(s):
Color photo
VASNA WILSON/THE VIRGINIAN-PILOT
Harry Walsh relaxes while undergoing acupuncture from Dr. Jesse
Broome in Virginia Beach. Beginning Jan. 1, Sentara Health
Management will offer 25 percent off fees for thel procedure.
Photo
VASNA WILSON/THE VIRGINIAN-PILOT
Dr. Jesse Broome gets ready to treat Richard Paradiso for lower back
pain at his Virginia Beach practice. Traditional therapies failed to
take away Paradiso's pain, but acupuncture has given him some
relief.


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