As hospitals elbow each other to attract patients, increasingly they're hoping to tap into Americans' interest in — and willingness to spend money on — complementary and alternative medical therapies such as acupuncture and massage.
According to a recent survey by the American Hospital Association and the Samueli Institute, a nonprofit research group focusing on complementary medicine, 42 percent of the 714 hospitals that responded offered at least one such therapy in 2010, a significant jump over just five years earlier, when 27 percent of hospitals offered such treatments.
Experts say hospitals are embracing these therapies for many reasons, including a growing recognition that some integrative therapies, as they're also called, are very effective in some instances.
In addition, hospitals aren't blind to the opportunity these therapies present to attract patients and perhaps make some money. According to the most recent report from the National Center for Health Statistics, Americans spent $33.9 billion on integrative therapies in 2007 — money that came out of their own pockets, since most of these therapies aren't covered by insurance. That figure includes fees for about 354 million visits to complementary and alternative medical practitioners, and represents about 11 percent of total out-of-pocket expenditures on health care.
Hospitals offer most of their integrative therapies on an outpatient basis, usually at designated centers located at or near the hospitals. The treatments are typically aimed at relieving symptoms of serious or chronic illness: A physician might prescribe that a patient get acupuncture for relief from nausea while undergoing chemotherapy, for example, or recommend massage or meditation to help reduce anxiety and stress.
Although research supporting the efficacy of various complementary therapies is increasing, if hospitals confined themselves to those procedures supported by evidence there wouldn't be much to offer, says Ian Coulter, a senior health policy analyst at the Rand Corp. (The same could be said of many conventional medical treatments, of course.) So hospitals pick and choose, based on what they judge to be most effective and what they believe patients want.
"Patient demand not only determines why hospitals choose to (offer these services) in the first place, but it also determines the (types of treatments) they choose to offer," says survey designer Sita Ananth, director of knowledge services at the Samueli Institute.
According to the survey, the top treatments offered at outpatient centers were massage therapy, acupuncture and guided imagery. (The latter uses mental techniques, including visualization, to achieve such goals as reducing stress.)
On an inpatient basis, the top offerings are pet therapy, massage and music/art therapy, according to the survey.
Over the past decade, Grinnell Regional Medical Center, a rural community hospital in Grinnell, Iowa, has built a comprehensive integrative therapy program that offers the inpatient services described above as well as an array of treatments at its outpatient center six blocks away.
"We're looking for ways to improve the patient experience and to improve outcomes," says Todd Linden, president and chief executive of the medical center. For example, patients awaiting surgery are offered a 10- to 15-minute "comfort massage" to help reduce anxiety. After a massage, "IVs go in easier, people come out of anesthesia quicker and some physicians say their patients have less pain," he says.
That's good for patients, but Linden says it should also help the hospital's bottom line if, for example, it helps shorten a Medicare patient's hospital stay; that means the hospital can keep a bigger chunk of the preset payment for a given illness or injury.
And as providers increasingly become part of accountable care organizations, in which they're paid to take responsibility for a patient's overall health rather than provide services a la carte, "we need to add new core competencies . . . like keeping people healthy," he says. Integrative therapies are part of that strategy.
Debby Pohlson, 59, has been going to Grinnell's outpatient facility for acupuncture treatments for the past six years. For most of her life, Pohlson has suffered from irritable bowel syndrome, a condition that causes painful stomach cramping along with constipation and diarrhea. Conventional medicine hadn't helped her, so when her husband brought home a brochure describing the acupuncture services at the outpatient center, she decided to give it a try.
It took a few months of weekly hour-long treatments to see results, but gradually her painful, unpredictable symptoms abated. Now Pohlson, who is on the hospital’s board of trustees, returns every three or four weeks to have small needles placed around her navel, below her knees, at the back of her head and elsewhere. Except for occasional flare-ups, her condition is now under control.
The couple's insurance doesn't cover her treatments, but they deposit enough in their flexible spending account every year to cover the $55 sessions with pre-tax money. Meanwhile, Pohlson's quality of life has improved tremendously. "Now I can eat out without fear," she says.
Despite her positive experience, research to date hasn't found evidence that acupuncture improves irritable-bowel symptoms.
For their part, hospitals find that patients are pleased to have the options, and that is often reason enough for them to offer the services. The hospital survey found that patient satisfaction was the No. 1 measure used to evaluate the success of a hospital's complementary and alternative medicine program, cited by 85 percent of respondents. Only 42 percent said they were using health outcomes to measure the success of their programs.