Overview of CAM and its Credentialing Process Within VA

1
Overview of CAM and its Credentialing Process
Within VA

• Stephen Ezeji-Okoye, MD
• Chair, VHA CO CAM FAC

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Outline

• How did we get here?
• Practicing CAM within VA
• Final Thoughts
• Questions

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How Did We Get Here?
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Definitions

• Complementary and Alternative Medicine.
• A group of medical and health care systems,
  practices and products not presently considered
  to be part of conventional medicine.
• Complementary medicine.
• Used in conjunction with conventional medicine.
• Alternative medicine.
• Used in place of conventional medicine.
• Integrative medicine.
• Combination of mainstream and CAM therapies for
  which there is some high quality scientific
  evidence.

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How Does CAM Fit Within VA?

• Is CAM part of the UBP?
• VA Employee Handbook revised 6-18-98 states VA
  Public Law 104-262 calls for VA to furnish
  hospital and medical services that are defined as
  needed. VA defines needed as a need for care or
  service that will promote, preserve and restore
  health.
• VHA Vision Statement
• VHA will continue to be the benchmark of
  excellence and value in health care and benefits
  by providing exemplary services that are both
  patient centered and evidence based.

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CAM within VA

• Use is widespread - Healthcare Analysis and
  Information Group (HAIG) Study on CAM Utilization
  in VHA 2002
• 84 of VA facilities provide some form of CAM
• Most common offered modalities
• Acupuncture, biofeedback, chiropractic care,
  guided imagery, hypnotherapy, meditation, music
  therapy, progressive relaxation, and stress
  management.
• Most provided by conventionally trained
  practitioners
• Integrated into treatment plans
• Wide variation in process used to credential
  privilege providers.
• Limited oversight in training, experience,
  certification and practice of CAM providers.
• Limited utilization of scientific evidence to
  support use of CAM or support its safety and
  efficacy.
• HAIG 2010/11

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White House Commission on CAM Policy

• Established March 2000 by Executive Order 13147.
• Aim to ensure that potential benefits of CAM
  become available to all citizens.
• 29 Recommendations covering 4 areas.
• Research.
• promotion of rigorous scientific study of CAM.
• Education.
• Ensure appropriate education and training of CAM
  and conventional practitioners.
• Ensure availability of quality information on CAM
  and training of practitioners.

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WHCCAMP

• CAM Products and Standards.
• Ensure consistent quality and consistency.
• Advertising must be truthful.
• Collection of data on adverse effects.
• Access and Delivery.
• Improve access to safe and effective CAM
  practices.
• National oversight of how CAM practices are used.
• Develop and disseminate information on optimum
  models of complementary and integrative care.
• Coverage and Reimbursement by Health Plans.
• Federal Agencies required to respond.

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VAs Response

• CAM Workgroup.
• chartered March 2003 to examine
• Appropriateness of CAM practices and process in
  VHA.
• Suggest strategies for providing ongoing national
  guidance related to CAM for VHA facilities and
  providers.
• CAM appropriate if safe, efficacious and
  delivered by practitioners with appropriate
  training, certification and accreditation.
• Recommend VA form a Field Advisory Group to
  promote research, integration, education on CAM
  within VA.

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VA CAM Field Advisory Committee

• Commissioned September 2004.
• Chartered to
• Identify, assess and recommend practices for
  integration into VA healthcare.
• Advise on the integration of CAM practices into
  clinical practice guidelines.
• Identify areas where additional research is
  needed to determine the safety and efficacy of
  CAM practitioners.
• Recommend standards for the credentialing and
  privileging CAM providers within VA.

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CAM FAC General Principles

• Safety of the practice must be ensured.
• Must be proof of effectiveness.
• VHA will establish credentialing standards.
• Includes education and training.
• State licensure vs. national or international
  standard.
• All practitioners must meet standards.
• Care may be provided by allopathic or CAM
  providers.
• Same process for evaluating allopathic practices
  should be applied to CAM.

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Practicing CAM Within VA
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Utilizing CAM Within VA

• CAM modalities permitted within VA must be safe
  and effective.
• Evidence USPTF equivalent rating of B or better
• At least fair evidence practices improves
  important health outcomes and benefits outweigh
  harms. There is a sufficient, strong and
  consistent evidence of positive effect.
• Practices without clear evidence of effectiveness
  may be considered if
• There is some evidence of effectiveness
• They are known to be safe
• Treatment options are limited
• Provider believes it may offer benefit to veteran

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Delivering CAM

• All CAM procedures require informed consent.
• Utilize same standard as allopathic treatments.
• VHA will establish credentialing standards
• Includes education and training.
• State licensure may be used as basis for
  standards where it exists.
• Education programs must be accredited
• Must be by state or agency recognized by US
  Secretary of Education.
• Certification is desired
• Must be proof of minimum level of ongoing
  education and training.

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Delivery cont.

• CAM providers must be credentialed
• Primary source verification is required
• Must be recorded in Vetpro
• CAM scopes of practices must be reviewed by PSB
  or equivalent body
• Approved CAM activities can be provided by VHA
  employees, of station contract or fee personnel.
• All care must be ordered by and provided by
  licensed personnel.
• VHA employees may only provide CAM if it is
  allowed within their occupational class.
• CAM care must be documented in the medical
  record.

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CAM and Fee Basis

• Fee basis use should follow the same rules as
  allopathic treatment.
• VA must offer a reasonable treatment for a
  condition.
• VA does not have to offer all treatments
• No requirement to offer CAM
• Currently no CAM modality is the best treatment
  for any condition.
• CAM may be offered on fee if there is proof of
  efficacy and there are believed to be benefits
  from this treatment over other options.

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Final Thoughts

• CP is ultimately a local issue.
• Central guidance
• Lack of CAM occupational classes within VA
• Education
• Need to establish acceptable standard
• Licensure and Certification
• Integration into holistic treatment plan
• Treatment vs. Wellness