harmonizing the paradigms

[Guest guest]

Emmanuel Segmen wrote:

>>>Jim,

    You've raised an interesting point with regard to "hospital privileges".  One thing is that they don't really exist any more ... not since 1998.  MDs have been paying for the "privilege" to see their patients in the HMOs. 

    After reading one of your recent posts, I envisioned the re-invention of hospitals.  You know, except for county hospitals, hospitals in many ways have ceased to exist.  I had this crazy vision of practitioners opening a clinic with treatment rooms and then recovery rooms.  In some cases they would be the same room.  My point is that one could have a patient remain in a treatment or recovery room for an extended period of time the way an old country doctor would do ... or my great grandmother herbalist would do.  This would be a "hospital" in a sense. 

    Crazy what your imagination does when you wish for what's been lost.

Emmanuel Segmen<<<

 

 

Emmanuel et al,

For the past few months I have been envisioning a moderate- to small-sized TCM teaching hospital with WM integration here in the West and wonder what that would look like. I have quite a few thoughts about it and wonder if anyone would like to help envision it. I live in Arizona and work at Phoenix Institute of Herbal Medicine and Acupuncture (PIHMA), so I envision the "teaching" part being the integration of PIHMA. I believe the only way to keep the envisioned hospital from turning into a WM-dominated thing would be to keep CM people at the top and have WM doctors work for us, not the other way around as is common in society at large. Perhaps we would have to put the thing on an Indian reservation in order to get away with it legally. Does anyone out there have much hospital experience? I am serious about starting such a phenomenon here in the West, the first I know of. Somehow, if Joseph Campbell and Kevin Costner are right, and I follow my bliss and build it and they will come, the money for all this will appear from somewhere.

Joseph Garner

[Guest guest]

, " dragon90405 " wrote:

> Is that what we want? >>>

 

 

Ken:

 

Well, I don't know what we want either. My issue is that we simply

do not preclude options before they are discussed or offered. And we

shouldn't preclude that CM may have a positive effect on the current

medical system if we are allowed to participate.

 

Again, the unanswered question: who and what is getting integrated---

if not the money qi . . . ?

 

 

Jim Ramholz

[Guest guest]

, " Emmanuel Segmen " wrote:

> After reading one of your recent posts, I envisioned the re-

invention of hospitals. You know, except for county hospitals,

hospitals in many ways have ceased to exist. I had this crazy vision

of practitioners opening a clinic with treatment rooms and then

recovery rooms. In some cases they would be the same room. My point

is that one could have a patient remain in a treatment or recovery

room for an extended period of time the way an old country doctor

would do ... or my great grandmother herbalist would do. This would

be a " hospital " in a sense.

> Crazy what your imagination does when you wish for what's been

lost. >>>

 

 

Emmanuel:

 

Thanks for an interesting response. And think not only of the room

itself, but about the people in that room who may not have otherwise

chosen or thought of CM as an alternative.

 

Perhaps if we don't outright preclude CM's integration into all

area, things like this could be possible again. CM may be the

impetus that the medical system needs to slowly change. You could

already say that it has helped change things 'outside the walls.'

Imagine what else would be possible if we were allowed inside.

 

 

Jim Ramholz

[Guest guest]

Joseph,

Julie Shpiesel and I joined with Howard Harrison and Aikow Wang a couple of years ago to do what you have suggested. I can imagine Marne and Kevin Ergil rolling their eyes right now. Bear with me. It did have it's dark side, and dear Julie Shpiesel with her good heart endured some of the darker sides of it which included a severe lack of funding. Nevertheless, I have to hand it to Howard for having a vision that came close to working. It appeared as if Art Torres (head of CA Dem. Party) might have diverted some Title XX moneys to provide a series of integrated practice clinics through the poorer sections of California's Central Valley beginning with the Fruitvale Clinic in Oakland where Julie worked (for free!!!) for one year. If you want to ask Julie her thoughts on this, I think she's has sufficient recovery at this point to tell the story and how it might have worked better. We are enduring a huge state deficit at the moment so the circumstances have changed. Back then Art Torres actually had some CA state revenue streams that were already directed to CA Comm. Clinics.

At the moment such clinics, I am told, do exist and are individually administered by nurse practitioners. I don't see why one of those nurse practitioners couldn't be an L.Ac. or why an L.Ac. couldn't be one of those nurse practitioners. Basically our vision back then was an L.Ac. working beside the nurse practitioner in those community clinics. The funding and political will never came through.

My wife is taking the rigorous on-line MSN program now from University of Phoenix. After a long acupuncture apprenticeship in Taiwan, she then wants to finish her L.Ac. here. The uniting of independent nurse practitioners with L.Ac.s might be a natural alliance.

Such are my thoughts for today.

Emmanuel Segmen

 

-

acugrpaz

Friday, May 09, 2003 10:44 AM

Re: Harmonizing the Paradigms

Emmanuel Segmen wrote:>>>Jim, You've raised an interesting point with regard to "hospital privileges". One thing is that they don't really exist any more ... not since 1998. MDs have been paying for the "privilege" to see their patients in the HMOs. After reading one of your recent posts, I envisioned the re-invention of hospitals. You know, except for county hospitals, hospitals in many ways have ceased to exist. I had this crazy vision of practitioners opening a clinic with treatment rooms and then recovery rooms. In some cases they would be the same room. My point is that one could have a patient remain in a treatment or recovery room for an extended period of time the way an old country doctor would do ... or my great grandmother herbalist would do. This would be a "hospital" in a sense. Crazy what your imagination does when you wish for what's been lost. Emmanuel Segmen<<<Emmanuel et al,For the past few months I have been envisioning a moderate- to small-sized TCM teaching hospital with WM integration here in the West and wonder what that would look like. I have quite a few thoughts about it and wonder if anyone would like to help envision it. I live in Arizona and work at Phoenix Institute of Herbal Medicine and Acupuncture (PIHMA), so I envision the "teaching" part being the integration of PIHMA. I believe the only way to keep the envisioned hospital from turning into a WM-dominated thing would be to keep CM people at the top and have WM doctors work for us, not the other way around as is common in society at large. Perhaps we would have to put the thing on an Indian reservation in order to get away with it legally. Does anyone out there have much hospital experience? I am serious about starting such a phenomenon here in the West, the first I know of. Somehow, if Joseph Campbell and Kevin Costner are right, and I follow my bliss and build it and they will come, the money for all this will appear from somewhere.Joseph Garner Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

Jim,

 

> Well, I don't know what we want either. My issue is that we simply

> do not preclude options before they are discussed or offered.

 

OK. I was simply responding to your statement

that real integration would not occur until

Chinese medical practitioners were being reimbursed

by third party payers. I took it up because

I don't believe it is true and as we

have covered, the path that leads to full

participation in the economics of health

care in the States is full of landmines.

 

I'm certainly precluding any options,

simply discussing the one that suggested

as mandatory.

 

Speaking of options, you said something

in an earlier post that has been on my mind.

You said that you choose not to accept third

party payments because of the hassle but

that you wish you had the option.

 

Seems to me that if you don't have the option

then you're not actually making a choice not

to accept such payments. Rather than this

being beside the point, I mention it because

I think it may be very close to the point

at which the desirability of " going mainstream "

is located and fixed in the imaginations of

many people.

 

The great tool of the mainstream establishment

is its inertia. People experience this inertia

as wanting a piece of the pie. So-called

" alternative medicine " is a hold over from an

age that challenged the status quo from many

quarters. The media developed the term " alternative "

to sum up a range of social movements and expressions

that included such wide ranging ideas and

events as The Black Panthers, The Weather Underground,

Students for a Democratic Society, communes, hippies

in general, J.R. Tolkein, Timothy Leary, about

ten thousand other oddities...and acupuncture.

 

All alternatives. What the mainstream couldn't

enfranchise and consume, it destroyed or left

behind. This is what the main stream does.

It collects everything that will float and leaves

behind what will not.

 

That in mind, it's important I believe to

recognize that each and every consumer/patient

decision is a matter of free will and people

can, should, and I think more and more do

exercise their options when it comes to

making choics in healthcare.

 

If we want to integrate into people's lives

we should definitely be aware of the economic

aspect of the integration. And the question

becomes do we want to offer people an alternative

to their current health care options? Or do

we want to take our piece of the pie,

become further enfranchised in the mainstream,

and ensure that we are not swept away or left

behind?

 

The only caveat I would place on the second

option...and it is a significant one I think...

would be to also question where the mainstream

is going. We've already seen a substantial

disintegration of that mainstream in the

chaos of the American healthcare system of

the 1990s. And I think that a great deal of

the ascendancy of Chinese medicine in that

decade can be linked to the growing incoherence of

conventional medicine as the public came to

experience it.

 

The gist of the coherence that can and should

exist between doctor and patient is rooted

in their private communication and exchange.

This is why I harp on the primacy of language.

 

But the economic exchange that takes place

between doctor and patient is also an

essential one. Medicine came to be known as the

Art of Benevolence in traditional China and

an essential aspect of this benevolence

concerned the nature of the social contract

that existed between doctors and patients

related to the economy of providing medicine.

And as all contracts, this one included

clauses concerning payment.

 

The cliched and probably inaccurate

remark that sums up these clauses is

that patients paid their doctor when

they were well and not when they were

sick. Curiously, this is more or less

the same approach that medical insurance

pays. That you make ongoing payments while

you are working and earning money to

cover the contingency of what might happen

should you require expensive medical care.

 

The idea isn't a bad one at all, but between

the idea and the reality there falls a

great shadow.

 

This, once again, is a big subject not a

small subject. And I frankly do not understand

it clearly enough to provide a precise summary.

 

I only bring it up to emphasize my agreement

with your statement that we need to discuss

these issues thoughtfully, because they matter

so much to the outcome of individual clinical

encounters and of the progress and development

of the whole field.

 

When I say they matter to the outcome of

individual clinical encounters I mean that

the agreements that exist between doctors

and patients as to how medical care will be

reimbursed forms an essential part of the

cognitive nexus in which medical interventions

take place.

 

We should also bear in mind the admonition

of Sun Si Miao that doctors must treat patients

in need regardless of their social status,

wealth or ability to pay.

 

And we

> shouldn't preclude that CM may have a positive effect on the

current

> medical system if we are allowed to participate.

 

Certainly not. We should work to realize this

positive potential. It certainly exists.

 

 

>

> Again, the unanswered question: who and what is getting integrated-

--

> if not the money qi . . . ?

 

I think the question will remain unanswered

except in terms of individual interactions.

Someone may come along and study the scene

from time to time and publish reports containing

surveys and statistics and the like.

 

And in any case, the question is not

whether " the money qi " is or should be

flowing. It's where from the stream you

want to drink.

 

So as you can see, I'm not at all against

discussing all of this. I think it's critically

important. As I said before, if we paid more

attention to the flow of money in our field

we'd likely have a much clearer understanding

of where we're at and where we're headed.

 

Where does all the money go?

 

Certainly not to authors!

 

Ken

>

>

> Jim Ramholz

[Guest guest]

, " dragon90405 " wrote:

> > Again, the unanswered question: who and what is getting

integrated---if not the money qi . . . ?

>

> I think the question will remain unanswered

> except in terms of individual interactions.

> Someone may come along and study the scene

> from time to time and publish reports containing

> surveys and statistics and the like. >>>

 

 

Ken:

 

Some of the details for the integration of WM and CM are already

being worked out. See link below for article " Medical Acupuncture At

A Complementary Medical Clinic: A 2-Year Retrospective Study. "

 

One line reads: " Although insurance coverage of CAM therapies is

still limited, insurers have been motivated by consumer demand to

offer more extensive coverage. Some insurers have developed major

medical plans that specifically include CAM coverage. CAM use would

likely increase significantly with added insurance coverage. "

 

Jim Ramholz

 

http://www.medicalacupuncture.com/aama_marf/journal/vol14_1/article4.

html

[Guest guest]

Jim,

 

 

>

> Some of the details for the integration of WM and CM are already

> being worked out. See link below for article " Medical Acupuncture

At

> A Complementary Medical Clinic: A 2-Year Retrospective Study. "

>

> One line reads: " Although insurance coverage of CAM therapies is

> still limited, insurers have been motivated by consumer demand to

> offer more extensive coverage. Some insurers have developed major

> medical plans that specifically include CAM coverage. CAM use

would

> likely increase significantly with added insurance coverage. "

>

> Jim Ramholz

>

 

No doubt.

 

This is precisely what it will look like...

what it does look like...what it is.

 

Doesn't change the fact that we remain

responsible for our decisions and actions

and that we do need to carefully consider

the ramifications of such " progress. "

 

Ken

[Guest guest]

Interesting,

 

 

I been "fantasising" with the idea here in Guatemala,

 

Traditional medicine hospital

 

With department of Traditional Chinese epedimolgy (epedimology according to Chinese medicine)

and hence one would need a Astro-medical focus or department.

 

A Department of interactive health, where the patient would could learn about their constitution, meditation, Qi Gong, calligraphy food and so forth.

 

Various treatment departments, tunia, acumoxa, herbal... I have no idea what a traditional hospital in Asia is like but presumably a memorandum of co-operation with China, Vietnam Korea would be a good start.

 

As for diagnosis and treatments a policy of both pattern and disease first according to Chinese medicine with treatment plan-strategy, within that constitutional and simultaneous diagnoses of more or lesser known individual practices and or focuses.

 

Western medicine, not sure if the hospital need to cater with western medicine since most people if they can will go both to western doctors and else where. However with regard to western epedimolgy, western medicine diagnoses by a western doctor would be relevant.

 

I am trying to get the ministry of health in Guatemala to at least open up a Chinese medicine clinic but being bureaucrats they are formulating laws and regulations and not sure if they will be conducive to patient and hence Chinese medicine or vice versa.

 

 

 

-

acugrpaz

Friday, May 09, 2003 12:44 PM

Re: Harmonizing the Paradigms

Emmanuel Segmen wrote:>>>Jim, You've raised an interesting point with regard to "hospital privileges". One thing is that they don't really exist any more ... not since 1998. MDs have been paying for the "privilege" to see their patients in the HMOs. After reading one of your recent posts, I envisioned the re-invention of hospitals. You know, except for county hospitals, hospitals in many ways have ceased to exist. I had this crazy vision of practitioners opening a clinic with treatment rooms and then recovery rooms. In some cases they would be the same room. My point is that one could have a patient remain in a treatment or recovery room for an extended period of time the way an old country doctor would do ... or my great grandmother herbalist would do. This would be a "hospital" in a sense. Crazy what your imagination does when you wish for what's been lost. Emmanuel Segmen<<<Emmanuel et al,For the past few months I have been envisioning a moderate- to small-sized TCM teaching hospital with WM integration here in the West and wonder what that would look like. I have quite a few thoughts about it and wonder if anyone would like to help envision it. I live in Arizona and work at Phoenix Institute of Herbal Medicine and Acupuncture (PIHMA), so I envision the "teaching" part being the integration of PIHMA. I believe the only way to keep the envisioned hospital from turning into a WM-dominated thing would be to keep CM people at the top and have WM doctors work for us, not the other way around as is common in society at large. Perhaps we would have to put the thing on an Indian reservation in order to get away with it legally. Does anyone out there have much hospital experience? I am serious about starting such a phenomenon here in the West, the first I know of. Somehow, if Joseph Campbell and Kevin Costner are right, and I follow my bliss and build it and they will come, the money for all this will appear from somewhere.Joseph Garner Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

, " dragon90405 " wrote:

> Doesn't change the fact that we remain

> responsible for our decisions and actions

> and that we do need to carefully consider

> the ramifications of such " progress. " >>>

 

 

Ken and all:

 

CM is becoming more integrated with WM; but we are simply not

involved in it.

 

It would be interesting to hear what is planned or going on at the

national level. Does anyone know?

 

 

Jim Ramholz

[Guest guest]

>>>The uniting of independent nurse practitioners with L.Ac.s might be a natural alliance.

    Such are my thoughts for today.

Emmanuel Segmen<<<

 

Emmanuel,

Thank you for your thoughts. While I appreciate what you had to tell me and the great difficulties inherent in such undertakings as starting TCM hospitals in America, I think the only way to go is to think big, so to speak. What I mean is that we need to go after doctors, not because they're necessarily better (or perhaps even as good, sometimes) as nurse practitioners, but because they are the top of the medical respect food chain. What we need is credibility, and for all their failings, medical doctors have more medical credibility than anyone, so we need to integrate with them if we're going to integrate. I think the Chinese model of CM/WM integration, inasmuch as it occurs in China, is something we can use as a goal. Hopefully we can do better than the Chinese do, at least in the long run.

 

What I'm trying to say is that to start a TCM hospital in America means starting a real, though perhaps small, hospital, with all that entails. Perhaps it's asking too much of the universe right now, and perhaps the only workable route is to go through an established hospital and "work our way up" as it were. I sure would like to see a small hospital with someone who has TCM firmly at heart in charge, though. Boy, would I ever. Perhaps the way to go is to concentrate on neurological cases at first, since stroke patients in China are routinely sent straight to acupuncturists once they recover enough. Even the diehard WM doctors in China would have to admit that CM does a better job of getting them well.

Joseph Garner

[Guest guest]

Joseph,

Here in San Francisco ACTCM has worked it out to have clinics at Davies Hospital stroke ward to treat stroke patients. So you hit the nail on the head as far as where WM seems to be accepting CM.

Consider the fact that MDs don't run things anymore at HMOs. MSN nurse practitioners do. Kind of strange but true. The MSN students are kind of funneled into HMO middle management in place of high salary MDs. MSNs are perfectly happy to work for $80K to $90K per year.

Also consider people who do public health, MPHs. It's the MSNs and MPHs that are being trained to administer hospitals, not MDs. The MSNs and MPHs know HIPAA better than anyone these days.

Emmanuel Segmen

 

 

-

acugrpaz

Monday, May 12, 2003 3:24 PM

Re: Harmonizing the Paradigms

>>>The uniting of independent nurse practitioners with L.Ac.s might be a natural alliance. Such are my thoughts for today. Emmanuel Segmen<<<Emmanuel,Thank you for your thoughts. While I appreciate what you had to tell me and the great difficulties inherent in such undertakings as starting TCM hospitals in America, I think the only way to go is to think big, so to speak. What I mean is that we need to go after doctors, not because they're necessarily better (or perhaps even as good, sometimes) as nurse practitioners, but because they are the top of the medical respect food chain. What we need is credibility, and for all their failings, medical doctors have more medical credibility than anyone, so we need to integrate with them if we're going to integrate. I think the Chinese model of CM/WM integration, inasmuch as it occurs in China, is something we can use as a goal. Hopefully we can do better than the Chinese do, at least in the long run.What I'm trying to say is that to start a TCM hospital in America means starting a real, though perhaps small, hospital, with all that entails. Perhaps it's asking too much of the universe right now, and perhaps the only workable route is to go through an established hospital and "work our way up" as it were. I sure would like to see a small hospital with someone who has TCM firmly at heart in charge, though. Boy, would I ever. Perhaps the way to go is to concentrate on neurological cases at first, since stroke patients in China are routinely sent straight to acupuncturists once they recover enough. Even the diehard WM doctors in China would have to admit that CM does a better job of getting them well.Joseph Garner Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

, acugrpaz@a... wrote:

I sure would like to see a small hospital with someone who has

TCM firmly at heart in charge, though. Boy, would I ever. Perhaps

the way to go is to concentrate on neurological cases at first,

since stroke patients in China are routinely sent straight to

acupuncturists once they recover enough. >>>

 

 

Joseph:

 

I suspect your idea that we develop institutions of our own---carve

out our own economic niche---is a absolutely necessity one. Have you

worked out the money, logistics, and liability issues for putting

something like this together?

 

Integration with WM does not seem possible in any real equitable way

when it comes to money. Medical acupuncturists will undoubtedly fill

all the high paying positions in hospitals and ERs, leaving us to

work for them for less.

 

When I looked into it a while back, hospitals and pain clinics were

paying acupunturists about $25/hour; but billing out their services

to insurance at about $400-500/hour. It seems futile to argue that

we know more when we are not paid like it.

 

 

Jim Ramholz

[Guest guest]

Emmanuel,

Thank you for your information. I am not hung up on having MDs as such. I just want this to work. I know a number of holistically-minded MDs, and if I can get them to cooperate with me on this endeavor, and some have expressed interest, I will certainly use them. I hope I do not seem to badmouth MDs in my posts. I mean just what I say, no more, no less. I think MD training and experience is invaluable, not to mention legal and societal credibility. I know MDs have their strengths and weaknesses as a profession, as do nurse practitioners, MSNs, etc., as do CM practitioners. That's what this is all about. As Clint Eastwood would say, "A man's got to know his limitations." Each profession and practitioner has limitations, and that's where the referrals come in. And I really don't care how this all works out, but I do have a yen for a TCM-type hospital of some sort along the lines of the Chinese model, only cleaner (much cleaner).

Joseph G.

[Guest guest]

All,

I forgot to paste in Emmanuel's post that I was replying to. Here it is. I hope this comes out properly. I am not the master of email. Yet.

Joseph G.

 

>>>Joseph,

    Here in San Francisco ACTCM has worked it out to have clinics at Davies Hospital stroke ward to treat stroke patients.  So you hit the nail on the head as far as where WM seems to be accepting CM. 

    Consider the fact that MDs don't run things anymore at HMOs.   MSN nurse practitioners do.   Kind of strange but true.  The MSN students are kind of funneled into HMO middle management in place of high salary MDs.  MSNs are perfectly happy to work for $80K to $90K per year.

    Also consider people who do public health, MPHs.  It's the MSNs and MPHs that are being trained to administer hospitals, not MDs.  The MSNs and MPHs know HIPAA better than anyone these days.

Emmanuel Segmen<<<

 

Emmanuel,

Thank you for your information. I am not hung up on having MDs as such. I just want this to work. I know a number of holistically-minded MDs, and if I can get them to cooperate with me on this endeavor, and some have expressed interest, I will certainly use them. I hope I do not seem to badmouth MDs in my posts. I mean just what I say, no more, no less. I think MD training and experience is invaluable, not to mention legal and societal credibility. I know MDs have their strengths and weaknesses as a profession, as do nurse practitioners, MSNs, etc., as do CM practitioners. That's what this is all about. As Clint Eastwood would say, "A man's got to know his limitations." Each profession and practitioner has limitations, and that's where the referrals come in. And I really don't care how this all works out, but I do have a yen for a TCM-type hospital of some sort along the lines of the Chinese model, only cleaner (much cleaner).

Joseph G.

[Guest guest]

Hi Joseph,

Sounds like you're on a roll. With the rising energy of spring, the worst you could do is learn some lessons. Since ACTCM has at least gained entry into a local HMO at CPMC Davies Hospital, you can talk to the people who organized it. Speak with either Stanley Leung or Laurance (Law-ronts'), and see what they went through to set this up. You can call them at 415-282-9603. Maybe there's a hospital near you where CM instructors can train their students with clinical rotations on stroke wards.

To actually establish a clinic with revenue streams to support in patient care sounds like a wonderful undertaking. Start talking now to your local politicians and others who might know where funding might be available in your state. You might interview non-profit clinics in your area either to expand their practice to include CM or to guide you to people who understand funding in your local area.

Keep us posted on your progress.

Emmanuel Segmen

 

-

acugrpaz

Tuesday, May 13, 2003 12:10 PM

Re: Harmonizing the Paradigms

Emmanuel,Thank you for your information. I am not hung up on having MDs as such. I just want this to work. I know a number of holistically-minded MDs, and if I can get them to cooperate with me on this endeavor, and some have expressed interest, I will certainly use them. I hope I do not seem to badmouth MDs in my posts. I mean just what I say, no more, no less. I think MD training and experience is invaluable, not to mention legal and societal credibility. I know MDs have their strengths and weaknesses as a profession, as do nurse practitioners, MSNs, etc., as do CM practitioners. That's what this is all about. As Clint Eastwood would say, "A man's got to know his limitations." Each profession and practitioner has limitations, and that's where the referrals come in. And I really don't care how this all works out, but I do have a yen for a TCM-type hospital of some sort along the lines of the Chinese model, only cleaner (much cleaner).Joseph G.