HOSPITAL POLICY

Our major goal has been to articulate reproducible guidelines to help health care institutions understand how to credential CAM providers and conventional providers to offer CAM therapies within an evidence-based medical center, and to help such institutions manage potential malpractice liability in the process.

In accord with these objectives, the following projects are either complete or in progress:

1. Credentialing Practices, Malpractice Liability Policies, and Guidelines Governing Recommendations Involving Dietary Supplements (2000-2002): This research project, funded by American Specialty Health Plan, involves analysis of data concerning credentialing practices, risk management policies, and guidelines regarding pharmacy and therapeutic committee practices afforded to complementary health care providers as they apply to inpatient and outpatient domains of representative medical centers. To date, 17 medical centers have returned completed surveys. A draft manuscript is presently being circulated to participants and the sponsor for review.

2. Credentialing, Liability, and Dietary Supplements Policies (2000-2002): This research project, funded by the Medtronic Foundation, Inc., has used the resulting data from the ASHP-funded project and brought legal and regulatory expertise to bear on supporting the initial steps towards the planning and establishment of an integrative clinical care center at a site to be determined within the HMS-affiliated hospital system. To date, we have completed our cycle of planning meetings, in which we have explored legal and regulatory issues pertaining to credentialing policies, liability issues, and therapeutic recommendations involving dietary supplements as they shape establishing a clinical care center.

3. Models of Integrative Care in an Academic Health Center (2001-2005): The research, funded by NCCAM, involves helping to develop the complementary and integrative care clinical facility, particularly with regard to guidelines for credentialing providers, managing liability risk, and establishing guidelines concerning vitamins, herbs, and other dietary supplements. In Phase I of this research grant, we have completed a paper on credentialing and liability issues, together with credentialing guidelines for our planned integrative clinical care facility, and other appendices (90+ pages total). We are presently reviewing these documents with relevant personnel at HMS-affiliated hospitals (including designated legal counsel and chairs of credentialing committees) and our team on the grant, and with the Harvard Risk Management Foundation/CRICO.

4. Legal and Social Barriers to Alternative Therapies (2002-2005): The research, funded by the National Library of Medicine, uses qualitative and ethnographic research to prepare a scholarly, book-length manuscript that critically evaluates the integration of CAM therapies into conventional medical settings in the United States. Mary Ruggie, Ph.D., at the Kennedy School of Government, is co-investigator in the project. We are engaged in our literature search, identification of suitable centers for this research project, and interviews. Our interviews include the following: the medical director of the integrative care facility; key clinical personnel (e.g., nurse, exercise physiologist, chiropractor, massage therapist); pharmacy director at the affiliated hospital; relevant administrator (and/or legal counsel, if available); and legal scholars with expertise in health care law.

In addition, we have completed the following publications:

Cohen MH, Eisenberg DM. Potential physician malpractice liability associated with complementary/integrative medical therapies. Ann Intern Med; 2002;136:596-603.

Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, van Rompay MI, Cooper, RA. Credentialing complementary and alternative medical providers. Ann Intern Med, in press, 2002.

In addition, many of our faculty have been active in leadership or consulting roles in national and international discussions of regulation and policy. For example, Dr. Eisenherg also served as a principal consultant to the United States Federation of State Medical Boards in their deliberations to create “Model guidelines for the use of complementary and alternative therapies in medical practice”. These guidelines, recently approved and published (http://www.fsmb.org), differ dramatically from those of previous Federation committees on “health care fraud” and “unproven health care practices”. They suggest that the medical profession as a whole is slowly but surely acknowledging the primacy of a patient-centered and relationship- centered approach to health care.

Both Dr. Eisenberg and Mr. Cohen have testified before the White House Commission on Complementary and Alternative Medicine Policy. Both Dr. Eisenberg and Mr. Cohen participated in a Massachusetts state commission reviewing licensing of CAM providers; and Mr. Cohen has participated in a roundtable on health law and ethics sponsored by Health Canada.