|Naval Hospital Camp Pendleton’s (NHCP) Holistic Health Program (HHP) is a pilot program that was specially funded through W-186 or Wounded Warrior Psychological Health (PH) Recovery plan. This program is the first of its kind in the US Navy, and is unique even when compared to other similar multi-disciplinary programs in the US Army. The Army has embraced Complementary and Alternative Medicine (CAM) and integrative medical modalities for over 6 years, and they now have multiple interdisciplinary clinics providing care largely focused on pain management, as per the Pain Management Task Force (May 2010 final report from the Office of the Army Surgeon General: Providing a Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors and their Families). However, the HHP at NHCP is under the Mental Health Department, and the clinical focus is on PH and mild Traumatic Brain Injury (mTBI), as well as supporting the medical needs of the Wounded Warrior Battalion (WWBn). If the Defense/Veterans Brain Injury Center (DVBIC) is considered the operational arm of Defense Center of Excellence (DCoE), then the clinical focus of the HHP may be considered an operational arm of the National Intrepid Center of Excellence (NICoE).
The HHP clinic started from scratch with the 1st two clinicians reporting for duty on July 5th, 2011. We determined eligibility criteria, developed clinical standard operating procedures (SOP’s), and implemented a plan of care policy to best serve our population in accordance w/ NHCP’s mission and within the Mental Health department. 90% of the patients have PTSD as their primary diagnosis. The HHP consists of one full-time licensed acupuncturist (L.Ac.), one part-time healing touch practitioner, and one medical support assistant (MSA). The program is slated to include a massage therapist, a registered yoga teacher, and a Tai Ji/Chi instructor, and possibly another L.Ac. With the additional investment in staff, we’re anticipating an enhanced ability to facilitate recovery in our patient population and an increased capability to further develop overall patient loyalty.
Pt demand for services has been overwhelming. As of June 15th 2012, the L.Ac. has seen over 320 individual patients, w/over 1500 encounters, performed over 2,540 procedures, and has over 349 referrals for acupuncture services. Eastern (Chinese) Medicine and Acupuncture has proven to be a very effective (and drug-free) system to treat the PTSD cluster of symptoms, other PH cases, mTBI, chronic pain, co-morbid substance abuse, etc. The Healing Touch practitioner has completed over 509 encounters. The HHP began tracking specific ICD-9 codes on 01Jan2012, and an AHLTA report from 01Jan2012-15Jun2012 reported that the acupuncturist has treated 35 pts w/ a diagnosis of mTBI, 331 pts from the WWBn, and 235 pts w/ a diagnosis of PTSD. CPT codes for Acupuncture are available and reimbursable, and assigned within AHLTA. In 2010, DoD and OTSG created a Pain Management Task Force advocating for the implementation of a tiered system in pain management to include acupuncturists as Tier I providers. Technicalities surrounding this are currently being worked out with credentialing. A CHCS report from 05July2011 – 15Jun2012 was recently generated and returned the following data: The acupuncturist captured 1582.4 RVU’s in that period, which is valued at $37.43 per RVU.
CPT codes, number of procedures, RVU factor, RVU total:
97810 1474 0.6 884.4
97811 355 0.5 177.5
97813 710 0.65 461.5
97814 1 0.55 0.55
Pt response and perceived benefit has been very positive. We have anecdotal evidence that HHP treatment modalities have allowed pts to substantially reduce the dosage on their PRN medications, pts are reporting improved sleep quality, reductions in stress and anxiety, and their acute/chronic pain levels have decreased. We have Rx questionnaires, BAI, and elaborate customer relations feedback worksheets that we will be turning into data. We are also in the early stages of a formal retrospective study focused on tracking a reduction in polypharmacy usage amongst a group of pts diagnosed w/ PTSD who completed courses of tx w/ Holistic Health. Associating a cost savings figure with this should be very interesting. The HHP is actively working in conjunction w/ the Naval Center for Combat and Operational Stress Control (NCCOSC) on providing best measurable outcomes, and research. We are also in collaborative negotiations w/ DVBIC to expand our services, in terms of staffing and in clinical scope, in supporting the future Warrior Recovery Center (WRC). A future goal is to support SARP services, by using acupuncture in a group setting to help minimize the cravings involved w/ various substance afflictions. Acupuncture has been well-studied in this context, and is relatively widely utilized for such tx throughout the country. A well-known agency in this arena is called National Acupuncture Detox Association (NADA).
The HHP promotes health awareness, and like the other outpatient services in Mental Health, provides education and encourages our patients to become active members in their own recovery. Goals of this patient empowerment are to increase resilience and prompt action in our population, whereby they can continue to practice healthier behaviors as well as discover renewed motivation as they undergo lifestyle transitions. A long-term impact of our (Mental Health, IOP, SARP, HHP) multi-disciplinary programs, with regard to treating this population, may reflect in a better educated and better prepared segment of veterans as they return to civilian life. If they can successfully use the skills that they’ve learned in treatment along w/ the positive lessons gained from their time in service, we may see an improved socioeconomic condition for GWOT era veterans.
With the recommendations that the Defense Health Board made to the DoD/VA regarding widespread CAM/Integration (June 14th, 2011), multidisciplinary or integrative medicine may be here to stay. The Army centers are now located worldwide, including: Landstuhl, Germany; Tripler and Ft. Shafter in HI; Ft. Lewis, WA; Ft. Hood, TX; Ft. Bliss, TX; Ft. Gordon, GA, Ft. Bragg, NC; and Ft. Sam Houston, TX. With entities like DCoE, NICoE, and DVBIC leading the way, the Mental Health programs at NHCP can serve as a shining example of forward thinking and progress in Navy Medicine; a medicine that is patient-focused and that provides the multi-faceted care that over a decade of intense conflict necessitates, that our population deserves, and that they demand. We intend to continually provide outcome measurements, collect clinical data, and conduct research to best serve our patients, the command, and decision-makers as we move forward in a changing culture of medicine.