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Availability of CAM

• Eighty-three percent of MTFs offer one or more of a variety of CAM services with relaxation therapy, acupuncture, progressive muscle relaxation, guided imagery, and chiropractic being the most common.
• MTFs most commonly cite not having the necessary providers as the reason for not offering CAM.
• In general, our study's findings about CAM in MTFs are quite similar to results of the VA's CAM survey conducted in 2011, such as percentage of facilities offering CAM and the number of CAM types offered, among other findings.

Usage of CAM

• These CAM services are used for a variety of conditions, many of which can be difficult to treat with conventional medicine — e.g., chronic pain, stress, anxiety, and sleep disturbance.
• CAM services make up a substantial portion of the MHS: roughly 76,000 patient visits per month with 1,750 full-time equivalents of staff and contractor time involved in delivering these services annually, and a minimum labor investment of $112.7 million per year.
• Patient visits for CAM make up a small but nontrivial portion of total outpatient MTF visits.

Documenting CAM services

• There is some inconsistency in the criteria used for credentialing and privileging CAM providers.
• There is also a need for better documentation and coding of the use of CAM services.

Complementary and alternative medicine (CAM) comprises a large number of therapies (e.g., acupuncture and chiropractic) that developed outside the conventional biomedical model of care. About one-third of the general population report using CAM either on their own (e.g., yoga) or through the services of a CAM provider (e.g., massage). While CAM is offered within the military health system, no systemwide data are available on its use. RAND conducted an environmental scan (CAM survey) of military treatment facilities (MTFs) to understand the availability of CAM, the conditions for which CAM is being used, and the types and process of credentialing and privileging of CAM providers.

Most MTFs (83 percent) offer CAM services, usually up to eight different types, with relaxation therapy, acupuncture, progressive muscle relaxation, guided imagery, and chiropractic being the most common. Lack of provider availability was the primary reason reported for not offering CAM. These services are most often used for chronic pain, stress, anxiety, and sleep disturbance. There is variability across MTFs and types of CAM in the process and criteria used for credentialing and privileging providers. While most MTFs reported that CAM use is usually documented in a patient's electronic medical record, there was variation in the availability and use of procedure codes.

Standardization of CAM coding would allow consistent tracking of CAM providers and use for better manpower management, and easier data collection for future comparison studies. Standardization of CAM provider credentialing and privileging would ensure that providers are properly trained and have clear practice requirements.

• Chapter One

  Background

• Chapter Two

  Methodology

• Chapter Three

  CAM Prevalence Across MTFs

• Chapter Four

  Conditions and Diagnoses for Which CAM Is Used

• Chapter Five

  Demand for CAM Services at MTFs

• Chapter Six

  Practitioners Who Provide CAM at MTFs

• Chapter Seven

  CAM Coding and Documentation

• Chapter Eight

  Summary and Recommendations

• Appendix A

  Acupuncture at a Glance

• Appendix B

  Chiropractic at a Glance

• Appendix C

  Diet Therapy at a Glance

• Appendix D

  Mindfulness Meditation at a Glance

• Appendix E

  Stress Management/Relaxation Therapy at a Glance