Steven H. Stumpf, EdD

Randomized controlled trials (RCTs) are hardly the sine qua non of educational research. By contrast, medicine regards RCTs as the highest form of scientific research. Most medical research actually falls into the realm of social science research where RCTs are considered insufficient, inappropriate and ineffective for demonstrating effectiveness. Evaluation models are more appropriate in most cases than RCT and even other alternative (e.g., ethnographic, quasi-experimental) research models.

I received an email request last week from my health insurer to complete an online survey. Providers and insurers are required to collect and report "quality" information. The process can be costly (in person hours and/or $$) if sound survey principles are employed. Insurers have deeper pockets than provider groups so outcomes for insurers often have more defensible arguments where reliability and validity are concerned. I wrote an article for a professional magazine in 2000 describing cost effective and reasonable shortcuts for providers.

The best choice today for insurers and providers is to conduct the survey online. If information is required the applications are almost without limit.

The practice of surveying healthcare organizations to determine what everyone is paying for a certain medical service (e.g., hospitalist, interventional cardiologist) is a very good idea whose value and utility is often overlooked. This is a Fair Market Value survey. Organizational diligence in surveying the market, in many cases, supports compliance with regulations governing the purchase of services from third-parties, many of whom are also potential referral sources for patients. In order to encourage survey participation certain tactics can be employed. Respondent identity is confidential or even anonymous, known only to the survey consultant. Quid pro quo works, i.e., complete the survey and I will share the blinded report with you. Challenges remain including (1) finding the person with the information; (2) persuading that individual to respond to the questions; and (3) deciphering unanticipated information. I am distributing my current Fair Market Value survey online.

It is not unusual to learn that a hospital employs questionable policies and practices in order to stay competitive in the marketplace. This is why confidentiality is so important. When I conduct the survey over the phone I have all the identifying information of the respondent. When I do it online the respondent's ID is anonymous. The online approach protects the respondent and the surveyor.

A Fair Market Value survey can help the individual hospital determine if they are paying what is fair. It also can provide important unanticipated information that could help the hospital take corrective action before its next audit either internal or by external government agency.

Venice Family Clinic (VFC) is a long-standing community clinic with two locations in the Santa Monica and Venice neighborhoods of Los Angeles, California. Many people are surprised to learn that VFC serves a diverse and poor population of Westside adults, women and children. After all, the Westside is far better known for movie people and fine restaurants than it is for underserved and under-insured communities. There are many poor families and individuals living on the Westside for whom VFC is the only provider of quality healthcare, in part because it is a training site for UCLA Geffen School of Medicine healthcare students.

Provider coverage and timely treatment are a common challenge for many community clinics also referred to as "safety-net". For many people these clinics are the last resort for healthcare. Budgets have razor thin margins and there is tremendous reliance upon providers in training. Physicians "triage" each patient that comes into VFC making a referral to the appropriate "service". Wait time for follow through is always an issue.

A pair of forward-thinking integrative physicians at VFC, Myles Spar and Mary Hardy, wanted to test whether referral to treatment might be enhanced with an integrative and innovative Chronic Pain Clinic. "Integrative" is the term that has emerged for describing a blend of mainstream medicine with Complementary and Alternative Medicine (CAM). The two physicians proposed teaming chiropractors, acupuncturists, and an osteopathic doctor with themselves to offer services within the CAM providers' scopes of practice to VFC patients.

Blending CAM with mainstream medicine is not so unusual. The Wilshire Boulevard corridor in West LA is home to dozens of integrative practices featuring MDs, LAcs and DCs offering a range of remedies. However, the Chronic Pain Clinic at VFC is the first I have been involved with or read about that extends the model to underserved populations.

My role is data management and analysis. Together with the integrative MDs and the VFC administrative team we were able to demonstrate positive outcomes in the first Phase of the project to earn a prestigious LEAP award from the California HealthCare Foundation.

You can read about the award here.

In a recent post I discussed ideas for cross-training acupuncturists to function as extenders to primary care providers and deliver care within the scope of their license. My inspiration comes from 10 years helping develop two USC Physician Assistant degree programs and my experience with the VFC chronic pain program. I am confident cross-trained LAcs can fulfill the triage function reducing the wait period while continuing to deliver quality healthcare to the families and individuals who rely on safety-net clinics for their primary care.

The question of how CAM providers can blend in with mainstream medicine remains open. The VFC chronic pain program is demonstrating one way that benefits patients and the clinics seeking to serve them.