Mayo Clinic’s CAM-IM Integration:  Strategy and Growth in a Bastion of Conservative Medicine

aobean@gmail.com Blog from Integrator

Written by John Weeks

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Brent bauer, Mayo Clinic IM leader Brent Bauer, MD

Brent Bauer, MD, is always quite conscious of the name and reputation of the Mayo Clinic in his work to grow integrative medicine inside his medically conservative institution.

For many, Mayo Clinic is a brand that is synonymous with excellence in conventional medicine.Bauer notes that the Rochester, Minnesota-based system, with locations in Phoenix, Arizona and Jacksonville, Florida, has a reach that is world wide. Patients are drawn to Mayo from all over the world for its executive health programs. Some 35-million are reached through Mayo Clinic publications.

Bauer knew that integrating CAM into patient care at Mayo meant big challenges. He also viewed the potential payoffs as significant, not just for Mayo, but for the IM field. A single positive article on a non-conventional therapy in a Mayo publication would be considered by many to be a good housekeeping seal of approval, a welcome into medicine’s fold.

So what would be the strategy for bringing CAM-IM into this bastion of conservative medicine? How is it going? May penetration into Mayo be viewed as a national marker for the general advance of integrated care?

IBN&R contacted Bauer, Mayo’s director for integrative medicine, to check in on the progress of his program. Bauer’s strategy, while instructive, may not surprise. But the rich diversity of initiatives underway provides intriguing insight into how integrated care is beginning to shape conventional institutional behavior.

ImagePreparation, Building an IM Resume

Bauer, an internist, believed that to be integrative medicine’s messenger in Mayo, he needed relationships, and a resume. “Early on, it was just me,” he recalls. He spent a good deal of volunteer time in the late 1990s slowly becoming known as a CAM-IM leader in Mayo. He had no formal title. He focused on making connections, finding others with a CAM interest, submitting review papers, talking up ideas, making contacts, building his resume and the confidence of his institution that he would respect its culture while introducing it to unknowns.

In 2001, integrative medicine finally became an “official program” at Mayo. The Clinic contributed internal funds, which allowed Bauer and a couple of his colleagues to have minor pieces of their time focused on building the program. A significant philanthropic grant more than matched the Clinic’s contribution. Bauer gained a title, as director of integrative medicine.

Still, the preliminary phase, a kind of institutional courtship, continued. Bauer speaks of the long process: “We were fortunate to receive a generous grant from Lucy Gonda which gave us the time to create the relationships and the internal network we needed. The rubber didn’t really hit the road until 2002 or even 2003.”

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Mayo Clinic

Integrative Medicine Program at a Glance
Some Projects Currently Underway

Clinical Research

– Ginseng in patients with cancer-related fatigue
(working with Wisconsin ginseng growers)
– Use of Yoga in cancer-related fatigue
– Valerian for sleep issues in cancer patients
– Gingko biloba for “chemo brain”
– Acupuncture for nausea
– Paced-respiration (Yogic breathing)
Nurse-led proposals on pain-management
(guided imagery, essential oils, others)
– Appointed to NIH study panels
– Received their first significant CAM-related
NIH grant via NCI

Physician Education

– 4 MD’s trained through U Arizona Associate
Fellowship in Integrative Medicine
(support from the Bravewell Collaborative and Lucy Gonda)
– Creation of an electronic curriculum for practitioners
– Develop an IM curriculum committee in the medical school
(chaired by Ralph Gay, DC, MD)
– Supervision of medical student-led CAM-IM study group
– Regular grand rounds and guest lecturers
– An e-list of 550 Mayo practitioners
– Joined the Consortium of Academic Health Centers
for Integrative Medicine (2006)

Clinical Services

– Formal Mayo Integrative Medicine Consultation Service
(includes MD-IM, nurse-hypnosis)
– Seated chair massage pilot for patients in the breast
diagnostic center
– Massage therapist in cardiovascular surgery
– Ambient and music therapy
– Use of mind-body CDs created internally
– Participation in trials
(typically 200-250 patients per trial)

Publications/Outreach from Mayo’s IM Team

– 100 peer-reviewed articles
– 30 book chapters
– 2 books
– Articles in Mayo publications
– Creation of mind-body CDs for patients
– Bauer gives 100+ talks a year
“from patient groups to church groups to
international academic centers”

Uptake into the Mayo System

Bauer’s strategy was to refuse to build a separate integrative medicine clinic. He didn’t want CAM-IM isolated. Rather, he worked to create a context in which components of CAM and IM might be uptaken throughout the system.

The calling card for CAM in Mayo would be outcomes gathering. “We’ve attached outcomes to everything, so we can know how it comes out, good, bad, or indifferent,” states Bauer. This was necessary in developing credibility. All initiatives were engaged as limited pilot projects, requiring no ongoing commitment.

Bauer’s work also had another organizing impulse. “We didn’t want to push anything on anyone,” he states. His focus was instead on creating enough knowledge, curiosity, and respect for the Mayo IM team “that the departments would be coming to us for projects.”

In 2003, 2004, the long courtship began to pay off. Pilots for complementary care began with the powerful oncology and cardiolology specialties. Care focused on diminishing pain, limiting fatigue, reducing adverse effects and enhancing the quality of patients as they moved through Mayo’s care processes. Music entered surgical suites. Chair massage assisted with pregnancy, and in supporting people in anxious waiting. An array of pilots began turning into large projects of 200-225 patients each.

Bauer states the complementary strategy succinctly: “We focused on things that were helpful.”

Developing Staff Expertise in Integrative Services

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Ann Vincent, MD — Mayo IM Consultation

A key focus in creating a band of providers who could assist in the program, and in delivering integrative services, has been to select a few physicians to take the two-year Associate Fellowship in the Program in Integrative Medicine offered through the University of Arizona. Gonda funds were used to train Ann Vincent, MD. On completion, she became the leader of Mayo’s first standing clinical offering, Integrative Medicine Consulation Services.

More recently, a special fund from the Bravewell Collaborative, created by Colby and Alana Jones, long-time philanthropic supporters of the University of Arizona, allowed three more physicians to engage the training. Under the program, Bravewell paid 50% and the sponsoring system or physician paid the remaining costs. Bauer particularly notes the importance of the network of relationships around the country these physicians gained through the Fellowship experience.

Other CAM-IM providers have also begun to fill out the potential for offering services. A massage therapist is in the process of being hired into cardiovascular surgery. Interviews were completed for a licensed acupuncturist, a position recently credentialed at the institutional level.

Meantime, inside the medical school, educational initiatives, and the direction of Ralph Gay, DC, MD, followed a parallel path. Explains Bauer: “We did not want to have (CAM-IM) off by itself. He is working with all the curriculum chairs to incorporate (CAM-IM) into the regular teaching.”

Looking Forward, and Back

Moving from a research rationale for CAM-IM integration, into ongoing clinical integration poses new challenges.  Says Bauer: “The question becomes how to fund these beneficial therapies in our goofy reimbursement situation.” One strategy is to side-step it. The cost of the massage therapist in cardiovascular surgery is likely to be “absorbed through being spread out through the costs all patients.”

Bauer reflects on the philanthropic contribution which helped get the program going. “Lucy (Gonda) jump-started something that has reached hundreds of thousands of people already, both directly and through our publications.We now have directors of other departments coming to us. This is all increasingly imbedded in Mayo, imbedded in what we are doing.”

Disclosure note: In the early years of IM development at Mayo, I was loosely connected to the work as an advisor to Lucy Gonda’s philanthropic investments.