Category Archives: Alternative Medicine

Cancer-associated thromboembolism (CAT) is a common yet serious condition that occurs due to the physiological changes brought about by malignancy. The two conditions that are the most prevalent are deep vein thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is the standard of care for these thrombotic problems, however, in the event these medications are contraindicated, other treatment modalities may be needed. One common example is in the setting of an active bleed, such as gastrointestinal (GI) cancer. A treatment that has been used more frequently in recent years is the inferior vena cava (IVC) filter. These can be placed to provide a physical barrier to prevent a thrombus from moving through the circulation and potentially embolizing critical organs. An advantage of these devices is that they can be placed and removed when the use of pharmacological agents is better indicated. This report is a good example of a situation where an active GI malignancy created a hypercoagulable state leading to multiple thromboembolisms. An IVC filter was placed in the perioperative setting to prevent further thrombus migration while the primary malignancy was cured with a hemicolectomy.

Cancer-associated thromboembolism (CAT) is a common medical phenomenon; 20% of all thrombotic events occur in patients with neoplastic processes and they are the second leading cause of death in this population [1]. Deep vein thrombosis (DVT) is clotting that forms in the distal veins, and they have the potential to migrate to other locations which can have grave consequences. Pulmonary embolism (PE) is the most common and potentially life-threatening thromboembolism that is seen at a rate four times higher in patients with cancer than without [2]. Thrombotic events have an increased rate of incidence because of the bodys hypercoagulable state induced by neoplastic disease processes. Tissue factor (TF) and other cellular products are released into the circulation. They create inflammatory conditionsand promote platelet adhesion as well asthrombin formation [3].

Treatment of CAT, in the setting of a DVT or PE is widely discussed in the literature, with chemical anticoagulation as the mainstay of treatment. Common pharmacologic agents include low-molecular-weight heparin (LMWH), warfarin, and more recently the use of direct oral anticoagulants [1]. The task of treating a CAT becomes more difficult in the setting of an active gastrointestinal (GI) bleed from malignancy. These lesions typically result in slow blood loss, which can lead to symptomatic anemia, and may require transfusions of packed red blood cells. In such cases, it may be inappropriate to use standard anticoagulation medication, as it can further exacerbate an active bleed.

Another treatment option available is the use of an inferior vena cava (IVC) filter. These devices are typically used in the perioperative setting where a patient is at high risk for thromboembolism, and when standard anticoagulation is contraindicated or must be stopped. In these scenarios, retrievable filters are generally used and should be removed once anticoagulation is started or restarted. Ideally, they should be removed within 30 days to decrease the risk of recurrent DVT or IVC filter thrombus formation [4]. This report highlights the appropriate use of a perioperative IVC filter in a 59-year-old African American male with a GI malignancy complicated by symptomatic anemia and multiple CATs.

A 59-year-old African American male presented to the emergency department with a five-day history of right calf swelling and pain, as well as left calf pain. The patient has a significant medical history of hypertension, prediabetes, and iron deficient anemia, which resulted in hospitalization. Three months prior, he was diagnosed with a stage IIA adenocarcinoma of the cecum, and a stage IA2 primary, epidermal growth factor receptor (EGFR) positive non-small cell lung cancer of the right lower lobe(Figures 1-2). Before presenting to the emergency department, he was seen in a walk-in clinic with the current symptoms where bilateral lower extremity venous duplex ultrasound was conducted. Results of this exam demonstrated a right-sided, acute DVT from the mid femoral vein down through the distal right peroneal veins and a partially occlusive thrombus in the right posterior tibial veins. There was also a non-occlusive acute DVT on the left lower extremity extending from the left popliteal vein down through the distal posterior tibial and peroneal veins. Finally, it revealed superficial thrombophlebitis of the small saphenous vein. Upon discovery of these findings, the patient was transported to the emergency department for further evaluation and management.

Initial vital signs in the emergency department showed a blood pressure of 151/94, pulse of 101, temperature of 100.2F, respiration rate of 19, and oxygen saturation of 99% on room air. Initial physical exam demonstrated swelling in the right lower extremity, tenderness to palpation bilaterally behind the knee, and the skin was warm to the touch. Bilateral digital clubbing was also noted. Review of symptoms was positive for a 20-pound weight loss in the last three months and was negative for chest pain, shortness of breath, dizziness, syncope, dark or bloody stools, bleeding, or craving ice. Initial lab studies were significant for hemoglobin of 5.8 and hematocrit of 21.5%; platelets were 470,000and a stool guaiac test waspositive.

Since his presenting conditions had a high suspicion of PE, a helical CT study was conducted. Results showed filling defects within the lobar branches of the right middle and lower lobes. Additional filling defects were identified within segmental and subsegmental branches of the right upper, middle, and lower lobes, as well as in the left lower lobe. Upon these findings in the emergency department, he was admitted to the internal medicine unit for further evaluation and management.

On the floor, he was given 2 units of packed red blood cells given the severe symptomatic anemia; he was started on a porcine heparin drip following hospital protocol at 20 units/kg/hr to treat the thromboembolisms. Hematology/oncology was consulted for further recommendations regarding anticoagulation in the setting of chronic slow lower GI bleed, and current bilateral DVTs, and PE. In addition, colorectal surgery was contacted because he was scheduled to undergo a right hemicolectomy the following day.

Following transfusion, his hemoglobin levels increased to 8.2 and remained stable for the remainder of the hospital admission. Hematology and oncology recommended the placement of a retrievable IVC filter to be used in the acute perioperative setting. Colorectal surgery consultation resulted in the planned right hemicolectomy being postponed until successful placement of the IVC filter. Four days after admission, with the help of fluoroscopic and sonographic guidance, an OptionElite (Argon Medical Devices, Plano, TX,USA)IVC filter was placed infrarenal without complications(Figure 3).

On day seven of admission, the surgery team evaluated the patient and decided to move forward with the previously postponed procedure. They initiated bowel preparation and started the patient on a clear liquid diet which then transitioned to a 'no diet' at midnight with the maintenance of IV fluids prior to the operation. They also recommended pausing the porcine heparin drip for six hours leading up to surgery to avoid any excessive bleeding. The following day, a laparoscopic right hemicolectomy with intracorporeal ileocolonic anastomosis was successfully performed without any immediate postoperative complications. On the days following the procedure, the patient was able to eat a normal healthy diet and have bowel movements regularly and without pain or bleeding. One month following the initial hospitalization, he returned to have the IVC filter removed, which was accomplished without complication. At that time, he was followed by pulmonology and thoracic surgery to address plans for future procedures to address the lung adenocarcinoma.

CAT is an acute medical emergency superimposed on a chronic condition. While they are not uncommon, the sequelae can be devastating. This unique hypercoagulable environment is made possible due to an imbalance in hemostatic mechanisms that lead to an increase in thrombus formation and a decrease in lysis. The specific pathophysiological cause is complex and is induced when tumor cells express TF, pro-coagulant proteins, and metalloproteases. These products, in turn, activate endothelial cells, platelets, and leukocytes. Activated leukocytes produce and release other substances such as soluble and contact factors which lead to increased platelet adhesion and thrombin activation [3]. TF plays a role in the coagulation cascade by binding to factors VII and VIIa after injury to blood vessels. Significant levels of TF do not typically circulate in the blood without vascular injury, but various neoplastic processes are known to promote the expression of TF and may lead to a hypercoagulable state and promote thrombus formation [5].

GI malignancies are notorious for causing slow bleeds that can, in time, lead to symptomatic anemia due to blood loss. In many cases, this loss may not be obvious or apparent in the stool. Instead, there may be a slow and even microscopic blood loss that can lead to symptoms of fatigue, lightheadedness, and/or syncope over time. In such events when the hemoglobin level of the patient reaches a low enough level, below 7.0, transfusion of packed red blood cellsmay be necessary. In addition to the slow, chronic blood loss that can result from a GI malignancy, the risk of CAT is also present.

Anticoagulation is the mainstay in treating CATs, however, in the setting of an active GI bleed, standard therapy might exacerbate an active bleed and make the symptoms of anemia worse. Common pharmacologic agents include the use of warfarin, heparin products, and direct oral anticoagulation. While these medications are effective in treating thromboembolisms, they come with an increased risk of bleeding. In the case presented, a porcine heparin drip was used to treat the CAT because it can be turned off quickly in the event of increased bleeding or for surgical interventions. However, to effectively prevent the recurrence of GI bleeding in these patients, the underlying malignancy must be treated. This accomplishes two important tasks. First, by treating the source of active blood loss, the patients anemia resolves naturally. Second, eliminating the malignant cells which caused the hypercoagulable state restores the natural physiology of hemostasis. In some situations, alternative treatments may need to be used as an adjunct to traditional methods.

Current guidelines from the American Heart Association (AHA), American College of Chest Physicians (ACCP), and the American College of Radiology (ACR)/Society of Interventional Radiology (SIR) recommend the use of IVC filters in patients with venous thromboembolism who have an absolute contraindication to anticoagulation, in situations where pharmacologic intervention must be stopped, or have recurrent thrombus formation despite adequate anticoagulation [4]. The introduction of retrievable filters has slightly expanded the indication for use of IVC filters to include patients with large PE who are at risk for recurrent thrombus formation and embolization, those who are not compliant with medical management, patients with limited cardiopulmonary reserve, large free-floating DVT, patients with a high risk of complications from anticoagulation, such as active bleeding, and those who have CAT [4]. Even though the indications for use of an IVC filter have been expanded in recent years, the decision to use one is taken case by case, analyzing the risks and benefits of the intervention.

The use of IVC filters is generally safe and well tolerated, however, nothing comes without risk. These risks are present during the initial placement of the filter, during the postoperative setting, and during retrieval. During the initial placement of the filters, the most common complication is due to bleeding and thrombosis formation. Less common issues can be due to improper placement, or migration, or it can be placed in the wrong location. These can lead to the filter not being able to operate properly or can lead to difficulty retrieving it when the indication is no longer present [4]. In the postoperative period, thrombosis is also possible, leading to an increased risk of developing a DVT, PE, or even renal failure if a thrombus affects the renal vasculature. Perforation of the IVC is also possible because hooks present on the filters to prevent migration may injure vessels. Filters are made of strong metallic materials; however, they can fail and send shards up the circulation to various vital organs such as the heart and lungs [2]. Finally, serious complications exist at the time of filter retrieval. During this period, it is possible to create an injury or dissection to the IVC or have a failure of the filter causing fragmentation. It is generally recommended that the filters are removed when the increased risks of CAT or another thrombus formation have passed. This is generally done within 30 days of initial implantation [4].

The art of medicine is present in a case like this because one must weigh the risks and benefits of treatment modalities when multiple conflicting problems exist. The provider must decide which problem is the most acute and attack that problem first before less acute issues can be treated. In complex disease processes like the one presented, one must take a holistic approach and make informed decisions that will benefit the patient the most. There is no standard treatment for each person because every patient and situation is different from the next. Even though there may be similarities between cases, each case is ultimately unique and may require different treatments for the disease processes involved.

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Inferior Vena Cava Filter Use in the Setting of Gastrointestinal Blood Loss, Malignancy, and Multiple Thromboembolisms: A Case Report - Cureus

Taking place at Crawfordsburn Activity Scout Centre this Sunday (August 21), Happy Fest aims to address the recent statistics concerning mental health problems within the province.

Northern Ireland is reported to have the highest prevalence of mental health issues in the UK with psychiatric morbidity 25% higher than in the UK.

The latest official figures, from the Health Survey (NI) 2019/20, report that around a fifth or 19% of the adult population aged 16 or over had a high score indicating a possible mental health problem, thats 18% of males and 21% of females. However the Covid-19 pandemic was a catalyst for change.Alternative and healing therapies have always been in Northern Ireland, but this industry is gaining momentum.Happy Fest is a first-of-its-kind event that was conceived by local entrepreneurs Ciara Daly, founder of Ciara Daly House of Make Up and Ciaran May, founder of Natural Resilience with the focus of showcasing alternative and healing businesses from Northern Ireland.Co-founder Ciara Daly, said: Alternative therapies changed my life. I was struggling with my mental health and the medication being prescribed by my doctor only helped in the short term. I was in a dark place and I knew something had to change. This is when I started exploring alternative therapies and that is when things started to change.I felt compelled to create an event that bought together practitioners who offer healing and alternative therapies where they can speak with the public who are curious about the services. Being a mother, I wanted to create an event that is family friendly.Exhibitors include hypnotherapists, reiki practitioners, reflexologists, kinesiologists, relationship, mindset and wellness coaches, breath work and plant medicine practitioners.There will also be guest speakers to share their experiences and inspiring stories. Paddy McGurgan will speak about his weight loss journey while Lisa McFarland aka Relationship Coaching NI sharing her wisdom and encouraging us to talk. Grainne McCoy will be on hand to discuss her approach to business and mindset.Happy Fest will include yoga sessions, workouts, mindset workshop, breathwork and meditation guidance, short art therapy, archery, orienteering, rock climbing, bouncy castle, face painting, live music, and food trucks.At the end of the day, co-founder and cold-water aficionado Ciaran May will invite guests to partake in a sea swim at Crawfordsburn Beach. Happy Fest co-founder Ciaran May is a mentor for men and owner of Natural Resilience Wellness Centre in Lisburn.

He explained: There is an outdated belief amongst men that anything holistic or alternative is for women only, that the best way to deal with their problems is through drink and drugs. We only need to look at the suicide rate amongst men to see that its not helping.Times are changing. People are getting back to nature, rediscovering that sense of community, the importance of connection and physical, mental, and emotional wellness. Certainly, my own life improved dramatically when I started to explore and embrace these methods and treatments.So many people have been going through huge changes these last few years, whether its in their personal or business lives and it just feels right that they can all meet and get to know each other.

Read more from the original source:

Alternative and healing businesses set to showcase in Northern Ireland - Belfast News Letter

Recently, there has been heightened suspicion regarding orthodox medicine as people are taking more interest in alternative medicine. The consensus is that orthodox drugs are artificial chemicals that are harmful to the human body. Unfortunately, the postulates of this theory disregard the good, desirable effects of orthodox therapies. Rather, the adverse effects which are touted as the major disadvantages of orthodox over alternative medicine are magnified.

Many people would rather take herbal teas, supplement pills, and topical herbs than orthodox pills. It's the same formulations and appearances, but one is perceived as harmful and the other harmless. Reasons for this include dissatisfaction with conventional orthodox treatments, high cost of treatment, incompatibility with individual values, and religious and cultural beliefs. The term "natural" treatment or supplements brings down the guards of individuals who disregard the use of orthodox medicine, as they are often willing to try out "natural" remedies. Who says these "natural supplements'' do not have their side effects?

It appears that alternative medicine does not get the same level of distrust that orthodox medicine gets from the general public because alternative medicine may date back many centuries and be known to be quite effective. It's more like a case of the devil you know is better than the angel you do not know.

Furthermore, apparent trust in alternative medicine may be attributable to its lower cost, availability, and accessibility. Orthodox medicine includes prescription medications that cannot be dispensed without a doctor's prescription. Hence, the person must make a doctor's appointment, as well as go through some time-consuming processes, before treatment commences. Individual patients often have limited interaction with the physician which may cause some dissatisfaction with diagnosis and treatment modalities.

A combination of alternative medicine with faith/ spiritual healing also makes alternative medicine more attractive. This is because combining the two makes it more likely to align with a patient's religious and cultural beliefs.

More so that the alternative medicine dispenser takes time to listen to the client's complaints and is perceived as a person with special healing powers. This perception may play a role in improving mental attitude toward illness, which has been known to determine, to a large extent, response to treatment of an ailment.

Some people would swear by the effectiveness of traditional medicines even with the nonuniform preparation methods and poorly measured doses administered. This is not disputable, as many traditional remedies are discovered and used based on anecdotal evidence. Some are dissolved in solvents produced in environmental conditions where contamination is inevitable. Side effects are considered part of the mechanism of action. People believe that their forefathers enjoyed a better life without orthodox medicine.

In fact, some orthodox medications were adopted from traditional remedies after scientific evidence from the research showed how effective they were in treating that particular ailment. A good example is the Cinchona bark which was and is still being used as a traditional treatment for malaria. The antimalarial derived from cinchona tree bark quinine is still a very effective antimalaria medicine.

Some persons strongly believe that orthodox drugs they ingested have altered their natural genetic makeup. And that pharmaceutical companies are not to be trusted, as they are in it for the money alone, and therefore studies and results of research are often false or fabricated. They can then be extremely paranoid in their discussion with medics, so much so that it begins to sound like a personal attack on individual medical personnel.

Medical personnel need to be careful not to get defensive and further heighten suspicion.

It is best to broach this subject diplomatically, citing scientific evidence, research, and evidence-based medicine. Pointing out that the consequences of research misconduct are grave, and that pharma companies would not be involved in such, as there are many regulatory bodies with rigorous processes before a treatment is approved. Even when new treatments are approved, adverse effects are reported and drugs may still be withdrawn if the risk of harm supersedes the benefits.

We have seen some integration of traditional and orthodox medicine for instance, training of traditional birth attendants (TBAs) and working hand in hand with them in communities in some parts of Africa. This has been found to reduce maternal and perinatal mortality. These integrations may allay fears and distrust of orthodox medicine in the communities, although some are set in their ways and will stick to their beliefs and misconceptions despite overwhelming evidence.

Adults who have the capacity can decide to refuse orthodox medical treatments. And that's fine if it doesn't put other people in harm's way and is not a public health concern.

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Orthodox vs Alternative Medicine: Which Is the Villain? - Medscape

Personalized alternative cancer treatment in Tijuana

Tijuana has a variety of traditional medicine options, but it also has the services offered by Immunity Therapy Center (ITC). Unlike traditional therapies that are usually followed by side-effects that lower a person's quality of life, ITC has a totally different process.Programs offered for each patient are unique, since they are based on several different factors. For example, to offer an efficient treatment, ITC professionals take into account the initial diagnosis, the patients current condition, previous cancer treatments received by the patient, their medical history, and the patients mental and physical health.In addition, there are different treatments for different kinds of cancer conditions, while also treating autoimmune diseases, chronic degenerative diseases, and infectious diseases.Cancer is a disease that can show itself in different parts of the body and cause harm in different ways. Due to this, ITC is specialized in more than 50 types of cancer, among which there are: prostate cancer, esophagus cancer, liver cancer, stomach cancer, basal-cell carcinoma, vulva cancer, vaginal cancer, uterine cancer, spinal cancer, skin cancer, etc.

If you have this or any kind of cancer and want to receive a personalized treatment, call MedBaja]MedBaja at 619-333-6066 or leave your information in the form down below:

Autoimmune diseases are caused by an abnormal response by the immune system, i.e., the immune system attacks healthy cells and tissue instead of fighting against strange pathogens.Usually, autoimmune disease symptoms are unpredictable; they may be mild, severe, or mortal. ITC has the experience to deal with this type of disease, while offering several personalized programs for each particular case.Something to note about these medical centers treatments is the attention and care that doctors themselves give during the entirety of cancer therapy. They accompany patients during the entire therapeutic process and talk to them creating a comforting and familiar environment, while, at the same time, carrying out a thorough analysis regarding the patients emotional health. All of this contributes to personalized therapies being done effectively. Depending on the patients complete health, there can be even better care, attention, and adaptation of their treatment. The patient is completely free to ask whatever questions they deem necessary about the processes, as well as their health condition.Immunity Therapy Center has more than 30 ways of treating cancer. One of them is biomagnetic therapy, which is carried out by using magnets through several instruments such as bracelets and magnetized cushions. The magnetism in these objects stimulates molecules, ions, and the bodys energy, correcting any kind of interruption that could contribute to the growth of potential cancer cells. At the same time, they relieve patients of cancers painful symptoms.

Find out more about these alternative treatments at MedBaja]MedBaja.com, calling 619-333-6066, or leave your information in the form down below:

When it comes to alternative medicine research, investigations, and breakthroughs, there is a theory regarding injected nanoparticles into tumors, exposing this treated area to a magnetic field for several minutes. Experts think that an iron particle in a magnetic field can cause movement inside the affected area, creating enough heat to attack and reduce tumors. This therapy could help to relieve any sort of inflammation or body imbalance. The magnetic field, meanwhile, would create an increase in blood flow, generating more oxygen and nutrients in the affected area, strengthening the immune system.Another therapy used is radiofrequency ablation. This therapy combines electric energy and heat to destroy cancerous cells without damaging the surrounding healthy tissue. This therapy also tends to be used in patients with arthritis, warming the nervous tissue, which decreases pain in the area. This also works in cancer cases; while cancerous tissue is destroyed, discomfort and pain caused by symptoms are decreased. It can also be used for precancerous cells.

One of the advantages of radiofrequency ablation is that it is a minimally invasive procedure. Once the area where the tumor is located is identified, the doctor positions the thin needle to inject the cancerous tissue. High frequency radio waves go through the needle, heating up the tissue. The therapys intensity will depend on the patients health, as well as tumor size. Radiofrequency therapy can last from 30 minutes to a few hours, and a number of sessions may be necessary.If you want to know more about this or other cancer treatments, go to MedBaja]MedBaja.com, call 619-333-6066, or leave your information in the form down below:

Learn More about Immunity Therapy Center

Types of alternative cancer treatmentsMore than 21 alternative therapies and natural treatments for cancer are combined with traditional treatments. Some of the options are:

Enzyme therapy Vitamin and mineral therapies Oxygen therapy biomagnetic therapy Laser therapy HALO therapy Hyperthermia

It is important to note that most stays are for six weeks, but depending on the patient and the progress of their condition, this period may be longer or shorter. Instructions are provided so that the patient can continue their treatment at home after leaving the center.

This type of treatment is unique because of its use of alternative therapy, and therefore not covered by medical insurance, so each patient must pay for his or her own expenses. Patients can contact the center for help finding the best payment option.

Most patients come to the center accompanied by a loved one, so that they have the support and company of someone they trust, which is crucial when undergoing treatment for disease.

To learn more about the center and its therapies, visit the following link. This could be the life opportunity youve been looking for.

Get in contact with a specialist and learn about Alternative Cancer Treatments in Tijuana, fill-out the contact form below:

Alternative Cancer Treatment in Mexico | Survivor Testimonials

Call us at MedBaja Services on (619)333-6066 to find out more about this cheap, revolutionary, and holistic approach to cancer treatment, or fill out the form below so we may contact you immediately.INDEX: CANCER TREATMENTS IN MEXICOIs it safe to travel to Tijuana to receive cancer treatment?What to expect from an Alternative Cancer Treatment in Mexico?What makes Tijuana a leader in alternative cancer treatments?Viral anti-cancer vaccine, an innovative alternative treatment in TijuanaWhy is cancer treatment significantly more affordable in tijuana?How to choose a cancer center in Mexico?Where can I find a Cancer Tutor Verified Center in Tijuana?ITC: The best level of healthcare for cancer patients is in TijuanaTestimonial from a Cancer Survivor Treated in Tijuana, MexicoGuanabana: Why Fly to Tijuana, Mexico, For This Alternative Treatment?Anticancer Uses of Turmeric: Why Travel to Tijuana For This Asian Cuisine?5 Safer Natural Alternatives to Chemotherapy Available in Tijuana, MexicoWhat is the Cost of Cancer Treatment in Mexico?5 groundbreaking alternative cancer treatments in Mexico

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Personalized alternative cancer treatment in Tijuana - Yahoo News

Overall, neither systemic nor vaginal hormone replacement therapy (HRT) increased the risk of breast cancer recurrence (the cancer coming back) in women diagnosed with early-stage, estrogen receptor-positive disease. Still, using vaginal HRT slightly increased recurrence risk in women who received an aromatase inhibitor, according to a Danish study.

The research was published online on July 20, 2022, by the Journal of the National Cancer Institute. Read Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study.

Aromatase inhibitors are a type of hormonal therapy that treat estrogen receptor-positive and progesterone receptor-positive breast cancer.

There are three aromatase inhibitors that treat breast cancer:

Arimidex (chemical name: anastrozole)

Aromasin (chemical name: exemestane)

Femara (chemical name: letrozole)

Tamoxifen is another type of hormonal therapy that treats estrogen receptor-positive and progesterone receptor-positive breast cancer.

Many post-menopausal women take HRT to ease symptoms of menopause, such as hot flashes, night sweats, and fatigue.

There are two main types of HRT:

Combination HRT contains the hormones estrogen and progesterone.

Estrogen-only HRT contains only estrogen.

There are several ways to take or use HRT:

Systemic HRT usually contains a higher dose of estrogen and comes in many forms, including pills, skin patches, creams, gels, sprays, or vaginal rings. Systemic means the medicines travel through the bloodstream to all parts of the body.

Topical (local) HRT contains a lower-dose of estrogen and comes in the form of creams, tablets, or low-dose vaginal rings. These medicines arent as readily absorbed into your bloodstream and mostly stay in the vaginal tissue.

Systemic HRT effectively treats many symptoms of menopause, including hot flashes and night sweats. Topical HRT only works on vaginal symptoms, such as dryness and discomfort during sex.

National and international guidelines say that women who have been diagnosed with breast cancer should not take HRT of any type. This is because the hormones in HRT can cause hormone receptor-positive breast cancers to develop and grow.

Still, only a few small studies have looked at HRT use in women with a personal history of breast cancer. In this study, the researchers wanted to see if there were links between HRT use and recurrence in women who had been diagnosed with early-stage, estrogen receptor-positive breast cancer.

The study included 8,461 Danish women who received treatment for early-stage, estrogen receptor-positive breast cancer between 1997 and 2004:

2,007 women received tamoxifen for five years after surgery

403 women received an aromatase inhibitor for five years after surgery

2,939 women received tamoxifen and an aromatase inhibitor in sequence for five years after surgery

3,112 women received no hormonal therapy after surgery

The womens ages ranged from 35 to 95 years.

Overall:

1,957 women used vaginal HRT

133 women used both vaginal HRT and systemic HRT or used only systemic HRT

6,371 women didnt use HRT

Women who didnt use HRT were more likely to be:

older

diagnosed with a larger breast cancer

diagnosed with node-positive breast cancer (which means cancer was found in the lymph nodes)

The researchers followed half the women for more than 9.8 years and half for shorter periods of time.

During follow-up, 1,333 women had a breast cancer recurrence. Of the women who had a recurrence:

111 used vaginal HRT

16 used systemic HRT

1,206 didnt use HRT

The researchers looked at the risk of breast cancer recurrence by the type of HRT the women used, as well as by the type of hormonal therapy the women received:

Women who used vaginal HRT had about the same risk of recurrence as women who didnt use HRT.

Women who used systemic HRT had a slightly higher risk of recurrence 0.05% higher than women who didnt use HRT.

Women who took an aromatase inhibitor and used vaginal HRT had a 39% higher risk of recurrence than women who didnt use HRT.

Of all the women in the study, 3,370 died before Jan. 1, 2017. Of the women who died:

497 women used vaginal HRT

47 women used systemic HRT

2,826 women didnt use HRT

The researchers analysis found that using HRT didnt increase the risk of dying.

In post-menopausal women treated for early-stage, [estrogen receptor-positive breast cancer], use of [vaginal HRT] or [systemic HRT] was not associated with increased risk of recurrence or mortality, the authors concluded.

[T]he results of this highly clinically relevant study by Cold and colleagues suggest that patients who are taking tamoxifen and experience severe genitourinary symptoms of menopause may safely initiate vaginal estrogen, as [it] does not appear to statistically significantly increase risk for breast cancer recurrence or survival, wrote Elizabeth J. Cathcart-Rake, MD, and Kathryn J. Ruddy, MD, MPH, both of the Mayo Clinics Department of Oncology, in an editorial accompanying the study. Patients who are taking aromatase inhibitors should try alternative strategies for management of genitourinary symptoms because [vaginal HRT] will likely increase their risk for breast cancer recurrence.

If youve received treatment for early-stage, estrogen receptor-positive breast cancer, this study offers important information.

The study suggests that, if you take tamoxifen, you can safely use vaginal HRT to ease vaginal dryness, overactive bladder, pain during sex, and other reproductive- or urinary-related issues associated with menopause. Still, its important to remember that HRT usually doesnt help ease hot flashes and night sweats.

If you take an aromatase inhibitor, its a good idea to talk to your doctor about other ways of managing menopausal symptoms. Research suggests that lifestyle changes, complementary and alternative medicine techniques, and non-hormonal medicines may help.

Lifestyle changes include:

identifying and avoiding hot-flash triggers, such as stress, alcohol, caffeine, and smoking

maintaining a healthy weight

exercising daily to reduce stress

Complementary and alternative medicine techniques include:

acupuncture

meditation

yoga

Non-hormonal medicines include:

antidepressants such as Effexor (chemical name: venlafaxine) and Celexa (chemical name: citalopram)

high blood pressure medicines such as clonidine

anti-seizure medicines such as gabapentin and Lyrica (chemical name: pregabalin)

overactive bladder medicines such as oxybutynin

Learn more about Treating Menopausal Symptoms.

Learn more about Using HRT (Hormone Replacement Therapy).

Written by: Jamie DePolo, senior editor

See the article here:

HRT Doesn't Seem To Raise Risk of Breast Cancer Recurrence in Certain Women - Breastcancer.org

You may have heard about homeopathy. But what is it exactly?

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Homeopathy is a system of therapeutics that was developed at the end of the 17th century by Dr. Samuel Hahnemann, a German physician. Homeopathy believes that using extremely minute diluted amounts of plants and minerals can help the body repair itself by promoting healing.

This alternative medicine remains popular worldwide. However, theres no strong evidence for homeopathys effectiveness greater than a placebo.

So, how do you know if its safe? And if it works? Integrative medicine specialist Yufang Lin, MD, explains the theory behind homeopathy.

Dr. Hahnemann believed in the natural law of healing similia similibus curantur or likes are cured by likes. He thought that a disease could be treated by drugs that have shown to cause symptoms of the disease in a healthy person, but only if a very small dose was used.

Its based on this idea of similitude, says Dr. Lin. Dr. Hahnemann realized that something in its natural form can cause a specific symptom. He believed that if you take that substance and dilute it, the diluted medicine can treat these symptoms.

Research has been limited on homeopathy, though. Although there have been some randomized controlled trials comparing homeopathy to placebo, many of these studies are of low scientific quality.

Critics of homeopathy suggest that any results or outcomes are due to the placebo effect, where symptoms may improve although no real medicine was taken. Another criticism of homeopathy is that the medical practice focuses on symptoms instead of treating their underlying causes.

Intuitively, a lot of people find that homeopathic medicine doesnt make sense, says Dr. Lin. The concept is so unusual that its very hard to logically make sense of it.

Homeopathic doctors, also known as homeopaths, dilute or weaken an ingredient by adding water or alcohol. The product then is shaken, or potentiated, to activate its properties. Then, one part of that mixture is diluted with more water or alcohol. This process is repeated until the desired potency is reached.

A common potency or strength of a homeopathic remedy is 200c. That means that one part of the tincture, the extract of the ingredient, is mixed with 99 parts water or alcohol. This process is repeated 200 times. This is a high level of dilution and none of the initial plant-based raw material or mineral may remain in the final tincture.

Some homeopaths propose that homeopathic remedies work as nanomedicine, says Dr. Lin. They believe the original ingredient is broken down through potentization into nanoparticles, even if its below the level of detection.

However, no scientific studies have demonstrated this theory to be true.

For example, poison ivy causes a red, itchy rash. A homeopath would take the poison ivy and dilute it down by going through the potentization process repeatedly. The homeopath would use that treatment to treat the rash.

Some other common ingredients used in homeopathy include:

Homeopaths use their therapies to treat a wide variety of conditions, such as:

To get a better understanding of your symptoms, a homeopathic doctor may ask questions like:

You may also have heard of naturopathy as an alternative medicine system thats akin to homeopathy. While homeopathy and naturopathy may appear similar, they are, in fact, different.

Naturopathy, also known as naturopathic medicine, combines many different types of treatments. Those methods may include lifestyle changes, herbal supplements, exercise therapy and psychotherapy.

Naturopathic physicians are trained through a four-year graduate level program and a certified naturopathic medical school, says Dr. Lin.

However, make sure you do your homework. People may claim to be a naturopath but may have no naturopathic training, as requirements vary from state to state.

According to the National Institute of Healths 2012 Health Interview Survey, about 6 million people in the United States had used homeopathy in the prior year. A large majority of this use was by individuals choosing and purchasing homeopathic products on their own.

Homeopathic medicine comes in different forms like tablets, gels, liquid drops, creams and sugar pellets. Theyre sold in stores or online.

Although most homeopathic medicines are likely harmless, theres no rigorous evidence that homeopathy is effective for any health conditions. Importantly, despite any marketing that advertises it as an alternative to vaccines, homeopathy should never be used as a replacement for standard immunizations.

If youre considering taking any form of a supplement, you should speak with a physician first. Homeopathy shouldnt replace conventional care so dont put off a visit to your doctor if you have a medical concern.

See the article here:

What Is Homeopathy and Does It Work? - Health Essentials

Many Western New Yorkers who are desperate to find a treatment or cure for their mental health issues, aches, pains, and other disorders and are getting increasingly frustrated by standard medical treatments are turning to the ancient practice of hypnotherapy.

Hypnotherapy, also known as hypnosis or hypnotic suggestion, is a common yet controversial treatment that puts users into a trance-like state, decreasing the awareness of whats going on around them, and making them more vulnerable to suggestion.

Hypnosis has been around for thousands of years, and in recent years has made a resurgence in the alternative medicine community as a treatment for a variety of ailments.

Although many people immediately think of those silly shows where volunteers become hypnotized and start barking like a dog and crowing like a rooster, many medical experts agree that hypnotherapy can be a viable option for those seeking help for a certain condition.

According to the Mayo Clinic, research has shown that hypnotherapy can be used to successfully treat many physical and mental conditions, including but not limited to:

Although hypnotherapy is considered a valid treatment for many ailments, just like any other type of medical treatment, there are risks involved and not everyone is a good candidate for hypnosis.

Hypnotherapy isnt recommended for individuals who suffer from severe mental illness and has even been found to occasionally result in creating false memories.

Other potentially unpleasant side effects from hypnotherapy listed by the Mayo Clinic are headaches, dizziness, distress, and drowsiness.

As always, before trying a form of alternative medicine like hypnotherapy, its a good idea to do plenty of your own research to see if its something that you could potentially benefit from. In addition, before your first appointment, ask your potential hypnotherapist about their qualifications, credentials, education, results, and anything else you need to know to make you more comfortable with the person that will be potentially hypnotizing you.

If youre interested in learning more about and possibly trying hypnotherapy, these places in the Buffalo area could be a good place to start.

Amherst Hypnosis

57 Thomas Jefferson Lane, Snyder

BlueSky Hypnosis

359 Quaker Road, East Aurora

Extraordinary Change Hypnosis

1313 Walden Ave, Buffalo

Hamburg Healing Center

5854 Camp Road, Hamburg

Heart's Desire Hypnosis and Wellness Center

168 Robinson St, North Tonawanda

Master Mind Advanced Hypnosis

300 International Drive, Buffalo

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Where To Find Hypnotherapy In Buffalo, New York - wyrk.com

Feeling anxious? Suffering from whiplash or tennis elbow? Why not stick a needle in your ear!

Yes, all these conditions and more can be managed by ear acupuncture or so its claimed. What does the science say? The buck stops ear, folks! Lets find out more.

Acupuncture is a pillar of traditional Chinese medicine (TCM). In this system, youve got your life force energy called qi. Qi flows from your vital organs outwards through the body via channels called meridians. If the flow of qi is disrupted or imbalanced, so the theory goes, your health suffers.

By inserting fine needles into your body at certain points along the meridians (and a few other important places), acupuncturists say they can rebalance your qi and heal you.

Ear acupuncture is sometimes called auriculotherapy or auricular acupuncture. Its the same deal, but it focuses only on the acupuncture points found in your ears.

A typical ear acupuncture appointment could take up to an hour. And its vital to visit a licensed, qualified and experiences acupuncturist to ensure a safe experience.

Acupuncturists claim there are more than 200 individual points in the ear which each have a different effect when the needle is applied. Some schools of thought may differ, but youll typically see the five most important points listed as the:

Proper mapping of the ear is vital because some of these points have very different effects to their neighbors. The antihistamine point, for example, is right next to the one for testicular secretion. For the record, ovary secretions are next to the subcortex.

Some acupuncturists use the image of an inverted fetus (as it would be at about 34-ish weeks of pregnancy) and map it against the ear. This is because the lower ear pressure points deal with conditions affecting the head. Internal organs are in the middle of the ear, the spine and lower body are located at the top of the ear.

Others represent this by using an upside-down map of the ear so its easier to visualize how pressure points correlate to different areas on your body. Either way, there are some exceptions and contradictions; one of the highest points on the ear actually deals with the tonsils.

The most common conditions which ear acupuncturists claim to be able to treat include:

Some professionals also say they can use ear acupuncture for things like muscle spasms, whiplash, inflammation, tinnitus; the list goes on and on.

Obviously, thats a pretty broad range of conditions for one treatment to tackle. You might be wondering how much hard evidence there is backing it all up

Acupuncture often gets lumped in with other alternative medicines as pseudoscience or quackery. It wont shock you to hear that hard evidence is lacking for qi, meridians, or any associated mystical concept.

However, there are a number of small-scale studies out there which suggest ear acupuncture might have tangible medical value:

BUT, theres one common theme running through all these limited studies in the vast majority of cases, sample sizes were small and the resulting data wasnt of the highest quality. This is particularly true when it comes to the longer-term effects of ear acupuncture.

Efforts are being made to standardize and improve the quality of ear acupuncture trials. For the time being, there dont appear to be any safety risks posed by this type of alternative medicine, and its often delivered alongside other treatments.

If you feel it could help you, its highly recommended to seek qualified medical professionals advice first.

Your first ear acupuncture session could last anywhere from 20 minutes to an hour, depending on what youre trying to fix. Every acupuncturist will work slightly differently, but most sessions should follow a loose format.

The therapist will start by asking a series of questions to get a sense of your medical status. Topics could include your sleeping pattern, sex life, stress levels, not everything might seem immediately relevant to the reason youre there.

Dont be alarmed. Acupuncture takes a holistic, interconnected view of the body. It connects systems which mainstream medicine might not think are actually linked. Answer as honestly as you can to get the best possible acupuncture experience.

Were assuming youre only here for ear acupuncture, in which case youll get your treatment while seated. If youre getting more points looked at, you may be invited to lie face-down.

From there, the therapist will use sterilized single-use needles to work the chosen pressure points. These are hella thin, so you should hardly feel them going in. The needles are left in for the duration of the treatment, which might feel odd for a moment while you get used to it.

Most people may experience deep relaxation during an acupuncture treatment due to the release of serotonin, endorphins, and dopamine naturally from your brain. New patients might even feel sleepy. For this reason, its often recommended to rest after a treatment.

Once the treatment is complete, the needles will be removed (again, usually painlessly) and disposed of.

You might get asked a few quick questions after the treatment to see how it went. If you book a second appointment, the therapist might offer you some other types of TCM to supplement the acupuncture.

When its done properly by a licensed provider, ear acupuncture is usually safe. But there are risks to acupuncture if its not performed right. These include:

More commonly, some people experience mild nausea or dizziness during acupuncture. Of course, theres also the possibility of pain and tenderness to the areas being treated. Cos, ya know needles.

It might be a good idea to speak with your health care provider if youre taking blood thinners or have a bleeding disorder like hemophilia.

Finally, there is one pressure point which is said to induce labor. Science has yet to make a firm ruling on that, but for now, pregnant people should speak with a health pro about acupuncture if youd like to go that route.

If youre going to try ear acupuncture, its vital to visit someones thats qualified and accredited by a reputable body, wherever in the world you live.

If youre in the US, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is the only organization who validates acupuncturists. They keep an updated list of licensed acupuncturists on their website.

Alternatively, your doctor or other mainstream health professional might be able to recommend an acupuncturist near you. The UKs National Health Service (NHS), for example, gives information on acupuncture and links to trusted providers.

Dont be afraid to ask your prospective new provider some questions to get a feel for their credibility. They should have no trouble talking about their qualifications and experience.

If needles arent your thing, consider using ear seeds instead. This is actually acupressure an alternative to acupuncture which uses the same qi-balancing points across the ear. A licensed therapist will use tiny little stickers with a seed attached to them, placing them on your ear so that the seeds press into the right points.

Youll then spent the next three to five days being able to gently massage those seeds, allegedly providing the same range of medical benefits as acupuncture. Theres a similar lack of quality evidence for how effective ear seeds really are at the moment, however, theres not a lot of reason to feel unsafe either.

Side effects of ear seeds are usually limited to skin irritation from the stickers.

If youre also following a proven course of medical treatment for a condition, theres usually no reason not to back it up with ear acupressure if you want.

Acupuncture has developed over time into a complex art. While we seriously need more hard scientific data on the specific mechanisms it uses, some (preliminary) evidence seems to support it as a valid treatment.

Millions whove tried it swear by its effectiveness. As long as it accompanies a proven form of mainstream treatment, ear acupuncture could offer you some much-needed relief from a range of conditions. But make sure youre visiting licensed acupuncturist only.

See the original post here:

Ear Acupuncture: Treatment and Potential Benefits - Greatist

Dan Deming| Special to the Hutchinson News

There's disagreement on whether Hutchinson faces a shortage of familypractice doctors with the local hospital saying it's "significant" and "overwhelming" while PrairieStar Health Center maintains "the need simply does not currently exist."

Thelatter assessment comes from Bryant Anderson, PrairieStar CEO, in a seven page website answer to my June 26th column.Hutchinson Regional Medical Center has ventured into hiring and heavily advertising, providing primary care physicians that previously were only offered by the Hutchinson Clinic (which is yet to respond), PraireStar and private practice physicians.

"There's always room for improvement," saidAnderson, who notes "differentiating between primary care and family practice is important in understanding why there isn't a shortage."

Anderson counts several types of providers:internal medicine, pediatrics, obstetrics/gynecology and mid-level workers, such as nurse practitioners and physician assistants, when he assesses primary care needs.

PrairieStar contendsthere are 49 primary care providers in Hutchinson; not only the 18 family practice doctors listed on websites.In arguingthe hospital needs to do more recruiting, President/CEO Ken Johnson has cited outside hospital paid studies and a state health care analysis, saying Reno County has 55 primary care physicians and should have 72.

According to Anderson, 25% of Americans don't have a PCP and a Kaiser Foundation study showed nearly half of 18 to 29 year old's don't.The surge of walk-in care, alternative medicine options and specialists also doing primary care are all listedas reasons why Hutchinson doesn't face a shortage the hospital claims in launching open competition for family doctors with the for profit Clinic and PrairieStar, a federally qualified health center.

Anderson says all three medical centers along with The Summit offer services "grounded in their unique areas of expertise" and that "exceptional continuity of care can only be achieved when each focuses on what they do best, avoiding fracturing the system further by diversifying into areas they lack expertise."

"Patients end up paying the price when the medical community becomes fractured,"Anderson said.

PrairieStar also says there is "no question that some patients are going elsewhere forhealthcare, but it has nothing to do with a lack of access to family practice providers." The hospital contends "$100m plus is going outside Reno County" because of lacking primary care doctors.

The East 30th and K-61 facility plans to hold a Hutchinson Health Care Summitin coming months, inviting providers, patients and the community to discuss areas where the medical community is falling short.

"We need to find a way to earn the trust of those patients leaving our community to have their overall primary care and specialty needs met," Anderson said.

A social media survey is also planned by PrairieStar with additional information available on their web site. In our earlier interview, Hutch Regional CEO Johnson said the hospital is "trying to focus on the big picture," stopping leakage of patients outside the community while improving local health care options.

As a former hospital board member and chairman in the early 1980s, I can only say that if the four major local health care providers along with other medical interests and patients actually get together to discuss and resolve local healthcare territory and concerns, it could lead to the most significantimprovement in local medical care since Hutchinson'stwo hospitals merged in 1971 and opened 4 years later.

Dan Deming, former general manager of Hutchinson radio station KWBW and former Reno County Commissioner, can be reached at 620-960-6733 or dan.deming2@gmail.com.

The opinions expressed in this column are that of the opinion writer and not necessarily The Hutchinson News.

More here:

Medical community in Hutchinson at odds over shortage of physicians - The Hutchinson News

Safety-net providers can benefit from demonstrations of condition-specific and defined-scope-of-practice alternative payment models that account for the nonfinancial as well as financial risks that providers face.

Am J Manag Care. 2022;28(8):In Press

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Takeaway Points

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In September 2020, CMS issued guidance designed to accelerate the adoption of value-based payment arrangements under Medicaid.1 This guidance followed a decade of demonstration projects and a 2016 rule that explicitly allowed states to require their Medicaid managed care organizations (MCOs) to direct a portion of Medicaid payments to providers using alternative payment models (APMs). Some states had already begun using APMs in their managed care programs before this rule, and since its enactment more states have introduced these reimbursement models in their Medicaid programs. Currently, 26 states mandate some type of APM in their Medicaid managed care contracts, and 18 states have established specific APM spending targets for their Medicaid MCOs.2

More recently, the Biden administration announced a commitment to 3 goals for value-based payment (advancing health equity, improving quality, lowering costs)3 and strategies4 to extend more APMs to safety-net providers.CMS also expressed a strategic goal of increasing value-based models clarity and transparency.4 These objectives are laudable, but including more safety-net providers in APMs and promoting equity will require understanding the full range of financial and operational challenges that shape providers risk exposure. Payers and MCOs should more clearly understand the promise and the risks of different APMs as they engage safety-net providers in experimental payment reforms.

Because calculating the risk inherent in different types of APMs is a multidimensional task, many MCOs may not know precisely how much financial risk they are passing on through these contracts. Safety-net providers have slim operating margins and may be hesitant or unwilling to participate in APMs that involve financial risk. Moreover, APMs expose providers to insurance, technical, utilization, and performance risks.5 Without a way to consider the full range of vulnerabilities that affect Medicaid and especially safety-net providers, MCOs may adopt APMs that inadvertently destabilize the very providers on which Medicaid members and states often depend.

How might specific types of risk be relevant for safety-netproviders?

Insurance risk refers to normal variation in utilization of medical services and differences across subpopulations and speaks to the numbers of members needed to smooth this risk. There is increasing recognition that social factors, such as housing status or income level, can influence the demand for medical services, leading to calls for payment models that account for social as well as clinical risks.6

Technical risk refers to how many structural elements a model has and the complexity of calculating allowed amounts (eg, based on index events, time periods, or exclusions). Models with high technical risk, such as shared-savings APMs, are complex to design, implement, and monitor. Accounting for social risk factors in payment models, although crucial, would add technical risk. CMS has recently called for making APM parameters and details more transparent and easily understandable to help reduce complexity and encourage adoption.4

Utilization risk refers to how changes in service utilization affect provider costs and profitability in a payment model. For example, in a fee-for-service (FFS) model, assuming payment rates cover costs, increased utilization leads to higher profit margins. But traditional FFS models are vulnerable to utilization risk, as many providers discovered when patients avoided or delayed care during the COVID-19 pandemic.

Performance risk refers to the potential for inefficiency, suboptimal quality, and high cost of carecriticisms that have been leveled at FFS medicine. Lack of technological savvy or the capacity to address social factors influencing patient health have also emerged as performance risks and may be exacerbated under population-based payments. Many safety-net providers are underresourced, making them especially vulnerable to these risks. Contracts with financial penalties for poor performance could further diminish quality among these Medicaid providers.

The Health Care Payment Learning & Action Network (LAN) APM framework outlines 4 major payment categories: (1) diagnosis-related groups and FFS payments with no link to quality and value; (2) FFS payments linked to quality and value; (3) retrospective performance-based payments built on FFS architecture; and (4) population-based, prospective payments.7 These last, so-called LAN category 4 APMs, offer payments that are up front, flexible, and predictablequalities that support provider viabilitybut the individual APMs within the category differ in important ways. Some category 4 models, such as comprehensive population-based payments (category 4B), tend to have high risk across the board; integrated finance and delivery systems (category 4C) tend to have high insurance and utilization risk.

Our research suggests that only 1 APM can be designed to involve low to medium risk across all risk categories and provide strong provider flexibility and revenue stability: defined-scope-of-practiceor condition-specific payments (category 4A). These payments provide less risk across all categories than other population-based payment models. Examples of category 4A APMs include bundled or per-member per-month payments for primary care, mental health, oncology services, and substance use disorder treatment.7 In 2018, only 23% of Medicaid payments were funneled through APMs, and only 1.9% of Medicaid dollars were disbursed in the form of defined-scope-of-practice or condition-specific payments.8,9 Despite being relatively underutilized, category 4A APMs seem to have several advantages over other APMs, particularly for safety-net providers.

At a time of change and uncertainty in health care delivery, flexibility and revenue stability are critical to provider stabilityone of many lessons of the pandemic. Category 4A payments also offer safety-net providers more freedom to use services such as telehealth and to address nonmedical and social factors such as food and housing insecurity, which contribute to poor health and high health care costs. By providing a consistent revenue stream, population-based, prospective payments might also attract providers to work in specialties with persistent shortages, such as primary care and mental health.

CMS recognizes that relatively few of its APM demonstrations have focused on Medicaid or been relevant to safety-net providers or the populations they serve.4 The latest CMS innovation strategy calls on MCOs and other payers to consider many types of risk, beyond the financial, in establishing value-based payment arrangements. Instruments such as the APM Risk Evaluation Tool for Financial and Non-Financial Risk10 can help inform states, MCOs, and other payers as they evaluate various APM options and their appropriateness for safety-net providers. The APM assessment process can also inform where additional supports, learning collaboratives, technical assistance, or directed value-based payments11 might be targeted.

At the same time, the CMS strategy calls for a more streamlined portfolio of models to deliver high-quality, person-centered care. In light of this commitment, there is room at the federal level to expand demonstration and evaluation of category 4A models across services such as primary care, mental health, and substance use disorder treatment. These might serve as stepping stones to safety-net providers successfully adopting APMs with greater risk.

At the state level, states and MCOs should take a rigorous approach to evaluating the appropriateness of the APMs they adopt, particularly for safety-net providers, and make future model selection decisions based on a wider understanding of the risks inherent in these models. Safety-net providers are in short supply and urgently needed to reduce health disparities. Careful model consideration and rigorous evaluation will reveal which APMs work best for attracting and sustaining safety-net providers. Given CMS declared intention to include equity in evaluation criteria for Medicaid demonstrations and other payment initiatives,12 finding payment models that support providers should help advance equity in the communities they serve.

Author Affiliations: George Mason University (AEC), Fairfax, VA; Bailit Health (MBD), Needham, MA; Bowling Business Strategies (RM), Philadelphia, PA.

Source of Funding: None.

Author Disclosures: Dr Cuellar reports consultancies for Casey Family Foundation, grants received from the National Institute for Health Care Management and the National Institute for Mental Health, and honoraria from federal grant review panels. Ms Dyer is employed by Bailit Health, which has contracts with state Medicaid programs and managed care organizations; these funding sources had no role in the conceptualization, preparation, review, or approval of the manuscript. Ms Matulis has received honoraria from the National Council for Mental Wellbeing and the Rhode Island Primary Care Association, and she is employed by Bowling Business Strategies, which has contracts with state government agencies, government consulting firms, provider organizations, and associations; these funding sources had no role in the conceptualization, preparation, review, or approval of the manuscript.

Authorship Information: Concept and design (AEC, MBD, RM); drafting of the manuscript (AEC, MBD, RM); critical revision of the manuscript for important intellectual content (AEC, MBD, RM); administrative, technical, or logistic support (AEC); and supervision (AEC).

Address Correspondence to: Alison E. Cuellar, PhD, George Mason University, 4400 University Dr, Fairfax, VA 22030. Email: aevanscu@gmu.edu.

REFERENCES

1. Value-based care opportunities in Medicaid. CMS. September 15, 2020. Accessed July 2, 2021. https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/smd20004.pdf

2. Medicaid managed care contracts as instruments of payment reform: a compendium of contracting strategies. Catalyst for Payment Reform. 2019. Accessed July 2, 2021. https://www.catalyze.org/wp-content/uploads/woocommerce_uploads/2019/12/Medicaid-MCOs-as-Agents-of-Payment-Reform-1.pdf

3. Brooks-LaSure C, Fowler E, Seshamani M, Tsai D. Innovation at the Centers for Medicare and Medicaid Services: a vision for the next 10 years. Health Affairs. August 12, 2021. Accessed August 14, 2021. doi:10.1377/forefront.20210812.211558

4. Innovation Center strategy refresh. CMS. 2021. Accessed November 12, 2021. https://innovation.cms.gov/strategic-direction-whitepaper

5. Spector JM, Studebaker B, Menges EJ. Provider payment arrangements, provider risk, and their relationship with the cost of health care. Society of Actuaries. October 2015. Accessed July 2, 2021. https://www.soa.org/globalassets/assets/Files/Research/Projects/research-2015-10-provider-payment-report.pdf

6. Nerenz DR, Austin JM, Deutscher D, et al. Adjusting quality measures for social risk factors can promote equity in health care. Health Aff (Millwood). 2021;40(4):637-644. doi:10.1377/hlthaff.2020.01764

7. Alternative payment model: APM framework. Health Care Payment Learning & Action Network. 2017. Accessed July 2, 2021. https://hcp-lan.org/workproducts/apm-refresh-whitepaper-final.pdf

8. APM Measurement: Progress of Alternative Payment Models. 2019 Methodology and Results Report. Health Care Payment Learning & Action Network. 2019. Accessed July 2, 2021. http://hcp-lan.org/workproducts/apm-methodology-2019.pdf

9. APM measurement effort. Health Care Payment Learning & Action Network. 2019. Accessed July 2, 2021. https://hcp-lan.org/workproducts/apm-infographic-2019.pdf

10. Matulis R, Dyer MB, Cuellar AE. Alternative payment models: risk evaluation tool for financial and non-financial risk. George Mason University. 2021. Accessed November 1, 2021. https://hap.gmu.edu/health-policy-issue-briefs

11. Directed payments in Medicaid managed care. Medicaid and CHIP Payment and Access Commission. June 2022. Accessed July 7, 2022. https://www.macpac.gov/publication/directed-payments-in-medicaid-managed-care/

12. Paving the way to equity: a progress report. CMS. January 2021. Accessed December 13, 2021. https://www.cms.gov/files/document/paving-way-equity-cms-omh-progress-report.pdf

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Value-Based Payment, the Safety Net, and Rethinking Risk - AJMC.com Managed Markets Network