Not-So-Big Business . . . Yet

But Hopkins' Lee says counting on insurance or cash payments to bring a center into the black can be dicey. "A serious consideration is maintaining financial viability," she says, noting that integrative medicine services require the practitioner to spend significant amounts of time with each patient, whereas traditional physician visits can be 15 minutes per patient or even shorter and still qualify for full reimbursement—which, for specialists, averages perhaps 16 times what a comparable amount of time is worth in integrative treatments. "There's no such thing as a 15-minute visit in this kind of care."

Lee says hospitals shouldn't look at integrative medicine as a way to make money, at least initially. "It shows patients you recognize the problems with conventional medicine, but it's unwise to get into it thinking you're going to make a huge profit off of it."

Physician suspicion
Not lost on Lee is the skepticism with which she is often met by her fellow physicians.

She is careful to point out that her own 17-year history at Hopkins has been a key driver in gaining acceptance and referrals from other physicians. Still, she says, it took a special person to "stick his neck out" to sponsor and drive referrals to the center. In her case that person was Anthony Kalloo, MD, the chief of gastroenterology and hepatology at Johns Hopkins—which is why the center has the term "digestive center" in its name even though it provides care to patients suffering not only from GI issues, but also cancer and heart problems, for example.

"It will continue to be a challenge. We are very critical about which therapies we want to offer," she says, adding, "There are a lot of questionable practices out there, like colon cleansing." The Hopkins center is careful to specialize in helping patients who have chronic disorders for which other therapies have not been successful.

Big growth potential
Despite the fact that such centers are often not profitable now, that could be changing. Paul Keckley, executive director of the Deloitte Center for Health Solutions, says evidence of such programs' efficacy—often a significant barrier among physicians who are skeptical of patient benefits from such therapies—is growing.

"The more you look at it, there's evidence that some of this works as well as traditional medicine in that it actually improves outcomes," Keckley says. As more physicians and patients accept the efficacy of such treatments, payers will begin to jump aboard. "Most [integrative programs] struggle to break even because traditional insurance has not covered many of these modalities, but that's beginning to change," he says.

It may be common sense that such therapies work, but it can be difficult for them to show financially viability without factoring in the softer metrics that may influence patients to choose facilities with intergrative medical services. That's one reason the Hopkins Center was opened in September 2008, as Lee and others recruited practitioners who had been successful at other locations to practice under one roof at Hopkins.

Hospital administrators are interested in integrative medicine "because there's a huge demand for these services," Lee says. "It can be a multibillion-dollar industry. The reality is that many patients do not just want to sign up for the conventional approach."

Despite this, she says building glass-and-steel monuments to donors might be a mistaken approach.

"They're paying a lot just for bricks and mortar and electricity," she says, adding that the Hopkins center boasts just 2,200 square feet and six exam rooms.

"But we're busy," she says. "Resist the temptation of having your own separate facility because it will continue to need infusions of money. Start with clinical services first, and as you expand you can add to the physical space as required."