Immunology

Correspondence:

Received: January 01, 1970 | Published: ,

Citation: DOI:

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Abstract

patients, medicine, physicians, non-physicians, treatment, chiropractors

Opinion

Functional Medicine is a new term creeping up as a new concept in patient care. Functional Medicine is described as a medical displace that promote a customized and patient-centered approach so that patient and practitioners can work together to address the underlying causes of disease and promote optimal wellness. The root causes analysis of the illness and then addresses it. There will be a debate about this medical discipline, is it a new concept, or a return to what primary care physicians have sought to do for years–seek the root cause of the underlying illness and address it. Or is it a marketing spin to reach patients outside of insurance reimbursement, self-pay patients.

The Institute of Functional Medicine is certifying physicians, as well as non-physicians, such as chiropractors, nurse practitioners, physician assistants, and dieticians, under a certification program that is not sanctioned by the American Board of Medical Specialties. Board certifications in Functional medicine will not satisfy requirements for hospital privileges or for privileges with insurance companies or perhaps physician networks and organizations. The concept of functional medicine is to recognize that genetics, hormonal balance, lifestyle, nutrition and the patient’s environment are major factors in the presence of disease, but also factors that must be considered to address the total wellness of the patient. Few physicians would argue the role that these factors play in the cause or intensity if illness.

Functional medicine then moves from the treatment to understanding the cause, the root cause of the illness and then addressing the causes as part of the treatment. The difficulty in functional medicine is where it fits with the current insurance arrangements, especially fee-for-service which recognizes procedures as the payment methodology. Functional medicine is more akin to concepts of population health or chronic care management, and payment models for these concepts are based on outcomes as well as reductions in utilization of hospitals and other resources, which should be the desired outcome.

Physicians looking as incorporating functional medicine may find difficulties with payment methodologies available unless such services are sought outside of fee-for-service insurance covered services. In which case it would be best to get a clear understanding of what each of your insurance plans will cover, and what they will not. You do not want to be in a position where you are providing services which you believe are “functional medicine” not covered, and have the plan take the position that they are included in the benefit plan, and the patient cannot be held responsible for the costs. Similarly, you need to makes sure the patient understands the line of demarcation between covered services, and what they are individually responsible.

Some physicians are incorporating elements of functional medicine into their practice by the addition of other non-physicians right as part of the practice. Since nutrition and diet play a major role in individual’s health and wellbeing, the addition of such providers in the practice adds a service that can directly contribute to the patient’s wellbeing. Check with your insurance carries as to the coverage they offer for such services.