Facility Profile: The Mind/Body Medical Institute of Bon Secours

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December/January 2001

By Peter Pesavento

Taking the Road Less Travelled

Tom Wojick, MA, and Katherine L. Dec, MD

The Mind/Body Medical Institute of bon Secours focuses on self-care for its patients through integrating the body, mind, and spirit.

Mind/body medicine is a discipline that integrates modern medicine and psychology with nonpharmacological treatments to strengthen the natural healing capabilities of the mind and body. It teaches and encourages self-care and responsibility, along with the role of belief and spirituality in the healing process. Mind/body therapies and approaches have proven to reduce costs, improve medical outcomes and well-being, and help prevent the onset of stress-related disorders. At the Mind/Body Medical Institute at Bon Secours, Richmond Healthcare System, in Richmond, Va, many of the programs incorporate this discipline.

According to Katherine L. Dec, MD, medical director of the Mind/Body Medical Institute, "Our mission at Bon Secours is to provide a holistic, compassionate approach to the people we are treating, particularly their physical, social, emotional, and spiritual well-being."

Using a self-care approach

Although the Bon Secours facility is a contractual affiliate of the acclaimed Mind/Body Medical Institute of Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, which was founded in 1988, the original concept was synthesized in the mid-1960s by Herbert Benson, MD. Benson, a cardiologist, is the founder and president of the Mind/Body Medical Institute of Beth Israel, and an associate professor at Harvard Medical School. "Around 1966, I started noticing that people had high blood pressure in my office, but not outside my office, which really got me interested in the influence of stress. I went back to Harvard Medical School to work in laboratories. I created an animal model for stress-induced high blood pressure. Then I was approached to study transcendental meditation, which I did in 1968. Through this study and the help of Robert Keith Wallace, PhD [a physiologist who is renowned for his research on transcendental meditation], the physiology of meditation was defined." Today, Benson is recognized nationally for his pioneering research on stress and its effects on health and well-being.

Benson explains, "The Mind/Body Medical Institute conducts a program that is based on the model of a three-legged stool that we call health and well-being. The first leg is pharmaceuticals, the second leg is surgery, and the third leg is self-care. In the self-care leg we have relaxation response, nutrition, exercise, stress management, and the belief system of patients. The third leg is easily integrated with the other two legs because it is scientifically based. What makes our program unique is the close integration of the third leg with the relaxation response, which builds on the belief systems and spirituality of the patients."

A Truly Holistic Paradigm

Benson points out that his paradigm is not alternative medicine. "What we are doing is building in a self-care leg. Self-care is different from alternative medicine because all of the components are scientifically proven and self-care is not being 'done' to the patient or 'for' the patient. There is little difference between an herb or a pharmaceutical because both are given to the patient. There is little difference between acupuncture or surgery because they are both done to the patient. What we are doing is what patients do for themselves. In our current health care environment, the self-care leg is the one that leads to decreased visits to health care professionals."

A Proactive Approach

Dec points out that the Mind/Body Medical Institute at Bon Secours and its programs are different from typical outpatient rehab efforts in several ways. "We do not offer passive treatment in the sense that modalities like manual therapy, massage, and ultrasound, which are typically offered in the outpatient rehab setting, are not used. Patients are taught self-care techniques like movement therapy, cognitive restructuring, and relaxation response. They learn through classes where they are given 'homework.' They are required to do daily charting and practice of the skills taught in class."

Patients at Bon Secours are identified differently. "We type patients by symptoms, instead of diagnoses," Dec explains. The Institute typically deals with symptoms such as headache, back and arthritis pain, cancer, insomnia, coronary artery disease, postcardiac bypass patients, gastrointestinal disorders including irritable bowel syndrome, and chronic illness like diabetes.

"The self-care approach is taught in an educational format. We examine the stress in their lives, their nutritional status, and what exercise is needed. We respond to them one-on-one if necessary in order to effectively guide them through the rough areas while they are changing their lifestyle."

Stress Recognition and Reduction

Tom Wojick, MA, director of the Institute at Bon Secours, says, "All of the illnesses, diseases, and symptoms that we treat at the Institute basically have a relationship to stress. We treat patients primarily from a stress perspective. We do have very specific programs that deal with cardiac wellness, oncology, and a sector deemed general symptoms and healthy lifestyle, which is a big category." Presently, about 65% of the patients are in the general symptom/healthy lifestyle program, 30% are in the cardiac wellness program, and the recently added cancer program composes the remaining 5% of patients.

According to Dec, 73% of the patient population are participants in the mind/body cardiac classes and have cardiovascular medical issues ranging from status/post coronary artery bypass graft to secondary prevention issues of modifiable high risk factors; 27% of the patients are participants in the medical symptom reduction classes and have diagnoses like hypothyroidism, pain, fibromyalgia, heart palpitations, obesity, hypertension, multiple sclerosis, fatigue, asthma, irritable bowel syndrome, mitral valve prolapse, anxiety, and panic disorders. Nearly half, 46%, of these symptom reduction patients are experiencing myofascial pain of the lower back and 31% are obese.

Wojick mentions that the Institute started out with a major focus on the general symptom/healthy lifestyle program because statistics show that the largest number of people utilizing health care services (such as primary care/family practice networks) are in this group. He adds, "Problems such as insomnia, migraines, gastrointestinal problems, lower back pain, asthma, diabetes, arthritis, and fibromyalgia are what bring people to a primary care physician; they all have a relationship to stress."

The treatment programs at the Institute have specific areas of focus in their educational efforts. Included are: stress physiology, where patients are taught how the body's systems and mind react to stress, and cognitive therapy, where students learn to recognize distorted perceptions of activities or incidents that may overwhelm them psychologically or physically. Then patients are challenged to change the way they think about and view situations in order to remove harmful feelings and reactions. Patients are taught how to use the following coping strategies:

Cognitive restructuring log. "We ask people to identify the stressor, identify how they felt, and then identify the automatic thought they had when the feeling came on, and also to notice any physiological responses," Wojick says. "The log will help students to effect a change in their thoughts, so instead of automatic negative thoughts, automatic positive ones will result."

Positive affirmations. "Patients select an aspect of their life that is causing stress, decide what they want to happen or how they would like to feel in that situation, and then articulate this as a goal in a first person statement," Wojick explains.

Situational reframing. "This is sometimes also called situational redefinition, and basically patients change the way they think about themselves."

Stop-breathe-reflect-and-choose. "We ask our patients and students to stop, take a few seconds to breathe to reduce physical tension, and then reflect on what it is about the situation that is upsetting them so much. Then they need to choose a decision that is going to serve them in the most positive manner in the situational challenge that they have," Wojick notes getting payors on board.

One of the largest challenges and most significant issues facing the Institute is getting reimbursed for the programs. "In the payor community, the insurers have not fully comprehended [the Institute programs'] value and importance, so depending on what part of the country you are in, reimbursement can be severely affected. In Richmond, Va, there is a total lack of knowledge on the part of payors, so we receive almost 95% private pay. Only 5% is paid for by insurance companies. One of the most distressing things for our group is that our programs are evidence-based, but because the Institute's programs are conducted in groups instead of the traditional 'one-on-one' medical visit, insurance companies have not favored it."

Katherine L. Dec, MD, Assists a patient with body awareness through flexibility training.

Additionally, Wojick comments that the Balanced Budget Act (BBA) also affects the Institute's efforts: "While the BBA has mostly affected hospitals, it has put these same hospitals under a great deal of financial pressure; services such as our mind/body programs, where the revenue is not as great, are in jeopardy. Because there are such diminished margins, many hospitals cannot accommodate services that are break-even at this point in time, even though these same programs may become the medicine of the future."

In an effort to keep the Institute in the black, it uses a two-pronged approach to get the word out. "We are very proactive," Wojick says. "We are talking with major insurers, like Cigna. One of the things we can demonstrate that a lot of other medical treatments cannot is the outcomes of our programs. We do outcome studies. Before patients enter one of our programs, they fill out a number of questionnaires that document their current stress levels and health behaviors. Upon program completion, we administer the same tests and we measure the difference in change. We also do follow-ups for 6 months thereafter. This shows that a health care dollar spent on our services has a specific, measurable outcome."

The Institute is also approaching employers. Wojick says, "Employers are becoming more and more invested in how to cut their health care costs while still providing quality care, but also with the present labor market, they need to retain as well as attract people," Wojick declares.

As for future objectives, Wojick notes, "One of our main goals is to make these programs available to as many people as possible. Another goal is to help the traditional medical establishment integrate the self-care concept." Benson also asserts, "The approach itself of a three-legged stool is quite sound, and should be built into all paradigms of medicine. That is our ultimate goal. Too many people consider only the first two legs."

Peter Pesavento is associate editor of Rehab Management.

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December/January 2001