Acupuncture and Insurance

I keep hearing questions and complaints about insurance billing and acupuncture.  I don’t have an original post ready. This is adapted from an email exchange with some colleagues and thought it might be a good starting point for a conversation, despite the odd lack of context. But if you’ve been around for a while you can probably imagine what preceded it! (Then again, we should probably be out enjoying a holiday weekend rather than pondering our profession’s future.) —

“I am absolutely fine with practitioners pursuing all of the various business models that are available to us.  I want anyone who wants acupuncture to find a way to access it. Depending on both the practitioner and the patient, there may be certain models that are more appropriate or appealing than others.  Private room treatments at varying levels of cost with the money coming directly from the patient or indirectly via an insurance company, sliding scale models, in group or private settings, treatments as part of other medical care, I’m good with all of it.  I don’t believe that a patient’s willingness to make life changes is related to what they are paying for treatment. I don’t believe that lots of talk and time is necessary for people to benefit from treatment, though I believe it can have benefits.

“I do believe that lots of graduates come out of acupuncture programs with very little information about how to choose which model might be best for them or for the community in which they wish to work. I believe they often come out having been told some version of “if you build it they will come.” It makes me sad and angry when folks who invested so much in their education don’t have the business skills to make a go of it, especially when there are so many areas so underserved by LAcs.

“I don’t believe that fraud is necessary to make a living from an insurance based practice, and, I have seen many conversations about insurance billing for acupuncture that revolve around questionable practices. I certainly don’t think all practitioners engage in these practices, but some do. I also see practices that are by the book, but are still likely to have unconsidered consequences.  How many acupuncture treatments that are not billed to insurance involve three distinct sets of needle insertions, compared to those that are billed.  Does it take more sessions to treat back pain with acupuncture when the treatments are covered by insurance?  (Does the billing provider think of the treatments as being preventative once the back pain is in remission while the non-billing provider might not be thinking about back pain at all and instead pondering the client’s inability to relax even when on vacation?)  How do the answers to these questions impact data on the cost effectiveness of acupuncture?  As purchasers of health insurance, how do we feel if we think an MD is doing a more complicated procedure, with a higher reimbursement rate, than another, cheaper procedure that is equally effective?

“I did not mean to give the impression that offering a higher level of service when warranted will get a provider kicked out of a plan. However, if a provider’s patients consistently need a higher level of service that will get noticed by an insurance company. It may well be audited. And, it will be taken into account when the insurance company is deciding whether to continue to contract with a particular provider.  When you refer to this as an urban myth is it your position that insurance companies do not care whether a provider consistently bills for more services than other providers serving a similar population?”

Thoughts?

Talking about our Education

“We have over (2000 hours, 4000 hours, 3 years, 4 years) of education and they want to do acupuncture with (a weekend, less than ten, 200 hours) of training!The public is in danger.”

“The (PT’s, Chiropractors, MD’s) doing acupuncture are significantly undertrained! If they want to do acupuncture they need to go to acupuncture school, or at least take (400, 500,1000) hours of training.”

It’s a no brainer, right? But ….

1) We are comparing our total professional education to additional post-professional-degree hours.

An MSAOM curriculum includes: Biochemistry, Introduction to Organic Chemistry, Anatomy and Physiology, Microbiology, Introduction to Western Pathology, and a Survey of Western Clinic Sciences (3 semesters). M.D.’s have already covered these classes in their education.

2) Does the aspect of “our” medicine they want to use require a full TCM education?

Is Tai Qi, Qi Gong, Introduction to Botany, 40 credits of herbal medicine, a semester of auricular acupuncture and 3 semesters of point location needed for a PT to safely use a needle to release a trigger point? (If you insist they learn all of that, won’t they then argue that they can also do auricular acupuncture and distal points?)

3) How well-educated are most acupuncture school graduates? How worthwhile was most of their time spent in school?

ACAOM standards were based on the programs that existed at the time credentials were being established. They were not based on a careful analysis of what was needed to train safe, effective, successful practitioners. Acupuncture related Facebook groups include posts asking about using moxa to turn breech babies, how to treat TMJ (no pulse, tongue, or presentation information provided), and recommendations for treating people undergoing chemotherapy. With our thousands of hours of training, shouldn’t we know the answers to these questions? (Or have a better source than Facebook for answers?)

4) Is there a correlation between the length of a program and the quality of the graduates? Were the early U.S. practitioners (many of whom had less than 1300 hours of training) harming the public?

It is an article of faith in the acupuncture community — our training of X hours is necessary for safety, and anything less is an affront and a danger. Yet a colleague recently wrote “I am at a medical acupuncture conference. Exceeding my expectation. The presenters know their stuff. Lots of depth…. I am going to find out about their training. Maybe they are a special group….what i am seeing here meets any high standards TCM conference…. Very surprised.”

The more (as defined by us) = better has done us no favors. The numbers we fight for are arbitrary. The argument is easily refuted by other providers. Adopting it within our profession has increased the business strangling debt-burden new grads carry. And created internal divisions which only further harm our growth. (How long before a state (or the NCCAOM) demands the FPD to become an LAc?)

Please, let’s let the knee-jerk “less is dangerous, more is better” argument go.

Acupuncture in Louisiana

If a resolution is passed and no one is listening, does it still impact the profession?  Sadly, in this case, yes.

I wasn’t planning to write today, but then I came across Louisiana SCR 22 which has been moving through the legislature. It may have passed already (I’m trying to find out), though according to the information here it is still in a House Committee. (5/21, verified, this is not YET a done deal, there are still two opportunities for the resolution to be amended!) You may know that in Louisiana only MDs and DOs can be Acupuncturists.  An individual who has gone to acupuncture school or passed the NCCAOM exam can apply to be an “Acupuncture Assistant” and work under the supervision of an MD. This resolution would establish The Practice and Regulation of Acupuncture and Oriental Medicine Review Committee, and could have been a terrific opportunity to make the practice environment in LA more amenable to LAcs.  It gets off to a great start –.

WHEREAS, the practice of acupuncture and oriental medicine provides important health benefits to the residents of this state; and

WHEREAS, the practice of acupuncture and oriental medicine has become a well established, widely-used, viable modality across the United States; and

WHEREAS, when practiced as a whole medicine, by a fully trained practitioner, the practice of acupuncture and oriental medicine satisfies a missing niche that includes a prophylactic approach that allows the patient or a referring medical director a proactive avenue towards health when neither symptoms nor severity of disease warrants other forms of treatment; and

WHEREAS, oriental medicine often becomes a valuable way to identify those in need of a referral to a western medical provider.

THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby direct the Department of Health and Hospitals to create the Practice and Regulation of Acupuncture and Oriental Medicine Review Committee

But, look at the language for the committee membership  –

(1) The secretary of the Department of Health and Hospitals or his designee.
(2) The Senate president or his designee.
(3) The speaker of the House of Representatives or his designee.
(4) The executive director of the National Certification Commission for
Acupuncture and Oriental Medicine or his designee.
(5) The executive director of the American Association of Acupuncture and Oriental Medicine or his designee.
(6) The executive director of the Louisiana State Board of Medical Examiners or his designee.
(7) The executive director of the Louisiana State Medical Society or his designee.
(8)A chiropractor designated by the Chiropractic Association of Louisiana who is certified as a diplomat of the American Board of Chiropractic Acupuncturists or has completed equivalent training in acupuncture.
(9) A physical therapist designated by the Louisiana Physical Therapy Association.

 

So, eight members, including a DC and a PT, but no fully-trained acupuncturist. The AAAOM doesn’t even have an Executive Director at this point, and probably doesn’t have the funds to hire one, and in any case represents only a tiny portion of the profession.  The NCCAOM should be on our side, but their input in Delaware, for example, wasn’t positive for the majority of LAcs.  Once upon a time we might have looked to the PTs as allies, but our speech and actions regarding dry needling destroyed that.

I did send this Letter to Senator Mills today (which you can borrow from), but if the resolution is engrossed it is too late. The best we can do then is advocate for acupuncture friendly designees, make sure to stay in touch with the eventual appointees, and hope we can show them that the public would be served by allowing those trained as acupuncturists to be acupuncturists.  I’m sorry that this one got by me (I’ve got a practice to maintain), and sad that we don’t have a national organization to track and act on such things. AAAOM, where were you? I have high hopes for the CSA, but, without a state organization, Louisiana probably wasn’t on their radar. This was a missed opportunity.

Licensure News

Finally! At the May 6th Delaware Board of Medicine meeting two experienced and NCCAOM-credentialed acupuncturists were granted Delaware licenses, bringing the number of the LAcs in the state to just under forty. This is good news for the people of Delaware. It is also good news for the profession as whole. And hopeful news for the practitioners who are now commuting to Maryland, or not practicing, because they were unable to obtain a Delaware license.

Why did it take action from the MD’s on the BOM to get these practitioners licensed?

These LAcs had appeared before the Acupuncture Advisory Board four times since applying for licensure in late 2012/early 2013. At several of these appearances the Acupuncture Advisory Board members acknowledged the applicants’ excellent qualifications but refused to grant licenses despite having the authority to do so.

For decades one of our “sacred cows” has been that we need our own boards. Then we’ll have the power to control our destiny. Sadly, when given the chance, some of us prefer to control our destiny right down the tubes.

Consider the history of the independent California Acupuncture Board, with its unique accreditation and exam process, and its ongoing problems. Or Nevada, with an independent board, 53 LAcs, a $1000 application fee and $700 per year renewal fee.  If Delaware had an independent board my colleagues would have had to go to the courts to present the argument (made by a public member of the Board of Medicine) that requiring an herbal education and exam for individuals who do not want to use herbs in their practice, in a state in which anyone can sell and recommend herbs, is restraint of trade.

It isn’t the M.D.’s and “the system” that is limiting the growth of our profession these days. It is other acupuncturists. I’ve asked and asked, but I have yet to find anyone who can explain why the Florida (independent) Acupuncture board is increasing the education and testing requirements for licensure. Have patients been harmed? If a change is needed are there options that would be less burdensome for the profession?

I’ll be interested to see the full minutes of the May 6th DE BOM meeting. In a classic conjunction of issues, a practitioner instrumental in drafting the restrictive Delaware law, and a current Acupuncture Board member who had voted against granting licenses to the two qualified acupuncturists, appeared before the BOM to ask them to do something to stop PT’s from doing dry needling.

Did either of these practitioners consider that their previous actions that limit the number of LAcs in Delaware increase the odds that citizens will seek treatment from non-LAcs? Or that our political power is limited by our small numbers? Did the BOM wonder what’s up with this profession — they don’t want anyone to use a needle, even other LAcs?  (FWIW, the BOM doesn’t regulate PT’s.)

You’d think that our own self-interest would prevent the credential and educational creep that costs us so much. But it hasn’t. The AMA Code of Medical Ethics states “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.” Restrictive laws and rules that limit access to qualified acupuncturists are contrary to the best interests of patients. Let’s work for change – for the people who need acupuncture and the qualified individuals who want to provide acupuncture. Credential creep hurts us all.

Five Important Dry Needling Developments

Yes, more on dry needling.  More about education will have to wait.

Five things to know —

  1. The Oregon Ruling did not (despite the Acupuncture Today headline) determine that “Dry Needling is Acupuncture.”  For a full exploration of the case, read this post. In summary, the ruling of the court was that Dry Needling is not physiotherapy.
  2. On April 1st Utah Governor Gary Herbert signed HB 367, legislatively adding Dry Needling to the scope of Physical Therapists.
  3. On April 24th Arizona Governor Jan Brewer signed SB 1154, legislatively adding Dry Needling to the scope of Physical Therapists.*
  4. On March 25th Massachusetts HB 3972 advanced. This redraft of acupuncture bills HB 2051 and SB 1107 was necessary because the bill could not advance with the language that “dry needling is acupuncture.”
  5. At the end of April the Illinois Department of Professional Regulation issued an informal ruling that dry needling was not within the scope of practice for Physical Therapists “as the acts are currently written.”  That last phrase is important. From what I can tell there are about 550 LAcs in IL and over 9,000 PT’s.  The PT’s aren’t ready to call it quits. Time will tell if the victory for the LAcs is a lasting one. The PT’s could well look to Arizona and Utah and work for a legislative change.

(A colleague practicing in Delaware recently told me of the urgent phone calls and emails she’s been receiving — she must get involved in the fight against PT Dry Needling! Delaware is a state in which a few LAcs on the Advisory Board refuse to grant licenses to qualified acupuncturists. There are so few LAcs (less than 40) that they can’t maintain an association and citizens are far more likely to get acupuncture from a DC or an MD than an LAc. Now the profession wants to take on the PT’s? If there’s an urgent need for action from the LAcs of DE, perhaps it should be action to bring LAcs to the state?)

For those who insist we must do something about this serious risk to our profession, here are some suggestions. They would do far more to benefit our profession than this ongoing battle with the PT’s.

* One of the acupuncture profession’s strategies from the start of the Dry Needling issue was to argue, as the AAAOM wrote in their 2013 position paper,– “the addition of TPDN to physical therapy practice is being determined by physical therapy regulatory boards, deleteriously circumventing transparency and public health safety protections provided by standard legislative process.”  This was a mistake. Given the relative political strength of the PT profession and their MD supporters legislative victories are likely. Had we been willing to work with our health-care colleagues in the regulatory arena we might well have had input and influence in the use of this procedure.

A Call to Action

We have an opportunity to help Californians, and all acupuncturists, but we need to act now. As I’ve written before, states setting their own super-special requirements for acupuncturists seeking licensure is expensive and limiting for practitioners and the profession. I’ve never seen evidence that the public benefits from such requirements.

California has been one of the worst offenders. An exploration of the unique educational requirements can wait for another day, but we now have an opportunity to do something about the exam.  (Please note – much of what follows is based on my best understanding of the situation from respected colleagues in California.  I have not been personally able to fully research the California situation.)

The California exam has had problems for years, among the lowlights — a California Acupuncture Board (CAB) chair sent to prison for selling the exam; a point location exam shown to be so subjective that the State mandated that the CAB cease using it; incidents of extremely high failure rates and serious scoring errors; and CAB’s refusal to compare two exams for possible unfair scoring.

A recent Sunset Committee is turning up the heat on the CAB. Senator Lieu, the Sunset Committee chair, may support a bill that will allow potential licensees to take the NCCAOM exam rather than the California state licensing exam. It is time to let the Senator know that this change would benefit the people of California and all acupuncturists.

Please send emails this week to:

marty.block@Sen.ca.gov, ted.lieu@sen.ca.gov, tom.berryhill@sen.ca.gov,
ellen.corbett@sen.ca.gov, cathleen.galgiani@sen.ca.gov, ed.hernandez@sen.ca.gov,
jerry.hill@sen.ca.gov, alex.padilla@sen.ca.gov, lark.park@gov.ca.gov, Anna.Caballero@scsa.ca.gov, Denise.Brown@dca.ca.gov, Tracy.Rhine@dca.ca.gov, Sonja.Merold@dca.ca.gov, LeOndra.Clark@sen.ca.gov, kimberleywoo@sbcglobal.net, bluelotushealth@gmail.com, blueheartacu@gmail.com, crystal.clk@gmail.com, Spencer.Walker@dca.ca.gov

Some possible language –

I formally request that the Sunset Review Committee mandate that the CAB and staff use the national certification exam (NCCAOM) as the main exam for California Acupuncture licensure.

The NCCAOM exam is widely known to be a fair and comprehensive exam. It is relied upon in almost every state except California. Those practitioners who are credentialed by the NCCAOM have an excellent safety record. To require a unique exam for California, especially one shown to have ongoing problems, increases expenses for all California practitioners, costs which are ultimately borne by the public.

I urge you to require the use of the NCCAOM exams as the main exam for CAB licensure.

Thank you for your consideration.

We will all be better off when meeting one set of standards allows us to practice anywhere in the country. Changing the situation in California would be a wonderful step in the right direction.

Acupuncture Education

Between conversations on Facebook, dialogues on list serves, and college tours with my child, I’ve been thinking about acupuncture education a lot recently. There are several topics I plan to address in the next few weeks.  First off –

To those considering becoming an acupuncturist:

  • Talk to practitioners in your area. Do they recommend the school they attended? (Ask if they are employed by the school in any capacity to help evaluate their response.) Are most of their classmates are still in practice? How long did it take them to establish a successful practice? (How do they define success?) Are they easily able to make their student loan payments? Are they on an income-based repayment plan?
  • What percentage of the school’s graduates are still in practice 3/5/10 years out. The admissions office should be able to tell you this. They won’t be able to. Don’t be fooled – knowing the percentage of students passing the credentialing exams is not sufficient data to make a major investment. And make sure to ask what they mean by “still in practice.”  Here’s one school’s information about graduate success.
  • Will the education you receive at the school enable you to practice in the states you might want to practice in. Verify the information the schools provide, as many students have been misled. State requirements vary and are changing. Some only approve graduates of particular schools, some require additional education in certain subjects, some are very specific about whether the school has full ACAOM accreditation (ACAOM approved, or ACAOM candidate status won’t do it).
  • While schools may say that LAcs are employed in hospitals and other health care settings, know that this is a tiny percentage of practitioners. The vast majority of practitioners are establishing their own private practices upon graduation. What are the schools business classes like? Do they bring in marketing experts, accountants, lawyers, to give you guidance?
  • In a recent NCCAOM survey 62% of respondents reported a personal income, before taxes, of less than 65K.  Most “employment” situations for LAcs do not include sick time, paid vacation, family leave, health insurance, disability insurance, retirement savings plans, or payment for time spent on administrative tasks. If you are thinking oh, 30 clients/week at $80.00 = $124,000 — I’ll be rich, you should think again.Your ongoing expenses are likely to include fees for licensure, your NCCAOM credential, the CEU expenses to maintain that credential, malpractice insurance, liability insurance for your office, rent and utilities, marketing, supplies, taxes (of course) which are higher for the self-employed. If you intend to work within the insurance system know that while you may build a practice more quickly, the amount you receive as reimbursement can be changed at the whim of the insurance company. Expect that some amount of your time and money will be spent on additional services to help you track and pursue reimbursements.

Don’t get me wrong.  Many practitioners love what they do and wouldn’t trade it for anything.  This includes people who admit that they are struggling financially. I’m not saying don’t go to acupuncture school. I am saying do the research you would do before any other 80K (or more) purchase.

It’s Like Herding Cats

It’s a common refrain about reaching consensus in the acupuncture profession. But why try to herd cats? I learned a long time ago that opening a can of tuna would bring kitty running.

If there were an attainable action that would:

  • Increase patient access to Licensed Acupuncturists,
  • Assist in national marketing for the profession,
  • Decrease educational costs and student debt,
  • Decrease licensing expenses,
  • Increase political power,
  • Expand professional opportunities, flexibility, and mobility, and,
  • Increase the value of your practice,

Would that be like tuna to a kitty?

(Whirrr of can opener)

Tuna for me = Identifying the least restrictive licensure requirements necessary to protect the public and create successful practitioners and working to establish that as a standard in all states.

Before panic ensues, consider some of the situations I’ve heard about in the past few years:

  • Highly experienced and qualified LAcs unable to obtain licensure, even in states where there are so few LAcs that the public has little choice but to get their acupuncture treatment from Chiropractors.
  • Practitioners who want to sell their practices but have a limited pool of buyers because of the unique licensure requirements in their state.
  • Practitioners travelling many, many hours in order to practice, or leaving the profession, because life has taken them to a state in which they can’t obtain a license.
  • Practitioners and students who have no interest in using herbs being required to spend tens of thousands of dollars and thousands of hours learning herbal medicine in order to obtain an acupuncture license.
  • Acupuncturists supporting discriminatory laws or regulations such that the only group of people in a state who can not practice herbal medicine are other Acupuncturists.
  • Practitioners having to maintain licenses in multiple states because changing regulations mean that if they give up a license they will be unable to obtain it in that state again.
  • Acupuncturists being unable to advance reasonable state or national legislation because restrictive practices keep practitioner numbers so low that political support is unavailable.
  • The profession being unable to effectively educate the public about their excellent education and credentials because those credentials vary so much from state to state.
  • Acupuncturists struggling to build a practice in overserved areas, but unable to obtain licensure in nearby underserved areas.
  • Acupuncture organizations fighting for inclusion in managed care and federal health programs, even though many states have too few LAcs to serve the population. (Demographic data can be found at these links: Acupuncture Today LAc Map, US Population, Physicians per State.)

The current system in which some states require graduation from particular schools, others have their own exams, and others have their own educational requirements does not serve us as a profession. The situation is getting worse, not better, as states like Florida increase their requirements. Yes, states have differing scopes. (Those who advocate for scope changes should be required to consider and advertise the impact the changes will have on licensure requirements.) Yes, it is in the interest of the public and the profession to insist that practitioners limit their practice to the tools and skills in which they have been trained. Additional, optional, training can always be required for those who wish to practice more advanced techniques or modalities. The least restrictive licensure requirements have shown themselves to be sufficient for safe practice.

Limited, standardized, licensure requirements would lower practitioner expenses, promote mobility, ease national marketing, and help the profession grow. It sounds great — as good as tuna smells to a cat. Does it make you make you want to come running? Many changes in licensure requirements could be made at the regulatory level and are within our reach. It does not depend on establishing reciprocity. One problem — the LAcs within a state have the power to make or block change, and, especially in restrictive states, the small group that set up the rules is often in power. Another problem — many LAcs don’t care about this until they are directly impacted.

This is a place where national coordination is needed. I hope the CSA sees that this is a place where they could make a positive difference. Let your state association know if you support a more standardized and simpler licensure environment. It should not require any herding.

Cat Food

Cat Food

 

 

Late March Update

The weekend is winding down and I didn’t make it to my planned “The Biggest Problem Facing the Profession” post.  However, there is lots of news in Acu-World. Here are some items to keep you busy until I get back to the keyboard.

  • Want to support the profession in a positive way? You may have contributed to funds for inter-professional squabbles or federal legislation. That money hasn’t helped us in a lasting or tangible way. Support POCATech and you’ll be supporting an acupuncture school committed to providing an affordable education. How would your practice be different if you didn’t have educational debt? Check it out here! POCATech will help more people get acupuncture from acupuncturists — it is a win/win.
  • ACAOM is considering changes to the post-Graduate Doctoral Program and they want to hear from you.  The survey took me about 15 minutes, most of that for reading. Personally, I support a Doctoral track open to those who have an acupuncture-only education. There is a long history of practitioners choosing one specialty.  The movement in some states to insist on complete OM or Herbal training and credentialing is discriminatory against acupuncturists and expensive! It is important that we all weigh in, whether or not we plan to pursue a doctoral degree. Deadline for response — April 17th.
  • In January NCASI was celebrating a ruling they believed meant PT’s would not be able to do dry needling in Utah. In March, Utah HB 367, legislation which would add dry needling to PT scope of practice, went to the Governor’s desk for a signature. Shouldn’t be a surprise to anyone. Utah has fewer than 100 LAcs and about 4000 PT’s.
  • Likewise, “despite the warning” of AZSOMA, SB 1154, which would add dry needling to PT scope of practice, has passed the Senate and made it through two committees of the House. The votes have not been close.
  • Last, and maybe least, the AAAOM collapse continues.  Acupuncture Today printed part II of their article, now with updates. The AAAOM came out with a response (prior to the latest updates). Given the latest updates it probably isn’t worth the time to go through the AAAOM response. Suffice it to say, it contains plenty of spin and quite a few inaccuracies. Mostly, I continue to note that we’ve heard nothing from the AAAOM about who is currently in charge there. And, no practitioners really seem to care.

That should be enough to keep everyone busy.  Back soon, with “The Biggest Problem Facing the Profession.” (No, it isn’t Dry Needling.)

A Practical Next Step

Okay, I’ve heard the critics — too much blaming the profession and focusing on mistakes, not enough positive things we can do now.  So, here goes –

A very practical next step, or maybe the most important thing to do to prepare for a next step, is getting your bearings. Any confusion about where you are now and your next steps might be in the wrong direction.  So let’s take a look at where we are with our old friend Dry Needling –

On January 23, 2014, the Court of Appeals of the State of Oregon issued a ruling regarding the practice of dry needling by Chiropractors. Surfing the web I’ve read “the issue came down to whether chiropractors could perform dry needling after having 24 hours of training,” and “The Oregon Court of Appeals ruled “dry needling” is acupuncture and not within the scope of practice of chiropractic medicine” and “This ruling sets a precedent which can have far-reaching effects beyond Oregon. It becomes part of the record for each state acupuncture Association to use in it’s own fight for appropriate licensure, training, and practice.”

It is certainly correct that the ruling does set a precedent, so let’s be sure we understand what that precedent is. I encourage all of you to read the ruling, linked above.  It isn’t long and it is interesting. You can see a nice summary here. Most critically –

  1. The ruling does not say that dry needling is acupuncture.  I don’t believe it includes any mention of the word acupuncture.
  2. The ruling does not consider how much training is necessary to practice this technique safely. Hours of training are irrelevant to this ruling.
  3. Patient safety is not explored or addressed in this ruling.

The Court focuses on the Chiropractic Board’s argument that Dry Needing is Physiotherapy and rules that it is not, based on the understanding of the word in 1927, when Physiotherapy was added to Chiropractic scope in Oregon.   (The Court clearly states that it does not find that Physiotherapy is the same as Physical Therapy.)

So, if you are in a state in which the PT Board or Chiropractic Board has argued that Dry Needling is Physiotherapy, and if Physiotherapy was added to that Board’s scope in the late 1920′s, this ruling sets a very important precedent.  I’m guessing the ruling may not quite live up to its reputation as a game-changer.

In other news, while NCASI is celebrating the Utah DOPL’s decision that dry needling is outside the scope of practice for Physical Therapists, there is a bill (HB 367) moving through the Utah House that would add Dry Needling to the Physical Therapy scope. (There are fewer than 100 LAcs in Utah, and several thousand PT’s). Similarly, Arizona S.B. 1154, legislatively adding dry needling to Physical Therapy scope has passed the Senate.

So, that’s where we are. And if you don’t buy my argument that knowing where we are counts as a practical next step, here, on its one year anniversary, but so relevant it could have been written today, are not ten, but ELEVEN, positive, practical, and fulfilling next steps.