We have a lot of organizations and associations for a small profession. Here’s some of what they’ve been up to.
Finally, communication from the AAAOM. According to their April mailing they’ve revamped their membership structure and are planning their first annual conference in over five years.
The new membership structure includes a free “Basic Membership” category. Does the basic membership give access to the annual report or permit the member to vote in BOD elections? If not, it isn’t a membership, it’s a mailing list. Calling it a membership gives the AAAOM cover to inflate their numbers (they’ve been throwing 7000 around) and mislead policy-makers about their strength.
The first Annual Meeting of the American Society of Acupuncturists was held March 4-5. You can read the full summary here. It includes updates on the activities of many other professional groups. Check it out, including the links.
I’ve only recently been alerted to significant problems in the 7th Edition of the CNT Manual released in July 2015.
One example – is wiping a point with alcohol prior to needling still required? In the position paper on their website and the July 2015 AT article CCAOM indicates that the skin does not necessarily need to be swabbed prior to insertion. Page 97 (or 73 in internal pagination) of the CNT manual puts swabbing with alcohol on the Critical (required) list, with the text “swabbing continues to be recommended.” Which is it, critical, or recommended?
The manual also contradicts itself regarding the cleaning of chairs and tables between patients. Must each table and chair be disinfected or cleaned? Between each patient, or only daily?
With our many traditions and practice styles it is difficult to define or describe a “standard of care” for many aspects of our medicine. This gives documents such as the CNT manual extra weight in the legal system.
This area of practice is outside my bailiwick. Is there an expert out there willing to do a thorough review and write a guest post? It is critical (not recommended) that we get this document right.
NCCAOM Academy of Diplomates
Yes, another new national organization. My feelings about it are as conflicted as my feelings about the NCCAOM.
On the one hand, NCCAOM Diplomates are a significant portion of the profession, and the NCCAOM has the money, power, and support staff to get things done. Earning a seat on the CPT committee (see the ASA report), for example.
On the other hand, an organization that promotes Diplomates only (and how can they vouch for anyone else) runs the risk of deepening a fault line in the profession. The NCCAOM’s history in the regulatory arena shows 1) they are persuasive and 2) their positions often benefit the NCCAOM and some subset of practitioners at the expense of the profession as a whole.
We don’t have a balance of power in the profession. The NCCAOM is in a weight class by itself and the Academy further tilts the scales in their direction.That concerns me. On the other hand, we’ve got no other group heavy enough to get in the ring with non-Acupuncture groups right now.
Let’s keep a close watch on the Academy.
The sparsely attended (30 practitioners?) February Town Hall covered why the NGAOM-affiliated malpractice insurance is such a bargain, how the OPEIU can help the NGAOM, and what’s happening in various states regarding dry needling and insurance reimbursements.
What I didn’t hear was further discussion of NGAOM’s baffling goal of mandating malpractice insurance for licensees in all states. Despite their claims, there is no evidence that lack of mandated coverage has had any impact on scope of practice issues or on how we are seen by other professions. Any insurance plan, landlord, wellness center, or employer can choose to require malpractice coverage. But if a self-employed or unemployed (by choice or circumstance) practitioner decides to bear the risk of working without malpractice insurance, they should be allowed to do so.
If this is the NGAOM’s idea of helping practitioners, we’re in trouble.
A few months ago I mentioned that change might be coming to The Acupuncture Observer. I haven’t yet resolved the tension between sharing breaking news and saving my limited time to explore the broader philosophical and strategic issues facing the profession. Would any of you like to be a breaking news blogger? (ASA, would you like a state update column every now and then?) For now, I’ve added a Facebook feed to the home page of the blog. Checking there (or liking The Acupuncture Observer on Facebook) should help you stay informed between posts.
American Exceptionalism is the idea that The United States of America is inherently different from other nations. That our founding and background gives the US a unique mission to transform the world and a superiority over all of other nations.
I’ve recently noticed that practitioners of Chinese/East Asian Medicine have their own version of this, which I call Acupuncture Exceptionalism.
The attitude of exceptionalism skews the interpretation of events. Our own actions are given the benefit of the doubt and ascribed to the best of intentions. The actions of others are considered with a critical eye.
Some examples of Acupuncture Exceptionalism:
We regularly advise clients regarding vaccinations, pharmaceuticals, procedures, and dietary plans suggested by other health care providers. When other providers advise about acupuncture and herbs we are outraged at their presumption.
We widely share studies and news reporting positive results from acupuncture treatment. Studies and news showing a negative outcome are dismissed because “they aren’t doing it right” or didn’t tell the whole story.
When a patient reports harm from “Western medicine” or a treatment done by a non-LAc we rant about the failings of the system or the provider. When a patient reports harm after a treatment provided by an Acupuncturist we find ways to deny that harm occurred, find another cause for the situation, or place responsibility on the patient.
We encourage patients who have been harmed by dry needling to report it to the authorities, and if they won’t we will. We are shocked and angry when a patient files a formal complaint pertaining to treatment received from an Acupuncturist.
We complain that PT’s are engaging in insurance fraud by using the Manual Therapy code for Dry Needling. We justify the use of pain codes for every client, because, well, everyone has pain and, after all, the system is stacked against us.
We are furious that other professions are using “our” medicine, especially without what we determine to be appropriate training. We add homeopathy to our scope without a second thought.
We support and celebrate a lawsuit filed against a PT Regulatory Board as an appropriate defense of our profession. We are outraged when a counter-suit is filed against our board.
An attitude of American Exceptionalism does not increase the standing of the US in the eyes of the world. You can’t learn from mistakes when they are denied or explained away. Hypocrisy and double-standards impress no one.
Likewise, Acupuncture Exceptionalism does a disservice to our medicine and to our future as health care providers. If our medicine is powerful enough to help people, it is powerful enough to cause harm. Denying risk puts our patients and our profession at risk. Dismissing valid concerns about acupuncture and herbs from other professionals prevents us from establishing collaborative and respectful connections. If we want to improve our skills and training and service, we must take a clear-eyed look at where we are succeeding and where we could do better.
I’m confident enough about the benefits and overall safety of this medicine that I’m not afraid of looking inward with a critical eye. Are you?
We lack a national news source for the profession and so we are often in the dark about the forces shaping our future.
Here is some state-level news with national implications —
In January 2016 the NGAOM joined with CAOMA and nearly advanced AB758. This would have overturned last year’s legislation which moved California to the industry standard of ACAOM school accreditation rather than depending on the troubled CAB.
The NGAOM successfully fought for legislation mandating Malpractice Insurance for all LAcs. Practitioners in CT report this was done without consultation with the state association. Malpractice insurance is a significant expense, and a needless one for licensees not in active practice.This new requirement doesn’t seem to benefit anyone other than insurance companies and the NGAOM (which gains members through discounted coverage) despite the NGAOM’s pro arguments.
Regular readers know that the DE Acupuncture Advisory Council has generally refused to use their waiver power to license practitioners lacking the full NCCAOM herbal credential. The BOM knows that depriving the public of qualified practitioners is not a public service and is proceeding with draft legislation (text not yet available) that would establish tiered licensure. While it’s not the best solution, it’s an improvement. New Council members are taking their seats in the next few months. Let’s hope we can all work together to grow the profession in Delaware.
The Nevada Board continues to push for an increase in educational requirements far beyond the Masters level. Having again ignored the advice of Nevada’s Deputy Attorney General they are now moving to hire their own counsel, perhaps explaining why Nevada’s fees are the highest in the country.
Acupuncture Today didn’t just miss these important news items, history shows AT is willing to selectively hide some developments within the profession.
After a series of well-received columns in 2007 author Lisa Rohleder received a letter from Executive Editor Crownfield — “After several conversations with my publisher and others, we are concerned about continuing your column under its current “theme”, for lack of a better word. While the concept of social entrepreneurship, particularly the “pay according to what you can afford” aspect, is admirable, it has dangerous potential from the perspective of professional advancement.” Yes, AT considered affordable acupuncture dangerous. (The ideas did have potential. The ideas Lisa presented developed into POCA. POCA has established a school, helped clinics provide millions of treatments, helped practitioners establish successful businesses, and provided free CEU’s and many other benefits, to members.)
The Acupuncture Observer may change a bit over the next few months. But until the profession develops a reliable source for news delivered in a timely fashion, TAO will do what it can to keep you in the know. Let’s keep each other informed. Are you aware of news of importance to Acupuncturists? Is there regulation that could keep Acupuncturists from practicing in your state? Is a group pushing for change that seems detrimental to the practice environment? Email email@example.com with your news. Let me know if you’d like to write a guest post. And subscribe to TAO (box on the upper right of the home page, your address will not be shared or sold) for news updates.
Dry Needling wins again – it receives “the greatest threat to the profession” practitioner’s choice award.
In recent years, Acupuncturists have devoted more resources to this issue than to any other.
Even our wins have been temporary. For example –
– the Georgia Acupuncture Board added language stating that Dry Needling is acupuncture. The PT’s then added Dry Needling to their scope via legislation. (Could Georgia PT’s now advertise they’re doing acupuncture?)
– the October 2014 ruling in Washington State against dry needling was widely celebrated. Now the PT’s have introduced bills which would add Dry Needling to their scope. With almost 5,000 PT’s in the state, and about 1,100 LAcs, it’s likely they’ll eventually succeed.
We say the PT’s:
- are stealing our medicine! (But we don’t own it.)
- are illegally expanding their scope. (The majority of states have ruled it is in the PT scope. Modifications to scope are common in health care.)
- are using Regulation to do what should be done Legislatively. (Scope clarification is often done via Regulation, which gives the public and other professionals the opportunity to weigh in and is preferable to politically driven legislative action. The public is protected through regulation. The PT’s have been successful in passing Legislation allowing dry needling.)
- are pursuing this because their own techniques don’t work. (Even if true, 1) why does that matter, and 2) does the argument apply to us when we add techniques lasers, essential oils, e-stim, herbs – to our scope?)
- can’t possibly know enough to do this technique safely. (Many clearly do.)
- can’t possibly be providing good treatments. (Their patients disagree.)
- wrongly say that dry needling isn’t acupuncture. (Is it better if they say it is? Is there a legal reason our definition should prevail?)
- make the public fear acupuncture. (Insisting this technique is acupuncture will contribute to the problem. Don’t we have the same problem when we use the technique?)
- should use hypodermic needles. (Does that show concern for public safety?)
We can continue the fight to stop dry needling – getting caught in the cycle of suit (complaint) (never-mind the SCOTUS ruling) and counter-suit (NC PT lawsuit). We can fight state by state, and attack any Acupuncturist who suggests anything other than “the PT’s must be stopped.” We can keep insisting that if we just devote more resources and fight harder, we’ll win.
Or, we can learn from our history and the history of all of the other professions that have fought to maintain a monopoly on technique or turf.
We could be fighting for strong regulations. Mandated adverse effect reporting, strict definitions of what dry needling is and what it isn’t (other than whether or not it is acupuncture), requiring direct supervision for all clinical hours, requiring PT’s to post their hours of training, requiring registration with the PT Board, requiring physician referral for dry needling – all of these are possible.
A PR campaign promoting acupuncture and helping the public find an Acupuncturist? That’s possible too. Supporting ease of licensure so that people in every state can find an LAc? We can work for that. Support for new practitioners so that the public can actually find an Acupuncturist? That’s a great goal. Building collaborative relationships with other professionals who want to decrease pain and suffering? That would serve everyone.
Putting our energy into stopping dry needling? Not so much. It’s our obsession with stopping dry needling that is the greatest threat to the profession.
Many Acupuncturists hold that increasing insurance coverage is necessary for our professional future. It’s a main goal of the NGAOM. HR 3849 is the same legislation the AAAOM has lobbied for in the past. The Acupuncture and Oriental Medicine Society of Massachusetts is working on legislation mandating insurance coverage, and a similar bill has been introduced in Vermont. A handful of states include acupuncture in their ACA plans.
I don’t believe Acupuncturists have to sell their soul to participate with insurance, and I don’t believe insurance companies are evil.
I do believe many practitioners haven’t considered the overall impact of insurance coverage on their business, the profession, and the medicine.
Participating with insurance invites a third-party into the treatment room. The Acupuncturist (or any Care Provider), the Patient, and the Payer share one goal – that the Patient feel better as quickly as possible. Beyond that, there’s plenty they don’t share, including – how to define treatment success and fair compensation. How many and what type of treatments are necessary. What provider types to reimburse. How best to control health care spending. How to provide care for those with expensive medical conditions. How to assess quality care.
Patients and providers often see the payer (a faceless bureaucracy that isn’t in the treatment room) as the bad guy. But the payer’s business depends upon watching every penny, and always trying to get more for less. Payers often say no (or that’s too much) to patients and providers.
In the past year, conversations about insurance coverage have included:
- Practitioners about to open their first practice with no idea where to begin.
- Copies of statements from an Acupuncturist who bills insurance $2,000 per treatment.
- A practitioner insisting that billing a Manual Therapy code for point location is legit.
- Many responses of “everyone has pain somewhere, so bill for that” to questions about codes for a specific condition.
- Discussions of how to use CPT codes so that reimbursement amount equals desired amount.
- Concerns about audits.
- Concern regarding reductions in reimbursement rates.
- Complaints that panels are closed (the insurance company won’t accept additional practitioners in-network).
- Reports that companies are requiring current NCCAOM credentials for participating providers, even when not required for state licensure.
- Anger when offers of expedited payments for reduced amounts are offered.
- Complaints about time spent resolving billing or reimbursement errors.
- Questions about proper policies around co-payments and co-insurance.
- Discussions of how to serve the patient who has not yet met their deductible.
- Concerns about retaining patients who have reached their treatment limit.
- Stated goals of treating patients with limited resources, without recognition that those patients often have limited coverage.
We’re inviting a powerful bureaucracy into our practices, one with the power to define our medicine in the eyes of the public. Other professions have strong and responsive support systems to balance the power of that bureaucracy. We don’t. Are we prepared for the continuing effort that will be necessary to protect our interests? We play this game at our peril.
If we want people who want acupuncture to receive it from an Acupuncturist, acupuncture education deserves our attention.
There aren’t good statistics on how many Acupuncturists or acupuncture students there are in the US. But those handy maps printed in Acupuncture Today can give us some idea. The December 2013 issue (with an article on AT’s unprecedented growth) showed 24,342 Acupuncturist and 3,124 student issues mailed. In December 2015 – 24,231 Acupuncturist and 2,624 student issues mailed. That’s not growth. The 2014 NCCAOM Annual Report (the most recent available) also reveals – we are not a growing profession.
There is a lot of churn in Acupuncture education — schools close, schools open, programs merge, new degree programs are established. New Gainful employment rules adopted in late 2014 may well contribute to that churn. They require for-profit schools (about 50% of acupuncture programs) to provide at least some debt and jobs data to prospective students.
Small class sizes can skew the data. Still, check out these reports (selected because they came up first in Google): Emperors, ACAOM (the school not the agency), Arizona School of AOM, Midwest, AIAM, and Colorado School of TCM.
Only two schools reported job placement, at 50% and 67%. Median loan amount (omitting a 1.5 million figure given by Midwest that must be a mistake) ranged from 17K to 72K. A real eye opener was the percentage of students completing the program in the expected time frame. The average across all 6 programs was 55%. Omit the 100% reported by Arizona, currently on probation with ACAOM (the agency), and it’s 46%.
It’s not encouraging. Add student uncertainty that the degree they obtain will enable them to practice and it is no surprise our profession isn’t growing.
Imagine if we could tell prospective practitioners – “A Master’s Degree in Acupuncture from any ACAOM accredited program will fulfill the educational requirements to practice in any state.”
I may not love the ACAOM standards but I’ll accept them to help the profession. Is there a downside to offset the upside?
NGAOM you have a stated goal of establishing uniform standards, yet are fighting to keep California schools out of the ACAOM system. Please explain.
We had some significant losses in Acupuncture education in 2015.
Spring brought news that Dianne Connolly and Bob and Susan Duggan would no longer teach or be part of the program at MUIH (which Bob and Dianne founded in 1974 as The Maryland College of Chinese Acupuncture). Bob and Dianne are part of the foundation of this medicine in the US. They profoundly influenced my acupuncture journey and it is a significant loss that they won’t be part of every MUIH student’s education. I am glad they are continuing to teach and share their wisdom in other settings.
Bob Duggan played an integral role in establishing acupuncture standards, credentials, agencies, and commissions. His goal in so doing was to enable this safe and effective medicine to be legally available to more people. He shared in a personal communication his ambivalence at how things turned out – that though his work enabled so many people to be healers and to be healed, “If I had real courage I’d have gone to jail and insisted this was the people’s medicine and we shouldn’t allow it to be professionalized.”
2015 closed with another loss, the death of Dr. Richard Teh-Fu Tan. Dr. Tan was an excellent teacher, deeply committed to teaching. Directly, and through his students, he eased the suffering of countless patients. Dr. Tan made no secret of his doubts about the caliber of acupuncture education most of his students received in their degree programs. Many seminar attendees reported learning more about effective acupuncture in four days with Dr. Tan than in four years of acupuncture school.
Attention must be paid.
The 40ish days between January 1st and the Lunar New Year are perfect for reviewing the past year and preparing for the next year. What worked, what didn’t? What direction will we go in when the days warm, the yang rises, and we spring forward?
There is much to consider when evaluating our practices and our profession. To understand how it all fits together we need to dive into the weeds. It’s going to take a few posts, but it will be shorter than the tax code!
AAAOM (The American Association of Acupuncture and Oriental Medicine): Historically, our national professional association. And, historically may be all. The website shows no action items since 3/13/14, and no President’s blog post since 10/9/14. Is there anybody there? Is the AAAOM still alive?
ACAOM (The Accreditation Commission for Acupuncture and Oriental Medicine: Graduation from ACAOM-accredited schools is a requirement in many states. 2015 ended with an announcement of a Degree Titles and Designation Project. This should be interesting – there are already graduates of and students in the existing range of programs and there are widely varying state rules. Better late than never? (Wouldn’t it be easier for the public if we were all Acupuncturists?)
ANF(Acupuncture Now Foundation): Finally, there is an international charitable organization dedicated to educating the public, other health care providers, and those who work in health care policy. For too long we’ve relied on piecemeal efforts to educate others.The ANF is just getting started and needs our support to provide a visible, accessible and positive message about who we are and what we do.
ASA(American Society of Acupuncturists): This non-profit collaboration of state associations launched in 2015. The ASA has potential, and challenges. One challenge – “six degrees of separation” between individual practitioners and the group. A planned website should help bridge the gap. Of greater concern – at the state level, the ASA defers to the preferences of the state association. If an ASA-member state association supports a law or regulation that serves its current members to the detriment of all other LAcs, too bad, so sad for the profession as a whole. There are good people involved with this group so I remain cautiously optimistic. I hope that, before too long, the member groups will see that a victory that disadvantages other Acupuncturists isn’t a win.
CCAOM (Council of College of Acupuncture and Oriental Medicine): The membership association for schools and colleges of AOM with ACAOM accredition or candidate status. They administer the NCCAOM required CNT course, and released an updated (available free!) CNT manual this month.
IHPC (Integrative Health Policy Consortium): The IHPC “advocates for an integrative healthcare system with equal access to the full range of health-oriented, person-centered, regulated healthcare professionals” and has been working to build enforcement of Section 2706 of the ACA to end insurer discrimination against classes of licensed health professionals working within their scope. I don’t know of any LAc that doesn’t support this group’s mission, so it is odd that many LAcs support legislation that would create this sort of discrimination.
NCASI (National Center for Acupuncture Safety and Integrity): One individual? Silent for many months now.
NCCAOM (National Commission for the Certification of Acupuncture and Oriental Medicine): The NCCAOM “validates entry-level competency in the practice of AOM through professional certification.” Their vision is that AOM “provided by NCCAOM credentialed practitioners will be integral to healthcare and accessible to all members of the public.” They are powerful, organized, effective, and better funded than any other acupuncture group. They have had a major role in the path to licensure in many states. However, if you are not an NCCAOM diplomate, feel that the credentialing process is out of hand, and/or if you value traditions other than TCM, the NCCAOM is probably working against your interests.
NGAOM (The National Guild of Acupuncture and Oriental Medicine): A professional medical society organized as a guild under the OPEIU, affiliated with the AFL-CIO. The NGAOM list of 13 VP’s includes the VP, Immediate Past President,Treasurer and one additional board member of the AAAOM and following in that tradition there is significant mystery around their membership and their decision-making process. They want the profession of acupuncture to be more like other health professions. Many LAcs affected by their work aren’t pleased with the consequences. You’ll learn more in upcoming posts.
POCA (The People’s Organization of Community Acupuncture): Mission — “to work cooperatively to increase accessibility to and availability of affordable group acupuncture treatments.” 708 Punk (Acupuncturist) members, 138 clinic memberships, and 1348 patient members. Minutes of meetings posted in their forums, 8 free CEU’s for practitioner members, loads of member support, and a school (POCA Tech) working towards ACAOM accreditation and currently accepting applications for the third cohort of students. This is a successful acupuncture organization.
State regulatory boards are not professional organizations or associations. Their mission is to protect the public, not promote licensees.
An exploration of acupuncture education, events in the states, legislation and regulation, and other items of interest, including more about these organizations, will be coming soon.
We have a little more than a week to influence regulations that will impact our profession. The regulatory and legislative process typically includes long periods of incremental movement suddenly replaced by small windows of major activity. One of those windows is open in the District of Columbia, but only until December 26th.
The proposed regulations are especially important because Washington DC is the seat of our Federal Government. If Acupuncturists hope to influence policy at that level we’ll need a strong community of practitioners, the more experienced the better, ready to serve in our governmental agencies.
The good news is that a small group of practitioners worked diligently to move the regulatory activity in a positive direction over the past three years. The bad news is that amidst the positive proposed changes are a few problematic sections. The additional bad news is that we are now late in the process. But maybe not too late. It would be good for the profession and for individual practitioners if we were able to correct those problematic sections. Let’s try.
You can see the text of the new regulations here. Comment by clicking on the blue “Make Comment” box at the bottom of the page (the tab at the top doesn’t seem to work). The comment form will only accept 500 characters, which meant a boatload of editing and three separate comments for me. Feel free to borrow my Three Issues DC2 language for your comments.
In addition, I’ve sent this Dear NCCAOM letter to Mina Larson, (MLarson@thenccaom.org) and Kory Ward-Cook (firstname.lastname@example.org) asking for their assistance. Again, the more letters the better. Feel free to use my letter as a template.
Remember, a regulatory change anywhere sets a precedent for changes everywhere. If we want people to get their acupuncture from LAcs, we need to remove obstacles to licensure. Please submit comments and share this post with other’s who would like to weigh in. It doesn’t cost anything except a little bit of time. Imagine what we could do if we took the energy and funds used to battle other professions and focused more on improving our own situation.
I limited my comments to the issues I consider most problematic and easiest to correct.
As I discussed in this post, these regulations will impact us all. Some of our colleagues thought it best to keep these proposed changes from the greater community, and that’s a shame. We need to be in the loop. The more we know, the more we can do to bring about positive change.
Changes in acupuncture regulation in any state matter to each of us individually, and to the profession as a whole.
Here are 9 reasons why —
- We don’t know what the future holds. Unexpected moves happen.
- You may need to hire practitioners or sell your practice. Can interested parties easily move to your state?
- Your patients might move and want a practitioner just like you. Will one be available?
- Growth in the profession is not keeping up with demand. Regulatory uncertainty diminishes the appeal of the profession.
- High educational and credentialing costs interfere with business growth. If the requirements vary from state to state, the impact is multiplied. (See this report on Occupational Licensing.)
- Regulatory differences lead to divisions within the profession. With fewer than 25k acupuncturists in the US unity is critical.
- What happens in one state impacts every state. States look at what has happened elsewhere when considering regulatory changes.
- Changes in one state can lead to changes for everyone. When CA increased required educational hours every school and ACAOM soon changed as well.
- Different regulations, training requirements, and titles make it difficult to educate the public about our qualifications, draw contrasts with other professionals, or advocate for our profession as a whole.
Staying informed is not easy. Neither is getting involved. We are all busy, we don’t always know how to assess the pros and cons of a possible change, and things can get heated and unpleasant when there are differences of opinion.
And, the future of our profession and our businesses is greatly impacted by regulatory changes – even those happening across the country.
Please, stay involved.
Forgive two posts in quick succession, but regulatory changes are on the way. You’ll hear from me again soon.
(Note — I advocate for standardizing and simplifying the regulatory process for acupuncture licensure. I am not advocating for standardizing the medicine itself. Our diversity is powerful indeed.)