Survey, Part Three

The ASVA membership meeting was April 7th and I’ve been meaning to write about it ever since. I heard good things about the associated weekend seminar, the setting was lovely, and ASVA received support from a number of vendors. Two folks stepped up to fill open positions on the board, and it looks as though good things are happening for the group.  I remember well the hard work it takes to run an organization and big events like this one – kudos to the board for their efforts.

The survey results, though, diminished my good spirits (and please read 6 even if you skip the rest!)  —

1) 75% of respondents replied yes to supporting efforts to add Acupuncturists to the list of covered providers in the Social Security Act. I only wish the profession had more information about what a successful effort would entail, the odds of success, and the potential impacts of success. I have seen nothing that comes close to a well-done analysis of these issues.

2) 82% support the national effort to include acupuncture as a federally mandated EHB. The current HHS policy is that if a state does not establish their own EHB, the federal government will rely on existing plans within that state to establish an EHB. Any efforts to include acupuncture in a federally mandated EHB would first require a complete change in how HHS is establishing EHB for states. I don’t know of any active national effort to bring about this change and unless the acupuncture community believes that we can win an argument with all of the states and the US Congress about greater federal control of healthcare, an arena more typically left to the states, this is a non-starter. (And if we were successful it would have some huge impacts for us that I have not seen discussed anywhere — I’ll be posting about it one of these days.)

3) 75% support fundraising for the purpose of updating the Virginia scope. There wasn’t any conversation about what changes anyone had in mind, so I’m not sure what people are supporting. See my March 26 post about scope for more on this issue, but, based on what was said at this meeting, there is still a lack of understanding of what “scope” means.

4) Only 60% supported a grassroots campaign to support the election of legislators supportive of acupuncture. Perhaps ASVA members are reading this blog? I hope my look at the question and the relative lack of support for the strategy as stated does not translate to a lack of involvement with our legislators.  It is super-important that we, as individuals, get involved in local campaigns and stay involved with our state politicians. Done right, this is one of the most important things we can do, and a great place for help from our state organizations. The tricky part is doing it so that we develop allies, not create enemies.

5) 68% supported fundraising for legislative efforts to restrict other professions from practicing acupuncture. I can’t begin to imagine a way that such legislation could be successful in Virginia — where low regulation and the free market seem to rule (except in matters of the uterus). I can imagine many ways the mere introduction of such legislation could create division and hard feelings with fellow health professionals.

6) About 10% indicated they’d be willing to serve on a committee. Which leads me to two thoughts —

a) (and most obviously) – success in any of these areas would require far more than 10% of the profession to step up and serve. Of course, being on a committee isn’t the only way, but we’d all need to be involved and contributing time and money.

b) (and most importantly) – it is easy to say we support an idea or an action in the abstract. But when we are in touch with the real time and effort a yes entails, it’s not so easy. Questions 1-5 would have a far greater impact on our day-to-day workload and life than serving on a committee. So, colleagues, before you say you support inclusion in Medicare or legislative action or acupuncture as an EHB, give it just as much thought as you would the decision to serve on a committee.

Insurance — Ensuring Trouble?

“The insurance company used to pay this code, now they won’t, what can I do?” or “Why are they asking for preauthorization all of a sudden?” Questions like this have suddenly become common in acupuncture discussion groups. I believe that until recently, most insurance companies in most jurisdictions saw a relatively tiny number of claims related to acupuncture services. Now, as more practitioners and patients take advantage of increasing coverage for acupuncture, we’ve crossed a threshold. Some companies now pay out enough for acupuncture services that it has become worth their while to pay closer attention to claims.

Given the cost of conventional medical care (greatly related to technology and Big Pharma) insurance makes sense. It is easy to imagine circumstances, and many of us don’t have to imagine, in which one could owe tens or hundreds of thousands of dollars for medical care. That isn’t the case with acupuncture.

It’s great if you’ve decided that part of your practice will be working with insurance. It is nice that we have the option. For some it signals that “we’ve arrived.” It helps our acceptance and it enables us to reach a population that might not otherwise consider our medicine. Currently, acupuncturists who know how to work well with the insurance system may do well with their reimbursements, coming close to matching their regular fee.

Please, though, be aware. The more your income is controlled by the insurance companies the less control you have . And the more our profession depends upon insurance the more power that industry has over our medicine. If the industry decides to cut reimbursements, or to further limit the codes they will cover, or the number of treatments they’ll cover (and if we look at the experience of other professions we know they almost certainly will) we may find ourselves stuck.  If the insurance industry determines they will only cover acupuncture for back pain will that influence even those paying out of pocket?

Some practitioners are not working well with the system but are instead working the system — billing for more units of acupuncture than they perform; adding additional services to the treatment, or even worse, just to the bill; using ICD codes that get reimbursement even if that isn’t the focus of treatment. They sometimes cross the line into fraud, though they believe they have good justifications for doing so. Big Insurance is unlikely to agree, and that will reflect upon all of us.

Personally, I’ve made the choice to discount my fee directly to my clients. I find it much more enjoyable than getting the same amount only after a painful dance with the insurance industry. It’s great if you make a different choice. But don’t forget that with greater participation comes greater scrutiny. When you play with the insurance companies, they set the rules, and they can always find a way to win, even when playing with professions far more powerful than ours.

 

Survey, Part Two

I want to get back to the ASVA survey I mentioned in the “Know Before You Go” post. Again, I’m glad ASVA wants member feedback. And I don’t want to be that annoying critic sitting back and complaining. And, we need to analyze our options if we want to work smarter.

Imo, surveys are often worse than useless. Many issues are too complex for a simple yes or no, and without background it is all too easy come up with a knee-jerk answer that, when allowed to drive policy, can take us where we don’t want to go. (Definitely a problem not limited to the acupuncture world.)

Here are the other questions on the ASVA survey, and my commentary —

  1. Should ASVA support efforts to have “Acupuncturists” included as a provider in the Social Security Act?  (What efforts? Is some group preparing to introduce a bill? Have practitioners received any more information about what it would mean for us if we were succesful? What happened with past efforts and why would it be different now?)
  2. Should ASVA support the national effort to include acupuncture as a federally mandated essential benefit (EHB) through the Patient Protection and Affordable Care Act (PPACA)? (What national effort? Who is working on this? Wasn’t it determined that the states would determine their own EHB, and if they didn’t the Feds would rely on plans within a state?  What is ASVA talking about?)
  3. Should ASVA consider fundraising for the purposes of introducing state legislation to update the scope of practice for licensed acupuncturists in Virginia? (Is there a problem with the current scope? Does ASVA have particular changes in mind?)
  4. (The one I wrote about in the other post.)
  5. Should ASVA explore fundraising for legislative avenues to restrict other professions from practicing acupuncture in Virginia? (Really?!?!?!! Is there any chance that a majority of legislators would vote for a bill like this given the relative numbers of other professionals? What would our reasoning be — we want to maintain a monopoly? Do we think other professions will accept this? Might there be blowback?)
  6. Will you serve on a committee? (Well, good for them for asking.)

I suppose I’ll find out on Sunday whether members gave a knee-jerk yes, yes, yes (except for #6 of course). I won’t be surprised if they did.

Legislative battles are often messy and expensive and can take years of ongoing commitment. Last minute changes to legislation can be harmful. Could we use our limited resources in ways that would bring a more immediate and direct benefit? How about asking what sort of business support members could use? I often get questions about the legality of various billing arrangements, could the state association focus on finding answers? How about educating members about existing state regulations?