Acupuncture Degrees and Debt

“Federal options for debt forgiveness” is often given as a reason why we must seek Medicare inclusion. And the expense of our education is considered a big factor in why people aren’t entering the field. So why aren’t we laser-focused on what can be done to keep costs down and prevent that debt from accruing?

Wouldn’t that be in keeping with everything we know and teach our patients?

When our patients have a lifestyle that is leading to depletion, we don’t encourage them to keep expending Qi beyond their means, with a promise that if they fight hard enough somewhere down the line they’ll find a miracle cure.

The history of the Acupuncture profession in the US has included a steady increase in the required hours of training. With some state-level variations, required training to enter the profession has gone from 1000 hours prior to 1990 to a minimum 1905 hours as of 2011. If you are in a state that requires herbs it’s 2525.

I have never seen any evidence or even heard anyone arguing that the increase in required hours was a response to a revealed deficiency in the education or preparation of entry-level practitioners. That’s not to say there weren’t and aren’t deficiencies. (A lot can be done to improve education and training without adding hours.) But lots of those early program-grads, the ones that took those shorter programs, went on to have long and very successful careers.

The expansion in hours of education required seemed to be primarily…marketing. We want legitimacy and respect. “The establishment respects education.” They respect “Doctors.” We point to our hours of training with the expectation that “they” will defer to our expertise. And we are dismayed when they (still) don’t.

My best recollection is that my acupuncture-only training in the early 90’s cost about $26,000, or $55,411 in today’s dollars. Multiply by 160% to reflect the increase in hours (it’s a bit complicated because I was in a window when training was described in credit hours), and we get $88,658, which is about what a Master’s degree will set you back these days. Wouldn’t there be less debt with a $56,000 degree? And being mostly out of the workforce for a 2-3 year program, while not easy, is likely to result in less debt than being mostly out of the workforce for 4 years.

There’s another problem with our current degree situation. Prospective students have a much more complicated decision to make than we used to back in the day when it was an MAc or nothing. Now, if someone is considering a career in acupuncture, they need to consider where they might want to practice for their entire career. If they want to keep their options open they’ll be encouraged to get a more expensive OM degree. And if they are worried about building a practice they might feel pressured to go for the Doctorate – for the marketing value if nothing else. And they might learn that for some states there will be additional requirements (Florida and injection therapy training) or credentials (the CA exams). It’s easy to imagine potential students, stuck between choosing a degree they can almost afford but fear will limit them, or a degree that’s a real stretch but keeps their options open, giving up and choosing a different career.

Let’s focus on making acupuncture degrees more affordable. This would make our training more accessible and decrease the educational debt of our future practitioners. Isn’t that a better bet than focusing on a way to access debt forgiveness programs that might be available in the future if we manage to get the massive health-care bureaucracy to let us in?

Anyway, I only started this post to ask everyone to listen to this podcast and read this post. They are great and absolutely worth your time.

Powerless

Regular readers might recall that I’m trying to set healthy boundaries. When a leader in the push for Medicare wrote recently “New Rule: Old guard practitioners who paid $10K for their education in this field don’t get to even weigh in on federal advocacy” it was only surprising in its bluntness. It’s been clear for ages that those calling the shots don’t care what the “old guard” has to say.

As Clive James wrote about Tyrion Lannister “in an unreasonable society, to have reasoning power guarantees nothing except the additional mental suffering that accrues when circumstances remind you that you are powerless.

I can’t manage additional mental suffering right now, and so I’ve been focusing on things where my involvement has a better chance of making a difference. Not easy when I know that giving up and checking out doesn’t help make the world a better place.

So I’m super-grateful that Lisa Rohleder is still out there, keeping an eye on things, and doing what she can to appeal to reason and to make the world a better place. Please read this post about the latest Town Hall. And also this, and this one, about Acupuncture as a business.

Just tool around the Acu Safety Nerd site. It’s a fantastic blog with many great articles, and unlike The Acupuncture Observer at the moment, putting out new content regularly.

(Admittedly, plenty of my old content is still relevant. I wrote this about insurance almost a decade ago.)

(Lisa doesn’t only write. She makes stuff happen. While I’ve been trying to work within the “system” she’s been the motivating force for the community acupuncture business model, which made huge strides in making acupuncture accessible without depending on our flawed third party payer system. AND, she’s the force behind POCA Tech, a fully accredited acupuncture school that provides an affordable education. Yet I see comments on FB dismissing her writing as “lacking solutions.” Huh?!? The lack of informed discourse on FB is one of the reasons I started this Blog, fwiw.)

And here’s another blog post worth reading, about the number of folks entering the profession in California. When things aren’t going well in California, how well can they be going elsewhere?

One last, off-topic thing. Am I the only person who wants to scream/cry/laugh/vomit when I see non-Asian, US-trained, Acupuncturists accusing non-LAcs of Cultural Appropriation for wanting to use acupuncture needles? (Hey, if you prioritize honoring the culture, how about respect for the elders?)

 

Middle of the End

The opinions in this post are mine alone, and do not represent any organizations or associations with which I am affiliated.

The profession is in trouble. And as of the October 26 NCCAOM/ASA Town Hall even our leaders admit it. That last bit is new. But what isn’t new — as far as those leaders are concerned, there is only one way to save the profession. It’s their way. And it depends upon working LAcs to shut up about our concerns, and do what they tell us to do.

My experience with the ASA in the Spring 2020 was yet another reminder of the profession’s dysfunctional patterns. I believed (despite previous experience) that a mainstream Acupuncture organization was willing to transparently explore the risks and the benefits of a proposed course of action – in this case, of becoming Medicare providers – with the thought that in so doing we could prepare to mitigate the risks, increase the likelihood of benefits, and build consensus on a course of action.

Instead, at the 11th hour, after 100’s of volunteer hours from a group of individuals invited to participate, almost every mention of “cons” disappeared. A slanted pro-inclusion document was released, followed by a poll designed to tilt pro-Medicare. Still, support for the fight was, and continues to be, tepid. And rather than address or acknowledge the legitimate concerns of working practitioners, what we get from the leadership is exhortation and pressure.

This is a repeated pattern.The organizations choose a direction: increase hours of training, add credentials, become doctors, increase insurance coverage, fight other professions. It’s our only hope. Practitioners who raise concerns are ignored, sidelined, or attacked. When the success we were promised doesn’t arrive, it’s our fault. The organizations may change, but the song remains the same.

A year ago I was privileged to have lunch with Mina Larsen and I made the following request —

The ASA and NCCAOM have decided that becoming Medicare Providers is the only way forward. I keep being told that I have nothing to worry about, that I’ll be able to opt out and continue to practice the way I do now. As a way to show working professionals that you have our backs, let’s pretend the language passes tomorrow, boom. Can the ASA and NCCAOM prepare a document, “So, We Won, What Next?” Lay it out for us. What, specifically, do we need to do to Opt Out? Is it a one time thing? Can I change my mind? How does opting out impact my patients? If I want to be a provider, how do I sign up? Do I need to make changes to my record keeping? Are there any accessibility issues regarding my office? If I make errors in billing am I in any greater legal risk? What are the profession’s plans for lobbying on an ongoing basis? Won’t we need to prepare to fight rate cuts? What’s the budget for that?

(I’ve been asking these questions for a decade!)

So far, crickets. There hasn’t been any effort to help us prepare for what happens on the other side of “success.” Just as we’ve been left to fight with the insurance companies and devote more time and money to training.

Other thoughts while listening on the 26th —

– Has anyone explored how many LAcs are likely to choose to participate in Medicare? What percentage of the 50 million Medicare beneficiaries Mr. Taromina mentioned will LAcs end up serving? If other professionals provide more of the acupuncture treatments, could it speed our demise as a relevant profession?

– Why hasn’t increased insurance coverage increased LAc satisfaction and practice success? Is it true that increased insurance coverage hasn’t impacted non-participating providers at all? (It isn’t true, but that’s what we were told at the time, and now we’re being told the same about Medicare.)

– Is there evidence showing that treatments from LAcs are more efficacious than acupuncture treatments provided by others?

– The presenters raved about a future in which, in a pediatric oncology setting (a weird example for a discussion about Medicare), LAcs would treat not just physical pain, but also the emotions and spirit of patients and their families. Are third party payers reimbursing for treatment of emotions and spirit? Do practitioners feel that the time and visit constraints of third party payers impacts ability to deliver deep, holistic, treatments?

– Mr. Taromina mentioned that the lack of unity in the profession resulted in missed opportunities when it came to Covid, the opioid crisis and the ACA. What’s a specific thing he thinks we could have done differently? (I mean, sure, working together, but for what specifically?)

– Mr. Taromina said that no one has come to the leadership with “better ideas” about helping the profession. Why have suggestions to revamp our educational and credentialing process to create a shorter and cheaper path to entering and remaining in the profession been ignored? (I raised these ideas years ago, and I’m not the only one.)

Was the presentation on the 26th too alarmist? No. It might not be alarmist enough – “the profession” is in trouble, there will be consequences for most of us, and the only “solution” under consideration by those in power won’t help.

It’s critical for regulated professions to have healthy organizations and institutions and I’ve devoted huge amounts of time and energy to supporting these groups. Facing, once again, their lack of learning from the past and their disregard for the actual lived experiences of working professionals is painful as hell.

I have no suggestions about what we do next. For me, it’s time for a healthy boundary. There’s no point in continuing conversation with those who refuse to hear. I’ll save my energy for the treatment room.

Good luck to us all.

Medicare and Acupuncture: End of the Beginning, or Beginning of the End?

The opinions in this post are mine alone, and do not represent any organizations or associations with which I am affiliated.

 

When I started this post in early June I wrote –

Join your state association. The states will be distributing ASA-developed Educational materials and a survey regarding Medicare inclusion soon.

I was honored to be asked to participate in the ASA Medicare Working Group developing the materials. My goal, as always, is to provide vetted information and analysis so that we can make wise decisions and be prepared for consequences. The ASA Board knows I won’t tolerate anything less. It’s concerning that the NCCAOM made statements that they’re already pursuing Medicare inclusion, but the ASA insists they won’t move ahead without the support of the community.

By mid-June, I was concerned.

There was an inexplicable urgency to complete our work. There had been no attempt to work with outside experts to get definitive answers to issues still up for debate. Academics have studied Medicare’s impact on medical practice and physician satisfaction, and there are lawyers who specialize in Medicare law. Why not give us the time to hear from them about the likelihood of an opt out, or whether we can really expect better reimbursement rates?

I noticed a double-standard as we debated which opportunities and risks to include on our list. But I reminded myself that perception wasn’t reality, and that the ASA doesn’t have a ton of resources. That preparing legislation would take time. I still believed the ASA was committed to an honest process and I told myself that the board would correct any bias when they received the document for review.

I was going to write that the process was challenging, and the document wasn’t perfect. But it was the result of a good-faith effort and everyone should participate in the survey.

By late June, I was distressed.

The slight pro-inclusion tinge had been amplified by the Board’s edits. Several changes were so extreme that two of us (given only a few hours to express our concerns) asked that our names not appear on the ASA-Medicare-Educational-Brief (in the end it was signed “The Medicare Working Group”).

I was going write about where the document fell short, and where it was wrong. I’d share my growing sense that the ASA BOD wanted the survey results to give them a particular answer.

I’d encourage everyone to watch the recording of the June 24th ASA/NCCAOM Town Hall, because all of the scrambling to sell Medicare inclusion didn’t completely obscure hard realities. (Sure you’ll lose a little money on every treatment, but you’ll make up for it in volume!)

By the first days of July, I was dismayed.

Perhaps the ASA BOD doubted they’d get their hoped for outcome? Suddenly, the most controversial issues were no longer a concern. We’d definitely get opt out, reimbursement rates would be better. The ASA Revised Medicare Educational Brief was rushed out, which shows only two potential risks of Medicare inclusion. The old survey and any responses were killed and a new survey was distributed. There was a new Town Hall, and now we were told that we had nothing to worry about. The ASA newsletter asked “Are L.Ac.’s ready to take their rightful place in the federal medical system and reap the benefits of being a recognized part of mainstream medicine?” Look, Ma, NO Risks!

Had they finally consulted with experts and gotten better information? No, the sources were the lobbyists – those who make a living from convincing others that what the lobbyist advocates for is a good thing. Incorrect information about settled issues (such as the proper use of Advanced Beneficiary Notification) continues to be circulated.

(Will the lobbyists accept a contract based on Medicare reimbursement rates?)

I surrender.

The NCCAOM has resources and the ASA has the power to speak for the profession. It seems clear that, at some point, they will pursue legislation to add LAcs to the list of Medicare Providers. If this survey doesn’t turn out the way they want, there will be another.

The more we become enmeshed in the mainstream medical system, the more we’ll need the money of the NCCAOM (our money) to protect us, the more we’ll need to support the ASA so that they can look out for us. The lobbyists will have job security. I’m not so sure about us.

My upset isn’t because I believe Medicare inclusion will be bad for practitioners and the profession, though I do. It’s because our leadership is selling us a fairy tale rather than preparing us for the challenges that await.

I was recently described by a member of the ASA BOD as a straight shooter with great credibility. Believe me when I say that the ASA Medicare Educational Brief, in its current form, is a slanted document that presents an inaccurate picture of what life will be like for LAcs as Medicare providers. If you answer the survey keep this in mind.

Good luck to us all.

Medicare & Acupuncture: The Good, the Bad, the Ugly, the Unknown.

Did you hear? Medicare now covers acupuncture. (For chronic low back pain (cLBP), with restrictions.)

January 22nd’s announcement was met with cheers, jeers, and confusion. There’s a lot we don’t know. And a fair bit we do. Let’s be informed and thoughtful.

Here’s the formal decision memo. The one page summary covers the important stuff. Please read it. And take a deep breath.

Here’s the helpful announcement released by the ASA and NCCAOM.

Please note – 1) LAcs with Master’s degrees from ACAOM accredited schools and a state license are included, no need for the NCCAOM credential, active or otherwise, unless your license requires it, and 2) LAcs won’t be able to bill directly for their services due to bureaucracy, not disrespect.

This announcement was a surprise. Just a few months ago CMS proposed clinical trials to evaluate acupuncture’s usefulness for cLBP. Perhaps the input from the ASA (CMS Commentary ASA) and the ANF, among others, made a difference.

My thoughts —

  • There is an opportunity here for LAcs interested in working in physician’s offices, and for physicians who want to provide their clients with non-pharmacological pain relief. That’s good.
  • It’s bad that reimbursement is limited to cLBP that is “nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease).” This limitation rules out many causes of pain that are likely to respond to treatment. The requirement that the pain be chronic, present for a minimum of 12 weeks, will also rule-out reimbursement for treatment in most hospital settings.
  • It’s bad that the billing arrangement and requirement of some (“appropriate”) supervision, as well as the administrative costs and reimbursement rates, will limit the number of participating practitioners thereby limiting the number of Medicare recipients who can access treatment.
  • Despite that, the limitation on direct billing by LAcs, and our designation as auxiliary personal, is, in my opinion, good, at least for now. Those of us who don’t want to participate don’t need to opt out, and LAcs won’t face restrictions on who we see and what we charge.
  • It’s bad that the profession is still relying on volunteers to navigate the complex bureaucracy involved with both public and private third party payer systems, and for keeping the profession informed. Those volunteers have been doing a great job, but it is a huge job. Until we, as a profession, provide the resources to hire professionals with expertise in these areas, we’re going to keep being surprised and unprepared.
  • We have spent decades demanding that the establishment appreciate the benefits of acupuncture, and also insisting that no one other than LAcs provide treatment. It’s ugly to sneer at the doors that have now opened. If we’re serious that Acupuncture should be accepted by the establishment and made widely available, and that the only qualified providers are LAcs, it’s on us to figure out a way to provide it.
  • It’s unknown how, or if, the United States will address our out-of-control health care spending. It is known that the problem is not just CEO compensation or administrative overhead. A system which rewards those who provide the most services is going to be expensive. It’s not sustainable to have “the system” pay more for acupuncture treatment than individuals could or would. We will be facing increasing limits on what third-party payers will cover. We need to spend more time preparing and less time whining about how unfair it is.

Over the years, the profession has given support to those advocating for greater participation in the system. Acupuncturists concerned that many benefits of East Asian medicine would be left behind, or that we’d regret our lost independence, didn’t get traction. We chose which wolf to feed. The future is here and we can’t go back.

Let’s think through our next steps, and be prepared for what we create.

 

 

The Last Acupuncture Observer Post?

The planet is burning, the country is splitting apart.

I can imagine the despair of the climate scientists. They sounded the alarm when there was time to change course. But those in power prioritized their own short term interests. The rest of us were powerless to make the big changes. And we remain mostly unwilling to suffer the discomfort that smaller (though still helpful) changes require. We take long hot showers, drive big cars, take cruises, crank the air-conditioning on hot days, and lament the loss of the natural world we know. Being really good at recycling isn’t enough.

In the grand scheme of things, the loss of a Profession isn’t as serious as the loss of cool summer evenings and Orangutans and New Orleans. The knowledge and wisdom of this medicine preceded Licensed Acupuncturists and will live on without us.

I’m no Greta Thunberg. But I will sound the alarm again, and hope that the Profession I love will change course before it’s too late.

  • We have created a growing demand for acupuncture. Patients want it, insurance companies want to include it in their offerings, governments – federal 1,state and local, want to provide it to their citizens. There are lots of jobs, and lots of practices available.
  • There are many Acupuncturists who are leaving the field.
  • There are many areas with no Acupuncturists at all.
  • Enrollment in entry-level Acupuncture programs is down more than 20% in the last five years.

It’s an odd combination. High demand, unfilled jobs, LAcs leaving the profession, and fewer people entering the profession.

Representatives from ACAOM and the NCCAOM, asked about the drop in school enrollment at the ASA conference2, chalked it up to “the economy” and the “overall drop in people attending graduate school” and the change in “employment goals” for “the current generation.” And, “as we have more jobs more people will see it as a viable profession.” In short, ¯\_(ツ)_/¯

They aren’t being honest – maybe not with themselves, certainly not with us.

It’s simple. The investment required to become an LAc, and the education and training students receive, is disconnected from the job skills, jobs, and compensation available to most acupuncture school graduates.

People are spending four plus years in school, graduating with significant student debt, offered jobs that don’t match that investment, and without resources to start or purchase a practice. In some states even four years of education isn’t enough. Florida just added a requirement for training in injection therapy for licensure.

Meanwhile, most entry-level acupuncture jobs don’t require injection therapy or herbal skills. (Not necessary for Modern Acupuncture or most Community Acupuncture jobs, for example).

In order to pass Board exams, extensive study of TCM is needed, even though that system is not required to practice safely and competently, which is what licensing exams are supposed to test.3 The NCCAOM acknowledges the problem, but hasn’t offered a solution.

Existing LAcs spend a lot of time bitter that things aren’t better. Many believe that if only “the profession” fought harder they’d get the higher pay and monopoly on techniques they believe they deserve.

Now is the time to speak clearly.

  • The vast majority of LAcs will never be paid physician level salaries. We can spend more time in school, we can get more titles, we can all refuse to work for reimbursements we consider insufficient, and, still, average net incomes of even 80K are a long way off.
  • We cannot, in general, prevent others from using techniques we consider to be “ours.” 4
  • The higher the demand for acupuncture and the higher our expectations for compensation, the more quickly the system will shift to having non-LAcs provide acupuncture.
  • There is a bipartisan consensus that restrictive Occupational Licensing harms the economy.
  • We are vastly outnumbered by most of the professions we view as competition.
  • If you think that we haven’t been able to “protect the profession” because we haven’t fought hard enough you have not been involved and have no grounds on which to judge.

There are things we can do, powerful things within our control, that could help us survive. We must –

  • Streamline our schooling. The focus must be on competencies, not hours. Safe and competent practitioners can be trained in far less than 2000 hours. We know, because we used to do it all of the time.5
  • Minimize the expense of the necessary training. Much could be accomplished through distance education. Bring back apprenticeships which served us well for many generations (we can call them clinical internships, if we’re afraid of what the mainstream will think). Employers can provide additional post-graduate training in specific techniques and modalities.
  • Demand that the NCCAOM develop licensure exams that test minimal standards for safe and competent practice, not specific knowledge irrelevant to practice.6 The NCCAOM bears the responsibility of designing a JTA that supports the development of an appropriate exam. Particular settings or styles that want to do additional testing can chose to do so. Schools bear responsibility for assessing  knowledge of their particular traditions/lineages.
  • Protect licensure for everyone who has sufficient training in acupuncture, which includes teaching that all health providers have a duty to limit their practice to their own training and experience. Requiring all Acupuncturists to have additional training in herbs, or any other specific, optional, modality shall not be a requirement for licensure.
  • Understand that our success as a profession depends upon our having sufficient LAcs to provide treatment in a timely and affordable fashion in most communities in the US, not on whether the Cleveland Clinic has a few OMD’s on staff. We must provide resources to help and support those willing to practice in underserved areas.7
  • Drop the expectation that “the system” will pay us what we think we deserve. Everyone wants to pay less for health care – people, insurance companies, governments.

We must reclaim Acupuncture as a simple, straightforward interaction between a practitioner and a patient, and recreate the accessible path to licensure we once had. Otherwise, we are creating a future with fewer Acupuncturists, who may manage to pay for their extensive education and keep up with demand only by handing off patient care to minimally-trained assistants working for low wages.

Individual acupuncturists and our professional organizations must acknowledge that we have a problem. It may be a little uncomfortable, but we have the power to make changes that will, at least, delay the day when an Acupuncturist in the US is as rare as the critically endangered Sumatran Orangutan.8 It’s not too late.

 

Notes:

1) Please read this, and comment, on the CMS proposal! Deadline August 15!

2) The ASA did a great job with their first conference. Excellent speakers, well-organized, great facility. Very impressive right out of the starting gate.

3) “The sole purpose of a licensing examination is to identify persons who possess the minimum knowledge and experience necessary to perform tasks on the job safely and competently–not to select the “top” candidates or ensure the success of licensed persons. Therefore, licensing examinations are very different from academic or employment examinations. Academic examinations assess how well a person can define and comprehend terms and concepts. Employment examinations can rank order candidates who possess the qualifications for the job.” (from https://www.clearhq.org/resources/Licensure_examinations.htm)

4) Vermont recently deregulated auriculotherapy. Here’s an opinion from Washington state regarding Nurses and Acupuncture.

5) Other Professions have altered training and education in order to address worker shortages and minimize debt (which also encourages increased diversity). Acupuncturists in Nevada were finally able to bring their licensing requirements closer to what we find in other states.

6) My individual conversations with NCCAOM reps at the ASA conference didn’t move beyond quick chats in passing. I’ve got some hope that they’ll work to improve the recertification process. I’m less hopeful that there will be progress in the other areas in which I’ve expressed concerns. Meanwhile, a big congratulations to Mina Larson on her appointment as the next NCCAOM CEO. I know that she understands the challenges facing the profession.

7) Dealing with the shortage of rural providers.

8) Current population of the Sumatran Orangutan estimated at 14,613.

 

 

Accomplishments of the Acupuncture Profession

We know acupuncture can treat pain and chronic illness, assist with recovery from addiction, increase fertility, and help people manage stress (just to start). Acupuncturists know it would be good if more people could get more acupuncture.

Many dedicated individuals have devoted significant qi to increase insurance coverage, to add acupuncture to Medicare covered services, and to bring acupuncture to hospitals and clinics. All with the hope of increasing access.

Other practitioners are committed to gaining mainstream respect and acceptance to further the goal of greater access. They’ve published research, increased training and credentialing requirements, and fought to keep others from using acupuncture techniques without that training and credentialing.

Our “return on investment” has not been great.

We’re still a lot of money and many years away from Medicare inclusion. How much time and energy gets taken from clients to deal with insurance? How many potential patients have meaningful coverage, and how long will that last? Increased training and credentialing and variations in requirements from state to state slows entry into the field and increases expenses, further diminishing our political strength. In areas with few LAcs, efforts to block other professionals from utilizing pain-relieving acupuncture techniques leaves the public with no access at all.

We’re not using our qi efficiently. Our efforts haven’t done much to shorten the path between most practitioners who want to treat, and most people who want treatment.

It’s motivating, helpful, and informative to read a book illustrating the power of a direct path between practitioner and patient. Acupuncture Points are Holes, is a great read.

It’s several books in one: a captivating personal story, an exploration of the process of establishing an acupuncture practice, and an analysis of some common limitations in acupuncture training. It examines the focus required to keep the path between practitioner and patient clear. The book and appendices contain lots of direct, straightforward, easy-to-read help for you and your business, whether it’s a POCA clinic or not.

The author’s decision to directly address the impediments that keep people in need from accessing acupuncture led to: adoption of a practice model which was then shared with others, establishment of a Co-op to support the system and interested practitioners, and, as of 2014 , an affordable acupuncture school to train future POCA practitioners. The 158 POCA clinics that answered a 2016 survey provided 880,596 treatments. One three-location group sees over 8000 unique patients each year. So far, POCA Tech students have a 100% pass rate on NCCAOM Exam Modules.

All this in less than twenty years.That’s a lot of accomplishments.

Getting the book will be an excellent return on investment. Get the e-book here, the paperback here or here. All proceeds go to POCA Tech.

 

Success is Accessible!

When choosing or upgrading your office there is one consideration that will have a profound impact. Prioritizing it will help you —

  • retain clients for decades
  • appeal to clients who need your services regularly
  • decrease the need to make house calls
  • contract with insurance companies
  • participate in federal programs (such as Veterans Choice and ACA plans)
  • gain respect and referrals from other health care providers
  • keep your office in one location for the duration of your career
  • reduce legal threats
  • minimize workplace injuries to you and your staff
  • comply with civil rights law.

It’s a win, win, win, win, win, win, win,win, win, win.

That consideration is compliance with the Americans with Disabilities Act of 1990 (ADA), a federal civil rights law that prohibits discrimination against individuals with disabilities in every day activities, including medical services. Any private entity that owns, leases or leases to, or operates a place of public accommodation (that includes your office) is responsible for complying with Title III of the ADA. (Source – DOJ/HHS Publication)

19% of the US population reported having a disability in the 2010 census.

If you are blessed with good client retention and a lengthy career your patient population is likely to increasingly include those with disabilities. You might develop your own temporary, or permanent, mobility issues.

Acupuncture schools need to teach students about our responsibilities under the ADA. Ethics classes should address the de facto discrimination that occurs when we choose inaccessible work spaces. And, when practitioners seek advice from peers about potential office arrangements, renovations, or accommodations (such as interpreters) emphasis should be on the legal, ethical, and practical benefits of compliance. Preemptive absolution is offered too often, especially by those who don’t understand the law.

The ADA does include exemptions to protect small businesses from accommodations that would be an “undue burden.” Is a $2,000 lift table an undue burden? How much have you spent on Biomats, lasers, tuning forks, and travel to conferences? Rent for a first floor office might be more, but house calls also affect your bottom line. (If you rely on house calls to comply with the ADA requirements for accessibility, remember: you can’t charge more, you must offer the same level of service, you have to offer flexible scheduling as you would to your in-office clients, and, if you are accepting new clients it is discrimination not to accept those whose disability would make your office inaccessible.)

It’s true, individual practitioners who don’t comply are unlikely to suffer legal consequences and many Practices flourish despite a lack of accessibility.

“Getting away” with not complying is no way to run a business or a health care profession. Doing all we can to meet the needs of those with disabilities is good business, good for the profession, and good for the public. It should be a top priority.

Here are some resources to help you understand the ADA and our responsibilities —

Access to Medical Care for Individuals with Mobility Disabilities

Americans with Disabilities Act Title III Regulations

Title III Highlights

ADA Q & A for Health Care Providers

ADA Checklist for Existing Facilities

ADA and Small Businesses

NPR Story about Accessing Care for People with Disabilities

Post on California Law impacting Lease negotiations

ADA Enforcement Activities

ADA in a Health Care Context

ADA for Deaf and Hard of Hearing

Insurance and Acupuncture 2015- The State of 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.

 

 

9 Reasons why Acupuncture Regulations There Matter Here!

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.)