Tag Archives: scope

Survey, Part Three

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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.

Survey, Part Two

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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?

You Keep Using That Word. I Do Not Think It Means What You Think It Means.

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Scope of Practice. We use the phrase often. However, the term does not, as Inigo Montoyo would say, mean what you think it means.

When a jurisdiction determines that a particular profession should be licensed, it defines a range of activities that it considers to be a part of that profession.That is what we think of as the scope of practice.

For a super-great exploration of scope of practice I strongly, strongly, urge you to read this and this.  Based on these sources, my own experience on a regulatory board, and additional reading and experience —

  1. Scope does not give a profession a monopoly or a copyright. Scopes overlap. Convincing the public that TPDN is acupuncture will not prevent PT’s and other professionals from adding the technique to their scope.
  2. Something does not have to be formally listed within a profession’s scope to be legally used by licensees. It is not necessary to legislatively add Tui Na or herbs to a scope for it to be permissible for qualified practitioners to use those modalities, as long as their scope does not expressly forbid it.
  3. Adding a technique to a formal scope can increase the educational and testing burden on all licensees, not just those who intend to use the technique.  The acupuncturist who has no intention of incorporating herbs into his or her practice, but who can’t obtain a license without also spending years and tens of thousands of dollars studying and obtaining herbal certification is an acupuncturist whose livelihood is unnecessarily threatened with no benefit to the public.

Our superficial understanding of scope of practice leads us into battles that we will ultimately lose, limits our opportunities, and distracts us from efforts that could better serve the profession and the public.  What a shame.