Category Archives: Policy

2013 Review for Acupuncture Professionals

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As 2013 was dawning, the WhiteHouse.gov petition to include acupuncture in Medicare was circulated by the AAAOM, NCCAOM, and loads of school and practitioners. Because coverage is not determined by the executive branch, over 30,000 signatures made no difference. That our professional organizations either didn’t know enough or didn’t care enough to educate acupuncturists about how the system works did give me the final push to create The Acupuncture Observer. From the first post last January through # 49 today, I’ve tried to provide thought-provoking strategic analysis of where we are and where we are headed.

The planned March AAAOM conference on a cruise ship didn’t set sail, making 2013 the second consecutive year without a conference. Things began looking up with April’s announcement that experienced professional Denise Graham was named AAAOM Executive Director.

However, by mid December, Ms. Graham and three Board members had resigned. (Previous ED, Christian Ellis, managed only three months in the fall of 2010.) A majority of the current board members have been appointed rather than elected. Something at the AAAOM smells. The Whistleblower Protection Policy, prepared in conjunction with the Confidentiality Policy adopted in April 2012, never resurfaced after it was pulled by then President Michael Jabbour (who is now managing the “operational transition”). We’ll probably never learn what is really going on in the board room, but 2013 marks the year I gave up hope that the AAAOM could become a viable organization serving the profession. It’s now become a single-interest (Federal legislation) organization, under the control of a small number of people, and without the resources to accomplish its priorities.

Throughout 2013 qualified LAcs were denied licensure by the Delaware Acupuncture Advisory Council’s insistence on the NCCAOM OM credential. New Florida regulations will limit licensure to those with NCCAOM Herb credentials beginning in October 2014, putting another state off limits to many practitioners and greatly increasing educational costs and the regulatory burden for those who intend to practice in those jurisdictions.

Outrage at  P.T. Dry Needling continued throughout the year. Some LAcs made arguments that reflect poorly on our concern for the public, such as suggesting we’d drop our objections if PT’s agree to use hypodermic needles for this technique. Various state associations began efforts to redefine acupuncture and to push for discriminatory insurance policies in response to dry needling and the end of 2013 brought newcomer NCASI (and their lawsuit against Kinetacore) onto the scene.

Late Summer brought proposed policy changes from the NCCAOM that would move the group several steps closer to becoming a regulating rather than credentialing body. In a bit of good news, comments from the profession sent the proposals back to the drawing board.

Over the course of the year growing numbers of practitioners added insurance billing to their practices.  We’ve been quick to throw stones at the billing practices (or rumored practices) of PT’s, yet many acupuncturists offer justifications for questionable practices and few seem clear on the exact nature of their agreements with the insurance companies.

In the waning days of 2013 a job opening for a Licensed Acupuncturist at Brooke Army Medical Center was posted on Facebook. Initial responses cast an interesting light on our profession’s self-regard. There were complaints that the salary (about 70k) was too low, some suggested that a PT would certainly get the job, and others complained about the requirement for a flu shot.

In a few days I’ll be back and begin looking forward. What will serve us in the year of the Wood Horse? When the dragon brings the energy of the spring back to earth, how should the seeds of the profession grow?

The Acupuncture Profession, News and Analysis

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Three dedicated AAAOM Board members and AAAOM (super-qualified, knowledgeable, and committed) Executive Director, Denise Graham (my last hope that things could get better) resigned recently.

One board member spoke of an uncomfortable and increasingly controlled board environment, a declining membership (now less than 2% of the profession), and poor relationships with national and state leaders. Another stated that the AAAOM doesn’t have the support, revenue, or credibility to make progress towards legislative goals.

This isn’t the first time AAAOM has been on the ropes. If it hadn’t been for money from the AAC and support from other organizations, I doubt they would have survived this long. Somehow, though, they still manage to control the conversation.

In other news, NCASI, the National Center for Acupuncture Safety and Integrity, has appeared on the scene. NCASI’s list of “10 Facts” should be titled “10 Things We Insist are True and/or Important.”  Dry Needling by PT’s is legal in many states. Review my past posts on dry needling and scope for more background. We take real risks when we files lawsuits like these.

For twenty years, the acupuncture organizations have insisted that our success depends upon —

  • Increasing credentials/educational requirements/scope. It doesn’t matter if the old education, credentials, and scope worked fine. It doesn’t matter if it increases practitioner expense, decreases practitioner flexibility, or prevents some LAcs from utilizing techniques available to any other citizen.
  • Getting someone else to pay for acupuncture. Fight for third-party payment systems even if other professions report they make good medicine more difficult and practice less enjoyable. Ignore the hypocrisy of participating in a system that requires discounting services while also criticizing LAcs who offer low-cost or discounted treatments directly to patients. Insist that practitioners who don’t want to participate won’t be impacted, and turn a blind eye to the fraud that many practitioners engage in to make the $’s work.
  • Demanding a monopoly.  There’s no need to earn your market share by providing the best product — instead establish it through litigation and turf battles. Don’t worry if this requires you to disparage your fellow health providers or contradict your message that the public should be able to choose their providers.

After twenty years many LAcs struggle to stay in business, and most voluntary acupuncture organizations struggle to survive. Got questions about ADA compliance, insurance billing, privacy issues, advertising questions, disciplinary actions? You won’t get answers from the AAAOM and you probably won’t get them from your state organization.

It’s time to change our strategy. We have enough training, clients who seek our services, and other providers who respect the medicine so much they want use it themselves. Yes, we always need be aware of and informed about the regulatory/legislative landscape, but we also need business skills, PR, positive marketing, and an easing of the regulatory burden.  We need a good hard look at the cost of education. We need legal advice and business tools and positive interactions with potential referral sources and colleagues. We don’t need more legal battles, more regulation, more legislation, more degrees that further divide us.

When our organizations provide these things, we’ll have successful organizations, and successful practitioners. (If you don’t believe me, ask POCA.)

 

Acupuncturists and Medicare, Questions for the AAAOM

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I’m thankful I spend my days helping people. I’m grateful I’m my own boss and that I’m able to treat every client as a unique, complex, individual, not as a diagnostic code. I could write a whole post on what I’m thankful for, but, this coming Sunday, it’s time for another AAAOM Town Hall. There are other things I’d rather be doing the evening of December 1, but I plan to participate, and I hope you will too. So, before we head off to sweet potatoes and cranberry sauce, here are my questions for the AAAOM —

  • Given the current political climate and the current level of involvement from the profession, what are the odds these bills will be successful within the next 5 years.
  • How many LAcs intend to become participating providers in the Federal Health Programs?
  • Does the small number of contributions from practitioners to the AAAOM legislative fund indicate that this effort is not a priority for the community?
  • Given that there are fewer than 30K active licensees in the US, and that not all will participate, could legislative success benefit other professionals who use acupuncture more than it helps LAcs?
  • Do the Medical Acupuncture and the Chiropractor communities support this legislation? Will they participate in the legislative effort?
  • Many LAcs treat Medicare beneficiaries. If acupuncture becomes a covered service won’t LAcs who opt-out lose most of that portion of their clientele to providers choosing to participate?
  • How many LAcs are providing acupuncture via the Medicaid system in the five states that permit it?
  • Is it possible that the opt-out provisions could be stripped as part of the legislative process (related to the small number of potential providers)?  Would the AAAOM be able to stop the legislation if that happened?
  • Can you clarify the distinction between enrolling, participating, and opting in?
  • On page 8 of the FAQ it refers to patients falling into the opt-out exceptions.  Is it providers or patients who opt out?
  • On page 10 of the FAQ it states that the legislation will not require LAcs to use electronic medical records.  Is it true that participating providers will be penalized a percentage of their reimbursements starting in 2015 if they do not use EMR’s?
  • If you opt-in, and the beneficiary reaches the limit for their number of treatments and/or wants treatment for a condition that isn’t covered, are you able to treat them and bill them for those services?
  • If you opt-out could you still treat Medicare beneficiaries who have surpassed their treatment limit without impacting their future benefits?
  • If opting-in, can practitioners limit the number of Medicare beneficiaries they accept as clients?

There are other things the AAAOM could focus on that would be more helpful to the average LAc and be more likely to succeed. But this Town Hall is limited to the AAAOM legislative efforts. I am thankful they are asking for input, and I will oblige.

Happy Thanksgiving everyone — and thanks for reading.

Smart Policy for the Acupuncture Profession

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That’s my agenda —  to help acupuncturists and their affiliated organizations (AAAOM, NCCAOM, ACAOM, state organizations, schools, etc.) explore and analyze policy choices to help identify smart and effective policies and to avoid knee-jerk wild goose chases and unintended consequences.

My agenda is not to overthrow the NCCAOM, undermine the AAAOM, or to create conflict and division.

We are suffering from a professional auto-immune disease. How many subjects have been the greatest threat to the profession? How many LAcs have walked away from professional affiliations disheartened at the amount of energy spent attacking other professions or colleagues? How many of us react with outrage the moment we hear of some challenge, ready to mount an attack before we have all the information?

As acupuncturists, we see the suffering that results from an overactive immune system. Let’s stop making that mistake.

Last month I shared my email to my state association regarding their comments at an Advisory Board meeting. Here is ASVA’s response, and here is my reply. (I include the documents to show how challenging it can be to have non-triggered dialogue on an issue facing the profession. Rest assured, I am grateful to those who serve.)

News Update

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and a bonus at the end —

October 1st, NCCAOM, Facbook —

 NCCAOM has received a significant volume of responses, and the results of this feedback will be taken into consideration during the development of the final policy and standards, as NCCAOM continues to strive for increased customer satisfaction. We are always eager to hear your suggestions for changes that will benefit you, the Diplomate, and the AOM profession overall. It is with your feedback that we can continue to meet your needs.
We are listening!

Spin?

October 2nd, date of scheduled AAAOM Town Hall, AAAOM website —

Legislative Town Hall

CALL POSTPONED – DATE TO BE DETERMINED

No additional news.

October 9th, Richmond, VA, Meeting of Virginia Acupuncture Advisory Board.

Agenda includes discussion of an alternate path to licensure due to conflicts between Virginia law and the NCCAOM proposed policy changes.

The representative from the state association (ASVA) was against any discussion of the NCCAOM issues. ASVA stated  — “lowering of standards…would do harm to both our profession and the public.” Who mentioned lowering standards? Is there evidence that anyone is harmed in states that do not rely on the NCCAOM credential?  Here is my post-meeting email to the association  –  ASVA comments.

The NCCAOM rep at the meeting was clear — the proposals were just proposals, stakeholder comments will be taken into consideration, any language referring to the effective dates of the changes was referring to effective dates for the proposed changes, not the actual changes. I envisioned someone pedaling backwards.

Questions of the Day — We attack when another profession “interferes” with our practice (DVM’s “stealing animal acupuncture”, PT’s “stealing acupuncture”, MD’s wanting to see our patients) even when we have little or no power to change anything. Why are we unwilling to even discuss it when an organization supported by our money, controlling our profession, at our request, takes action that costs us or limits us? We made a difference this time (we hope) – why aren’t our professional associations helping?

Here is a new page on Legislation and Regulation. It contains important and valuable information. Please, read it and pass it on.

I’ll be working on a page about the Acupuncture orgs (the alphabets) and another for potential acupuncture students in the coming weeks.

Control

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Who determines your professional future? First, read An Example of one person, wearing two hats, limiting opportunities for LAcs. (He’s received honors for the work he’s done.)

We have one week to comment on the NCCAOM’s “proposed” policy changes. Do that here. Some of us think these changes are wise, some of us wouldn’t be personally impacted. We all should participate in the conversation. Ask your professional communities to comment. (You can see the NCCAOM’s response to my initial comments here.)

My follow-up comments are below. The NCCAOM is the most powerful organization in our profession. I have seen them, with our help, control regulation (or essentially subvert it) and legislation. Our interests may overlap, but don’t think your future is their primary concern.

Dear NCCAOM and Ms. Basore,

Thank you for your response regarding the proposed policy changes.  Here are some additional questions and comments.

  1. You wrote “The Criminal Background Screening Program for new applicants will not take effect until January 2014.” Has the final decision to implement these policies been made?
  2. The Criminal Background Check and language requirements go beyond your mission as a “national organization that validates entry-level competency.” These policies usurp the role of state regulatory boards. (For example, Virginia exempts those serving certain communities from our language requirements.)
  3. Many states use the NCCAOM exams but do not require the NCCAOM credential. Establishing background checks and language requirements as part of the testing application circumvents those states’ specific desire to maintain an independent credentialing process.
  4. How many students responded to the assessment regarding the foreign language exams and what were their responses? Please define the demand “sufficient to offer a psychometrically valid defensible examination.”
  5. Is it significant to an applicant if the background check fee goes to the NCCAOM or to a third party? Could NCCAOM staff involvement ultimately increase exam costs?
  6. Can you describe the criminal background check appeals process? Would the NCCAOM risk legal liability if applicants were allowed to sit the exam upon appeal?
  7. Is there any documented case of harm from practitioners who had a criminal history at the time of sitting the exams?
  8. If public protection is the justification for requiring the background check prior to examination, should it be required prior to school admittance? This would protect individuals from making a huge investment in a career they will ultimately be unable to practice.
  9. Could the recertification process be simplified by trusting Diplomates to use their best judgment regarding continuing education?  Has there been any documented patient harm as a result of unreviewed or unmonitored continuing education?

 

I believe that for much of the past twenty years the NCCAOM has provided a net benefit to the profession while honoring its commitment to the public welfare.  More recently the NCCAOM has repeatedly acted out of self-interest, choosing control over the profession and the attendant financial rewards ahead of either the profession or the public. Your push for the full OM credential as a requirement for licensure in DE is a prime example of action that served the NCCAOM at the expense of all others. The stakeholder comment you request is routinely disregarded.

Re-consider these proposals. Acupuncture practitioners have an incredible record of safety. The imposition of additional de facto regulation is unnecessary and burdensome.

Sincerely,

Elaine Wolf Komarow, LAc (VA)

NCCAOM Diplomate (Ac)

A Very Important Question

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Dear NCCAOM,

Will feedback received influence your proposed(?) policy changes?  Ms. Basore’s comments to my previous post indicate the changes are a done deal. Please let the readers of The Acupuncture Observer know so that we can effectively use our qi.

Thank You.

Dear Readers,

I’ll send my many questions and comments about the policy changes to the NCCAOM (and post them here) if our input matters.  In the meantime, please  —

  • Contact NCCAOM via Facebook to weigh in on the proposed(?) changes. (Are they listening?)
  • Contact AAAOM via Facebook to share your thoughts on the NCCAOM’s proposed(?) changes.
  • Respond to the AAAOM’s latest Call for Comments (deadline September 19th), and let them know if you think they should be focusing on the proposed(?) changes.
  • Contact your state professional association to point out that the proposed(?) changes interfere with the state regulation of acupuncture and ask them to get involved.
  • Ask your state association to raise this topic with the Council of State Associations. (There doesn’t seem to be any way for the average professional to contact that group directly.)

That’s a good start while we wait to hear back from the NCCAOM. Oh, and spread the word!

P.S.:  Here’s a story about background checks.  Keep in mind, in the NCCAOM’s proposal, the poor applicant wouldn’t even be allowed to sit the exams.

Proposed(?) NCCAOM Changes

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September 30th is the deadline to submit feedback on the NCCAOM’s proposed(?) policy changes.  These changes will impact the profession and may impact you. Don’t be taken by surprise and don’t let the profession change without your input. Weigh in! (Why the question mark after the word proposed? Because according to the latest NCCAOM spotlight, the criminal background check is already in effect.)

There are Four Proposed(?) Policy Changes.  As you prepare your feedback you will benefit from reading the NCCAOM’s Summer Newsletter for information on the NCCAOM’s role in the profession (which I will write more about soon) and for details of the proposed(?) criminal background check policy.

Here is my input to the NCCAOM (my email bounced back, so I’m sending via snail mail) —

As an NCCAOM Diplomate in Acupuncture, a member of the Virginia Advisory Board on Acupuncture, and a past board member of the Acupuncture Society of Virginia and the AAAOM, I share the following input on your proposed policy changes (which reflect my personal views and not the opinion of any board or organization)….

1)      The public and the profession would benefit from requiring a reasonable degree of English proficiency of NCCAOM Diplomates.  This goal is best met by requiring an intermediate score on the TOEFL or by other documentation of proficiency.  The NCCAOM should continue to offer the credentialing exams in other languages.  Many experts in this medicine were educated and trained in foreign languages.  Many great scholarly works are not available in English and much is lost in translation. Continuing foreign language testing, while requiring documentation of English proficiency would ensure that NCCAOM Diplomates can communicate effectively with regulatory boards and the public, while also allowing the study of the medicine in the language which best serves the practitioner.

(Since writing this I realized that all of the language requirements fall outside the NCCAOM’s mission of determining competency. Language requirements should be left to the states.)

2)      Based on the Summer NCCAOM News, input regarding criminal background checks for applicants is being requested after the policy change has been implemented. That is unfortunate.  Reporting that the “appropriate” staff will review each case is not helpful.  Who is the staff and what is their training?  Is this policy change in response to specific failings of the current credentialing and licensing process, or is it a preemptive jump on the bandwagon? In the absence of evidence that harm has occurred that would have been avoided had the policy been in place it is unnecessarily invasive and potentially discriminatory and should not be implemented.

3)      The PDA Provider Categories policy changes, especially the changes that seem to have been already established for 2015, will be detrimental to the profession and the public. While many professions trust licensees to obtain CEU’s useful to the needs of the practitioner, the NCCAOM’s increasingly restrictive policies seem designed to benefit only the coffers of the NCCAOM.  I have not found NCCAOM PDA providers to offer a higher caliber of class or to provide the range of classes that would be most useful to my practice.  I resent the degree of control the NCCAOM has over my continuing education through these changes and the hidden “tax” you will receive from every PDA point I earn.

These proposed changes contribute to my increasingly strong opinion that states should move away from requiring ongoing Diplomate status. (Since writing this I realized that because these policy changes impact who can sit the exams, getting away from the NCCAOM ongoing credentialing won’t address the issue.  Until the NCCAOM ceases the standard inflation that has begun to feel like a shakedown, I’ll support states developing an alternate path to licensure that doesn’t depend upon the NCCAOM.)  While I see the benefit in establishing a minimal level of education through the NCCAOM exams, your proposed policy changes work against the diversity that is an important part of Asian Medicine. Tightening the stranglehold on acupuncturists benefits neither the profession nor the public as increasing numbers seek our services.

Sincerely,

Elaine Wolf Komarow, LAc, NCCAOM 005020

If I Had 3 Million Dollars

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I would buy you all a boat.

Just kidding.

I would —

  • Compile and make available a list of the specific requirements necessary to obtain an acupuncture license in each state, making sure to highlight current and oncoming obstacles. (For example, as of October 1, 2014, Florida will require passage of the NCCAOM Oriental Medicine Module for licensure. Although the Florida rules will continue to show that those enrolled in school prior to August 1, 2007 need complete only a two-year course of study which does not need to include herbs, the new examination requirement means that no one with only the two-year education will be able to obtain a Florida license.)
  • Compile data on the professional success of acupuncture graduates of every US school. The data would be available to all.
  • Explore why those who aren’t practicing have left the profession and whether there are different rates of success among graduates of different schools. If there is a difference in graduate success, are there factors common to the more successful schools?
  • Gather data on the safety record of acupuncturists in various states. Does it matter if the state requires NCCAOM exams or credentials? In acupuncture? In herbs? If the states require graduation from ACAOM schools?
  • Use the data to identify the lowest common denominator. Identify the least restrictive education/credentialing necessary to ensure public safety and prepare practitioners for success.
  • Show how uniform and non-burdensome state standards are a critical step in providing acupuncture to the 313.9 million people in the US. Build consensus for reasonable minimum standards, and work for their adoption in all states.
  • Establish a team of public policy professionals with expertise in regulation and legislation to help develop a set of attainable and effective strategic initiatives.

Where would I get my 3 million dollars? Not by yet another “now is the time, we must submit legislation that mandates access to the federal healthcare system” fundraising effort. We’ve heard this before. We should know by now that submitting legislation is guaranteed to suck up resources, it is passing laws that can make a difference – if we’re prepared for the consequences of success.

Please, respond to the AAAOM’s call for comments by August 31st. With, at best, 30,000 acupuncturists available to 313.9 million people, is submitting legislation which has a snowball’s chance in hell of passage really the best use of 3 million dollars?

And, if you really want to do something that will improve access, ten minutes and two stamps will do it – here’s how.