Petitions, Medicare, and Licensure

Notable news items in the acu-world this week:

1)  We finally got a response to the petition to the White House to add acupuncturists to the list of Medicare providers. My regular readers already knew that a petition to the White House is not going to create the legislative and administrative changes that would be required.  (Newbies, you can use the tag cloud to find previous posts on the petition and Medicare.)  The response has (no surprise) created the usual teeth-gnashing, with acupuncturists (who seem not to have read the response) lamenting that Obama doesn’t like acupuncture, that it’s all about money and power, that we’re doomed,…. The conversation also shows that even among those most strongly advocating for becoming part of the system, there is still significant ignorance about what would be needed to succeed and the consequences for the profession of “success”.  Also not surprising — no response from the AAAOM or NCCAOM who helped distribute the petition — even though they should have known enough to predict the response and had a year to prepare.

2)  The latest Acupuncture Today newsletter included an article on the six states in “licensure limbo.”  I suspect that overzealous regulation on our part (for example, Delaware and Florida requiring extensive herbal credential requirements for acupuncture licensure) contributes to the lack of enthusiasm for a practice act among practitioners.  I also believe that the acupuncture community’s aggressive and disrespectful response to PT Dry Needling and to MD’s and DC’s who do acupuncture is a significant factor in the unwillingness of those communities to support a practice act in those states.  Actions have consequences.

3)  A new “threat” on the horizon — some LAcs on Facebook are up in arms about Tattoo artists who are doing “dry tattooing” for skin rejuvenation.  You know the drill — how dare they, we have so much training, we need to gather the troops to fend off this encroachment. My points — tattoo artists can use needles, they can do cosmetic work (tattooing eyebrows for people with alopecia and tattooing nipples for people who have had breast reconstruction, for example) and they could tattoo someone’s face completely blue if the client wanted it.  Facial rejuvenation acupuncture is typically not taught in acupuncture school. Is there any reason (other than arrogant self-importance) why we believe we should have control over this technique?

I’m still adjusting to the addition of Facebook into my life. I haven’t figured out how to stay informed and involved there without taking the energy and the dialogue away from The Acupuncture Observer.  For those of you on Facebook, like the Observer page and you’ll get breaking news updates between blog posts.

Also, for those of you interested in learning more about navigating the political/regulatory system I’ll be doing a breakout session at POCAfest,  on March 15th in Tucson.  I’d also be happy to come to your state association meeting, conference, or other event. Knowledge is power.

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2017. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

10 thoughts on “Petitions, Medicare, and Licensure

  1. Elaine have you any count on how much $ the acu world has been spent on Medicare lobbying over the past 3 decades? Tried to post this in the other medicare forum but comments were closed.

    • Sorry about the closed comments — there is a lot of spam out there, so I have the blog set to close comments after about 3 months, and that cuts down some of it.

      It would be very hard to quantify. I’m not sure how much activity there was before the past decade, but even then, there is both the money spent, and the time and attention that has been diverted from other issues. It’s also hard to know because the AAAOM has not been transparent with their finances.

      I know that a few years back Frank Brunelli was paid about 60K for his lobbying efforts on behalf of Medicare. I know that money was paid to Beth Clay for her most current round of bill writing for the AAAOM, but I don’t know how much. But then you have things like that Medicare petition of last year — how many people signed it and sent it to colleagues and alerted patients — lots, but how do you measure the cost. It certainly made our profession look ignorant since it was so out of touch with how these decisions get made, and there is a cost to that. And, it leaves those practitioners who got behind the petition jaded and disillusioned and bitter when it goes nowhere, so there is a cost to that.

      The AAAOM recently raised about 28K for their legislative effort, based on their website. At the last “Town Hall” they said they would provide an accounting of how that money was spent, but it’s been more than two months and still no word.

      A related question would be how much has been spent providing other services to LAcs…. I don’t have an answer for that either, but it isn’t much!

  2. Funny, when this petition was circulated and ended up in my inbox from many well-intentioned colleagues imploring me to sign, I did not. I received a couple of follow-up e-mails asking if I had signed yet (made me wonder if they were looking at all the signatures), and I never replied to those inquiries. I’m reminded of the many arguments regarding safety (if performed by a properly trained acupuncturist; in other words, NOT an MD, DC, or PT). I do also recall discussions being made with regards to adverse events in acupuncture were mostly due to the improperly trained practitioner (implying MD, DC). Much to my surprise that I come across a study of adverse events to acupuncture performed in China….
    http://www.who.int/bulletin/volumes/88/12/10-076737/en/

    • Well, it’s a bit off topic from the petition, but I can relate. I see it time and again — a report of acupuncture needle-related harm at the hands of a PT, MD, DC gets widely circulated and referred to time and again as a sign of a terrible problem and reports of acupuncture needle-related harm at the hands of an LAc gets explained away. In the same vein, when someone posted a question on Facebook asking for input on why some patients don’t get better there was a long list of responses looking at the patient side of things — they don’t come often enough, they don’t change their diet, they expect a response too quickly, and so on. Certainly these things happen, and, could it ever be the “fault” of the practitioner. There is an arrogance that is rampant in the profession — we are the experts, our training is superb, we know what is best — it reflects poorly on us and it interferes with real improvement and success. If we took 75% of the energy we spend defending ourselves and attacking others, and spent it on self-improvement, we’d make some real progress.

      • Well, I found that petition to be embarrassing but the suggestion to mandate hypodermics for dry needling made me feel downright ashamed. I had to leave that Facebook group as I found the level of discourse to be let’s just say, discouraging. However, the constant harping on dry needling and vilification of the PT profession made me start looking into what PT’s actually do, and spending more time at their seminars and on their websites and reading their books. My conclusion so far is that while the PTs have their own internecine struggles, as a whole, they are advancing and innovating at an incredible pace. Their incorporation of dry needling is not a cynical ploy to steal our profession as some would characterize it. They are simply grabbing every tool available and pushing in to its limit. There are of course downsides to this and even in the PT profession there are a lot of detractors of dry needling. The PT profession is generally more scrupulous about adapting new techniques and you are less likely to hear statements like “it’s all about intention, it’s all good, etc.” Because they predicate what they do on science and research, there is a move to keep expanding and creating and refining techniques to keep up with new discoveries. They take our old technologies like cupping and gua sha and repackage and reframe these in modern terms. And why shouldn’t they? Our profession certainly isn’t going to do it. We remain mired in the sentiment that acupuncture is almost a sacrament and we are the only priests qualified to administer it. Where is the innovation? Acupuncture Today in my opinion is rife with get rich quick schemes but I can’t think of any genuinely exciting new development in the practice of acupuncture within the last 10 years, besides POCA, but I am referring to technique in this case. I know there are those who maintain we must go back to the classics and that’s the root of our medicine, etc. and forget all this reductionist, scientific stuff. But I think that is what is really at the heart of all this dry needling paranoia and lack of direction, we don’t have a solid core. We buoy our inferiority complex by saying we are the possessors of some ancient esoteric knowledge that science is too limited to understand. Right. The PTs have picked up our stuff, moved on, and are not looking back. In 5 years they will probably have stuff that is undreamed of today, while we will still be wondering how to get included in Medicare. So to those who say, well they can do acupuncture after one weekend training why can’t I do chiropractic/PT after one weekend I say, expand your horizon, stop trying to restrict other professions because it’s not going to work, and start learning what it is they actually do sucessfully. Start taking PT seminars, get up to date on what is actually happening in neuroscience, you will be surprised how much you can actually do.

        • I hope we move into a professional era where some of us revel in going back to the classics and the root of our medicine, and others push forward with all this reductionist, scientific stuff, and it’s OK with everyone. A world where the private acupuncturists have wine (OK, organic) and pizza (OK, gluten-free) with community acupuncturists. Where translate-the-classics types and the intuitive call-in-the-guides types can just enjoy each other with no condescension. That’s my wish for our profession.

  3. Yes, thank you. Our profession has wasted time attacking each other and every other. It only has weakened us. Instead being respectfully organized to stand as one strong, ethical, appropriate, effective profession; the profession has hurt each other, consistently. Respecting each other, our teachers our colleagues, sharing development. It has been painful to experience. Practicing decades; learning decades; this dialectic continues to damage us.

  4. Yes, thank you. Our profession has wasted time attacking each other and every other. It only has weakened us. Instead being respectfully organized to stand as one strong, ethical, appropriate, effective profession; the profession has hurt each other, consistently. It has been painful to experience. Practicing decades; learning decades; this dialectic continues to damage us.

  5. I do think it is good you are out there educating acupuncturists on what is really going on and what it takes to pass laws. Someone needs to tell the truth whether we agree with or not. I do think the work you are doing is important. No one else is painting the picture as it truly is. The schools just want to make money and some will tell you what you want to here. Thanks, for maintaining this blog. It is very important that we all know the truth.

    • You are very welcome Susan. One of these days I will finally get to the post for potential acupuncture students!

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