Insurance, Again. The s**t got real.

Photos of an acupuncturist in a prison jumpsuit, bond reduced to $455,000, facing charges of racketeering, insurance fraud, engaging in an organized scheme to defraud, patient brokering, and unlawfully waiving copays and deductibles. It’s bad for the profession.

It’s worse when the acupuncturist taught insurance billing seminars.

Whether or not she is ultimately found innocent, I’m sure none of us want to be in her shoes. Let’s learn what we can from the case, and from the discussions about it happening on social media and elsewhere.

(Here are additional stories about the case: Indian River Meeting MinutesMarch 2017August 24, IRC MemoFlorida CFO, September 13)

My takeaways –

  • There are wonderful, respected, kind, people who engage in criminal activity. Encomiums about the accused show us humans aren’t one-dimensional, but are irrelevant to guilt or innocence.
  • Insurance billing is no game, despite books, seminars, and conversations presenting it as one.
  • As a profession (the community acupuncture folks being the main exception), we haven’t accepted the conflict between wanting people to get as many acupuncture treatments as we think appropriate/they desire, earning what we “deserve”, practicing in our preferred style, and the overall health care economy. We grabbed insurance as the savior. It isn’t.
  • It is easy to rationalize wrongdoing. Practitioners justify creative billing to help their clients or counteract an unfair system. That’s bad for our profession, personally risky, and, because “insurance money” comes from people buying insurance, ultimately costly to anyone buying insurance.  If a plan doesn’t cover acupuncture for depression, explaining that to your clients, and giving them a discount if you’d like, is honest. Believing that the insurance company is forcing you to figure out a way to “treat them for pain so it gets covered” is dishonest.
  • If you want to advocate for better coverage, be prepared with data to show the economic benefits. Do you want your premiums to cover other non-medically necessary choices? Who should decide?
  • We need to be honest when discussing the efficacy and cost of acupuncture. Many practice websites, and much of our lobbying for increased coverage, refer to a course of treatment of eight to twelve visits. If an average of almost forty treatments/year, as in this case, is appropriate “for today’s complex patients” (as many commenters stated) we need to own that. If it varies based on condition (of course it does), let’s make sure we let patients and insurance companies know. If you are treating for a complex condition, but code for a simple one to facilitate reimbursement, you’re skewing the data about acupuncture efficacy.
  • There are lots of acupuncturists eager to give definitive answers to questions outside their area of expertise. Having a successful insurance-based business does not make one an expert on insurance law.
  • Our burdensome systems for approving CEU/PDA classes don’t provide quality control.
  • Having demanded entry to the system, we owe it to ourselves (as consumers and providers) to speak up when we see wrongdoing. We need to acknowledge that our colleagues who review charts and advise insurance companies are necessary if we are going to be part of the system. It’s a bad sign when those within the profession who work to protect the consumer are dismissed as the enemy. The insurance companies will find problems even without our participation.
  • Context is important when determining legality. Patterns of individually legal actions (in this case, waiving co-pays was permissible) can add up to illegal activity.

Here’s more on Health Care Fraud – from an investigator.

Being a health care provider is serious business. Participating in the insurance system is serious business. Let’s be careful out there.

 

 

 

The NCCAOM Replies

In early August I received a comment from Mina Larson of the NCCAOM in response to A Feature or a Bug. I approved it, replied, and now, with a bit more time, will give it a closer look.

I always encourage those who disagree with my posts to share their thoughts in the comments. I moderate to limit rudeness, screeds, and ad hominem attacks, not viewpoints. I’ll run guest posts, though I admit I’m more enthusiastic when the guest is a voice that doesn’t already have access to various other megaphones.

As I wrote in About Me,

” I continue to do my best to serve the profession and the public by encouraging a deeper exploration of the professional choices we are making. This blog is an effort to provide a forum for the dialogue necessary for our success.

All of my writing for The Acupuncture Observer reflects my own opinion.  I do not speak for any organization or board and am not representing any group here. I apologize in advance for any mistakes. Please let me know of any errors so that they can be corrected.”

Now, Mina’s comment (in italics), and my responses:

Elaine, it is very disappointing and alarming that you do not share with your group the many times I have communicated with you, informed you and updated you on updates on and rationale for proposed and new policy decisions – even our decision to not move forward proposed policies when we received input from our Diplomates (you were one of them) regarding a PDA and eligibility proposed policies a few years back. You also conveniently forgot to mention the fact that we delayed our linear testing (that we have to do to stay complaint with adaptive testing) and pre-grad elimination (also to stay compliant [sic] for our accreditation) based on stakeholder input. Please see NCCAOM Student Webinar: http://www.nccaom.org/nccaom-webinars-posted/student-webinars/

 

Mina, I have been unclear on whether all of our discussions are “on the record.” In several cases I have not shared our communications as I was unsure what was official NCCAOM policy. I’ll do better in this regard in the future. In many cases our discussions have not changed my assessment of the situation. Some of our talks were a factor in my feeling that the NCCAOM talks out of both sides of their mouth. I did not “forget to mention” to the times the NCCAOM has changed or delayed changes in response to input, I specifically refer to it. I even include a link to the announcement of the delay in linear testing, as well as an additional post (June 5th) reporting on some changes.

You continue to also bring up the NCCAOM testimony in Utah, in which I have provided information about our Chinese Herbology exam and requirements upon request by the Utah Advisory Board of Acupuncture. We testify at state hearings upon request from state regulatory boards and state associations to provide information about our standards and our exams. That is what credentialing organizations do! The herbal exam is one of our requirements for OM Certification and if you listen to the testimony at the Utah hearing, we provided information. We did not “side” with any group during that meeting. I had several meetings with groups opposed to and for the CH exam. We do not “pick and chose” what hearings we should go to – we are there to provide information about our standards and exams and to support our Diplomates in that state. How do you think there are now 47 states that have a practice act for acupuncture? We have been involved with helping a majority of these states to develop a practice act. How convenient you leave this info out.

I included a link to the entire testimony in the post about Utah. In that post, I include a link to a letter (UtahNCCAOMletter), distributed under the NCCAOM’s auspices and letterhead, showing that the NCCAOM supported the position of the state association and regulatory board to require the herbal testing. Although, in discussion, you told me that the letter was a mistake, the NCCAOM has not done anything to correct record. If the profession is confused about the NCCAOM’s position, that is on the NCCAOM. You and I went through that post word for word. In the end, the only place you could quibble with my writing was that my statement that the NCCAOM was unwilling to reconsider the hourly requirements for sitting the test did not include your position that that change was not within the NCCAOM’s purview.

In the interest of space, every post leaves out all sorts of history. Overall, I have often expressed my appreciation for the hard work of the NCCAOM.

Yet some people want to blame the NCCAOM for any problems with the profession. They want to point out that we moved to DC from Florida, but leave out the fact that not one dollar was spent on “moving employees”. Any employee who moved to the DC area from Florida, paid their own expenses. It is very disturbing to see people making false assumptions and publish information that is not validated. We did not invest, lease or buy headquarters, in fact, we are sharing our space with other associations in DC so that we can give those funds back to our Diplomates through our advocacy and PR work for promoting them and our profession.

I can’t be held responsible for what “some people” think. I have often defended the NCCAOM. I have not concerned myself for one second about where you are moving and how much it is costing. It’s an insignificant issue in my book. The NCCAOM has a MONTHLY column in Acupuncture Today, and the ability to mail or email every single Diplomate in the US. If you can’t make your case to “some people” I hardly think I’m responsible.

Now the gossip continues by assumptions that we go out and testify on selected issues, when what we do and have always done is testify and provide support to state associations who need our help or regulatory boards who request our input on NCCAOM standards. How come you do not speak of the many times we have traveled to states to provide information to advance the profession and our work with the Bureau of Labor Statistics and the VA? You and others on this blog choose to ignore the information on our website and focus on assumptions.

I have often reported on the work of the NCCAOM in various states. Your work is widely reported in AT and in your news alerts. There is no need for me to cover it extensively, though I do cover it. I link to the NCCAOM website and publications regularly.

You seem to leave those details out! How come you publish our 990s but forget to reveal that Kory, I and other NCCAOM dedicated employees work around the clock to help our Diplomates? You even have my cell phone number and I have taken your calls weekends, nights, holiday, but you are on a mission to discredit the NCCAOM because there needs to be someone to blame for issues in the profession. Anyone can also take a look at our annual report on our website with our financial statements. In fact, if you were to look at the data from the last couple of years, you will see a deficit as we have invested to give back to the profession. If you want evidence, just contact associations in Kansas, Wyoming and others who received practice acts last year as well as associations like FSOMA whom we have helped over the years, just to name a few.

I don’t leave those details out. I am glad for your hard work, and have said so many times. I appreciate your willingness to communicate. The 990’s and annual report stand for themselves.

In is also interesting that you have also left out the PR and advocacy work that the NCCAOM has accomplished (please go to http://www.nccaom.org for this information) to advance the profession. I have learned in my 15 years of serving this profession, there are some amazing people that make a difference by collaboration, selflessness and hard work and some who will continue to point fingers, have agendas, and cause needless disruption at a time when we need to unify to strengthen our medicine and the profession.

I haven’t left any of this out. I agree that there are many people working hard to strengthen the profession. I too, have worked selflessly on boards, with associations, to increase collaboration and unity. My goal is never “needless disruption” and I am sad that you seem to believe that is what I am doing.

Many of us have worked to build a better profession. And, honestly, much has been done that has not served us well. We have created fault lines, left qualified practitioners with limited options (requiring the herbal exam of all practitioners is one example), and selected winners and losers among the varied lineages behind this medicine. My efforts have always been to help us learn from our past and from the experiences of other professions, so that we protect the public without unnecessarily limiting freedom to practice and without putting additional burdens on professionals who are struggling for success.

It’s too bad that within this medicine, which looks for balance and harmony, we have so much trouble negotiating our differences.

Ethical Questions

Our future requires a willingness to explore beyond our quick conclusions of what is “right” and what is “wrong.” How do we proceed when two “rights” are in conflict with each other, or when a good end might depend upon a questionable means (or vice versa)?

Providing safe, effective, and accessible treatment to everyone who wants/needs treatment while also supporting ourselves and our families requires us to face various ethical quandaries. Many ethics classes are short on teaching principles to guide ethical decision-making and are long on lists of rules like “don’t have sex with your patients.”

Marilyn Allen’s recent column on ethics demands our attention. She’s had a significant role in shaping the acupuncture profession, and she teaches ethics. She has power.

The column focused on a discussion about “gainful employment” that has since been removed from the AAAOM practitioner forum.

The forum included colleagues sharing concerns about their debt, and upset at schools that exaggerated the future acupuncture job market while glossing over the skills and financial backing needed for success.

Ms. Allen (who has given considerable funding to the AAAOM over the years) is angry that this discussion was permitted. She insists that it is in the best interest of the profession, and our future colleagues, to keep concerns to ourselves. Even a shared conversation in a practitioner forum is too risky. We “should have shown support for the schools,” she writes.

Ms. Allen proposes the Rotary’s Four-Way test in her column. It’s not my preferred guideline for ethical decision-making, but since she refers to it I’ll use it —

 

1) Is it true? Many graduates of acupuncture schools do struggle to pay off debt. Schools did use misleading data in promotional materials, leading to unrealistic career expectations. The proposed Gainful Employment regulations did raise concerns about acupuncture programs. The forum topic is no longer present to allow for a complete fact check, but my assessment is that much of the content was true.

2) Is it fair to all concerned? What do we mean by “fair.” Who is “all concerned?” And what is “it?” I could write a post on each question. When a topic is being explored by many people, in many settings, does each contribution need to reflect the views and feelings of each stakeholder? Is it unfair to share our personal experiences and opinions about a system in which we have little power and bear the consequences? Is it fair for a membership association to solicit the opinions of its members? My assessment – it was fair for the AAAOM to provide a forum and for practitioners to use it.

3) Will it build goodwill and better friendships? Humans do better when we know we are not alone. Sharing our concerns and our experiences is a way to build community and friendships, which support us in our sometimes isolated professional life. Knowing that other regulated fields share these concerns can also help build goodwill and understanding. If we feel that a friend (or, in this case, a system) is taking advantage of us, does it strengthen the friendship and build goodwill if we speak up, or stay quiet and suffer? Yes, the discussion had the potential to build friendships and goodwill. Ms. Allen’s column, by advocating denial and repression, does not.

4) Will it be beneficial to all concerned? My list of people who would benefit from the conversation, even if it escaped the private forum: current debt holders who feel alone and unheard, schools who care whether graduates are satisfied, potential students who may not have fully explored the economics of entering their dream career, and taxpayers who may not want to subsidize ineffective programs. The discussion isn’t beneficial for the schools that want to keep raking in loan money while avoiding responsibility. Should we be censored for their benefit?

Ms. Allen writes “It is sad when you read an article about the profession that contains negativity coming from inside the profession. Essentially, this is giving the other professions (those looking to treat acupuncture patients) the ammunition they need to diminish acupuncture and attain their own goals.

I say, it’s sad when those with the power to change things for the better instead advocate for a flawed status quo. It’s a danger sign when secrecy is demanded for the good of the group. The Catholic Church and the Penn State Football program are examples of the moral failure that comes with that argument.

Thank goodness we’re dealing with finances and not child abuse. Nonetheless, shutting down conversation and preaching secrecy is neither ethical nor effective. If Ms. Allen wants to uphold acupuncture as the place “where hope and healing meet” then we need to delve into our challenges, not hide them.

 

 

Dry Needling and Acupuncture 2015 – The State of the Profession

Dry Needling wins again – it receives “the greatest threat to the profession” practitioner’s choice award.

In recent years, Acupuncturists have devoted more resources to this issue than to any other.

A (fairly accurate) review of legal and regulatory actions shows that we’re not having much success. (Here’s another review, APTA’s Dry Needling Resource Paper.)

Even our wins have been temporary. For example –

– the Georgia Acupuncture Board added language stating that Dry Needling is acupuncture. The PT’s then added Dry Needling to their scope via legislation. (Could Georgia PT’s now advertise they’re doing acupuncture?)

– the October 2014 ruling in Washington State against dry needling was widely celebrated. Now the PT’s have introduced bills which would add Dry Needling to their scope. With almost 5,000 PT’s in the state, and about 1,100 LAcs, it’s likely they’ll eventually succeed.

We say the PT’s:

  • are stealing our medicine! (But we don’t own it.)
  • are illegally expanding their scope. (The majority of states have ruled it is in the PT scope. Modifications to scope are common in health care.)
  • are using Regulation to do what should be done Legislatively. (Scope clarification is often done via Regulation, which gives the public and other professionals the opportunity to weigh in and is preferable to politically driven legislative action. The public is protected through regulation. The PT’s have been successful in passing Legislation allowing dry needling.)
  • are pursuing this because their own techniques don’t work. (Even if true, 1) why does that matter, and 2) does the argument apply to us when we add techniques lasers, essential oils, e-stim, herbs –  to our scope?)
  • can’t possibly know enough to do this technique safely. (Many clearly do.)
  • can’t possibly be providing good treatments. (Their patients disagree.)
  • wrongly say that dry needling isn’t acupuncture. (Is it better if they say it is? Is there a legal reason our definition should prevail?)
  • make the public fear acupuncture. (Insisting this technique is acupuncture will contribute to the problem. Don’t we have the same problem when we use the technique?)
  • should use hypodermic needles. (Does that show concern for public safety?)

We can continue the fight to stop dry needling – getting caught in the cycle of suit (complaint) (never-mind the SCOTUS ruling) and counter-suit (NC PT lawsuit). We can fight state by state, and attack any Acupuncturist who suggests anything other than “the PT’s must be stopped.” We can keep insisting that if we just devote more resources and fight harder, we’ll win.

Or, we can learn from our history and the history of all of the other professions that have fought to maintain a monopoly on technique or turf.

We could be fighting for strong regulations. Mandated adverse effect reporting, strict definitions of what dry needling is and what it isn’t (other than whether or not it is acupuncture), requiring direct supervision for all clinical hours, requiring PT’s to post their hours of training, requiring registration with the PT Board, requiring physician referral for dry needling – all of these are possible.

A PR campaign promoting acupuncture and helping the public find an Acupuncturist? That’s possible too. Supporting ease of licensure so that people in every state can find an LAc? We can work for that. Support for new practitioners so that the public can actually find an Acupuncturist? That’s a great goal. Building collaborative relationships with other professionals who want to decrease pain and suffering? That would serve everyone.

Putting our energy into stopping dry needling? Not so much. It’s our obsession with stopping dry needling that is the greatest threat to the profession.

 

 

Acupuncture Licensing and Regulation – The Future

Imagine that your acupuncture license meant you could easily practice in every state.

Imagine that licensure exams focused on the skills and knowledge needed to practice safely.

Imagine that acupuncture schools used the time spent teaching things “you won’t need in practice but they’ll be on the exam” to teach things that you really will need in practice, including all that business stuff.

Imagine that acupuncture boards, associations, and organizations worked to make it easier and less expensive for practitioners to obtain and maintain licenses and practice within their skill set.

I wish I could say “it’s easy if you try” – but for most of us it isn’t. (Unless you look to other professions.)

The Florida Acupuncture Board now requires all new practitioners to spend thousands of hours and tens of thousands of dollars on additional education and testing to become Board-certified in herbs. Even though there was no evidence of public harm under the previous rules, and even for those who won’t use herbs in practice.

The Nevada Board is trying to change the regulations to require a DOM or DAOM of all applicants (about 40K on top of an 80K MAOM). Not because there is evidence of public harm, but because that’s the way it is in China. And never mind that the entire state is served by fewer than 50 acupuncturists.

In July 2015 the White House released Occupational Licensing: A Framework for Policymakers. While acknowledging that licensing can provide health and safety protections to consumers and benefits to workers, it concludes,

“State legislators and policymakers should adopt institutional reforms that promote a more careful and individualized approach to occupational regulation that takes into account its costs and benefits, and harmonizes requirements across States. If they are successful, the collective effect of their efforts could be substantial: making it easier for qualified workers to find jobs and move where they choose, increasing access to essential goods and services, and lessening heavy burdens on certain populations….”

Acupuncturists are the policymakers in our profession. Wouldn’t it be great to determine what’s truly needed for public safety and to adjust educational and licensing requirements accordingly? Rather than blaming others for our difficulties, wouldn’t it be more productive to direct our energy to changing the things we can control? We can demand that the insurance companies pay us more because our education cost so much, or we can make our education less costly. We can sue the PT Boards to try and protect our turf, or we can make sure that anyone who wants acupuncture is able to access convenient and affordable services from an acupuncturist.

I’ll be sharing actions you can take to change our practice environment for the better. Like the Acupuncture Regulation US page on Facebook and stay tuned in here, at The Acupuncture Observer, for updates.

 

 

 

Acupuncture Safety, and, a Matter of Fairness

Protecting the public safety is a good reason for regulation.

People have been injured by PT’s or Chiropractors doing dry needling.  When we see a story about that we share it. So I understand the comments on the previous post.

And, there were two recent threads on Facebook that caught my attention.

An LAc posted a question about whether it was possible to cause an infection by needling CO4. He’d treated a patient who later developed redness at the area. The patient visited an MD and was prescribed an antibiotic. I was surprised at the practitioner’s question, and surprised and mortified at the responses.  Which included: The MD is just trying to cover his ass, they just like to prescribe antibiotics, not if you used sterile needles, not if you used an alcohol swab on the area first, people freak out all the time, etc. A day or two later, the initial questioner reported that the patient was now hospitalized with a staph infection.

Another LAc wrote that a patient reported she’d had a pneumothorax from a treatment and was now asking for financial compensation for a portion of the medical expenses and several weeks of missed work. What should the practitioner do? Of course, getting some documentation makes sense, but the responses also included: if it really happened why doesn’t the patient have a lawyer, if you’d given her a pneumothorax you would have known it immediately, she must have had some sort of underlying medical condition so you aren’t responsible, etc.

Personally, I know some amazing practitioners who have firsthand experience with pneumothorax(i?) on both ends of the needle.

I don’t believe we have sufficient record keeping to know the relative safety records.  Dry Needling does involve a deep and aggressive needle technique and so is more likely to do damage.  That’s true even with an LAc holding the needle.

When a story comes out that involves harm done by an LAc, we make all sorts of excuses and focus on our generally good safety record. When we find out about damage done by a PT or DC, we trumpet the news, and make smug and superior comments.

When it comes to fairness, most of the things I hear LAcs complaining about are either self-inflicted or, sometimes, imagined.  The length of our training — we’ve been behind the increase. The differing insurance reimbursement — is that insurance thing working out for anyone?

This post is mostly blogger’s prerogative to give what is really a comment on the previous thread a higher visibility.  I won’t make a habit of it.  But hwds’ are one of my pet peeves — that’s hypocrites with double standards, and when our response to what happens at the pointy end of the needle seems to vary so much depending on who is at the handle, I think that term applies.

 

 

17 Foundational Beliefs of The Acupuncture Observer

Embracing the season of gratitude and thanks, it’s time for The Acupuncture Observer to take a step back and share some of her foundational beliefs about the medicine, the profession, and life.

  1. Acupuncture/OM works. The unique situation of the patient and the unique skills of the provider influence effectiveness. No single tradition provides all of the answers or benefits.
  2. Acupuncture/OM has fewer negative side effects and risks than conventional treatment for many conditions.
  3. Access is a necessary precursor to effective treatment.
  4. Effective treatment will increase wellbeing and could decrease health care costs.
  5. Every means to increase access carries trade-offs. Those trade-offs must be understood as we determine our path forward. We should learn from the experiences of other professions.
  6. Understanding and explaining the mechanism of acupuncture from the knowledge base of modern biology and physiology is useful and interesting, but is not necessary for acceptance by the medical establishment.
  7. The current “science-based” understanding of health is known to be limited. Insisting that Acupuncture/OM be taught, thought of, or explored only in the language of modern medicine/science is unscientific and risks centuries of experience and wisdom.
  8. Consumers should have significant freedom of choice in health care. Understandable and clear information about potential benefits and risks, as well as an exploration of the costs (financial and otherwise) is necessary for good decision-making.
  9. Self-serving thinking leads to hypocrisy. Special attention is needed when an argument for patient protection creates an economic benefit for particular providers.
  10. Simple, easily learned treatments can be effective and safe.
  11. There is the potential for growth and success within the acupuncture/OM profession.
  12. Many acupuncture programs do not provide sufficient or accurate information about post-graduation life and do a poor job of teaching business skills. This can be changed easily and inexpensively.
  13. The financial and karmic ROI (Return on Investment) of positively promoting our profession is superior to that of engaging in political/regulatory battles with others.
  14. The future of the medicine and of the profession are interconnected but not identical.
  15. Thoughtful and respectful analysis can identify areas of common ground.
  16. Focusing on areas of common ground decreases factionalism, and builds unity, understanding, and participation.
  17. The profession lacks venues for respectful dialogue on these issues. As a result, many scholars and potential leaders within the profession avoid involvement.

Do we agree on some of these? Can respectful dialogue increase the areas of agreement? What if we read the Tao Te Ching, the I Ching, and The Art of War first? What if we go deeper than our Wei level response to some of these issues? I believe it is possible that we’ll be able to find a new path forward, one we can walk together, with our hair flowing free. After all, I’m an acupuncturist.

Talking about our Education

“We have over (2000 hours, 4000 hours, 3 years, 4 years) of education and they want to do acupuncture with (a weekend, less than ten, 200 hours) of training!The public is in danger.”

“The (PT’s, Chiropractors, MD’s) doing acupuncture are significantly undertrained! If they want to do acupuncture they need to go to acupuncture school, or at least take (400, 500,1000) hours of training.”

It’s a no brainer, right? But ….

1) We are comparing our total professional education to additional post-professional-degree hours.

An MSAOM curriculum includes: Biochemistry, Introduction to Organic Chemistry, Anatomy and Physiology, Microbiology, Introduction to Western Pathology, and a Survey of Western Clinic Sciences (3 semesters). M.D.’s have already covered these classes in their education.

2) Does the aspect of “our” medicine they want to use require a full TCM education?

Is Tai Qi, Qi Gong, Introduction to Botany, 40 credits of herbal medicine, a semester of auricular acupuncture and 3 semesters of point location needed for a PT to safely use a needle to release a trigger point? (If you insist they learn all of that, won’t they then argue that they can also do auricular acupuncture and distal points?)

3) How well-educated are most acupuncture school graduates? How worthwhile was most of their time spent in school?

ACAOM standards were based on the programs that existed at the time credentials were being established. They were not based on a careful analysis of what was needed to train safe, effective, successful practitioners. Acupuncture related Facebook groups include posts asking about using moxa to turn breech babies, how to treat TMJ (no pulse, tongue, or presentation information provided), and recommendations for treating people undergoing chemotherapy. With our thousands of hours of training, shouldn’t we know the answers to these questions? (Or have a better source than Facebook for answers?)

4) Is there a correlation between the length of a program and the quality of the graduates? Were the early U.S. practitioners (many of whom had less than 1300 hours of training) harming the public?

It is an article of faith in the acupuncture community — our training of X hours is necessary for safety, and anything less is an affront and a danger. Yet a colleague recently wrote “I am at a medical acupuncture conference. Exceeding my expectation. The presenters know their stuff. Lots of depth…. I am going to find out about their training. Maybe they are a special group….what i am seeing here meets any high standards TCM conference…. Very surprised.”

The more (as defined by us) = better has done us no favors. The numbers we fight for are arbitrary. The argument is easily refuted by other providers. Adopting it within our profession has increased the business strangling debt-burden new grads carry. And created internal divisions which only further harm our growth. (How long before a state (or the NCCAOM) demands the FPD to become an LAc?)

Please, let’s let the knee-jerk “less is dangerous, more is better” argument go.

Licensure News

Finally! At the May 6th Delaware Board of Medicine meeting two experienced and NCCAOM-credentialed acupuncturists were granted Delaware licenses, bringing the number of the LAcs in the state to just under forty. This is good news for the people of Delaware. It is also good news for the profession as whole. And hopeful news for the practitioners who are now commuting to Maryland, or not practicing, because they were unable to obtain a Delaware license.

Why did it take action from the MD’s on the BOM to get these practitioners licensed?

These LAcs had appeared before the Acupuncture Advisory Board four times since applying for licensure in late 2012/early 2013. At several of these appearances the Acupuncture Advisory Board members acknowledged the applicants’ excellent qualifications but refused to grant licenses despite having the authority to do so.

For decades one of our “sacred cows” has been that we need our own boards. Then we’ll have the power to control our destiny. Sadly, when given the chance, some of us prefer to control our destiny right down the tubes.

Consider the history of the independent California Acupuncture Board, with its unique accreditation and exam process, and its ongoing problems. Or Nevada, with an independent board, 53 LAcs, a $1000 application fee and $700 per year renewal fee.  If Delaware had an independent board my colleagues would have had to go to the courts to present the argument (made by a public member of the Board of Medicine) that requiring an herbal education and exam for individuals who do not want to use herbs in their practice, in a state in which anyone can sell and recommend herbs, is restraint of trade.

It isn’t the M.D.’s and “the system” that is limiting the growth of our profession these days. It is other acupuncturists. I’ve asked and asked, but I have yet to find anyone who can explain why the Florida (independent) Acupuncture board is increasing the education and testing requirements for licensure. Have patients been harmed? If a change is needed are there options that would be less burdensome for the profession?

I’ll be interested to see the full minutes of the May 6th DE BOM meeting. In a classic conjunction of issues, a practitioner instrumental in drafting the restrictive Delaware law, and a current Acupuncture Board member who had voted against granting licenses to the two qualified acupuncturists, appeared before the BOM to ask them to do something to stop PT’s from doing dry needling.

Did either of these practitioners consider that their previous actions that limit the number of LAcs in Delaware increase the odds that citizens will seek treatment from non-LAcs? Or that our political power is limited by our small numbers? Did the BOM wonder what’s up with this profession — they don’t want anyone to use a needle, even other LAcs?  (FWIW, the BOM doesn’t regulate PT’s.)

You’d think that our own self-interest would prevent the credential and educational creep that costs us so much. But it hasn’t. The AMA Code of Medical Ethics states “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.” Restrictive laws and rules that limit access to qualified acupuncturists are contrary to the best interests of patients. Let’s work for change – for the people who need acupuncture and the qualified individuals who want to provide acupuncture. Credential creep hurts us all.

LAcs = Tea Party & Acupuncture Today = Fox News?

The threat to acupuncture from dry needling is like the threat to “traditional” marriage from gay marriage. That is, the real threat is our obsession with the issue and our willingness to make any argument, no matter how ridiculous, to keep people from connecting with the provider of their choice.

Despite thousands of years of experience and a big head-start, we didn’t establish ourselves as the undisputed experts of this method of pain relief. Having failed to convince the PT Boards that PT’s performing dry needling is a danger to the public, or that LAcs should get to determine the appropriate training for this technique, we are now arguing that we’ll accept it, as long as it hurts.

The November 2013 issue of AcupunctureToday included Dry Needling: Averting a Crisis for the Profession, here is my response to AT —

Dr. Amaro’s “obvious solution” to Dry Needling, that PT’s be judicially mandated to use a hypodermic needle, is awful. Has it come to this? Despite our 2,000+ year head-start our plan for success is to require other providers to use a tool that causes tissue damage and pain? There is no non-political reason for a board to require its licensees to use an unnecessarily harmful tool. To present it as a possibility is an embarrassment to the profession.

While some auto insurance and worker’s compensation will reimburse for dry needling, for the most part Trigger Point Dry Needling is not a billable service when performed by a physical therapist. It is considered “experimental and unproven” by Medicare and major medical insurance companies. And, if it were true that PT’s were getting rich on reimbursements for this technique, is that an argument against allowing them to perform an effective procedure? Don’t we support people getting relief from pain, regardless of who is paying the bill?

It would be tragic if we were successful in requiring everyone using a filiform needle to use the term acupuncture while losing the battle to prevent non-LAcs from performing the technique. Given various rulings of state AG’s, and of the regulatory boards responsible for other professions, this is a strong possibility. Then, we will have lost our ability to distinguish what we do from what others do. (And, ironically, would help PT’s obtain reimbursement.)

We had decades to establish ourselves as the experts in this technique. We didn’t, and, frankly, many of us are unpracticed with it and uninterested in making it a major part of our clinic offerings.  Addressing unfair reimbursement scenarios is reasonable. Respectfully presenting evidence-based concerns about risks to the public is part of our civic duty. Our ongoing panicked response to TPDN, with arguments based on misinformation or a misunderstanding of such basic topics as scope and the regulatory process, culminating in the argument in Acupuncture Today – that it’s okay as long as it hurts –  is the real threat to our reputation and our future.

I encourage you to read all of my posts on this topic (you can get them via the categories or tags on the homepage) and on scope of practice. It is time for the acupuncture profession to stop shooting itself in the foot.