The Acupuncture Profession, News and Analysis

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.)

 

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.

20 thoughts on “The Acupuncture Profession, News and Analysis

  1. All of this is so pointless at this point. If they wanted to do something they should have done it years ago not when Rome is already burning. I don’t know if acupuncture will survive as an occupation considering the bureau of statistics won’t even acknowledge it as a profession. Schools will also start to fall soon. In 2015, any school that does not create a certain amount of reliable jobs will not get financial aid. The two schools I went to in CA have already closed it’s doors. I believe acupuncture will become a tool scooped up by other professions to be used as a modality. That is the direction I see things headed. We had no true leadership steering the ship. It is truly terrible.

    • I’m not sure what the “this” is — arguing about dry needling?

      I don’t think the BLS will make a difference — we haven’t been acknowledged for the past twenty years and we’ve survived. Some of the schools deserve to fail — they haven’t been teaching the students what they need to know to be successful and haven’t been honest about what graduates can expect when they head out into the real world, and they haven’t done anything to control the cost of the education. Lots of the ACAOM requirements don’t seem to equate to a quality education.

      I think acupuncture, as a profession, could have an amazing future. But we need to stop thinking that insurance will save us. We need to devote our resources to positive marketing, we need to make sure schools teach business skills, etc. We have not been focusing on the things that will bring us success. All the states changing legislation, requiring OM credential, etc. It doesn’t help us succeed, it makes success more difficult.

      If we changed our focus and devoted resources to the things that would help, we could make a big change fast.

    • Susan, can you elaborate on that info about schools needing to create minimal reliable jobs or they don’t get financial aid as of 2015? I never heard that before.

      By the way, a case might be made that financial aid was the beginning of the end – tuition prices started jumping when acupuncture schools were able to qualify for students to get financial aid. I went to school before we were part of the financial aid system, and the three years of education was tough to afford, for sure, but definitely do-able.

      • I would agree that financial aid was the beginning of the end re tuition pricing. It was a disincentive to schools to control costs, and enabled students already in debt to attend school — which only made things more difficult when they graduated and were trying to start a business. I remember how happy we were when the ability to get financial aid came through. I fear a similar wake-up call is happening re insurance coverage, but more on that another day.

        I think Susan was referring to this —

        2015 is just when the data collection will begin. Which is a start….

  2. I’d like to know a little more about who is behind NCASI, and perhaps some history of how it came to be and what groups are associated with it or backing it. It seems to have just suddenly appeared, and their website doesn’t give much background.

    • I don’t know much about them. My guess — a handful of guys were tired of what they believed to be an insufficiently aggressive response from the existing acupuncture organizations and formed their own so that they could take charge of the situation. I don’t know of any groups or organizations that are backing it, but I’m sure there are a few. I know that Massachusetts and Arizona acupuncture groups are in the process of introducing legislation to stop TPDN, so they might support NCASI’s efforts.

    • Whoever is behind them, I looked on the IRS’s website list of 501c3 non-profits, and they are not listed. So I don’t know what kind of “nonprofit” they are (find out before you consider giving them your hard-earned cash!) but they probably should’ve googled their initials first, because the National Council for Air and Stream Improvement got there first.

  3. Ok, clicked on the ncasi link. Ugh…again….dry needling! Not one mention how we treat through a medicine model. Let’s give up on dry needling and focus on our medicine. Why aren’t we using “TCM” or “five element” terms rather than a broad term acupuncture? That’s what we do! That’s the difference. Dry needling is only one format to use for treatment. The power of acupuncture is our medicine. Let’s sell that! No wonder insurance won’t pay us more for “acupuncture”. Maybe we should promote payment with insurance companies for TCM treatment instead of acupuncture? There’s a real lack of education on many levels. I never realized how bad this is. We are like a dysfunctional family at the holidays.

    Plus, as you mentioned, a lawsuit!! Duh. Can i bang my head against a wall? First I had no clue this was going on. Are we crazy? What a horrible step. In 10 years of practice, I’ve never lost a patient to a PT. I have lost clients to MD Dr’s since insurance coverage specified MD only for acupuncture. That never worried me since a MD is limited to trigger points. To any certified acupuncturist….not all licensed acupuncturist are behind this. I want to work with you, not against you.

    That said, Elaine, my pet peeve is about certified acupuncturists who advertise on their websites that they treat with TCM. In particular, there is a chiro in my town who advertises on his site about using TMC to treat clients. I personally know this person has dabbled in some continuing education classes in TCM, but doesn’t have the background we do. Shouldn’t a degree in TCM be the deciding factor on who can say they are TCM trained. I find this upsetting. It misleads clients and lessens (to me) a medicine that takes time/dedication to learn. Why oh why aren’t we protecting the one thing that really distinguishes us from acupuncture….our medicine?

    • There’s a lot in your comment — Some of what you are saying varies from state to state. In Virginia, an MD or Chiro with 200 hours of training can do acupuncture, not just limited to trigger points.

      As for insurance companies, what we say we do will not impact what they pay. They will reimburse the minimum possible to provide the services they are legally required to provide or they want to provide to attract clients. There is no reason for them to pay more for “TCM” than for “acupuncture” unless we can show the distinction is worthwhile, people get better faster, for instance. (I can’t find any studies that show the degree of training of the practitioner makes a difference in outcomes.)

      The thing about TCM — what is it, what does it include? Lots of LAcs do lots of things they call TCM, but aren’t really. Is auricular acupuncture TCM? Is lying on a biomat? Is it TCM if I don’t take pulses or look at tongue? Is hara diagnosis TCM? What about electro-acupuncture? Is it the technique that makes the difference or the diagnostic philosophy? In any case, it isn’t something we’ve trademarked. (If someone had I’m sure a few folks would pay big bucks to be able to use the term, but most of us wouldn’t be able to.) I was trained in 5E acupuncture, so can I say I do TCM? Most of these distinctions are nothing but confusing to patients. Bottom line for me — I need to do the very best treatments I can do. If those treatments help people they will tell their friends. If people go to the MD, and get good treatments, they will tell their friends. If people go to the MD and insurance pays and they don’t feel any better, well, I guess I won’t have to worry about what he calls what he does.

      For almost all things in life, I try to put my energy where it can do the most good. Trying to control the use of a term that isn’t trademarked — seems like it would be a losing battle. Making sure I do good work and making it available to the people who want it — that seems like a good use of energy.

      • Sorry if this post is a bit unorganized. I can’t figure out how to quote your post.

        Youre right. Licensing is so different from state to state. I’m assuming that certified acupuncturist (in CT it’s the 200 hour program) hasn’t learned the points. Unless they have a drive to self educate, they probably have no knowledge to use sp3. Wouldn’t they lean more towards trigger point therapy? Or should I say dry needling? 😉 can you tell if they are using some sort of pattern diagnosis?

        Ok, voice of reason. You’re right. If no studies show pattern diagnosis improves outcome they will never pay. Yup, it’s about get results with the smallest outpay for insurance companies.

        I’m realizing it didn’t do a good job explaining myself. With a licensed acupuncturist, they have been taught a system to select points for treatment. Isn’t that the biggest difference between “us” and “them”? Yes, licensed acupuncturists cross our treatments. Completely agree with you. But if all this fighting over dry needling is useless, what can we focus on to improve our marketing? I a bit confused on what you think. Can you clarify?

        Yes, completely agree. What’s been my best success? Working my ass off to be the best acupuncturist in the area. As I mentioned before mediocre results don’t grow a business. Word of mouth is my best marketing tool. But it’s been a hard journey to get a practice going and kept stable. With the poor economy it’s been especially hard. My practice hasn’t grown, but it think most businesses have the same experience. I feel for the new practioners coming out of school. It’s tough times.

        • I think the 200 hour courses the MD’s take do not focus on trigger point needling. They learn points and do not do the aggressive thrusting manipulation for TPDN (though they might decide to learn that too). I think the main difference is in the diagnostics. I’m sure they learn the main points most of us do most of the time. (I’m sure a list of 30 points would cover 90% of what I do.) And then I believe they learn some basic points combos — for migraines, LIV3, CO4, and, if one sided, some GB points, for instance. Or, for backpain, KI3 and 6, SI3, BL 64….. I mean, I don’t know if it is those, but something like it. You can learn a lot in 200 hours (that’s more than 4 weeks, full-time.)

          But plenty of LAcs treat similarly. That’s the thing about the us and them — there’s a huge range in what “us” learn, and probably some range in what they are doing too. I mean, they could buy those acugraph systems…. I don’t think they learn much about pulse and tongue, if anything. But, I’ve also heard of LAcs who don’t take pulses or look at tongues. So, again, us/them.

          I suppose that would be something useful our associations could teach us — what do people learn in the 200 hours classes.

          I don’t want to make it so simple — it’s just marketing. Like I said in the post, there’s a lot of other things we need for success — better business classes in school, more education about how and where to locate a practice, etc. We mostly don’t talk about pricing except to say if people want treatment they will find a way to pay for it, and that’s ridiculous. How much will the initial series of treatments cost your clients and what is the median income in your area…. That would be good to know. Are our hours convenient? Do we run on time? Is there parking…. Also, what are we expecting to earn? I think a lot of students sit in class (I did) and think wow, 25 hrs/wk at $80.00 x 50 weeks — we’ll be rich! But we don’t understand overhead, amount of time a business takes in addition to client-time, taxes, health insurance, disability insurance (maybe), saving for retirement, sick days — oh, and student loan payments.

          I also think the us/them has kept us from building good connections with potential referral sources. Before we started all the fighting about dry needling, if we had gone to every PT office, introduced ourselves, talked about how we could be a good adjunct to PT, we might have gotten referrals.

          For most of us, what we like about the medicine is that it isn’t just about making a physical ailment go away — if we focus on that, I’m not sure we’ll succeed. If we go back to body/mind/spirit, the medicine is about moving through the challenges of life with balance and harmony, we’ll offer something people won’t be getting from their PT’s/MD’s. But that is just one example.

          • Wow. I have to say, hearing that “them” learning our profession in 200 hours is a bit anger inducing. All in all I feel certified acupuncturist don’t hurt my business and has helped me get clients.

            Yes, schools suck at business education. I was very lucky to have a degree in accounting. It helped to understand the balance of income/expenses. I came out of school with no clue. I just pounded the pavement with ok results. The web definitely changed my marketing.

            This is what I find difficult. Clients who want to use insurance. Just this past week I had two potential clients who would only come to me if I take insurance. In my area clients want the mind/body support. In fact I had 3 fertility clients today who needed education and support. That takes time. Insurance doesn’t pay for that. I don’t think you can bill for another unit of acupuncture to cover the intake? So who’s my competition? Other licensed acupuncturists who take insurance.

            Talking about jobs, I got a flyer in the mail looking for acupuncturists to work in a clinic. The clinic takes insurance. The requirements? Work 50 to 65 hours a week, treating 100 to 150 clients. I’m sure it pays well. But I bet burnout is high. Of course you need “to learn their methods” – ie: modalities to bill insurance.

            No wonder some acupuncturists don’t look at tongue and pulse. Can’t bill for it?

          • Well, this illustrates why I’ve been cautioning our colleagues to not look at insurance as the solution. And why they need to stop saying that it is just an option and won’t impact anyone who doesn’t want to take it. The impact of insurance on other healing professions is obvious — more care provided by technicians with less training, an increasing reliance on procedures and not on time spent in consultation. This should not be surprising to anyone, and I certainly think the increasing influence of insurance on the profession will not be a positive.

            The procedure codes for acupuncture do allow enough time to take pulse and tongue, but, most practitioners are fudging the numbers (ie fraud) in order to get the reimbursements that they think they deserve.

            I have no idea why our colleagues got so into the insurance idea without doing any research or analysis of what has happened with other professions.

    • I’m sorry, but that chiropractor who does TCM or acupuncture or both is not an acupuncturist unless he has a license (not certification) in acupuncture. Here in CT we recently had a practice act passed that prohibits anyone from calling themselves an acupuncturist unless they are state licensed, which requires a three-year master’s degree plus passing NCCAOM acupuncture boards. Of course they can still advertise “acupuncture” but they cannot advertise or say that they are an acupuncturist. This may be a fine point, but it’s an important one.

      • Thanks for the info Kathleen. When I read the chiro’s website they are certified but the presentation is like an acupuncturist. The page talks about channels and using acupuncture to balance the body. You know the usual stuff you see on an acupuncturists website. What I feel upset about is the misinformation given to a potential clients. I’m guessing here but I bet the chiro uses the acupuncture to have another billing modality. Why? Because they’re having a hard time making ends meet with insurance payment.

        Since we are licensed….what makes us different from certified acupuncturists? You and I know the difference but how can we clarify things for the public?

        • Samantha,

          I don’t think we know what training the Chiropractor has. Maybe they’ve studied all the channels and apply Chinese Medical Theory. I know LAcs that give a lot of nutritional information. They’ve done a lot of study. A nutritionist might think that LAc was misleading their clients, since after all, the LAc is not a nutritionist. The MD’s wanted to protect the public from us, back in the day (and some still do).

          Do we have any evidence that the DC is getting insurance reimbursement for the treatment? And if an LAc uses a heat lamp, or does moxa, are they doing it to have another billing modality? (And the answer is yes sometimes. Which again points to all the challenges of going into a system which pays by the procedure. Why did we think that was a good idea?) If the client improves, do they care about the different training of different providers?

          It makes me sad that any provider who isn’t an LAc is seen as using acupuncture only to make money. I’m all for helping the public understand the complexity of our training, but mostly I think they care if they feel better. What would we think if the Psychiatrists set out to undermine the LCSW’s — they can’t help you, they don’t have the extensive training we have — they’re just trying to separate you from your money…. Or the MD’s blathered on about the minimal training of the Nurse Practitioners? MD’s do have more training — but if they don’t give me better care, who cares.

          We seem to live in this oxymoronic world — our training makes us super-duper qualified, we are the best, and anyone without our training using this medicine is a charlatan, and, the public won’t be able to tell how great we are unless we make sure they know that our training is so much better than theirs.

          We seem to have some real self esteem problems.

  4. Bravo, Elaine.

    It’s tough (and somewhat comical, I admit) to witness the old guard dressed up in a changing variety of names/acronyms yet crumbling under the weight of the same stale approaches.

    Keep up the good work, here. You know you ain’t alone.

    • Thanks, Andy.

      It would be easier for me to connect with comical side if I wasn’t so aware of the time and money and energy folks have wasted on these misguided efforts. And if I didn’t see how some of that energy is making things worse for us. My guess is the first thing even non Dry-Needling PT’s think of when they think of LAcs is no longer “They’re a great resource and can really help.”

      But, I’ll do my best to get in touch with the Don Quixote comical side 😉

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