A Mature Profession, Part Two.

(An intercepted letter)

Dear K,

Thanks so much for the time you’ve given to our dialogue and for the work you’ve done for the profession thus far.  You are incredible.  Forgive my response in a numbered list.  There are so many issues and it is often a battle between my natural wordiness and my hope for clarity (and that people will stay tuned in).  Also, I’m quoting you because you bring up good points shared by many; I’m not intending to pull things apart word by word as though your quick email was meant to be read like a scholarly article.

1)       You wrote ” I don’t really think anyone in our profession understands how the federal level works – our profession is still so young that it is really completely state regulated, and differently in every state.”  I agree that our profession has a shortage of individuals with a good understanding of how things work at the federal level.  However, our youth alone is not an excuse.  In fact, if we’d educated ourselves about how things work on a federal level even two years ago, the last time a petition like this went around, we’d be in much better shape today.  Our ignorance is due to the fact that no national organization has made it a priority (or, been able to act effectively if it was a priority) to do the important work of hiring some teachers and consultants to inform us about “how it works,” or even just to provide a safe forum for exploration.  The longer we stumble around in blindness the more lost we get.  The CSA and state orgs are great, but we need national leadership to help us see how state issues impact the whole, and an understanding of federal issues is critical.

2)      If you go to the NCCAOM site and click on the Job Task Analysis Fact Sheet you will see their write-up about the BLS process.  I don’t see a connection between the BLS process and Medicare in that document.

3)      You use the introduction of HR 646 as a clue to help you figure out potential connections (or lack thereof) between BLS and Medicare.  The existence of HR 646 shows only that Congressman Hinchey likes acupuncture and acupuncturists and, in every congress since 1993, has introduced a similar bill.   I’m not going to take time to compile a list of nutty bills, but I’m sure I could.  I’m not saying that 646 was nutty, but that having a bill introduced in Congress is not evidence of much.

4)      Regarding benefits and costs of Medicare Inclusion – I’ve read and written thousands of words on this topic in various acupuncture-related list serves and publications but I have yet to see a careful study and analysis by experts to help us explore this issue.  That is my main complaint here.  There is evidence from other professions on the impact of Medicare.  Let’s have a national exploration of the issue based on more than what you or me or my great Aunt Tilly thinks is a good or bad idea.  I’ve written a lot of checks to national acupuncture organizations over the years.  Is a well-done exploration of this issue too much to ask?  Is distribution (again) of an at best minimally useful petition the best they can do?  And let’s not forget, this isn’t just about the impact of Medicare inclusion on individual practitioners, but on how it could impact the medicine itself.   Issues such as best practices and standardization are sure to arise.

5)      Sorry for the confusion about my use of the word “covered.”  I was referring only to Medicare.  Acupuncturists are not listed as providers in Medicare AND acupuncture is specifically listed as a service that is NOT covered.  So, my thought/question was around whether additional action would be needed to remove acupuncture from the not covered list, even if acupuncturists were listed as providers.   There must be some expert somewhere who could tell me.  (And, yes, the piecemeal nature of state laws about things like titles for professionals who do acupuncture would no doubt complicate any action on a federal level.)

6)      Regarding the EHB effort.  I hear you.  I was on the AAAOM Board at that time and it was like something from a dystopian novel.  The people in power believed what they wanted to believe and anyone who didn’t accept their beliefs was shut down.  There is no way I can succinctly sum up the dysfunction I observed.   It just about broke me.

As for the rest of your email, it fits right in with my Barking up the Wrong Tree post.  We’ve got a bunch of “solutions” being promoted and we don’t even have a good understanding of the problems.   Not only that, it’s been a long, long time since we’ve had a forum or group that’s truly exploring the big picture, helping the profession really understand the problems and explore possible solutions.  That’s not to knock CSA and the hard work of many, many people, but it’s the national level that is missing.


With hope for the future,



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