Assistance for the Working Acupuncturist

I went down the Facebook rabbit-hole, and while I was there I learned a few things.

For instance, “just a quick look” and “I’ll just scan my notifications” can quickly lead to a month without a blog post. I will not let that happen again.

Also, based on posts about HIPAA, insurance billing, choosing office space, maintaining records, etc., we have  a lot of questions and we are looking for answers. It’s great that we’ve got communities of colleagues to ask. It is also inefficient, and sometimes downright dangerous that our colleagues are often the only source of answers.

Looking at HIPAA and ADA for example, we see that some professions (but not acupuncturists) have access to lots of resources from their national associations.

  • a search of the AAAOM site gets one, not very useful hit, regarding HIPAA-related responsibilities.
  • Here’s information from the APTA (American Physical Therapy Association) site on HIPAA.
  • Here are the search results for HIPAA over at the American Chiropractic Association.
  • I can find no information on the AAAOM site about acupuncture offices and ADA compliance.
  • APTA provides these useful links about ADA compliance.
  • The American Psychological Association has great information about ADA compliance.

While acupuncture organizations are working on national legislation, increasing insurance coverage for acupuncture, adding an entry level degree, and fighting with other professions to limit the use of the acupuncture needle, we search for authoritative assistance on current practice issues in vain. (Luckily, the links above are pertinent to our practices.)

To make matters worse, sometimes it seems that we prefer ignorance. In my time on Facebook I was reprimanded for self-promotion when I shared useful links to this blog, and I was threatened with banishment from Acupuncturists on Facebook because I “acted like [I] know it all.” (I don’t know it all. I do know a few things.)

When many of us don’t understand or comply with our obligations under the ADA and HIPAA, are we ready to be a part of the Medicare system or have acupuncture be an EHB? Isn’t accurate information about ADA compliance an important part of our stated goal of having acupuncture accessible to all? It’s past time for our schools and organizations to make sure we have the skills, knowledge, resources and information to be successful practitioners now. The FPD, Medicare inclusion, higher standards, and expanding our scope/suing our competitors should wait.


Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. 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.

19 thoughts on “Assistance for the Working Acupuncturist

  1. Re: “I’d like to think it isn’t too late.”

    Like I said on the POCA forums, your odyssey is fascinating to me in particular because you’re like my road not taken. When I started writing about the problems I saw with the acupuncture profession, people had a lot of (legitimate) complaints about my approach. You’ve corrected all of them. You’re inclusive — talking to all acupuncturists instead of just community acupuncturists. You went through the existing channels instead of starting up yet another acupuncture organization. Most of the time you’re really polite about your criticisms. Nothing you write sounds like this:

    You have a long history of being engaged and doing the hard, unglamorous work at the state level; if there’s street cred in this profession, you’ve got it. You did what you’re supposed to do with street cred and you joined the Board of Directors of the national organization. You worked hard there, but it was such a mess you couldn’t make any progress. So you started this smart, clear, well-informed blog. In order to get more people to hear your message, you took your message as directly as possible to the rank-and-file: the largest L.Ac. group on Facebook.

    And the results you got there suggest to me that the acupuncture profession actually does have the leaders it wants and deserves.

    The big issue that all the nice people in the acupuncture profession agonize over is the apathy: bad leaders, bad decisions, bad results, rinse and repeat. As you said above, acupuncturists seem to prefer ignorance. I’m not a nice person and I don’t have to worry about apathy; it isn’t one of POCA’s problems. I selected for smart, angry, motivated dissidents (who are mostly not nice either, but lots of fun to work with). But even *I* am disappointed with what’s gone down here, and I would’ve said I was past all disappointment when it came to acupuncturists. So this is my question:

    to you nice L.Acs who read this blog, if the state of the profession isn’t what you want, what are you going to do about it? Are you going to do anything? Ever?

    And Elaine — so, what’s your next move?

    • Good question. To a certain extent my next move is more of the same. Change can look like no progress, no progress, no progress, then, wow, how did that happen overnight — so maybe I’m counting on that? Some change is happening. In the Fall the NCCAOM was poised to make a bunch of policy changes, and were so sure of themselves that they posted the dates the changes would take effect. Many people told me that NCCAOM would do whatever the heck it wanted regardless of comments received, and others, including my state association folks, told me that these would be good and wonderful changes that would protect us all. Somehow, though, those changes are all on hold now. Why? I suspect that the input from even the relatively small number of people I reach had some role.

      (I’ve also noticed that more and more LAcs say they are doing community acupuncture as part of their practices. It isn’t POCA-style, and for some it’s little more than a marketing/feel good attempt. Still, there’s been less of the knee-jerk “you’re de-valuing the medicine” type of responses. Maybe, a growing number of practitioners are willing to ponder prior to rejecting/judging?)

      Part of more of the same will include some more formal teaching. I’m planning for my session at POCAFest to be the first of a series of informational events for practitioners about strategy, policy, acu-politics, etc. Yes, my state association was quick to turn down my offer of a class, but the local acupuncture school seems to be considering the benefits of teaching their students about the regulatory environment.

      I get that a new organization that could provide support to professional acupuncturists of all business styles would be a very helpful thing. We need a group that can provide a balance of power with ACAOM/NCCAOM and can provide thoughtful analysis of acupuncture-related issues. I’ve been contacted by many who agree with that need. But I’ve yet to find the person (including me) that’s ready to put in the time and energy and money to build that organization.

      So, yes, more of the same for now.

      • I think your work was without a doubt what tipped the situation with the NCCAOM in the fall. It had to be — nobody else did anything about it at all. You know that saying, “sunlight is the best disinfectant”? Blogs can be sunlight and disinfectant, especially when it’s a question of putting pressure on a relatively small group of people who know, on some level, that they’re doing something questionable. (And now we know that about the NCCAOM, thanks to you.)

        The acupuncture profession needs a lot of things and sunlight and disinfectant are definitely on the list. Fortunately, they can also be relatively easily provided by a thoughtful, attentive individual.

        But a lot of other things on the list of what the profession needs can’t be provided by individuals. As Kathleen said above, “It is a sad comment on the state of our profession that social media seems to be the best – no, perhaps the only – way for us to ask questions and get advice about issues.” You know why? Social media requires zero investment in, or commitment to, building infrastructure. All that conversation between acupuncturists on Facebook? Facebook owns every last character and keystroke. Acupuncturists like communicating on Facebook in part because it asks so little of them, but when you communicate like that, you’re not building anything — not unless you’re also doing it somewhere else at the same time.

        I don’t mean to be unduly critical. I am very, very interested in whether or not things are going to get any better for working acupuncturists and strategies that might accomplish that. The thing is, though, at some point a bunch of people are going to have to change how much energy they bring to the process. You can disinfect and illuminate, and I’m grateful that you want to, but a bunch of other people are going to have to follow it up by rolling up their sleeves. I’m interested in how either you’re going to motivate them or how they’re going to motivate themselves.

        • So, first off, no worries about being critical. You bring up great points. And I hope my response doesn’t sound defensive, because I’m not feeling defensive. You are absolutely right that infrastructure would be incredibly helpful. A sad thing is that our profession has some semblance of infrastructure, but it is so misguided and worthless that it often does more harm than good. I would say that most of our states have at least one acupuncture organization that has a board of at least 6 people. So, maybe 200 + people are out there doing some sort of organizational-type stuff, just inefficiently, and often with goals that are based on misunderstanding — of the process, of the benefit, of the fallout. We’ve also got regulatory boards — another 200 or so people, often not understanding what their job is about. I mean, I guess this points up the lack of good communication even more, but maybe it shows that educating 200-400 people could make a huge difference.

          The worst thing with Facebook isn’t that Facebook owns the keystrokes,imo, it’s that there is a whole lot of talking and very little listening. And everyone’s opinion is given the same weight. It is worse than worthless.

          A sad experience that proves your point is that while I played a role in the NCCAOM policy change, I doubt that it was what I wrote here that made much of a difference. I suppose bringing it to people’s attention helped. But I suspect what made the difference was that I knew enough about Virginia law to know that the policy changes would make it impossible for Virginia to continue to use the NCCAOM exam. And my position on the Advisory Board enabled me to persist in bringing it to the attention to the people at the Department of Health Professions, despite the leadership of my state association stating their full support for the changes and attempting to get the issue pulled from the agenda. So, if the issue had come up at a time when I wasn’t on the board, all the blogging in the world probably wouldn’t have stopped it.

          Some things are happening that might be pretty motivating for the profession. The AAAOM can’t maintain the façade of functionality any more, so they aren’t there for people to lean on. And those who insisted that insurance would save the profession are getting a taste of reality in the EHB states — and providing a cautionary tale that is hard to ignore. The issue of student debt and its drag on the economy isn’t going away. POCATech is coming, and while the school won’t be suitable for everyone, I imagine the other schools will get tired of questions about why their program costs so damn much when there is a program that provides a degree for so much less.

          For now, all I can do is continue to work for a critical mass of thoughtful people to begin asking more of their organizations and associations and schools, etc. It would be amazing if someone put together an organization and asked me to be the Policy Director, and raised the money, etc. So far, I can either do the work of building an organization/raising money for someone else to build it, or I can keep doing my writing and educating. The writing and the educating is my thing. So, I guess, my pitiful and plaintive response is, more of the same and maybe the snowball is growing…..?

          • Sounds like the AAC might have some $ they’d like to redirect. 😉

            You didn’t sound defensive, I just don’t want to give anybody a hard time when they’re actually *doing something*, since that’s so rare around here. Anyway, it looks like we’ll have a chance to see if the collapse of the AAAOM is, indeed, motivating.

  2. A few comments:

    1. As helpful and informative as facebook forums may be (and they are), facebook is surely not the best way for acupuncturists to get vital information. There are inherent problems with social media, such as not everyone is logged in, there is no way to know how knowledgeable the contributors are, and posts may contain inaccurate information presented with authority.

    It is a sad comment on the state of our profession that social media seems to be the best – no, perhaps the only – way for us to ask questions and get advice about issues.

    2. Like Elaine, I often find myself going to websites from other professions, in particular chiropractic, physical therapy and sometimes physicians (both MD & ND), to get answers to questions about medicare, subcontracting, ADA, corporate entities, HIPAA, fee for service discounts, and all sorts of issues.

    National leadership would be nice, but is lacking. State associations could take a lead by posting links on their websites or having apolitical (i.e. just the facts, ma’am) website pages devoted to pressing issues. If there is no information specifically pertaining to acupuncturists on a particular topic, there’s no reason they can’t provide links to pages on websites of our sister professions covering those issues, such as Elaine has done in her post.

    3. The facebook rabbit hole is a spiral downward. I was part of that facebook discussion on ADA, an extremely important issue which we should all take seriously. Elaine was told to tone it down, and I wonder if the other participants were also threatened with removal from the group if they didn’t tone it down. The very important information brought to light in that fb discussion was lost in the fray – A further illustration of why facebook and similar groups are better suited to discuss, and not purvey, these kinds of issues.

    Let’s get our professional ducks in a row with the ins and outs of day-to-day business that affect working acupuncturists before we race off to change laws we know little about under the battle cry of “Discrimination!” In the end, we’ll be a stronger profession for it.

  3. I hear you and agree with the frustration. We need to work as a group not independantly. Right now, I don’t see that happening. It’s very disappointing but don’t give up. You never know what could happen. It seems you are all doing Ok for now. I am happy studying OT. It is giving me a new perspective and I really like it. I do think I can co-mingle the two together very nicely. It is unfortunate that we are out there to fend for ourselves with no leadership. I hope someday that will change.

  4. Unfortnately, I don’t think that we matter that much. If we did don’t you think they would have done something by now? Marketing? They can’t get themselves on track how do you think they are going to help us? They have no idea what they are doing and have no direction. This group has a better handle on things than they do. You could do more for them.

    • I tried, I tried…. Sadly, the misguided priorities have infected a lot of practitioners too. You’ve got a lot of people who insist that fighting with PT’s and DC’s is the most important thing we need to do now. And while folks in the EHB states seem to be reporting that life as a provider of an Essential Health Benefit leaves a lot to be desired, practitioners in other states are pushing legislation to make acupuncture an EHB.

      I recently offered to do an event for my state association on Regulation and was told that no one would come…. I have no idea whether that is true or not, but I was a little taken aback by how quickly they dismissed the offer.

  5. I agree that they should focus on creating an educational standard that includes every state. Maybe, institute acupuncture in colleges and universities not vocational schools. Finally, make a decision on a curriculum that every school should follow and have test standards that every state agrees upon. This is part of the reason we are not included in the medical community. Our credits mean nothing and we need to re-do everything like A&P, chemistry classes and ect… Why don’t they start there? Our profession needs so much but we need to start some place and stop jumping all around.

    • While I think there is a lot about our education that could use improvement, I’d really like to see energy going to help those practitioners who have already paid for their education, gotten their license, etc. Working toward licensure standards that are as close to the same in every state as possible would be a great start. Organizations that help us with the tools working practitioners need now would be great. Easier CEU’s, better positive marketing, and so on. Thoughts about curriculum changes are what led to the FPD — and that isn’t going to do anything for those of us already in practice, and despite the hype, may not have the huge impact on medical community acceptance that’s been promised.

  6. Elaine, I agree with you that good and helpful information about many practice management issues are seriously missing from the information available from national acupuncture organizations, while so much money and time goes into tilting at windmills, like thinking acupuncture would be included in Medicare anytime soon. There is no political will to add any benefits to Medicare, and in fact it is more likely that benefits might be taken away.

      • Great article! And I agree that while it may be “too late” for some things, in some ways, it is certainly not too late for changing focus of our organizations to that of education; of acupuncturists re useful specifics of practice issues and compliance with regulations, and the public and greater medical community as to the fullest nature and potential of OM. This seems to me to be the better “horse before the cart” order of things.

        • The working title of my next post is Who speaks for the LAc, for they have no Tongues. (Yes, a play on the Lorax.) Because while it isn’t too late, at the moment no one is really speaking for the working LAc, and/or many LAcs support the organizations in their current high standards/fight with other professions world.

          In the March there will be an AOM Leaders meeting — participants are ACAOM and CCAOM and NCCAOM, perhaps SAR. I don’t know if the AAAOM will be there this year, but they usually are. I do know the CSA (Council of State Orgs) will be there, and they are our best hope. But my state organization seems to be right on board with the cart issues. They spoke in support of the NCCAOM’s proposed policies this fall, which had little benefit (being generous) to working LAcs, for example.

  7. I agree with you. Like I have said in the past the time was 10 years ago. Now, they are playing catch up and the ship has already sailed. Instead of focusing on things that would be beneficial they are focused on something that may never happen. The leadership is not there but we have mentioned all this before. It just the same old story. I hope you can find a way to move things along in a product way that would benefit acupuncturist as opposed to the damage our leadership as done.

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