Medicare & Acupuncture: The Good, the Bad, the Ugly, the Unknown.

Did you hear? Medicare now covers acupuncture. (For chronic low back pain (cLBP), with restrictions.)

January 22nd’s announcement was met with cheers, jeers, and confusion. There’s a lot we don’t know. And a fair bit we do. Let’s be informed and thoughtful.

Here’s the formal decision memo. The one page summary covers the important stuff. Please read it. And take a deep breath.

Here’s the helpful announcement released by the ASA and NCCAOM.

Please note – 1) LAcs with Master’s degrees from ACAOM accredited schools and a state license are included, no need for the NCCAOM credential, active or otherwise, unless your license requires it, and 2) LAcs won’t be able to bill directly for their services due to bureaucracy, not disrespect.

This announcement was a surprise. Just a few months ago CMS proposed clinical trials to evaluate acupuncture’s usefulness for cLBP. Perhaps the input from the ASA (CMS Commentary ASA) and the ANF, among others, made a difference.

My thoughts —

  • There is an opportunity here for LAcs interested in working in physician’s offices, and for physicians who want to provide their clients with non-pharmacological pain relief. That’s good.
  • It’s bad that reimbursement is limited to cLBP that is “nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease).” This limitation rules out many causes of pain that are likely to respond to treatment. The requirement that the pain be chronic, present for a minimum of 12 weeks, will also rule-out reimbursement for treatment in most hospital settings.
  • It’s bad that the billing arrangement and requirement of some (“appropriate”) supervision, as well as the administrative costs and reimbursement rates, will limit the number of participating practitioners thereby limiting the number of Medicare recipients who can access treatment.
  • Despite that, the limitation on direct billing by LAcs, and our designation as auxiliary personal, is, in my opinion, good, at least for now. Those of us who don’t want to participate don’t need to opt out, and LAcs won’t face restrictions on who we see and what we charge.
  • It’s bad that the profession is still relying on volunteers to navigate the complex bureaucracy involved with both public and private third party payer systems, and for keeping the profession informed. Those volunteers have been doing a great job, but it is a huge job. Until we, as a profession, provide the resources to hire professionals with expertise in these areas, we’re going to keep being surprised and unprepared.
  • We have spent decades demanding that the establishment appreciate the benefits of acupuncture, and also insisting that no one other than LAcs provide treatment. It’s ugly to sneer at the doors that have now opened. If we’re serious that Acupuncture should be accepted by the establishment and made widely available, and that the only qualified providers are LAcs, it’s on us to figure out a way to provide it.
  • It’s unknown how, or if, the United States will address our out-of-control health care spending. It is known that the problem is not just CEO compensation or administrative overhead. A system which rewards those who provide the most services is going to be expensive. It’s not sustainable to have “the system” pay more for acupuncture treatment than individuals could or would. We will be facing increasing limits on what third-party payers will cover. We need to spend more time preparing and less time whining about how unfair it is.

Over the years, the profession has given support to those advocating for greater participation in the system. Acupuncturists concerned that many benefits of East Asian medicine would be left behind, or that we’d regret our lost independence, didn’t get traction. We chose which wolf to feed. The future is here and we can’t go back.

Let’s think through our next steps, and be prepared for what we create.

 

 

 

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2020. 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.

3 thoughts on “Medicare & Acupuncture: The Good, the Bad, the Ugly, the Unknown.

  1. Great synopsis, Elaine. Many thanks to all who tirelessly advocate for our profession.

    I agree we need to spend less time whining and more time preparing. The number of voices in our community crying foul surprised me. If we want it to work, we need to cooperate to create our future in the CMS system. Many of the accusations of unfairness are over assumptions about reimbursement, fees, and supervision – the details which are still unknown.

    I don’t know how this will work for community acupuncture, which operates on a sliding scale basis. Might there be an issue with fees? Not that it can’t be worked out.

    “It’s not sustainable to have “the system” pay more for acupuncture treatment than individuals could or would.” Is this true? Look at how physical therapy rates have sky rocketed with insurance coverage. Few can afford to pay out-of-pocket for PT and they are sustaining just fine. Also true for MD’s and probably other medical professions.

  2. Congratulations to people who worked on this. It’s something.

    I don’t know if this is something that I will be able to make use of, as a community acupuncturist working in a Community Acupuncture clinic.

    But, I certainly hope it creates more access to care and puts more practitioners to work helping people in pain.

    • I think that Community Acupuncturists are likely to be the best positioned to “take advantage” of this change. Community Acupuncture clinics often have strong supporters in the Medical community, and, practitioners are good at seeing a lot of patients in a relatively short period of time, focused on things like relieving pain rather than long conversations about destiny.

      I don’t know that many CA clincs/practitioners will WANT to work in this system, but if they want to they should have the skills and connections to make it work.

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