Control

Who determines your professional future? First, read An Example of one person, wearing two hats, limiting opportunities for LAcs. (He’s received honors for the work he’s done.)

We have one week to comment on the NCCAOM’s “proposed” policy changes. Do that here. Some of us think these changes are wise, some of us wouldn’t be personally impacted. We all should participate in the conversation. Ask your professional communities to comment. (You can see the NCCAOM’s response to my initial comments here.)

My follow-up comments are below. The NCCAOM is the most powerful organization in our profession. I have seen them, with our help, control regulation (or essentially subvert it) and legislation. Our interests may overlap, but don’t think your future is their primary concern.

Dear NCCAOM and Ms. Basore,

Thank you for your response regarding the proposed policy changes.  Here are some additional questions and comments.

  1. You wrote “The Criminal Background Screening Program for new applicants will not take effect until January 2014.” Has the final decision to implement these policies been made?
  2. The Criminal Background Check and language requirements go beyond your mission as a “national organization that validates entry-level competency.” These policies usurp the role of state regulatory boards. (For example, Virginia exempts those serving certain communities from our language requirements.)
  3. Many states use the NCCAOM exams but do not require the NCCAOM credential. Establishing background checks and language requirements as part of the testing application circumvents those states’ specific desire to maintain an independent credentialing process.
  4. How many students responded to the assessment regarding the foreign language exams and what were their responses? Please define the demand “sufficient to offer a psychometrically valid defensible examination.”
  5. Is it significant to an applicant if the background check fee goes to the NCCAOM or to a third party? Could NCCAOM staff involvement ultimately increase exam costs?
  6. Can you describe the criminal background check appeals process? Would the NCCAOM risk legal liability if applicants were allowed to sit the exam upon appeal?
  7. Is there any documented case of harm from practitioners who had a criminal history at the time of sitting the exams?
  8. If public protection is the justification for requiring the background check prior to examination, should it be required prior to school admittance? This would protect individuals from making a huge investment in a career they will ultimately be unable to practice.
  9. Could the recertification process be simplified by trusting Diplomates to use their best judgment regarding continuing education?  Has there been any documented patient harm as a result of unreviewed or unmonitored continuing education?

 

I believe that for much of the past twenty years the NCCAOM has provided a net benefit to the profession while honoring its commitment to the public welfare.  More recently the NCCAOM has repeatedly acted out of self-interest, choosing control over the profession and the attendant financial rewards ahead of either the profession or the public. Your push for the full OM credential as a requirement for licensure in DE is a prime example of action that served the NCCAOM at the expense of all others. The stakeholder comment you request is routinely disregarded.

Re-consider these proposals. Acupuncture practitioners have an incredible record of safety. The imposition of additional de facto regulation is unnecessary and burdensome.

Sincerely,

Elaine Wolf Komarow, LAc (VA)

NCCAOM Diplomate (Ac)

A Very Important Question

Dear NCCAOM,

Will feedback received influence your proposed(?) policy changes?  Ms. Basore’s comments to my previous post indicate the changes are a done deal. Please let the readers of The Acupuncture Observer know so that we can effectively use our qi.

Thank You.

Dear Readers,

I’ll send my many questions and comments about the policy changes to the NCCAOM (and post them here) if our input matters.  In the meantime, please  —

  • Contact NCCAOM via Facebook to weigh in on the proposed(?) changes. (Are they listening?)
  • Contact AAAOM via Facebook to share your thoughts on the NCCAOM’s proposed(?) changes.
  • Respond to the AAAOM’s latest Call for Comments (deadline September 19th), and let them know if you think they should be focusing on the proposed(?) changes.
  • Contact your state professional association to point out that the proposed(?) changes interfere with the state regulation of acupuncture and ask them to get involved.
  • Ask your state association to raise this topic with the Council of State Associations. (There doesn’t seem to be any way for the average professional to contact that group directly.)

That’s a good start while we wait to hear back from the NCCAOM. Oh, and spread the word!

P.S.:  Here’s a story about background checks.  Keep in mind, in the NCCAOM’s proposal, the poor applicant wouldn’t even be allowed to sit the exams.

Making a Difference, in ten steps.

  1. Write a letter to the Delaware Acupuncture Advisory Council, and mail it by this Friday, August 23rd. Here is a new, improved template!  Do this now! (Please cc Gayle MacAfee at the board and send a copy to de@theacupunctureobserver.com. Thanks!)
  2. Share this post on facebook.
  3. Tune in. Subscribing to this blog is a good start but I can’t keep track of everything. Check in at websites for the AAAOM, NCCAOM, ACAOM, your state association, POCA, etc.  A few current issues (which I’ll be posting more about soon) — AAAOM is calling for public comment by August 31st on draft legislation, NCCAOM wants public comment on proposed changes by September 30th, ASVA (Acupuncture Society of Virginia) is having a town hall October 19th to discuss possible changes to scope, and the IHPC wants us to stay involved regarding implementation of section 2706 of the Affordable Care Act. Any one of these issues could impact your ability to practice.
  4. Question Authority. Is X really the biggest problem facing the profession? Is the public better off in a state that requires the OM certification rather than the AC certification? Is an independent board better for acupuncturists? Will an FPD degree lead to greater respect? Does scope mean what you think?
  5. Know the system. For example, boards can only regulate their own licensees. And the executive branch doesn’t determine what Medicare covers, regardless of how many signatures are on a petition.
  6. Avoid us/them thinking. In Our Worst Enemy I wrote about the practitioners in focused on increasing standards as a “them.” That was a mistake.
  7. Remember, we are all in this together. What happens in another state or a change that seems to impact only new students or new licensees might end up affecting you in unforeseen ways.
  8. Assume good intentions. Assuming bad intentions (the PT’s want to do dry needling to make money, for example) doesn’t lead to productive dialogue.
  9. Be consistent. Do we support the right of people to choose their healthcare provider? Are herbs safe? Is acupuncture safe? When we change our answers to these questions based on the circumstances we create a negative impression.
  10. Learn from history. Has participation in  health insurance been good or bad for healthcare? For providers? Has a standardized system of Chinese Medicine led to greater effectiveness?

In the short run it is easier to ignore the big issues, to figure you’ll be okay, or to decide you can’t really make a difference. Staying involved takes time and energy you’d rather use to see clients or spend time with your family or learn that new technique. Do it anyway. Tune in, question, participate. The future you save may be your own.

You Can Make a Difference

Many LAcs do their best to ignore the “politics” of acupuncture. The experience of participating in professional dialogue can be disheartening and discouraging. It isn’t easy to participate even when we want to — things are happening at the state level, with schools and ACAOM (the coming FPD), or with credentialing (proposed changes at NCCAOM), for example. All too often the debate gets heated and divisive. It is hard to get the whole story and figure out the possible consequences of a change or know what action might be effective. When the licensure legislation was developing in DE few outside of the state were involved. Some of my colleagues in DE had concerns, but they eventually gave up what felt like a fight for a better bill.

Five years after the DE legislation went into effect, there are approximately 35 LAcs serving a population of over 900,000 people and many of those practitioners were either grandfathered in or granted a waiver. Two years went by without a single non-waivered approval. Clearly, the legislation is not giving the people of DE access to qualified LAcs. As I wrote about in my last post, I know of two excellent practitioners who have recently been denied licensure even though their credentials surpass those of many practitioners in the state.

In the long run, the Delaware legislation should be changed. Rules that exclude the majority of NCCAOM credentialed Acupuncturists make no sense, especially when acupuncture can be done by other professionals with far less training. In the short run, the Acupuncture Advisory Council should acknowledge the record of safety of NCCAOM AC practitioners and consistently grant waivers to those with that credential.  In the very short term, the Council should grant waivers to Virginia LAc Sharon Crowell and Maryland LAc Sue Berman.  To facilitate those short term goals I ask that all of you write to the Acupuncture Advisory Council expressing your support of such a waiver.  Please mail your letters by August 22nd!  Feel free to post a copy of your letter in the comments section to inspire others. Email a copy to de@theacupunctureobserver.com. That will help if further action is necessary.

You can see the letter I sent (and borrow from it if appropriate) —  DE Observer Letter.  I’ve also generated a DE LAc sample letter that you can personalize. You could add some of these Possible concerns or your own concerns (please share any additional concerns in the blog comments). The letter can be modified for clients or others who are interested. If you’d like an excuse to visit Dover, DE, the next Advisory Council meeting is September 12th. It should be lovely at that time of year – but don’t count on being able to find an LAc in town :).

 

A Level Playing Field

This was a comment to It’s Not Fair.  You can see the beginning of the exchange there.  Frank raises some great issues, so I’ve cut and pasted his comment below, along with my responses in italicsI’ll split it into a few posts to keep the length under control.

Frank writes:  Here is why I think we are not on a level playing field:

(I’m not a sports fan,so my analogy is probably off, but there is a difference between a non-level field and not knowing how to put together a team or play the game to your advantage.  My position is that while there are things that put us at a disadvantage we could still develop a winning strategy and a winning team. Underdogs can and do win.)

Exogenous factors  (All have endogenous aspects.)

1) Licensing. Not every state even licenses acupuncture, and of those not all include the scope of practice (herbs,nutrition, tuina) that people are taught in school. As far as I know, every state licenses PT.

If you haven’t seen my post about Scope, please read it. Most of our “leaders” don’t seem to understand the term, and, subsequently, we spend a lot of time and energy fighting unnecessary battles. A technique does not need to be specified in your legislation to be within your scope. Herbs, for example, are unregulated by the FDA and so anyone, including the check-out guy at the 7-11 can sell them.  (Check out the ingredients of Airborne, for example.)

Sometimes I wonder whether licensure has done more harm than good (a discussion alive in the ND community) but, accepting, for the moment, the conventional  wisdom that it is a good thing, shouldn’t we focus on licensure in all 50 states before pushing for Medicare coverage?  Shouldn’t we pay attention to reciprocity, agreeing on a mutually agreeable minimal set of requirements for licensure so that qualified and experienced LAcs in one state are likely to be able to practice in all states? (I’ll be posting more on this, but I find it tragic that within the profession we are setting rules that exclude so many of our colleagues!)

2) Money. PT is a $30 billion industry. A lot of the big clinics are funded with private equity money. They use aggressive Starbucks style positioning and can run clinics at a loss in hopes of pushing other big clinics out of business. Plus, they can fund advertising campaigns that make PT seem like a normative activity, and of course they can generously donate to candidates.

Yes, there are more PT’s and it is an industry. I don’t know enough about the specific business practices to comment, but I do know that many investors in PT practices are MD’s, powerful allies to have.  They also seem to have a strong national association.  Meanwhile we’ve got associations which have been promising they’ve turned the corner for years.  And we’ve spent so much energy fighting with other providers over our fear that they will “steal” our medicine that we’ve made enemies rather than friends (check out Love the Bomb). From what I can tell, there are enough people open to acupuncture that it is normative.  WebMD talks about it on a regular basis. Folks often report the great results they’ve seen when their pets receive treatment, for example. Our problem is that we have been unable to make good use of the positive buzz that is out there.

As for advertising, again, we have the money to do this, we just do it poorly. The AAAOM spent two years coming up with information cards that were intended to carry a positive message about our profession.  Instead, the first line reads — “Many healthcare providers are performing unlicensed therapies similar to acupuncture, but each state licensed acupuncturist has extensive training in an accredited college that ensures their dedication to providing excellent healthcare.”   We can’t even start on a positive note without casting aspersions on professionals who could be allies. This one sentence contains several inaccuracies/inconsistencies:  a) professions are licensed, not therapies, b) hasn’t the profession been arguing (foolishly imo) that these therapies are not similar to acupuncture but are acupuncture,and c)not all licensed acupuncturists graduated from accredited schools — it depends on the state and on whether they attended a US school. I’m no advertising executive, but that isn’t a helpful introductory line.  How many MD’s or PT’s (who could refer to us) would agree to display a card like that in their office?

It doesn’t take necessarily take big bucks to influence legislation — it does take a winning strategy, choosing issues wisely and building alliances whenever possible. We have not done that.

Survey, Part Three

The ASVA membership meeting was April 7th and I’ve been meaning to write about it ever since. I heard good things about the associated weekend seminar, the setting was lovely, and ASVA received support from a number of vendors. Two folks stepped up to fill open positions on the board, and it looks as though good things are happening for the group.  I remember well the hard work it takes to run an organization and big events like this one – kudos to the board for their efforts.

The survey results, though, diminished my good spirits (and please read 6 even if you skip the rest!)  —

1) 75% of respondents replied yes to supporting efforts to add Acupuncturists to the list of covered providers in the Social Security Act. I only wish the profession had more information about what a successful effort would entail, the odds of success, and the potential impacts of success. I have seen nothing that comes close to a well-done analysis of these issues.

2) 82% support the national effort to include acupuncture as a federally mandated EHB. The current HHS policy is that if a state does not establish their own EHB, the federal government will rely on existing plans within that state to establish an EHB. Any efforts to include acupuncture in a federally mandated EHB would first require a complete change in how HHS is establishing EHB for states. I don’t know of any active national effort to bring about this change and unless the acupuncture community believes that we can win an argument with all of the states and the US Congress about greater federal control of healthcare, an arena more typically left to the states, this is a non-starter. (And if we were successful it would have some huge impacts for us that I have not seen discussed anywhere — I’ll be posting about it one of these days.)

3) 75% support fundraising for the purpose of updating the Virginia scope. There wasn’t any conversation about what changes anyone had in mind, so I’m not sure what people are supporting. See my March 26 post about scope for more on this issue, but, based on what was said at this meeting, there is still a lack of understanding of what “scope” means.

4) Only 60% supported a grassroots campaign to support the election of legislators supportive of acupuncture. Perhaps ASVA members are reading this blog? I hope my look at the question and the relative lack of support for the strategy as stated does not translate to a lack of involvement with our legislators.  It is super-important that we, as individuals, get involved in local campaigns and stay involved with our state politicians. Done right, this is one of the most important things we can do, and a great place for help from our state organizations. The tricky part is doing it so that we develop allies, not create enemies.

5) 68% supported fundraising for legislative efforts to restrict other professions from practicing acupuncture. I can’t begin to imagine a way that such legislation could be successful in Virginia — where low regulation and the free market seem to rule (except in matters of the uterus). I can imagine many ways the mere introduction of such legislation could create division and hard feelings with fellow health professionals.

6) About 10% indicated they’d be willing to serve on a committee. Which leads me to two thoughts —

a) (and most obviously) – success in any of these areas would require far more than 10% of the profession to step up and serve. Of course, being on a committee isn’t the only way, but we’d all need to be involved and contributing time and money.

b) (and most importantly) – it is easy to say we support an idea or an action in the abstract. But when we are in touch with the real time and effort a yes entails, it’s not so easy. Questions 1-5 would have a far greater impact on our day-to-day workload and life than serving on a committee. So, colleagues, before you say you support inclusion in Medicare or legislative action or acupuncture as an EHB, give it just as much thought as you would the decision to serve on a committee.