Expanding Insurance Coverage

[LonnyJ]

There are several issues that are apparent from the recent annual
meeting.

1. Older practitioners with a depth of clinical experience in general
practice who have thriving practices don't want insurance coverage
because it offers no advantages.

2. Younger practitioners who don't have busy practices and people in
specialties such as pain management, hospital treatment, and Community
acupuncture do want insurance.

I agree with Kirsten Porter's assessment that it's ethical for people
to have access for our medicine. I wholly disagree that Insurance
coverage is the best answer to that ethical problem.

If it is the will of the majority of practitioners to have expanded
coverage then it is imperative to do this in a thoughtful way that
honors all traditions of practice. I heard a lot of people talking
about "what's good for the profession" but I didn't hear much about
"what's good for the medicine".

My Ruth's bill is a Least Common Denominator bill. It does not include
any provisions for parity because, I suspect, Mr. Ruth's goal is to
fund his Community Acupuncture practice and he will be very happy to
receive $25 a session.

If we put through this bill it will be an unmitigated disaster.
Personally, I will do whatever I can to see that no bill goes through
that does not include a parity clause from the get go. The notion that
we can "negotiate later" is ludicrous. It is my suggestion that Mr.
Ruth withdraw or amend his bill and add a parity clause and work with
the board to craft a bill that we can get behind. That way he might
garner the support of those experienced practitioners who now oppose
his efforts. I will note that I had dinner with Mr. Ruth two years ago
with 20 other acupuncturists and asked him to send me the bill he was
working on stating I'd be more than happy to comment and offer advice.
He declined.


Warm regards, Lonny Jarrett

[Della Lawhon]

As a whole, community acupuncture receives little benefit from
insurance coverage. Discussions on the community acupuncture forums do
not support the pursuit of acupuncture cpverage as a good use of
resources.

I wasn't able to attend the meeting. Can you tell me more about CAs
support of this?

Sent from my iPhone

[scina]

I am opposed coverage by large HMO entities as I believe it will
ultimately dictate how we practice acupuncture, not to mention it will
greatly reduce our reimbursement, maybe not in the short term but most
certainly in the long term. The smaller programs that exist tend to
reimburse 100% and have yet to fall into the managed care trap. I'm
more than happy to offer sliding scale when necessary for those who
can't afford my care. I think that needs to be the alternative. I
have seen too many physician and chiropractors change to a cash based
business as a result of the control placed on them by managed care.

To answer the issue "acupuncture won't become mainstream unless is
receives coverage" I disagree. With the progression of research and
the continued acceptance of our medicine in the eyes of the consumer,
our patient numbers will keep growing.

[eshig...@comcast.net]

I would respectfully disagree with Lonny's post. It seems Lonny is
presenting his assumptions of other people's opinions and motives as
"facts", which they are not.

I would consider myself an 'older' practitioner, I have been in
practice since 1982, which is 27 years.
I have a wonderful practice, and yet, contrary to his point, I DO want
us to be able to accept insurance coverage. It is wrong and misleading
to say that "only" those who are new at acupuncture or those who do
not have busy practices are in support of insurance reimbursement.

This, for me, has really nothing to do with my own private practice,
but, with making this wonderful medicine accessible to a greater
number of people.
That is the ethical position that I think is important.

I have started 4 free-care acupuncture programs at Boston Medical
Center, all of which now provide acupuncture to populations who would
be unable to afford this medicine at any price. This is not about a
particular style of practice, it is about making sure that we are,
true to our most altruistic motives: providing quality care for all.

The insurance subcommittee of AOMSM has worked for the past year to
gather opinions and input from acupuncturists around the State. It is
our intention to create as open and reasonable a dialogue as possible
around this 'hot' issue. We will continue to collect information
about Richard Ruth's proposed bill, as well as other possibilities.

I would ask that people consider not just their own practice, but a
larger view of what we can bring to so many. Insurance reimbursement
is probably not anyone's first or ideal choice, but, it is most likely
the best way to provide our valuable services to the greatest number
of people.

Ellen Highfield

[LonnyJ]

I will support a bill that shows me that we are bringing the values of
our medicine to the Biomedical/insurance field. I will not support a
bill that compromises the integral values of our medicine. I ran a
free AIDS/HIV program for 5 years and I've treated every single
sincere patient for 24 years regardless of what they could afford to
pay. I'm totally against insurance as it's an already failed system.
It should be for catastrophic illness to stop people from losing their
homes and livelihoods and that's it. I'm all for practitioners
volunteering en masse to support programs like Ellen's.I wholly
disagree that insurance reimbursement is the best way to bring our
medicine to a great number of people. That depends on what you think
"our medicine" is. Again, I heard a lot of talk about "the profession"
and very little about "the medicine" which might be a good place to
start.

Mr. Ruth's bill is a disaster and puts us in a position of weakness to
negotiate with insurance companies who have all the power and whose
bottom line is the dollar. This current bill puts us in the position
of having to live with whatever we are handed.

That said, I trust Ellen's motives and the motives of people like
Cristine Porter. If a bill can be crafted that represents our values
I'll get behind it to support unity in the state and the profession.
But I'd like to see the State Association oppose Mr. Ruth's bill which
1. Simply will not pass because the state is not going to give an
across the board mandate (they would be crazy to) and 2. Because it
lacks the all important parity clause. This is simply rectified with
the following phrase, "Any Massachusetts insurance company that covers
the practice of CM by a physician must also cover it for a licensed
acupuncturist and reimburse at the same rate of pay."

Without this clause, I'll do what I can to oppose the bill. Again, I
asked Mr. Ruth Politiely twice two years ago to include me in the
process of crafting the bill and he declined.

[Hudson Doyle]

From the annual meeting, it was apparent that about 90% of those in
attendance at the meeting (N~ 60-70) voted in favor of working to
expand insurance coverage for acupuncture, as did 80% of those who
responded to the AOMSM survey (N= 180). So to make an assessment that
those who are younger are for and those who are older are against is
disingenuous at best.

Regarding: "My Ruth's bill is a Least Common Denominator bill. It does

not include any provisions for parity because, I suspect, Mr. Ruth's
goal is to fund his Community Acupuncture practice and he will be very
happy to receive $25 a session."

While I myself am uncertain of how well designed the current MA bill
is, I find the criticism that the wording is "least common
denominator" because it does not stipulate parity invalid and
unproductive. Parity is something we all desire, clearly. As Ruth
stated at the meeting, the opinion of the AAAOM lawyer (Michael
Touramino) and the state legislators who looked at this bill is that
this is not the time/stage to address that aspect. I don't know
whether or not this is in fact tactically judicious. However, the
bill does seem prudently specific to Lic Ac’s in its wording that all
insurance plans "shall provide benefits for services rendered by a
licensed acupuncturist". Which, to me, clearly states the Lic Ac's
are to be reimbursed for acupuncture services and does not require
acupuncture coverage for MD's, etc. Of course, we should--among other
issues--continue to pursue parity as such.

Regarding: "I heard a lot of people talking about "what's good for the

profession" but I didn't hear much about "what's good for the

medicine" " When I interned at the Zhejiang hospital of TCM in
Hangzhou, acupuncture was covered by insurance, it was delivered in a
large open community clinic setting, and it was very informal/open/
nonchalant. Far different from the typical private, 1-on-1 clinical
setting that predominates in the West. So to suggest insurance
coverage for acupuncture will undercut how acupuncture is
traditionally practiced is at odds with how it is practiced in China.
And even if this is different from one’s conception of how acupuncture
was practiced since before the Common Era (as Lonny alluded to at the
meeting), can the medicine not adapt? Has it not already?

Regarding the insurance issue at large, if you do not want to accept
insurance--then don't. But why deny others the opportunity to work
from within the system? Why deny the opportunity for the profession
and the market for acupuncture/acupuncture jobs to expand with
increased financial resources? Is it ethical to deny other’s this
opportunity to provide and receive this care?
Hudson Doyle

[LonnyJ]

1. Which, to me, clearly states the Lic Ac's

are to be reimbursed for acupuncture services and does not require
acupuncture coverage for MD's, etc.

Lonny: In fact, the bill, as written, put's the terms of how it is
implemented ENTIRELY in the hands of the industry. All it does is
mandate coverage, but as no details of that coverage are stated, what
that coverage will be is up to the carrier. Any bill we submit must
have parity in it upon submission. If the legislature will not provide
parity that is a statement that we are not valued for what we do and
strongly suggests the nature of the compromises we will have to make
to get whatever terms the deem to give us. We aren't unionized ad we
have nothing to "negotiate" with because those willing to take the
least favorable terms will carry the day.

I interned at the Zhejiang hospital of TCM in
> Hangzhou, acupuncture was covered by insurance, it was delivered in a
> large open community clinic setting, and it was very informal/open/
> nonchalant.  Far different from the typical private, 1-on-1 clinical
> setting that predominates in the West.  So to suggest insurance
> coverage for acupuncture will undercut how acupuncture is
> traditionally practiced is at odds with how it is practiced in China.
> And even if this is different from one’s conception of how acupuncture
> was practiced since before the Common Era (as Lonny alluded to at the
> meeting), can the medicine not adapt?  Has it not already?

Lonny: Hudson, you miss my point entirely. Chinese medicine was
disavowed by the the State in the 1800's and was revived by Mao under
the auspices of dialectical materialism and state enforced Atheism in
the 1940's. CM has thrived in the West for 200 years with diverse
styles thriving developing in our culture in a way that has been, and
is, impossible under a fascist regime. The medicine has adapted and
evolved in the West beyond a cheap and fast way to provide symptomatic
relief to the masses so they can get back to work more quickly. The
entire insurance system is broken and failed, therapists and
physicians are bailing left and right. Just yesterday I was i the post
office and a local physician walked out with his hands filled with
envelops from insurance companies. He looked at me said, "Hi Lonny,
you are so lucky you don't have to deal with this, it's just awful."
Generally, it is my opinion that the desire for coverage represents a
lack of training, confidence, and self esteem by practitioners who
find fault with the system instead of taking clear stock of the
quality of training they've been given. And, instead of taking
appropriate action they are looking for a handout without thinking of
who is paying for it and what the real cost will be in so many ways.
To those who want to work in hospitals etc, etc. I think
it's fine, though I would consider that an area of specialization. But
in service to their obvious higher aspirations I would support an
insurance bill, but not one aimed at getting some minimal coverage so
they can work in hospitals and administer quick session to the masses
billing in 15 minutes increments. I'll support a bill that specifies
PARITY so that I, and others, am free to work advancing the medicine
beyond palliative care.

>
> Regarding the insurance issue at large, if you do not want to accept
> insurance--then don't.

Lonny: This is SMUG. If 30 practitioners within 20 minutes of my
office are taking insurance then I'll ave to. And if I'm going to have
to start paying people to do paper work and take 5 times as many notes
per session, I'm going to have to raise my prices significantly.

 But why deny others the opportunity to work
> from within the system?  Why deny the opportunity for the profession
> and the market for acupuncture/acupuncture jobs to expand with
> increased financial resources?  Is it ethical to deny other’s this
> opportunity to provide and receive this care?

Lonny: I've worked tirelessly for this profession for 29 years and
I've treated everyone who walked in the door whatever they could
afford to pay. I'll support a bill that acknowledges the profession
with the stature it deserves. I will not support a bill that puts us
in the position of "negotiating" with the most corrupt industry in
America o its terms. Write a good bill and I'll support it. It's that
simple.

[LonnyJ]

1. Which, to me, clearly states the Lic Ac's

are to be reimbursed for acupuncture services and does not require
acupuncture coverage for MD's, etc.

Lonny: In fact, the bill, as written, put's the terms of how it is
implemented ENTIRELY in the hands of the industry. All it does is
mandate coverage, but as no details of that coverage are stated, what
that coverage will be is up to the carrier. Any bill we submit must
have parity in it upon submission. If the legislature will not provide
parity that is a statement that we are not valued for what we do and
strongly suggests the nature of the compromises we will have to make
to get whatever terms the deem to give us. We aren't unionized ad we
have nothing to "negotiate" with because those willing to take the
least favorable terms will carry the day.

I interned at the Zhejiang hospital of TCM in
> Hangzhou, acupuncture was covered by insurance, it was delivered in a
> large open community clinic setting, and it was very informal/open/
> nonchalant.  Far different from the typical private, 1-on-1 clinical
> setting that predominates in the West.  So to suggest insurance
> coverage for acupuncture will undercut how acupuncture is
> traditionally practiced is at odds with how it is practiced in China.
> And even if this is different from one’s conception of how acupuncture
> was practiced since before the Common Era (as Lonny alluded to at the
> meeting), can the medicine not adapt?  Has it not already?

> Regarding the insurance issue at large, if you do not want to accept
> insurance--then don't.

Lonny: This is SMUG. If 30 practitioners within 20 minutes of my
office are taking insurance then I'll ave to. And if I'm going to have
to start paying people to do paper work and take 5 times as many notes
per session, I'm going to have to raise my prices significantly.

 But why deny others the opportunity to work
> from within the system?  Why deny the opportunity for the profession
> and the market for acupuncture/acupuncture jobs to expand with
> increased financial resources?  Is it ethical to deny other’s this
> opportunity to provide and receive this care?

[Naomi]

To All,
I think that we should poll our patients and see what they would
appreciate. These are the people we are serving and we need to know
whether they would want insurance coverage.
Also, we should look at the population we are serving. If we are
serving only a small segment of the population, we should review our
policies.
Keeping the integrity of the medicine is important, keeping the
integrity of individuals is paramount, and also, in the end it is
the patient that we are here to serve.
Richard Ruth apparently ( this from Pignatelli's office) wanted
to include parity in the bill and was advised to add it in committee
by the national association of Acupuncturists, I will find out which
organization specifically.\
I would like to see a link to this discussion obviously posted on
the
AOMSM website, is that possible? Does anyone in this discussion have
that information?
Naomi Alson

[LonnyJ]

If you ask people would they like their insurance company to pay for
their treatment they will say "yes". If you ask them if they'd like to
pay less taxes they'll say "yes", and if you ask them if they'd rather
buy herbs at cost rather than at 10% above cost they'll say "yes".
Patients saying "yes" doesn't mean that insiurance or this bill are
good for the profession or the medicine. If a good strong parity
clause is added I'll support the bill. -Lonny