Saturday, July 21, 2007

Teeter-Tottoring with Community Acupuncture

Lately there has been much buzz concerning community acupuncture as such clinics have been popping up all over the country. These clinics offer acupuncture on a sliding scale fee from between $15-$40 per session with treatment taking place in a group setting, These patients are typically placed in a recliner rather than on a table, and remain clothed as the majority of points used are distally located. According to the Community Acupuncture Network:

Acupuncture has been a community based medicine for most of its long history. In Asia, acupuncture has traditionally been practiced in group rather than individual settings. For acupuncture to be most effective, patients need to receive it frequently and regularly -- far more frequently and regularly than most insurance plans will pay for. As acupuncture has moved toward the mainstream, it has been forced into a paradigm of one-on-one treatments and high prices, which has decreased not only patient access but treatment efficacy.

While on one hand, this may be a cost efficient delivery model, the first thing that comes to mind is "what about HIPPA?!" Where is the patient confidentiality? I suppose this differs from clinic to clinic, but I can't help getting the image of the dryer section in a beauty salon with everyone knowing each other's business. The range of reactions to treatment, especially in those with mental/emotional issues, are not often things to be shared with strangers.

I am interested in the use of the word "efficacy" when they are cutting out a good number of acupuncture points and limiting available modalities. Sure, you can get great effect using the yuan primary, xi-cleft, and eight-extra meridian points, but you mostly eliminate Mu and Shu points as well as the local ashi for pains on the back and lower abdomen. What about moxa, plum blossom and cupping? Is there time for electro-stim or tui na? Is several affordable treatments lacking in completeness truly better than one full, private session?

Also, I wonder about the patient-client relationship. Much of the reason many of us go into alternative medicine is to have a more personal contact with our clients than many of us may have experienced with our primary health providers. This model sounds dangerously close to factory mill. It also increases the possibility of mistakes or accidents.

By providing lower cost service, are you still providing the same quality care that you would one-on-one or is the client, "getting what I paid for?" You are also undercutting other practitioners by providing a cheap service that does not represent the full spectrum of the medicine. It is up in the air whether this coveted "boost in awareness" of acupuncture will serve to bring the profession up or put it on the level of the corner trend market (remember the oxygen bar?). To put it another way, you don't see internists or GPs hanging out there shingle with an advertised price. Sliding scale fees in western medicine are typically done through organizations that verify employment and income. And no one I know has a very high opinion of the "stop and doc."

Lest you think I am totally dismissive, this style does have advantages, especially for new practitioners, in that you can see more patients and gain rapid assessment skills while honing your treatment style. You can see a broad range of people and conditions that may have otherwise not had access to treatment, potentially put new clients at ease by the casual atmosphere, and, pardon the bluntness, increase your income stream in a way traditional acupuncturists cannot accomplish. There are all kinds of things you can add, such as auricular acupuncture, foot cleanses, and massaging chairs, that would add to the experience and effectiveness. Just as cognitive behavioral therapy has been found to be a good adjunct to traditional psychotherapy, perhaps group acupuncture for people with similar ailments would have have an amplified effect.

An intriguing model would be to have a duel practice similar to the Western MD "group". Partnering with another acupuncturist(s) allows for a combination of both models thereby offering more options to your patients while having a few other professionals to consult with. Hmmmmm . . . .

Monday, July 16, 2007

I'm Back

It has been a couple of months since my last post and there has been quite a bit of news in the acupuncture world. More research and testimonials as to the effectiveness of Oriental Medicine, more worldwide and national coverage of local clinics and larger hospitals, more emergence of community acupuncture clinics that, depending on who you are talking to, undercut peers and undermine the profession or provide low-cost therapy to those who could otherwise not afford treatment, . . . more "asian medicine" clinics being busted for a phony prostitution front. Any way you look at it, acupuncture has been in the news while I have been away and I am ready to pick-up and resume inserting my 2 yuan. In the meantime, here are a couple of websites/blogs I have run into in the past few days. Enjoy!