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 . . . .


Evan said...

I love the community acupuncture model.

The diagnosis doesn't need to be done within hearing of others so confidentiality shouldn't be a problem.

This seems to be the only way to make acupuncture affordable - also an important ethical issue.

With the range of points available treatments it should be possible to treat just about anything.

In Australia, where I am, acupuncture is usually a middle class luxury and this seems to be the only viable alternative.

I'd also like to see acupuncturists educating people so that therapy is not necessary.

A great post, thanks.


Letha Hadady said...

You complaints about chair acupuncture are Bull----. That's how it is done in some areas of China and Latin America. Do you only want to treat people with Money?
I know of an MD in NYC who has treated people for drug addictions using acupuncture in the ears for over 30 years. He has excellent success with ear acupuncture.

You don't need to use moxa and cupping--primative. I use a laser, but using needles for people who cannot afford it works well for many problems.

Whether it is or is not TRUE acupucture according to what you have learned in a clinic situation depends on the clinic. Try looking into what works and why. Then use chair acupuncture for patients who come and pay nothing or very little.

Distal points (in hands and feet) work great for inflammatory problems from headaches and toothaches to dizziness etc. Look into ear and facial acupuncture as well. Some people are so weak or elderly or sick that one or two points are enough to evoke a response. Why use the same point formulas for everyone?

Besides, looking at a person, talking to a person in a chair--dissolves the "I am the expert and you are my patient" power thing. You 2 seem more equal. You can be more open to your patient's needs when he/she is not stretched out on a table and you are howering over.

An interesting topic worthy of serious consideration. Thanks,
Letha Hadady

JING Acupuncture said...

I just love it when people are passionate about their beliefs. Of course I love it even more when people read the entire commentary, not just the portions on which they want to lash out over.

My concerns with community acupuncture lie with HIPPA and safety concerns more than anything. I think you are to quick to dismiss moxa and cupping as primitive - in a clinical setting I have seen these work wonders in stubborn cases. Ear acupunctureis a fantastic modality and the use of distal points are essential to successful treatments - I know very few trained acupuncturists that use "cookbook" style acupuncture treatments. As far as money, you can make a lot more with the community acupuncture model, if that is your goal due to the sheer volume of clients.

I think I covered many of the advantages you refered to in your comment, however I appreciate the point about the elderly that I did not mention. On that note, you may want to check out the work with fractal acupuncture and the one-needle treatments.

As a DAc, author, and teacher, I am surprised that you seem to be disparaging of expertise. As an acupuncturist, you are using your knowlegde to facilitate wellness in others. It is a collabrative effort between practitioner and patient, however that patient is coming to you because they see you as an authority, not because you are a pal who read a book or two on Chinese Medicine. Being an "expert" does not mean that you have to act in a condecnding or demeening manner nor does it mean that you cannot say "I don't know."

I had a chance to look through your blog and it looks like you have a lot of exciting teachings coming up. It is too bad I don't live a little closer to New York or I would love to take some of those duel acupuncture/RN CEUs!

Michael said...

Well, actually, yes, I am the expert.

I have studied long and hard. I have used vast amounts of energy and intention to learn what I have. I use my skills and knowledge to help people.

Believe you me, when I need my teeth worked on, my blood checked, or my car fixed. I am indeed looking for an expert. And I want one with experience and ability.

It is not about power. It is about knowledge and ability. Am I "better" than my patients. Of course, not. Do I know something that will help them with their headache, digestion, or sleep. You bet I do. In fact, if they could have resolved the problem without me, they would not be in my office. I they are anything like me, they want an expert to help them.

Anonymous said...

You all might want to check out the Community Acupuncture Network's public blog:

With regard to HIPAA, there is a lot of misinformation among acupuncturists (and other medical providers) about what HIPAA actually covers and actually means. According to the HIPAA government website, the main focus of HIPAA is the electronic transmission of protected information and there is not necessarily a conflict with treating patients in a community setting. Also, the New York Times recently did an article about HIPAA, and apparently, the only complaints that have been investigated by the government related to HIPAA were ones in which patients requested and were denied access to their OWN medical information.

JING Acupuncture said...

Having had to sit through more boring lectures than I care to remember and working in a nursing specialty where privacy borderlines on the pathological, I can relate to how confusing HIPPA laws can be. I hate having to tell a concerned family member or friend "I cannot confirm or deny that person is a patient here . . . " I also live in one of the most litigious states in the country where everyone errs on the side of caution when it comes to the privacy act. And everything else.

I doubt anyone is going to sue a practitioner because two other people found out they had Liver Qi Stagnation, but it would still behove those in the practice of community anything, not just acupuncture, to be extra careful about discussing details of treatment publically.

Also on that subject, Acupuncturists Without Borders are having some up-coming trainings on emergency acupuncture in the field.