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July 12, 2007

Friendly Arguments Over Community Acupuncture and The Hinchey Bill

I found a blog post on the Community Acupuncture Network Site complaining about a dig I made about Community Acupuncture (CA) in my post about the Hinchey Bill. The poster also seemed to have much issue with the bill.

I wanted to re-post the CA blog entry and my response so everyone can have their two cents.

The Hinchey Bill- Where do I sign up!?!?????
Post by Skip on July 09, 2007 04:49PM

The ol' Ball and Chain (that's Lisa Rohleder) pointed out that TCM Student posted about the improved prospects for the Hinchey bill in Congress with a gratuitous snark at Community Acupuncture (CA), to boot, back on May 25. My apologies for not keeping up with the latest in what TCM Student has to say!

Anyway, that got me to thinking about the Hinchey bill and does it really mean potential doom for CA as we know it as Mr. Student hopes? Honestly, after getting over my laughing spasm, I can't say that it will affect CA even if it does pass. Why?

- The Hinchey bill would cover 49 million Americans, potentially. That's out of a total U.S. population of 301 million and change. So we are talking about a sixth of the population. So when the TCM Student says...

Additionally, all those "Community Acupuncture" clinics popping up across the country would be defunct in my mind cause REAL community Acupuncture would be done by a societally funded healthcare...aka...Medicare.

...he's confusing Medicare with a hypothetical federal health care program (like in Canada or various countries in Europe that don't cover acupuncture). Again, the Hinchey bill doesn't cover five-sixths of Americans.

- Working Class Acupuncture sees about 325 people/week. I estimate that maybe 3-8 of those patients get Medicare. (That's 0.9-2% of our patients.) We see no one who is eligible for the FEHB (Federal Employee Health Benefits) program.

- Looking further, one-fourth of the FEHB participants are already eligible for acupuncture (sometimes only from a M.D. acupuncturist) so you should cut out close to 2 million of that 49 million.

-Speaking of M.D. acupuncturists, though the Hinchey bill defines qualified acupuncturists as being any state licensed acupuncturist, it is noted that the exact definition will be decided after this bill is passed. Maybe the definition will remain any state licensed acupuncturist but to my mind the definition can only get narrower, potentially cutting out many currently licensed acupuncturists. This makes me leery.

- The bill also does not say what exactly will get covered. What CPT code items might we get to treat, if we are actually allowed to treat in the first place? this also will be decided after the bill is passed and not by us.

- Finally the bill does not give out rates of reimbursement (obviously) though it says that we can't normally charge more than 115% of Medicare approved rates. I see this and think, would this affect me? I can't say I know for sure but I think of two types of practitioners:

a) An acupuncturist acquaintance of mine here in Portland has a thriving ambulance chasing practice where he charges $200+ per visit. My guess is that he isn't holding his breath for the Hinchey bill to pass.

b) For years now we've heard of M.D.'s who have opted out of seeing Medicare patients because of both the brutal paperwork and also the low reimbursement rates. Leaving the paperwork question aside, low rates is one of the most important tenets of CA. My guess is that if the Hinchey bill ever makes it through to be signed by some president, the rates we will see will be a lot lower than what most acupuncturists are hoping for.

So let's summarize:

- Five-sixths of Americans won't be covered.
- The definition of what an acupuncturist is isn't defined.
- What might get covered (the CPT codes)_ isn't defined.
- The rates also aren't defined.
- All of these undefined things will be decided by the same bureaucrats who have driven allopathic medicine crazy with their rules.
- All this for from .09-2% of our (WCA's) patients.

Yep, sounds like one helluva bill to me!

Seriously though, a couple things come up from reading the Hinchey bill and TCM's snark at us. One is that once again an acupuncturist just doesn't get it that most people are not covered by Medicaid or other insurance plans. The great majority of Americans have to pay out of pocket for acupuncture and even if the Hinchey bill passes they still will.

This makes me reminisce of when I was in acupuncture school in the early 90's. Back then, it was thought that very soon insurance plans everywhere would start reimbursing for acupuncture. For a couple of years some more insurance carriers did indeed extend coverage to acupuncture for some of their plans. But since then there has been a reversal of that trend and there's no sign of that changing, Hinchey bill or no Hinchey bill. Just the difficulties of getting the Hinchey bill passed should show acupuncturists where they stand in terms of health care reform- nowhere. Not even on the edge. The general public, including the Democrats and Republicans in D.C., know that there are big problems in the health care system in this country. But acupuncture is not on the table as being even part of the system. Acupuncturists in general are so far out of the loop that many of them are hoping that they can get a Hinchey bill passed which doesn't even address any of the health care problems in the U.S.

Look folks: there aren't enough acupuncturists around to get a seat at the table of health care reform in this country. Until we get our numbers way, way up we will not even be an afterthought. To get our numbers up we have to change how we do business since what we are doing now isn't working.

CAN is trying to get a discussion on how to do that by working on one potential solution. That's a lot more productive than waiting for the government to save us. And the bottom line : CA won't be affected by the Hinchey bill even if it passes, even if TCM Student hopes it is -- and what's THAT about, anyway?

TCMStudent's Response:

TCMStudent guy here. Thanks to Blythe for posting (again!) on our message boards about Community Acupuncture (CA) and this blog so I could see myself getting lynched :).

First, so as not to make everyone angry, let me explain why I took a little dig at CA. I was mad. I had just gotten an invitation for an event commemorating the beginning of a CA clinic in Philadelphia (which would be the second actually). The event was to help raise money for opening the clinic. I applaud the concept of CA, but unless you are actually starting a non-profit (which wasn't the case here), CA is just another business model. I was peeved that someone was essentially asking for a free donation of venture capitol to help them start their business, under the guise of helping the community. At the same time I was also ticked off that the Hinchey Bill only had 12 cosponsors, and has gotten no strong support from the AOM community for the past 13 years it's been brought up in Congress.

Second, let me share my thoughts on medicare and my long view on the medical system in this country, and why I think CA would be crazy not to support it.

First off, Mr. Skip, I understand that Medicare and FEHB only cover a small percentage of Americans. Yet how you can possibly scoff at instantly adding 49 Million people to the "covered by Acupuncture" category? If every CA practice in the country grew exponentially it would take a long time to reach that many possible patients. I feel it's hypocritical to claim your goal is to "get our numbers way, way up" and not see the benefit of adding Medicare to the list.

My general goal for this bill, and what I think it will do, is to create a domino effect of coverage. Achieving coverage for Medicare will slowly lead to coverage in all aspects of government funded insurance including Medicaid, CHIP and all the state programs. This could boost the numbers covered by another 20 million. Additionally, the case has generally been that third party insurers tend to follow the lead of Medicare in both determining what they cover and how much they reimburse. The Hinchey Bill will set the stage for the Blues, Aetna and UHC to follow Medicare's lead as they tend to do. I'm not naive here. This will take TIME! Let's get the ball rolling already so it can happen. And there's always the dream that we will expand Medicare to cover every uninsured and then we'll be way ahead of the curve (as the NHS in Britain is doing now).

As I said in my post, Medicare coverage will also provide a new setting for Acupuncturists other than cash based ones...the hospital. I'll tell you when I graduated I wanted nothing to do with setting up my own business. I couldn't understand, and still don't, why we don't have hospital privileges. Ms. Casey, I'm amazed that a CA-minded person would be against having Acupuncturists in hospitals, regardless of the condition they are currently in. Is CA a lifestyle choice or a way to bring the treasure of Oriental Medicine to those who most likely would never be able to afford it? Don't get me wrong, hospitals are for certain broken. Yet where would you go when in a car accident, or diagnosed with cancer, or just had an MI or TIA? Hospitals aren't going anywhere and for Acupuncture to TRULY reach mainstream and reach the greatest number of people, it must be available in every hospital. Even if Acupuncture ends up just being another tool in the arsenal of allopathic medicine, so be it. That in itself would be the definition of mainstream.

Skip, you said something which proves why we DO need the Hinchey bill. You said: "But acupuncture is not on the table as being even part of the system." The Hinchey bill will MAKE us part of the system. When the sorely needed revamp comes of our health system, I want Acupuncture to already be a part of it and get swept in with the changes. That's just pure political strategy.

Please, everyone, don't misjudge my dig at CA. I don't actually think that if the Hinchey Bill passes that CA will be gone, nor do I wish it to be. To me, CA is a great adaptation of easily accessible retail medicine, just like having a nurse practitioner at a big box store is becoming for allopathic medicine. My first clinical rotations were done in free or low pay clinics in depressed neighborhoods with three of us seeing about 50 people a day (in Boston, MA). I know how CA works, I've done it in the past and I support it fully.

Also, Skip, don't misjudge my desire for socialized medicine as "waiting for the government to save us." Access to quality healthcare for all is, in my opinion, the greatest step forward our healthcare can make. Then, just like now, there will be ample room for CA based practices like yours, federally covered practices, and cashed based practices like mine (ps..I only charge $45-65 a visit as I try not to be too evil).

Let me go over Skip's summary too:
- Five-sixths of Americans won't be covered.
[1/6 of Americans covered is a fantastic step in the right direction.]

- The definition of what an acupuncturist is isn't defined.
[This is on purpose because Maurice Hinchey's sole purpose of the bill is to get coverage for non-MD Acupuncturists]

- What might get covered (the CPT codes) isn't defined
[and never is when setting a federal mandate. This could work to our advantage to set up codes for herbs, moxa, and other supplemental techniques...don't focus on the negatives here.]

- The rates also aren't defined.
[don't worry. they'll be low. it's medicare after all. Though, it will probably equal CA rates, probably higher in the beginning, so CA has nothing to lose.]

Thanks for reading. Just as an FYI, I'm posting Skip's post and my response on TCMStudent so my message boards can discuss this as well.

Steve Mavros, L.Ac. - Admin - TCMStudent.com

Posted by Admin at July 12, 2007 02:07 AM