Means Testing, the Sliding Scale and Reduced Lunch

The power of the sliding scale is its ability to provide an inlet for working and middle class people to experience acupuncture. A $15-35 or $40 sliding scale is a strong motivator for people to try something they have no experience with. Couple this with a recommendation from a trusted friend or family member and you have a new patient. Often times, however, I am asked how I know that people aren’t taking advantage of the sliding scale and paying at the low end when they could afford to pay higher up. Wouldn’t it make sense to perform some form of income verification or means testing to assure that I am being properly compensated? My position is that means testing is exactly the type of thing that will deter working and middle class people and by no means should be considered a good business practice in the community acupuncture model. Also, if you are considering it, you should check your motivations for adopting community acupuncture and consider the effects it can have on the mentality of those you seek to serve.

When I was a kid we were eligible for and received reduced lunch. While other kids would pay about a dollar a day for their meals, my siblings and I would pay only a quarter. When we got to the cashier, we would hand over our reduced lunch card, it would be punched, we would pay the quarter and go. Every week we would get a new card. While this sounds benign, it was actually a source of much shame and embarrassment for me. It made me very uncomfortable that I was different from the other kids and that I had to go through this step to get my lunch. To avoid this dilemna, I eventually learned to mill about, wait for the line to form and go to the end. Looking back, I was not the only one with free or reduced lunch status waiting at the end of the line.

The point I am making here is that when we do means testing, we are asking people to prove that they are less worthy, less valuable than others. The lunch assistance program really helped my parents out and by no means am I criticizing it here. What I want other practitioners to consider is that no matter the good intentions and positive effects of programs like this, there is an inevitable sense of shame and embarrassment that goes along with receiving it. People, especially working and middle class people want to provide for themselves. We want to be able to take care of our own and just as important, give to those in need who can’t take care of themselves sufficiently. Asking people to somehow prove that they are eligible for a practitioner’s charity will undoubtedly bring up shame and embarrassment in a patient and assuredly cut down on word of mouth referrals. It is unnecessary and should be avoided.

We should not make our patients feel like they need to mill about in the waiting room for fear of shame and embarrassment. Means testing in any practice speaks to the disconnect between the expectations of a practitioner and the reality of economics. That it exists at all speaks to the necessity of the expansion of the community acupuncture model and the shortcomings of a predominantly private room model in this country.

Author: LarryG

CA punk for 12 years. AZ License #600

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  1. Larry, you brought back a

    Larry, you brought back a painful memory for me. Being asked to demonstrate that you deserve a handout is not only a time consuming administrative chore, it is humiliating for the recipient. Thanks for sharing this story.

    Darlene Berger

    Community Health Acupuncture Center

    801 Livernois, Ferndale, MI 48220


  2. thanks for sharing this…

    I think it’s hard for people to know what this kind of experience is like unless they’ve had it — or unless they have concrete examples of how embarrassing/alienating/ uncomfortable it is to have to prove that you are poor enough to deserve help. When I teach workshops now and people ask about using income verification, I tell them that income verification is a great solution to a certain problem:  the problem of having too many patients and too much business in your clinic. If you have that problem, by all means, start asking for income verification — you’ll get rid of all those pesky patients in no time flat. It’s an excellent way to “disperse” your practice.

  3. Its also a huge waste of energy and time

    I am sure some L.Ac. /C.P.A. on the lecture circuit could tell you its easy to do


    I’d rather be jabbin’ steel

    than mistrusting someone’s word

    perhaps there’s a ear point for stinginess for that initial treatment

    love yall

  4. As if “school lunchroom” isn’t nightmare enough by itself….

    …at least I know it was for me.  That story makes me so hopping mad (wtf is the point of making the kids go through that EVERY DAY!? and could we not, as a society, just get it together to prioritize kids’ well-being and education?!!?!?!!?)  It sucks that we would make kids prove that they need assistance just to fill the basic human need (I would say right) to eat; and to do it every day (you know, as if that need is going to change) is just like the 400 blows.

    With means testing, not only are you asking for someone to jump through these hoops, but you’re also doing it about something they need; you’re kicking someone when they’re down, and exaggerating the power relationship.  It’s not like asking someone who is broke but otherwise doing well to prove they need the discount to go do something really fun (see their favorite band perform, or something).  Probably half the new patients we see (in SANTA CRUZ, for god’s sake) have never had acupuncture before, and don’t know whether it’s going to be pleasurable or painful (or painful but worth it); why would we want to alienate them right off, by essentially forcing them to beg for it?  If I wanted that kind of relationship with my clients, I’d quit acupuncture, and make the big bucks as a dominatrix.  



  5. Honor System

    The other problem with means checking is you’re saying to patients you don’t trust them. I doubt that’s the message anyone would want to send – it would poison your relationship before it even starts.

    Plus, people all have issues that may or may not show up on their tax form or whatever you’re using for means checking –
    – Health problems (if under 3.5% of expenses in the US)
    – Child support payments
    – Unemployment
    – Recent move
    – Car trouble
    – A long commute (made much worse by gas prices)
    (and a lot more)

    Just doesn’t seem worth it to me.