On Locate-A-Clinic Changes, Circles, and POCA

The requirements for being listed as a POCA clinic on the Locate A Clinic page have changed. This is the summary of the changes:

The main difference is this: In order to be eligible for LOC approval, all acupuncture treatments must be provided in a group or community setting only, with consistent hours at least three consistent days and twelve consistent hours per week, and these hours must be listed on the clinic’s website.
This means no private, or one-on-one treatments. All treatments are in a group setting. No exceptions. Hybrid clinics no longer will be listed on LOC though individual acupuncturists and patients from those clinics may be POCA members.

But why write a blog about it? Because I think it’s a good opportunity to talk about how POCA works as a co-op.

I went on and on about this in Fractal, but I have to say it again: POCA is unusual in that what we organize and share is not financial capital, like a lot of co-ops, but social capital. For us, social capital means goodwill, word of mouth, and a staggering amount of volunteer labor. And to quote the keynote speech again (because I’m lazy that way):   as acupuncture patients, we’re trying to ensure a stable, reliable supply of affordable acupuncture for ourselves and everyone we care about; and for acupuncturists, we’re trying to build a collective patient base that is big enough to support all of us to make a living. That’s what our co-op’s about.

When we made POCA as a multi-stakeholder coop, we could have made just three categories: patients, practitioners, and organizations. But we included a fourth category, clinics, knowing that most of what POCA would organize and share was social capital — because clinics are where much of POCA's social capital gets exchanged. Yes, the website is very useful, and POCAfests are really fun, but on a day to day basis, most of POCA's reason for being is happening in the clinics. The clinics are the linchpin. The clinics are where POCA delivers on its commitments.

And if you missed it in previous posts and announcements, our co-op is organized in a vaguely sociocratic style.  From Wikipedia’s entry on sociocracy : The sociocratic organization is composed of a hierarchy of semi-autonomous circles. This hierarchy, however, does not constitute a power structure as autocratic hierarchies do. Each circle has the responsibility to execute, measure, and control its own processes in achieving its goals. It governs a specific domain of responsibility within the policies of the larger organization. This seems to be a really good way to organize volunteers in particular. Because most of the work that sustains POCA is unpaid, the people who are doing it need to enjoy it, and being in control of what you do and how you do it helps a lot with enjoyment.

So what does this have to do with hybrid clinics and Locate A Clinic?

The issue of hybrids has been a challenging one all along; we’ve tried a lot of different things. Earlier this year, as I was trying to rewrite the Remedy, I kept finding paragraphs in it that made me wince. One of those, at the very end, was where I encouraged people who had conventional practices to try to add community acupuncture a couple of days a week. I guess it would’ve been pretty audacious (even for me) to finish my first book with, “And however you’ve been doing acupuncture up until now? STOP IT.” But still, I winced when I read that paragraph, because within a year after we published the Remedy, we all knew that hybrids could be problematic.  

As a result, CAN wasn’t friendly to hybrids. When we were putting POCA together, though, we were changing so many things that we decided to revisit the issue. We decided to experiment with letting hybrid clinics sign up as clinic members and be listed on Locate A Clinic alongside the all-community acupuncture clinics, as long as the community acupuncture they offered fit within certain parameters.

Here’s what we hoped would happen:  a regular patient of a POCA clinic tells her mom, who has debilitating pain, about the wonders of community acupuncture. Mom lives in Any Small Town USA; there’s only one acupuncturist around for miles and miles. Mom becomes a patient member of POCA, and armed with support and information, approaches this acupuncturist about making acupuncture accessible to her. The acupuncturist already has a conventional practice and is hesitant to start doing any community acupuncture; there’s no way in hell he’s going to overhaul his entire practice. Mom won’t give up, though, and she eventually persuades Mr. Conventional Acupuncturist to start offering community acupuncture a few times a week, in return for Mom answering his phone, showing new patients how to use the invisible receptionist, and telling everybody she knows about Any Small Town Community Acupuncture — which totally should be listed as a POCA Clinic! Everybody wins, right? A beautiful idea, right? Multi-stakeholder coop in action!

But it didn’t happen. No Moms that we know of were able to persuade any Conventional Acupuncturists in Any Small Towns to make their practices more accessible.

Here’s what actually happened:  a bunch of hybrid clinics behaved badly in POCA.  Sometimes non-cooperatively and sometimes, just plain badly. They managed to annoy POCA volunteers in a variety of Circles. Some of them were just difficult to work with; some of them told bald-face lies in order to get a listing on Locate A Clinic; some were transparently using their “community acupuncture” as a loss leader and as advertising for their conventional practices. It became clear that a lot of them saw a Locate A Clinic listing as something they were entitled to if they paid their money, and being consistent with POCA’s requirements was merely an irritating technicality. Hybrids were a headache to the volunteer LOC Hammer. Hybrid clinics who asked for help from Clinic Success refused to listen to their volunteer mentors’ advice. Hybrid clinics joined POCA for the sole purpose of getting a microloan; the volunteer Finance Circle looked at their applications and realized that they would never feel good about giving them money. Hybrid clinics reacted with hostility when POCA volunteers opened new community acupuncture clinics in the same (quite sizable) towns.

That’s what some of the hybrid clinics did, but just as important is what all of them didn’t do: volunteer. For anything. Ever.

So when a few different POCA volunteers simultaneously raised concerns about hybrids, the conversations among the Circles all went in the same direction. How are hybrid clinics a benefit to the cooperative again? They’re not fun to work with. The concept of social capital and the principle of mutual aid seem to be eluding them. A lot of them treat POCA like a vending machine: I want this, I paid you, now give it to me! OK, so that part of hybrids-in-the-coop is clearly not going so well. But are they helping us to build our shared patient base? Are they contributing to a reliable supply of affordable acupuncture?

Some people seem to think that being a multi-stakeholder cooperative means trying to make everybody happy. It does, but only up to a point. What is more important for a multi-stakeholder than making everybody happy is balancing the interests of the different member categories so that the coop functions well and everyone has the opportunity to benefit. Members often benefit proportionally to their contribution: you get out of it what you put into it. At this point for POCA, the most important interests to balance are the interests of patients and practitioners. And POCA was founded specifically to prioritize the interests of patients who were not the kind of people who typically get acupuncture in conventional acupuncture clinics.

The feedback from the Circle volunteers was that a lot of them were reluctant to refer patients to hybrid clinics, because the experiences that patients had were at best inconsistent and at worst, not good. The patient members of POCA who were stepping up to do major volunteer work for POCA were not coming from hybrid clinics. A lot of them weren’t enthusiastic about hybrids, either. It became clear that having hybrid clinics on the Locate A Clinic page was doing nothing to help us build our collective patient base, with its collective expectations of affordability, consistency, and a general spirit of cooperation amongst POCA clinics. A few horror stories emerged that suggested some of the hybrid clinics on the Locate A Clinic page were probably undermining everybody else’s efforts toward building a collective patient base. (I’ll spare you the details, let’s just say it’s a good thing that sometimes the Hammer is willing to play secret shopper, so that she can have experiences that we wouldn't want our patient members to have.)

So to sum it up: our volunteer workforce was unhappy about working with hybrid clinics; hybrid clinics seemed to be inclined to do things that were not in the interests of our patient members; it turned out that we had only a handful of hybrids who had actually made it on to the Locate A Clinic page anyway — and so the semi-autonomous Circles of POCA decided pretty much unanimously that the requirements for being a POCA clinic needed to change.

Unsurprisingly, we’ve already been accused of fascism: “by limiting LOC to CA-only, (POCA) is acting more like an exclusive club–Only pure-bloods need apply.” A couple of things about that: if you don’t volunteer for POCA, you may not believe me, but I can assure you that we’re not that ideological. A lot of decisions evolve organically and practically out of the process of being a coop run mostly by volunteers. If you want to see your viewpoint reflected in POCA’s decisions, it’s simple:  join a Circle and volunteer.  I have to say, though, the pure-blood reference is really bothering me. It makes me feel that perhaps all is not entirely well in my personal relationship to POCA. To wit: why do I not yet have a giant snake? And minions? If we’re going to be accused of being pure-bloods, I think I deserve those things. You all can make it up to me by henceforth referring to me as She-Who-Must-Not-Be-Named. I’m cool with that. But I’ll be waiting for my giant snake.

Author: lisafer

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  1. I’m really happy about the changes. I’ve never been comfortable with the idea of a hybrid because it felt like the CA part of the practice existed to sustain/introduce or somehow promote the private practice or, in some instances, keep it going. It always felt like a side dish, not the main course. And, I couldn’t help wonder how the practitioner wasn’t torn between two worlds, so to speak – because private practice is so different from community, in every way actually. Treating an individual for the individual’s sake is so different than treating an individual for the community’s sake. I think CA has been piggy-backed on for long enough. We can, obviously as we’re continuing to prove, stand on our own as united communities across the country. CAN grew up, right? And became POCA. And, we’re here to stay and we’re committed to changing the world, really. If hybrids want to do something different, go for it. The more acupuncture, the better. No one’s gonna tell me I don’t know who I am or what I believe in, in terms of this. And, that feels just right.

  2. One quick addition to this info: if you are a current clinic member in good standing and your clinic is a hybrid listed on the LOC, or is currently in the middle of the approval process, you are grandfathered in until your next membership expiration date. So, the old LOC rules apply to you until your current clinic membership expires.

  3. Has the top end of the sliding scale always been $50? I looked at the guidelines the other day and was surprised by that. $50 seems really expensive to me, like potentially to the point of scaring people away. And I say that as someone with a sliding scale of $20-40.

  4. Hi-
    We do a lot of cupping, gua sha, and herbal consults too. Because the clinic is wellness center too we can offer those services to people who elect them and still keep the CA part of the clinic totally separate. So I’m not sure if we qualify for LOC. We’d sure like to.

  5. Herbal consults must be done on the same sliding scale as the community acupuncture. Cupping and gua sha can certainly be done with community acupuncture and are considered part of the acupuncture treatment, but they must be included in the treatment fee – there can’t be an add-on charge for them.

  6. What we’re doing is a little different but not so much that I think it goes against the guideline. It’s just that we need to do a bunch of different modalities to make the clinic work. The cupping treatments don’t even take place in the community space. So can we charge for those separately as a totally different treatment modality like massage? and not on the same sliding scale?

  7. I don’t think so but that is really something that will have to be worked out with clinic approval when you apply – there is a new process that involves an application to be filled out and evaluated by the hammers. We’ll take a look at your set up and see if you’re within the guidelines.

  8. You know how you don’t know you’re holding your breath until you can breathe again? That’s how I felt when I read this blog post, Lisa. Thank you. And thanks to all the POCA volunteers who make this coop as amazing as it is. Look for upcoming thoughts from me while I’m on vacation–about introducing students to POCA clinic style, about branding POCA clinics separately from the term “community acupuncture,” about how POCA members can support the coop with more participation.

    I love POCA so much. I love it more with the new (old) LOC guidelines. I feel like it’s time to stop referring to our clinics as “community clinics” and time to start branding them as POCA clinics.

    I’m all in. And I’m bringing staff, patients, students, and strangers with me.

    Dear She-Who-Must-Not-Be-Named, if this is the dark side, I don’t want to be a good guy.

  9. So you’re saying that you think I might not qualify for the Locate a Clinic because we do cupping in a separate room and charge for it a separate fee? Patients expect and really appreciate that they can get a variety of services here. We’re truly holistic. We offer a lot classes too, reiki, yoga, nutrition, and movement (dance, tai chi). We attract a lot of people that really appreciate that they are able to support us in giving them access to acupuncture. The true cost of the treatment is not important to us, so much so that we’ve technically been loosing money on the community treatments. But we’re devoted to our patients, and we need to have other modalities and the rent from other practitioners coming in to make the rent. I’m afraid if we don’t get listed on POCA’s site we won’t get as many referrals from other clinics. We mostly signed up for POCA for the listing and not so much the other services.

  10. Healing Chakra-
    It’s great that you’re invested in giving patients what they need, but from what you posted it seems that what you think your patients need and what you or your healing center need are a bit confused, or at the very least confusing to potential patients.

    For example you say that you are loosing money on the community treatments and that you are depending on the rent from other (non-CA) practices for rent. Your idea of separating out cupping as service that you charge an additional fee for also seems to be a strategy to address your money concerns. What your patients need is access to affordable acupuncture. What your business needs is to make ends meet (including payroll expenses.)

    All businesses have to make the bottom lines of income and expenses match, if you could simplify what it is you’re offering, it will make it easier for people to know what they’re getting. This = access. This will drive the success of your business, not trying to be everything.

    Also- not sure what you’re thinking when you say you signed up for the listing not the other services. The POCA LOC listing is the tip of an iceberg. The “other services” are not really services at all, but an open invitation to jump into the forums and blogs. There are thousands of useful conversations, ideas, tidbits, etc. posted here by this community of passionate punks who’ve gone before you. Jump in and serve yourself up some POCA- there’s a lot to digest.

  11. Healing Chakra, if you think there is a “true cost” that you should also ignore then I can tell you haven’t dug into the forums or the wiki or the especially splended new POCA Tv! You didn’t buy an ad on the LOC with your membership fee – you joined a community that has all the resources you need to set up and be successful at running a high volume/low cost community acu clinic. I get it, everyone is crapping bricks when they start a business, it can be terrifying especially when it comes to money. You can do the modalities you like in the community clinic – a lot of punks do – but if what ends up happening is you’ve basically chopped up a private treatment into 7 different visits for each modality, each with their own fee, you’re not really running a hv/lc clinic! So right now you need to go watch Lisa’s classism POCA Tv video, which will explain the numbers in detail, and the set up in detail, and it really goes to the heart of it all. Then go into the forums and get a mentor from Clinic Success (talk about a service!) and do what they say!! And introduce yourself in the all-member Fishbowl. What are you still doing here? Go!

  12. Thank you for this excellent summary of how our process worked in this case. For anyone who is prone to disagree, I can tell you that many volunteers spent many hours of conversation in email, on the phone, on video calls, and in person at POCAfest discussing how we wanted to proceed with redefining clinic requirements for the LOC.

    Our Clinic Success Circle has great, substantial data (thanks to our annual survey) on what makes a successful POCA clinic, and they know what works and what doesn’t. What works? POCA mainstream LOC (as it is now) brings more clinics closer to success than anything else. What doesn’t work? Hybrids of any stripe (including private cupping sessions and separate charges for community and private patients). We don’t know of any hybrid clinics that can successfully balance the different mindsets it requires.

    Our Finance Circle decided we only want our micro-loans to support POCA’s ideals. All applications are scrutinized closely (including 23-page business plans) to ensure that not only does the applicant adhere closely to POCA LOC guidelines, but that they have an interest in POCA’s future and would like to help us get there.

    But mostly, many of us heard back from patients who wanted to buy gift certificates or punch cards for their family members in another town. Their experiences were pretty unpleasant (“They said I could buy a gift certificate for $35 per treatment, and seemed not to understand about a sliding scale. I want my relative to get acupuncture the way I get acupuncture, and they didn’t sound like you guys.” Or, “I was on vacation and I went to a clinic that was listed on the website, but they only had a few hours for community acupuncture every week and tried to get me to make an appointment for a private treatment.”).

    It’s difficult for us, as punks, to look up every clinic on the LOC to see if they are the “real deal” POCA-style clinic, or if they’re following some made-up script of their own. We wanted to be able to confidently say to our patients that they would have a similar experience in Any Town, USA, if their clinic is listed on the LOC page.

    So I’m very grateful to S-W-M-N-B-N for the blog post, and to all the involved volunteers who thoughtfully worked on the LOC guidelines, and to the GC and BOD for agreeing to change the guidelines.

    Also, I have 5 minions. You can borrow them any time, either singly or in any combination. But they prefer community style, and don’t like snakes.

  13. Healing Chakra Health Center,
    I do cupping and blood letting at the clinic where I work. Not so much gua sha, so I can’t say anything about it in a CA setting. My co-workers and I are all each providing more or less 5,000 treatments a year. We can make time for cupping and blood letting when it seems appropriate. It is part of the acu treatment with no added cost. It is possible to find creative ways to do acupuncture related modalities in a CA setting while sticking to the hv/lc format, but it does mean that they are done briefly, and very rarely if ever, done in a separate room. Listen to Cris and Kim, dig deep into the forums.

  14. Thank you everyone for your support and comments. I certainly will check out the forums.

    I love CA and what POCA has accomplished. I never went into acupuncture to make a lot of money. I went into it because I wanted to help people. Now I feel like because my clinic is part of a multi-disciplinary health center I am being penalized. What gives? Isn’t POCA’s mission to bring more CA to more people?

    The thing that confuses me is that while there is much talk about community acupuncture being inclusive, there doesn’t seem to be much tolerance for more integrative practices like mine. We care for our patients too and that’s why we want to give them lots of options. We do what we do because our patients have told us that they want and need other healing therapies besides acupuncture. We want to be inclusive of those things for our patients.

  15. “There is much talk about community acupuncture being inclusive”- that’s absolutely right- inclusive for our patients! No one’s “not tolerating” your clinic. It just doesn’t fit on LOC, for all the many, many reasons listed above. There are indeed a number of places in the world that offer CA as part of a variety of services, or within an existing health center, or even in a non-healthcare setting. Great. But those things are not POCA clinics as we define them, and so they’re not listed on LOC either.

    You are more than welcome to be a member of POCA if you support our mission, and your membership comes loaded with a really unbelievable number of resources, including the forums, Wikis, mentorships, and more. As many have said, the LOC listing is not something you can purchase. There are numerous web-listing services out there should you want that kind of service. That’s not what POCA provides.

  16. That is well said, Demetra. Being inclusive is not the same as one stop shopping and being all things to all people. You wouldn’t go to a pizza shop and ask them for sushi or a Pho noodle take out place and ask for pasta and meatballs. Our clinics offer acupuncture, some clinics do herbs, but we don’t do massage, or yoga, or ionic foot baths for a reason. All of those other things, even though they are great, muddy the waters to providing low cost/high volume acupuncture in a sustainable way.

  17. I hate to say this but sometimes the community acupuncture community seems un-necessarily harsh. We all work hard for our degrees in acupuncture, as well as to learn many other things that can help others. I work with a great bunch of alternative healers and I love being around all of them as well. I wouldn’t want to practice in such a limited way as to only do acupuncture. I want and need to make a fair wage doing this work which is why I have creatively designed my clinic the way it is. I try to do as much as I can on our community days. I even do back treatments for people who need them. I wish you all could see how your vehemence might drive more sensitive people away.

  18. Healing Chakra,
    I don’t know how you were introduced to community acupuncture- but if you attended a CA 101 training you might remember Lisa’s metaphor of the clothes that people wear to a party. In a CA clinic, we’re basically geared toward those who would find something in a thrift store or Old Navy, and try to get a lot of use out of it. From the sounds of it, your practice is more of a Macy’s or a more expensive dress shop with a sale rack in the back. If your community practice is loosing money- figure out why- and take the sensitivity out of it. Make use of clinic success for as long as you’re a poca member, and really listen- those people have extremely busy clinics and know what they’re talking about. It’s about numbers, facts, not emotions (maybe somewhere in there- but it’s business and what does and doesn’t work reveals itself). Something about the way you’re interpreting community acupuncture is not working. From the sounds of it, you have a community clinic hidden in a spa. Most people who need community acupuncture are not going to venture into that setting. I’m really not trying to be mean, but even the name of your clinic is going to lose a lot of people. A reference to chakras is not what people who aren’t already into yoga etc. are going to relate to. (In all fairness I would even change the name of my clinic Barefoot Doctor if I didn’t already have so much word of mouth referral!) Last, I don’t know about other people, but I get probably 1% of my patients from finding me on LOC. I’d say 95% from word of mouth and the rest just because Im an affordable clinic in a particular area of Philly. There is so much support and information in these forums, blogs, and now Poca TV that can help you- you should take advantage of being a member! If you just want a listing somewhere you you can find that on the NCCAOM site or Acufinder.

  19. From the blog: “This means no private, or one-on-one treatments. All treatments are in a group setting. No exceptions. ”

    Roppie, July 8 comment: ” It is possible to find creative ways to do acupuncture related modalities in a CA setting while sticking to the hv/lc format, but it does mean that they are done briefly, and very rarely if ever, done in a separate room. ”

    The 2nd statement appears to violate the ‘no exceptions’ statement in the blog. Which is correct: no exceptions ? or rarely/sometimes do treatment in a separate room (w/ no additional charge for being in the separate room)?

  20. Hi David-

    Private treatments as referred to in the new (old) guideline is specifically about private acupuncture treatments. LOC is no longer going to list clinics with both private and group acupuncture treatments, but instead will only include places where acupuncture happens in a group room. There is no acupuncture done in private rooms.

    For cupping, gua sha, bleeding- the new (old) guidelines say you can’t be charging a separate fee for these things- they’re included in the price of treatment.

    Some clinics will put a patient on a table- say in the intake room- to do some quick bleeding or cupping. But they don’t do it often, and they don’t leave patients in there for more than 10 or 15 minutes and they don’t do it as a course of habit.

    Some clinics bleed, cup, scrape right there in the recliners. There’s lots of dependent factors, who the patient is, who the punk is, what the patient is wearing that day, etc.

    The guidelines are a way to steer clinics towards the best practices that will help them stay in business and to keep giving more acupuncture AND to give patients an experience that is consistent when they travel between clinics, or send their loved ones to clinics hoping that they will receive treatment in the same kind of setting that they know and love.

  21. I’ve already said that I don’t think it’s fair to be limited to only do acupuncture. There are times when my training from my teachers can really help someone and I don’t understand how any of you can educate people, properly in a group setting. Proper nutrition, and other lifestyle advice are essential to a patients evolution. Why does POCA feel that it can tell people how to best practice when you all have no idea about my extensive training, and healing intuition.

  22. and furthermore the sliding scale is hard to explain, and I don’t want to give my private patients less. And they’re the ones likely to pay more because they know the true value and worth of my treatments. That will at least help support the community clinic and those who can’t afford to pay more. I feel like I’m being generous offering group treatments at all.

  23. HCHC: I have not talked to any of the other people who responded to your comments, but here’s my 2 cents.

    Community Acupuncture is ACUPUNCTURE. You are obviously not a good fit with POCA, or you would understand this already.

    Your comment, “I feel like I’m being generous offering group treatments at all” makes this abundantly clear. Good luck with your multi-modality approach. It’s not what we’re doing here.

  24. “I feel like I’m being generous offering group treatments at all.” Then please, please stop. Please. Just do what you actually want to do, and don’t do anybody any favors.

  25. HCHC~ I am a CA patient, so I do not know much about acupuncture training, patient evolution, or healing intuition. My thought is this: surely anyone would value a treatment that makes them feel better. However, valuing the treatment does not magically make more money appear in a checking account. I DO know that I can go to a CA clinic, pay an affordable rate, and feel better.

  26. I can say that I’ve tried every which way to make a hybrid practice work under the assumption that I couldn’t make a living wage from CA and thus would need to use the private treatments to “fund” CA – and it didn’t work! If you do CA right, you can make a living wage because you’re treating more people in a given time slice than you can in your private practice.

    I found that some patients just want an hour or so of my undivided attention, and those were the ones coming to private treatments even with a community option available. For the most part, though, when I succeeded in talking these folks into CA instead of private treatment, they were just as happy being with a group of people as they were with the one-on-one! (Oh, my bruised ego!) The rest for the most part could afford to go to another acupuncturist if they were stuck on the idea of one-on-one.

    So, from an income and service perspective, there’s really no reason to go hybrid at all…

  27. So I’ve tried to search the forums and I’m not really finding the answer to this: how to treat the patient who has a condition that you know would benefit from points located in areas that you don’t want exposed in the CA setting? For example, GB 30 for the person with sciatica, or belly points for qi constraint around the middle… not by any means an inclusive list…

    I did see one post where I think Lisa advocated using the expedient treatment that was best for all over a treatment that might be best for a given patient, if there was this sort of conflict between the open room and a patient’s privacy (please correct me if I misread that). So is this always the case? If you feel that a back treatment, for example, is what a female patient really needs but you can’t do it without removing the shirt, do you go with a “lesser” treatment? Is there such a thing as a “lesser” treatment? Or do you put the patient in a private room, or screen off a small section in the CA room – or does this create unnecessary divisions?

    I’d like to give my patients the best treatment possible but, assuming I know what that is (!) – is it always possible? I would love to hear some creative answers from those who have dealt with the same issue.

  28. We treat almost entirely with Tan, and have no sense of treatments being “lesser” by choosing distal points over stomach or back or chest points. We definitely wouldn’t treat this way if we thought our patients were “missing out on something”! Congrats on moving out of a hybrid clinic!

  29. ckstopford,
    you gotta dig deep in the forums. There is a lot, a ton, of info on treating with distal points. Keep an eye out for CA 101 classes and where they are happening. Go to the WCA website and order a copy of Acupuncture is like Noodles, get a copy of Dr. Tan’s Acupuncture 1,2,3 and/or take a class with him or with someone who teaches Master Tung methods.

    so much info, dig deep!

  30. I just re-read my copy of Acupuncture is Like Noodles and I’m adding to it with my own point prescriptions as I go. What I love about that book is that every time I hit a roadblock where my conventional acupuncture training kicks in and says, “yes – BUT….” I find a line in the book that rekindles my confidence that anything that can be done in a CA clinic is just as good as any other acupuncture treatment (maybe better, in some respects).

    I’m not (for a number of reasons) treating a high volume of patients right now and I think the key will be to do lots of distal treatments on lots of people. Confidence and the ability to experiment without worrying about the “perfect” treatment comes with treating many patients, many times, in rapid succession. At least that’s what they tell me!

  31. One thought:
    I just visited my parents near Charlesron, SC, and had the chance to visit Chad at Charleston Community and Ortho Acu.

    And it got me thinking about his practice, and Steve Knobler’s practice in WA…and made me wonder… didn’t CAN have two search options under LOC? Straight CA clinics and other members?

    $40-$60 sliding scale is a damn sight less expensive than most ortho clinics, and these folks also have tons of CA hours that fit POCA guidelines.


  32. This question about the historical precedent of CAN having had a LOC listing for CA clinics and a member listing that listed all members (remember there was only one type of membership in CAN), and how that might apply to clinics now- is one that we considered when we changed the LOC guidelines the first time, and then when they were changed back this most recent time.

    POCA exists to support its mission of providing lots of affordable acupuncture, and lots of things happen to that end- lots of organizing, trainings, job creation, day to day punking, forum posts, mentorship, loans, etc. right… so there are lots of different things that support POCA’s mission- so why not an acupuncture treatment that is say 1/2 or even 1/3 the going boutique rate? Why doesn’t this support POCA’s mission you might ask?

    So while it’s great that people are doing what they can to make their services more affordable, what is really affordable? If the median income for US households is $51K even $40/wk say for 1x week x 4 weeks- is about 11% of that weekly household income.

    On a $15 to $40 sliding scale- if the average payment is say $20 per tx- that’s only 5.5% of weekly household income for at least 50% of the households in the US.

    POCA clinics as defined by the LOC guidelines (and btw the sliding scale range was not what was changed)- hours, set-up, systems, really nice people that we like- all super and good-but if it’s mostly affordable, or kinda affordable, it’s not really affordable to most people.

  33. sorry garbled last paragraph-

    POCA clinics are not only defined by the hours, systems, set-up, separate from the sliding scale. And not only is a higher sliding scale not really affordable, but the issue of private treatments is what was really up with this return to the old LOC guideline. I think private treatments sufficiently confound the whole of the system to say that they actually interfere with POCA’s mission.

  34. Thanks for your comments Nicole. I appreciate your mention of Chad’s and my clinic.

    For the record, we provide ALL our treatments in a community setting and we don’t do insurance. About 80% of our patients get regular treatments, at $20-$40, and the remaining 20% pay in the $40-$60 range. Our average payments are $25 for regular treatments and $45 for ortho treatments.

    We have two fee ranges because we spend much more time with patients who have really debilitating conditions or injuries. We only see 2 per hour for ortho treatments, but always in a community setting. We have 2 rooms with 3 and 5 chairs/tables each. There are no dividers or curtains. At 2 treatments per hour, we charge more in order to keep our doors open and many are happy to pay it. Why? Because folks typically heal in a lot fewer visits, so ultimately, they pay less.

    I don’t see us as a hybrid and when we were taken off the LOC page, I wrote multiple emails trying to explain our setup. I got nowhere, so I dropped the discussion. It’s sad, because I remember talking with Skip about ortho and he encouraged me to find a way to fit it in the community model. I thought we came up with a good solution.

    Since joining CAN/POCA, I’ve contributed much on the forums, and I know several folks have benefited from the Excel business planning model I created. I love community work and am totally committed to it. I wish all POCA clinics success in finding their best way to deliver low cost, high quality, community service to those in need.

  35. Thanks Nicole for bringing up my name/clinic and Steve with a neutral question. I love everything about POCA, I love and admire most of you, and am proud to have been a part of the movement from the early stages. I am ever grateful for what I have learned from Lisa, Skip and CAN that got me up and running in 2009. There is so much to be said about what Steve and I(and any other clinics)are doing and how it works for us, and our patients/community and as I have read above from cris, MM, and others, arguments against it. I am not a bad guy. Neither is Steve. I actually think Steve is one of the nicest men I have ever met(and I am not just saying that). Steve and I did not collaborate except a phone call or two, it just happened that we had similar ideas/visions of the nuts and bolts of our clinics and a deep desire to change up how the clinic runs things. I hope that you see that it is a successful business model based on the LOC business model that is replaceable and reproducible. Also, in my opinion, it works really well. It provides treatment OPTIONS for patients who want them/need them. I have so many patients who ask for it upfront(local needling with estim or cupping), came to CCA because of it. I wish there was some common ground that could be found to maintain in the LOC guidelines. I ask that a new blog or if you may, a behind the scenes discussion take place that would address the inevitable and constant change/growth of POCA/CAN.

  36. Steve and Chad, you may have noticed that this blog was originally written over a year ago and these guidelines have been in place long enough that we are all pretty comfortable with the decision made to put them in place. In discussions that were not behind the scenes, we have gone over the possibilities several times, revisiting the logic that drove this latest iteration of the guidelines, and still are quite comfortable with them.

    Everyone, and I mean everyone I know of, was disappointed to lose your clinics from the LOC. Northsea and Charleston CA were anchors in POCA since before there was POCA. And we miss your voices in the forums.

    That being said, POCA LOC clinics have found ways to serve their patients very well without resorting to a two-tier payment system. I don’t think anyone would consider your clinics as hybrids, but the two-tier payment system and the “more-personalized” nature of the orthopedic treatment creates a situation where patients may come in thinking they will be paying on a POCA-type scale but encouraged to take the higher-payment treatment.

    So a patient might think, “oh, if only I had the money to pay more for the ‘better’ treatment, I could feel better faster”. Surely you can see how this is not in keeping with what POCA is suggesting as a standard?

    No one disputes your right to set up your clinic the way you envision it, or your need to serve your patients in a certain way. We are just not able to say to our patients, “send your family member to this clinic, where they will have an experience very much like the one you had here”. That is the essence of these LOC guidelines.

    There are a lot of clinics, at least 184 of them as of today, that are getting results similar to yours with treatment systems that allow them to stay within the LOC sliding scale guidelines. That’s a clear-cut choice.

  37. I’d like to bump this thread back up for discussion because it’s almost three years later, and I’m wondering if my new clinic is going to fit the LOC guidelines. I’m starting over again by opening a clinic in an area where no one knows me (I moved here a year ago). It’s an underserved area in two of my favorite fields: acupuncture and nutrition. Last month I decided to open a combo-CA and Nutritional Counseling clinic. I’d be wearing two different hats at two different times. I’ve always had the problem of wanting to give nutritional advice at the same time giving acupuncture, and realize that’s not a good practice for a CA punk. The conversation slows down and dilutes the acupuncture offered to the public.
    So I’d like to have separate hours for acupuncture and separate hours for nutritional counseling. No private acupuncture at all. And when I’m giving acupuncture, if I think the patient needs nutritional help, I can quickly suggest that they look into patronizing the nutritional part of the clinic, too, at a separate time, in a different format. The introductory information will all be in the waiting room.

    Do this invalidate a membership as a POCA clinic? I have no intention of sneaking into the list without revealing this other face of the clinic. the thread seemed to end here, so I am guessing that the 2013 changes still hold for LOC inclusion? I leave it to you to decide, and will honor your decision whatever it is, as I know it is always made for the good of the entire community.