CA & Devaluation ?
So I have an interesting story to pass on to the CA folks out there. It is a conversation I had with a doctoral student here at my acupuncture school (I’m a master’s student). I was at my work study job in the library when said doctoral student came in and started to complain about the deterioration of the Oregon Acupuncturist’s Association (OAA) under the leadership and philosophy of the new president (read: Lisa Rohleder).
Being a doctoral student, this person has a Master’s degree already, and has been practicing acupuncture for, I think, at least 5 years. His theory is, in a nutshell, that by charging $15 for a treatment, community acupuncturists are devaluing our profession financially and degrading our practice in the eyes of the medical establishment – insurance companies and biomedical doctors. Furthermore, once the insurance companies learn that there are $15 acupuncture treatments available, they will quickly drop their reimbursement levels. I guess for practitioners who rely heavily on billing insurance, this would be an unwanted turn of events.
From a previous conversation I’d had with this person, I know that he is a proponent of contract work for acupuncturists in clinics run by accident-driven chiropractors, where we can treat pain situations and charge the insurance companies loads of money. He told me this is the only realistic way an acupuncturist can repay student loans while maintaining a regular private practice.
As an uninsured student who is drawn to acupuncture and Chinese medicine for its holistic energetic nature and the idea that it can be very affordable, I was a little put-off by this blatant attack on a medicine-model that seems to tip the scales of health empowerment from the insurance companies back to the citizens. I hear his argument that these companies will not want to pay loads of money when there are $15 alternatives out there, but, to me, it’s the insurance companies that are the bane of this western medical system. He thinks CA is the bane of the his existence as an acupuncturist and is writing his doctoral capstone on this theory.
I will practice CA when I graduate. Our society is in desperate need of a medical paradigm that provides affordable, and therefore usable, health care. I know that there is no one-sided solution to any problem, and i don’t want to compete with MDs. But I do want to contribute one part to a solution. Most of the people in this country (not to mention the world) have no “health care”. If we have the ability and power to provide that missing level of care, why should we not do it? And is it possible to survive as a practitioner on a sliding-scale model? Do we have the power to fight the system?
so then, what is my responsibility?
This reminds me of my first trip to India. I went with 2 Australian friends, who had both lived in Asia for many years and were used to seeing people suffer. However, I was stricken by the poverty and poor standards I saw everywhere we went. So I began tipping and giving extra for what I thought were either extremely cheap goods or excellent service. I felt it was the right thing to do.
Then my friends explained to me that by giving extra I was encouraging the vendors to lift their prices and contributing to the demise of the cheap trade that indeed bought tourists to those areas, without which the Indians in those areas would surely be worse off. And sure enough, this was something I witnessed every day. The white person was clearly charged more, certain vendors had ridiculous prices purely because they had been taught that we could afford more…even the government at the Taj Mahal charged locals 1 price and tourists about 1000% more…
So the dilema…Is it my responsibility to ensure I maintain the status quo, simply because so many people have organised themselves around it, or do I do what I feel is right and let the cards fall where they may? This seems also to be the question for us CA acupunks…
screw that doctorate dude
he’s small minded. what’s more important? intellectualizing or actually helping? my unsolicited advice- look back in 3 years and see the goodness you’ve added to the world with your CA – where ever you practice – and forget about that naysayer. naysaying has been high octane fuel to help me get closer to realizing a CA in tucson. what did Gandhi say – first they ignore you, then they laugh at you, then they fight you, then you win. by following your inner truth, you’ve already won. best on your trip! -keith
My 2 cents
Wow…
Yeah, I definitely agree with Jessica (and the rest of you). This guy’s just afraid. But stop for a minute to see where he’s coming from (not that I support it). Most of us have little to no business training or experience, so you can’t really blame him for getting lured in by the $$$ that chiro’s talk about. (Many of them are not necessarily doing well, but most of their business models rely heavily on insurance. They have to have high throughput and spend a lot of time billing – with all the overhead mentioned above – to make any money. They are also sold on the idea that having a bunch of employees is another way to “work smarter, not harder.”) This guy feels he has done well for himself by entering a system that serves a small number of people unsustainably. That’s his short-sightedness. Let’s have a bit of compassion while trying to open his eyes (and all of those like him). We are not attacking him personally, just starting a new kind of business – “thinking outside the box.” Ultimately, we will never convince these people, but it is nice to have something to say when they get in our faces…
I love Keithananda’s Gandhi quote. Here’s another good quote “Those who say it cannot be done, should not interrupt those who are doing it.” -(credited to multiple sources)
Those acupx (and people in general) who refuse to abandon the unsustainable systems of the past and recognize the needs of today, will be left behind. And they will be angry about it. I have had to sacrifice some of the treatment modalities I enjoy because they were not financially viable. I could not make a living doing privates at $40 (where most people were paying on my sliding scale) and spending most of the time in the room with the patient (medical qi gong, Kiiko style, 30 minute pulse diagnosis…).
One of the best rules in business is to look at what is needed in the world and fill that need. CA is just that. More BA’s are not. More insurance acupx are not. Higher reimbursement, more recognition and all of the other things that they are fighting for are not.
I’ve never been much of a protester. I think that our government is too big and cares too little about what people think (look at the 9/11 protests, or read some Chomsky). I would rather change the world by making people feel better. My patients can do the rest. Once they are more relaxed, in less pain, etc, they will be nicer people (most of them). They’ll make better decisions for themselves, their families, coworkers, the environment, the government. As hard as it can be sometimes, I’d like to follow the Dalai Lama’s example: Calm, patience, and strength in the face of opposition and persecution. Fighting never led to anything but more fighting.
[steps down of his soapbox]
OK…this is an interesting discussion…
But will somebody please explain to me why, if CA is the bane of this particular doctoral student’s existence —
HE IS STILL USING MY BUSINESS NAME FOR HIS WEB ADDRESS??!!??
(www.workingclassacupuncture.net)
Perhaps his doctoral capstone will make it all clear.
Crazy-Making
This whole discussion makes me insane! It’s completely based in fear, believing that there aren’t enough patients to go around. There are over 300 million Americans, 50 million of whom are un/underinsured. WHO estimates that there are 1.5 million physicians in the US, few of whom seem challenged to attract enough patients for their practices to flourish. There are 15,000 acupunturists–1% of the number of MD’s!–and we’re stressed that we might have to fight for patients to treat?!?
Among medical doctors, those who choose to become physicians to the wealthy don’t sit around lamenting that there are so many doctors who take care of the poor. What would that argument even look like?! “Oh, I can’t believe Dr. Smith set-up a low-cost clinic right in the middle of the working class community. Now how am I supposed to attract people who are willing to pay me thousands of dollars for a nose job?! They’ll just go to the cheapy walk-in clinic down the street for their needs…” *sigh*
Doctors who choose to attract a high-paying clientele are grateful for those who choose to care for the working class patients, because it means the high-cost MD’s don’t have to cut their fees for patients who can’t afford the full price of their services. The MD’s actually make more money, because they only care for people who are willing to pay full-price for their care.
Some doc’s bill insurance, others charge private fees, some do a bit of both…I haven’t seen that impact the overall fee structure in the allopathic profession. Everybody does what fits best with their clientele and practice.
If an acupuncturist wants to charge $250 for a boutique treatment, I say let ’em! They have a smaller population to work with, but that’s their choice. If the BA’s all want to fight-it-out and see who can attract the most patients for the highest fee, let the best woman win!
If some acupuncturists want to deal with the hassle and expense of billing insurance companies, go for it. Based on my experiences doing billing for a chiropractor, anyone wanting to do insurance needs to factor in at least $50,000 annual overhead, seeing 100 patients per week, at $100 per treatment for the billing staff, forms, stamps, envelopes, ink, dedicated phone and fax lines.
After all of that, the practitioner is expected to take a price-cut as an in-network provider, losing up to 85% of billed dollars. These practices always carry an accounts receivable, averaging two-months of billed services ($80,000), much of which is uncollectible and ultimately written-off (unless one is also employing a case manager to fight the claims in appeals court…). How exactly does that make more money for the practitioner? I dunno. But if they want to try and make it work, more power to ’em.
If a CA wants to use a $15 – $35 sliding scale, the BA’s can show a little gratitude. There’s no rule that says we all have to charge the same price, or all have to bill insurance. Our communities consist of a variety of populations, some of whom want to pay more for private attention and pillow-patting, others who just want to get in and out with minimal fuss and low-cost, others who want to pay insurance premiums, deductibles, co-pays, and co-insurances to feel like they’re getting an in-network health-care deal. How fortunate that we can all choose which style of practice suites our desires, and then attract the patients who resonate with our values and interests!
Can’t we all just get along?…
Jessica Feltz
The Turning Point
http://www.TheTurningPointAcupuncture.com
Frederick, MD
thanx
Thanks to everyone for the encouragement, opinions and input. CA is such an inspiration to me while I slog my way through the starting blocks… seth
it is a gift to have seen the truth
share it the best you can,
many blessings
Honestly (sigh)…
In my experience while running a CAP for almost a year, the bio-med docs aren’t put off by affordable acupuncture. In fact just the opposite, as the medical provider who forges fresh biz/clinical models for the purpose of increasing access to care is generally appreciated by those who also take care of people for a living.
The acu-doc student plainly spoke of his motivation (second-hand anyway) vis-a-vis riding on the backs of ambulance chasers to take advantage of the insurance companies.. What more needs to be said?…