Public Service Announcement, Part One


The collapse of the AAAOM has made my inbox an interesting place this past week.

All sorts of conversations are being revisited in all sorts of places. For me it’s a little weird; it’s like somebody hit the rewind button back to 2007 and I’m having to explain the relationship of POCA to the acupuncture profession all over again. I thought I’d been doing that in the interim (like, a LOT)  but apparently there are some areas that need a refresher.

Area #1: Price Fixing.
My introduction to the term “price fixing” occurred before CAN and before POCA, when I attempted to ask my state association about what acupuncturists were charging and how their businesses were faring. (I had an intimation, if not yet a full-fledged clue, that the acupuncture profession might not be quite what it seemed.) The representative of the association basically recoiled in horror and said that we could never talk about fees, AT ALL, because to do so was “price fixing”.  Back then, no acupuncturist I knew publicized their prices anywhere. If you wanted to know what somebody charged for acupuncture, you had to call them up and ask.

Quick digression! We’ll get back to Area #1 in a minute but before we go much further we should visit Area #2, because everything will make more sense.

Area #2: Me.
Raised working-class. First in my family to go to college, let alone graduate school. My grandfather was a gas station attendant, that’s the stable side — my mother’s side — of the family. My father walks with a limp because when he was a child he was hit by a car and nobody had the money to take him to a hospital. He also had to steal food in order to eat. Do I feel sorry for acupuncturists who are deprived of the ability to work in hospitals and earn upper-middle class professional incomes? Not really. Did I get lots of good middle class socialization about how not to talk about money because it isn’t polite? Not so much. Was my relationship to the acupuncture profession guaranteed to be troubled? Yup.

Can you shut me up, or shut me down, by making me feel like I or my patients or my friends are low class/unrefined/rude/disreputible/not good enough? I know exactly what the world thinks of people like me; it’s not like you can scare me with it, so don’t bother trying.  No wait, I take that back — go ahead and try. You have no idea how motivating it is when you try.

But back to Area #1! If you want to treat people who don’t have much disposable income, you MUST let them know what treatments cost. Making them call you and ask will keep them from getting care. If you want to reach out to people who haven’t been able to afford acupuncture, you have to reassure them in advance that they won’t feel embarrassed if they try to access your services.  If you want to talk about issues of economics, let alone class, in your profession, you have to be able to talk about what things cost. But what with one thing and another, I forgot all about price-fixing until somebody in the acupuncture profession accused the Community Acupuncture Network of it, circa 2008. This was the same round where they accused us of  generally ruining the profession for everybody else, and also of terrorism, so it was an exciting time.

Knowing that a bunch of acupuncturists really had it in for us motivated me (and some other people) to do some research. One of the high points of that research was when I called the Attorney General of Oregon and asked if what we were doing was price fixing. The AG is a busy person and I had to explain it all to one of her assistants, who told me warmly that he thought what we were doing was “just wonderful, regardless”. Eventually I got a message back from the AG’s office that if I really wanted to know, I’d have to consult an extremely specialized lawyer, but in the meantime they were not concerned about us. Fast-forward to POCA’s incorporation when we asked our high-powered business lawyer the same question. His response was that some hallmarks of price-fixing are secrecy and manipulation, so a multi-stakeholder cooperative that publicizes its business practices (including sliding scales within a certain range) was highly unlikely to draw the ire of the federal government.

Speaking of secrecy and manipulation, though…

 I’m not saying that I’ve seen conversations on Facebook that suggest that certain people who are very unhappy about the way that POCA clinics are “devaluing” acupuncture are getting together to talk about “what they can do about it” — but if I had, mind you, I would think that this kind of scheming by erstwhile competitors is actually much, much closer to the definition of price-fixing that is, you know, illegal.  Never mind repeated, public lamentations about how POCA is causing insurance reimbursements for acupuncture to go down because insurance companies can’t tell the difference between community acupuncture and boutique acupuncture. (You know a funny thing? Lots of patients can’t, either. You would think that acupuncture was acupuncture! But I digress.) If you are trying to affect how insurance companies reimburse your services (how a third party determines the value of acupuncture) by putting any kind of pressure on POCA, you are flirting with price-fixing. Don’t. It’s wrong.

Back to Area #2! I know — we know — what you think of us. I know that you feel that we should know our place, or if not, maybe someone like you should put us in our place. I know that you are concerned that our existence is jeopardizing your ability to play the insurance game. If we were more considerate of you, we wouldn’t exist at all, particularly in your neighborhood.  If we insist on treating people who don’t have much money, we should at least have had the decency to wait until integrative socialized medicine fell from the sky and the government paid all acupuncturists $100,000 a year to provide unlimited acupuncture to all US citizens. That’s what we were supposed to wait for, right?  Instead we boot-strapped our way to having our own businesses that treat the patients we want to treat at prices they can actually afford. And we have the bad manners to be proud of it. And to publicize it. And to help each other. And to organize.

One of the ironies here is that we really believe in acupuncture. Unlike a lot of acupuncturists who are quick to assert that “Chinese medicine is so much more than just acupuncture”, we are genuinely moved by acupuncture’s ability to relieve suffering. We ditched the insurance model for two major reasons:  1) insurance that covers acupuncture is a privilege and vast numbers of people don’t have it; and 2) acupuncture often works best in large doses, larger than any insurer will underwrite, particularly for chronic conditions.  Maybe it’s hard for you to believe, but we didn’t adopt this business model just to be difficult, or because we wanted to interfere with your relationship with insurance companies. We wanted nothing to do with insurance companies (or you, but that’s another topic.) We love acupuncture and we love our patients. Insurance companies don’t. It’s that simple. If you love insurance companies, that makes them your problem — not ours.

To be continued…

lisafer
Author: lisafer

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

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  1. Hell yea! You keep amazing me. This is why POCA and WCA rock! This passion. This passion is amazing. I’ve learned so much by being a part of this. I’ve been spreading it into other healing modalities that have been price gouging and keeping people from receiving help when they need it. I wish all healers had this passion for healing all people. I feel this passion is spreading, and soon, health care is going to look a lot more like we see it in the community acupuncture clinics. thank you! <3

  2. It’s my understanding (via my Practice Management class with Marilyn Allen), that insurance companies won’t reimburse a practitioner that charges different prices to different patients. So a sliding scale means we aren’t eligible to bill insurance. Que lastima, so sad too bad.

  3. Hey Lisa – Don’t forget that integrative socialized medicine paying that $100k a year would also include generous benefits, vacation time and – oh yes! A Doctor title! As for “price fixing”, it is true that a professional membership association could be seen as violating Anti-Trust laws if they advocated a specific price structure for professional fees. But that is not what CAN did or POCA is doing. It is apples and oranges. POCA is not violating Anti-Trust laws any more than your local 99 cent store is. Matt Bauer

  4. “We love acupuncture and we love our patients. Insurance companies don’t. It’s that simple.”

    Amen, Lisafer, Amen!!

    Thanks for keeping the fires lit!

  5. “some hallmarks of price-fixing are secrecy and manipulation” and

    ” If you are trying to affect how insurance companies reimburse your services (how a third party determines the value of acupuncture) by putting any kind of pressure on POCA, you are flirting with price-fixing.”

    Excellent.

  6. Speaking of history repeating itself- and not just in the Groundhog Day kind of way that the AAAOM seems to be stuck in…

    I was just reading about the Capper-Volstead Act aka the Magna Carta of ag. coops.
    Representative Volstead, in discussing the Act, said:

    The objection made to these organizations [cooperatives] is that they violate the Sherman Antitrust Act, and that is upon the theory that each farmer is a separate business entity. When he combines with his neighbor for the purpose of securing better treatment in the disposal of his crops, he is charged with a conspiracy or combinations contrary to the Sherman Antitrust Act. Businessmen can combine by putting their money into corporations, but it is impractical for farmers to combine their farms into similar corporate forms. The object of this bill is to modify the laws under which business organizations are now formed, so that farmers may take advantage of the form of organization that is used by business concerns.

    Until the Capper-Volstead Act was enacted in 1922 farmers had periodically been prosecuted for violating anti-trust laws, most specifically the Sherman Act of 1890. In 1913 the Clayton Act was amended to exempt ag. coops who did not posses any capital stock or pay dividends, but this eventually became a problem for the ag. coops who realized that some capital was need simply to serve the needs of the members.

    So two things: any ire from the speculation that POCA somehow responsible for lower reimbursement rates should be aimed at the corporate entities who are ACTUALLY responsible for the lower reimbursement rates; over a hundred years ago lawmakers felt it necessary to level the field a little for the many small farmers growing our nations food; the wealthiest already had the protections of forming corporations. The resurgence of coops is in response to the same needs that were present over a hundred years ago.

    and if you look at modern law suits brought against ag. coops accused of being in violation of anti-trust laws (and in violation of the coop requirements that ag coops that fall under the Capper-Volstead Act must adhere to) these law suits have generally come when these coops are accused of limiting supplies to artificially drive up prices.

    Not only is POCA serving a totally underutilized market for acupuncture services, but we have continued to do nothing but remove the obstacles of cost and access; this could hardly be construed as limiting production. POCA Tech is the antithesis of limiting production too.

    So BAH! price setting my ass!

    https://www.uwcc.wisc.edu/info/capper.html
    https://www.americanbar.org/content/dam/aba/publishing/antitrust_source/Dec10_FullSource.authcheckdam.pdf

  7. Price fixing! What a laugh. You know the detractors have little to work with when they are grasp for straws. It displays how little they understand about business.

  8. Some Acupuncturists do not understand:
    1. State Acupuncture Examiner Boards are in place to regulate the acupuncturist to protect the public, not protect the profession from the public or other businesses.
    2. Antitrust laws are intended to protect the public from artifical high prices, not insure high rates for businesses.

  9. Great info here. The issue of price-fixing came up today, after people and news came back from the 2016 ASA meeting… A simple little question like, “Isn’t this price-fixing?” was put to POCA/Lisa after the Skype presentation. Kind of like asking, “Isn’t everything you do illegal and going to get you shut down?” Some wish it were so, but we knew that already.
    Amazing to hear an argument presented that it’s illegal to purposely charge less, but perfectly ethical to let the free market (free of POCA that is) keep the prices high. For the benefit of private acupuncturists, I imagine, who see themselves in competition with POCA, who see themselves in a better place without POCA.
    Le sigh, isn’t there enough healing to be done for everyone to contribute without knocking one another down in the process? Maybe not by doing things the way it used to work, when affordable acupuncture wasn’t. Assimilate that nutrient.
    Anyway, even if some hammer did fall on POCA regarding pricing, I imagine there’d be a way to adapt and continue to offer affordable acupuncture. Toothpaste doesn’t go easily back into the tube.