When Opportunity Knocks

    Turns out that POCA Fest wasn’t the only exciting thing on the slate for PCA this year.
    Here’s the story: A month or so ago Thundermist Health Center (TM) contacted us set up a meeting at PCA with one their head-honchos. TM had heard of us because one of their lead project managers has been a PCA patient (of course). They wanted to know if we could help them with their chronic pain patients. The guy we met with knew almost nothing about acupuncture, or community acupuncture, but as an engineer I think he was excited, or at the very least understood our concerns about “setting things up right.” We told him that we’d want at least 2 days a week, possibly more and that we could staff it with PCA folks. TM was concerned about cost of course, since they run on tight margins too. I suggested our punks be paid our rate for salaried punks, $25, which was agreeable to them.
    Without a tour of their site we couldn’t get into any more specifics, and so our hour long meeting ended with a brief overview of how TM might be able to have some of their own practitioners doing the needling; basically they (their MDs, NPs, MAs, nurses, detox counselors, family service counselors, etc.) could pursue legislative changes to allow for NADA certified practitioners to practice in RI and we would stand beside them in support of this. Why? Because we want more people to get more acupuncture and at the moment we, like so many other bigger CA clinics, need more punks (did I mention we’re hiring?). Its logical to me that a place like TM could use some of their own employees to help deliver much needed acupuncture care. We all know that legislative changes can take years, but TM guy seemed intrigued by this idea.
    Fast forward a month- Last week we took a drive for a site visit and meeting at their facility in West Warwick, RI. West Warwick (say West Warrrrick) is a typical small New England mill town. Mill ponds and the weedy banks of the Pawtuxet River that once powered the area mills peek out behind duplex and triple-decker houses lining the main street. Bigger, fancier houses, built by the town’s elite, the mill owners, the doctors, the bankers, dot the landscape, as do newer apartment houses, corner stores, and churches- lots of churches. There is still an active industrial zone, with plastic extruding factories, and mills that make this machinery. Driving up a meandering Main Street a few miles after leaving the highway the river bends a bit and then suddenly along both sides of the road are masses of brick and stone rising up from the ground. It’s an amazing thing, rows and rows of brick and windows, waterfalls, steel trussed bridges, some abandoned some housing new ventures like TM. There is a beautiful and awesome architectural consistency to these buildings that says: “The Industrial Revolution happened here.”
    Our tour of TM began as soon as Milagros, one of the office administrators met us up front in the main reception area; a bright relaxed room, with a glassed-in play area in one corner, and round upholstered (orange!) benches in the middle. Twenty-five foot ceitlings with exposed beams, brick, and ductwork made the space feel way less “medical” than your typical doctors’ office. Milagros told us that teams of Thundermist employees had been consulted in the design of the new space. Receptionists had requested no glass between them and patients, and that an electronic pager system (like a lot of restaurants use these days) be used to call patients in for their appointments rather than shouting out their names.
    The 34K square foot building consists of 3 large bays separated by huge tin covered wooden doors set on tracks in wide-arching brick doorways. The center bay is all examination rooms with a large staff room in the center dubbed the Party Pod, which around these parts is said “pah-ty pahd. Around the periphery of the Party Pod are at least a dozen work stations, but right in the middle is a central counter that allows teams of nurse practitioners and medical assistants to sit face-to-face to discuss patient care. Milagros introduced us to the other TM employees who apparently had already heard about us and were eager to know when we were coming. After a few rounds the questions you’d expect (does it treat…? does it hurt?..) our conversation turned to the bigger picture; how could we create more sustainable health care for our communities, and how do we control the negative influence of big corporate interests on health care? It was reassuring to be having these discussions with TM folks.
    We moved on from the Party Pod to the next bay which houses TM’s Quick Care Walk-in center, open 7 days a week. Quick Care, open to the community at large, is set up to minimize emergency room visits by providing easy access to medical care. Behind the Quick Care rooms is a large community room that hosts a demonstration kitchen, a movie screen, projection equipment, tables, chairs, moveable partitions, and a treatment room off to one side. This treatment room is used for group medical consults. Group care is a relatively new innovation for allopathic care where individuals dealing with like conditions like diabetes, or pregnancy, are individually assessed, but then are “treated” or in a group. This money and time saving approach to certain kinds of care where prevention, and self-monitoring make for better outcomes, has also had an un-intended consequence of diminishing isolation and building community. Imagine that! We were feeling right at home. The community room is the room we will use for the community acupuncture clinic.
    Each section of TM has design features built-in for a specific function. The community bay houses the Quick Care, and community rooms, and several rooms large enough for a family medical consult, or a team of medical residents to meet. TM is a patient centered medical home that believes treating a patient means involving the patient’s social network in the process. They’ve designed their space with that in mind. It’s not that another space couldn’t be retrofitted for these functions, but coming from a place where we think a lot about layout and how that can foster or hinder connections, it’s good to know that this is happening in other parts of the health care world. TM hosts a medical residency program affiliated with a nearby hospital’s family medicine department. Across the US there is a growing shortage of family doctors that will greatly impact places like TM over the next few decades. They’re doing what they can to attract people to family medicine, and hopefully they’ll snag a few good, eager young docs from a few of the resident cohorts. Like POCA clinics, many FQCHC’s can’t depend on the medical schools to produce family doctors, they’ve got to put their hands into the process if they are going to get practitioners that get why family docs (punks) are so needed.
    The last third of the building is for staff and administrative uses. It has a kitchen/break room, exercise machines, bathrooms with showers, and lockers. Floor to ceiling windows along the periphery of the building allow a panoramic view outside the building of the river, outdoor patio, community garden and large parking lot where a weekly farmer’s market happens. Milagros told us to visit “her father’s bench” in the community garden, and joked with one of the nurse practitioners about what a flirt her dad was when he came as a patient to TM. “He loved the blonds!” We met another group of clinicians in the staff room who told us they had already heard about us in their “leadership meeting.” There was a friendly, informal, and welcoming vibe coming from everyone we met, patients included.
    It’s a funny feeling that I have about this project suddenly dropping into our laps. It’s not funny-worry; the whole thing seems relatively low risk. Mostly what we need to do is show up to punk; they supply the chairs, the needles, the publicity, the patient base, and our regular hourly wages. I know that we’ll need to expand hours quickly if we want to make CA available to TM and the surrounding community. TM is starting us out with 2-2hour shifts per week in the community room. We’ve already told them that we think 3 shifts per week would be better, and they’re open to that it seems. For now the existing PCA staff is going to take on those shifts. But I have questions for TM, and for my accountant, and for all of you folks running clinics and/or reading this blog. I’m going to post some of those questions here inside the forum here.
    Last week I mailed TM a package with Fractal, Acupuncture is Like Noodles, and Why Did You Put that Needle There? along with a copy of the Calmest Revolution. They are going to loop the documentary on their in house video system so that lots of people, patients too, can see it. Can I say how glad I am that we have our own documentary? I’m sure there will be TM folks watching POCATv really soon. Thanks to our awesome Coop, our revolutionary fervor in the relentless pursuit of our mission, more people are going to get acupuncture. And knowing that POCA Tech is coming too- Amazing!
    Thundermist, like POCA, like POCAtech, like PCA, and so many of our clinics, keeps hurling itself forward with the same sense of urgency to lay down tracks for the oncoming train. The margins are thin, and a lot has to be done with the available resources. Thundermist’s 2010 strategic plan says:

    So much of health care reform relies on the transformation of primary care from a system focused on episodic care with little coordination outside the doctor’s office, to an integrated system of care delivery. One that is designed to help prevent illness, reduce disease burden and move patients toward wellness. We have said for years that the best things we do in health care are FREE, because the current reimbursement system does not pay for the things that really matter in changing a patient’s health status- care coordination, prevention, education, social services, empowerment and information exchange- all of which dramatically improve a patient’s health far more than the visits and procedures for which we do get paid.

    Included in their goals are operating at 100% capacity, expanding their W.Warwick location by 500% (which happened with moving to the new/current mill space), expanding services, diversifying who they serve, innovating in all of this delivery of care, types of services (like community acupuncture), and raising funds, coalescing the community around and with the work they do. We’re excited to be a part of their plan.

    Of course one of my hopes is that this project mean a lot more people who wouldn’t normally be getting acupuncture will. PCA is just 11 miles away from TM, W. Warwick, but in a state that is 48×37 miles that’s a long way. This is chance for us to extend our reach and to partner with another organization in our community that has some similar approaches, and ideas about health, medicine, and community, that comes at a point where we were already speculating about PCA #2. One of the things that has not been worked out yet is if we are actually opening a 2nd clinic, piloting a clinic for TM, or some combination of those things. From my experience the underlying business structure does matter in ways that are not always obvious, but that reflect outwardly in the decisions and systems that follow. In keeping with the basic CA tenet of “Simplify” I don’t want the relationship between TM/PCA and the folks we want to provide acupuncture to, to become overly complex, and I want it to be sustainable, transparent, and stable. I’m interested to hear from all of you your hopes for this new kind of partnership for our clinics. Do you have woes about it? suggestions on how to set things up? What would you do if your local FQCHC contacted you next week?
crismonteiro
Author: crismonteiro

I've always thought that I would live to be 100 years old and now that I have an actual idea of what it might be like to inhabit this body for a century I want to be damn sure that Community Acupuncture is around to help me through my days and in the end, on my way. In the meantime, I am passionate about getting shit done, and also having fun.

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Responses

  1. We started South Shore Community Acupuncture because a doc wanted acupuncture in his clinic. It took awhile to work out the kinks, but we had the awesome opportunity to have no start up costs and full creative freedom of how it would run. We are happy to now have a sweet little clinic within the walls of a western medicine peds clinic, showing the peds patients and the greater community that acu is accessible both financially and medically.
    Lic. Ac’s work in the clinic. This to me makes a lot of sense. We are all POCA members and have been to a few POCA/CAN trainings/fests each and have a pretty good understanding of why we are doing what we are doing.
    We also get paid $25/hr.
    I like having POCA peeps. I don’t know how much I would like having western trained medical folks poking people, unless they too had a similar understanding and attended POCA trainings. I know this brings up the whole territory conversation, and I don’t want to be territorial (deep down, I really don’t) – but this is a big move to stand by opening up the field. I think anyone practicing CA should attend POCAtech (once those doors open). Two days a week doesn’t translate into many poking hours and could be covered by one person. I say let’s train peeps.
    I love the medical community that I have the opportunity to work with and I am very grateful to the doc that brought us on board – but we bring a very different vibe to the clinic. Just wondering what it would look like to get the western med peeps on board to practice acu. What would they be happy being paid?
    How would this decision affect our relationship with the national acu peeps? How would it be marketed in the setting to get people in chairs? We expected lots of referrals and it all came down to our marketing and then word of mouth. The docs didn’t seem to know how or when to refer, even after trainings and “newsletters”.
    This is exciting stuff, and it brings up lots of questions.

  2. Hi Cris – Exciting stuff. I would like to connect with you to maybe get and offer more detailed info but one thing I would stress is that you make sure that TM’s employees, including administrators, get treated too. You don’t want to try to pull-off something like this if the ones you will be relying on to make it work right have not experienced the process themselves. More technical stuff to say like checking on malpractice issues and written contract terms, etc. Best – Matt Bauer

  3. Nicole you wrote: I don’t know how much I would like having western trained medical folks poking people, unless they too had a similar understanding and attended POCA trainings. I know this brings up the whole territory conversation, and I don’t want to be territorial (deep down, I really don’t) – but this is a big move to stand by opening up the field. I think anyone practicing CA should attend POCAtech (once those doors open). Two days a week doesn’t translate into many poking hours and could be covered by one person. I say let’s train peeps.

    I understand your concerns and I say: let’s train ’em. We can here in RI 😉 see discussion inside forum.

    Matt- totally agree- let’s get the workers-clinicians, reception, maintenance in the chairs along side one another and patients too. Acupuncture “the great equalizer!” I fantasize about our government halls lined with recliners full of politicians -poked with needles.

    Michelle- I hope you can come hangout with us at TM sometime, you too Kevin. Come and visit PCA too.

  4. Sounds like a fantastic new opportunity! How separate are you hoping to keep PCA from TM? Is this new venture being seen as a branch of PCA at TM? These are the boundaries that seem trivial but might make a big difference to the higher-ups, the administrators, all the bigwig types. Sounds like I’m going to have to make sure the next surfing jaunt down to ‘Gansett includes a side trip to check out PCA! 🙂

  5. I love the idea of a “medical home” and CA being part of the family. It’s about what works for the patient and your willingness to take a leap of faith (not without research, but a leap nonetheless) to come to where the patients are is awesome. CA has already broken the mold by making acupuncture more accessible and affordable, but one area that still needs work is to mainstream the whole idea of acupuncture as a logical part of an integrated approach to a patient’s health rather than some “alternative” treatment where the patient is on his/her own in the game.

    I’ll be interested to see how this evolves and how you get over some of the inevitable hiccups to reap the (equally inevitable!) benefits, so I hope you will keep us posted!

  6. This is very encouraging. I also loved your descriptions, reminiscent of Balzac. No, seriously, so visual, documentary. I will definitely read more about TM and follow your joint project. One year from now, what will this look like, what will we have learned? So much, without a doubt.