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March 2020 Newsletter

Table of Contents – March 2020

Medicare and Acupuncture: Two Perspectives

It’s happened. Medicare has announced coverage for acupuncture for low back pain under certain circumstances, and it is likely that it will be expanded to other diagnoses (see Section 1862 (a) (I) (A) of the Social Security Act).

After many years of promotion, advocacy, debate about the evidence, and all the challenges that go with such major paradigm shifts, CMS has finally decided to move forward with coverage for acupuncture for its population. There have been numerous inquiries from our members since its announcement. The focus of this newsletter brief is to inform our members what we do and do not know thus far. 

What we do know:

  • CMS announced the change on 1/21/2020.
  • Acupuncture services will only be covered for chronic, non-specific low back pain.
  • Up to 20 treatments per year with up to 12 of those in the first 90 days, and the other 8 thereafter, if positive improvement demonstrated. 
  • LAcs are not CMS providers and are considered “auxiliary personnel” (which would take an act of congress to change).
  • Therefore, LAcs may only bill for acupuncture if they have physician “supervision.” 
  • Said supervision does not need to be direct; it may be provided “at an appropriate level.”
  • Supervising physician does not need to be an acupuncturist, but should be able to assure proper diagnosis, alignment with an appropriate team of care, safety, and connection to medical services, follow-up care, and assessment of effectiveness of acupuncture. 
  • PAs, NPs/clinical nurse specialist and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:Masters or doctoral level degree in acupuncture or oriental medicine by a school accredited by ACAOM. 
  • PA, NP/clinical nurse specialist require physician supervision. 

What we don’t know:

  • When will such services be implemented?
  • At what rate will said services be reimbursed? 

Gerald L. Leglue, MD, FAAMA Responds
As a private practitioner who has been opted out, and a non-provider for many years, I see no major change or influence on my practice. Over the years I have had the option to charge (or not) all Medicare patients that I have treated, and I controlled what that charge would be. I can say I have never charged cash, but I have bartered such services … fresh vegetables, homemade jelly, and lots of cookies and cakes have been the norm. I would not have such options had I participated with Medicare. 

Joseph Audette, MA, MD Responds
As an academic physician practicing in a large, not-for-profit medical group, I do not have the option to opt out of Medicare. The concern, of course, is that compared to fee-for-service practices and commercial insurance, Medicare reimbursement is likely to be low and may not cover the marginal cost of the service. It is absolutely the case that participating physicians, such as myself, will be required to accept whatever Medicare pays for this newly covered service. This means that I will no longer be able to charge my usual fee-for-service rate for acupuncture when a Medicare patient is referred for acupuncture and their diagnosis is low back pain. 

On the positive side, this CMS decision should herald a new era in medical acupuncture, making it a mainstay of conventional medicine. This should open the eyes of more physicians to the benefits of acupuncture, create new referral sources, and drive more clinicians to seek training and join organizations like the AAMA. This will help those of us who work in institutions or practice settings where it has been difficult to implement a self-pay model of care. 

It will be important to find ways with your acupuncture practice to be more efficient with this population, making sure you have adequate treatment space to accommodate the larger volume of patients. With CMS coverage, conversations with your employer about space may be easier than when the service was self-pay.

Importantly, Medicare coverage of acupuncture will give options to the elderly poor that they have not had before. 

One out of every five elderly Americans is on a fixed and limited income with little flexibility for extra medical expenses and it is the experience of many of us that these patients just cannot afford a self-pay service. One thing I think we can all agree on: This change in CMS coverage will definitely help with legitimizing acupuncture as a evidenced based approach for the treatment of pain and, as physicians acupuncturists, this can only help to move our field and our organization forward.

Gerald L. Leglue, MD, FAAMA
Joseph Audette, MA, MD
Members, AAMA Board of Directors

Welcome New AAMA Members

Please join us in welcoming the following new members who became part of the Academy in February 2020:

  • Nadejda Alekseeva, MD, of Shreveport, LA 
  • Beth Du, MD, of Midlothian, VA 
  • Sabrina A. Cerny, MD, of Roca, NE 
  • Tatyana C. Strong, MD, of Pewaukiee, WI 
  • Farzana N Tausif, MD, of Sylvania, OH 
  • Dean H. Hommer, MD, of El Paso, TX 
  • Thuytien Dang, NP, of Kansas City, MO 
  • Mark Winemiller, MD, of Fort Collins, CO 
  • Jie Qu, MD, of Stanford, CA 
  • Jose Alcazar, MD, of Ponce, PR 

If you have peers or colleagues who aren’t currently members of the AAMA, please encourage them to learn more about the benefits of membership by visiting the website or contacting Janice Brown, the membership committee chair.  

Physicians Earn ABMA Certification

Congratulations to the following physicians who have completed the process (www.dabma.org/requirements.asp) set by the American Board of Medical Acupuncture (ABMA) to be certified as a Diplomate for 10 years: 

  • Patricia L. Johnson, MD, DABMA, of Indianapolis, IN
  • Nalini R. Prasad, MD, DABMA, of Roslyn Heights, NY 

Legislative Advocacy – Committee Update

Drs. Donna Pittman and Gavin Elliot, committee co-chairs, continue to monitor and respond to state and federal bills related to medical acupuncture. Action has been taking on the following items this month: 

  • AZ S 1127: This bill would permit athletic trainers to perform dry needling. We oppose this legislation as written. Committee chairs worked with the Asian Medicine Acupuncturists of AZ on a response to this bill. 
  • NJ A 2316 / S 867 / A 539: These bills would permit physical therapists to perform dry needling. The AAMA position paper on Dry Needling was sent along with the Academy’s objections. 
  • OK SB 1880: The bill allows acupuncture to be practiced without licensing. A letter was sent emphasizing the need for proper training and certification. 
  • RI HB 7371 / SB 2232: These bills would place physician acupuncturists under the general supervision of LAcs for the NADA protocol. A letter was sent to the authors of the bill, and wording was revised. 
  • SD HB 1136: This bill establishes licensure and regulation of acupuncture. Physicians in SD may practice acupuncture under the scope of practice and do not require additional certification. A letter was sent to clarify wording regarding “a licensed health care professional certified to perform acupuncture” for a position on the governing board. 
  • SD SB 1219: This bill promotes acupuncture as an alternative to opioids. A letter was sent in support of this bill. 
  • TN SB 1743: This bill would include coverage for acupuncture services under TennCare. A letter was sent in support of this bill. 

(Emails were sent to AAMA members from AZ, OK, RI, SD, and TN regarding the above bills.) 

Washington, DC Section 4703: Washington, DC, changed its criteria for physicians to provide acupuncture. The new wording prevents physicians that are not board-certified by the ABMA from becoming licensed. Committee Co-chair, Gavin Elliott is working on getting this revised. 

Medicare Survey: The committee contributed to the preamble and questions for the survey of AAMA members regarding Medicare coverage of acupuncture. The results will provide guidance for the AAMA’s response to CMS coverage of acupuncture and the pending legislation (HR 1183 – Heroes and Seniors Act) for Medicare to cover all acupuncture services, Legislative tracking and advocacy are ongoing priorities of the AAMA Board of Directors. 

Please remember: If you become aware of legislative issues/bills being proposed in your state that would affect medical acupuncturists, we encourage you to let us know by email (info@medicalacupuncture.org) or phone (310-379-8261). 

AAMA 2020 Annual Symposium Canceled

With great regret, the AAMA Board decided last week to cancel the AAMA’s 32nd Annual Symposium and associated activities. No AAMA events will take place April 22-26, 2020, in Orlando, FL.As the Covid-19 situation continues, the Board and staff are mindful that AAMA attendees, panelists, presenters, and exhibitors represent a diverse mix of health care practitioners whose work is critical in the organizations and communities they serve. The vast majority of the AAMA community is deeply immersed in the preparations for, and the fight against, Covid-19. For these reasons, widespread travel restrictions and the impossibility of assuring the safety of our attendees, the Board determined it’s in the best interests of attendees, their families, patients, the hotel staff, and entire associated communities, that the April meeting not take place.

We are currently exploring ALL options and opportunities to provide the program that was developed for this April. Whether trying to reschedule and/or utilize some virtual education options, the Academy is working to bring you this education programming.If you have made hotel reservations, please contact the hotel to cancel that reservation directly (407-351-5555). You should also cancel/change air travel reservations – most airlines are being forgiving on change fees right now, but you should be sure to make those changes soon. We will process refunds for attendee registrations as quickly as possible. If you prefer to have the fees roll over to either the re-scheduled meeting or for next year’s meeting, please let us know (info@medicalacupuncture.org).

We are sorry for these interruptions and changes, but it is the Academy’s highest priority to keep members and attendees safe and healthy so that you may continue to provide a positive health care impact within your own communities. 

AAMA Fall Workshop Focuses on Common Musculoskeletal Conditions

Save the date! “Treating Common Musculoskeletal Conditions with Osteopathic Manipulation, Meridian Therapy, Dry Needling and Manual Muscle Testing” will be presented by Jay Sandwiess, DO, and Joseph Audette, MD, in Chicago on October 24-25, 2020. 

This workshop will offer participants an opportunity to learn applied kinesiology and osteopathic muscle testing strategies for common musculoskeletal conditions in order to identify neuro-muscular inhibition patterns. Participants will learn to integrate basic osteopathic manual methods with acupuncture techniques, such as dry needling and meridian therapies, to resolve the condition and restore muscle and joint function instantly. These methods are part of a series of acupuncture techniques that produce rapid effects. Drs. Audette and Sandweiss will present a highly effective approach for diagnosing and treating common problems such as: tennis and golfer elbow, rotator cuff syndrome, carpal tunnel syndrome, knee pain, ankle sprains and neck and back pain issues throughout the spinal regions. Upon completion of this workshop attendees will have new tools for quickly assessing and treating musculoskeletal conditions throughout the body. Learn more. 

Last Chance for 2020: Become a Fellow of the AAMA

Fellowship in the AAMA represents superior commitment to the practice of medical acupuncture. Election of Fellows occurs each Spring during the annual election of AAMA officers and directors. The application deadline this year is March 27, 2020. To be nominated to Fellow of the Academy, members must submit applications documenting the following:

  • Possess an MD or DO degree or equivalent.
  • Be licensed to practice as an MD, DO or homeopathic physician in the US or Canada.
  • Be Board Certified by the American Board of Medical Acupuncture.
  • Be a current Full member of the American Academy of Medical Acupuncture.
  • Have a minimum of five years of Western medicine practice experience or be Board Certified in his or her medical specialty.
  • Have a minimum of four years of clinical experience in medical acupuncture since completing a basic training program in medical acupuncture.
  • Have published or have accepted for publication an acupuncture related article in a recognized medical periodical ... OR ... Have documented ten hours or more of experience teaching medical professionals on acupuncture related topics.  

ICYMI: In Case You Missed It Last Month

IRS Considers Acupuncture a Medical Expense
As reported by the journal Medical Acupuncture, the latest Internal Revenue Service publication 502 includes acupuncture as a medical expense so taxpayers can add it to their calculations of medical expense deductions.  

Call for Papers: Acupuncture and Internal Medicine
Medical Acupuncture is planning a special issue focusing on how acupuncture and auricular medicine can be used as an effective adjunct to treat a variety of internal medicine related conditions. The deadline for manuscript submission is May 1, 2020.  

Professional Development Opportunities

*CANCELLED: 2020 International Congress on Integrative Medicine and Health
April 28-May 1, 2020
Cleveland, OH 

ICMART World Medical Acupuncture Congress
June 26-28, 2020
Athens, Greece 

KIOM-SAR 2020 International Research Conference
September 10-12, 2020
Seoul, South Korea

AAMA Workshop Fall 2020
October 24-25, 2020
Chicago, IL
“Treating Common Musculoskeletal Conditions with Osteopathic Manipulation, Meridian Therapy, Dry Needling and Manual Muscle Testing”
Presented by Jay Sandwiess, DO, and Joseph Audette, MD 

AAMA Website: Education Listings
The AAMA maintains an ongoing calendar of educational events and professional development opportunities related to medical acupuncture. The calendar is accessible on the AAMA website. Members are encouraged to share events and calendar items from their regions and about educational topics that may be of wider interest among peers and fellow AAMA members.  

Medical Acupuncture Journal Updates

New Scientific Research

An integrative medicine case exemplar: The perspective of a family physician credentialed in acupuncture
[Advances in Integrative Medicine]
Although the meaning of Integrative Medicine differs by individual patients, their demand for a more inclusive and integrative approach to care that utilizes both conventional and complementary medicine modalities has been increasing. Integrative medicine is an attempt to fulfill this growing demand for more holistic approaches to healthcare. The perspective and exemplar of a dually credentialed—board certified family medicine physician/acupuncturist led to two possible scenarios to fulfill this need: 1) encourage clinicians to receive training in both conventional and complementary medicine to create more multi-credentialed clinicians (MCPs) and/or 2) foster inter-professional collaboration among providers. (Note: Iman Majd, MD, LAc, DABMA is a member in Seattle, WA.) 

Efficacy of Acupuncture in the Treatment of Elderly Patients with Hypertension in Home Health Care
[The Journal of Alternative and Complementary Medicine]
Conclusions: This study suggested that in the home health care hypertension population, antihypertensive drugs plus acupuncture may be more beneficial in lowering BP and in regulating autonomic nervous system activity than drugs alone.

Role of Neuro-Immune Cross-Talk in the Anti-obesity Effect of Electro-Acupuncture
[Frontiers in Neuroscience]
There is evidence to show that electro-acupuncture (EA) has a promotive effect on both lipolysis and thermogenesis, and that these mechanisms underlie the anti-obesity effect of EA. The sympathetic nervous system (SNS) is known to play a role in thermogenesis. Additionally, obesity is characterized by a chronic low-grade inflammatory state. Based on these findings, the aim of the present study is to investigate the potential neuro-immune mechanisms underlying the therapeutic effect of EA in obesity.  

Acupuncture for in vitro fertilization in women with poor ovarian response: a systematic review
[Integrative Medicine Research]
In conclusion, the results of this systematic review suggest that acupuncture and electroacupuncture may improve the quality of oocytes and increase the pregnancy rate in women with POR. However, more studies are needed to determine the association between acupuncture and POR-related outcome measures.

October 2020 Workshop

Treating Common Musculoskeletal Conditions with Osteopathic Manipulation, Meridian Therapy, Dry Needling and Manual Muscle Testing Weekend Workshop

Presented By:  Jay Sandweiss, DO, FAAMA and Joseph Audette, MD, MA

October 24-25, 2020
Chicago, IL


Scientific Research

Read more evidence-based research on acupuncture and its applications in medical practice.