insurance for acupuncture

[Guest guest]

Dr. Nourse:

 

thank you for your eloquent and beautifully descriptive characterization of

the modern insurance practice. (included below my signature) I couldn't

agree more. as you gave permission in advance to forward on your words, i

am sending this to a couple of TCM email discussion groups in which i

participate, and to the WNC Acupuncture Society.

 

I will also forward your correspondence to Barbara Barry, VP of NCAAOM. i

encourage you to send your comments to the org directly. as you say, the

juggernaut seems to be rolling, but the many of us who do not want the push

for insurance coverage in NC need to make our voices heard. right now the

board seems to think that 90% of NC LAcs want this train to go forward,

based on the feedback of those who attended one mtg last year, that took

place in the eastern part of the state, and in which no prior notification

was given that this issue was on the mtg agenda. based on feedback i've

received, i am certain that there is a large constituent of NC LAcs who do

not want this runaway train going down the tracks. i feel we need to do

what we can now to stop this train before it picks up more momentum. once

it gains speed it will be more difficult to stop. thankfully, we have a

lack of $ and volunteers to the NCAAOM working in our favor. let's hope

they won't be able to harness the necessary energy.

 

in solidarity,

 

Chinese Medicine

 

(yes, Kath is my preferred first name - shortened years ago from Kathleen).

 

On Wed, May 28, 2008 at 1:30 PM, Dr. Jim Nourse <acushrink

wrote:

 

> Dear Kath,

>

> Forgive me if Kath is an abbreviation and I'm not calling you by your

> correct name. A short time ago I read your email regarding insurance

> coverage for acupuncture and set it aside, feeling resigned to the idea that

> the movement toward such coverage is a juggernaut that will just roll over

> anyone in its way. But I read something today that prompts me to lend my

> voice to those opposed to this development. Feel free to pass this harangue

> along.

>

> I have been practicing acupuncture for four years and clinical psychology

> for thirty-three. In the late 1970's and early 1980's, national and state

> psychological organizations succesfully lobbied for independent provider

> status for psychologists as well as the right to receive insurance

> reimbursement. We were successful on both counts. Our prestige was

> immediately enhanced and we were, for the most part, on a par with

> allopathic medicine regarding our ability to bill third parties for our

> services with virtually no limitation on number of sessions or type of

> therapy provided. In the past twenty-five years, this situation has changed

> radically, to wit:

>

> " ...psychologists have a fiduciary obligation to be knowledgeable about

> and confirm with insurers the extent to which the type of treatment they

> will be offering meets the company's mental health benefit criteria... "

> --The Register Report, Vol. 34, Spring, 2008

>

> This quote is from the magazine of the National Register for Health Service

> Providers in Psychology. Not from a Medicare advisory. Not from a Blue

> Cross publication. From a guild organization entrusted with promoting the

> integrity and values of the profession.

>

> This is what happens. When you let third party payers on board, they will

> hijack you and take you to where they, not you, want to go. And as we know

> from the psychology of hostage phenomena, hostages can eventually come to

> identify with their captors.

>

> I once heard a Native American story of a conversation between a young man

> and an old man. The young man was explaining the benefits of accomodating

> the white man, trying to work things out with him, giving some so you can

> get some. The old man listened patiently and when the young man had

> finished, he replied " You gotta watch these guys. They steal your land. "

>

> Our efforts to be included in third party arrangements is analagous to a

> small but increasingly independent and prosperous nation petitioning a

> larger nation to become a colony.

>

> Think for a moment. What will insurance company control of your practice

> look like? And, please, do not be so naive as to imagine they will not

> control it. The first step is generally to simply write acupuncture into

> certain policies, but with a limit on the number of sessions per year. Not

> so bad. They may invite you to lower your fee so that you can join a

> provider panel which will, they assure you, result in more referrals coming

> your way. If you're a new or incompetent provider, this sounds attractive.

> They may for a time pay for the services of both participating and

> non-participating providers, the latter being granted less payment but no

> ceiling on the charge. Eventually they drop the non-participating provider

> status. If you're not in-network, no coverage. The next step is then to

> introduce a case management component with pre-authorization, followed by

> case review every several sessions to determine if continued treatment is

> " medically necessary. " How do you imagine a conversation with the case

> manager going? How do you deal with the silence on the other end when you

> have just described the problem as a liver yin deficiency with yang rising

> producing wind in the head? They are not, hear me, going to learn Chinese

> medicine in order to know how best to evaluate your treatment plan. They

> could care less about your treatment plan. It's not about care, it's about

> rationing care. If it were really about quality of care, from time to time

> case managers would suggest that MORE treatment is advised. In thirty-three

> years of practice, only one case manager has ever encouraged me to see a

> psychotherapy client more often. He was canned.

>

> Incidentally, we have a word for the consequence of the incentive as an

> in-network provider to lower fees in return for more referrals: Burnout.

> But fear not. It turns out they were only kidding about more referrals

>

> Getting in bed with this bunch will get you pregnant, and what will be born

> will grow up to be a caricature of Chinese medicine, redefined to conform to

> the Western world-view and driven by economics rather than the spirit of

> healing.

>

> The founder of Gestalt therapy, Fritz Perls, M.D., once said that

> psychoanalysis had become the problem for which it purported to be the

> solution. Let us please cultivate wisdom over expediency. What the

> ancients have handed us is a treasure. May we never treat it as a

> commodity.

>

> James C. Nourse, Ph.D., L.Ac.

>

 

 

 

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