TO: Members of The White House Commission On Complementary and Alternative Medicine Policy
FROM: Marshall H. Sager, D.O.
The American Academy Of Medical Acupuncture
DATE: November 28, 2000
RE: December 5-6 Commission Meeting on Guidance for Access to, Delivery of, and Reimbursement for Complementary and Alternative Medicine Practices and Interventions.
The ancient medical modality of acupuncture is rapidly evolving as an effective complimentary paradigm within the framework of modern American medicine. Since President Nixon's trip to China in 1972, and the New York Times' James Reston's dramatic appendectomy during that trip, interest in, and the popularity of, acupuncture has surged in America. This popular pressure has led to scientific investigation of acupuncture's physiologic impact by the World Health Organization and, most recently, by the National Institutes of Health (NIH). Studies by these august bodies have concentrated on pain management and various disease entities and health problems as well as the integration of acupuncture into contemporary medical practice. The results of these studies have been positive and enlightening, lending credence to the efficacy of acupuncture – a medical paradigm which has persisted for more than 5,000 years.
Medical Acupuncture, as distinguished from acupuncture, is the clinical discipline of acupuncture as practiced by a physician who is also trained and licensed in western bio-medicine. With its foundation in ancient Chinese medical theory and practice, Medical Acupuncture has become a therapeutic partner with conventional western bio-pharmacology. A physician who practices Medical Acupuncture offers a uniquely comprehensive approach to patient health care – an approach that combines western and eastern medical modalities. In other words — the best of both worlds.
Physicians who practice Medical Acupuncture treat as wide a spectrum of medical challenges as do their western bio-medically-oriented counterparts. The distinction lies in basic philosophy. While western physicians treat problems people have, the Medical Acupuncture physician treats people with problems. With Medical Acupuncture, the concentration is on the well-being and health of the whole person. The goal is to restore the individual to a state of balance and harmony within him/herself and with his/her environment. This is in contrast to the traditional western medical approach which concentrates on ameliorating or combating a particular problem or symptom. As the Medical Acupuncture physician is well versed in both western and eastern paradigms, he/she can combine acupuncture effectively with conventional medical or surgical interventions.
The American Academy of Medical Acupuncture (AAMA) has experienced an approximately 20 percent annual membership increase over the last 5 years. Its current membership is nearly 2,000 physicians. As the only medical specialty society for physicians practicing acupuncture in North America, the AAMA is a leader in establishing and maintaining the highest standards of training and continuing education in practice of Medical Acupuncture. The AAMA is committed to the pursuit of excellence in this field of medicine and will continue to maintain this ideal as its highest priority.
Just as there are many sub-specialties within western medicine, so there are multiple disciplines within the practice of Medical Acupuncture and all of them are represented in the AAMA's membership. The training and practice requirements for membership in the AAMA are based on international standards and serve as a model for state licensure of medical acupuncture physicians, hospital practice privileges, liability coverage and third party reimbursement.
DEFINITION OF MEDICAL ACUPUNCTURE AND PHYSICIAN RIGHTS
Acupuncture practice by physicians falls within the scope of the practice of medicine. Medical acupuncture specifically represents the use of acupuncture by fully trained and licensed physicians. By effectively combining the practices of western and eastern medicine, the Medical Acupuncturist fills a unique and critical role in patient care. Once again, we reiterate – the best of both worlds.
The AAMA adamantly believes that appropriately trained Medical Acupuncture physicians must be permitted to use his/her knowledge and skill to benefit his/her patients. Healing is both an art and a science. The ability to help and to heal is the ultimate privilege. This ability must not be abridged or curtailed in any way. Understanding the depth of commitment of physician acupuncturists and regulating their practice rights must come from one's peers. Therefore, the AAMA contends that, as is the case with any other medical specialty, regulation of physicians practicing acupuncture must come only from medical boards.
Incredulously, the medical acupuncturists' private practice rights are currently threatened by the restructuring of health care delivery and reimbursement. The AAMA seeks protection of the physician acupuncturists' rights, appropriate endorsement by the conventional medical establishment and recognition by health care providers of medical acupuncture physicians whose practice may be uniquely different from that of their other medical colleagues as well as non-physician acupuncture practitioners.
ACUPUNCTURE QUALIFICATIONS FOR PHYSICIANS
The AAMA requires all members to be graduates of accredited American medical schools with more that 4,000 hours of allopathic education and licensed to practice medicine in their State. In addition, the AAMA requires 200 hours of formal, approved acupuncture instruction, consisting of 120 hours of didactic education and 80 hours of clinical training followed by two years of clinical acupuncture practice. Satisfaction of each and every one of these requirements entitles a physician acupuncturist to Full Practice Membership in the AAMA. The AAMA also requires each member physician to fulfill 50 hours of approved continuing education in acupuncture every three years.
These requirements are consistent with the world-wide standards established by the World Health Organization and the World Federation of Acupuncture/Moxibustion Societies.
After completing comprehensive training, medical acupuncture physicians are eligible to sit for an exhaustive examination which could lead to board certification through the American Board of Medical Acupuncture. This examination is the most comprehensive measure of expertise in the multiple disciplines of acupuncture in the world.
COMPLEMENTARY AND ALTERNATIVE MEDICINE ACCESS, DELIVERY AND REIMBURSEMENT
It is of little value to have the potential for receiving the best medical care in the world if access to that care it is routinely blocked. This is precisely the case with delivery of Medical Acupuncture services throughout America. And this problem is critically and sadly magnified for the elderly — those who would most benefit from easy access to Medical Acupuncture.
Reimbursement for Medical Acupuncture services is sparse, at best in 21st century America. Essentially, these medical services are limited to those patients who can afford to pay out of pocket. While physicians are routinely reimbursed by third party payers for conventional Western medical paradigm related services such as Evaluation and Management (E&M), rehabilitation, inoculations and the like, payment for and access to the ancient, well-respected and effective medical practice and intervention of Medical Acupuncture is generally precluded. This is illogical and disturbing, especially when we consider caring for our elderly – those who could benefit significantly from easy access to Medical Acupuncture therapy. Let us not forget that the elderly suffer from chronic and painful problems which are often uncontrolled by bio-pharmaceuticals. Let us also not forget that our elderly are most likely to suffer from drug interactions and adverse side effects. And finally, let us not forget that Medical Acupuncture is side-effect free, painless and effective. Those of us who care respectfully request — no, we demand that this inequity be remedied.
Unfortunately, there is no “quick fix' to this problem. It must begin with today's medical students and extend to continuing medical education programs throughout the nation. Medical students and physicians must be educated about the use and effectiveness of all complimentary medical modalities, especially Medical Acupuncture. And they must understand that, when administered by a licensed physician, Medical Acupuncture is an ideal compliment to traditional western drug and surgical interventions. They must understand its benefits and applications so as to be able to inform their patients of the conventional, complimentary and alternative medical options and choices available to them. And they must understand that Medical Acupuncture is not a threat to their practice, it is an enhancement to their success.
In the present medical reimbursement climate, knowledgeable physicians who prescribe complimentary and alternative medical interventions must constantly weigh the insurance coverage considerations against the out-of-pocket burden both for themselves and their patients. Being able to assess every patient from both Western and Eastern vantage points represents a remarkable advantage for the patient. Again, we repeat, the best of both worlds. Insuring that physician acupuncturists are appropriately compensated for their expertise and time insures the integrity of the practice of Medical Acupuncture and the safety of the patients. The best and the brightest will not be able to afford the extraordinary amount of time and emotional commitment to learning this complex paradigm if they will not be appropriately compensated at the end of their efforts.
This fact of non-reimbursement for physician acupuncturist is causing a strain on our healthcare system. The fact that most health care plans do not reimburse for physician acupuncturists has forced patients from their primary medical care providers and out of the healthcare system. This tends to fractionalize health care – a less than desired condition. Furthermore, a disparity in health care delivery that borders on discriminatory is created with the poor patient unable to participate because of limited out-of- pocket resources.
Finally, we must look at hospital care in America. Earlier I mentioned famed columnist James Reston. In China, he benefited from acupuncture analgesia and anesthesia. Yet in America there is a virtual dearth of Medical Acupuncture in the hospital setting. This must be changed. Hospitalized patients can benefit enormously from Medical Acupuncture to alleviate pain and expedite recovery. Medical Acupuncture saves money. Patients recover faster. Post hospitalization office visits are reduced. Everyone benefits.
In fact, that's the main point of my presentation. Medical Acupuncture creates win-win scenarios. Patients benefit by a speedy recovery and bio-pharmaceutical reduction. Surgeons benefit because their patients heal faster. Hospitals benefit because of shorter hospital stays. The public benefits because of reduced health care costs. A win-win all around.
Thank you for your time and consideration.Marshall H. Sager, D.O.