Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 This dx code thing is a big problem, which could perhaps be circumvented if doctoral training included western dx. but that would require a lot more school and clinic than is planned for the current doctorate, as well as change in scope of practice laws to allow these new skills to be actually used. These are major hurdles. The schools will have difficulty enrolling students if the program is too long or too much western medicine is included, so they have no interest, I bet. Getting state education departments to grant the title of DOM, OMD or whatever will also be very difficult. It is already opposed by the Oregon Board of Medical Examiners. Even if the title is granted, it will be much harder to expand scope of practice (lab tests, etc.) unless the schools have provided training at least equivalent to a nurse practitioner in these areas, which they would be reluctant to do (see above). I think it is unlikely that we will be able to legitimize our method of diagnosis, unless some objective parameters can be demonstrated (for example, levels of certain hormonal metabolites [17-hydroxycortisol excreted in urine] correlates very highly with kidney yang deficiency). Contact http://www.ITMonline.org about this. We are not going to get mainstream insurance companies to accept a scheme that uses liver yang rising, etc. Several insurance companies that cover herbs (like ASHN) are going the following route: 1. closely micromanaging your cases, requiring detailed paperwork justifying your TCM dx, which can be rejected by the company 2. limiting herbal treatment to particular formulaes for certain patterns 3. maintaining their own pharmacy to drop ship products to patients instead of reimbursing your pharmacy thus, you are limited to set diagnoses, certain formulaes and limited ability to modify or be creative. this is the price we can expect to pay in the HMO system, as the framework is identical to that imposed on medical doctors, as well. the question is can TCM be practiced effectively in this constrained cookbook way? Doctors say this system wreaks havoc on western medicine, which has a much more linear diagnostic process. , " Luke Klincewicz " <l.klincewicz@w...> wrote: > > The discussion about frequency was fruitful to me. We U.S. > practitioners, within the current socio-economic paradigm, i.e., > insurance and the prevalent thought that acupuncture is not worthy of > reimbursement..., find ourselves in a position forcefully stuck > between being forced to subside our ways to ICD-9 codes and > recommended procedures or to go beside these, and then we face > oblivion.... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 > This dx code thing is a big problem, which could perhaps be circumvented > if doctoral training included western dx. ... > I think it is unlikely that we will be able to legitimize our method of > diagnosis, unless some objective parameters can be demonstrated (for > example, levels of certain hormonal metabolites [17-hydroxycortisol > excreted in urine] correlates very highly with kidney yang deficiency). > Contact http://www.ITMonline.org about this. We are not going to get > mainstream insurance companies to accept a scheme that uses liver yang > rising, etc. I'm not familiar with the details of the system in place in Japan, but I understand that the reimbursement standard for herbal medicines used in that country by medical insurers is Shang Han Lun. If a prescription is based upon a formula from this book, it is reimburseable. The text itself provides the linkages between diagnostics and herbal therapeutics. It's always seemed to me that what makes such a scheme feasible is that Japanese people tend to be familiar with Chinese words, thought, and expression. Chinese classical texts have often provided the roots for Japanese developments, not only in medicine but in many fields. Thus there's a cultural predisposition towards accepting as valid a standard that is 2,000 years old. There is also a kind of internal coherence and logic to organizing the practice, including insurance policies, of traditional Chinese medicine according to traditional Chinese sources. Might it not be a sensible first step to developing rational reimbursement standards to adopt such a model? It doesn't presume the existence of conclusive pharmacological and pharmaceutical research, clinical trials, etc. It rather admits as reasonable evidence of efficacy the past 2,000 years of empirical evidence and provides a starting point for further research and development. Of course, the big question is whether or not those who practice Chinese herbal medicine here are familiar enough with Shang Han Lun in order to make proper use of its formulas. Once again, we wind up in the field of medical education, which is where it seems to me that an enormous amount of work awaits. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 I don't think this this the answer. I think we have to stick to our guns, our diagnosis, treatment plans, the whole nine yards. . . .and present a coherent plan to whatever entities, i.e. hospitals, insurance, or HMO's are interested in Chinese medicine. We are NOT trained or licensed to practice western medicine. . . .and, yes, those H.M.O's that cover herbs severely limit options on herbal treatment. I personally have a cash practice, and refuse to deal with these entities. If patients want to bill their insurance, I will give them all the information and available codes necessary, but I refuse to be an HMO slave. Micromanagement of cases takes patient care out of our hands, and puts it in the hands of the middleman. I agree with Paul Unschuld, who asked, 'why do TCM practitioners want to become part of the medical establishment?' We need to create an alternative system, develop our own insurance programs, and, as I have mentioned before, a standard terminology that can be cross-referenced by different practitioners. Anyone can translate according to their ability, but there has to be some way to get the diagnostics down for reference with other practitioners. I don't think Chinese medicine can survive by being absorbed into the prevailing paradigm. >This dx code thing is a big problem, which could perhaps be circumvented >if doctoral training included western dx. but that would require a lot >more school and clinic than is planned for the current doctorate, as >well as change in scope of practice laws to allow these new skills to be >actually used. These are major hurdles. The schools will have >difficulty enrolling students if the program is too long or too much >western medicine is included, so they have no interest, I bet. > >Getting state education departments to grant the title of DOM, OMD or >whatever will also be very difficult. It is already opposed by the >Oregon Board of Medical Examiners. Even if the title is granted, it >will be much harder to expand scope of practice (lab tests, etc.) unless >the schools have provided training at least equivalent to a nurse >practitioner in these areas, which they would be reluctant to do (see >above). > >I think it is unlikely that we will be able to legitimize our method of >diagnosis, unless some objective parameters can be demonstrated (for >example, levels of certain hormonal metabolites [17-hydroxycortisol >excreted in urine] correlates very highly with kidney yang deficiency). >Contact http://www.ITMonline.org about this. We are not going to get >mainstream insurance companies to accept a scheme that uses liver yang >rising, etc. > >Several insurance companies that cover herbs (like ASHN) are going the >following route: > >1. closely micromanaging your cases, requiring detailed paperwork >justifying your TCM dx, which can be rejected by the company > >2. limiting herbal treatment to particular formulaes for certain >patterns > >3. maintaining their own pharmacy to drop ship products to patients >instead of reimbursing your pharmacy > >thus, you are limited to set diagnoses, certain formulaes and limited >ability to modify or be creative. this is the price we can expect to >pay in the HMO system, as the framework is identical to that imposed on >medical doctors, as well. the question is can TCM be practiced >effectively in this constrained cookbook way? Doctors say this system >wreaks havoc on western medicine, which has a much more linear >diagnostic process. > >Todd > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 I wholeheartedly support an approach like this. . . .Ken is really on the mark on this one. We have to base what we do on the valid standard of 2000 years of empirical evidence, on such texts as Shang Han Lun and Jin Gui Yao Lue. The amount of time and expense to create a database of empirical studies is too prohibitive to get done in time for studies like Todd suggests. I always have, in insurance, and in claims cases put up by patients, stuck to my Chinese pattern diagnoses. . . .with some explanation, and have not had problems. Folks, we have a great system of medicine, a clear alterative choice. Why not promote it, and offer it to all comers, including the present health care forces? > > > >> This dx code thing is a big problem, which could perhaps be circumvented >> if doctoral training included western dx. ... > >> I think it is unlikely that we will be able to legitimize our method of >> diagnosis, unless some objective parameters can be demonstrated (for >> example, levels of certain hormonal metabolites [17-hydroxycortisol >> excreted in urine] correlates very highly with kidney yang deficiency). >> Contact http://www.ITMonline.org about this. We are not going to get >> mainstream insurance companies to accept a scheme that uses liver yang >> rising, etc. > >I'm not familiar with the details of the system in place in Japan, but I >understand >that the reimbursement standard for herbal medicines used in that country by >medical insurers is Shang Han Lun. If a prescription is based upon a formula >from this book, it is reimburseable. The text itself provides the linkages >between >diagnostics and herbal therapeutics. > >It's always seemed to me that what makes such a scheme feasible is that >Japanese people tend to be familiar with Chinese words, thought, and >expression. >Chinese classical texts have often provided the roots for Japanese >developments, not >only in medicine but in many fields. Thus there's a cultural predisposition >towards >accepting as valid a standard that is 2,000 years old. > >There is also a kind of internal coherence and logic to organizing the >practice, including insurance policies, of traditional Chinese medicine >according to traditional Chinese sources. Might it not be a sensible >first step to developing rational reimbursement standards to adopt >such a model? > >It doesn't presume the existence of conclusive pharmacological and >pharmaceutical research, clinical trials, etc. It rather admits as >reasonable >evidence of efficacy the past 2,000 years of empirical evidence and >provides a starting point for further research and development. > >Of course, the big question is whether or not those who practice >Chinese herbal medicine here are familiar enough with Shang Han Lun >in order to make proper use of its formulas. > >Once again, we wind up in the field of medical education, which is >where it seems to me that an enormous amount of work awaits. > >Ken > > > > > > > > >------ >beMANY! has a new way to save big on your phone bill -- and keep on >saving more each month: Our huge buying group gives you Long Distance >rates which fall monthly, plus an extra $60 in FREE calls! >http://click./1/3821/9/_/542111/_/961364343/ >------ > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare >practitioners, matriculated students and postgraduate academics >specializing in Chinese Herbal Medicine, provides a variety of >professional services, including board approved online continuing >education. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 I agree with Z'ev and Ken, We should focus on the postitive and what we as TCM practioners can do. If we help each other to focus on TCM fundentementals and give to each other a stronger foundation our patients will benefit. Ed Kasper L.Ac., Santa Cruz, California Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2000 Report Share Posted June 18, 2000 In a message dated 6/18/00 4:13:18 PM, herb-t writes: << Getting state education departments to grant the title of DOM, OMD or whatever will also be very difficult. It is already opposed by the Oregon Board of Medical Examiners. Even if the title is granted, it will be much harder to expand scope of practice (lab tests, etc.) unless the schools have provided training at least equivalent to a nurse practitioner in these areas, which they would be reluctant to do (see above). >> It depends on the scope of the lab testing given. If herbs are part of the scope, as is nutrition, it falls within responsible limits to be able to request those tests that qre needed to observe changes in the body that might be affected by those substances. If one wants to go into ordering other tests, you might also see the insurance people being against you. Justifying the tests according to scope of practice and responsibility is a fair way to do things. Since your board is subservient to the Board of Medicine, you might ask the medical board to make a ruling requiring a patients primary MD to order tests you request. Then you get the oversight and MD income they are looking for, combined with the availabiltiy you are looking for. Of course, you could also go for an independent board. David Molony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Z'ev, I want to make an additional point, picking up on something you said in your other post on this topic, namely that you have a cash practice. Whenever a doctor admits an insurance company into the relationship with patients the dynamics of the interaction are profoundly influenced. Habituation to the presence of such third parties can and does dull the senses of both doctors and patients, but the influence remains. Personally, I would never let a patient front any third party for his or her own responsibilities. Why? What valid therapeutic purpose does it serve? For those who will scream " reality " in response to this sentiment, I point out that the " reality " of having ghost-like insurance agents present in the doctor-patient dynamic can be a devastating one. One of the truly great potentials of Chinese medicine is the restoration of genuine trust between patient and practitioner. I wholly endorse your practice of cash for service and urge people to think it over at least three times. Whether or not it was ever true that patients of Chinese doctors once paid them only when they were well and suspended payments during the course of an illness and subsequent treatments, the principle is a profound one. If we deliver Chinese medicine according to its fundamental principles, then we work to keep our patients from ever getting sick. Insurance companies will have to come a long way before they have a code for " Patient is well and happy. " I firmly believe that what our society currently starves for is leadership away from a healthcare model that dooms all participants to existences as servo-mechanisms of vast computer networks. Ken > I wholeheartedly support an approach like this. . . .Ken is really on the > mark on this one. We have to base what we do on the valid standard of 2000 > years of empirical evidence, on such texts as Shang Han Lun and Jin Gui Yao > Lue. The amount of time and expense to create a database of empirical > studies is too prohibitive to get done in time for studies like Todd > suggests. I always have, in insurance, and in claims cases put up by > patients, stuck to my Chinese pattern diagnoses. . . .with some > explanation, and have not had problems. Folks, we have a great system of > medicine, a clear alterative choice. Why not promote it, and offer it to > all comers, including the present health care forces? > > > > > > > > > > > > >> This dx code thing is a big problem, which could perhaps be circumvented > >> if doctoral training included western dx. ... > > > >> I think it is unlikely that we will be able to legitimize our method of > >> diagnosis, unless some objective parameters can be demonstrated (for > >> example, levels of certain hormonal metabolites [17-hydroxycortisol > >> excreted in urine] correlates very highly with kidney yang deficiency). > >> Contact http://www.ITMonline.org about this. We are not going to get > >> mainstream insurance companies to accept a scheme that uses liver yang > >> rising, etc. > > > >I'm not familiar with the details of the system in place in Japan, but I > >understand > >that the reimbursement standard for herbal medicines used in that country by > >medical insurers is Shang Han Lun. If a prescription is based upon a formula > >from this book, it is reimburseable. The text itself provides the linkages > >between > >diagnostics and herbal therapeutics. > > > >It's always seemed to me that what makes such a scheme feasible is that > >Japanese people tend to be familiar with Chinese words, thought, and > >expression. > >Chinese classical texts have often provided the roots for Japanese > >developments, not > >only in medicine but in many fields. Thus there's a cultural predisposition > >towards > >accepting as valid a standard that is 2,000 years old. > > > >There is also a kind of internal coherence and logic to organizing the > >practice, including insurance policies, of traditional Chinese medicine > >according to traditional Chinese sources. Might it not be a sensible > >first step to developing rational reimbursement standards to adopt > >such a model? > > > >It doesn't presume the existence of conclusive pharmacological and > >pharmaceutical research, clinical trials, etc. It rather admits as > >reasonable > >evidence of efficacy the past 2,000 years of empirical evidence and > >provides a starting point for further research and development. > > > >Of course, the big question is whether or not those who practice > >Chinese herbal medicine here are familiar enough with Shang Han Lun > >in order to make proper use of its formulas. > > > >Once again, we wind up in the field of medical education, which is > >where it seems to me that an enormous amount of work awaits. > > > >Ken > > > > > > > > > > > > > > > > > >------ > >beMANY! has a new way to save big on your phone bill -- and keep on > >saving more each month: Our huge buying group gives you Long Distance > >rates which fall monthly, plus an extra $60 in FREE calls! > >http://click./1/3821/9/_/542111/_/961364343/ > >------ > > > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare > >practitioners, matriculated students and postgraduate academics > >specializing in Chinese Herbal Medicine, provides a variety of > >professional services, including board approved online continuing > >education. > > > > > > > > > ------ > Failed tests, classes skipped, forgotten locker combinations. > Remember the good 'ol days > http://click./1/5531/9/_/542111/_/961367557/ > ------ > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Z'ev, Amen to no insurance. I also have a cash practice, and also provide codes to patients who who wish to submit. Every medical doctor I treat is in envy. Most have made the comment that if they had known how insurance controlled the medical field, they would have thought twice about entering the profession. Mark Reese - " " <zrosenberg Sunday, June 18, 2000 5:27 PM Re: ICD-9 > I don't think this this the answer. I think we have to stick to our guns, > our diagnosis, treatment plans, the whole nine yards. . . .and present a > coherent plan to whatever entities, i.e. hospitals, insurance, or HMO's are > interested in Chinese medicine. We are NOT trained or licensed to practice > western medicine. . . .and, yes, those H.M.O's that cover herbs severely > limit options on herbal treatment. I personally have a cash practice, and > refuse to deal with these entities. If patients want to bill their > insurance, I will give them all the information and available codes > necessary, but I refuse to be an HMO slave. Micromanagement of cases takes > patient care out of our hands, and puts it in the hands of the middleman. > > I agree with Paul Unschuld, who asked, 'why do TCM practitioners want to > become part of the medical establishment?' We need to create an > alternative system, develop our own insurance programs, and, as I have > mentioned before, a standard terminology that can be cross-referenced by > different practitioners. Anyone can translate according to their ability, > but there has to be some way to get the diagnostics down for reference with > other practitioners. I don't think Chinese medicine can survive by being > absorbed into the prevailing paradigm. > > >This dx code thing is a big problem, which could perhaps be circumvented > >if doctoral training included western dx. but that would require a lot > >more school and clinic than is planned for the current doctorate, as > >well as change in scope of practice laws to allow these new skills to be > >actually used. These are major hurdles. The schools will have > >difficulty enrolling students if the program is too long or too much > >western medicine is included, so they have no interest, I bet. > > > >Getting state education departments to grant the title of DOM, OMD or > >whatever will also be very difficult. It is already opposed by the > >Oregon Board of Medical Examiners. Even if the title is granted, it > >will be much harder to expand scope of practice (lab tests, etc.) unless > >the schools have provided training at least equivalent to a nurse > >practitioner in these areas, which they would be reluctant to do (see > >above). > > > >I think it is unlikely that we will be able to legitimize our method of > >diagnosis, unless some objective parameters can be demonstrated (for > >example, levels of certain hormonal metabolites [17-hydroxycortisol > >excreted in urine] correlates very highly with kidney yang deficiency). > >Contact http://www.ITMonline.org about this. We are not going to get > >mainstream insurance companies to accept a scheme that uses liver yang > >rising, etc. > > > >Several insurance companies that cover herbs (like ASHN) are going the > >following route: > > > >1. closely micromanaging your cases, requiring detailed paperwork > >justifying your TCM dx, which can be rejected by the company > > > >2. limiting herbal treatment to particular formulaes for certain > >patterns > > > >3. maintaining their own pharmacy to drop ship products to patients > >instead of reimbursing your pharmacy > > > >thus, you are limited to set diagnoses, certain formulaes and limited > >ability to modify or be creative. this is the price we can expect to > >pay in the HMO system, as the framework is identical to that imposed on > >medical doctors, as well. the question is can TCM be practiced > >effectively in this constrained cookbook way? Doctors say this system > >wreaks havoc on western medicine, which has a much more linear > >diagnostic process. > > > >Todd > > > > > > > > ------ > Missing old school friends? Find them here: > http://click./1/5534/9/_/542111/_/961367196/ > ------ > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 What those of you reading this Japanese herbal prescribing/insurance billing thread should know, is that only medical doctors in Japan are allowed to prescribe these formula --- and no others. Acupuncturists are not allowed to prescribe herbs. Mark Reese - " " <zrosenberg Sunday, June 18, 2000 5:32 PM Re: ICD-9 > I wholeheartedly support an approach like this. . . .Ken is really on the > mark on this one. We have to base what we do on the valid standard of 2000 > years of empirical evidence, on such texts as Shang Han Lun and Jin Gui Yao > Lue. The amount of time and expense to create a database of empirical > studies is too prohibitive to get done in time for studies like Todd > suggests. I always have, in insurance, and in claims cases put up by > patients, stuck to my Chinese pattern diagnoses. . . .with some > explanation, and have not had problems. Folks, we have a great system of > medicine, a clear alterative choice. Why not promote it, and offer it to > all comers, including the present health care forces? > > > > > > > > > > > > >> This dx code thing is a big problem, which could perhaps be circumvented > >> if doctoral training included western dx. ... > > > >> I think it is unlikely that we will be able to legitimize our method of > >> diagnosis, unless some objective parameters can be demonstrated (for > >> example, levels of certain hormonal metabolites [17-hydroxycortisol > >> excreted in urine] correlates very highly with kidney yang deficiency). > >> Contact http://www.ITMonline.org about this. We are not going to get > >> mainstream insurance companies to accept a scheme that uses liver yang > >> rising, etc. > > > >I'm not familiar with the details of the system in place in Japan, but I > >understand > >that the reimbursement standard for herbal medicines used in that country by > >medical insurers is Shang Han Lun. If a prescription is based upon a formula > >from this book, it is reimburseable. The text itself provides the linkages > >between > >diagnostics and herbal therapeutics. > > > >It's always seemed to me that what makes such a scheme feasible is that > >Japanese people tend to be familiar with Chinese words, thought, and > >expression. > >Chinese classical texts have often provided the roots for Japanese > >developments, not > >only in medicine but in many fields. Thus there's a cultural predisposition > >towards > >accepting as valid a standard that is 2,000 years old. > > > >There is also a kind of internal coherence and logic to organizing the > >practice, including insurance policies, of traditional Chinese medicine > >according to traditional Chinese sources. Might it not be a sensible > >first step to developing rational reimbursement standards to adopt > >such a model? > > > >It doesn't presume the existence of conclusive pharmacological and > >pharmaceutical research, clinical trials, etc. It rather admits as > >reasonable > >evidence of efficacy the past 2,000 years of empirical evidence and > >provides a starting point for further research and development. > > > >Of course, the big question is whether or not those who practice > >Chinese herbal medicine here are familiar enough with Shang Han Lun > >in order to make proper use of its formulas. > > > >Once again, we wind up in the field of medical education, which is > >where it seems to me that an enormous amount of work awaits. > > > >Ken > > > > > > > > > > > > > > > > > >------ > >beMANY! has a new way to save big on your phone bill -- and keep on > >saving more each month: Our huge buying group gives you Long Distance > >rates which fall monthly, plus an extra $60 in FREE calls! > >http://click./1/3821/9/_/542111/_/961364343/ > >------ > > > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare > >practitioners, matriculated students and postgraduate academics > >specializing in Chinese Herbal Medicine, provides a variety of > >professional services, including board approved online continuing > >education. > > > > > > > > > ------ > Failed tests, classes skipped, forgotten locker combinations. > Remember the good 'ol days > http://click./1/5531/9/_/542111/_/961367557/ > ------ > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
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