[CHA]Work comp

[Guest guest]

I just received a letter from State fund denying any more acup on a patient of

which i am not the treating physician. Treatment is by referral from an MD. So

it looks like even though the law is not supposed to impact us yet, the insu

companies are applying the chiropractic guidelines to acupuncture as well. Boy i

feel sorry for those that depend on work comp for a living.

Alon

 

 

[Guest guest]

Alon, was the State fund, a Workers Comp case? Are you going to follow up to

(try to)

get your money? i'm not sure insurance companies can make up the rules as to who

they will accept treatments from. Or is this something new from the WC Board?

AHHHHH!'

doug

 

, " alon marcus " <alonmarcus@w...>

wrote:

> I just received a letter from State fund denying any more acup on a patient of

which

i am not the treating physician. Treatment is by referral from an MD. So it

looks like

even though the law is not supposed to impact us yet, the insu companies are

applying the chiropractic guidelines to acupuncture as well. Boy i feel sorry

for those

that depend on work comp for a living.

> Alon

>

>

[Guest guest]

Reading this again, I assume you mean that you are not the Primary Physician

(not the

Treating Physician as you said).

doug

 

, " alon marcus " <alonmarcus@w...>

wrote:

> I just received a letter from State fund denying any more acup on a patient of

which

i am not the treating physician. Treatment is by referral from an MD. So it

looks like

even though the law is not supposed to impact us yet, the insu companies are

applying the chiropractic guidelines to acupuncture as well. Boy i feel sorry

for those

that depend on work comp for a living.

> Alon

>

>

[Guest guest]

State fund, a Workers Comp case

>>>I am not sure how much energy i will put into getting paid as it is only

about 8 visits. But i protested that we are not supposed to be part of the new

rules and she just said, sorry that is they way things are going to be from now

on. WC can make its own decisions on what is necessary regardless of the

physician opinion

Alon

 

 

[Guest guest]

Primary Physician (not the

Treating Physician as you said).

>>>Yes i am not. The treating Dr is an MD. They just say we do not care if he

writes an Rx or not.

Alon

 

 

[Guest guest]

Dear Alon, and others:

 

This particular thread has caused a lot of consternation among my friends

and colleagues. Yet I do not understand exactly what is being said. Alon,

can you please give more complete details about what you refer to as

" chiropractic guidelines " in this original email dated March 24? Also, is it

just back pain that is being denied? Is it just for cases in which the

acupuncturist is NOT the treating physician? Is there a law you can refer us

to, or a decision? How will acupuncturists who are actively involved in WC

cases be informed of this change, if indeed it is a change? You are usually

so brief in your statements, but this time, please elaborate a bit more!

 

Thank you.

 

Julie Chambers

 

 

 

 

-

" alon marcus " <alonmarcus

 

Wednesday, March 24, 2004 1:29 PM

Re: Work comp

 

 

> I just received a letter from State fund denying any more acup on a

patient of which i am not the treating physician. Treatment is by referral

from an MD. So it looks like even though the law is not supposed to impact

us yet, the insu companies are applying the chiropractic guidelines to

acupuncture as well. Boy i feel sorry for those that depend on work comp for

a living.

> Alon

>

[Guest guest]

The later i read was for back pain, but it clearly stated that they are

following evidence based standard of care from 2004 on. I talked to Connie

Taylor from CSOMA and she has a whole bunch of them and have not heard anything

yet. While she stated that we can demand a review by an LAc, if work comp must

follow evidence based criteria then an LAc can not change these rules. The only

indication acupuncture has that has so-called evidence is nausea. So i am

assuming that they will deny all treatments for musculoskeletal problems. The

new chiropractic/PT guidelines are a total of 24 visits per life time of an

injury. This is combined chiro and PT. The other guidelines are that they will

not pay for any passive care, which acupuncture falls under. Although they will

pay for manipulation by chiropractors which is passive care as well. The letter

i sow also denied a TENS unit, as it is passive care.

I actually wander what is going to happen with our use of manual therapies. Are

we going to be allowed to get paid for manipulation? The bottom line is that we

will need a lot of money to even clarify many of these issues. CSOMA wasted all

its funds on the group that resulted in the little hover commission and may have

destroyed our profession anyway. But don't get me started on that one.

 

 

[Guest guest]

, Julie Chambers <info@j...> wrote:

> Dear Alon, and others:

>

> This particular thread has caused a lot of consternation among my friends

> and colleagues. Yet I do not understand exactly what is being said.

 

I think everyone who has a vested interest in this matter should pursue it with

the

state fund, etc. we will get no where speculating. Alon, thanks for bringing

it to our

attention, but we need some more facts. If others could report back to us on

this

matter it would be great. However, everyone should be aware that even if this

report

is not as dire as it seems, the days of striking gold in work comp are probably

numbered. Even if L.Ac. are still covered when the dust clears, the

compensation will

be greatly reduced as will number of treatments. I heard on NPR the other day

that

the state is proud of its record on improving safety and decreasing fraud by

workers.

Now it plans to take on what it calls the WC " industry " .

 

I was suprised to hear that things are not so dire in NY as I thought the s__t

had

recently hit the fan vis a vis the no-fault clinics in that great state. And

remember as

goes california so goes the nation. Arguably, states that caught on to

acupuncture

late in the game are still enjoying a honeymoon period where legislators, the

public

and even MD's are blindly fascinated. All I can say is it used to be that way

out here.

And you have to ask yourself why this has all changed almost suddenly. I think

the

honeymoon is over in CA and nows it time to get down to the actual hard work of

making a relationship work. We have six thousand L.Ac.'s plus the most active

and

powerful lobby in the country and we are losing the battle. Those in other

states who

think events are on some arc to a new paradigm should get back to me in a few

years.

I really hope I am wrong.

 

I think the main research tactic to offset this trend is to compare acupuncture

to

already accepted therapies. If the standard WM therapy has been tested double

blind

itself (or whatever the gold standard is for the therapy type), than a

comparison with

acupuncture will only have to show acu is as good or better to justify insurance

coverage. comparisons to sham acupuncture must have much better results with

real

needling in order to be accpeted. This is according to Richard Hammerschlag at

OCOM. given the difficulty of doing sham needling, this seems the best path for

many reasons (BTW, the sham is sometimes defined as needling an actual point

with

only mild stimulation - how do you like them apples?). Comparative studies

should

logically prove that covering acupuncture services is at least as cost effective

as

standard therapies. However cost effectiveness, not just effectiveness, is

going to be

the key here. So consider the following issues:

 

1. will the amount of acupuncture necessary to treat the patient be comparable

in

price or cheaper than standard care? the answer would be yes if we are talking

about

PT or surgery or chiro, but no if we are talking about drugs. However drugs are

rarely

sufficient in most cases. This will at least not raise the cost of healthcare

and

pssoibly lower it by avoiding unnecessary surgery.

 

2. if sham needling works as well as real needling, can sham needling be

delivered at

a lower cost than real acupuncture? this will eventually demand studying as

governments attmept to lower overall healthcare costs rather than just stabilize

them.

 

3. valid experiments must involve protocols. there has been a lot of talk

about

outcome studies in some circles. However any outcome study that fails to

randomize

and blind is open to major criticism for self-selection and other biases. Any

study

that allows acupuncturists to individualize their protocols for each patient is

automatically unblinded. Yet we don't do standard treatments in acupuncture, so

what will happen if we study standard protocols? I think the only way to get

acupuncture recognized is by doing standard protocols. But I do not think this

will

affect practice in any meaningful way. I think the L.Ac. will still be able to

tailor tx in

his clinic as long as he gets good results and does not overcharge the insurance

companies.

 

BTW, I hope no one mistakes my focus on studies of this sort as my inability to

comprehend cutting edge ideas like complexity theory and outcomes studies. I

think

I understand these ideas as well as anyone.

 

1. I think their relevance or " cutting edge " is way overstated, mainly by

people with

no background in either science or research. It reminds me of all the

non-physicists

who think quantum theory explains the nature of qi.

 

2. even if there is a cutting edge alternative to so-called normal science

(kuhn's term

for the status quo of the era), no one who makes decisons about healthcare

policy is

either conversant or interested in this topic. Its just considered " out there " .

I don't

know if people noticed that conservative forces dominate most mainstream debates

these days. While republicans like free trade of anything (including herbs),

they are

not typically the first to jump on a radical bandwagon about a new theory of

science,

especially one that even futher challenges the idea of an anthropomorphic god.

 

If you doubt my take on this matter, just consider Al Gore's book called Earth

in the

Balance. this book proposed the most radical environmental policy after offered

by a

mainstream politician. Laced with new ageisms throughout, this book arguably

set

back the environmental movement as it proved a great target for conservatives to

blast. I thought this was a great book and things would be much different today

if

many of Gore's ideas had been implemented, including the constant strife and war

over oil in the middle east. But his radicalism served only as lightning rod

for the

ignorant who rule our planet. To pursue a research agenda based upon so-called

cutting edge ideas would only draw the lightning strikes upon us.

 

I imagine this posturing is why I have been characterized as running scared.

But sun

tzu advised us to engage the enemy with strategy, the goal in the short term

being

victory, not the application of ideals. that could come later. To me running

is when

one chooses not to engage at all. and there is a fine line between being brave

or

foolish. I consider the radical and idealistic approaches foolish strategies

baed upon

my reading of history. This does not mean that the ends justifies the means,

though.

If one achieves the victory through fraud or deceit, the tables will eventually

be

turned. While this posturing has also been characterized as crystal ball

reading, I

rebut it is more about knowing history. If you don't know history, you are

doomed to

repeat it. The idealists always lose. Look at Ralph Nader. It is the

pragmatists who

are able to end the rhetoric with facts. Let's produce some facts.

 

[Guest guest]

I think the

honeymoon is over in CA and now it time to get down to the actual hard work of

making a relationship work.

 

>>>>I think the honeymoon for alternative med is over in general. Evidenced

based medical policy is what is coming to everybody including biomedical med.

Don't be mistaken, biomedicine is being shaken just as much as everybodyelse.

As far as Cal and work comp, if the wording from state fund is correct (i.e.,

the new EACOM rules which apply to all insurance companies)and they can only

approve treatments that have evidence,then

we clearly are out. Chiros can only see low back and neck pain in the acute

setting, there is no evidence for chronic care for chronic neck and back pain. I

do not believe they have evidence for any other type on injury period.

Many injection therapies are out, including trigger point injection, prolo

therapy, and i think even epidurals, although there is growing evidence for

epidurals.

Most surgeries are out or at least much more restricted. The surgeons are going

to have to mount much more evidence for many procedures.

There is good evidence for many of the drugs but not for all. No evidence for

almost any of the physical therapy modalities except for active rehab education.

The world is going to look very differently.

I do see however a silver lining in that patients are going to have to start

paying for their care, in terms that if they are going to seek palliative care

they will probably look at alternative medicine.The question then will be can we

win the publicity war. Is main stream statements saying we do not have evidence

for this or that or even worse saying that " good studies " show no difference

between sham and real,

will that destroy the public confidence in us or not?

 

However cost effectiveness, not just effectiveness, is going to be

>>>>Todd cost effectiveness is not so simple. For example, would Kaiser continue

to offer a modality that must be considered as placebo if studies do not show

sham better than real. The mission statement of Kaiser and many other policy

makers is the holly grail of not providing placebo treatments regardless of cost

effectiveness. Nothing is more cost effective than a sugar pill which works

great for many patients. They cannot use sugar pills however. So this issue is

just beginning. Now that acupuncture is " accepted " the questions are for what.

And this is were we are going to get killed if we do not show much better

outcome than sham. You are quite correct, its much cheaper to give somebody a

good NSAID than ongoing care of anykind. Even though NSAIDs cause many deaths

and cost a huge amount of money in treatment of complications from them.

 

 

valid experiments must involve protocols. there has been a lot of talk about

outcome studies in some circles.

>>>>>>When doing so-called outcome studies one of the biggest issues is

population selection. Most people in our profession unfortunately have no idea

what they are treating in terms of biomedicine and how to appropriately patient

select. So the study at the end would be close to useless. Also, in outcome

studies objectivity must rule the evidence.

Alon