The Integration of Acupuncture and Western Medicine
Dear Editor:
The movement to integrate acupuncture into the current health care system was initiated by former president Bill Clinton, who established the White House Commission on Complementary and Alternative Medicine (CAM). One recommendation of this committee was that the federal health plans, Medicare and Medicaid, commence insurance coverage of acupuncture. As a result, 47 percent of employees with PPOs and private health plans were offered acupuncture coverage in 2004, up from 33 percent in 2002.
However, even though acupuncture benefits were offered among some private insurance programs, they remained limited, i.e., acupuncture coverage through one insurer was restricted for a circumscribed number of visits, or spending for only "acceptable" (non-experimental) treatments of nausea and vomiting, and the pain associated with post-dental surgery.
To this end, Congressman Maurice Hinchey, along with legislative advocate Bob Marcus, were the driving forces supporting the integration of acupuncture with Western medicine in 2005. In 1976, former Assemblyman Hinchey authored the landmark legislation that licensed providers of acupuncture in New York state. When elected to Congress in 1993, Rep. Hinchey wrote the Federal Acupuncture Coverage Act. Throughout the years, congressional support for this bill has been moderate; in particular, when HR 818 was re-introduced to the 109th Congress on Feb. 15, 2005, it had the record-high total of 25 bipartisan co-sponsors. Specifically, HR 818 sought to amend title XVIII of the Social Security Act to make available acupuncturist services under part B of the Medicare Program, and to amend Title 5 of the United States Code to provide for acupuncture coverage under the Federal Employees Health Benefits Program (FEHBP).
The Medicare national health insurance program is for persons aged 65 years and older, and the disabled, providing coverage for more than 40 million Americans. Part B is the "fee for service" component of Medicare that insures for a given physician's services and outpatient care. The program is administered by the federal government (Centers for Medicare and Medicaid Services/ CMS), which determines the reimbursement rates for Medicare participating providers.
Contrary to the Medicare program, the FEHBP provides health insurance to the federal workers, their dependents, federal retirees, and their survivors. FEHBP is administered by the Office of Personal Management (OPM), which negotiates with private health companies to provide medical coverage to its beneficiaries. This PPO plan sets specific predetermined policies that are administered by individual insurance companies which establish their own contractual rates of re-imbursement for a participating provider.
HR 818, did not, in and of itself, specify the individual acupuncture procedures that would be covered by this bill. Rather, these decisions will be made after the legislation is signed into law by the CMS and OPM. Currently, the AMA CPT (2006) has acupuncture codes, but they only benefit those individuals having current acupuncture riders with private insurance companies.
An increasing dissatisfaction and/or frustration exists with the U.S. health care system. Specifically, American consumers have grown disenchanted with the limitations and invasiveness of Western medicine.
Toward this end, acupuncture is not toxic; it does not rely on new medical technology, "pricy" equipment or pharmaceuticals. It is not an invasive procedure. Acupuncture patients do not require prolonged hospital stays or long recovery periods.
Medicare beneficiaries and federal employees alone comprise 20 percent of our population, or 49 million Americans. With the astronomical costs of health care, seniors, the disabled, federal workers and retirees are not likely to pursue treatments not covered by their insurance. Additionally, I am one of the millions of Americans who know first-hand how effective acupuncture treatment can be for acute and chronic pain. However, I have also had to pay for these treatments out-of-pocket, as my health insurance does not advocate nor promote the practicality of acupuncture.
From the standpoint of consumer interest in the healing arts, I do not think Congressman Hinchey's bill, the Federal Acupuncture Coverage Act, to adopt insurance coverage for acupuncture to be "far-fetched." Rather, it is an "idea that has come of age."
Johnna Williams
Novato, California
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Kegel Exercises May Not Be Best for Reducing Urine Leakage
Dear Editor:
I am writing to comment on Dr. Ronda Wimmer's article, "Exercise-Induced Urine Leakage in Female Athletes." I am a physical therapist specializing in the treatment of incontinence, and share an office with my husband, who is an acupuncturist. It is great to have a multidisciplinary approach to treating incontinence in athletes, and the article was informative.
The one piece of information that is currently incorrect is the advice that Kegel exercises are most beneficial and should be done "while urinating by stopping the stream of urine." This used to be the way women were instructed to exercise; however, it is now not advised, as it can cause bladder or kidney infection. As Dr. Wimmer pointed out, the bladder is actually a muscle, so it is actively contracting to empty. If you then engage the pelvic floor musculature to close the urethra and stop the flow of urine, the urine can flow back up to the bladder or the ureters to the kidneys. This also decreases the neuromuscular coordination of the pelvic floor musculature and the bladder. It would be best to have a specialist advise on exercises for this particular medical issue, as there are many options including and beyond Kegel exercises which are specific for each individual case.
Nancy Charlebois, MSPT
Portland, Maine
