Partnering for Success

Could occupational medicine revolutionize the field of acupuncture and Oriental medicine and health care in general? The Academy of Oriental Medicine at Austin (AOMA) is involved in a joint initiative with Whole Foods Market (WFM) and Lerner Education to provide an avenue for acupuncturists wishing to get into the field of occupational medicine. This is the story of our efforts to establish a greater presence for acupuncture and Oriental medicine in America. Seeds were planted for the AOMA Occupational Acupuncture Initiative when Margot Roth, director of global risk management for WFM, contacted AOMA Vice President of Operations Linda Fontaine, who also served as a former national tax expert for WFM. They discussed acupuncture as a potential treatment for workers' comp claims. In the words of Margot Roth, "Whole Foods has a desire to move towards a deeper solution and away from pharmaceuticals and surgery for the ongoing management of chronic pain. This is really key for all employers. Whole Foods Markets needs and wants to get off that treadmill, as do their employees."

Whole Foods Market often talks about its mission in terms of "Whole Foods - Whole People - Whole Planet." These values play a vital role in the company's success. When speaking of Whole People, WFM refers to the team members who make up the company. WFM team members are passionate about healthy food and a healthy planet, which aligns with one of the company's core values: Team Member Excellence and Happiness.

Standard care in occupational medicine uses physical therapy, pharmaceuticals and surgery. These treatments are covered by workers' compensation or occupational benefit plans. Yet, an increasing body of evidence suggests that the loss of both productivity and quality of life for the injured occurs with chronic pharmaceutical treatment of pain. The rising costs of worker's compensation and the liabilities of being self-insured are ongoing concerns. World Food Market believes that acupuncture will help to lower worker-related medical costs while providing team members a better experience when required, giving them the ability to get back to a productive and happy work environment.

Chinese medicine seems to align with WFM's philosophies and core values. At Margot Roth's request, AOMA sent a team including Xiaotian Shen, Linda Fontaine and me to make a presentation to WFM's claims and safety specialists. In attendance at the meeting was Gallagher Basset, a major third-party administrator for workers' compensation, and Wortham Insurance & Risk Management, WFM's broker. After the presentation, WFM asked AOMA to put together a group of practitioners qualified to practice in the occupational medicine arena.

National standards do not exist for workers' comp skills in the field of acupuncture and Oriental medicine. I explored the ACAOM criteria, but they have nothing related to performance in this arena. The NCCAOM also does not test these skills. I must stipulate at this point that workers' comp has not been identified as an entry-level skill. Further, we as a profession cannot say our graduates are competent in occupational medicine unless they truly are.

Chart and utilization reviewers for workers' comp and other insurance venues tell me that AOM professionals lack skills for defining patient data in a manner consistent with the rest of the health care delivery system. A level of complexity is introduced. We are isolated by the professional language used in the practice of AOM, and we are on the outside looking in.

While we may think we have everything that we need to be in the game with no further preparation, this is not an accurate assessment of AOM's place in this culture. Every allied health care discipline - naturopathy, physical therapy, nursing, optometry, chiropractic and speech therapy - complies with the competencies set forth by the Institute of Medicine. AOM is the lone exception. At the same time, we must sustain our traditions. Language remains the crux of knowledge-building. For Chinese medicine, that language permits a "clinical gaze" that cannot be achieved through other perspectives such as biomedicine. Collaboration is facilitated through common language, however. In a contemporary global culture, collaboration is achieved through the language of biomedicine. If we write "liver fire and damp heat of the lower jiao," we are not collaborating, nor are we communicating. The common language that the other health professions use allows them to share charts without special preparation. This shared charting scenario will continue to grow as collaborations increase and joint electronic medical records become the norm.

Case management, measuring clinical outcomes and reporting them are necessary skills in workers' comp. A three-module series is being offered by AOMA and Lerner Education to bring practitioners up to speed in terms of the expectations for practice in the occupational medicine arena.

We decided to bring in a qualified instructor who is a recognized expert in the field of workers' compensation and occupational medicine. We considered whether or not this person should be an acupuncturist and determined that practitioners interested in this program already possess AOM competencies. We needed someone with expertise in systems-based care, outcomes assessment and the nooks and crannies of occupational medicine. Those are skills that one must acquire as a postgraduate, at least for now.

Fred Lerner, a chiropractor and a PhD, was chosen to teach this program because he is a trusted colleague and educator, and a person who both understands workers' comp and would provide a good "fit" for the WFM community. His views have helped many practitioners of AOM adapt to and socialize with contemporary health care settings in the United States.

According to Dr. Lerner: "While licensed acupuncturists receive high-quality training in the art and practice of traditional Chinese medicine, additional requirements exist concerning management of injured workers during a typical workers' compensation claim. This involves, but is not limited to, evaluating and using common Western medical methodology, reporting those results in ways commonly understood by other practitioners of non-TCM disciplines, and being able to manage and coordinate care with those practitioners, as well as nurse case managers, claims examiners and other parties. More specifically, these may include, but are not limited to, temporary disability benefits, permanent disability, and return-to-work issues. These aspects may require additional, specialized training, which is training that only licensed acupuncturists interested in this patient population would want, as opposed to the general practitioner population. Such needs gave rise to the AOMA Occupational Acupuncture Initiative."

Leaders for global risk management at corporations around the country are watching this WFM project to see if a difference in cost is realized. We believe that it will be, and WFM has the necessary infrastructures to identify the financial impact of this initiative. If we are right, a powerful wave of awareness could emerge throughout corporations that self-insure. The evidence for cost containment using AOM would be substantiated. This could have wide-ranging impact, shifting policy development regarding the AOM profession at the municipal, state and national levels. There may be further impact regarding the terms of reimbursement for AOM practitioners in other strata of global health care systems.

Who will profit? AOM has an outstanding opportunity to fix the cracked social structures and economics of health care in this country. It is the patients who will profit, first and foremost. Second, self-insured companies may save millions based upon a less expensive approach such as AOM. Third, the AOM providers who choose to provide care will profit through expanded practice. Fourth, the institutions and teachers who provide the education will receive a small amount of compensation. I am not profiting from this program or any like it. My efforts are paid for out of my fixed salaried time. I also work on this project as a part of my personal mission: to enculturate Chinese medicine in America through personal and social transformation. My commitment is to improve the success of not just AOMA's students and graduates, but also the profession and society as a whole.

Those who participate in the workers' comp system must have the necessary skills to provide care, follow-up reporting and treatment planning. It is a further advantage if AOMA practitioners can communicate with Western clinicians in a way that promotes our branch of the treatment team as a qualified, integrated whole.

We have created an initiative whereby acupuncturists can contribute to a social change. These changes may affect the face of corporate practices and subsequently governmental policy regarding the role that AOM practitioners play in the health care system. Second, this may empower the individual practitioner in the role that they play in occupational medicine. Third, this project may influence what are considered to be appropriate entry-level competencies for graduates of AOM institutions.

Freedom of choice presides for the AOM practitioner. Acupuncture has been covered for a long time by WFM insurance and any practitioner can participate in that aspect of care if they choose. The acupuncturist who wants to go into occupational medicine will have to gain particular knowledge. This remains a personal and professional decision.

For those desiring more information about the program, go to www.aoma.edu, look under AOMA News and Events and click on Occupational Acupuncture & Whole Foods Market.