In July, the American Society of Acupuncturists (ASA) Council voted to formally pursue inclusion in Medicare as practitioners. Medicare is the United States' national health insurance program that provides health insurance to Americans ages 65 and older.
Currently, Medicare provides services to close to 54 million people. This number is expected to surpass 80 million by 2030.1 Medicare recognition would enable acupuncturists to directly bill Medicare for services rendered to a growing pool of beneficiaries.
In preparation for the ASA Council's July vote to pursue Medicare recognition, the ASA, in collaboration with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), hosted a series of town-hall webinars and developed resources that clarified Medicare-provider recognition, as well as answered Medicare-related FAQs. (You can find the town-hall recordings and FAQs at https://www.asacu.org/ under "News.")
The ASA and the NCCAOM are working together to pursue Medicare recognition for the profession and will continue providing updates about the Medicare recognition process, as well as Medicare recognition's impact on the profession.
Our Current Recognition Under Medicare Limits Access
Currently, the Centers for Medicare and Medicaid Services (CMS) covers acupuncture services solely for chronic low back pain (cLBP), but does not recognize acupuncturists as Medicare practitioners. As such, acupuncturists can only provide cLBP services to Medicare beneficiaries as auxiliary personnel.
Auxiliary personnel are providers who do not have Medicare recognition, but are eligible to provide specific services to Medicare beneficiaries. CMS requires auxiliary personnel to practice under supervision and bill incident-to the supervising provider. This designation limits beneficiaries' access to acupuncture, as well as to licensed acupuncturists, as the acupuncture service-delivery model is not structured for supervision.
Appreciating The Benefits of Medicare Recognition
Medicare recognition would enable acupuncturists to provide services to Medicare beneficiaries without supervision and bill CMS directly for services rendered. Recognition would also grant many licensed acupuncturists access to new patient populations. In addition, it would provide many Medicare beneficiaries the ability to receive acupuncture from a licensed acupuncturist for the very first time.
Medicare's recognition of acupuncturists as practitioners would enable licensed acupuncturists to practice within their state scope-of-practice definitions and grant all Medicare beneficiaries direct access to acupuncturists' services, including the potential expansion of diagnoses covered for acupuncture.
Recognition also enables the profession to participate in more research studies, allowing the profession to generate more data and to facilitate more data collection. In turn, this will further establish acupuncture as part of the care continuum in the U.S., enabling more acupuncturists to serve patients in pain, as well as patients who could not otherwise afford acupuncture services.
Steps Toward Obtaining Medicare Recognition
Medicare recognition requires an act of Congress to amend the Social Security Act, which created the Medicare program in 1965. Current law informs the steps of this process, but successful efforts need to incorporate a provider group's uniqueness into its overall strategy.
It is important to acknowledge that what worked or occurred for one profession to obtain Medicare recognition may not be the same for another profession. The legislative effort to establish acupuncturists as practitioners under Medicare will be strategic and reflect the demonstrated interests and needs of our profession. Please note this is why we are pursuing our addition as practitioners. This nuanced difference will allow us to have an opt-out clause.
As advocates for this effort, the profession understands how acupuncturists are most effective in treating patients. The task at hand is to demonstrate this effectiveness to larger audiences that may be unfamiliar with acupuncture. Data that shows how acupuncture treatments help patients avoid surgery, require less medication, avoid illness, and increase wellness are critical to the success of this effort.
The profession will also need to be consistent and persistent in its messaging regarding the benefits of acupuncture as performed by licensed acupuncturists. The ASA and the NCCAOM will create issue briefs, one-page statements and research white papers, along with vital talking points.
With these materials, the ASA and the NCCAOM will work with members of Congress and their staff to advance legislation that would recognize licensed acupuncturists as Medicare practitioners. At the right time, this effort will require grassroots advocacy efforts that include members and advocates of the profession. Grassroots advocacy will include encouraging our patients and supporters to contact their congressional offices, and sharing testimonials by letter, phone and video.
We will also need your patience. This is a marathon, not a sprint. All of us will be needed to make this happen. At this time, we ask you to stay engaged and informed. Check the ASA and NCCAOM websites to learn more about the process and how you can be part of it.
The ASA and the NCCAOM are working on this issue diligently. As we determine each step of the strategic path to Medicare inclusion, we will provide updates and let you know exactly how you can help promote this effort. Until then, please be patient and stay tuned for more details. Please understand that this must be a strategic and well-designed advocacy effort.
Authors' Note: Questions? Contact ASA Advocacy Chair Jennifer Broadwell at Advocacy@asacu.org or Vice Chair of Public Policy Amy Mager at VCPublicPolicy@asacu.org. Additionally, you can contact NCCAOM Senior Manager, Policy & Government Relations, Molly Giammarco, at Advocacy@thenccaom.org.
Reference
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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