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Pinning down acupuncture rules for comp

Pinning down acupuncture rules for comp

Alternative therapies are mentioned often by participants in the workers compensation sector trying to manage injured workers’ pain while shifting away from the industry’s dependence on opioids — and acupuncture is the talk of the town.

States are working on making it easier to provide such treatment, but more work needs to be done to get insurers to cover the costs and regulators to approve providers, experts say.

“We are all over the place” with acupuncture, said Mori West, Torrance, California-based chief executive officer for AcuClaims Inc., which handles billing nationwide for acupuncturists, working with both group health insurers and increasingly workers compensation insurers. The guidelines for acupuncture “are not entirely spelled out and open to interpretation in some states.”

The therapy involves inserting hair-thin needles into pressure points and pain receptors on the body, helping to reduce inflammation, relax muscles, and reduce pain, all working in concert to provide a greater range of motion, said James Shinol, Huntington Station, New York-based president of the Acupuncture Society of New York and dean of the New York College of Health Professionals.

Treatments can cost $60 to $100, and multiple treatments — capped in most states — are usually required for effectiveness, according to guidelines in several states.

But acupuncture wins when comparing treatment costs to that of opioid dependency, experts say.

“It’s less expensive than pharmaceuticals,” said Dean Stiles, Wayne, Pennsylvania-based director of network management for Genex Services Inc. “People can’t return to work and do their jobs if they have (opioids) in their system. For the overall claims costs, it appears (acupuncture) is less expensive.”

Some states such as California and Oregon are more accepting of acupuncture than others, experts say.

“California is on the forefront,” said Mr. Stiles. “They are on the top end of regulating it, while in some states (regulations) don’t even mention acupuncture or alternative therapies.”

“Other places, within workers comp, (treatment) is heavily regulated,” he said. “If a primary care physician wants to push alternative medicine and they get buy-in from the adjusters or claims managers, then it is a seamless process. If the patient wants to go off-script (with acupuncture) it can become one of those things where the bill might be paid, it might not.”

The state of Washington, long lobbied by acupuncture professional associations and patients, has been collecting data on the treatment for injured workers suffering from lower back pain since late 2017, said Zachary Gray, an epidemiologist overseeing the data gathering program through the Washington State Department of Labor and Industries. The tracking will help tweak guidelines, which have been in place for years, he said.

“We are focusing on pain and function and getting people back to work … we want to see how it’s working,” he said.

At least half of states include acupuncture in medical treatment schedules, and in some cases have included acupuncture in fee schedules. In some states, it’s up to the medical provider to recommend acupuncture, said Ms. West.

But complications within New York’s workers compensation regulations, which allow for acupuncture but set limitations on providers, encouraged lawmakers to pass a bill that would broaden what is available for injured workers. As of late July, S.B. S6666 sits on Gov. Andrew Cuomo’s desk.

It’s the third time lawmakers have tried to change the issue in New York that limits who can provide acupuncture, but the bills have been vetoed every time, said Mr. Shinol.

The governor’s office did not return requests for comment.

In New York, a workers comp insurer is required to pay for acupuncture if the provider is both a medical doctor and a licensed acupuncturist — “like finding a unicorn” in some parts of the state, said Mr. Shinol.

“Half of the carriers realized how ridiculous this is and they pay for licensed acupuncturists” who are not medical doctors, too, he said. But the other half of insurers are denying payment based on the provider requirements.

“This is definitely an industry trend,” said Carlos Mota, Anaheim, California-based director of medical review services for Genex Services Inc. “Other states will begin to incorporate not only acupuncture but other therapies into the fee schedule, such as massage therapy.”

Anecdotally, acupuncture — often coupled with other therapies such as massage and physical therapy — is having its heyday as far as injured workers go, Mr. Gray and others said.

“More patients are asking for it,” said Ms. West. “They say, ‘I don’t want a cortisone shot (for inflammation). I don’t want to go under the knife. They want to try acupuncture first.”

The risks associated with opioid dependence and withdrawal have also made acupuncture attractive — a common rationale that had 40-year-old Steve DeMarco, a Suffolk County Police Officer, opting for hair-thin needles over pain pills.

“The alternative is pain medication, which causes other issues,” he said.

Mr. DeMarco suffers back and neck pain stemming from a reoccurring soft-tissue muscle injury sustained in his work as a police officer. Acupuncture is not an overnight fix — it takes at least four sessions to get him “back to normal,” he said. At least once a year he needs a round of treatment, he said. “It’s the only thing that keeps me going back to work.”


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