Organization Name

Neighborhood Healthcare

Organization Type

• Community health system
• Integrated healthcare system/network

National/Policy Context

• Evidence has demonstrated the efficacy of acupuncture as a treatment option for patients suffering from both chronic and acute health conditions (1, 2), including chronic pain (3).
• Medical acupuncture gives physicians the opportunity to integrate acupuncture services into their clinical practice as a complement to Western medical diagnoses and treatments without having to refer patients to an acupuncturist (4).
• Despite more physicians undergoing training in medical acupuncture, only a fraction are able to integrate acupuncture effectively into their practices (4).
• Traditional acupuncture training usually calls for sessions lasting over 60 minutes and follows fee-for-service reimbursement schemes.
• Given the growing interest in medical acupuncture especially among family medicine practitioners and the lack of training models in the setting of primary care, it’s important to develop an integrated model of medical acupuncture that allows for rapid and effective treatments that can be offered alongside Western medical care.

Patient Population Served and Payor Information

• The patient population served by Neighborhood Healthcare are predominantly low-income Medicare and Medi-Cal (California Medicaid) patients.

Training

• This intervention relied upon the physician’s background knowledge about acupuncture and training in the rapid acupuncture technique.
• Medical assistants were trained to remove treatments (needles) from patients. Training took less than 30 minutes.

Team Members Involved

• Administrator
• MAs
• Physicians

Workflow Steps

• During a primary care visit at the office, based on the patient’s needs, a patient is offered both Western medical treatment options (medications, specialist referrals, injections) and complementary medicine (acupuncture services).
  • Importantly, evaluation of patients during their visits to the clinic is Western-based and treatments are specific to Western diagnoses. Acupuncture is merely an adjunct.
• If the patient opts for acupuncture, he or she provides informed consent prior to the first treatment, which occurs at the same visit.
• The acupuncture treatment consists of a rapid technique (ear, scalp, hand, local points, laser, electric, cupping, scraping, and/or traditional Chinese meridians) with needles being placed for 5-10 minutes.
• Follow-up accupuncture treatments are also performed in the clinic as necessary.
• The clinic template remained unchanged after incorporating acupuncture and offers more appointments to patients than nine other peer family medicine providers in the same practice.

Budget Details

• Components of the budget might include:
  • Cost of physician attending a training session and obtaining certification in medical acupuncture (300-hour course; $8,000-11,000)
  • Cost of training the medical assistants to remove acupuncture needles
  • Acupuncture equipment
    • Needles (SEIRIN J-Type Needles, Box of 100: $18-20/Box)
    • Laser ($100-$10,000)
    • Chinese cupping sets ($5-15/Set)

Where We Are

• The project is ongoing.

Outcomes

• Number of patients scheduled per day: This was measured as a marker of clinical productivity. The clinic has been scheduling about 24 patients a day, seeing 20 daily. The maximum number of patients seen in one day was 30.
• Acupuncture treatments per day: This was measured as a marker of clinical productivity.  Acupuncture was performed on five patients per day. performing acupuncture on five patients/day. There has been a maximum of 14 patients receiving acupuncture in one day.
• Patients seen per hour: This was measured as a marker of clinical productivity. For the previous year, the clinic productivity was 0.25 patients more per hour than the peer average.

Benefits

• The integration of medical acupuncture in this practice allowed for an alternative treatment option for several acute and chronic health conditions while eliminating long wait times for treatment and decreasing the use of addictive medications.
• There has been increased interest from other physicians in the practice around adding acupuncture services in their clinics.
  • One other clinician in the same practice has become certified in medical acupuncture.
• The productivity of the clinic remained high after incorporating acupuncture into its workflow.

Unique Challenges

• Although training programs for acupuncture exist (e.g. “Rapid Acupuncture” by Richard Niemtzow, MD), there are no specific training programs available for performing medical acupuncture in primary care clinics.

Glossary

• Western medical acupuncture: An adaptation of traditional Chinese acupuncture which involves the therapeutic insertion of fine needles into the skin at several locations around the body . It is used primarily to treat musculoskeletal pain and is thought to act mainly by stimulating the nervous system (5).

Sources

(1) Gould A, MacPherson H. Patient perspectives on outcomes after treatment with acupuncture. The Journal of Alternative & Complementary Medicine. 2001 Jun 1;7(3):261-8.

(2) Coeytaux RR, Park JJ. Acupuncture research in the era of comparative effectiveness research. Annals of Internal Medicine. 2013 Feb 19;158(4):287-8.

(3) McKee MD, Kligler B, Fletcher J, Biryukov F, Casalaina W, Anderson B, Blank A. Outcomes of acupuncture for chronic pain in urban primary care. The Journal of the American Board of Family Medicine. 2013 Nov 1;26(6):692-700.

(4) Ledford CJ, Fisher CL, Moss DA, Crawford PF. Critical Factors to Practicing Medical Acupuncture in Family Medicine: Patient and Physician Perspectives. The Journal of the American Board of Family Medicine. 2018 Mar 1;31(2):236-42.

(5) Adrian W. Western medical acupuncture: a definition. Acupuncture in Medicine. 2009 Mar;27(1):33-5.