Why is acupuncturist owners’ insurance so important? There are two main reasons: For one, to comply with a regulatory requirement as most states (if not all) obligate an acupuncture business (or alternative treatments, in general) to have insurance, among other requirements, before they are allowed to conduct a business. Another is that insurance serves as a cushion so that if an issue of enormous magnitude (like a patient filing a case) falls upon an acupuncture business, the owner will handle it with assurance, knowing it has the needed protection.
If you are into alternative treatments and planning to open your acupuncture clinic, acupuncturist owners’ insurance should be on your must-do checklist. Here are some of its benefits:
Protection from malpractice complaints – for alternative treatments that include treating delicate parts of our body, such as acupuncture, anything can happen on the part of the patient. When a patient files a complaint claiming malpractice, you can rest assured that, with acupuncturist owners’ insurance, you have the necessary protection; there’s an entity that will help you financially if it requires you to shell out amounts of money for any expenses incurred.
Worker’s compensation – covers all of the employees of a business except when the concerned is an independent contractor. An employee working away from their state needs special provisions. Worker’s compensation is a no-fault system, which means injured employees do not have to sue their employers for compensation. For example, compensation is automatic for covered benefits, except for extreme negligence – where employers have protection from liability due to work-related injuries and illnesses.
Premises liability protection – here at the American Acupuncture Council, we call it Business personal property (BPP), which can cover the named insured for lost, stolen, or damaged property of the business, such as equipment. For example; a treatment table, furniture, or other business property that is not a permanent fixture of the building structure can be covered by this insurance policy.
If you are looking for a reputable company that offers acupuncturist owners’ insurance, look no further than the American Acupuncture Council. Please call (800) 838-0383 for inquiries.
In a very blessed way, my pulse diagnosis mentor, and then I became in love with the way I take pulses and frankly, that’s what’s kept me interested in Chinese medicine for the last 25 years.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, this is Dr. Martha Lucas, and today I am going to be talking with you about pulse diagnosis. I have a special system that I’ve been using for my whole Chinese medicine career in my offices in Denver and Littleton, Colorado. I am a research psychologist, so I started out my. Quote unquote medical career in Western medicine doing research in hospital settings.
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But I was immediately curious as researchers tend to be about what was operating with the patients I was seeing other than. They just had cardiovascular bypass surgery, so I knew the engine had been fixed a day or two before, but I wondered what else is operating for their healing. So I started to study various energy medicines including reiki, tonal alignment, and then I learned something called color puncture.
Which as you would imagine, is based on acupuncture, which is based on Chinese medicine. But the teachers didn’t talk much about the theory of why you did certain colors on certain points. So I went to Chinese medicine school. I. To learn that I didn’t really intend to become a practitioner of Chinese medicine.
I just wanted to learn why I was doing certain things, because I couldn’t imagine my patients asking, oh, Dr. Lucas, why are you doing blah, blah, blah? And I say, because Aquila said, Dr. Mandel says so there I met very. In a very blessed way, my pulse diagnosis mentor, and then I became in love with the way I take pulses and frankly, that’s what’s kept me interested in Chinese medicine for the last 25 years.
If I was doing prescription Chinese medicine, I’d be bored. So my goal, part of my goal in my practice is to help as many practitioners as want to be most excellent diagnostician. So we are going to be talking about pulse diagnosis. I. And I want to thank the American Acupuncture Council for allowing me this opportunity to do this show.
This will be part one in a series about pulse diagnosis. So let’s go to the slides. I, the whole presentation is called Pulse Diagnosis Beyond Slippery and Wiry because. I always say I went to a slippery and wiry school where everybody’s pulses were slippery and wiry. That’s what the teachers all knew.
And occasionally we could say they were thin and wiry, but that. That was about the extent of our experience with Pulse diagnosis. So I am excited to show people that there is so much more in Pulse diagnosis than just three and wiry, which is why I call my book and this presentation beyond slippery and wiry.
I am fascinated and I hope we all would be fascinated by the history of Pulse diagnosis. In fact, it has a very storied history, so I really don’t understand why in modern schools they’re not teaching it as our. Primary diagnostic tool. As I said, I was lucky to have a mentor. My school didn’t teach pulse diagnosis.
I think the theory teacher talked about it for about a week. Maybe occasionally someone would say, oh, let’s go around the room and feel everybody’s pulses. And guess what? They were all wiry, where students were spleen deficient, et cetera, et cetera. I the old pictogram actually is an image.
It’s the classic pulse taking with using three fingers. The other diagnostic methods or examinations are used in modern medicine as well as Chinese medicine. There’s an inspection, but in modern medicine, its imaging technologies. Our inspection tools are our pulses and our eyes, our fingers rather to take the pulses in our eyes.
There’s listening, obviously, or maybe not. So obviously the DOT MDs listen, they want to hear what your chief complaint is. We certainly listen to our patient’s chief complaint, but. As the great sociologist and survey master, Andrew Greeley said, people will tell you anything. And so that’s why he suggested we shouldn’t believe surveys.
I believe in pulse diagnosis that people will tell me anything or they’ll tell me nothing. How often does somebody tell you their digestion is great or. With women, oh no, they don’t have any PMS. Their periods are quote unquote normal. So I have learned for many years that people will just say anything and that it’s our job to really figure out what’s going on with people.
I know you’ve all heard someone say, oh, I’ve had acupuncture and it didn’t work. There are two reasons for that. Number one, the patient didn’t work at it. They had back pain for a bunch of years. They come in, they’re hoping you’re gonna make it better in one or two treatments, and so then they tell their friends, oh, I had acupuncture for that, and it didn’t work well, the patient didn’t work.
And then there’s the other reason, which is an incorrect diagnosis. A non a, not a total diagnosis that the practitioner just touches the pulses for a second and sees their wiry, and that’s their diagnosis. No, that is not, that’s not what you would call an adequate diagnosis. So that’s our inquiry part.
We can question the patient, but as I said they’ll say anything. So I feel like. We need to have a tool that even while they are talking with us, we can have our fingers on the pulses and we can be talking with them about what’s going on. For example, I have a patient who’s struggling with Lyme dis he is struggling with the treatments for Lyme disease, and right now he’s taking three different antibiotics.
That’s the protocol of either one or two doctors that he’s going to see, and of course, he. Tells me yes, he’s doing well because he can tell there’s die off and this other stuff. And I’m feeling his pulses and I can tell that his digestion isn’t right. And finally he admits. That he’s having some watery diarrhea.
And I explained to him already about the cold energy of antibiotics and how your digestion loves warm energy. And so he should be expecting maybe some negative side effects from the antibiotics. And of course, he tells me he’s. Pumping lots of prebiotics and probiotics, which also by the way, can have a negative effect on digestion.
Because I could tell that the digestion was struggling with the cold, I just put a Ong on Ren 12. No needles yet and put my fingers on his pulses and immediately could feel some young coming back, some more fullness to the pulses. And this young man has been seeing me and another practitioner who was trained in pulse diagnosis by me for a long time.
So he loves to talk about it, he loves to be educated about it. He’s very curious about how his kidneys are doing, how his liver is doing. And so it’s. I like educating our patients as well because an educated patient is a better referral source for you because they can say, I saw Dr. Lucas, she did blah, blah, blah.
She said, this is why this is happening. And then she treated it instead of, oh, I’m getting acupuncture and I don’t know what they’re doing. And it’s just a magical tool. It isn’t. It is not a mystery. It’s a medicine. And pulse diagnosis is not a mystery either. It’s a diagnostic tool that can be explained.
So for us to be able to decide what’s going on with the patient is the primary goal of every treatment in Chinese medicine. And we also have smelling right in, we would call these in modern medicine, more like blood tests and urine tests. My very first kidney disease patient, I could see. Smell. I could smell his kidney disease and he hasn’t had that smell since I think two treatments out.
So we’re all trying to do our diagnostic tools. And then the art of changing yin and yang. I call it balancing like my kidney disease patient. I balanced yin and yang. He came to me with priapism, and when I explained to a few students that I was doing some kidney yang points, they couldn’t believe it.
They’re like, yang. Oh my gosh. That would create an erection. Why on earth would you be doing kidney yang points for priapism? Because I was balancing. Not only kidney, yin and yang, but the whole system of yin and yang. So in the old days they used to say that the diag, you diagnosed the causes of illness according to what they called the complicated pulse.
And I just taught a seminar in cosmetic acupuncture, and we were talking about pulse diagnosis, and the students were saying, how, oh our teachers told us it’s too complicated. It would take a whole. 30 or 40 or 50 years longer than we’re gonna be in practice to learn it. And that is totally wrongheaded.
That is absolutely not true. You can absolutely learn how to be a good diagnostician. And the process back in the day was called ology, and this was as early as the inner canon talking about the normal pulse and the morbid pulses. Now, why is that important? Because if you don’t know how to see a normal pulse, if you don’t know what normal feels then you’re only ever going to be feeling.
Out of balance pulses. So part of what I like to teach people is the goal of every treatment is the normal pulse and how that feels. And I love the whole history of it. I love the original names and labels of things like the lung, great abyss. And honestly, if you think about the names, the original names.
It can also help you think about what you’re feeling in the pulses large intestine Union Valley of the Hand, young Ravine stomach surging young, like I just said, with that case study of the young man suffering through his medical treatments for Lyme disease. I put that Mong on run 12 to raise some young spleen surging gait, young pour the heart or also inside spirit gait celestial window, the small intestine beside the throat bend center, bladder bent part of the knee.
Great ravine, the kidneys. Of course the kidneys fund everything, right? Of course. They’re a great ravine. They fund all of the other movements, which is partly why they are so important. We all learn. Kidneys kidneys Ming Mu Fire, original Chief Fire in the belly. Why? Because that’s funding everything.
So if that starts to go down, then all of the other organ systems are going to be out of balance. There’s no such thing as an out of balance kidney pulse. Everything else is balanced. Not gonna happen. Palace of Toil. A colorful network vessel in the palm and rep represents the heart harmony, bone hole, sanja, suspended bell gallbladder, supreme surge liver.
And we know the liver helps. Move everything according to the inner Canon Pulse examination inspects the distribution of blood, and we know it’s of blood and oxygen inside the channels or meridians, and that diseases generate uneven distributions inside those channels. In other words, we are feeling the imbalances, the disruption of oxygen and blood in those channels, and that’s a part of how we make our diagnosis.
I. Some historical positions because I teach in my diagnosis courses, I teach it maybe what sounds like a few different positions. The basic positions are the same, but there are additional things we can feel like the uterus in the left uterus and prostate in the left kidney pulse. So in the old days. We might talk about the left distal pulse being heart, chest center, small intestine or pericardium or the right sun being the lung in the chest and the large intestine left, middle position, liver, diaphragm, gallbladder, spleen.
So these are all things that historically were felt you could feel in that position with the right side stomach and spleen. The left chair position, kidneys, pretty much the kidneys have always been in that. Most proximal position, kidney, abdomen, bladder, large intestine, and small intestine, because they’re deep, they’re in the lower jaw.
So it makes a certain amount of sense that we would feel that what’s going on with that organ system in the HUR position. Right side. Kidney, abdomen, pericardium, sanal, bladder life gait, small intestine, large intestine. Now, these are all historically talked about, the organ systems that we can feel in the certain positions.
The inner canine indicates that the stomach is the regular chie of a normal person, which of course I. Think is super, super ambiguous. But again, we’re going over a little bit of the history of it. And we talk about that being the person’s y qi. And if it gets weak, the stomach is going to come, become a little bit weak if it gets.
Vanquished gone. Stomach chi will be then scattered. And that’s a basic sign of life, right? That’s how we make our energy. So to have a good earth, solid earth, spleen, stomach, right middle side position is very important. And in my system, which goes back to early sixth century Korea. And from, in my experience, I know and teach about how early childhood trauma is held in that position, in that middle position on the right side, spleen, stomach, earth.
And it has to do with nurturing, lack of nurturing or even perceived lack of nurturing being separated from a parent at an early age or having early trauma. The classic of difficult issues mentions that if the upper part doesn’t have a pulse and the lower part has a pulse, that’s they call cumbersome, but we need to look at getting that better, right?
There shouldn’t be just a low pulse or a high pulse, a deep pulse in a superficial pulse. We need to get those pulses. Communicating with each other because the pulse can’t only have a root. It should have a root, but not only a root. And we all know that absence of a root pulse is going to show that there’s some debilitation in the kidney going on.
In the energy of the kidney, the history of pulse diagnosis isn’t only Chinese medicine either. Hindu physicians looked at the pulses they likened them to certain animals like the serpent, the frog, the swan, the peacock diseases were attributed to the humors, air, bile, and phlegm. And they felt like they were all reflected in the pulses.
And we talked certainly about. We talk a lot about phlegm being in the pulses. Otherwise, this wouldn’t be called beyond slippery and wiry. And they said that a disturbance in phlegm, the pulse would be slow and heavy, like the motion of a swan or a peacock, whereas dis some sort of disturbance in the air would be like the motion of a serpent.
Greek physicians also used pulse diagnosis. They included the knowledge of both music and geometry they felt were necessary in order to interpret the pulse and they. Paid attention to its rhythm or cadence. They also recognize size, frequency, force, and as I said, rhythm. And it is said that the physician Galen wrote more books on the subject of Pulse diagnosis than anyone before or since.
He emphasized the importance of feeling the pulse during healthy times so that we knew what a normal pulse felt like. And then the irregular, the imbalance, the illness pulses became more clear to us. They also studied the speed of the pulse length, depth, broadness strength, so you can see that not only Chinese medicine historians and doctors studied the pulses or all of these little subtle distinctions that can be in the pulse.
In fact, Galen even drew wave pictures, which is part of what I teach in my classes in Europe. Bordeaux brought about the idea of organic pulses and talked about. The, some of the pulses being shown above the diaphragm, seeing the organs above the diaphragm and some below the diaphragm, and then the superior pulses were divided into certain organs and the inferior pulses, the lower ones.
And I talked to people about feeling the upper, middle and lower jou locations of the organs in the pulses. So the earliest case histories used visual exam, listening, questioning, but palpation was the main diagnostic tool. They were palpating or reading what they called the grand rendezvous of the vessels.
And that is that area, the three finger width on both sides of the wrists, the grand rendezvous of the vessels. We have one dimensional models, which say the pulse is wiry. We have two dimensional models, which might say, I can feel a young pulse and a yin pulse, but we’re gonna be looking at more than three levels, three or more levels.
It’s quantum mechanics, which does sound complicated. Physics, quantum mechanics, that all sounds like it’s super, super comp complicated. But I can take that into. A discussion that everyone can understand and we can. Learn what I call a plausible methodology. So we’re going to be talking eventually about the top level skin, superficial level, skin surface, meridian activity, chief flow, emotions, the body’s interaction with the environment, middle level blood, functional aspects, organ function, metabolism are interfaced with.
Our internal organs in the environment. And then the deeper level, the bottom bone marrow organs, chronic disease, hidden emotion, unconscious emotions, adaptive level patterns that are fixed and you might not even know about. So unconscious emotions. And all of this means that we are going to be able to see current situations with the patient and older situations with the patient.
So the physical space that we’re feeling is going to give us a diagnostic. Perspective from birth or before birth up to the current because nothing is omitted in your pulses. It’s like a Rosetta Stone. It’s one symptom didn’t just come from yesterday. It’s a historical. Adding up of events that we can see in the person’s pulses.
So we are gonna be able to look at the circumstances, emotions, healing, disease progression, and that’s all gonna show up in the pulses. And the pulses should change during the treatment. You’re. Your treatment should work like that little Moab bong, changing the pulses while I was watching it, or your acupuncture prescription, changing the pulses.
So acupuncture treatments should be fluid, not prescriptions. I am not a believer in pre what I call prescription Chinese medicine, which means, oh, the person has. PMS. Let me look in a book and see what acupuncture points I should do. That is totally wrongheaded because not everyone’s PMS is caused by the same thing, and that’s your job to figure that out.
So this ends part one of my story or my training in Pulse diagnosis, my ex. You can see how excited I am about Pulse diagnosis and in part two, next time we are going to talk about what a normal pulse feels like. Talk about some emotions, talk about some case studies. So again, I wanna thank the American Acupuncture Council and I will see you next time.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, my name’s Michelle Gellis. I’m an acupuncture physician specializing in facial and cosmetic acupuncture classes. And today I am going to speak to you, I’m doing part one of a lecture on facial motor points. Can you go to the first slide please?
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So the title of this talk is Facial Motor Point, use for Cosmetic Applications, and in part two I’m going to talk about a little bit about facial motor points for neuromuscular facial conditions. Here is some of my publications from the Journal of Chinese Medicine. And I’ll put links up at the end to my social where you can actually view some of these publications.
And these are all the classes I teach today. The Motorpoint lecture will focus on treating neuromuscular facial conditions and some of my advanced techniques. Motor points have been used for a very long time, not just by acupuncturists. They’ve also been used by medical doctors and they. Date way back to the late 18 hundreds.
And more recently some acupuncturists and other physicians have been using facial motor points for neuromuscular facial concerns. So what is a motor point? When a muscle is either in spasm or in a flacid state. It is not firing properly, and if you take an acupuncture needle and insert it properly into the muscle’s motor point, it will cause the muscle to jump and reset it into normal function.
So this is what motor nerve looks like here. So this would be a sensory nerve going out to the skin and here’s a motor nerve going to the muscle, but in. With our face, the muscle is actually connected to the skin, so when you reset the muscle, it can help to enhance the appearance of the skin.
Now, motor points are not trigger points, mo trigger points or sore spots and muscles, but. Fortunately for us, many motor points are acupuncture points on the face. So it makes it easy for us to find them. So here’s a, just a picture of bone and muscle. And on the face, the muscle is connected directly to our skin, which is why we can move the scan.
On our face. So again, if the muscle is pulled tight, then the skin will wrinkle. So when we’re thinking of neuromuscular facial conditions, when we’re looking at the motor points, the face is innervated by two nerves, CN seven, and. Also the trigeminal nerve. So when you’re using facial motor points, they are wonderful for any conditions involving paralysis.
And what you do is you needle into the muscle, but not through the muscle. So on most of the face, you’re going to go on an oblique angle about a quarter to a half an inch into the muscle. And facial motor points will treat the muscle and the fascia, and this can help to enhance the appearance of the skin unless it’s some sort of a skin disease discoloration or a scoring.
So when might you use motor points if you’re doing cosmetic acupuncture? As someone who practices cosmetic acupuncture extensively, I always start with basic cosmetic acupuncture treatments and if they, my patient has a difficult to treat. Concern then I will use these motor points to help to enhance the effectiveness of my facial acupuncture treatment.
So here is what a face looks like as it’s aging. We have nasal labial folds, chin wrinkles. You can get loss of volume in the temples, we get lines between our eyebrows. The face can hollow, the jaw contours change. And we can get wrinkles in our chin and neck and also sagging underneath the neck.
So here would be an example of someone who’s not showing many signs of aging and then coming into their fifties, some signs of aging, and then more advanced signs of aging. So let’s talk about some specific types of wrinkles that you might see in your treatment room and when using cosmetic acupuncture motor points might be beneficial.
So one of those. Would be forehead wrinkles. And frequently an individual will have forehead wrinkles because their frontalis muscle has become very tight. And even when they feel like they’re relaxing their forehead and they’re not making an expression, the muscle itself is very tight. And the. Folds in the skin remain there.
So by relaxing the frontalis muscle, the entire forehead will relax and it will smooth out the wrinkles. Also treating the frontals can help to lift the lid, the eyebrows and also the eye lid at the same time. This was a patient of mine who came to me and she was noticing her brows were starting to descend as she was getting older, and so I treated just the left her left.
Eyebrow and I used the frontals muscle, and you can see after one treatment, when the muscle relaxed, the skin laid flat and it pulled the skin up into a more normal functioning for her.
So here we have the frontals muscle and the motor point for the frontals is fortunately for us, easy to find gallbladder 14. So if you wanted to work with the frontals muscle and the, again, the frontalis muscle wrinkles the forehead, it raises the eyebrows up and. What you would do is you would put the the needle straight in on a very slight oblique angle.
And you’re going to go into the muscle, but not through the muscle. Depending on how thick their forehead skin is, would determine how deep you have to go before you hit the muscle. So here’s a quick video. I had a patient who had Bell’s Palsy and they could not raise their eyebrows and they could not fully open their eye because of the Bell’s Palsy.
So I had put this needle in and stimulated it. And you can see the needle started moving immediately after the needle went in. And I put the needle right in the motor point. Is another example of when you might use a facial motor point would be if someone had very stubborn lines between their eyebrows, either the two or the one we call them frown lines, and we would needle the corrugator.
Muscle and the motor point for that is just lateral to bladder two. And it’s right in the corrugator muscle. The corrugator muscle pulls along with the procerus, pulls the eyebrows together very strongly,
and you would also, whoops. I have a little delay here. You would also needle the motor point for the processis, which is yin tongue, and when you’re using it as a motor point, you’re going to needle it slightly towards the nose.
Another area that. Motor points are very beneficial for is treating wrinkles in the chin. And as we age, these chin wrinkles or chin dimples can be more noticeable because the mentalis muscle and the depressor ang oris muscle, they can become. They don’t function as well. And so by doing the Le Depressor, Labi, inferior Aus and or the Mentalis and or the Depressor, angular Aus, all of these muscles are going to work together to cause that issue.
But. I’m showing you the de depressor, Labi inferiors and the motor point for that is the extra point. One soon lateral to this extra point here. And the way you. Oh. I’ll show you that in a second. And then medial to that is the mentalis and the motor point for that is a half a soon lateral to Ren 24.
So here is a video. And this was a patient, another patient who had Bell’s Palsy. And I had put the needle in the mentalis. And as you can see, when I stimulated the needle, the muscle jumped and my patient reported back to me that. The issue that she had been having with drooling when she was like brushing her teeth, she couldn’t spit she couldn’t drink through a straw and she had Bell’s palsy many years prior.
But still in this one side, she had issues.
Lip wrinkles can be treated very effectively with facial motor points. We would needle the motor points around the orbicularis orus, and there’s two of them on each side of the mouth. One is LI 19, and then the other one is between stomach four and Ren 24. So it’s like right here. Some other uses for facial motor points would be points on some of the muscles pertaining to the levator muscles and the oculis oculi.
So the lator muscles in the face, on the cheeks. Will if they’re not functioning properly, along with some of the tendons and other things, but can contribute to the nasal labial folds, the motor point for the rezos. If you treat that, it can help. With the little marionette lines, there are motor points for the neck that can help with the necklace lines and the neck bands.
And then there are motor points around the eyes, which I go over all of the motor points on the face in my classes. But there’s motor points around the orbicularis oculi that can help with crow’s feet. In part two of this lecture, I will go over facial motor point usage to treat neuromuscular facial conditions like Bell’s Palsy, Ramsey Hunt Syndrome, TMJ Hemi Facial Spasm, and others.
If you’re interested in checking out my classes, you can go to facial acupuncture classes.com and my social is for Instagram, it’s Michelle Gillis and Facebook. You can look up my Facebook group, which is facial acupuncture. Thank you so much.
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Today we’re gonna be talking about tracking for success. So is your practice on track? What stats should you be tracking? Are you tracking or aren’t you?
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, and welcome to another episode of To The Point. I am Dr. Nell Smircina with American Acupuncture Council, and let’s go to the slides. Today we’re gonna be talking about tracking for success. So is your practice on track? What stats should you be tracking? Are you tracking or aren’t you? What’s really interesting about this topic is I would say out of the practitioners and students that I coach when we talk about stats in clinic or stats in their practice, over 90% don’t track anything.
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So the little bit these nuggets that you’re going to get out of the presentation today, you’re already gonna be way ahead of the game just by going over these three top things that you wanna make sure you’re tracking in your business. So really things to think about. Like I said, most of practitioners out there, at least in the acupuncture industry, are unfortunately not tracking things.
This can be really problematic because not only is it not allowing us to be really intentional with what’s going on in our practice, but how are we comparing how we’re doing? If we’re growing? There are a lot more things than your bottom line revenue that we need to be looking at because it’s one thing to say, Hey, I need to bring in more income every month.
But it’s very different when you then wanna dive into where is that revenue coming from? Is it mostly new patients? Is it returning patients? Is it supplement sales? If you’re not really sure, then that’s gonna be really problematic when you are trying to decide what steps you wanna take next to continue growing your practice.
So the first thing you wanna think about is are you tracking to begin with? If you’re not tracking, why is that? Is it because you’re just not sure what stats you should be tracking? Is it because we get so swept up in the day-to-day, which is entirely possible, especially since most of us start out as solopreneurs.
You are the only one who is working all of the levers in your business. So I wanna help with some of those. . Maybe why not today And give you just some really easy things that you could take away and say, all right, this feels really feasible for me. I can at least get started with these three things.
And if you are tracking, that’s awesome. I just told you the stats on people I talk to, how often people are not tracking in their businesses. But if you are tracking, what are you tracking? Is it again, just that bottom line what comes into your practice? Is it the top line when it comes to sales before you take out all of your expenses?
Because what we’re looking at from patient count perspective and revenue can make a really big difference in the decisions that we make. So I absolutely want you to be looking at your finances. We need to budget, we need to plan accordingly. But when it comes to those first steps to take for what we’re gonna track when it comes
Two patients. Let’s take a look at these three today. So the first one, . I’m new. How many new patients are you bringing in? We wanna talk about you and your practice. So we’re gonna close up by saying how important it’s to talk to colleagues and how important it’s to compare you to you. But if you brought in four new patients last month, we wanna do better than that this month.
If you brought in 40 patients last month, we wanna see how to do better this month. We wanna start tracking these things so we can make informed decisions, not only when it comes . To how well is the practice doing, but we wanna talk about capacity. When is it important to bring on another practitioner?
When do you need to bring on office staff? When do you get to the point where you say, Hey, I’m doing too many patients. I don’t have time to run the back office at this point, and somebody really needs to help me. And the first easy one to do is just tracking the amount of new patients that come into your practice.
And I really like to look at this on a weekly basis. If you’re, just getting started with it and that feels a little overwhelming. Monthly is great as well. But really to have that weekly check-in and say how many new patients this week. What’s also great about tracking things is you start to identify trends.
When I had my practice and that was in la it was very, seasonal. I had a lot of parents in my practice, so people would be going away during the summer, they’d be going away during holiday breaks. And you need to be able to plan for that and start to see trends. But when are your new patients coming in?
How many new patients are coming in? Is the main thing that you wanna start with? The second thing is looking at return patients. Now I’ve seen this tracked a couple of different ways where I think it’s most meaningful for you to take something really tangible out of it and say to myself, wow, I really learned something from this process.
How many of those new patients are coming back? That doesn’t mean, all right, what percentage of my patients are returning patients? I think when you first start tracking metrics in your practice, you wanna look at . It could also be referred to as your conversion rate. So you have a new patient. How many of them are turning into a patient with an active care plan Who’s coming back for that next treatment?
That’s really important to know because if we look at that kind of staying at the same level, I. That that’s not improving. We wanna then be looking at, okay, what are ways that we can improve that conversation around why someone needs to go from that initial consultation and exam into an active care plan?
And so we can’t really start looking at what are the main things that cause that performance to increase if we don’t know what that baseline number is. So we need to know how many new patients are turning into return patients. And again. Get grounded in a weekly cadence of this. You can just look at a few things per week and that will start to give you a few metrics that make it really evident what’s going on in your practice, and you can always go from there.
I. All right, the last one with all these numbers this is one people don’t often think about, but it’s very important when you’re looking at planning your income and predicting out what your scheduling is going to look like. What is the average number of sessions that a new patient. Who then gets into an active care plan?
What does your active care plan session wise generally look like? And depending on your specialization, depending on the amount of days that you practice depending on, if your cash or insurance a lot of these things shouldn’t make a difference in this number, but realistically they do. It’s a little easier to have a conversation with a patient who’s paying with their insurance that they need to come three times a week.
Maybe that’s not as easy when you’re in a cash practice. I will say, and I’ve done shows on this before, I think that management of expectations and that communication is critical. You need to be telling your patients first and foremost what is best for them, what’s best for their health. And you can always come back to, okay, that’s not feasible for you.
Then this is how we can adjust. And then if that’s not going well, you can revisit. This is why I said this is what the frequency should be. But you need to look at what is that average number of sessions that you are prescribing someone as part of a treatment plan. Is it six for an additional an initial round?
Is it 12? Is it 10? So that when you know how many new patients am I bringing in and that what percentage of those patients are coming back and what is the average number of sessions that those returning patients are going to be engaged in? That really allows you to plan things ahead of time. So you start to see those trends in when new patients are typically coming and the activities you’re engaging in around that.
You get to see, all right, this is my conversion rate. This is who I’m bringing in as a new patient who then becomes a returning patient who’s engaged in an active care plan. And then, okay, what does that care plan look like? Now that they’re converted, and I know that . 50% of my people or 80% of my people are going to be engaged in an active care plan if I know that’s generally sessions.
Those three things allow me to plan very well and have a really good baseline for starting to look at my practice and how it’s doing, how it’s growing and when I need to bring on more help. . Again, like I said, the majority of people are not tracking. So if you just start with these things, you’re really going to have an incredible opportunity to be ahead of the game, like ahead of 90%
Of the practitioners that I talk to just by starting these. And you wanna compare you to you. So I think sometimes when we’re at the beginning of practice or when we’ve been stuck at a particular cadence and we’re trying to grow out of that and not be at a plateau, it can feel a little challenging.
We can play that comparison game with other people. It is important to measure growth. Also U to U. So if you were doing four new patients last month and you’re doing eight new patients this month, maybe that is not the same cadence as the acupuncturist down the street who’s been in practice longer.
But that’s a huge increase. That’s a 100% increase. So we should be excited about that and be able to then look at that and say, okay, something’s working. What are those things that are working? And also this can be a very isolating profession. So you wanna ask your colleagues, you wanna see are other people tracking things, what’s been really helpful for them?
People who are able to convert most of those new patients who do consultations or exams into returning patients. What are things that they’re doing? So really trying to leverage the people around us and create that support system is key. I love talking about this stuff. And this is always fun bringing you guys these bite-sized nuggets for your practice.
But if you ever have any more questions, please feel free to reach out to me at aac and don’t forget to tune in next week for another episode of To the Point. . .
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Greetings, all my colleagues, all my friends. Welcome to 2024. This is our first show for you. This is through the American Acupuncture Council, but I’m from the network. I’m the coding and billing expert, Sam Collins, and one of the big questions I get every year is, Sam, what do I do about fees? What has changed?
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What is updated? Of course. We do a big seminar on all that, but I wanna give you a little thumbnail of what’s going on for 2024. What can we expect for fees? Were there updates? What’s going on with deductibles? Can I raise my rates? Let’s get into all that. Let’s go to the slides. Let’s talk about 20, 24 fee updates.
Now, when I say updates, does that always mean an increase? Let’s face it. For many of you who have been in practice for many years, you’ve probably noticed. Sam, my fees from insurance companies that I’ve been contracted with for years have not gone up. Particularly those that belong to groups like I don’t know, a SH and similar, you’ll find those fees have remained stagnant.
We’ll talk about how you may be able to. Change that a little bit, but let’s talk about what’s going on for 2024. I think and under understand what our fees should be. We gotta think of how are our services valued? Who determines the worth or value? Who sets these fees? The fees are set really by the community in a way though obviously it’s gonna come back to the payer of the service.
What is the fee allowance for it? How much do we allow? What can we charge? It is interesting in our healthcare system. I’m sure you’ve noticed. Insurance companies can tell doctors what they’re gonna pay. Period. End of story. Take it or leave it. But do you ever notice that’s not the same for pharmaceuticals?
Now, that’s a whole nother topic we’ll get into, but bottom line is there is some mandates to what fees we can charge, particularly if you’re in network. So who sets the fees are gonna be the community standards, of course, for cash patients, what our patients will pay, but for insurance, who sets them? How are they set?
Part of it is gonna be something called a relative value unit. And that is the value of a particular service compared to another. The federal government has done this since the early eighties, and they do a study each year that updates the value of services from one to the other by example. Some fee schedules just use a simple conversion, a number, and then they take the relative value of your service.
Multiply that, and that tells you the fee. You’ll see this very commonly in workers’ comp in many states by example, in Texas, they’re gonna take the relative value multiply by 64, 83 or in Connecticut by 51 50 in let’s say Utah, I believe by $61 in Minnesota, or excuse me, in Michigan, they allow 200% of Medicare.
So it’s based on this relative value, the value of one service to another. I wanna give you a thumbnail of that. So you start to understand what does a service value at? I find most offices I consult often have fees all over the place. One fee, great, but then the other fee in relative terms is not correct.
So I wanna take you through how do I make sure to have relative values work for me to know the value of a service? We’ll keep it simple, but it’s not that hard. Obviously though we also have to deal with contracts. When you belong to an insurance, they set the fee for you. They tell you, Hey, join us.
This is how much we’re gonna pay you. However, it’s not gonna be as much as you’d like, but we’re gonna send you more patients. So you have to determine whether or not does that offset. Make up the difference. Can the volume make it up or is it fair? You’ll see these with preferred provider organizations like your Blue Cross’s, blue Shields, but you also see this with HMOs, particularly bigger, insurance companies like a Kaiser and that type health net, that study specific fee for that one.
But this means also the patient can’t go elsewhere. So the attractiveness is when you belong to these contracts, the patients get a better benefit, meaning less out of pocket, sometimes no out of pocket with these, but they set the fee. So you have to look at . Ooh, what is that fee? Is it fair? By the way, are there some things you can do or should do yearly to see whether or not you can get a fee increase?
’cause if you don’t ask, they’re not going to do it. Of course, you have to deal with fees, but also deductibles. What happens with deductibles? Deductibles start first a year, but keep in mind some deductibles. Based on when the patient visited, the prior year may roll over. So check the plans. Some plans may have, say a thousand dollars deductible, but any services the patient may have received from the last quarter of the year prior may apply to this year’s deductible.
I always thought that was unfair when you think about it. What if you got sick in December? Hadn’t gone to the doctor before you pay your deductible. Then January rolls around, oh, new year, new deductible, where now they’ve have a product where insurance is that often will roll that over.
So that’s certainly something to look at by example, deductibles for many types of plans can remain stagnant. 2 5500 thousands of dollars by example. The Medicare deductible did go up $14 this year. Prior in 2023 it was 2 26. This year it’s two 40. So do check that because of course deductible is the amount the patient has to pay out of pocket.
And then we have to figure out what’s that fee that we’re charging so that the patient is paying their portion? ’cause of course, you have to remember, there’s going to be co-payments and co-insurance, and let’s define that. A little bit better, I hope for you. When it comes to fees, the patient’s to pay their portion, when you belong to an insurance like a PPO or an HMO, we often turn that as a copayment.
It’s a specific set amount of money that is per the contract that says, oh, this patient pays $10 copay, $20 copay. So in other words, no matter what the patient receives, you’re gonna get some type of payment from the carrier and the patient’s gonna pay $10 or 20 a fixed amount. Sometimes it could be a percentage, though it could be 80% of the allowed rate, which means 20% of what was billed or allowed.
But often keep in mind we use the term co-payment to mean you are in network. It’s a set amount, but co-insurance would be a little different. And this is where it gets tricky when you are not in the network. What does the patient owe? That would be the co-insurance. In other words, everything the insurance has not paid.
So by example, if you bill a hundred dollars to the insurance and it pays 50, what would be the co-insurance? 50. So that means that patient would pay 50. Now, here’s where you have to be careful. What if you’re billing three different insurances and they all are being billed a hundred dollars? Same service.
One insurance pays 50, one pays 75 and one pays 90. If you’re out of network with each of those patients correspondingly have to pay you. One of them has to pay $50. One is paying 25 and one is paying 10. In other words, you’re not accepting what insurance pays this payment in full, but it’s a part of it to pay your full amount.
In other words, you’re getting paid a hundred some from the insurance, some from the patient, and this is the variation that when someone chooses to go out of network, they’ve gotta pay that entire difference. I’ve had a lot of acupuncture offices have some issues with that because what you cannot do is bill insurance as a fee, and then just simply write it off.
Unless you’re contracted. Now, when you’re contracted, that’s where the copay comes in. It’s fixed, but if you’re not contracted, it’s the co-insurance. So do be careful when it comes to setting your fees. Should you set your fee off the best paying insurance you have. Let’s face it them, there are some insurance plans that pay acupuncturists, and you’re gonna think, I’m kidding.
For some states, three to $400 a visit, I kid you not for acupuncture. That’s how much it’s valued. That’s great, but what about a plan that doesn’t value it that high? When I bill that high amount, does the patient have to pay the difference? The answer is yes. So you wanna be somewhere in the middle of what you’re gonna afford or what a patient can afford.
And remember, you always have to keep in mind my prices for insurance, if you will. Have to pretty much match my cash. Now, that can vary a little bit if you’re in the state of California. Familiar California has laws that allow you to have kind of that dual fee. But in other states, no. The cash price has to be essentially equal to the insurance price.
Maybe a small time of service discount, five to 15%. So when we’re thinking of how services are valued, it’s how do I value them? What’s their worth? How do I value it? What’s the best way for me to think about it? I think for 2024, what I hope to get more offices to do is begin to realize that if you are not doing something to update your fees, carriers will not.
By example, this year, Medicare has reduced fees, not by a lot, but by a very small percentage. They go, oh, how dare they? Has nothing to do with the doctors. Let’s face it. Is Congress and our government a little bit dysfunctional when it comes to budgeting? So of course, where do they start to cut? Will they cut other standard types or fees for Medicare?
Hence where that came from, has nothing to do with the value. It’s just, Hey, we’re gonna cut this. So realize, be careful if you’re gonna use Medicare rates. Realize Medicare rates went down this year. So this, should that mean, oh, I gotta lower my rates also? No, absolutely not. I would in fact, think, hopefully you’re doing this already.
Should you raise your rates 2%, maybe 4% a year? Absolutely. Because if you do not, how do you make up the difference of cost of living? Think of it. You can go years with the same rate and go I’m not making any more money. How would you when you’re not charging more? Because if you see the same patient volume, it’s gonna be the same and there’s gonna reach a finite point.
How many people can you see in a day? That’s not going to change. If you’re treating a person for 45 minutes, you’re gonna see maybe 10 or 12 maximum. Maybe a little bit more, but give or take, so you reach a point, you have to figure out how does this office continues to sustain when all your other increases, your cost of living prices, your cost of needles, your cost of gowns, all those things that go with your office.
So we gotta start to think of, I’ve gotta start to value and make sure am I setting the right fee? And this is where I hope to help you. Relative value units are the value or a fee comparison. Of medical services and overall, every CPT code, every single one has a relative value. And what this is based upon is the value of the service based on several factors.
The work value, the cost of delivering the service value, the cost of your education. So you’ll see when it comes even to acupuncture, there are variations that are year to year, and it simply just compares. One code to another. So make this very simple. If you have a code that has a relative value, let’s say, of 0.75, and you see another code, even if you don’t know what the code is and that code is worth a 1.0, what that should tell you is the value of the code worth one.
Should be 25% higher than the other, or 25% lower based on which way you’re moving. Because what I often find is acupuncturists in particular not understanding this way, undervalue services such as exams and therapies ’cause not understanding the real cost of them. It’s like owning a house in a neighborhood and not understanding the value of the neighborhood.
Remember when you do or sell a house, you don’t just go I paid X, Y, Z for it 20 years ago. I’m gonna charge this much more. What are you gonna do? You’re gonna look at the cost of the neighborhood. That’s what relative values do for you. So let’s look at what’s happened from 23 to 24, and you’ll notice not much of a difference.
1.14 is the value of 9 7, 8, 1 0, and 23. It moved up one percentage point in 24, 9 7 8 1 1 was 0.86 now to 0.85. But what I hope you’re seeing here, do you notice that’s a 30% difference? The big takeaway here is. Whatever my price is for my first set of acupuncture, the price corresponding below, it should be about a third or 30% less, give or take.
Now again, that means if my first set price was a hundred, what would be my second set price? About 70. That’s how you wanna think of it. I don’t wanna see you value something too low or too high. By the way, if you could tell me what an insurance pays for one code, I can tell you what it pays for the other, because every code.
Has a relative value by example. Do you know an exam 9 9 2 0 3 is worth three times the value of your acupuncture code? And I bet many of you undervalue that. So that means the price of a 9 9 2 0 3 based on relative value and cost should be three times that price. Where this helps you though, is you wanna start to think of what about the states, like I mentioned, like
Texas that they look at your RVs and give you a set fixated number to multiply 64, 83. By the way, Medicare takes this and goes by about $33. Now that varies a little bit depending on your location and state, but on average. So what I hope you can take from this is when it comes to your fees, when you’re updating this year, think of the fee differences, your difference between each code.
You’ll notice it’s about 25%. When it comes to the electro acupuncture, but you should be in the 25 to 30% range between the codes. By example, if I bill a hundred dollars for a service, but an insurance is willing to pay 120, if I bill 100, how much are they gonna pay me? A hundred, but they would’ve paid me one 20.
Have you ever noticed no one says, oh, by the way, we would pay you more . So you really wanna start to do a fee survey. That’s one of the things I do with our offices. If you do our seminar, of course, our network. I really dig into that and start looking at what’s your area? What are the costs? How do we look at the relative values?
What do other fee schedules tell us? Because you have to start thinking when you’re setting a fee, what is usual and customary for your area. What is it? The average, but also what is fair? You gotta think of, I might have an area where I could charge more, but you might say, no, Sam, I want to value it.
’cause I want to take care of the underserved group and have my practice more based on cash patients, which are per perfectly fine. But then we know that, and that could be why your fees are a little bit lower than the average. Because keep in mind it says here, may I have a dual fee schedule. Not really.
You have a service and a fee. Now I will clarify. Can you have a fee schedule that is for your ? Contracted groups, like a SH $26 $40. Sure. And then your regular insurance price. Because it’s by contract. Technically, yes. But once you’ve set a fee for insurance outside the contract, it’s pretty much the same across the board.
You’re not gonna have a hundred dollars for insurance and $50 for cash for the same service. Way too far off. Remember, you do have to collect, meaning if you’re billing a hundred and you’re not contracted, you’re collecting a hundred. If the insurance pays some portion of it, great, the patient pays out of pocket.
So start to think of for fees. What’s fair? What would I pay and what do I expect my patients to pay the value of my service? Remember, create value. People will purchase. Remember, the cheapest office is not always the most successful. In fact, often not because it’s perceived, it’s not as good a value. Give the patients good care, a fair and reasonable price.
But being cheaper isn’t always the thing. So I’d like you to start thinking of, if I’m gonna raise my rates this year, how and where do I do that? Do I use relative values? Do I look at common fees in the area? Yes, you should do all of that. I would look at your work comp fees. The simple rule might be just looking at the Medicare fee schedule and thinking what percentage above that.
’cause at least that way you’re doing relative values. It’s one of the things we give at our seminars is you get your fee schedule for Medicare and then can start to work off of that. Or even better, we work one-on-one on that, because you gotta start to think, if it’s first year, it’s time to start thinking of that.
How do I raise my fees? Do I have to inform everyone? You just raise your rates. You’re certainly gonna put notice that you’ve increased, but simply you’re just increasing. Be careful. If you’re not increasing, no one will. What? If you’re billing below what they allow, you’re simply gonna get that allowance.
Don’t be afraid to do more. And what if you are a network? Have you ever thought about asking for a raise? What things do you need to do to get that raise? You know what you have to do? Really create a value. To them show, Hey, I’ve been in your program for many years. Here’s the cost of my services. Here’s the value I bring.
I’m a tier six doctor. Let’s say you’re also an underserved. The more you can, I will say, I’ve had a few offices this year. When I say this year, I should say 23, that actually have gotten a 50% increase in their rates from managed care, particularly a SH. It’s something I’m finding is happening more if individuals are requesting it and you’re in good standing.
What I want you to think of though is that it’s first of the year, have costs of living gone up for you, gen generically. How has that gone up in your business? Have you really start to set a precedence if you don’t raise for years and then raise it 10 or 15%? People go, oh wow, but what if you raise just a small percentage every year?
Keeping yourself within range and keeping in mind how to balance whether you want more cash or more insurance. But what I’m careful of is if you’re not mindful of your fees in your store, no one else will be. I’m gonna say patients at the end of the day are gonna be the ones that are gonna dictate what can I charge?
I. What insurance is allowing. That’s not gonna be the end all be all, but it gives me a feeling for it. What about my contracts? How do I make those work? That’s what we do with the network. It’s what we do with our seminars. This just is a thumbnail start to learn how to really make your practice do better.
And it’s not just about insurance, it’s about everything and being successful in enjoying what you do. The American Acupuncture Council is your partner. We want you to be successful because if you’re not, you have no need for our services. We are partners. Good luck and best wishes for the year. . .
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While an alternative treatment business, like acupuncture, provides promising opportunities, it is not immune from challenges. One issue that an acupuncturist may face is when a client lodges a complaint claiming malpractice. Such a complaint may reach a courtroom battle, which can be expensive. For this reason, having acupuncturist business insurance is imperative—you should include it in your must-do checklist.
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