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Getting A Constant Referral Flow from MDs

 

 

Today we’re gonna talk about probably one of the most common things that I get asked about as an acupuncturist who has grown her practice in a certain way, and that’s MD referrals.

Click here to download the transcript.

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 everyone. I’m Dr. Nell with American Acupuncture Council. So thank you to AAC for having me on the show today. Today we’re gonna talk about probably one of the most common things that I get asked about as an acupuncturist who has grown her practice in a certain way, and that’s MD referrals. So let’s go to the.

Like I said, this is one of the most common things I get asked about. We know that most acupuncturists build their businesses based on referrals. A lot of times that comes from. Patients who are already in your practice who already know, trust you. But there’s always this desire for more referrals, right?

We want to have a constant flow into our practice and really what does that look like? Where are those referral sources coming from? And MDs are a great one. There can be a little bit of intimidation here, but we’re going to go through all of that today and make sure that you walk away with really tangible.

As to how you can get this done quickly and easily.

So you have got this. What does this look like? So again, I told you a little bit about myself. I am with aac, but I’m also first and foremost a practitioner. So I built my practice. Almost solely based on MD referrals. And this was something that felt really efficient for me. As soon as I got a good workflow with it, it worked really well.

So being able to do in-office visits, house calls, get really clear about what type of patient I want into my practice, and then what. MD is to refer to me, is part of the strategy that I employed. So I’ve been on panels with other MDs. A lot of times there’s this thought that, oh MD is an acupuncturist.

Maybe we have to work separately. Maybe we need to stay over here with other allied health providers. That’s simply not true. There is such an interest right now in our medicine and there’s a huge value add that we can have to really any type of medical. And so when I’ve been speaking with other MDs, whether it’s at a symposium, at a conference, on a panel, just as collaborators and peers, we get such incredible feedback about the results that we get for patients.

And so I’m gonna teach you today a little bit about how I employ the strategy throughout my practice.

But first and foremost, let’s address the elephant in the room. Why not? If it’s something that we can be doing, if there’s an interest, why is not every acupuncturist growing their practice in this way? Why isn’t every single MD referring to an acupuncturist? Why isn’t every surgeon saying. We need an acupuncturist to help with post-surgical recovery, or every cardiologist saying, wow, you could help with angina or lowering cholesterol.

Why isn’t this really happening? And so I think first and foremost, we need to address the fears on our end, the things that we can control, right? I’ve heard a lot of times this idea of intimidation, not just about MDs, but. Human nature, approaching a new person. What am I going to say to this person?

How do I get them to buy in? How do I get them excited about what I’m doing in my practice and get them to believe that I can really help them? With their practice as well. And so that fear is first and foremost something that we have to absolutely get rid of today. And we can, cuz we’re going to go through step by step how you can get this done safely, comfortably, and very effectively as well.

But before we go on, What’s the friction? How are we making this difficult and how do we make it easier? So there is a very real and tangible friction there. When it comes to us looking at who we want to approach for referrals. From an MD perspective, and this is coming from MDs I’ve actually spoken to.

So this is not just me pulling things out of thin air or wondering, I wonder if it’s this is actual feedback from other medical doctors. They don’t know you, first of all. There are patients who haven’t had a good experience with acupuncture, and more importantly and more likely MDs just don’t know an acupuncturist.

They don’t know that you’re there. So a lot of times it’s not an unwillingness. On the part of an MD to refer to us. It’s simply I just don’t know any acupuncturists. There’s also a lack of understanding, a lack of education there. Acupuncture versus dry needling. How do we fit into that? Do we do the same things that dry needle layers do?

Can we do dry needling? These are things that MDs have heard about but also need to be educated on. And so if. Don’t know you. They don’t know that there’s an acupuncturist in their area that they can refer to. How are they going to accomplish that? So it is about reducing that friction of making sure that MDs know that you’re there and they understand what you do.

Insurance is another big one that we have to talk about. Patients are accustomed to utilizing their, I. . More importantly though, they’re accustomed to utilizing the same mode of payment. Depending on what healthcare provider they go to, they wanna use the same thing. So for an example, if someone is seeing a cardiologist and they’re paying with their Blue Cross insurance and they get referred to somebody, they’re gonna want it to be somebody who takes their Blue Cross insurance.

That doesn’t mean that you can’t have a cash. Doesn’t mean that you can’t have a hybrid practice. In fact, that’s what I recommend, should talk to Sam Collins about that. But when we’re looking at those referral choices and who we’re going to work with, we need to think about it from the patient’s perspective.

And so there is friction occasionally when you have an MD who is willing to refer to you. But let’s say it’s an MD who is in network with everyone is working with. That’s gonna be a little bit of a roadblock for patients coming in. And it doesn’t mean we can’t work around that or work alongside it, but we first and foremost need to acknowledge it and be aware of it.

And the biggest thing is they don’t know you can meet their needs. , that does not mean that they don’t know the acupuncture works. It doesn’t mean that they haven’t heard of acupuncture before. Even if you’ve, all right I, they know I’m there at this point. They know I’m an acupuncturist.

There is still an innate human need to know what’s in it for me. How can this help me? And that’s from an MD perspective as well. That’s from. A surgeon saying how is this going to help me focus on what I want to do, which is surgery? I don’t wanna walk a patient through the recovery process.

I wanna be able to do surgery and be done with that. So when we’re gonna talk about next is the tangible ways that you can make this happen. One of the things that we’re gonna talk about is reducing that friction, about being really streamlined and targeted with our messaging around how we. The needs of whatever MD we’re talking to at that moment.

So let’s get into it nice and clean and specific. We’re gonna target, connect and follow up. What does this look like? All right. Targeting first and foremost. I do know acupuncturists who have sent out, thousands of letters to every MD in their area. That is certainly something you can do. It’s kinda that shotgun approach, right?

So just a lot of outflow and hope that something comes back. I’m really about efficiency. I know a lot of you that I’ve worked with are about efficiency and. A lot of times you’re running your own show as an acupuncturist, right? You might not have staff, or you have very limited staff, might just be you in the office.

So you need to be really clear about how you’re spending your time, what bandwidth you’re using how much of your cheese is gonna be used up on a project like this. And so if we can get really targeted with the MDs that we wanna work with, then this will be a much more streamlined process and a lot less work.

Let me do this in the form of an example for you. I work with Men’s Health a lot, so if I’m working with middle aged men who are experiencing andropause, I’m gonna say to myself alright. Where is a middle aged man? Normally going for his healthcare at this time when it comes to MDs, likely has a primary care doctor.

Probably has seen a cardiologist or a nephrologist. Kidney issues are very common. High blood pressure is very common at this age and then a urologist because urinary issues, prostate issues are extremely common in middle aged men. So that kind of narrowed my pool already, right? When I’m looking at, okay, I wanna be in middle aged men’s health, that’s who I wanna welcome into my practice.

So now I’m targeting those three types of specialists. Once I’ve narrowed down those three types of specialists, then I’m gonna figure out, okay, how am I connecting with these people? I find them in my area, but how am I gonna do that outreach and really what is my messaging with them? Because that’s incredibly important.

Part of that targeting into connecting approach is knowing that you’ve targeted the right people. Not only are they close by you, because again, if a patient sees someone somewhere, they’re not going to want to go an hour out of their way. So you wanna be really target. Really close close by if possible, least within easy driving distance.

That’s gonna make it an easier sell for the MD to just say, oh, they’re in the same building. That’s the best one. If you’re in a medical building, you can start right there. Very targeted. Who are the specialists that I wanna connect with? Are they close by? So those are two things in targeting.

Another thing is what we spoke about during that friction piece insurance. Do they have a cash practice? Do they have insurance? Do they have a hybrid practice? If they’re taking insurance, what insurance Are they in? Networking. Are you in network with those same those same insurance companies? That is going to matter.

It doesn’t mean that you can’t overcome that with a great value proposition. It just means that it’s something to be really aware of and it’s an additional cell that you are going to give to this MD in this second portion, which is to connect. So when we’re connecting with these very targeted people, what are we doing?

What are we doing when we connect? If you watched one of my previous shows, we talked about introductions and about your elevator pitch, and the main thing I hope you took out of that was that it’s about articulating value to the person you’re talking to. So when you’re connecting with an md, you know you found the right.

They’re close by probably a network with the same insurance company, or they have a cash practice and you have a cash practice, they can send somebody right down the hall to you, right across the street. But what are you saying to them? You need to address meeting their needs. They are humans, just like we are humans and humans wanna know how is this going to make my life easier?

How is this gonna make things better? I would love to sit here and tell you that it is enough to just be able to hand them a thing of research and say, look, acupuncture works. Tell your patients, but if you are looking for not only targeted referrals into your practice, but referrals that continue to come into your practice, there needs to.

An ROI on the other side for that md and that is the God’s honest truth. I’ve seen it with my own eyes. I’ve grown my practice in this way, and so if you can be really clear with how you can help them. I’ll give you another example. I work with a lot of surgeons, do a lot of post-surgical care in my practice, and I will research a surgeon prior to approaching.

Not only on their website and what they say that they do, but also on Yelp, on Google Reviews, looking at what are people complaining about? What do they love? What are the pain points for this doctor that I can address? So you bet. If there is a surgeon whose patients are going on saying, Hey, I really loved them.

They were great. The surgery went well, but I wasn’t so happy about the scar tissue. They didn’t do as good of a job as my friend’s surgery. That’s something you wanna speak to. You absolutely wanna talk about how acupuncture can help with scar tissue reduction. You also have to think about just the innate needs and personality of the MD that you’re approaching.

So again, a surgeon, they wanna cut, they wanna do surgery. They don’t wanna hold someone’s hand through the recovery process. Acupuncturists are great at holding someone’s hand through a recovery process. We are all about recovery. All about regulating the body. So if you can speak to that, if you can tell them that you’re gonna meet those needs that, oh, we can start acupuncture the day after surgery.

We can start it immediately. These are the things that it’s known to do. We’re gonna talk in the follow up about good collateral to have. But if you can speak to the things that you can take off their plate that they don’t wanna do. That is gonna pay dividends for you. On the other end of that, cuz it’s one thing to get an MD to refer to you once to just try it out, to say, oh yeah, I know an acupuncturist.

It’s another thing to get constant referrals into your practice from the same MDs and you have to be meeting their needs and getting them really excited about wanting to refer to you. So that’s the connect piece, making sure that you understand their innate needs and that you’re able to address. And then the follow up.

And this is, arguably the most important point because human nature, we’ve been talking about that a lot today. Human nature is out of sight, out of mind. So not only are you gonna give great results to the patients who are referred to you by MDs, but you’re going to have consistent follow up. And what does that follow up look like?

An initial follow up from a conversation can be in the form of collateral. Again, thinking, how do we make this really easy? How do we reduce the friction? Who am I gonna follow up with? Of course you wanna follow up with the doctor that you spoke to, but a lot of times the. Is who is making decisions in that office?

If a patient comes up and asks the staff a question after they see the doctor. The staff is gonna have a book of referrals or they’re gonna have someone at top of mind. And so being really friendly with not only the doctor but the staff as well, is something that will behoove you. So you can do follow-ups.

Talking to the staff. That’s very easy. If you’re in a medical building in the same area, just pop in and say Hi. I like to give one pagers as collateral and. You need to have an electronic option because a lot of people are not liking paper right now. That doesn’t mean you can’t have your old school brochures and that people don’t still like holding onto something.

But again, reducing friction. How do we make this really easy? And so part of making that really easy is that you’re gonna have multiple options so that it makes it the doctor’s choice or the staff’s choice what’s easiest for them. So I have a very. Clean, easy one pager that goes to surgeons and their staff.

And their patients. And then I have an electronic version as well. The electronic’s also great because you can put links in there. It can link to your website, it can link to research if you want. People don’t wanna read a ton of stuff so you can have a great infographic and. For those people who really wanna read a little bit more, they can click on those different links.

You have a lot of flexibility when it comes to those electronic options. It’s also very easy for the staff to pop that into a patient portal, to send it to them or to shoot it to them. Via email if they’re asking for a recommendation. So we always wanna be thinking not necessarily what’s easiest for me or what I like best as a business owner, but what would a prospective patient like the best?

What would the doctor that I’m interfacing with trying to get referrals into my practice, what would they like best? What would make their life easier? And these are also questions that are okay to ask when you’re in that initial conversation. And part of this follow up is being consistent, so I like to set reminders.

When you have a patient who is referred to you should have a system in place to thank the doctor for their referral. They should be signing a release of medical records so that you can send that doctor a report of their care. Not only, become their colleague and be able to liaise with them about this patient, but let them know that not only are you highly competent, but you’re highly collaborative and that helps reduce friction as well.

That is a concern for other healthcare providers that maybe we’re not gonna be super collaborative, maybe we’re gonna try to steal their patient. If you go requesting their medical records and not providing explanations for. , they might think that, oh, why is this doctor requesting these records and trying to take my patient?

You wanna do everything you can to show how collaborative you are and how excited you are to share in the care of that patient. And so with our documentation, you can very easily send that over to a doctor so they’re in the know about what’s going on with their patient as well. And this gets particularly important when you’re dealing with cases like surgery.

Patients who have been diagnosed with cancer you wanna be extra careful, you wanna protect yourself. We’ve done another show on informed consent, so that’s a conversation, you wanna keep going as well, so you wanna do right by the patients who are referred to you and make sure that you have MEChAs mechanisms in place so you can continue that conversation with the doctor and continue the follow up.

So I told you I like efficiency. We kept it nice and short today. Just wanna end by telling you guys, you’ve got this. This is something that I’ve seen other acupuncturists do. I’ve coached other acupuncturists on how to do this. This is solely the way that I built my practice and I know that you can do this too.

And so I just wanna thank AAC again for having me today and you guys have a very exciting. Coming up next week with Poney Chiang, and if you haven’t caught any of his stuff, I’ve done his stuff live. He is absolutely amazing, knows so much, and so you don’t wanna miss that one.

 

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Know Your Rights When Insurance Co. Asks for Money Back

 

Click here to download the transcript.

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 everyone. Welcome to another episode with the American Acupuncture Council. I’m Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, as well as the profession in general. This episode is gonna deal with a very common question that I get whenever I’m teaching a seminar or doing our network services.

People always ask, Hey, Sam, I got a payment. Now the insurance company is asking for money. What can I do? Is there anything I can do to fight this back? What if they recoup the money? There are many things you can do, and there’s laws and statutes that are on your side. Never assume what they tell you is correct.

Let’s face it, you do an insurance verification, you bill the insurance, they pay it, and then they come back later and say, Hey, we paid you money six months ago. Turns out we shouldn’t have. So let’s take a scenario like that. The insurance company pay. . Then they come back and say, Oops, we shouldn’t have paid because there were visits that were applied towards the whole overall benefit.

Maybe it’s combined with chiropractic, maybe with physical therapy, and now they want it back. What are our rights? What do we do? So let’s go to the slides. Let’s talk about what laws and things protect you in understanding how we have to deal with this. This is not uncommon. Now, I don’t want this to scare you off.

This doesn’t happen a lot, but it happens enough. You have to know what your rights. What are my rights when someone says, We shouldn’t have paid you and we want this back? So here’s a letter and please note everyone, this is a letter from Federal Blue Cross Blue Shield and notice what it’s saying. Dear Billing Department, they’re talking to us directly in regards to the request for repayment for claim.

The request made to you was a voluntary overpayment request. Because you are in network provider, you do not have to pay back any overpayment if the overpayment was discovered 365 days or more after the claim was finalized. So I wanna take a look at this letter and notice what they’re stating here.

They’re stating that they can request an overpayment if you are in network, but not if it’s over 365 days. So notice that’s why the letter says a voluntary overpayment realize most often when an insurance company is requesting a re. they’re doing. So just to see if you’re willing to pay it. So by example, let’s say a policy, as I mentioned, has 20 visits per year.

You verify it and they pay it, and then later they come back six months later, a year later and say, Oops, it turns out the patient already had visits with some other provider. Therefore, we shouldn’t have paid you. Frankly, whose fault is that? You did the proper verification, you bill it, they paid it.

Now they’re saying, Oops, we made a mistake. We want you to pay it back. So notice that’s why this says voluntary. So even though this provider is in network, they’re saying please pay us back. My issue is gonna be no thanks. Why should I pay you back if it’s your mistake? In essence, what they’re saying is, we made a.

And the patient’s benefits weren’t there. Therefore, we want you to pay back our mistake. My rule would be, no, you go to your insured, That’s who you made the mistake with. Cuz essentially what they’re trying to push you to do is you pay them back and now go after the patient. Why would we have to go after the patient if that’s your insured?

That’s where you’ll notice the difference here. Notice it says here, the request made to you was volunt. And because you are in network and it’s over 365 days. So notice now the difference if they had done this within 365 days because you’re in network, they can take it back. This is one of the downsides of belonging to an insurance you give them to right to recoup.

Even when the error wasn’t yours. It was their own mistake. So it’s one of the downsides of being in network. Now, if you were out of network, could you just completely refuse this and say, Actually you could in the absence of fraud, where something you build wrong or maybe they paid you twice, you are under no obligation to refund this.

I’m gonna point you to this is a letter that we use for those in our network, or those that come to a seminar that deals with an insurance company that has paid you and then subsequently wants it back. So notice at the top it says, We received your letter where your company’s requesting re refund the payment, and you reviewed the benefits and nothing here shows otherwise.

So let’s move down here. It says, I feel that you have do not have the right to place this burden upon my office by asking us to correct your error. And this is backed up by Case Law. Notice it says, I would like to bring your attention to cases involving the Federated Mutual Insurance Company, and essentially it says the insurance company is in the best position to know the policy limits and must bear the responsibility of their own mistake.

So again, if you’re out of network and the insurance is asking for this back, understand if they made the mistake and paid more than they should. Maybe there was a deductible, they didn’t apply or they just applied more visits than the plan allows. They have to bear the responsibility for it. And again, case law noting dating back to 1974, so for many of you may not have even been born yet.

The next case goes from here for national Western Life Insurance Company. And it says in the absence of. A healthcare provider is not legally obligated to run refund payments. It receives from an insurer if the insurer subsequently determines they were paid in error. So let’s do this example. You call, the plan says they cover acupuncture.

Great. You bill it, they pay it, and then six months later they say, Oops, it turns out we don’t cover acupuncture. Whose fault is that? You did everything properly. What they’re saying is, pay us back and you chase the patient. My rule would be, You go after your own patient. That’s why that one said voluntary.

You’re under no obligation to pay this. So when you were out of network, , you may completely push back on this with citing these two case laws, because if there’s nothing wrong with the claim, you didn’t bill anything in error. There wasn’t something billed that you didn’t provide, or they didn’t pay you twice.

If someone pays you twice for the same data service, you do have to refund the overpayment of that. But outside of that, the answer is absolutely no. Again, if you’re out of network. Now, why is it different if you’re in. It’s different when you’re in network because part of the contract we sign, when we join these insurances, it literally says in the contract, Should we make an overpayment?

Even if the error was on our side, we can recoup the money. And I’m sure many of you, almost Sam, that’s happened to me before. They just take the money from another patient. They will if you’re in network. If you’re out of network, they should not be because they have no right to that. In fact, the case law stands up, but let’s talk about if you’re in network.

Notice it said one year. Now that’s the federal statute, which is generally equal to what the billing time is. So if the billing time is one year, they have one year to recoup again, if you’re in network. So if you are in network, they can recoup. Within the timeframe of the statute of limitations, and that’s where this is a little bit different from state to state.

So I’m gonna give you a little breakdown here. This has every state, and you’ll notice it can vary from some, That’s one year, 36 months, five years, two years, all the way down to as little as 30 days for some. And some states don’t have any, which to me means it defaults to the federal statute. But always know the statute of limitations.

Just like an insurance. You know how some insurances are? You have 30 days to bill 60, 90, or one. The same thing applies here for a recoupment. The state law will break it down. So is it one year or otherwise? So know your state and whether or not you can push back. My rule would be always send a letter like this in a response when you are out of network.

Even in network, I would use the same protocols, but then follow up with the statute of limitations. Do not be. To push back. The assumption is often you don’t know better and are just gonna pay, cuz we’re afraid of the insurance we’re gonna get in trouble. If they could recoup it in network, they probably would’ve.

So take a look here. Here’s an Aetna claim, and notice what it says As a result of a routine claims payment, we previously notified you that there were some differences between the amount paid and the amount, which you should have been. That’s their own issue. So notice and I highlighted it in yellow, it says, Our records indicate the overpayment as noted on the enclosed document, is not eligible to be offset from future claim payments.

In other words, you’re outta network. So we can’t force you to pay it back, but we’re gonna please say therefore we must request you issue a check or money order payable to us in the amount that’s requested. You know what my answer to that is? No thank. Why would I voluntarily send it? When do they ever voluntarily say, Hey, you know what?

We’re not paying you enough. We’re just gonna go ahead and pay you more. Know your rights. Don’t be afraid to push back when there’s a request for overpayment. Was it truly overpaid? Did they pay you more than you billed? That you would’ve to pay back the amount over what you build? Or if they paid you twice.

But if you’re out of network and they later decide, they didn’t feel they should have paid it too. That’s on them. They should know their own policy. And the Statue of limitation applies for those of you who are in network, just like they put a limit to the time that you can send a. They will have limits to when they recoup.

This is why a lot of providers think maybe I don’t want to be in network, cuz I give them a little bit of power that’s part of that tradeoff. We did this in an earlier talk with you of trading off what is it worth it or not. Now this doesn’t happen enough to where it’s gonna major problem, but it’s something to note within your rights because many times they’ll just send you a letter hoping you’ll pay.

Let’s say you send a hundred of these letters out, maybe 50 of the doctors know the rule. They’re not gonna pay it, but the other 50. That’s an easy way for them to recoup money by simply having people not aware of what their rights are. Notice. These plans aren’t necessarily there for you. Always be able to push back and know where the laws fit.

That’s what we’re here to do. That’s what the American Acupuncture Council is there to do. We always wanna enhance your practice as I do. For those of you who would want to have help, just what we’re doing now where we can deal with this one-on-one via phone or Zoom or otherwise, you may wanna join our network.

Take a look at our site. You can do the QR code or go directly to our site. Remember, it’s aac info network.com. We’re always here. The American Acupuncture is always going to be your resource, your place for help. And remember, first of the year is coming. What’s gonna be changing, lots of things, codes, fees, and otherwise probably time to get to a continuing education seminar with the American Acupuncture Council Network.

I hope to see all of the future date. Until then, best wishes everyone.

 

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MENOPAUSE – The Treatment of Hot Flashes in Women

 

 

And today I’ll talk on a very unique topic of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

Click here to download the transcript.

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.

Hello everybody. I’m Dr. Yair Maimon, and I would like, first of all to thank the American Acupuncture Council for putting up this presentation. And today I’ll talk on a very unique topic on of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

For menopause and especially for hot blood, hot flashes. So let’s put up the slides first. Menopause. It’s to do with transformation. Al always, it’s a time of changes for women. It’s a transformation. And when we talk in Chinese medicine of transformation, it’s always something to do within any yang.

It’s always rooted in this constant transformation of matter into energy and energy into matter. Or we’ll talk about transformation of. And let’s look a little bit about the uniqueness of the way in Chinese medicine, the uru, the womb is understood. If you look at chapter 47 and chapter 33 the simple questions, you’ll see that the UREs is connected on one side with the bowel Ma, with UREs vessel to the heart, and on the other side with the bowel duress channel to the kidneys.

So immediately the UREs is between two very specific organs, the heart and the kidneys. And as the heart and the kidneys will present the water and. Or again, if we go deeper, we can say Matter and energy. And the UREs is a place of creation and of birth between fire and water, or between earth and heaven.

And fire and heart are connected to the she to the spirit, and the kidneys are connected to the jing and the meaning of these two phenomenas, the meeting of Ian Yang are creating. New life, a new possibility of life. So Duru in this way is perceived in a very deep way of connecting heaven, an earth of connecting the heart and the kidneys, and It’s very much related to the earth in Chinese medicine, but also to this two organs which are heart and kidney.

And it means also when we are utilizing acupuncture points, and especially later when we look at some research on hot flashes. So there’ll be some points related to the heart. Like heart seven, the low point of the heart, peric heart seven. And if you look at the kidneys blood at 23, that tonifies the kidney, Kidney three, which is the again, the source points, the un point of the kidney.

So we see all this un points of the. Perricone heart and kidneys and splint six, which is more related to the earth where all the in channels are crossing, and again, has a very closed link to the lower jaw and to dure. So this actually took this points. It’s very common pins, but they’re also been used in research, which I would like later to present, but.

This is another way to show the logic of Chinese medicine, of connecting the fire and the water, the heart and the kidney, and enhancing the, and reducing also side effects of menopausal changes. So menopause, it’s always this movement of transformation of in and young. And we know the cycling woman of every seven years of the cycle in around 49 is the menopause time.

By the way, the premenopause starts much earlier. So many symptoms can be much earlier than the menopause itself. In this lecture, I’m not going to talk on the, about the natural kind of menopausal symptoms and occurrence of symptoms, but more on menopausal symptoms and especially hot flashes which are occurring due to anti hormonal medicine.

Anti hormonal medicine is given. To women who had cancer, and especially cancer, which is sensitive. There is receptors on the cancer cells themselves, which are sensitive to estrogen. And then the treatment is anti-estrogen treatment, especially in different cancers, either gynecological cancer in very common breast.

So endocrine therapy in western medicine applies this anti hormonal medicine, and because the tumors that are hormone related, the, if there is more presence of hormones in the body, there is more tumor growth. So this is the very common, as a saying, breast cancer and in several gynecological cancer.

There’s two major ways of an of endocrine treatment. One is to block the receptors on the cells themself to estrogen. The other one is to stop the production of estrogen. This is a very common treatments like tamoxifen. If you see on the cells, there’s the receptors for estrogen. And the tamoxifen mimic or has affinity in binds to the surface of the cell and therefore the estrogen cannot bind to it and therefore start the growth of especially mutated cancer cells.

So this is the kind of competition idea. It binds to the receptors in the cells, so the oxen and the other one is aromatase inhibitors. The estrogens in order to become estrogen, they’re going through different pathway of changes. One of them is the aromats and when DITs is inhibit, then there’s no production of estrogen.

There’s different ways to block the production of estrogen. This is the very common one with aromatase inhibitor. The bottom line is very similar, is producing in women who are taking anti hormonal medicine. Many side effects of menopause due to this medicines. There’s many common side effects for women who are receiving endocrine therapy.

I, I s. Put here the most common one, like fatigue, hot flashes is a big one. Mood swing, insomnia, sometimes even disturbance in concentration and depression. And there is a whole list of symptoms of menopausal symptoms, which are reduced by the endocrine therapy. This medicines are taken for long time, five years, sometimes for 10.

And many women stop almost 30% are stopping. Sometimes the treatment, even though it can be very useful for them because of the side effects, but acupuncture, Has been shown and there is evidence that it’s extremely effective treatment to reduce side effects, especially hot flashes and joint pain.

In this presentation, I want to talk a little bit about the evidence that we have for acupuncture, reducing the hot flashes, but also enhancing general better wellbeing in this woman. One of the early studies, but still I think one of the very Inspiring studies was head to head study. Women breast cancer women are taking anti hormonal medicine.

Were divided into group two groups. One was receiving acupuncture and the other one was receiving venlafaxine, which is like s nri. It’s really, it’s a light antidepressant drug, but it has also the it reduces also hot flashes, so it’s commonly used also for hot flash. And they measured the outcome.

They gave a certain 12 weeks of treatment. Then the treatment stops both the. Hormonal. They, I had avela vaccine, so both the medicine and the acupuncture was stopped after 12 weeks. After three months, the women didn’t receive any other treatment, and then they looked at the outcome even one year later.

And the acupuncture group did extremely well and the. Obviously you’ll see the Venlo vaccine. As you stop the, as the women stop the medicine the effect was quite immediately reduced and hot flashes were back. You’re welcome to read the full study. I’m just giving some highlights.

So as the results, you can see that both group exhibits significant decrease in hot flashes, depressive symptoms, and other quality of life symptoms. But in the acupuncture group it was the same for the acupuncture in the Vela vaccine. But by two weeks after stopping the treatments, the Vela vaccine group had significant increase in hot flashes where the hot flashes in the acupuncture group remained very low.

So this is very important because we are showing the effect of acupuncture. As a, something that enhances the ability of the body to, to bring itself back to balance. So we are really talking about the quality of the healing qualities of acupuncture which is lacking when you treat sometimes symptomatically, like in this.

And also in the Vela vaccine, it’s also very commonly known as Vix had many adverse effects. There was those in dry mouse dizziness and anxiety with acupuncture group. The opposite. There was no negative effect, but actually there was some additional benefit, even increasing sex drive in some women. And most of them reported improvement in their energy, clarity of thoughts and sense of wellbeing.

So the acupuncture group, No side effects is opposite. Had other benefits comparing to the group that took the vela vaccine? So in conclusion to this research, the acupuncture appears to be equivalent drug to therapy in this patients. But it is safe, effective, it’s a durable for vaso matter.

Vasomotor is this hotline, flashes and secondary for long term is also. Long term use of estrogen and anti hermon estrogen use. The points that they used in this research were quite interesting. So the main points you can see, and I mentioned them before, was bladder 23, kidney three in spleen six. So strengthening the kidney and in enhanced also the all the in channels and the spleen.

And this is the point that. All of the practitioner news, and then there were secondary points that can be a according to TM diagnosis. So the practitioners had some kind of freedom to choose which points are the most beneficial for the patient so they could do a diagnosis, Chinese medicine diagnosis and be more.

Exact on what’s going on with the patient. So if it was more heat and young, they couldn’t do 14 or do 20 with The 14 especially can reduce a lot of heat and especially if the heat goes up to the upper parts of the body. If those cheat deficiency like fatigue, stomach 36, ran six, lung nine, and if there was more disturbances at night Dreams, sleep disturbances goldbar 20 and leave it.

Or more agitation. By the way, many menopausal symptoms are to do with more blood stagnation agitation and if it was more to address the she than per card seven and heart seven. And this is the points we discussed before, and it was for 12 weeks. So four weeks, it was twice a week, and then another eight weeks, once a week treatment.

So the total treatment was for 16 weeks. And I would like to present another research, a larger research with 190 women and they received 10 acupuncture treatment session. And again, both of this research was published in the Journal of Clinical Oncology. It’s a very reputable journal. So it’s in science, it’s not just what you publish, but where you publish it.

So publishing in such a journal has a lot of or additional weight to it. And especially if if you want to present a acupuncture evidence to oncologists or to the medical team, it’s good to quote high reputable journals such as the Journal of Clinical. So this also had a 10 acupuncture session.

So this group was doing as you will see, the choice of diagnosis and points was a bit more diverse than the first research. And this. Quite a few research on that topic I’m just presenting to, and they also followed up for three months and six months post-treatment visits. In both cases, we see its, and this uniqueness that it’s not just the treatment itself, but also when the treatment stops, we can still.

Even half a year and a year later, the effects of treatment. Cause many patients usually ask me, how long, do I need to come for acupuncture? Is it like a life thing? So I say, no. If you’ll come for a series of treatments, then the benefit. Should last long to me actually for many years. Because if the acupuncture was accurate in the diagnosis was good, it has an effect, which is a long term effect.

So again, here, the conclusion that acupuncture is effective integrity intervention which the quality of life and hot flashes for these women they use the much more elaborated. And actually, that’s what I love about this research. A real TCM diagnosis and Chinese medicine is a medicine we don’t just use points per condition, but we are trying to do a deeper diagnosis, understand better.

And different women will have hot flashes depending also on their The condition they came with. So if they came with more in deficiency, there’ll be more the hot flashes on and the quality of life impairment, your de deficiency. So there was a set of points, and here they actually looked at the percentage of the diagnosis.

16% of the women was diagnosed with kidney deficiency. I just highlighted the kidney points like 6, 3, 7, and 10 that they could choose. But obviously also you see here heart six, which is very good for heart and kidney in deficiency if it’s kidney in and young deficiency. Or kidney, liver in deficiency with some young rising then again will be different points.

So there’ll be still the kidney six, Percu seven as a kind. Major points to balance the kidney and percu of fire and water. But we’ll see here additional points like liver three and gold bladder 20 and maybe combination of liver three and large intestine four will to move the stagnation and enhance better levy and liver.

Two to reduce heat from the liver. So you see the point combination here is a different, Oh, sorry. Has a different dynamic including lung seven and kidney six, which is the opening the remi, the channel in front of the body, which is responsible for all the in. And then if it’s kidney and heart disharmony particularly, then you will see this group of points.

There’ll be more kidney points from kidney six to kidney two. Kidney two is one of the interesting points that can take back the heat into the kidneys and enhance the kidneys. So it’s not just reduces heat, but also enhances the kidney young. And additional point we’ll see per card six, hard six, the hard six that we discuss for the in of the heart.

And Percu six with each additional ability also to be the main point of the, in way my balancing all the in. In the body and enhancing the heart womb kind of balance. So also hormonally there will be much more enhancement in, in, in using this points. And additionally in this group, many other points that are to do with enhancing kidney and also relaxing points like on the du mind, CV 15, because the heart is so much involved.

And as you can see, there’s 10% in. Of patients in this group were 36%. So you see most of the patients were of kidney and liver in deficiency, so they were more coming from this group from Flame Studies, Flame of Chita. There were still, it’s very different diagnosis. You’ll see that we’ll have some other points like Stomach 40, splint 10.

So more looking at this dynamic of a phlegm and cheese stagnation additionally to kidney and hard points. And blood stuff is, interestingly enough, there was none in this group, but still in clinic in the when we look at the symptoms, sometimes the symptom. Is also very common and seen commonly.

When we I would like to say that one of my passions is to teach the treatments of cancer patients and especially to treat oncology, acupuncture. And we do a very extensive course at the TCM Academy, and the idea is to teach and give. Tools, but also the skills and the competencies to treat cancer patients and especially cancer patients who are having side effects.

And we combine the three pillars of Western medicine, Chinese medicine, and research and evidence base. Cause when we combine this three pillars, I think then there is a. Clearer understanding both of the sys, the symptom, the ability to communicate with the patients, and the also the medical team that is working with the patients.

And in cancer, it is extremely effective. Extremely effective, but extremely important to understand both the Western medicine and the Chinese medicine differentiation, which. Very relevant to cancer patients. So if you want to know more, you can check up at the TCM Academy website. And this is this extensive oncology acupuncture program which covers, There’s also in the website Ava free stuff, but covers also other ideas like pain, nausea, vomiting, fatigue, and other components which are has so much.

To treat cancer patient and to treat the side effects. So I hope you learned something about the treatment of hot flashes, evidence based behind it. And with this slide I want to wish you all the best of health and from Chantel. She thank you very much for listening and being with us, and again, I would like to thank the American Acupuncture Council for putting this up.

So all the best and thank you so much.

 

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How to Transition to a Cash-Based Practice

 

thinking about transitioning to a cash based practice so that you could just focus on helping your patient instead of figuring out what codes and how to jump through hoops, and then you’re in the right place.

Click here to download the transcript.

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.

If you are tired of dealing with the hassle of insurance, the paperwork, the, it’s taking too long to get reimbursed, sometimes even insurance companies saying that you have to jump through these hoops and even taking your reimbursement back. and you’ve been thinking about transitioning to a cash based practice so that you could just focus on helping your patient instead of figuring out what codes and how to jump through hoops, and then you’re in the right place.

But how this is Chen and your six and seven figure practice makeover mentor@introvertedvisionary.com and your host for the AAC show today. And today we’re gonna talk about. Just from having a lot of experience with helping our acupuncturists and other holistic health practitioner clients transition from an insurance based practice to cash-based practice, I’m gonna share with you some pearls of what has helped our clients with that transition well, so that you can apply if you’re thinking about transitioning to cash based practice or already planning on doing so.

So the, there a couple things in terms of. Certainly. Let’s first talk about some benefits of cash based practice, and then let’s also have a look at some of the biggest challenges to transitioning and what to do about it. So some of the benefits are that you don’t end up having this waiting period.

You could get paid right away. Also, you don’t have to have either yourself spend time on this admin stuff or having to hire a biller or someone to chase after claims and different things like that. No more cat and mouse kind of game, right? so many benefits of, or being able to, to transition, but what are some of the.

The challenges to to transitioning that I often see, So one of the things that I hear is that but if they’re used to paying for insurance, then once I transition to cash, then they’re not going to be staying or that I want to still be affordable. And by the way, in terms of if your patients are used to paying for insurance and you’re afraid that they’re, they won’t end up continuing to work with you.

I’m going to share with you a couple of practical tips that will help you with this. But the most important thing is if you have a way of attracting new patients in the door, even if you some patient. Don’t end up staying with you, you will still have a patient flow of of new patients willing to pay cash if you know what you’re doing.

And then as far as the concern about, I want to still be affordable. So I think it’s very important for you to be in alignment with your own practice philosophy and if there are still reasons where you really want to accept insurance and keep doing that, but there’s still. But some of the shortfalls of that is you may need to see a higher volume of patients in order to be sustainable in your practice.

Or you need to hire or things out like billing or have higher expenses related to that or your time insanity, right? So there’s a trade off with that. So it’s just a matter of you choosing what’s most in alignment for you and then. If you’re not liking it, explore other options like transitioning to cash’s practice.

But some of the other things that I hear are, But what about the economy? So even during the start of the pandemic and when people were freaking out and being concerned about how, I’m not working right now and not making money, things like that. In, in terms of potential patients in that situation, even during the start of the.

When potential patients might have been in that situation or there was just this fear about things there were still acupuncturists who were doing just fine with cash based practices. In fact, some of our clients who are, were completely cash based, were doing great during even the start of the pandemic, during the pandemic and even, and also now as well too.

There’s always a, at any economy, there are people who have the ability to pay cash there. Are there gonna be people who may not be able to afford it? That might be true, but there are always, in any economy, even if there’s a recession, there’s always people. Who are able to and willing to and open to paying cash and interested in seeing you in your cash based practice.

It’s just a matter of being clear about the who you would really like to be helping. So let me share with you three tips to transitioning to a cash-based practice. And I feel like the very first one, Is very key. When I, when you hear me say it, you’re gonna think, Oh yeah, I know that.

And then you might think, Oh, I’ll just skip a scope, but what about the next one? And and yet I feel like this one that I’m about to share with you is one of the reasons why a lot of acupuncturists don’t do it is just mainly because of this main reason. And is the distinction between those who don’t do it and who do it.

What’s the distinction? is being really confident in your abilities as an acupuncturist and in that you’re totally worth, people paying you even if it were cash based practice. So when you are able to show up from that place of confidence and that sense of where you are really the expert. and a both in the knowingness that you’re an expert and in that you are good with your clinical skills, then it’ll make it an easier transition to you having a cash based practice if you’re still feeling like you’re.

Not that good clinically or you are, You have a lot of fear coming up around this then in terms of how to transition, then maybe it’s not time to do it yet. You really owning that energetically is going to be the key to everything else I’m gonna share with you beyond this as well. . And then the second thing is and also I was gonna mention related to the first thing, cuz otherwise how come there are acupuncturists and other holistic practitioners we’ve helped who’ve come straight out of school, they’re totally fresh grads and they start off with a cash based practice.

In fact I have a, an acupuncturist client who just did that in the last two months and she is at 12 patients a week, and she could be seeing more actually. But she does go and goes to where they, the her patients are. So she’s more limited with being able to travel and that kind of thing.

That’s her preference right now. But There, otherwise she has the capacity to see more, and she has a hundred percent cash based practice straight outta the school. People are totally happy to pay it. So why is it that, that some fresh grads can do that, but then some acupuncturists are have been in practice for 20 years and are still afraid that if they were to transition to a cash based practice and then people won’t, will stop coming.

So that’s why this confidence factor and you really owning that your expertise makes a big difference. So then the second thing is to carve out your differentiating factor and what is your differentiating factor? What’s your specialty? By the way, specialty doesn’t mean that you always have to focus on.

One particular kind of health issue or anything like that. It’s just really looking at what differentiates you and how can you help people see that you are the one to go to, whether it’s in your community, whether it’s for a particular kind of a health issue that you’re the go-to person to go to, whether it’s for a certain kind of patient experience too.

So have you ever thought about that? What is your differentiating factor? Of your practice that makes your practice the experience of a patient coming through your clinic different than the experience of other people going to other acupuncturists. And if the reason for that is it’s either unique or it’s very, Like it’s something that people really want then, and you also are able to communicate that in such a way that people feel like, Oh, I just have to go see her, or I have to go see him.

Then you it’ll make it a lot easier for you to transition into cash base practice. And they’re not just comparing you like, Oh wait, but my insurance covers this. They’re feeling like I just need to see you. And so this could. Also there, there could be, as I mentioned, it could either be that you become, decide to really carve out like this, I’m the go-to acupuncturist for particular health issues.

Or it could be the patient experience whether it’s like you can always get seen within x number of hours. Maybe that’s your differentiating factor, right? That maybe it could be that they don’t have to travel, that you go to them. Maybe it could be that you are the, you’re just the go-to acupuncturist within this kind of, this vicinity in, in, in the area.

So it could also be how you showcase your credibility factor. So one of our clients who has a cash based practice, Whenever someone would call at her front desk and then they weren’t really sure if they cuz yeah, they weren’t really sure if they wanted to book with her. One of the things that her receptionist says before they hang up the phone is, go check out all our five star reviews on Google.

So that’s an example of where a contributing factor to your credibility factor. So how clearly are you showcasing your credibility in whether ways like reviews or in how you describe your clinic and how it’s different or in how you’d describe your story and journey and your expertise. Those are all aspects that make up your credibility factor.

That’s really important to help you with transition more seamlessly. And then the third key to transitioning to a cash based practice smoothly is having a way of explaining to people in such a way that, that they they like they’re totally willing to pay cash, right? So where you are able to be prepared with what to say.

To and the right visuals that support it too. So when we work with our clients and get a few key visuals in place and then make the transition, the patients, the existing patients also are able to. Not only like verbally hear it from you or experience from you about how you’re like the person they wanna still keep seeing, but also what’s happening in terms of what do they see on your walls?

What do they see in what you give to them that makes them just see this clinic, or see you as an acupuncturist as this is the place I still need to go to because. , there’s nobody else who does it like this, right? So do you have visuals in place that really differentiate your practice?

And I found that when we get these in place with, in working with our clients, it makes a huge difference in transitioning to cash based practice. Now, the fourth thing, a bonus tip here is. , you can also consider offering other kinds of products or services too that can help support cash flow in the practice as well.

So these could be either additional streams of income related to supplements, herbs, or there could be products that you feel like are beneficial for your patients or even just a lay public. It could be ancillary services, whether it’s, for example, an acupuncturist client of ours is doing point injection therapy and she end.

Making additional income stream by adding that on top of the acupuncture treatments. We have clients also offering other types of anular services that are in alignment with the rest of their practice, whether it might be microneedling or it might be having other practitioners in the clinic like are doing, fertility clinic and offering our Vigo massage.

And then there are also. Opportunities for, even things that don’t require your time. For example, maybe they’re, you feel like foot baths or sauna is great. Ionic fit foot baths or saunas or, that kind of thing that you end up having at the clinic, which can also help support your patients and cash flow.

And that can also. Be helpful as you’re transitioning to cash based practice, although for most of our clients in that timeframe of transitioning focusing on one main thing, which is about. Being able to have good communication with your existing patients so that it’s a seamless transition and that most of your patients do end up staying with you is the most important thing to focus on.

And then also with bring in new patients that are willing to pay cash and this is what it is. So some of, sometimes acupuncturists tell me they’re like But I’m still a little afraid that if I go all cash then I’m just not gonna have enough patience because that’s just how it was.

And how I, I used to track people through insurance companies. And so part of it in looking at this is by thinking about this, it’s like radio weights. If you are sending certain radio signals at at a frequency, let’s say it’s like 89.5, right? Is what you’ve been sending radio waves at for insurance, then you’re gonna keep attracting the insurance patients because of what you’re doing.

But if we just tune your frequency to 94. Nine . And then your, all your communication, all your messaging, all your radio waves are all about that, whether it’s in what you say, what people see also in your marketing and your communications with, then you’re attracting a different kind.

Of patient who is at that different wavelength. And so that’s what we need to get in place. And then you will be able to feel really comfortable with transitioning to cash based practice. And it doesn’t have to be hard, It doesn’t have to feel like you, you just, you keep putting it off until you get so.

Frustrated by having to deal with the headaches of insurance or having to stay late. For example, I know an acupuncturist who has a busy insurance based practice, he stays late every day to do charting and then and billing related stuff. His family’s not really seeing him like he has kids, and his wife is when are you gonna come home Earlier?

Because you’re missing your kids growing up, right? So you know, you don’t need to wait till it hits that point, because once it hits that point, you’re already burnt out. And then wanting to transition is just not as good of a place to be. So why not be able to plan ahead and then. Especially at the start of the year, it’s oh, is this a really good time to actually transition?

It is one of the moments of start of the new year. So new things on new practice, new you, new energy, right? In terms of, or evolution and reinvention. So if you are in a place where you would like help with transitioning to cash based practice, or if you would just like free six and seven figure practice makeover tips that can help support the growth of your practice so that you could grow with less stress and have a practice that you’re proud of, then go to introverted visionary.com, then go to introverted visionary.com and look around or book a free chat with us and happy to help you further.

Till next time.

 

Acupuncture Owners Insurance: Know Your Coverage Options

If you are an acupuncture clinic owner, you understand that your business must have some protection. You can realize that by obtaining acupuncture owners’ insurance. However, getting one can be more complex than it appears to be. For one, not all insurers can offer an insurance policy that best fits your unique needs. For another, an overwhelming number of providers say they are the best in town, which can challenge your decision-make process as you choose from plenty of options.

If you are to buy acupuncture owners insurance, here are some options to consider adding to your custom-designed policy to have more comprehensive coverage.

Professional liability insurance. It offers protection for you from potential malpractice lawsuits., which is necessary considering how delicate the nature of acupuncture services and our litigious society are. Remember, acupuncturists like you are still vulnerable to lawsuits – even in the absence of professional errors.

Business personal property. It offers protection to 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 not a permanent fixture of the building structure can fall under this insurance policy.

Premises liability. Commonly called slip or trip and fall insurance. This endorsement covers the potential risks of a guest on the premises alleging damage to their personal property or injury in the clinic area, such as slipping from a wet spot on the floor, tripping on a frayed rug, or fainting and falling off the treatment table.

The acupuncture industry has been experiencing a rapid expansion in recent years due to rising demands. We expect this to continue as data suggest more and more people seek alternative treatments. Make sure your business is ready for a potential surge of more clients and issues that may come along with it.

Protect your acupuncture business today. Get a comprehensive insurance policy.

Online looking for a reputable company that offers acupuncture owners insurance? Contact us here at the American Acupuncture Council today at (800) 838-0383.

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Treating Facial Wrinkles with Intradermal Needling

 

 

And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started.

Click here to download the transcript.

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 is Dr. Shelly Goldstein. Welcome to the American Acupuncture Council. Thank you so much for having me here today. And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started. We think of wrinkles on our face and we think of them as just wrinkles.

But in fact, there are many, types of wrinkles on the face, and they come from many different sources. We can get wrinkles from. Bone changes and over time, all of these changes occur on many different levels. So from the deepest level bone, as we age, bone resource, or starts to break down, bone is the underlying structure of our face.

And so when the bone starts to break down, so do the overlaying structures, including the skin or the surface, which is where the wrinkles. We can get wrinkles from muscle changes over time. We say muscles attenuate, which means they, they get stiff and stagnant and then they create different peaks and values increases in the face.

We can get wrinkles from fat changes. Over time, fat starts to break down and move primarily into the nasal labial fold, or that fold between the edge of the nose and the corner of the mouth and accentuates different types of wrinkling. And then of course, all of those wrinkles show up on the skin. So on top of the wrinkles that occur from the skin level.

Are those deeper wrinkles? So today we’re gonna focus on the wrinkles that we see that appear on the skin from skin changes. The skin is part of the Anta system. The anta system consists of that fat layer, the subcutaneous of the hypodermis. And then on top of that is, Dermal layer, which is the true health of the skin.

Skin cells start at the bottom of the dermis, make their way up to the epidermis, above the dermis, and then they float to the top and they come off. So the true health of the skin and the visible health of the skin reside in the epidermis and the dermal layer, and that is the layer that we’re going to talk about when we talk about intradermal needling.

Intradermal needling is one of many different types of needlings that occur when you go get an injection or a hypodermic shot if they go into the muscle. It’s called intramuscular need. If it’s at the slide slightly into the, that subcutaneous level that’s called subcutaneous needling, intravenous, lev needling goes right into the bloodstream, and then there is the intradermal needling, which goes between the.

Into the dermal layer. So we see on needling too deep is that it misses that middle dermis layer. If you needle too shallow, it stays too superficial at the epidermal level into, if it’s inserted properly, it goes into the dermis and you can actually see it creates a little swelling at the surface.

And that’s how you know if you are into the intradermal needling because you can actually see the surface of the skin popping. Why, intradermal needling into the dermal layer? What’s going on? Basically, and in a nutshell, we’re working in the connective tissue portion of the dermal layer. There are two types of connective tissue in the dermal layer of the tissue.

There’s the papillary layer. Which is that loose mesh work that we can see on the right, and this primarily provides the nutrients to the skin, and then there’s the rec particular level below, which is much thicker, and it provides the density of the tissue or density of that layer, the structure of that layer.

When we think about connective tissue, what are we talking about? The primary components that make up connective tissue are collagen. Collagen is the support system. It’s like the mattress that you lie on. It’s the firm structure that has enough balance in it to allow you to lie comfortably. But it also.

Has enough resilience and tension so that you have support. That’s collagen. It’s the mattress of the germal layer of the tissue and the mattress of connective tissue. In addition to connective tissue and collagen, we have elastic fibers. And as you can see in this slide, it’s a very thin vertical.

Structure and that’s gonna allow the snap or the ability for that dermal or the connective tissue to bounce back. So you lie on the mattress, it sinks in, you get up, it pops back up, and that’s due to the elastin fiber within the connect. Tissue and then also in the connective tissue. We have fibroblast cells.

And fibroblast cells are what stimulate the production of collagen, and then we, It’s all embedded in this aqueous solution of hyaluronic acid. And hyaluronic acid provides the moisture and the ability for cells to float around and receive the nutrients that they need to grow healthy. It’s also what keeps our skin nice and hydrated and moist.

Now as we age, what happens? We age, we start to lose the ability for the cells to mo migrate from the base of the germal layer up through the epidermis, and they lose their vitality. We start to lose the integrity of the collagen and the elastin in those layers. They begin to get disorganized or not line up properly.

We start to lose the VAs, the blood vessels that iva that area and nourish the, area as well. When all of this happens, we start to lose that plumpness, the plumpness of the. The connective tissue and the dermal layer itself. When it starts to, when we lose the integrity of that it starts to dry out, we start losing hyaluronic acid in within that area.

And then we start to see not only as it dries out, but that dermal layer in that epidermal layer start to thin and separate. Creates more dryness. And then as we lose that suppleness of disorganization of collagen, an elastin, we start to see pitting. And you can actually see in this image, you can see the surface of the skin starting to pit.

Sometimes we call that wrinkle. Sometimes we call it skin pitting. For our purposes, There are multiple types of wrinkles. There are fine lines are primarily due. They’re not wrinkles. They’re due to the loss of hyaluronic acid in the tissue or dehydration. And the key is to just drink more water.

We are apply more hyaluronic acid or hydration to the surface of your skin. For our purposes, we are going to look today at shallow wrinkles. Shallow wrinkles, you’ll see in a moment are very superficial wrinkles. When the collagen starts to move up and down, or the elastin starts to snap back we, lose the creases.

So the creases come when we’re activating our muscles or textures of the skin, and then they relax as they, as the shallow wrinkles become more sedentary, they move into deep wrinkle. And this is when we are actually start to see changes in the architecture and integrity of collagen in the skin tissue and, also lattin so it becomes more visible when the faces at Russ and then static wrinkles are are a different type of wrinkle.

They’re actually. Deep wrinkles that have been around for a while. And in this situation actually starts to create damage into the tissue via the loss of elasticity within an elastin within that skin tissue. And then again, this too is visible at when the faces rest. And then we have dynamic wrinkles.

And these have more to do with muscle as opposed to skin create, although they may. Static wrinkles and deep wrinkles and cello wrinkles. When you treat dynamic wrinkles, you actually have to treat the muscle as opposed to the skin. So here’s an example. Here’s shallow wrinkles are on the left. And as you can see in this image, the person on the left or the figure on the left is probably in her thirties.

The middle is probably in there, her fifties and sixties. And then the on the right is, older. Most shallow wrinkles occur earlier in. And as you can see, say particularly in this image starting at the nasal labial full dot full between the edge of the nose and the corner of the Mac, you start to see the creasing there.

You’ll start to see it in between the eyebrows, Ella creasing, and possibly across the forehead. As they move into deeper wrinkles, you can start to see the changes of the architectural changes in the face. You can start to see a deeper creasing between the eyebrows, the nasal labial, fo maybe around the mouth, starting to see a change in the mental crease, which is between.

The chin and the lower lips and the marionette lines, which are between the corner of the mouth and the jaw area. And then as they move into more static wrinkles, they create a number of changes in the architecture of the face. And you can see the visible difference here. In fact, it’s just a progression from left to right and most of it has to do with age and lifestyle.

And diet. What’s interesting about needling at different layers of the tissue, particularly at the epidermal level and the germal level, is the references to it that we’ve seen in the classics, notably the ling shoe over time. In the classics, they talk about numerous, there are numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh.

The channels around the muscles, and then at the layer of the bone. So there are constant references throughout time about different ways and the importance of kneeling at all of those different levels. Also in the Ling shoe, in chapter one, it says The skin, the flesh, the muscles, the tendons and the meridians occupy different places in the body and that different diseases respond to different methods of treatment.

In chapter seven, it talks about the illnesses. If illness is superficial and needling is deep, it will penetrate and injure the good flesh. If illness is deep and needling is superficial, results will not be obtained. So again, there’s the references to the changes, the importance of needling at different different layers, and then the results that can be obtained when properly kneeling into those different levels.

Intradermal needles is superficial needling, obviously, and it’s sim very similar to Japanese needling technique. We know in Japanese needling technique that the insertion is superficial, that the manipulation, if there is any manipulation occurs at the surface of the skin. We’re not needling for Dutch.

And the needle gauges. The needles themselves are different. They’re very thin, and the length varies, say between a very short needle and say a 30 millimeter, which is like an inch long. When we are needling for the purpose of intradermal needling, what’s going on? There are multiple theories as to why this works.

One that’s the most popular and actually the foundation of say Derma rolling or microneedling, is the fact that when you insert a needle into the surface of the skin, it actually creates a little wound. Wound healing results. When you put something in or you damage the surface of the skin fibroblasts, circle that area and immediately start to stimulate the production of collagen and elastin within that tissue to actually heal the wound from the inside.

This was what we called a wound healing cascade, and which case again? We insert the needle, it creates a micro damage into the surface of the skin or under the surface of the skin. Fibroblasts come in, they stimulate the production of collagen. Collagen starts to line up, as well as elastin into the dermal layer of the skin.

And you can actually see in this image, In the first image, you see where the damage was created, and then you start to see the abundance of fibroblasts building collagen and elastin at the dermal and epidermal layer to start to thicken and to heal this microtrauma. Another theory is in doing so, what we’re doing is actually enhancing not just the collagen, but also the elasticity as well.

So we’re building collagen, building elastin under the skin, stimulated by the trauma that was created by inserting a needle into the surface of the skin. And there’s also something else that’s going on, and that’s called Paso Electric. Collagen is the primary component in connective tissue, which we just learned, and it also is capable of transmitting electrical signals throughout the bottom.

So it has an electric energy, call it, she call it electro Paso. Call it whatever you want, but it creates a vibration or an electricity. that then signals throughout surrounding area. And it’s both mechanical. So inserting in the needle stimulates this Paso electricity. It creates both the mechanical and electrical properties that vibrate out into the surface and connect with other systems.

So when. Insert the needle as a form of an external influence. The electrical current in that tissue created by the collagen radiates out into neighboring structure. It’s a, it’s somewhat the foundation of acupuncture in our culture is creating some type of an energetic that then spreads, not just stays at the center where we’re need.

It begins to spread out throughout surrounding tissue. And in our world, the meridians that, that connected these points. So we need and put the needle in. Intradermal needling, it stimulates that wound healing cascade. It excites that collagen Paso electricity. And it also releases fascial tension, which is the tension that is created by holding that tissue in this stagnant place now for so long.

The slide in this presentation or in this PowerPoint is histological slide. So they take pieces of skin or where there are wrinkles, they put ’em on the slide and, they put them they put a little piece of glass on top of it and they slide it under a microscope and, then you actually get an, a larger image or a magnified image of what’s going on.

So here we see a wrinkle. And it looks like a little divot like this. This is another slide. The wrinkle is actually very, shallow. This would be considered a shallow wrinkle. This is very minor or more minimal wrinkle, moving into a deeper wrinkle. Here’s a deeper wrinkle. You can see it’s not just a, dip or, but more of a plummet, a little deep area.

So that’s a different kind of wrinkle. So as you can see, we’re going to see all different types of wrinkles, and we’re gonna needle them differently as well, depending upon the. The, wrinkle itself. So we can’t really look at a magnifying glass in our practice. We’re not gonna take a slide and put it under my magnifying glass.

So you have to start to train your eye to see what does a wrinkle look like? Is it very shallow? Does it look a little bit deeper? Does it look like it’s petted? And then we’re going to decide how to needle it, and we’re gonna decide which type of needles to. Most of the intradermal needles today are either the straight intradermal needles, the Japanese one, or the press tax.

And they’re good. They don’t give you a lot of flexibility if you, they’re very tiny. You have to use a pair of tweezers if you’re using an intradermal needle and just slide it in. And you get a very short distance of, being able of insertion the press tax. There’s only one way to needle it and it’s down.

So that is somewhat limiting. EUS is a new serum needle and I think it’s a really good needle, and it’s ones that I choose to use. They’re stainless steel needles. They’re triple polished. They’re similar to serum needles. They’re high. The, quality of them is great. They come in a bolt pack of four.

They’re really easy to use and they’re a little bit longer. Some, they range between they’re all about seven millimeters, but then the thickness of them is varies. Different sizes. So depending upon the type of needle you choose you can affect different types of wrinkles. All of them work. It’s just a matter of personal preference.

So I’m gonna show you these slides. So this is a shallow wrinkle, which means it’s going to show up and then disappear. So when the model lifts her eyebrows and cringes her forehead, then you’re gonna start to see them. And I’ve actually had her do this in this image. And so we’re gonna look at these needles.

It’s pretty good. It’s a little blurry, but basically she doesn’t have a lot of wrinkles. And the wrinkles that she does have moose. One way to find out whether it’s a shallow wrinkle list, actually, to have your patient lift their eyebrows, drop them further eyebrows, and see what stays, and see what goes away.

So in this situation, what I’m gonna do is I’m actually gonna spread. The tissue and needle very shallowly into the needle. So in this situation, when you’re spreading the needle it’s a very shallow insertion at the upper level of the dermal level. You open the wrinkle, slide the needle into the surface, and you can line them up because most of these are fairly long needles.

So this is a good technique to use if you’re doing, if you’re treating a very shallow. Let’s see. This is more of a deeper ecstatic wrinkle, and this is the nasal labial fold right here. It’s the different, it’s from the corner of the nose to the sock corner of the mouth. A lot of it has to do with tissue that has fat that has moved down, or gravity muscle attenuation.

Has some effect in it. But in this situation, you’re gonna actually treat the wrinkle itself. Now, it’s hard to spread this because it’s a deeper wrinkle and it’s static. You can see it, it will stay there whether the person is smiling or frowning or either or making any other muscle expression. So rather than trying to spread this, wrinkle, what you’re gonna do is you’re gonna actually grab.

Like this and pinch, and then slide the needle into the crease. So let’s take a look at this. So I’m pinching, it, and slide. Okay. I’ll show you. This is a closer version of it. This is a, and it’s a little bit blurry, but I think you get the image. You’re gonna pinch and slide. Okay. It takes little practice.

It’s almost as if you want to take that area, start further out, pinch it, and let’s do this one more time so that you can see it. You’re pinching, you’re starting f pretty far out. In order to pop it, pop the tissue up so that the only thing that you can actually see is the wrinkle. Perfect. Let’s keep going.

Okay. Now, we’re gonna talk about deep wrinkles for a moment. On top of the changes of the architecture that occur within the derma layer, when A wrinkle has been around for a long time, it starts to affect the tissue around it very similar to that of a. Scar tissue is composed of the same collagen protein as healthy skin tissue similar to this, but because of the trauma or because of the static nature of the wrinkle, the tissue around it starts to change.

So similar to a scar where during tissue healing, the collagen cells group together. Like this and bunch up. This is sometimes what a deep wrinkle looks like. We’re gonna look at one in a minute. The way to treat this is not to slide the needle in because that’s not gonna really break up the tissue is and not to pop it and go into.

Base, but actually to go into the wall of the tissue to start to break up the fibrous tissue that is starting to develop, to create this, that stagnant nature, that depth of, the wrinkle itself. So here we go. Take a look. This is, if you look at the, let’s look up here. This is what we’re gonna treat.

This where the red arrow is. But if you look at, and it’s right here on the large image. Now look at this wrinkle. This wrinkle starts at the, in the lip. It starts at the base of the bottom lip and actually projects all the way down, but right. This is the depth of the wrinkle. This is probably where it started, began to spread.

So here’s where the damage is. Here’s where potential scar damage is, what we’re calling scar damage, but it’s really not a scar. It’s basically tissue that has been in one position for a very, long time. So in order to affect this, we actually need to break this, tissue up and around it. So we’re gonna take.

And I’m gonna needle into the wall. You can either needle from the outside in or you can needle from the inside out, but the object is to actually get into the wall of that wrinkle as opposed to the base of the wrinkle itself.

So just as a recap, we have fine lines. Fine lines are basically due to creases in the skin surface caused by dehydration. And the way to treat it is to enhance water consumption or to apply it or both. We have shallow wrinkles, which have to do with creases that are just beginning, and they change so they’re not stagnant.

Over time, you spread the wrinkles and needle into the crease. We have deep wrinkles where the crease is caused by the beginning of. In a lack of integrity of collagen and elastin in the tissue itself, and they stma, they’re starting to show up and stay there, stay at the face, or stay visible when the face is at rest.

And then we have static wrinkles. And these result from a loss of elasticity, tissue damage, we see that build up or the change in the architecture of collagen elastin around those needle wrinkles. And the treatment is to, the intradermal, kneeling treatment is to needle into the crease of the wall. And then we have dynamic wrinkles, often known as ride tides.

And these develop from repeated facial movements, in which case we need to treat the muscle as well as the. So thank you for today’s presentation. If you have any other questions or want to know more about facial acupuncture or cosmetic facial acupuncture you can visit me@hamptonsacupuncture.com, my website.

You can email me@infohamptonsacupuncture.com or follow me on Instagram at Shellie underscore Goldstein. So thank you again everyone. Thank you, the American Acupuncture Council. It’s always a pleasure to be with you and next week stay tuned for Chen Yen she’s very exciting and a wonderful lecture. I’m sure you’ll enjoy her presentation as well.