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Acupuncture Malpractice Insurance – Diversify Your Practice and Increase Your Bottom Line

So I want you thinking along the lines of where are my patients coming from? Where might I seek some additional patients that I’ve never thought of?

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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, friends and colleagues. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council. We’ve always tried to help you a way to enhance your practice, make your practice better. What is always going to make a practice better is your ability to provide what you do.

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But you need patience. So I want you thinking along the lines of where are my patients coming from? Where might I seek some additional patients that I’ve never thought of? Where is that market? You always have to think of you are a business. You are a CEO. Are you doing things to make your practice enhanced?

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So let’s talk about where you’re getting your patients. Let’s go to the slides. Where are your patients? Your patients can be a lot of different types. Obviously, we have cash, but in my opinion, there’s three types of cash patients. Cash, prompt pay, prepay can be done. And then for insurance, there’s nine different types of insurance, but what I want to focus in on are veterans.

Acupuncturists are not tapping the market for veterans. Now, sometimes it’s more just they’re not aware, but realize the VA could be a very good add to your practice. And I’ll give you an example. The average VA patient payment to an acupuncturist for the number of visits they get is going to be about 3, 000 for every one of these patients you get.

Imagine you get two a month. How do we do this? Let’s focus in on that and where does this come from? Because realize, acupuncture has been accessible to veterans for quite some time and I think this is where maybe the problem is. Many of you aren’t aware that it’s covered. Imagine how many veterans aren’t aware that there’s this benefit.

So I want you thinking of, when you have a practice, you’re going to do a little bit of both. I want you to have a cash practice, but I would say that doesn’t mean you don’t take some insurance. In other words, cherry pick. If I get an authorization for a VA patient, I have no problem taking them because it’s guaranteed payment.

Now, some insurances I don’t want to take at all because it’s a little risky, but you need to have a bridge. Don’t assume one without the other. Here’s the part I’m bringing up. For veterans, how many are aware that the VA gives you marketing tools? This is available on the VA site, allowing you to use this, whether it be on your website or any other type of business, badging, social media, to make people know that you care for veterans.

I would bet if you put a sign like this in front of your office saying, we care for veterans, I bet you might run into a lot of people coming to your office going, what do you mean you cover veterans? There’s no veteran coverage for it. Because they’re simply not made aware. When’s the time you’ve seen a commercial or any type of marketing for someone that’s a veteran who’s having pain management or other issues that they could seek acupuncture care?

If they’re not doing that, why aren’t we? The offices I’ve seen that have embraced this have really increased the value. to their practice because they’ve increased the value to these patients. VA community care is what we’re talking about. Community care is stuff that the VA can’t do in their own place that they need to do outside or don’t have enough.

Now realize VA does have some acupuncturists that work in some of the facilities, not all. The VA community care program is provides medical care to eligible veterans and their dependents. Now let me be careful. Dependents aren’t going to be covered for acupuncture. So that’s out, but it’s going to cover the veteran for services that are not offered at that facility or aren’t accessible at that facility.

So here’s what we have. Notice here, this is the VA community care network. Notice what it covers. It covers acupuncture, but wait. It covers massage. Now, again, I want to be careful as an acupuncturist, so long as massage is within your scope, the VA will pay you to do it. But in addition, what if you’re a massage therapist?

Think about this for a second. Do you know massage therapists could apply and treat veterans and the VA will cover it? Get this though. You want to see where traditional medicine fits? They literally cover Tai Chi. So wait, can you imagine a Tai Chi instructor who learned about this? They could think, Hey, I could do a class for veterans.

and be paid by the VA? Here’s the problem. This has been around for quite some time, but we don’t have enough people aware. So I think part of it is making people aware that you do it. And I think the access for you is one that’s pretty good. Here’s what the VA says. Acupuncture is often associated with pain management, but it is also useful for other conditions.

In the body of literature for acupuncture effectiveness is growing. Acupuncture may be effective as a stand alone treatment or as an adductor treatment for other medical congestion interventions and notice the evidence map developed by the VA itself. It says this systemic review identified evidence of potentially effective Effect of several pain conditions, including chronic pain and headaches, mental health conditions, such as depression, anxiety, PTSD, as well as indicators such as insomnia.

So they’re really broadening here for the types of things people have. I had one patient. Or one office, I should tell you, that got referred a VA patient to treat weight loss. I kid you not, because they felt it was going to be helpful. It was, and they paid. It wasn’t even for pain management. So imagine this being available.

If you could start making patients aware of it, they have expanded non pharmacological treatments available to veterans by providing acupuncture services. Yet, yet. Yet, acupuncture use remains very low compared to other populations. It’s less than 1%. If you can increase it 10%, you wouldn’t have enough acupuncturists to handle these people.

Who in here, who of you probably could take 10 times your patients? So I’m thinking the VA could be something where we could really get you to access. But here’s the problem. Does the average veteran know that they’re even entitled to this service? They are. We’ve got to make them aware. We need to know they’re aware because what do they cover?

They cover acupuncture. Yes, acupuncture. Up to three sets of needles per visit. It covers the exams, whether new patient exams, subsequent, and so forth. It covers therapies of many types. Hands on therapies, exercise. Massage, Manual Therapy, Tuminog, Gua Sha, and so forth. In addition though, it covers something many of you are going to go, What?

Yes, the VA covers for acupuncture laser. This is actually new for 2024. It always and continues to cover cupping. So if you think of it, the VA is probably the most conducive to allow acupunctures to what you really do. So including cupping. So would this be a patient I want to see? I would. Why? Because they pay pretty decently.

They pay at Medicare rates, but hold on. Don’t get too down sided thinking Medicare rates are better than ASH, by the way. But notice, set one is 40 and subsequent sets about 30 on average. So that means if you’re doing three sets of visit, that’s 100. Your exams are going to be between 120 to maybe 80 or 90, depending on the lower levels for established patients.

But again, within that, supervised modalities, like an infrared heat, pretty cheap, More hands on, or I shouldn’t say hands on, but more modalities that require more expertise up to 25. They pay about 20 for cupping, again, an average. And then therapeutic procedures, hands on, massage, manual therapy, exercise.

Those are going to be between 28 to 40 and those specifically in the mid 30 range. So you can imagine when I talk those numbers, if you’re looking at the number of visits you might get, This is a pretty good patient. You know what they’re looking for? Make them better. Help them. Are you going to cure them?

No. You’re going to help them manage. Help them get better. Help them be allowed to get out in society and be functional. What do they authorize? When you do get these, they do have to be authorized, but they pay for 12 visits within the first 60 days. And what they’re going to look for is, did the patient improve?

If they’ve improved, they will allow up to 8 more visits every 90 days. And they even have one that once you’ve gotten within that, they’ll allow chronic pain management for the patient to use as is, if you will, after they’ve reached PNS or medical MMI, maximum medical improvement. to allow them to treat as they get a little bit of a flare up.

But let’s assume here you’re looking at probably at least 20 visits. And if you’re thinking it’s a hundred plus per visit, that’s where I said 2000 plus exams, a little bit more. So certainly something I’d want to get access to the, here’s the key. If you join and you don’t get a patient, that’s the worst thing that happens.

You don’t get a patient. But if you don’t join, for sure you’re not. What if you join and get a few and make people aware that you help, that you’re helping them? Think of how many patients that are existing veterans or have family members that are. You do have to join. Here’s a map. Notice if you’re Texas or west of Texas, it’s with a company called TriWest.

And if you’re in north of Texas or east, it’s going to be the company OptumHealth. There’s no cost to joining, just have to register. So to me, it’s a no brainer. Worst case scenario, you join, you don’t get a patient. You know who I blame if you don’t get a patient? Us. You. How do people know what you do?

Here’s my problem for acupuncturists. Ask the average person, what does an acupuncturist do? And I think you’ll hear a lot of ignorant answers. And I’m not blaming anyone, but I’m saying we’ve got to do a better job. Because how many people know you can treat anxiety, depression, PTSD, insomnia? Not to mention back pain, neck pain, all those things.

People aren’t aware. They think one thing, make them aware of more. And of course, as you well know, once a person has been to an acupuncturist, very seldom do they come back, Oh, that didn’t work at all. In fact, how many times have you heard them say, I’ve been to so many doctors and I went to the acupuncturist and after one visit, or maybe even just a few, my pain or my problem improved 50%.

That miracle happens all the time, but you got to create access. You’re so anxious to join so many of these other plans that pay you very little. Why not the VA? Understand how the VA works. What do they pay you for? They pay to make the patient feel better, meaning give me a pain decrease. Give me functional improvement.

If I make the pain go away, am I going to have more function? Absolutely. Can I show that they’re probably using less medication, even if it’s over the counter? And bottom line is demonstrate it objectively. If you go through the last time I did this program for you, I did one on authorizations, that kind of focused in on that.

Show me you’re making the patient better. That’s at the end of the day. That’s all that’s really cared about. The VA will look there. I’ve had people say Sam, I’m not getting additional visits when I request it. Did you follow this? I’m the expert that can help you with that. This is just a thumbnail.

We’re doing a seminar. We also offer a service called The Network where we’re going to help you. Don’t feel alone. Know that there’s a lot of sources out there and we’re one of the main ones for you. I wish you well and I want you to be prosperous. Be well, my friend.

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Acupuncture Malpractice Insurance – Acupuncture Preauthorization

One of the things that’s come up recently that I’ve had some issues with is people dealing with pre authorizations. This could be a pre authorization whether it’s a I don’t know, health insurance like ASH, maybe Optum, maybe a VA client.

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Greetings, everyone. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council and you. One of the things that’s come up recently that I’ve had some issues with is people dealing with pre authorizations. This could be a pre authorization whether it’s a I don’t know, health insurance like ASH, maybe Optum, maybe a VA client.

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And it’s always, what are they looking for? So let’s go to the slides. Let’s talk about that. What is required for a pre authorization? What in the heck are they looking for? How do we make sure to kind of streamline this? Make it easier for ourselves and ultimately know what are they looking for. And I think that’s what’s really important.

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So when you’re talking to pre authorization requests, you got to think of who does this come from? Well, number one, I think people think of the plans similar to ASH, American Specialty Health Network. That’s all over. And of course, those require pre authorization, particularly unless you’re a tier six. It could require authorizations after the fifth visit or eighth visit.

So what are they looking for? But we’re also running into issues. Optum Health, who manages United Healthcare is requesting, and we’re seeing it obviously from community care, meaning the va. And this includes Tri West on the West Coast, or Optum on the East Coast, which of course already is there ’cause we know Optum does require that.

But then there’s other plans, I’m sure you’re noticing Aetna, blue Cross, blue Shield, Cigna, and others. are beginning to put this in place. Not everyone, but whenever you run into this issue, one of the difficulties is trying to understand how do I make sure to get the care authorized, make sure I’m not running into a hassle and creating much more work for myself.

So what do they want? Why do they want it? Well, what they want really is a plan of care. What are you expecting to do? What are they expecting outcomes? So you do have to really write up a plan. I want to see this patient two times a week for three weeks or whatever numbers, but it has to be specific. It cannot be open ended.

The ultimate thing that they’re going to realize or look at though, is are you making the patient better? With pre authorization, it often is not the first visit, but it’s follow up visits. Even ASH will allow you about five. So what they’re looking to see is that, well, is this care working? Is it going to make the patient any better?

And they’re looking really, if nothing else, the why? They’re looking to avoid maintenance, supportive, or palliative care. It’s care I believe and I think is useful, but insurance, of course, So they’re always concerned that it’s going to give them just feel good. Now what I find funny about that is how much care that’s medical, meaning medicine, that’s curative?

Or is it maintenance? I mean, if you think of it, if I take blood pressure medication, am I curing it? Or am I just maintaining it low? Well, think of pain management. Well, maybe I’m not curing the reason for pain, but if I can maintain it, isn’t that a good thing? Kind of interesting how that kind of works in that way for us.

However, what I want to focus on is what are they looking for? So when you start doing a pre authorization, there’s some highlights you want to have. Medical necessity, when we look at this from American Specialty Health, and now this is not my opinion. This is taken directly from their guideline. The number one thing they rely on is your diagnosis.

And this is going to be true for anyone. Make sure your diagnosis is one that they cover. One big reason things aren’t covered is you don’t have the proper diagnosis for your care. Notice that they don’t cover everything, but know the things that they do cover and focus in on that. They do pay attention, however, to the past medical history, severity, complexity, Acuity, is it recurrent or chronic?

That does make a difference. When that is in play, it can create a greater need for care. But they also pay attention to comorbid factors. What are things underlying? Maybe I’m not directly treating it. But it’s causing the patient to be more difficult to respond. Maybe they’re diabetic. Maybe they have MS.

Maybe they’re very overweight. Maybe they’re very deconditioned. Anything you can think of that is causing it to take longer is important because otherwise they’re assuming everyone gets well in a few visits. And they do look at your exam findings, whether it’s range of motion, palpatory, orthopedic testing, orologic testing.

And remember for acupuncture, they do pay attention to tongue and pulse. Those are important, but you know what they really want to know? Within all these factors, what are the functional limitations of the patient? What is it causing the patient to have difficulty doing? Because pain always inhibits function.

So I always think along the lines of all these things leading to how are we making the patient better? And better means functionally, not just, I feel better. And think ultimately of what the goals are. So if you kind of start putting this together as a template, this is going to allow you to start to think of what things they’re looking for.

Now this is just American Specialty Health. Let’s take a look. This is the one from Cigna. Now I’m showing in big format here, but notice Cigna says, medically necessary services must be delivered toward defined, reasonable, and evidence based goals. That’s that first bullet. Medical and assessed decisions must be based on patient presentation, diagnosis, severity, and documented clinical findings.

Continuation of treatment is contingent upon progression towards defined treatment goals and evidenced by significant, objective, functional improvement. Do you notice how much they’re bringing in that function? That’s what you want to focus on. So notice it says, examples, outcome assessment scales, range of motion.

So notice, is this very different? From what we saw with ASH, not really. In fact, take a look at the last bullet. It says, medically necessary service, including monitoring of outcomes and progress within change in treatment or withdrawal of treatment if the patient is not improving. So notice the outcome is what they’re looking at.

Show me what they’ve gotten so far, how they’ve changed, what are the expectations, or what are the expectations based upon guidelines? Here’s more of it from Cigna. And you’ll notice again, the emphasis here, measuring progress. Pain scales. That helps. But a pain scale without context is not very good. We want to have interference with daily activities, functional outcome measures, length of relief after treatment.

And you know how a lot of patients feel better for a few hours, a lot better. But by the next day, they feel the same. If you just report how they felt the next day. Your care doesn’t appear to be working, but highlight those factors. But notice tenderness, palpation, range of motion. Here’s what I’m highlighting.

It’s not very different. Maybe semantically there’s some differences, but ultimately the same things they’re looking for. Even the VA jumps in on this. The VA says significant, durable pain intensity decrease. So we want to see pain decrease, but not pain by itself. When pain is better, function is better.

So when a person says they feel better, ask the question, what can you do now that you couldn’t do before? Maybe tying your shoe, driving the car, whatever the case may be. But notice it says meaningful improvement on validated disease specific outcome instruments. Acupuncture works well. Let’s make sure to demonstrate that.

Not just by what we verbally hear from the patient, but validate it. So we want to also highlight any documented elusive, documented lesser use. I don’t care if it’s over the counter or otherwise. If they’re taking less, that’s helpful. And then also look at any objective measurements. Again, things on your objective exam.

And again, you’re going to notice, well gosh, this is the VA, we did Cigna, we did ASH. Does it all kind of come out to be the same? Yeah, in fact, they even say here, include any barriers to recovery such as complicating conditions or comorbidities. But also how the patient has changed to date and how the care will continue the same trajectory.

At the end of the day, show me the patient is getting better. I think the simplest thing to do is always have outcome assessment tools at the ready. Whenever a patient first visits, that should be the first visit, and probably once a week or every two weeks at least, because your care is working. We want to show that it’s gaining.

by having direct measurements. Now you’re going to hear the term data driven care. It’s the data of what you collect. Tracking restrictions on activities of daily living is probably the best way. So you’re going to use what are called patient reported outcome measurement instruments. And there’s lots out there.

General pain index, specific functional scale, the short form for pain interference. There’s a long form. And then pain rating scales. Those are good. Oswestry, but everything has to fit within a goal. Now, some of you who are members in our network, remember our AccuCode has these on there all for you to use and how to use them, but ultimately let’s take a look at how they set up.

Here’s the general pain index. To me, one of the simplest, but most effective. Notice this is not a pain scale. It’s not about how much the person’s in pain, but how the pain affects their family and home responsibilities. They’re recreation, social activities, employment. In other words, if it’s a 0, they’re doing fine.

But a 10 means they’re a mess, and all we’re looking at is a number. The higher the number, the more dysfunction. As the patient improves, the number should reduce. Now you’ll see at the bottom it says the threshold score is going to be 5, meaning that if a person’s score is 55, they’re not better until at least they’re 50 or lower.

It’s got to be a 5 point difference. What you should notice initially, It’s a high number that will drop a lot, at least at the beginning, and then it begins to trickle. Now, that doesn’t mean because the trickle is happening you’re going to stop, but it just shows you’re continuing. An easy way of demonstrating it, because if you rely on the patient saying they’re feeling better, that’s not really going to give us enough evidence, because feeling better in what way?

You ever had a person tell you it’s a 10 but they’re almost functional and another person’s 5 is dysfunctional? So that’s why the pain scale is not as accurate. It’s the pain scale with function. So General Pain Index. In fact, the VA has one they prefer now. It’s called the Pain Interference Short Form.

In fact, you know what this is? It’s the short form for the General Pain Index. Notice, it’s the same six questions, but it just has a five answer. This is what I would say you probably do once a week, maybe the other one every two weeks. All this is doing, though, is giving evidence of how your care is working.

When you are seeking an authorization of care, the best way to authorize more care is to demonstrate how much the patient has changed. And then what the continuation is going to continue, the projection, if we’re improving 10 points or so each time we do this, there’s no reason to discontinue until it begins to flatline and there’s no further improvement.

Bottom line is they’re looking, are you making the patient better? That’s what they care about. Not about how they state it, but notice every single one focused on function. If someone says they want function, Give them function. Use an outcome assessment. Make it part of your daily note. In fact, there’s some new rules that are going to help us with pre authorization.

Now, these rules technically don’t take effect until 2026, but this is the movement. This new federal rule requires that they streamline and disclose more information. Do you ever notice sometimes, They don’t give enough information, I’m providing a lot of it here, but we want to see a process where if you’re participating in any federal plan, this doesn’t include VA and others, they must now respond to an expedited process within 72 hours.

But never greater than seven days. Now, many of them say, Oh, yes, we respond within, you know, five days. We know how that works. I mean, think of some of these VA claims you’ve probably requested. They can take a month. Now, they’re requiring that they respond sooner. ASH can respond pretty quickly, but it’s almost always negative.

So, if that’s the case, they must also include their reasons for denying. Often, when I deal with an office on getting pre authorization when they’ve been denied, The best way that can help them is I take a look at what was denied and the why to make sure when we make the next request, we hit the points that they want.

Remember, when someone wants A, B, and C, give them A, B, and C. I don’t care what you think, get what they want. Now that doesn’t mean if you like doing A, B, C, D, E, and F, great, but their focus is A, B, C. Give them that as the primary. Realize now you’re going to have a little bit more of a framework to look at.

Most often when they do give a denial, they’ll give a little bit of this. Now under federal rule, it’s going to be required. Don’t be afraid of it. Your care works. Demonstrate it. As always, the American Acupuncture Council Network is here to help. If you need some one on one help, want to make me part of your staff, join our network.

I hope to see you. Otherwise, everyone, I wish you well.

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Acupuncture Malpractice Insurance – Secrets of Marketing Your Facial Acupuncture Practice

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Hi, my name’s Michelle Gellis.

And I am a License Board Certified Acupuncture Physician. I will be presenting today on Marketing Your Facial Acupuncture Practice. Can we go to the first slide?

So a little bit about me. I am currently on the doctoral faculty at Yosan University, and I am a former faculty member and clinic supervisor at the Maryland University of Integrative Health. I have been teaching facial and cosmetic acupuncture classes since 2005.

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So today’s lecture is going to be part one of a comprehensive lecture on how to market your facial acupuncture practice. And part of this is from my upcoming book on Treating the Face and some of the material I learned from Dr. East Phillips and she can be found@dreast.com. So the topics today are I’m going to do a quick marketing 101, talk about social media, the power of testimonials the importance of before and after photos, and how to set up some accounts.

programs for your facial acupuncture practice. So the first thing to think about when you’re thinking about marketing your facial acupuncture practice, and this really is not just for a cosmetic acupuncture practice, but this can also be for if you’re doing facial acupuncture for, Neuromuscular facial conditions.

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It really falls under the umbrella of educating your audience. When most people now, nowadays, when they think about aging, there’s more of a push towards holistic aging, and aging in a healthy way. We can’t stop the aging process, but we all want to look and feel as good as possible. And the nice thing about acupuncture and Chinese medicine is that we’re not just treating the outside, we’re treating the inside.

So when you are Putting together your brochures or your online presence, any infographics that you’re putting together to talk about your facial acupuncture practice. You want to not only talk about how effective it is, but also The full range of benefits as far as physical health, emotional health and wellness, relaxation, and how it is a holistic approach, you’re not putting anything into the body or taking anything out of the body, as is frequently the case with Western medicine.

When we’re thinking about our marketing in general, one of the first things that we can be struck with is where do I come up with content? How often do I need to post? How much information does someone want at one time? And for a lot of us, we are healers, we are business owners, but we may not have a marketing department and or a background in marketing.

It’s important to know that consistency is the key. It takes the average person about seven times of seeing your ad before they actually take some sort of action. If you’re consistent, then people know that you’re not going to disappear. They can count on you to be there. And if they can’t buy right in that moment, then They’ll see your post again.

So it really is a matter of being in front of someone often enough so that when the time is right for them, they’ve been educated, they like you, get your message, they understand what you’re selling, and that’s when they’re going to hit the button to either call you or to sign up and make an appointment.

So marketing when you’re trying to think of marketing ideas, it can be overwhelming. Like I am just burnt out, I can’t think of a single other idea of what can I do for my marketing. So one idea is to market by the season, right? So each season you are going to come up with a new idea for marketing. So when we’re talking about the skin, maybe it’s a spring detox for the skin or summer skin.

Is your skin getting. Overcooked by the sun or dried out or is the humidity affecting your skin? Is your skin dry in the fall? And what about your winter skin? How is your, how are you tending to your skin during the winter? So you can set your marketing. by the season. Another way that you can set your marketing is holidays.

There’s so many holidays and for each holiday you can work your marketing around that holiday. Also every month of the year, and sometimes for every week of the month, there’s different awareness. So there’s Domestic Violence Awareness Month and Down Syndrome Awareness Month, Breast Cancer Awareness Month.

Different awareness things that resonate with you, your message. You can look them all up and then you can gear your marketing towards that and offer specials geared towards that.

You can also do your marketing so if you choose a month, or you’re in a month, you’re coming up on a month, let’s say January, you would come up with different discount codes that would relate to January. And then when you’re offering discounts on your services or your products, I strongly recommend if you’re going to be offering cosmetic acupuncture, that you do offer products.

So For example, for January, you could do New Year, or New You, or Beginnings, or New Beginnings, and then that discount code would be worth a certain amount of money. And within the month of January, you can also offer different challenges. This can be on your social media, where you offer a challenge for your patients to to have different activities related to their skin, whether it’s derma rolling or cupping and gua sha at home, or a product maybe that you’re launching.

You could offer a flash sale during the month that only happen during certain times, like if it’s snowing or if the temperature goes below a certain temperature. So this is another way that you can. Set your marketing and come up with different marketing ideas. You can also do it by days of the week.

Motivational Monday, Therapeutic Thursday, Feedback Friday. For example, on Therapeutic Thursday, you would have a discount or a promotion or something related to a specific topic. service that you offer. Maybe it’s red light therapy and Feedback Friday. You can invite people to provide feedback on, the experiences that they’ve had and people love to write and comment.

This also boosts your rankings on social media because the more traffic there is in your website or on your social media, the higher you’re going to rank. And it will also give you an opportunity to gather up testimonials. Something else that is wonderful for your to promote, help to promote your business, to drive people to your website and learn more about you and your practice is to develop a QR code.

And this is actually, Very easy. If your phone is near you right now, you can pick up your phone and scan that QR code and see where it brings you. But a QR code can easily be generated for free if you have Canva. You within Canva there is a QR code generator and Adobe also has a QR code generator.

And then there are a lot of programs and apps that will generate QR codes and you can even, at the bottom, You can even have a, like a little title, the name of your business, so people know when they’re scanning what they’re scanning.

As far as your social media I strongly recommend that you have a presence everywhere. I know a lot of my students say they left Facebook during the pandemic or they just got tired of being on Facebook. However, a lot of your customers, your patients are going to be 45 to 65 and they are on Facebook.

So if you don’t have a presence on Facebook for your business, you really should. And when you design your social media, you don’t want it to always be. the same thing. So it’s good to rotate between something a little more personal because people will like and follow people that they like. So if you make them laugh if they resonate with your message, then they are going, if you’re genuine and authentic people.

are really looking to connect with people that they can relate to on their social media. And so you can have something personal, not too personal. I strongly discourage my students, anyone from complaining on social media. Way back when Facebook was first created if you remember, there was only a like.

So it was really about making people happy. And if you’re complaining, no one, people have enough problems. They don’t want your problems. Keep it personal, not too personal. Educational, teach people something in a short bite within 15 seconds. 30 seconds max. Entertaining is great if you can make people laugh or if you have a skill or a talent and you want to show it to them.

Again, this goes into the personal. Something sales related. It’s okay to promote something that you’re doing. And This is a great place for your before and afters, your testimonials. Always have the closed captions because most people don’t have their sound on their phone when they’re scrolling on their social media.

And then everything that you post on social media has got to link back to your website. Because otherwise people will look at it. They don’t know how to find you. And I actually don’t have my social media on here, but you can find me at facialacupunctureclasses. com. So let’s talk about Instagram and this lecture is part of a much bigger lecture that I do in my masterclass on on marketing and I have my students do exercises and we really go into depth.

We do a deep dive on all of these, but like we’re just going to get some really good ideas now. So for Instagram, you, there is no way for someone to click on a link directly through your Instagram posts. So with Instagram, you have to open up. Linktree account. And in your Linktree account is where you can put links to your websites, your products, anywhere you want to direct your patients.

And that goes up in your bio. And then with your, in your post, you say, go to the link in my bio, and they can click on that. And that will take them to where you want them to go. Stories tend to be seen a lot more than posts, which are just stagnant pictures or reels, because someone has to actually go on to your profile to see that reel, whereas stories get shown.

So I always encourage to, if you’re making a reel, you can also redo it as a story. So having them in both places and having the stories more often. We don’t have time to get into how to make a reel, but reels are a great way to do something that’s a little longer than a story and to really present your message.

Facebook. I like Facebook because in Facebook you can have a conversation. So you can have videos, you can make reels reels. And you can also have direct links to your website, but you can really have conversations with people for better or for worse in Facebook. And it’s a lot more participatory.

There’s a lot of different ways to do you can have a poll where you ask people questions and you can have your personal Facebook and your business Facebook. And for my facial acupuncture classes, I have a group. With over I think we’re at 8, 000 acupuncturists in my Facebook group and it’s called Facial Acupuncture.

And people can ask questions and the nice thing about groups is whenever someone posts something in a group, everyone in the group is going to see it. Whereas posts, you have, they have to be light in order for people to see them. Whenever you’re doing Facebook posts, always have links to your website in there.

TikTok is a little different. You might not think about TikTok for your social media, but a lot of people are using it now. And you just make short, little, videos, you can show something that you’re doing or even something that you have on special. But again, if you make one video, then you can take that same video and show it on your YouTube channel, on your Facebook, on your LinkedIn.

You could just show it across all of your platforms. And the nice thing about TikTok is. It has a huge repertoire of music and the editing is really good within TikTok. And you can also do these things called duets. So you can find like an expert in our field and if they’re doing something like, let’s say I was.

presenting a technique and I allowed for duets in my TikTok video, you could put that up and you don’t even have to make the video. You could just be sitting there pointing to it or commenting on it and you have instant content.

Testimonials you have to check with your the state or area where you’re practicing, not All places allow testimonials. I know they don’t allow them in Canada. But if you’re practicing in a place where you allow them, they are great to have on your website. They’re great to have in your social media and in your waiting room.

If you have a book of articles and information for people to look at. And sometimes people just want to take a break from their phone when they’re sitting and they’re waiting to see you. And if you have a book with letters from patients and testimonials, some before and after pictures, this is wonderful.

But just make certain you have permission and you want to keep the testimonial very specific. What exactly was it that did that person like about the treatment? Did their eyebrows become more raised or their crow’s feet became reduced? If you can get your patients to speak to that, and especially if you have a picture, then that is wonderful.

When you’re taking before and after pictures I always take before pictures. I don’t always remember to take the afters, but it’s great if you can get them. But the important thing, because there’s so much photoshopping going on now, they’re not as credible as they were 20 years ago, but When you’re taking your before and afters, you have to make sure that they’re in a HIPAA compliant app and that the lighting is the same for the before and the after.

So if you’re Treatment spaces, windows, close the curtains. And you have to make sure you’re at the same distance and angle. I always have my patient sit on my treatment table, and if they’re taller, I will raise the camera up so that It’s always at that same angle. And the last thing I’m going to talk about today are programs.

And again, this is a state by state thing. Not every place allows you to sell a program or a package is probably the more common term. But what You can do in many places, you can set up like this is my standard program. With the standard program for this much money you get 12 treatments and Dermaroller for self care.

And then for the silver treatment you get everything in the standard treatment Plus, you get products to use with the roller. And then, you can go a step further, and then the gold treatment. This is everything in the silver, plus red light, etc., etc. And then, You would say to your patient which program interests you, and you can even have a little arrow.

This is our most popular program. And people like to be given choices, not too many choices. And they’re going to choose whichever is in their budget and whichever kind of resonates with them. That is the end of Part 1. And next time in part two of Marketing Your Facial Acupuncture Practice, we are going to talk about direct mailing either through email or through actual mail, and blog posts, community engagement, workshops, and collaborations.

So I look forward to seeing you in part two and thank you for coming today.

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Acupuncture Malpractice Insurance – Lumbar Pain: Supplementing Acupuncture with Therapeutic Exercise

Today I would like to show a side bending exercise I give with patients frequently in the context of treatment of low back pain, especially when the facet joints and the QL is involved.

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Hi, this is Brian Lau. I’m with Jingjin Movement Training, also an instructor with Sports Medicine Acupuncture Certification Program. So thanks to American Acupuncture Council. I always appreciate doing these webinars. A lot of fun to get together and share some information with you. Today we’re going to be referring back to the last presentation I did.

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We talked about the internal pattern, talked about the Zhui Yin and Xiao Yang channels in general. We looked at it in relationship to rotation. We even looked at a rotation exercise. Today I would like to show a side bending exercise I give with patients frequently in the context of treatment of low back pain, especially when the facet joints and the QL is involved.

It’s a great exercise, great to add to your repertoire when treating patients. It’s actually a great exercise to do for your own health. You get a twofer, you get something you can practice for yourself if you don’t have a good side bending exercise, but then something you can use to, to, as part of the treatment.

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So it’s an exercise that patients can do at home, yes, but as much as anything, I use some equipment for this. is it’s an exercise that I do after treatment to supplement the treatment to help open the tissue that I worked on with acupuncture manual therapy. So let’s go to the presentation.

We’ll start going over some some introductory information, a little bit of anatomy, and then we’ll look at the movement. Let’s talk about the quadratus lumborum, not the only muscle in the low back that causes low back pain by any means, but it’ll be a little bit of the star of the show for today.

And this exercise can work for a lot of different things, but when the QL is involved, it’s a really great exercise specifically for QL. Type pain. So this is the trigger point referral pattern of the quadratus lumborum. You can see some of the trigger point referrals can be out to the gallbladder channel, along the side, even to the greater trochanter.

They can wrap around to the liver channel. Sometimes the deeper fibers can go towards the SI joint or glute area. But by and large, it’s gallbladder and liver distribution. Now it’s interesting to me because I see, and we’ll look at a brief picture in a moment with the anatomy, I see that the liver, I somborum is part of the liver sinew channel which is a little higher up than the channel is classically described.

We’ll talk about that briefly. But interestingly also is liver V as a distal point, I do treat it locally local treatment is extremely important when you’re working with low back pain when the QL is involved. But as a distal point, liver V, the low connecting point, is a very useful point that becomes very reactive with QL pain.

And it’s interesting that this low connecting point treats this muscle that has a referral both to its its Xiao Yang partner, the gallbladder channel refers to the gallbladder channel, but it also refers to the liver channel. So its referral seems to be between those two those two related channels and the low connecting point would make sense that it would become reactive in that case.

So let’s look briefly at the QL anatomy. This is from Matt Callison’s Motor Point Index. He also has it in his Sports Medicine Acupuncture text. A great book if you don’t have it. This shows the iliac crest attachment, the 12th rib attachment, but also fibers that are going to transverse processes.

It’s a very complex muscle, multi layers. There’s actually three layers of the quadratus lumborum. We did a class on this that’s available on Net of Knowledge, and we talked about all these layers and different fascicles. It’s an interesting muscle. to spend a little more time on that we don’t have time today, but just to highlight that it does have attachments on those transverse processes and the 12th rib and the iliac crest.

It communicates with the multifidi muscles that also attach to the transverse processes and those muscles then go to the spinous processes. So this exercise we’ll be looking at would work those muscles too, but what really I want to highlight in this image in addition to the QL is the facet joints.

We’ll come back and talk about those in a second, but you can see them really well on this illustration. This is where the main movement happens from vertebra to vertebra. Facet joints are also called zygopaphyseal joints and these can be pain generators themselves. When there’s pain associated with a QL, multifidi, and or, and it’s often a and the facet joints this will be a really good exercise to complement it.

So the facet joints of the spine have a coupled relationship between side bending and rotation meaning that they both they, when they do one or the other, they do both. So when you’re side bending, there’s also a rotation component when you’re rotating the individual vertebrae can side bend.

And in particular, the lumbar region has limited rotation just by design. The facet orientation has limited rotation. So we’re going to be doing side bending to really exercise and move those facet joints. So if there is facet joint pain, moving the facets will help open that tissue up and help desensitize that tissue.

But when you’re moving the facets and sidebending, you’re also stretching and contracting, depending on which side you’re sidebending to. Stretching and contracting the quadratus lumborum, and you’re somewhat activating the multifidi also. So nice to know that these coupled relationships exist because really a good comprehensive program will include both sidebending and rotation.

We’re going to look at sidebending today. Here’s the liver sinew channel, so classically it ends at the groin, following up the adductors, adductor longus, pectineus, adductor brevis, gracilis, adductor magnus in my mind is part of the liver sinew channel, it’s more posterior, has a different fascial plane that it lives in, but we’re going to be looking more at those anterior adductors.

I also have in the list the lower portions of the channel, including the flexor digitorum longus, which is what you’d be needling into if you need a liver 5. So that would be affecting that fascial plane. And classically that ends at the groin, but if you follow that fascial plane up, it goes into the psoas, the iliacus, and the QL, all part of that plane, even though we access the QL from the back, it’s much more of a central muscle.

It’s on the fascial plane of the adductors. That would follow really all the way up to the diaphragm. So you can take that channel, in my opinion, up to the diaphragm. But QL is a big player in that and common cause of low back pain. So it’s important to understand these pathways. So liver organ itself has a particular movement that’s going to play into this.

So we looked at rotation at the last webinar I did with the American Acupuncture Council. So in the transverse plane, there’s a rotational movement of the liver in relationship to the diaphragm and the organs around it, like the stomach in particular, kidneys too. There’s a movement in the sagittal plane where it’s tilting forward, tilting back.

Those are going to be exercised much more with rotational type exercises. I want to look at this frontal plane movement. So the frontal plane movement, the liver moves in relationship to the left ligament that holds it up to the diaphragm. And as you side bend to the left and that liver flares up, you want it to be able to move in relationship to the tissues around it, like the transverse colon, the stomach, et cetera.

Then it can also rotate down so it can have a movement in that frontal plane that we’re going to be really highlighting in the rotation exercise. So you’re going to be stretching and contracting the QL, you’re going to be mobilizing liver, you’re going to be opening and closing the facet joints.

It’s important to do sidebending activities because they are underutilized and they’re extremely important for low back health and liver health. Alright, real brief, I’m not going to go into a lot of needle technique for the QL, it takes a little bit more time than I have here today, but I just wanted to highlight a couple directions that you could look at if you’ve had some training with the liver I mean with the liver sinew channel with the QL.

I can needle through this fibrous part of the thoracolumbar fascia where all the abdominal muscles meet, at least all their fascial compartments meet. And then it separates into fascial compartments that wrap around various aspects around the erector spinae and between QL. This is called the lateral raffae.

It’s the lateral seam of the abdominal muscles before they separate into various layers of the thoracolumbar fascia. So I can angle a needle into that. Sometimes that tissue is pretty reactive in and of itself. And that’s my target tissue. Or I could go through that and touch the QL. If I’m trying to needle the QL, I usually just go straight lateral, parallel with the table of the person was lying prone.

If they’re lying sideline, it would go straight towards the table, perpendicular to the table. So there’s some instructions here. If you go back and watch this, you can freeze here and look at those. I, again, this isn’t an instructional webinar on needling that. I just want to give some highlights real quickly here.

I’m palpating into that lateral raffae. So you can see I have about a 30 degree angle or so towards the table. So I’m at the edge of the iliocastalis lumborum advancing the needle into that lateral raffae. Maybe I touch the iliocastalis lumborum. Maybe I touched the quadratus lumborum. Maybe I’m in that fascial seam, which is my target.

And I think what happens is when I hit that fascial seam and engage that, it’s gonna pull on whatever structures it needs to. But it’s just a very reactive place and I needle the lateral raphe quite frequently based on palpation. If my goal is to needle the QL, I’m going to go more parallel to the table, directly cross fiber to the QL or needle it sideline.

I’ll have the leg extended to help depress the ileum on that side and then go straight down towards the table. This is my preferred way of needling the QL if I want to cross fiber the QL, but I might do it prone if I want to combine it with other points, for instance. All right I have some of these types of exercises, including this exercise, but I want to redo the video.

I have it on my YouTube channel, JingJin Movement Training, there’s a QR code there. I haven’t put short samples of those on my Instagram page too, so you can follow that if you’re interested in more information. But I want to now go and show some instruction for this particular exercise that you can use in your treatments.

So I’m going to exit out, and I’m going to back up, so give me just a moment.

Alright, so let’s initially, minimize something, sorry. Let’s talk about equipment first of all. So I’m going to show you two things that I use for this. This is a product called, from a company called StickMobility. StickMobility. StickMobility. com So I like the, I really think this is a solid product. I have them.

I, it comes in a set of two of these. This is a six foot one. I’m not super tall. If you’re taller, I’d get the seven foot one. So I’m about five eight. This one’s going to work for the exercise I’m going to show you quite well. But if you’re six foot tall or something like that, I would go ahead and get the seven foot tall one.

It marks them pretty well on the webpage. So it comes with two of these and it comes with a shorter one. I will say they’re a little pricey. So if you’re not going to use them a lot, I paid 180 for them. That was before greenflation or whatever we want to call it. So they’re probably, I haven’t, I meant to check before the webinar.

They’re probably 200 or 220 or something like that. Now it’s worth it. If you’re going to use them a lot, they’re very solid. They’re not going to break on you. For this particular exercise though especially if you’re going to give it to patients, I think it works just fine with PVC pipe. So with this PVC pipe, I put a little chair stand, whatever these are called that goes on the ends of the legs of the chair.

So I put those on the end because I wanted to be able to grip the floor so that this works out pretty well. These are just little rubber stoppers but the PVC pipe’s pretty strong. So this would be, I don’t know, 10, 15 or something like that. It takes you a little time. You have to go get it and find the appropriate stoppers for it, but it works out just fine.

So I’m going to use the stick mobility one since I have it, but this would be perfectly fine. I’ve never had a problem. PVC pipe’s pretty strong. I’ve never had a problem with that breaking. But I guess that is a consideration if you have a professional product, maybe from a liability standpoint. So maybe in your own office it’s worth having these, but if you’re going to give it to patients and they’re not willing to buy something that’s 200 and they’re only going to do this one exercise, I think the BBC pipe would be a really adequate way of doing it.

But you can also just give this in your office as a complement to the treatment, even if they don’t do it at home, at least they’re engaging that tissue that you just addressed with the acupuncture. So let’s get this set up. I want this to be somewhere about a foot away from my side of my foot. I don’t know, maybe with the metatarsals, doesn’t really matter.

It’s somewhere along the side of the foot, about a foot away. This exercise is easier the farther I move it away. But you’ll see as I go into side bending, if I have it too far away, it’s going to slip. So I need to have it close enough to where it grips. So that’s going to be a little bit of a challenge.

If it’s too hard, you need to move it away. But if you move it away too far, it’s not going to work so well. So about a foot is a good happy medium. So I’m going to put the Stick down. I’m gonna get my arm about at a 90 degree angle at the elbow. I’m gonna reach up, palm facing forward. So if I open my palm up, it’s facing forward.

Grab around. This is where if I was too tall, I’m gonna be like this. I’m not gonna be able to get my head under when I go to do side bending. So it needs to be high enough up to where I’m comfortable. Okay, so I want my chest to turn slightly Towards the bar, and what I’m going to do is I’m going to push out with the lower arm.

I’m going to let the top arm straighten, and I’m going to turn my chest forward. So that’s the position. I need to turn. So I’m pulling with the top arm, but I’m not pulling with the elbow. I’m pulling with the shoulder blade. And then I’m pushing out and extending out. So you can see it gives a really nice stretch all the way through the spine.

For Especially the lumbar spine, very complimentary for working with facet type pain and QL type pain. Come out of it slowly, I can turn my chest back, forward, and relax. So it does take a certain amount of strength for this. This one’s not overly, requires a lot of strength. It’s somewhat also positioning and learning how to use your whole body.

People mostly are trying to use the arms and it’s very difficult for them to push. I’ll show you how I assist them and help them in a second, but part of it is learning how to turn the chest and side bend into the, how to pull with the shoulder girdle without pulling with the arm. That’s going to shorten everything.

I need to pull my scapula back on that side, push the arm out on the bottom one, and then just lean and let it start to bend through the torso. Okay, I’ll show it on the other side and then I’ll show you how I help patients with it. So again, set up about a foot away, arm down, out about hip level, we’ll say about a 90 degree angle thereabouts, maybe slightly lower.

You can adjust it as you go for comfort, palm facing forward. Behind the bar, behind the stick, grab a hold, face my chest towards the bar, or at least in that direction. So I’m rotated in this case to my right, I don’t know if that’s going to show up because sometimes things get a little weird imaged on the webinars, but I’m facing to my right.

This is my right hand at the lower portion, and then I need to turn my chest forward. So I’m turning slightly to the left. Project, pull

the shoulder blade back, my left arm on my top arm, push out with my bottom arm, let everything side bend,

and slowly turn back when I’m ready, and there you go. So how I help. So let’s say I’m back on this side.

Patient can’t really do, first of all, the most often what they’re doing is they’re going to bend the top arm because they’re trying to pull. They need to learn how to let the lats lengthen, let that arm straighten, turn the chest. So it’s a little bit of a difficulty. So imagine I have a patient who’s struggling with this activity here.

I could be on the other side. I usually brace this with my foot and I help them. I’m not just pulling them through it. But I’m giving them some assistance and guiding them, let your top arm straighten, okay there you go, and then I’m helping pull them. Now, once they get into the stretch as far as they can get, I don’t want to just let go when they come out of it.

So I’m pulling, guiding them through it. Their chest is facing forward. Okay, so let’s come out of it. I’m slowly letting up as they turn their chest forward, especially if they have back pain. I don’t want it to be a very jarring activity where they’re in a somewhat compromised position and they just let go.

So I’m helping guide them through it. They don’t have to go as far as I went. Maybe they just go a little bit. Maybe they just get to here. But if I can help pull enough to where Pulls on this top arm, they’re going to start to get that stretch down through the lats, and then also into the QL. Highlight the movement.

I would definitely do it on both sides. So if it’s a lot of pain, maybe they only get this far, but usually this feels good for them. So if it is causing a lot of undue pain, I might come back to it in another treatment, but usually it feels good, feels therapeutic, it feels helpful. It feels like it supplements the treatment.

Same thing. I’d get them set up on this side, chest angled slightly towards the direction of the pole, turn the chest forward, push out, and that same thing. I might be over on this other side, guiding them, giving them some help, making sure they feel stable, guiding their positioning, let that top arm straighten.

Let everything stretch, giving them, coaching them through it, and giving them some guidance, helping them find the maneuver. So using the stick makes it really much more effective. Some people do a side stretch, which is great, nothing wrong with it. Or they might do something with the hands overhead, no problem.

Really nice, You can do a lot of the same types of things. There’s a windmill exercise I do, reaches through nice mobilization. I don’t like this one as much for back pain because of the rotation until they get a little bit more farther along the treatment and they can comfortably go in rotation without causing pain.

So there’s other ways of doing it, but the stick is a really guided way that you can work with patients. You can give them that assistance. You can take them through the process. In a little bit more controlled way. And to be honest, having that arm pulled and stretched from the stick really makes the stretch much more easy to access and takes them into it in a much stronger way.

So it’s a simple bit of equipment, even especially if you just got the PVC pipe. We’d recommend at some point, splurging and getting the stick mobility. I think they’re a really good product, but they are a little pricey. But it’s nice to have maybe the PVC pipe one also in your office so you can show patients and give them some recommendations for what to do in their at their own house when they’re practicing that.

But it, like I said, even just doing it that one time after treatment is part of the treatment. That’s how I view it. So I think you can take that same approach. All right. I think that covers the main information that I wanted to cover for this. Give it a go. Like I said, I have some videos on my YouTube channel, JingJin Movement Training.

I’ll make a point to get a new video up with this from different angles so you can see it and review it. But you can also review it from the webinar. That is on American Acupuncture Council’s Facebook page. It’ll also be on my YouTube channel. And if you wanted to go back and look at the rotation exercise I did, those will be at both of those places also, and it’ll give you a complimentary exercise for rotation that’ll also work.

The internal pathways quite nice. So thanks again for American Acupuncture Council. Look forward to seeing you guys at another time.

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Acupuncture Malpractice Insurance – Improving Vitality: Treating the Liver Channel and Organ

Today, we’re going to be looking a little bit at the liver channel. In particular, we’re going to look at the internal pathway, talk a little bit about some of the anatomy, and we’re going to then look at a therapeutic exercise that’ll help work rotation, liver channel primarily,

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Thanks for tuning in today. I’m Brian Lau. I’m with Jingjin Movement Training. I also teach with Sports Medicine Acupuncture certification program. I want to thank American Acupuncture Council for having me back. Today, we’re going to be looking a little bit at the liver channel. In particular, we’re going to look at the internal pathway, talk a little bit about some of the anatomy, and we’re going to then look at a therapeutic exercise that’ll help work rotation, liver channel primarily, but really all of the Jueyin channels and the Xiaoyang channels.

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That would also include, obviously, gallbladder, Sanjiao, pericardium, and liver, but we’ll highlight the liver channel, that’ll be the focus of the webinar. So let’s go ahead and go to the PowerPoint, and we’ll jump into some anatomy, and then we’ll look at a movement that will work some of this anatomy.

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So this image right here is showing my interpretation of the liver sinew channel. We’ll maybe talk a little bit about the sinews, but I want to go into the next slide, and we’ll go right into the liver channel itself. So many of you are familiar with this image from Dedman’s Manual of Acupuncture, or you’re familiar with other images possibly.

So just to highlight the internal pathway here we have the external pathway, acupuncturists are all very familiar with that, probably familiar with the internal pathway, but the external pathway, we have points. So we have a little better sense of the anatomy. Liver 13 would be actually a motor point, motor innervation for the external obliques.

Liver 14 would also be on the region of the external obliques, more at the attachment site. But let’s look at this little internal pathway. and discuss some of the potential anatomy for that. These internal pathways can be a little bit more vague. So I’m going to go to an image, a couple images actually from Netter’s Atlas of Anatomy, fantastic anatomy atlas.

So in Netter’s Atlas, here we have inside the abdominal cavity. So peritoneum’s removed. What we’re seeing is the liver reflected back. So you can see the little hook here, grabbing the liver, pulling the liver back. And what they’re trying to highlight. What Nutter is highlighting in this image is the lesser omentum between the liver and the stomach.

It’s a ligament that holds the liver to the stomach, allows for a particular amount of movement, but keeps some positioning of those organs intact. So I see that this lesser omentum is part of that internal pathway of the liver. Topography wise, it makes sense. It matches the topography fine, but if you open up in dissection and go inside of that Lesser Omentum, then I think it really gives a clear indication or at least a hint at what Deliver Channel is all about.

And that’s what we’re looking at here. We have the contents of the Lesser Omentum. We have the Hepatic vein, we have the portal vein, and then we also have what I think is really important to understanding the liver pathway and the liver channel itself, is we have a branch of the vagus nerve. In my view, and probably others the liver, Being a general, directing where the blood goes, is really about autonomic nervous system functioning.

Particularly, you could argue that it’s about the parasympathetic rest and digest portion of the autonomic nervous system. Very active at night, the blood returns to the liver at night, it returns to all these vessels inside the liver, these capacitance vessels that holds and stores a whole lot of blood.

Blood moves very slowly through that, they’re more full. At night, when we’re not moving, it’s more under the control of the parasympathetic nervous system. But it’s also really autonomic nervous system regulation, telling the body to give blood to the digestive organs, or do I want to give blood to the skeletal muscles because I’m out playing football or doing martial arts or something like that?

It’s where am I in my phase of activity? So it’s really about regulation between those. Now, we think of the liver oftentimes from pathology, which is more sympathetic overload, but in its health and most obvious function, it’s really more about that rest and digest, the most yin, the quietest portion of the nervous system.

And lo and behold, inside this lesser omentum, we have the branch of the vagus nerve. I would posit that this gives us a hint that internal pathway is following the vagus nerve or has something to do with the vagus nerve. I’m not saying it’s necessarily the entirety of the pathway, but it has something to do with that pathway.

So we’re going to look at a movement in a little bit, and I want to be able to move this region, or at least over time of practice of this movement. I want that to move the liver. and move the liver in relationship to the stomach to be able to exercise the contents in the lesser omentum. So just a real brief summary of movement of the liver.

The liver itself has movement in context of these ligamentous structures like the lesser omentum, in context with the diaphragm, of course, also. So the liver moves in the frontal plane. It moves up and down, follow, I’m gonna turn it over to Jim to talk about the the BAPT program.

The original BAPT program was designed in response to the COVID 19 pandemic to provide a way for the medical population to provide the needs of their bystanders to provide the necessary medical care. back and forth. We’ll look at that when I’m standing in a bit. And then it kind of moves in the sagittal plane, a tucking under type motion and a tilting motion.

So those are the motions we’re going to be really highlighting in this rotation exercise. So if you’re doing rotation and you’re letting that rotation wind through the body, it’s going to start to mobilize the liver, mobilize structures like the lesser momentum, and it’ll really complement Both for your own health, but if you’re treating patients and giving them exercises, it’ll really complement any treatments you’re doing for the liver channel, whether it’s musculoskeletal or internal type work, it’s good to have them be able to exercise these internal portions of the channels.

All right. So when we’re doing these rotations, like I mentioned, it’s sometimes you have movements that work a channel, but by and large, functional movements. We’re looking at networks, and when we’re looking at side bending and rotation, we’re looking at the Zhui Yin, Xiao Yang network. So all of these channels have something to do with rotation, and if that rotation is going through the pelvis, through the spine, through the shoulder girdle then we’re having both the arm channels and the leg channels of these Zhui Yin and Xiao Yang channels exercised.

So it’s really more of a functional network that we’re going to be exercising, but I’m highlighting the internal pathway of the liver channel. So just a couple images here, all of these are showing some aspect of either rotation or side bending with the exception of the middle image, which is really more about extension.

I put this one in here for a particular reason, because even when we’re doing activities like Tai Chi, like this is showing push hands or Tai Chi movement we’re stabilizing the lateral side of the body and the medial sides of the body. So to be able to have this nice posture and express the strength that would come from engaging the back and pushing forward we need to be stable, as the weight drops into the front leg, we don’t want that front, in this case, the left hip to rock up, or we don’t want the other hip to rock down.

We want to have a certain amount of stability from side to side. So this one is using the stabilizers and it is using this Joanne Xiaoyang Network. But to do it, it’s not an active movement that you see like you do in this gymnastics ring movement where you can see an obvious side bending or any of these rotational type movements.

So that’s why I put that one in there, but all of them feature some aspect of rotation or side bending, all featuring that Zhui Yin Shao Yong network. So we’re going to be looking at some pelvic movement, so using the liver channel, at least the sinews, pectineus would be one of those muscles, using the Shao Yong channels, piriformis and the lateral hip rotators.

To create and guide rotation of the pelvis, we’re going to be using the external obliques on the liver channel to help with torso rotation. Internal pathway of the, or at least internal portions of the liver sinew channel, QL, and the psoas will be active. Pericardium channel creates a sling around the body, that’s going to be active.

So really gallbladder channel is going to be active. We’re using those channels primarily, but I want to come back to that idea of exercising the internal pathway to complement treatments or to complement and help our own health. So this is showing some of the complex movements that happen between the two sides of the innominate bone, the pelvic bones.

Those also, when you’re walking, they’re going through a rotational type movement. And this is from a study that kind of highlighted those movements. We don’t need to get in the weeds with that. That’s very complex. That could be its own 20 minutes. Might not even be enough time, but its own its own webinar.

But just to highlight that when we’re doing types of movements like walking or turning, that there’s a discrepancy from side to side as one side does something, the other side does something different, we’ll look at that when I’m standing. All right, and that’s an image highlighting some of the, not just the pelvic movement, but how what happens in the pelvis relates to what happens in the ribcage.

So you can see in this boy running, the pelvis has a rotational and twisting type motion. The rib cage in this case has an opposing opposite action. So what’s happening on the right side of the pelvis is mirrored on the left side of the rib cage, but sometimes you can do rotation and have it mirrored on the same side.

The important thing to highlight is that lower rib cage and where the liver is, where the diaphragm is going to relate. It’s going to respond to what’s happening in the pelvis. So when we’re doing this rotation exercise. I want to look at how that winds from the pelvis up into the lower rib cage out into the shoulder girdle.

If you want to learn more about this, you can check out my YouTube channel. I have a lot of movement from a channel perspective movement exercises on there, Tai Chi, Qi Gong, some other types of calisthenic exercises, all from the lens of the channel perspectives, looking at it from the channel movements.

It’s called Jing Jin Movement Training. You can also check out my Instagram page. There’s a link or at least a QR code for each of those. All right, so I’m going to step back and we’re going to start looking at some of the exercises now. So I’ll get a little more back so you can see me more fully.

Let me just get something else out of the way. All right, so this is one exercise that I use a lot for myself. I give to patients also. It’s going to highlight that rotation in the pelvic girdle. It’s going to highlight that rotation In the lower rib cage, it’s going to highlight that rotation in the shoulder girdle, almost like a towel that’s being wrung out.

I want to have a wringing type motion that works throughout the whole body, so I can exercise that entire channel. I want to start with my stance about shoulder width. Maybe almost pelvis would be a really, a good marker. Maybe the outside of my pelvis could almost fit to the inside of my feet. So about a pelvic width stance would be good.

You can make it a little narrower, you can make it a little wider, but somewhere, I don’t want it to be super wide in this particular exercise. So somewhere about pelvis width, right? So I’m going to start with just a pelvis, so you can highlight that. I’m going to put my hands on my ASIS. This is not the motion, I just want to set the stage for it.

And I want to turn. Just to about 45, turn. As I turn, the pelvis is going to pull on the thighs, so there might be a little rotation, but I don’t want to lose form in my thighs. I don’t want my knees to cave in. I want to keep a certain amount of architecture in the knees. It’s okay if the legs move, it’s okay if the knees move a little bit, but I want to keep somewhat of an openness between the two knees.

I’m just turning, almost as if I’m a playing card at this point. So my ASIS facing 45, my shoulders are facing 45. So I’m not really moving yet in the torso, I’m just moving the pelvis. So even from the get go, there’s a little bit of movement in the pelvis. One side pulls back into a posterior tilt. One side moves into an anterior tilt.

You don’t have to do that. Should just happen once the pelvis loosens up. If you’re working with patients, sometimes they’re stiff and that has to take some time to manifest. But if they’re just getting a genital turn, they’re starting to exercise that movement from side to side, that contralateral movement of the pelvis.

All right, next phase, once I turn 45, I want to continue to turn, pulling through with the rib cage. So pelvis goes, Ribcage continues, as if I’m bringing my chest towards the side wall. Okay, so now let’s look at the full movement with that in mind. One arm up, one hand down, turn,

open the chest. So this hand pulls back to the tailbone.

Relax the torso, turn, open the chest. Relax the torso, turn, open the chest. Real briefly, I’m going to turn to the side so you can see from a different angle. So as I turn This hand, I want to let it pull back, turn my chest. So my chest is almost facing forward now. That’s going to depend on flexibility. I don’t want to torque myself past where I can comfortably move, but that’s the idea is I want to turn past where my pelvis can turn, open the chest, shoulder girdle moves,

soft, gentle. It’s not a real big deal with this exercise, but it can be very useful to do on a regular basis.

Okay. So facing forward again. I want to highlight a couple more things, and then maybe show it, and then I think we’ll be good. So as I turn, opening the chest, it’s as if somebody’s reaching through, pulling, So I want to turn fully to where this area moves. When I come to the other side, turn, move. So I want that whole lower ribcage to pull through so somebody’s reaching through.

See if you can see that as I’m doing the motion.

Might help with it is it might seem like there’s a little bit of a stand up at the end. Chest is bowed and soft. As I turn through, I get taller. Turn, move. Get taller, turn, get taller. So that getting taller is where you start working the lower rib cage and start working the internal pathway of the liver channel.

So that’s it. It’s a simple exercise. I want to get a full turn, but I don’t want to tense my body up and make a big to do with it. I’m just turning the hips, turning and opening the chest. That’s going to help my shoulder girdle open and just the gentle Once I get comfortable with it, then I can speed it up a little bit if I want to go faster.

But I would start small and start slow and get the pathway. Down, get the feeling down before trying to add speed.

I will get a video up on my channel for this. I might go from different angles, you can see it a little bit more. But I think from just that, it’s something to get started with. This is an easy exercise, easy for patients to do. It’s a little bit of coordination with it. It can take a little practice for people a little guidance.

You just want to watch them and see that they’re doing it in a very balanced way. But it offers a lot without too much difficulty, so I think it’s very applicable for a lot of people. You can do it seated also. Just keep in mind when you’re seated that you wouldn’t have access to as much turning of the pelvis.

So if I, if this area was fixed, I wouldn’t want to pull myself around. I wouldn’t want to pull my shoulder girdle around. You get the movement. I would still want it to be small ribcage turning in relationship to the pelvis so you don’t have as far to go in a chair, but it is applicable, it is something you can modify into a seated position.

It’s a good chance to work the liver channel, and it’s helpful for a lot of musculoskeletal, back pain, that kind of stuff, but really anything that’s involving that channel. Yeah. Thanks to American Acupuncture Council. It’s really enjoyable for me to come out and show some of these exercises, look at the pathways, to get a chance for us to feel movement in those channels.

And maybe we’ll check out side bending next time in the next webinar, and we’ll go over some some applications for patient exercises there for your own therapeutic benefit. So thanks again, and I look forward to seeing you guys next time.

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Acupuncture Malpractice Insurance – Are You Ready to Request A PPO Rate Increase?

So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah…

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Greetings, my friends. This is Sam Collins, the coding and billing expert for acupuncture and for you, but the profession as a whole. Thank you, American Acupuncture Council, for the opportunity. But let’s get into it. What’s going on, particularly for the first of the year? You’re always thinking business, money, pricing, and many of you have joined these HMO slash PPO plans and may have been in them for years and are noticing them.

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I’m getting paid the same thing, year after year, and at some point that becomes unsustainable. So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah, I will certainly say I’ve had offices that have had success in getting rate increases for PPOs, but there’s a way to do it that I think will lend to potentially having more success.

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This is no guarantee, but potentially more success in getting a rate increase. So let’s go to the slides. Let’s talk about that. What things do we need to do? To help ourselves request a rate increase and really get one, it comes down to making sure you create really a value opportunity about your office.

I want you to write a letter to them and request specifically an increase, but by writing a unique value proposition that makes your practice stand out. Maybe where you’re located. Okay, it might be an underserved area. Those types of things are helpful, but more than anything, always go by what’s your status within the plan.

Show your value. I’m sure many of you have heard of the company ASH or one similar, and you can rise in status from Tier 1 to Tier 6. Obviously, the higher tier status you have, The more prestige you have in the plan, and that creates more of a value. They want to keep those higher performing providers, and if you are one of those, that certainly makes it much, much better.

You want to also focus in on your utilization. Bear in mind, we do understand these plans raise your tier by not over utilizing care. That doesn’t mean you shouldn’t do the care that’s necessary, but be mindful, they’re not expecting everyone should get 20, 30 visits. They’re expecting, actually, an average of about 8 visits per patient.

And what that means is, you’re going to have some patients that you might see 20 times. They need it. There should be a balance with maybe seeing some of them two times, so that average comes in. Realize, don’t let one patient plan set it up, but the average over time. And if your numbers are lower, you can show that.

You would point out, heck, my average is six, let’s just say. You want to also highlight, what about the number of providers that might be in the region? Some areas are very underserved. Particularly now with the viability of acupuncture, the VA and all these things, they’re looking for providers. And if it’s an underserved area, that’s going to help.

But even if it’s over served, if you will, there’s a lot of providers. Where do you stand out? Your availability, your location, your hours. Your languages you speak. What if you have multiple languages? I would highly recommend if you have multiple languages spoken in the office, it should be brought up.

Do you speak Spanish? Do you speak Tagalog? I mean think of any type of language. It’s gonna be helpful to create access because that’s very important these PPO plans always creating access. Make sure you also point out their value Compared to other existing contracts. Other plans you’re part of, but I would start with Medicare and Workers Comp.

My goodness, even Medicare for two sets? When you look at the Medicare rate, it allows 70. Workers compensation is usually a percentage of that. Usually anywhere from 120 to as much as 200 percent of Medicare. So therefore, you want to start to use that to say, how is it a PPO thinks they’re sustaining when they don’t even meet the value of Medicare?

And Medicare is the low end. ASH is going to pay many acupuncturists 40 to a visit, which is literally one set, even for Medicare. And if there’s two sets for Medicare, you get 70. So it’s probably unsustainable, and it’s not reasonable, really. Because you have to look at inflation and cost of practice.

Don’t be afraid to bring up about your own specific issues in your practice. What does cost more? Certainly, when you first started practicing, your rates have increased. I’m looking at rates of rent now, which are through the roof. Could that be sustained? Look at gas, the cost of phone and internet, all those things are part of a practice and cost.

So you have to make sure that you’re creating all of that with the window to show your value and unique value to that plan of how you’ve helped people. Don’t be afraid to get a few testimonials from patients of how you’ve helped them. Make sure there are ones too that the patients didn’t have something where they needed hundreds of visits to.

But nonetheless, those types of things are going to be helpful because an insurance company has a vested interest. and making their clients Happy. You want to show that’s what your job is and what you have done. So here’s a way to focus that. This would be the highlights of how to put together some type of proposition or letter to the carrier.

And you can point out, I’ve been a panel provider since say 2015. For some of you, it might even be longer. I support the development of managed care in acupuncture because it helps to standardize documentation, promote evidence based care, and create greater accessibility. We want people to have access to get acupuncture.

We do. But we’ve got to make sure in doing so, we have to have a reasonable amount that’s paid to us to sustain it. You’ll highlight to them there’s been no significant change in reimbursement from your plan, and I’ve been a member for decades maybe. These days, I’ve increased costs. Staff salaries, rent.

Think of the work we have to do now with electronic health records, electronic billing. All the costs that are there. A lot of these plans require you to bill electronically. That doesn’t happen for free. Therefore, that’s got to be brought in. Software contracts and so forth. Not to mention your rent and the other things that go with maintaining your practice.

And frankly, the cost of other things. Cost of gowns. Cost of needles. It’s all increased. You’ll highlight to them, my overhead is nearly four times of what it was when I enrolled with you. My average cost of seeing the patient now is 41 a visit before there’s even a profit. So some of these plans are paying as little as 40.

So you got to think, wait a minute, if my cost is 41 and I’m getting 40, does this make any sense? No. Can you imagine every business just exactly makes what their actual costs are? You can’t stay open. There’s just no way. So this level of reimbursement is not a sustainable model, and while being on the plan to create a greater volume of patients, there’s still a limitation.

Let’s face it, an acupuncture visit is typically 30 to 45 minutes. How in the world can you sustain a practice where you’re getting paid? Less than 80 for an entire hour of work, maybe an hour and a half, and then going to be able to maintain that practice to be open. Think of just what you’re paying per square foot.

In some ways, I would argue we might be better off working at Starbucks or Panda Express, considering some of those places pay 40, 000 to 80, 000 a year. For a full time worker. Come on, as a healthcare professional, they can’t have rates that are at least sustained at that level. So you want to start to point out that hypocrisy by pointing out the rates for your insurance have increased to allow the plan to remain solvent.

I get that. Has insurance companies increased the rates to their insurance every year? I know and I redo my insurance every September. There’s been an increase every year I’ve been in there. However, are providers part of this increase? Isn’t it interesting how insurance companies typically say we’ve had to increase the rates because of the increase in cost.

And I agree, there’s an increase in cost. Where isn’t there an increase in cost? What provider is still getting the same, paid the same amount they have for years? So in reality, the provider costs are flat. Yet, they get all these raises to do what? Now maybe that’s to cover drug costs and all that, but at the end of the day How could they say we’re part of an increased rate when they’ve not paid us any more money?

They’re thinking you just can see more people. How could we see more people if it takes that much time? So it’s unreasonable for providers to bear this cost with no consideration, while the plan has increased their premiums and the adjustments in pay to their workers. If you work for these plans, I bet many of them, if not everyone, get some type of adjustment yearly, 2 to 3 percent.

I’m looking at least for that. I would think if you haven’t had one in a while, what about a 10 or 20 percent jump for this year? Because to sustain it in this way at some point just cannot be sustained. In my observation, healthcare services are the cornerstone of this business and have been left out.

I’m requesting if you’re getting per diem or even if it’s per service, a certain request over that, which will allow me to continue to welcome these patients to my office in the future. Because without an increase, I will no longer be able to sustain the relationship. Let’s be reasonable. It just won’t.

In fact, I’ve had a lot of offices that realized that it was a sum negative and they’ve dropped out. And this is someone I spoke to last week. This is not an exaggeration. They pointed out that they dropped out of one of these plans and they first were very panicked because they thought, Oh my God. And they go, Oh my God, Sam.

In the first two months, they lost 30 percent of the patients. But here’s what they realized. They lost 30 percent of the patients, but that only equals 6 percent of the revenue. What does that tell you about this plan? How bad it is? All this work and emphasis. Maybe it’s not worth it. And this is something that you have to start to look at as a business decision.

There’s nothing wrong with being part of these plans if they’re at a sustainable rate. But if they’re not, maybe it is time to move on. And this is what we look at. If they can’t sustain it, then let’s move elsewhere. Don’t be afraid to make a move. Don’t be afraid to request. Because at the end of the day, the power is with the providers if we wield it.

And don’t be afraid that ultimate power is your patient. And if that patient is still coming in without the plan and paying a fair rate, why would I push for this thing where I’m getting paid 25, 30? So do be careful, but I’m not saying not to request, not to do it, but at least this way you’ll know where you stand.

And if they’re treating you that poorly, maybe it’s time to move on. Don’t be afraid to break a relationship that relationship does not have mutual parts that are beneficial to both sides. And that rate increase to us, I think is important and without it, maybe we can’t stay there. So don’t be afraid.

I wish you well, as always, the American Acupuncturist and myself are always there to help our service. The network is a place where you can go and work with me one on one to really write up a protocol like this. I really wish you all well, continue a good practice and enjoy what you do.