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3 Key Ways to Drive Patients to your Practice in the New Normal

 

Thank you once again, to the American Acupuncture Council for having me host, the Look to the Point series.

Now my name’s Lorne Brown and I’m a doctor of traditional Chinese medicine in Vancouver, British Columbia, Canada. And I’m also a CPA and that’s how come, I guess I get to wear two hats and, um, be your practice management, uh, support.

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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.

I’ve written a book missing the point why acupuncturists fail and what they need to know to succeed. And, um, today I have, I’m very fortunate today because rather than you get to listen to me, you get to listen to somebody who’s really a force in the field of success. Her name is Tanya Chernova. She is an international speaker. Um, she is the author of undermine an excellent book. I’m removing those subconscious limiting beliefs to your success. The world wellness weekend, Canadian ambassador of the UN to their initiative of creating sustainability. And she is a visionary.

She offers coaching workshops, lectures like today, and she helps companies, practitioners, teams break through their limiting beliefs so they can reach their peak, potential great success, not only help healing their own minds and the minds of their teams, but the minds of the planet. And today I have Tanya in very short notice, would you be willing to come on and share this with my colleagues, my group, and she’s put together a presentation today called three ways to grow your practice in the new normal Tanya, welcome to the, to the point series. And I’m really looking forward to hearing what you have to share with my group.

Thanks so much, Lorne. It’s a pleasure to be here and thanks so much for everyone for tuning in this is such an important time in our lives, not just personally, but of course, professionally, and especially the people that are in the wellness industry. All of us in the wellness industry right now have an opportunity to really redefine who we are for others. So this is the time to really grow your business more than ever. Your business is the one that has to thrive. So if you want, I can just get to the point, right, and start the presentation. So I’ve put together a little bit of information for you. Now, normally we could talk about overcoming your limiting beliefs and things like that, but I do believe in being really practical. So my goal is for everyone to take away at least one significant action item that they’re going to put into practice as soon as they get off this call and see the results rather dramatically.

Okay, it’s really important. Kind of like an acupuncture session. I intend that off the tee, once you get off the table or off the zoom call, you’ll get something that’s really practical and important to the lifeblood of your business. Okay. So three ways to grow revenue in the new normal. The first thing I want to do of course is take a deep breath together so that we can harmonize and get into a place where you’re really receptive and not that subconscious place of resisting because you think, Oh, I just want to do the treatment and not worry about the business, but the business allows you to, it’s really the stage that you perform on. So let’s take a nice deep breath in through your nose and like hello to vibrate your Vegas nerve and release some of that oxytocin. Let’s take another deep breath in through your nose was like, we’re starting summer and there’s no allergies and you’re moving into a fresh field of breath, a great breath of fresh air.

Okay. So now that you’re going to take a deep breath. What I’m going to do is have you continue to do the deep breathing as you cross through the threshold of your comfort zone. Now I, what I love about this time that we’re in and I mean, I don’t have to tell you that with crisis brings opportunity. That’s such a big Maxim that people are talking about right now, but I’ve had the luxury quite frankly, to be in positions of, you know, crisis management consulting. So in 2008, it was my first crisis management, you know, mission that I went to Romania to Russia, to the Ukraine. And L’Oreal actually sent me on that big expedition for their, you know, hair and skin salons out, you know, in the area of beauty and wellness. And what was so dramatic at the time is that we were going through the oil and gas crisis and we saw the wave coming to Eastern Europe.

Who’d already been really thriving in the area of beauty and wellness because that’s such a European based core value. Is that above all else? Health is wealth out there. And what was really important to understand is that that’s when people’s spending and their income just plummeted. And yet still the people that went through my crisis management training out there didn’t only come out, but they came out as market leaders in their industry. And then in 2011, when we had that big real estate crisis in the U S that was so huge. Again, I went out as crisis management consulting all the way through the United States for four straight years, helping them rebuild and reinvent in preparation, not just for what the crisis brought, but for the wave of growth that comes thereafter. And that’s the thing I really want everyone to take away from today.

It’s like, yeah, we are really seeing a change in the way that people are spending. And we’re going to look at that a little bit more, but we have to understand that for every wave that goes through us, there is another aspect of the undertow that can actually take you higher if you can ride it. Okay. So I’m going to show you some ways to do that. Now. I just want to let you know that I’ve been on both ends of the spectrum as a practitioner in the area of wellness, and also having created my own brand of products. There was 11 different products that I created with my mother actually, who is a dermatologist from Russia. She used to create, um, creams that healed gangrene without amputation back then, I mean, she’s just an amazing human being. And, you know, she was the one that really taught me when we were working in the clinic, that it is your absolute obligation and solemn duty to give people what she called home Borg, you know, the things that you’re supposed to do at home once you leave the treatment and the treatment for her was really just the beginning of what was ultimately going to become their better self.

So you’ll look at this thing she’s wrapped in this big face bra and believe it or not, I actually went on the shopping channels around the world. And I grew my business to a million dollars in revenue my very first year. So it’s, it’s important for you to know that I’m, I’m not just speaking literally because I’m passionate about this subject and because I’m so excited for you to grow and succeed and that, because I believe that wellness is the most important thing that we can invest in, but I too have been where you are, and it’s not an easy place when you’re on the inside. And as Lorne mentioned, you know, I’m really passionate about neuroscience and specifically about overcoming self sabotage, having battled it in myself every single day as an entrepreneur. I know exactly what it feels like when you’re just, you know, ladened with procrastination, for the things that you don’t want to do.

And that’s usually because there’s some mindset behind it or a belief that’s driving it. You know, when we look at our business today and what COVID has given us, I mean, I don’t know about you Lorne, but for us, it’s, it’s really a gift. I think for everyone, if you can be in a place where you can receive everything that happens in life as sort of this gift that you unwrap and discover, you know, crisis doesn’t have to break a business, but it does reveal the cracks. That’s really what I’ve learned over all of this crisis management. And, you know, to understand like what those cracks are. It ultimately is in three specific categories that we need to innovate. Okay. And you know, even before I just explained this, I will say one thing. When, when we look back at this whole crisis, doesn’t have to break a business.

And I wanted to show you this, you know, my tank of guppies, I have this tank of guppies that’s here. My son is six years old and we bought this tank of guppies and I had to change the water. And as I started fishing out, all of these guppies, I know this is ridiculous, but, you know, I had to like go from one thing to the other from one tank to the other, cause we were transferring them. And by the morning, two guppies had died. Now, I don’t know if you have children, but that is not a good thing for me. I’m not like mom of the year for killing guppies. And when I looked at this Guppy in small detail, I’m going to tell you honestly, that the most profound quote that I truly live my life on, whether it’s business or personal came straight to the forefront, and I want to share it with you out of all the places I’ve traveled around the world.

And there’s been, you know, humbly over 60 countries where I’ve worked with businesses to help them grow and succeed, as well as these guppies. It’s taught me this, that when Darwin published his work in the origin of species, that it’s his bottom line was this is that in the survival, right? In the survival. It is not the strongest nor the most intelligent that survive, but the ones most adaptive to change. Now, I really want you to take that home because to be honest with you, I’m going to share some things with you. And you’re probably going to be like, Oh yeah, these are great ideas, but you really need to try to embody at least one of them, because I don’t want to see you floating to the top of the tank, like the guppies, right? You people that are on this call right now want to succeed, you’re investing in yourself.

So the least you can do is do the thing that, you know, you need to do, and it will call you forward as I present this information. Okay. So B happy, just keep swimming as Dory says it, right? So the three aspects of business success are mindset. First of all, how do we adapt? So what do we have to adapt inside of the mindset in order for us to grow and succeed? What new skills do we have to embody and what new systems do we need to bring in in order to automate a lot of what is necessary and what’s going to be necessary from us moving forward. Now, one thing I want to share with you is that, you know, we are a human touch business and I’m writing a new book actually now called, um, high touch in a touchless world. So it really examines all of the different businesses that are, that require a high trust, physical touch in a touchless world, because what happens again, if we have this whole people have to, you know, quarantine, et cetera, but not only that people are used to now staying home.

So we have to figure out how to inspire them out of their homes and get back on the table, get back into treatment and get back into life, full living. So it’s really important for us to understand that we can’t just go back to business as usual because the client consumption journey has changed now, just so that I, for sure, don’t forget to give this to you and I’m sure I’ll email it out or post it somewhere. But if you go to Tanya genova.com forward slash COVID-19, I’ve got like a rise and reinvent kit. So it’s for beauty and wellness businesses. And it’s a resource guide that talks about a lot of the tools that you’re going to need, like digital tools and other types of tools in order to make this sort of leap forward. Okay. So this makes things a little bit easier for you.

And I’ll bring this up again at the end. So as we jump into the actual specific points, I want to cover, I’d like you to take a minute and write down and Lorne you to write down a revenue number that you wish to achieve. However, you measure revenue for you and your business, whether it’s per day, per week, per month, per hour, whatever that is. I mean, per month is easier. So I’d like to, I’d like you to write down a, whether it’s top line or bottom line, that’s completely up to you. And even if you could divide it up into new business or new patients and existing patients, okay. New patients and existing patients. Now, if for any reason you ever get to a point where you say, I can’t take on any more patients, because I’m, I’m up to here. That’s when you know, you’re absolutely in a state of flood where you’re like spilling over. And if you don’t actually force the doors to grow, that’s when your business starts to recede and you’re gonna, you know, move into that place. Like they say, you’re not, you’re either growing or kind of shrinking. So we definitely want to continue growing. If you feel like you have no more room for your practice, you can email me and I’ll give you a different set of information, but write down a revenue number that you wish to achieve.

Okay, good circle that number three times. Okay. And then just add a zero to that number. And now you’ll know what I, you know, at least minimum what I want for you. Okay. That’s just like the minimum that I’m challenging you to grow, you know, this year, because you can take advantage of this opportunity now in order to understand where you are coming from. Okay. Where are we coming from when I’m, when I’m looking at someone as a wellness practitioner, as an acupuncturist like you are, first of all, we have to understand that today client spend is, I mean, it has been all of our lives. It’s driven by social values. What do we deem important? And up until now, we deemed important our kids’ education, which we still do. But look at how things have changed. We deemed a lot of, most people will tell you that they will put premium gas in their car, but for some reason, they won’t put premium food on their table.

Right? Most people will tell you that they’re willing to renovate their home, but they’re certainly not willing to renovate their body. Right. It’s up until now. We’ve really taken our health for granted in the North American landscape. Wellness has definitely been on the rise, but where, you know, status at one point was coveted as the most important thing that, you know, status. It’s like, Oh, what’s your job or the car you drive now nobody’s driving. It doesn’t matter. Take Uber. You know what I mean? So now everything’s really changed, but we used to believe that status and status symbols defined our success. Then eventually we moved into a new frame of reference, which was happiness. Like how happy are you? You know, five, seven years ago, an explosion of happiness books went on the market. And even the book that I wrote now, measures success in your JPM or your joy per minute.

But now we’re moving into a new quadrant of status, which is like, what is the definition of what do people envy? What do people look for? What do people say, wow, good for you. I wish I had that. And the number one answer to that is vitality. They are looking at people who are vital. They are vibrant, they are living life. They have the energy to get up, to get out, to cycle, to golf, to whatever it is that they’re doing. And they’re not just having that vitality today. They’re literally banking that vitality into the future and the younger generations, like the, you know, the younger generations now, whether it’s millennials or gen Zed, gen Zed, is even pushing their parents to make better decisions, to take better care of themselves. So now that we even see that vitality is what’s envied, when somebody looks good, like, wow, you are like radiant that I’m telling you, you cannot buy that.

You need to earn that. And that is where we come in. We are the people that are here to help people understand what the journey is for their personal wellness. And one of the things I’ll show you in a minute is something that I talk about called patient leadership or client leadership, depending on what quadrant you’re in. So I just want to talk to you a little bit about what prevents us from moving forward. This is before COVID. Now this isn’t every wellness industry. It doesn’t matter. It’s like, it’s like, we’re born with healer DNA. If you’re a person that wants to go out and help people, sometimes you might fall into this trap or your professionals that work with you. So one of the problems that we have when it comes to helping people make better choices, which means not just seeing them on the table, when they’re reactive to reacting to a pain like, Oh my gosh, my neck hurts.

I need to go see my acupuncturist. I go to see an acupuncturist for my pain too. Right. But it’s like, I wait till I don’t feel well. And then I go to fix it. But in the world of wellness, one of the mind shifts I want you to consider is that we are now moving into a much more proactive society society. And I’m letting you know this. Now. I want you to go out there and look for proof that’s. So I want you to start telling people, people are going to say, so what have you noticed? What have you noticed in your business? I want you to say to them, you know what? I’m noticing that people are taking a much more proactive approach to their health and wellness and they’re coming in well before anything bad happens so that they can align their body and be ready for their best life.

Now, like you need to be the person out there sharing that good news. Okay. So what prevents us from doing that is number one, often professionals in the healing industry, fear being seen as salespeople. It’s like, but I don’t want to sell you anything. You know, come in, you know, what’s good for you. I’ve got all these wonderful things and all these extra things. And if you don’t have extra things to sell them, this is a really important time for you to start thinking about what are the things that you personally rely on to make yourself well every day and what new revenue mix do you need to have on your shelves. But if you fear being seen as a sales person, that is a natural obstacle because you, what sales really is. And Lorne and I talked about this before, is that sales, what’s the active with the act of a purchase, the activist sale and a purchase together is the transfer of trust and enthusiasm.

Yeah. Like the act of I’m buying it, it’s trust and enthusiasm. And you need to know that if they’re already naked on your table, letting needles go into their neck, they trust you. And all you need to do though, is you need to be enthusiastic. But the problem is that whenever you have fear, you just choke right up because it literally just closes your throat. So we were doing that Oxy breathing before, ah, like really relaxing your vocal chords so that you get that oxytocin so that you, it doesn’t even really matter what you’re producing in there. You just have to realize something unless you’re enthusiastic and passionate, don’t wait for them to catch it. It’s gotta be contagious. Right? So spread that. But professionals in our industry often fierce, you know, being seen as salespeople because they don’t want to be untrustworthy, know that everything you’re recommending is for their best interest, not just today, not just to solve a current problem, but so that they can build their body of tomorrow.

And it can house the spirit that will last forever. Okay. So leading the sale is what’s necessary. That’s the next sort of thing. But that’s one of the obstacles we face. Another one is many clinics, especially now offering the same services and brands that are now also sold online, right? With all of these different services available. And it sounds the same, even though you’re very unique and I know you’re unique, the problem is that it, you know, it doesn’t really, people don’t really understand what the actual languages or how to differentiate you. So how to differentiate yourself. That’s a really big obstacle I feel, and that’s easier for you to do because if the first antidote, if the antidote to the first thing was understanding that all sales is, is a transfer of trust and enthusiasm. Once you’ve gained trust, you simply transfer enthusiasm and give them a new value to embody.

Number two is that it’s harder to differentiate your brand and your clinic as a destination. So you need to really dig into what is my wellness philosophy. You know, what is it that I believe in that’s so unique to us as a holistic way of living and offer holistic way of living and a path to vitality and not just services. Okay. And number three, with clinics, offering discounts, that’s, you know, you can’t control it. It becomes harder to attract and retain new patients without falling into that same discount trap. And let’s face it when somebody is in pain in front of you, they’re usually off of work. They’re usually a whole bunch of other stuff is happening at the same time. So it’s definitely very easy to say, look, why don’t you just take everything for free and I’ll help you. And then karma will bless me.

I wish I wish that was abs I’m listen. I’m sure you have a really full karma bank, but really it’s really important that you know, that when a person is struggling, that’s when they need to make that commitment to themselves, quite frankly, and invest the time and the money necessary to make themselves a priority. And if they don’t, their life will continue to speak louder into their life because we know more than anyone, that pain is a messenger. It’s not just a happening. It’s not just an accident. If you’re already connected to the higher source of everything, that’s guiding you in the world. If that’s you then you’ll know that these are, you know, we listen with love to our body’s messages. So it’s really important that we become people who are willing to share that passion and help other people understand and help our patients understand what it really means to listen with love to their body’s messages and prioritize their health now. So what do you think so far, Lorne, do you want to give me a thumbs up? If we’re in a good place,

We’re, we’re in a good place we have about, I think, five minutes, um, before we, we can wrap up and I can chat with you, but I want to reiterate again for everybody listening here is this idea of sales that, you know, you’re not really selling. You’re, you’re transferring trust and enthusiasm. It’s a form of education. And just to remind my colleagues, cause that slide about the fear around looking salesy. Um, this is, you know, you’re not selling them on toxic chemicals, um, things that you don’t have swamp land, you’re selling them, you’re providing them something that’s going to benefit them. There is value there. And now your job is to educate them about the value rather than like you said, premium gas versus premium food is changing the priority. Um, they can have that vitality now. So, uh, I really appreciate what you’re sharing here and please continue on.

Awesome. Thank you so much for sharing that. Okay. So the mindset shift is thinking, okay, I’m not just a service provider, but I’m also a wellness advisor and that’s really necessary because you’re going to start doing more things online as well as on site. And one of the things that, you know, I talk about a lot is embracing client or patient leadership, where you take them by the hand and guide them through, guide them through their path to vitality, to health, wellness, and vitality. So since we’ve got a few minutes left, I’m really excited to say that now that you’re not so worried about sales, I want to give you some psychology behind how sales happens for your consumer, your future patients and your current means. Okay. So there’s three different types of sales that I want you to consider. And then take one thing that you’re going to do away from just this next section.

Okay. So the simplest form of sales is transactional sales. Okay. That’s when your patient or your future, like your basically your future patient knows their need, right? They have a problem. They have a pain, they have poor circulation. They want to get pregnant. They know, they know that they have a need and they’re like, you know what? Acupuncture is where I want to go. The question you have to answer now in terms of your actions is how do you make yourself visible? How do you make yourself accessible? And top of mind, so is your, like how can you make your social media super targeted to the, whatever it is that you are very, very, very good at offering, especially when they know their need. How can you be top of mind? What can you do to be like absolutely there when they need you so that they think of you right away as if it’s like a law of attraction.

And then even if it’s on Instagram or Facebook, the ability to book an appointment, like honestly, the companies right now that have a human being, picking up the phone to say hello, instead of a giant recording, because we’re unlimited staffer COVID um, you will pick up 100% of the patients that hang up the phone on other people. Like you have got to make sure that you are 100% right there when they’re willing to spend the money. The second sale is a little bit longer process. It’s called solution sale. That’s when your patient knows their problem, but they don’t know what they need. Right. They can’t say, Oh, you know what? I love, I need acupuncture. I’ve said that before, because I know what I need. But now somebody might say, Oh, my hips are really sore. My back is really hurting me. My liver I’ve had way too much, you know, wine over the summer break.

I don’t know how to detox. Like they have a problem. Something hurts. Something’s bothering them, but they don’t know that you’re the solution. So now this is all about how well can you articulate the problem that they’re facing? Like, how good are you at saying, you know, are you feeling these pains and aches? You know, and that type of thing, or like that are related to detox. Are you finding yourself with headaches, et cetera. So the more they can go, wow, this person, this professional, this business understands me. And you can share the solution in a very concise way with a clear offer. Then they’ll want to buy it from you. Don’t be mistaking yourself by actually considering helping them consider an offer. But not saying, and from me, it’s like, yeah, you guys, can you take this vitamin? Or you guys can go and do this, or you guys can do it.

No, like from me, you need to take responsibility and get them on the journey and embrace those people yours. Okay. And then consultation of sales. Now that’s the third one. That’s a little bit longer, but this is when your patient doesn’t know their need. They don’t know their problem, but they know their goal. I love these kinds of people there say, you know what? I don’t really know what’s going on with me right now. But what I know is I want to be 65 and you know, touch my toes, climb, Mount Kilimanjaro, whatever the goal is. And that’s why I really always encourage your social media and your marketing and your website to have aspirational photos of people doing great things, because it’s not about just solving a problem. It’s about the aspirational goal of what health gives you. So your ability to uncover this is the key now with your questioning, their most pressing goals.

So it’s not about, where’s your problem. Where’s your pain. It’s about, where’s your goal. At what age do you want to look like, feel like X and let’s put together a treatment plan, a strategy to achieve it, which is why I’m going to recommend that you take at least one half day of your week and start booking consultations or product routine reviews with your patients over Skype or zoom and be goal oriented. Start to transition some of your reactive patients. The ones that have been loyal from reactive. Only when I need to basis into a proactive, I’m going to make a treatment plan. I’m going to prioritize myself because everybody I talked to this year and into the future will say, I want to take better care of myself, but they don’t know where to start. Even that offer to say, let’s get on a zoom call, get your consultation process nailed and have it done.

And the final thing, which you don’t have to necessarily remember, but this is when you’re able to inspire your clients with all of it. Like it’s insight selling. And you have, what’s called an ecosystem, which is what I envisioned for. You. Don’t go, don’t freak out. But normally we have like an onsite visit where they come in and they check in and they go to the treatment. They go to the amenity, they go to the washroom. But I want you to think about the fact that there’s an online journey. So when you think about having a clue, like that’s why it’s, like I said to Lorne, what are they called? They’re called patients, but they’re not going to be patients forever because you’re going to also see them when they’re healthy. So why don’t we give them something else? Why don’t we reinvent the name just a little bit so that we can see that we have a, basically a person that we’re going to take care of from, you know, in a, in an infinite loyalty loop. So from cradle to grave, as we say, right from fertility all the way through, and we really, you know, we really hope that you understand that who you are is so deeply important and that all the work that you do just fuels humanity to be its best because a person who’s in alignment and who’s feeling in harmony with themselves is a person who adds just the most beautiful music to the world. So I want to thank you so much

And yeah, thank you very much. And for those that want to go deeper, um, I have been chatting with Tanya and we’ve had her create a course. So if you want to go and do deeper, um, checkout for her course to release on healthy seminars.com, check out, um, Tonya terranova.com, her website as well for her coaching and speaking, um, her book. And, um, you can also check out, I offer workshops on a regular basis, Lorne brown.com. So lots of resources for you guys. Um, and the take home message here. There’s so many that you shared with us, Tanya, and, and just to remind everybody is there’s a change happening and there’s always change. We can always give it a name, but there’s always something going on in the world that seems, and at a more rapid pace that we’re having these times of uncertainty and the key here is to pivot.

If you want everything to stay the same, then I don’t know. I don’t have great advice for you. It’s kind of like, if you remember blockbusters, we don’t exist anymore. So if you see the environment changing, it does require you to pivot. So there is an opportunity keyword here’s opportunity when things are changing, they may look difficult. We do that deep breath, and then she talked about getting some skills. So there may be things you’re going to add to your repertoire as an acupuncturist that you can do. And there are so many things outside the box that you can do that you can continue to be of service and a value to your community, and therefore you can get paid well to make other people’s lives better for it. And so it can become an enjoyable process. And that was the idea of introducing, introducing new Tanja to the group is to let them know there’s ways to do this.

Um, yes, we’re in change, but guess what? We’re now always in change teams. And it’s our opportunity to pivot, take that deep breath, and this can be a playful, enjoyable process. And it’s really, that’s why I love your book. I’m about changing how you’re going to perceive, interpret what’s happening. And it’s an opportunity. And I see it, many people in our profession are stepping up and doing things for their community and for their colleagues, um, to improve their lives. And so we’re hoping you will step up and do this as well. You the listeners. So I wanted to thank you Tanya again for, for putting this together. And I look forward to your comprehensive course again on healthy seminars.com. If you’re looking for my manifestation workshop, that’s on Lorne brown.com. That’s also where you can access my book, missing the point. Here’s a great book to read. And, um, if you have any last words, I will wrap it up. But do you have any, anything, any last words you want to share with the group?

I mean, I do, first of all, thank you so much for everything that you do and what you’ve contributed to the entire industry. You’re exceptional

And I’m always in awe, the next steps that you’re taking in your life. But I want to share also with everyone, you know what we can call it, change. We can call it disruption. We can call it a lot of things. What it really is, is evolution. This is what the world looks like when it’s working. We are moving forward folks. And the most important thing is to get out of isolation, to get into conversation, to, you know, understand that this is the time where you poke your head out and start listening to all the different tools that are around you, you know, and really think to yourself. What’s the one thing I can do and start with the first small step and then the next small step. And it is like, you mentioned the evolution. It can be uncomfortable. It can be scary. It can be anxiety driven and yet the tools, and then you get to breathe and do these things to make the shifts. All right. I want to thank again, the American Acupuncture Council on for having me host to the point. And I want to remind you to tune in next week because we got your host Virginia drawn back on the AAC to the point. Thank you very much. [].

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Michelle Gellis Thumb

AAC – Treating Cosmetic and Neuromuscular Facial Conditions with Facial Motor Points

Click here to download the transcript.

Click here to download the slides.

Hi, everyone. Welcome this afternoon. I want to thank the American Acupuncture Council for this opportunity to present on treating the face with facial motor points, and I appreciate everyone coming out in the middle of their afternoon or evening or early morning, depending on where you are. If we can go to the slides, little bit about myself, my name’s Michelle Gellis, and I teach cosmetic and neuromuscular facial classes, facial acupuncture classes, internationally. This is a picture of me teaching a class about a year ago in Maryland. What I wanted to talk about today were a couple of things that work with both cosmetic and neuromuscular facial conditions, but before I did that, I did want to talk a little bit about facial acupuncture in general.

When we use the term facial acupuncture, we are talking about a very large topic, so it encompasses anything having to do with a person’s appearance and/or a function of their face so things like wrinkles and sagging skin, and also neuromuscular facial conditions like Bell’s palsy, TMJ, trigeminal neuralgia, stroke, ptosis, and many other facial conditions. Facial acupuncture is actually the largest growing subspecialty in acupuncture right now and so getting trained is something I’m going to talk about in a moment, but it is very important if you are going to specialize.

Facial hair acupuncture can include everything from just needling to using facial cups, gua sha, or doing microneedling on the face, and facial acupuncture is not some new and trendy thing that the Kardashians are doing on social media. Yes, they are and it is really something that has been around a very long time. When they found the emperor and the empresses in their tombs, they had jade gua sha tools and there are records dating back to the Sung Dynasty and even before that of people talking about facial acupuncture throughout history. I have written two publications for the Journal of Chinese Medicine. I’ve written many publications, but to specifically of interest, one is on treating neuromuscular facial conditions with more of a multifaceted approach.

Today we’re going to be speaking about facial motor points, and this is part of a multifaceted approach to treating the face. I’m a classically trained 5-element acupuncturist. I have been teaching at the Maryland University of Integrative Health, formerly the Tai Sophia Institute since 2003, and my second publication was on the importance of clearing energetic blocks prior to doing any facial acupuncture, and links to both of these can be found on my website facialacupunctureclasses.com. As I mentioned, there have been quite a few studies on facial acupuncture. I’ve listed a few here, and some of them are pertaining to the cosmetic effects and some of these are pertaining to more of the functionality of the face.

These slides will be available on the AAC site and when I teach my classes, I go over these in a little more detail, but I just wanted to let you see that there actually has been researched done on facial acupuncture. When you’re thinking about your practice and how facial acupuncture can fit in, if you’re just looking at the cosmetic aspects, it’s great because you’re not dealing with insurance. It’s a very reliable stream of cash income. Again, you’re not dealing with insurance. You don’t have to bill the insurance companies, and one thing that we’ve learned during this pandemic is just how much people depend on having other people take care of them for their appearance, and people will spend money on vanity before they will spend money on their health.

If you think about some of the signs, the protest signs for things to open up, they were, “I want to get my haircut. I want to get my nails done.” No one was saying, “I want to go see my doctor or my dentist.” People do spend money on vanity and also, if you learn the neuromuscular foundations of a lot of this, it can open your scope of practice. You can see patients or patients will seek you out because you have this subspecialty or someone who will be known for being able to work on the face. A lot of us, we go to acupuncture school where we don’t spend a lot of time needling the face. We’re not comfortable with it. We didn’t really focus on learning those points.

It opened your scope of practice, will give you a very unique skillset. These are some pictures of me doing some microneedling in a class and some facial gua sha. That’s the benefits for you, for your patients done correctly. A facial acupuncture treatment should include body points and should bring chi and blood to the face, to the muscles, to the skin. Facial acupuncture because it is a full body treatment helps with digestion, immunity, circulation, and all of these things. Everything shows up right here, and it will carry nutrients to your cells and by doing that, it helps to stimulate collagen and elastin production.

Also if you’re using intradermal needles, which are very small needles which require some specialized training to be very effective, it will actually stimulate collagen and elastin production. Again, for your patients, if your patients is having any sort of… This patient of mine had ptosis where one eyelid was lower than the other. You could see her eyelid on our right, but her left was lower than her other eyelid, and she was getting married. She was very self-conscious about it and through treatment, I was able to get the levator muscle to function better and help so that her eyelids were even. On a more cosmetic level, people that have rosacea, facial acupuncture treats the hormones.

We do hormonal points if that’s an issue, and it can help with different skin conditions. This was a student of mine in one of my classes and just during the course of class, I worked on one side of her face and she had a rosacea, and you can see how the rosacea cleared after I had done the facial cupping. People asked me all the time, does facial acupuncture work, and these are just a few of my before and after photos. This person up in the center and the top, she had a scar right in her nasolabial fold and through treatment, the scar softened and ultimately, dissipated.

This person down here in the center, had some dark spots and again, through treatment and some intradermal needles through microneedling and I also work a bit in my classes with skincare, with skincare, I was able to really help her to get some of those dark spots to disappear. This other patient here had a tremendous amount of modeling in her chin, a lot of wrinkling and the corners of her mouth were very much turned down. As you can see in the bottom picture here on her left on our right, that the corners of her mouth, instead of being turned down, they were starting to lift up. With her, I definitely used some motor points, which is the topic of today’s conversation.

Again, another patient. This was actually someone who’d been coming to me for years with wrist pain, elbow pain, shoulder pain on and off. She saw that I specialize in cosmetic acupuncture and she was concerned because she was having some asymmetry where her one brow and lid was coming down a little more than the other. I said, “Just get on the table,” and I treated the left side, and the difference was remarkable just from one treatment. Again, I used motor points in that treatment. Getting trained is important. The American Acupuncture Council does require that if you are doing cosmetic acupuncture, that you get trained by one of their certified providers, and I am one of the few people on their list of people who do training.

The reason for that is because there is special documentation, there are precautions, there are red flags and you really need to prescreen your patients for different contraindications. If someone hasn’t been screened properly and you are doing cosmetic acupuncture, you can bring on things like headaches. If they are prone to high blood pressure, it can raise their blood pressure, and many other things. The other part about training is, as you can see, there are 43 muscles in the face. Many of them are very small and when you’re working with the musculature of the face, you really need to know what you’re doing so that you don’t cause asymmetry, overstimulate a muscle or the nerves and the blood vessels, the capillaries on the face.

Some of them are very close to the surface, and really knowing where they are and how to prevent bruising is important. I’ve made a list of some of the neuromuscular facial conditions that I see most often in my practice. When someone within a 20- to 30-mile radius of where I live is looking up acupuncture for one of these conditions, I’m going to come up because this is something I specialize in. Again, specializing in facial acupuncture can be very beneficial for your practice and when I’m treating any of these conditions, of course, I will treat the underlying condition and I do use a multifaceted approach. Meaning, I use some submuscular needling and facial cupping, some gua sha, some scalp acupuncture, but motor points are a big part of treating neuromuscular facial conditions.

Also when we’re working strictly with cosmetic conditions, if you think about our emotions and how they manifest on the face, really understanding each one of the emotions, either from a 5-element perspective or just from a TCM perspective, how these organs being out of balance, what kind of wrinkles that might cause on the face. Using some of the motor points to really as reset switches, and we’ll talk about that in a second, can really help with things like hooded eyelids, the frown lines, crow’s feet and Bell’s palsy. I found these pictures in a book for artists or sculptors. They are artists, but I love them because they show a face at rest and then four different emotions, which of the facial muscles are used.

As we age, these muscles become not as functional as when we get older. Now some of them get overused, some of them don’t work as well. Some of the muscles that we overuse are going to end up causing lines and sometimes early sagginess on our face. You can see here when someone is showing rage, just how many different muscles are involved, and the same thing with joy. Motor points are something that were discovered actually quite a long time ago. Medical doctors have used them. I found an old medical text, and they were using motor points with hypodermic needles and stimulating them. I’ve listed some of the researchers, some of the people that have done a lot of work in the motor point world and what a motor point is, it’s the most electrically excitable part of the muscle.

When you find the motor point, you can stimulate it, and it is where the motor nerve bundle is… The nerve is actually attached into the muscle. Fortunately for us, many of them are acupuncture points. We don’t have to have a deep knowledge of anatomy in order to find them because we have the acupuncture points as reference points. If a muscle is too flacid, it’s not firing properly and if it’s too tense, it’s not firing properly. By stimulating the motor point, you are helping the muscle to function properly, whether it’s to relax or to get back to doing its job that it should be doing. As I mentioned, many motor points are also acupuncture points, but they are not trigger points or ashi points.

A trigger point is really a sore spot and you press on it or you needle it, and it feels good. It could be like a knot, but motor points are different, and there are motor points on the face. All of them are innervated by the seventh cranial nerve, except for the temporalis and the masseter, and those are innervated by the trigeminal nerve. In order to figure out which motor point you should use, if you looked at those other drawings, there’s arrows going in every direction. You have to understand what the functions of the different 43 facial muscles are.

When I teach my neuromuscular class or I have an advanced cosmetic class, I go through every single one of the emotions or every single one of the issues that might come up with a particular, if someone had Bell’s palsy and which motor point to use, but we are going to talk about a couple of them today. Normally, you just needle straight in or slightly at a slight oblique angle, and you want a needle into the muscle, but not through the muscle. I think I just did this slide this morning. I think this is all of the facial motor points. I’ve got one dot for each. I got a little crowded on one side, so I put some on the other side.

As you can see, there are quite a few facial motor points, and then there are others for the platysma and for the temporalis and also for the SCM, but I don’t have those marked out on here. Let’s talk about a couple, and the first two would be the procerus and the corrugator, and they give you the angry eyes or the frown lines. Here’s the corrugator muscle and the motor point. This brings your eyebrows together. It works in conjunction with the procerus, which is right here, but for the corrugator, the motor point is just lateral to bladder two. For the procerus the motor point is actually Yintang, so it’s easy to find. Again, these two muscles work together to bring the eyebrows together.

Another muscle group is the frontalis, which helps to raise your eyebrows, like if you’re surprised or inquisitive. For each wrinkle just about, there is an underlying emotion and it’s a topic for a whole nother conversation, but I just wanted to bring that up. I could talk about this for six hours so I’m trying to squeeze everything in in a half an hour as much as I can so. The frontalis again causes these horizontal wrinkles. The frontalis is two muscles right here and the motor point is gallbladder 14, and I have a little video. I had needle this on a patient and just stimulated it. You could see that her issue was a drooping eyelid on one side, and the frontalis is connected to your eyebrows so I had needled that.

As you can see, it really woke the muscle up. The orbicularis oculi is something that can be affected if a person has Bell’s palsy or a stroke, and the way you would test for it, can the person close their eyes and open their eyes. From a strictly cosmetic point of view, it is involved and these are called crow’s feet. Here is where the orbicularis oculi is, and there’s two motor points. One is between Qiuhou 23 and gallbladder one, and the other one is the extra point right here, which is more or less between stomach two and gallbladder one. Another motor point and this is something that is important for pursing your lips, bringing your top lip up.

If someone had some sort of paralysis around their mouth, if they put their lips together and they blew out, air would come out. If you or I did it, it would come out evenly, or it wouldn’t come out at all, but if someone had paralysis on one side, the air would only come out on the weak side, and it can also cause lip wrinkles. You can see a picture right here of how all of this works, and the name of the muscle is the mentalis. It makes your lip go down. There’s actually three different muscles that are involved in getting your bottom lip up to your top lip, but it can cause wrinkles on your lower chin and wrinkles all around the lips, and here is a video.

I had a student in class who had had Bell’s palsy years ago, and she said she still could not close her lips completely. I went ahead and needled the mentalis, and I noticed immediately that the muscle started twitching. I stimulated it, and you can see what happens. This was a muscle that wasn’t functioning at all. One of the things that comes up right now during this time, we’re in the middle of a pandemic, and our patients should be wearing masks in our treatment room. There was a lot of questions that have come up. I teach my classes now via livestream webinar, and my students have asked, “Well, how am I going to do my job?” Well, I just started back to work last week, and I gave a lot of thought to I can certainly protect myself, but I want to keep my treatment space protected as well.

The first thing I did was I took a box of surgical masks, and I did a little video. If you go to my Facebook group, I have a Facebook group. It’s called facial acupuncture, or my Instagram is also facial acupuncture. If you go to either one of these, you will see I have hundreds of short demonstration videos, articles and this was I think last week. I just took a surgical mask and so anyway, I have a demo video of how I made this, but I just took a regular surgical mask, cut the elastic, folded it. I use some hemming tape, like seamstress might use, or you might use if you wanted to hem your pants without the needle and thread. I just use the tape on the inside, and then I just reattached the elastic.

You can see the front and the back, and this wasn’t the best version. This was a version that I did. I hadn’t tucked the sides in, but other than LI20 and right around the top and bottom of my lip, if someone is wearing this mask, you can get to their entire face and neck. If they were to cough or sneeze or whatever, it’s still contained under a mask which works. I used one six times last week and I just give it to my patients, and then throw it out. Surgical masks are easy enough to get on Amazon right now. They’re inexpensive too. The next level that I’m working on, I saw this idea on the right, which was designed for aestheticians, and it’s a lucite box. I actually ordered one, but for my purposes, it was too open.

I was concerned that it was just too open, so I’ve actually been working with the manufacturer. I have designed this box on the left. I don’t have a photo of it, until I let them know how many I want. I’m not going to be selling these for profit. I’m going to probably order five or 10 or a hundred, and then just have them shipped to acupuncturists, so they can safely treat their patient’s face. Your patient’s head would go here. There’s holes for your arm. It’s very high up. It’s 15 inches, so your patient doesn’t feel claustrophobic, and I angled this part. When you’re sitting and working on their face, you can lean over and get a little closer. The little dots here, these boxes are actually collapsible.

When it comes in the mail, it’s whatever five pieces, and then you just put it together, and that way you can take it apart if you’re traveling or if you just want to store it, you don’t need it, but it was my extra level of sneeze guarding because a large part of my practice is treating people’s faces. That is my very quick talk on facial motor points, and I am going to open it up for questions. Alan, if you’re there, I don’t know what to do with my slides while we’re doing questions though. I see. Something in the chat box, leave the slides. Okay. I left the slides. No questions. Yeah. If you have questions, you can put them in the comments, and I will answer them later.

If you have questions afterwards, you can just put them in the comments and I can answer them. Okay. Thank you again for tuning in, and you can visit my website, facialacupunctureclasses.com. There’s information about my livestream and my recorded webinars, and I want to thank the American Acupuncture Council again for giving me this opportunity. Thank you so much.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Sam Collins for HJ Ross

Telehealth – Coding, Documenting and Compliance of Telehealth

Hi, everyone. This is Samuel Collins, your coding and billing expert for acupuncturists. Specifically, the American Acupuncture Council’s Insurance Information Network and Malpractice. Today’s program, as you’re probably aware, is going to be one that’s very important considering the crisis we’re going through right now, and on telemedicine. Is it something appropriate? Is it something we can code? And how do we do it? Well, of course we have to make sure, first of all, that we are getting ourselves together. Because of course our patients are changing, can they come into the office? So without further ado, let’s get to the slides. Let’s make sure we’re understanding what’s going on for telemedicine.

So you’ll see here on this first slide, I’ve got my email address and of course take a look at our website, the American Acupuncture Council Insurance Information Network, which is AACinfonetwork.com. But here you can see a teleconference call. Now on the left side here you’ll notice this picture, a woman opening her tongue, doctor observing. So what can we do? Well before we get fully there, let’s talk a little bit about making it a little bit light. I’m not always required to see patients online, but when I do, it’s a 99243, that is the code of course for the 30 minute visit online. But it could be for of course the diagnosis of Z03.818, which is the encounter for observation for a suspected exposure to other biological agents to be ruled out, which of course could be COVID-19.

Now again, that’s not something you’re going to be treating for, but of course this is why now many patients can’t come in. So what are the diagnosis for COVID-19? Just to make sure everyone’s aware of the diagnosis under ICD10 is U07.1. And of course if it’s just for observation, Z03.818. Now of course we’re not going to be seeing patients for that, or you won’t be seeing patients for that, but likely for the conditions that you’re already treating for, but they cannot come into the office, maybe they’re in a high risk group. Certainly it’s not something that you have to close your office per se, if there’s a person in acute or severe pain. Certainly you should be helpful to them, but make sure of course you’re using all the safe practices.

That being said, let’s talk about telemedicine. It is a patient initiated service with a physician, or as I underlined here, or other qualified healthcare professional, which would fit an acupuncturist, for the evaluation, assessment and management of the patient. In other words, an ENM code. It’s not intended for the non evaluative electronic communication simply of test results, scheduling of appointments, or communication that doesn’t involve an ENM. In other words, consider it, it’s like an office visit but just done online. You would be doing all the same things of discussion with your patient: history, exam and so forth. So essentially this is an ENM visit, simply in a non-direct face to face manner, but through electronic communication. Basically doing the patient’s history, evaluation, medical decision making, and counseling.

Patients must be under your care and likely under your care for acute or chronic pain, and how to manage without direct treatment. You might have a patient that cannot come in but they’re having a severe episode of back pain. What are we going to do to help them? Well, this is the point. You can do it via the phone or virtual, meaning through your computer or tablet, to make sure to evaluate the patient and give them instructions how to help themselves.

What would this include? Well, here’s an example of a self management of a patient that you all likely do or would do face to face. Talking to the patient about how to rest and reduce strenuous activities; changing their ergonomics and posture; appropriate exercises including Tai Chi, Qi gong, yoga; stress management or meditation; joint protection; weight loss; self massage; self acupressure; maybe the use of hot or cold packs or relieve discomfort. Educate the patient about the causes, what things they can avoid, and then potentially about brief use of supports if necessary in the acute stages to limit motion. In other words, the same recommendations and things you would do face to face without care.

So in other words, simply put, this is a patient you are helping, just doing it online, doing it without physically touching or hands on the patient. So telemedicine, the patient must be an established patient. It can’t not be a new patient, someone you’ve never seen before, but it can be an established patient that has a new condition. So the problem may be new to the provider, but it must be an established patient. And it must be initiated on a HIPAA compliant secure platform, typically. That would be something where you’re going to use obviously some sort of secure platform. But however, due to this recent COVID issue, they have made a mandate that providers may use simple communication through phones or tablets with simple services like Skype or FaceTime. In fact, it was recommended by the centers of Medicaid and Medicare Services yesterday that patients that are of an older age probably should just get their grandchildren or children to come over and then use their phone or tablet for them. So don’t be afraid to initiate in that way as well.

Now what are the codes? Okay. So for online digital evaluation of a patient, which means you’re going to do some type of virtual visit, the first code is 99421, that is online digital evaluation management service for an established patient for up to seven days of cumulative time during a seven day period, for five to 10 minutes. So in other words, it’s the entire time up to a seven day period. So this might be several communications with a patient within seven days, and the time would be cumulative. But it certainly could be just for one, if it’s only one within that time. You’ll notice the codes are relatively simple, in that one is for five to 10 minutes, one is for 11 to 20 minutes, and one is for 21 minutes or more. So simply put, once you get over 21 minutes, then it’s just a 99423, and this would be again, the accumulative time for each patient. And again, it’s online, meaning through some type of virtual platform.

These are patient-initiated services for the assessment and management of the patient. They’re not intended for non-evaluative communication for test results. I want to be clear, it’s not for a patient where you’re calling and saying, “Hey, your test results came back,” but literally just like you would do on a regular visit. The patient had an ENM within the last seven days, these codes cannot be used for that problem. So if you saw a patient yesterday, this part of it would be counted as part of that visit. It’s not till after seven, which I believe we’ll see a lot of this because of the time that’s extending for patients that would’ve had an appointment, this certainly is going to fit, particularly if it’s just initiating here.

So certainly keep in mind if you saw the patient the day before and a phone call the day after, or a virtual visit, that would not count towards this. But for a patient within or after a seven day period, and again it’s cumulative time. If the inquiry is about a new problem, certainly if that’s no problem, and it can be sooner than seven days. So, so long as that is a new condition. And I would question, even though a patient may be initiating right now, they’re dealing with some new issues because they cannot come in. So certainly I think this is going to fit. And we might see a nonissue of that seven day period. The issue here is that it’s simply a visit with the patient that’s done on an online platform to address their concerns of how you may help them.

Obviously you’re not going to be able to do direct treatment, but the things you can do to help them, and maybe it might even be to get them in, and of course if it is to get them in within a 24 hour period again, that wouldn’t count because it goes towards a visit, but certainly for a patient that can’t be seen or a person in a high risk group, obviously that is mandated to stay home.

Now again, to count the times for these codes, start the seven day clock when the physician first performs a persona’ review of the patient’s question. Add the time for the review of the relevant patient records and data interactions or the clinical staff to the problem. So in other words, what this is including is the time you may take to review the records before that phone call starts. Now I would be careful, I would certainly say, don’t tell me you spent a half hour reviewing records, but certainly a few minutes would count. And this would include communication with the patient by digital means that doesn’t fall under another ENM code, meaning it’s not with a phone call. This is going to be the online. It includes decision-making, assessment, management by those in the same group practice as well. So again, if you’re in a group setting, that could work.

What I want to emphasize here though, is that it is simply the doctor doing an ENM. And when I say doctor, I mean the licensed acupuncturist doing an ENM with that patient just simply online. And that means the documentation would fall into the same way. So for the medical record, the guidelines just direct you to keep permanent documentation, either electronic or hard copy. And to make this simple, simply document like you would any other visit, as if the patient were in the office. Make notes, put the time down, obviously, the time you started and ended. You do not need to record the phone call, but you would record the visit in the same manner. So take the same type of copious notes you would as with any other visit.

Now what else can we do besides a virtual visit? Well there’s the telephone evaluation and management service, which certainly could be useful as well. And this is provided by the physician or established acupuncturist to an established patient. And again, I want to make sure that we see that’s established patients for this, not a new patient. Now it could be an established patient you have not seen in six months. And if they’re calling for a problem, then of course you can see them. It’s simply just not for the new patient. Now this services, again not within the previous seven days of the first visit, or the last visit, and it can’t lead to an appointment within 24 hours. So that’s something you’ll see kind of uniquely here for the telephone visit, is that it cannot be the result of the phone call is to come in for treatment. This is literally for the patient to manage at home, not come in within the next 24 hours or next available appointment.

So what are the codes here? 99441 is for five to 10 minutes, 99442 is 11 to 20 minutes, and 99443 is for 21 to 30 minutes of medical discussion. So again, this is going to be that discussion with the patient, essentially, again, an ENM visit where you’re discussing with them the history of the issue, evaluating their outcome, what can they do at home, this is what this is going to be used for.

Now, one thing about these codes though is that you have to document them properly in the sense that I want everyone to note here at the bottom, the place of service is not 11 as you normally would do on a claim. The place of service would be 02, which indicates a telemedicine visit. So again, if the patient’s in the office, it’s 11. If you go to a patient’s home to do a treatment the place of service is 12, but if you’re doing a telemedicine visit, the place of service is 02.

But now one thing I’m sure everyone’s concerned with is, what would be an appropriate charge for these codes? Well, I really can’t give you what your charge should be, because of course everyone’s going to vary as to the location. But what I can help you with is the relative value unit. The relative value unit is the value comparison of one code to the other, or a ratio. So what I put here at the top is the relative value of manual acupuncture, which has a relative value of 1.05. Now for our intents and purposes, let’s just say it’s approximately a value of 01. So now when you look at these other codes, you’ll notice all their RVUs are broken down to 0.43, 0.86 and so forth.

So in a simple term, think of it, it’s a ratio. If you were charging whatever you’re charging for acupuncture, roughly 99421 would be about 40% of that. 99422 would be about 86%, and so on. So again, just think of it as a simple ratio. So by example, if someone were charging probably $70 for manual acupuncture, the relative price for a 99421 would be 40% of that, or about $28. So again, just keep it really simple. We want to make sure, of course, that acupuncturists are available to patients who are managing their chronic pain, who are managing many issues that they otherwise would not get help for. You could be the person that really gives them a good sense of feeling of assuredness that you’re there for them to give them even just stretches, how to use hot packs, maybe it’s even dealing with some of the herbal consult that you’ve had.

What I want to make sure is that we’re doing a good job and continuing to help our patients in this time, and make sure they’re aware that you’re available. There would be nothing wrong with sending something out to your patients to let them know that you are available, potentially in the office for appointments, but also online and it will be covered by insurance. Ultimately, we want to make sure you’re doing well. The American Acupuncture Council is your resource, and I’m going to make sure that anyone that’s listening that’s of course a member of my network, you’re welcome to give me a direct call or email so I can help you with these.

Of course, if you’re not in the network, I apologize for that, but we do offer a service for it. You may want to see that we upcoming seminars that will allow you to, with some help, and the seminars will be virtual as well. But please take a look, we have more information on our website, to go to our Facebook page or to our Instagram account to take a look there. We’re here for you. The American acupuncture council is your partner. Your success is our success, and we’re your partner to make sure your practice continues to thrive even during this time. Next week’s post will be Virginia Duran. And until then, this is Sam Collins, the coding and billing expert for the American Acupuncture Council, and I wish you all well and be safe.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Best of TCM Research in 2019 – Drs. Doran and Barzilay

 

Hi, I’m Virginia Doran, host of To The Point, generously hosted by the American Acupuncture Council. Today, my guest is Gil Barzilay, and if you haven’t heard him speak, you’re in for a treat. He has a big following internationally, and besides a diploma in Chinese Medicine, he also has studied Chinese and Macrobiotic Nutrition, Kiiko Matsumoto-style Japanese acupuncture and he actually went to college in London at the Imperial College there at the University of London. Has a PhD in from Oxford in Cancer Research and European Medical Biology, post-doctoral fellowship at the Weitzman Institute. He’s got 11 peer-reviewed publications in leading medical journals.

He brings a special dual knowledge in the field of cancer research as well as other kinds of research. He works in Tel Aviv in Israel’s leading complimentary alternative medicine clinic, Rehovot, and he teaches acupuncture, Chinese medicine, research issues all around the world. He’s part of the International Committee of Chinese Medicine, ICCM, which holds an annual conference, which I hear is just fabulous. He also works with the Evidence-Based Acupuncture Foundation and writes regularly, reviews and newsletters.

You can see him on Facebook at DrGilTCM and/or contact him through the ICCM or Evidence-Based Acupuncture. Anyway, without further ado, I would like to introduce everyone to Gil Barzilay.

Thank you, Virginia.

Sure.

What a long introduction. Yeah, that’s all right.

Well, you have a lot of credentials.

Thanks for that.

I wanted to ask you, what makes a good research study in your opinion and why? The studies that you’re going to speak about today, why are those your best of?

Okay. There’s about a thousand, I think, publications that are published on Chinese medicine every year. I get those alerts on Google twice a week. There’s a lot of information, but I think [inaudible 00:03:41] Western medicine research apply for Chinese medicine research without going into the debates, include having randomized controlled studies. So having a control, comparing a compounder to something.

There’s been a lot of debate on sham acupuncture, and I’ve seen some of the speakers that you’ve had before. I’m sure the debate of what sham acupuncture is and whether it should be controlled has been up there, so I’m not going to go into that, but there has to be a good control of some of the subs that have chosen to date had not been in any could control. They have to have a good number of patients. So of course if these Jersey studies are made in China, they sometimes can have thousands that are conducted in North America or in Europe. We’re probably talking about a hundred patient, maybe a few hundred patients.

Also, the third component of whether the study is good or not in my opinion, is having objective and [inaudible 00:04:47]. So we’ve seen a lot of placebo research that has been conducted actually in other universities around the world. One of the ways to better understand whether something works or doesn’t work is having objective and subjective measures. Because when you ask patients only, “Has your quality of life improved?” or something like that, it really depends on the data in the hospital or the clinic, so the answers can be so confusing and really not good enough for measuring the effect of an intervention.

Having a mix of both of them, these are the three that I’ve chosen have these within them.

Mm-hmm (affirmative). You know, I just wanted to interrupt for a second. I’m hearing a reverb. I don’t know, are you hearing it at your end, kind of like an echoing with the technology?

I’m fine. I can’t hear anything.

Well, hopefully the viewer won’t hear it. Okay, good. I guess there’s a little bit of one, but as long as we can still understand you. So tell us about your criteria for a good research study and why these ones are your best.

So, these are the three that I’ve chosen, but I wanted to start with putting things in little bit in a context of where we are now in terms of, not the world we live in, never talk about global warming, but I did want to share some slides. So let’s move into the slides that I’ve created. One second. Have I done something wrong?

Thank you so much for making these slides because it really helps the viewer to anchor that information.

One second. I need to put my glasses… new share.

Oh, I see the slides. Alan sees the slides.

See the slides, but they’re not moving forward.

You can’t see them.

No, I see them, but they’re not moving forward. Oh, now they are. Okay. Okay, no, something’s not working.

I see the title but not the content.

What’s up with the slide?

It says stopped sharing.

Okay.

All right, good.

Now it is on, but okay, let’s see. Okay, so I wanted to put things in context because I wanted to say that one of those things that has been… One second. Not working, yeah, I know. Okay, so one of the things that we’ve seen this year is that of course there’s some things coming about Chinese medicine for the fact that is making it into the clinics with the World Health Organization a categorization of acupuncture as a medicine. Of course that got some good headlines, and then some nasty headlines like the integration of quackery with real medicine.

We have, of course, on the right side you can see Novak Djokovic during the tennis U.S. Open bragging about being treated with acupuncture and the moxa. You see Lady Gaga showing you off her cosmetic acupuncture, but at the same time you have some bad news like Spain planning to ban alternative medicine in health centers. You have an article here that was published the Forbes Magazine that says, “Don’t do this: 156 medical practices that are all failures,” and saying that acupuncture is quackery again. Then you have this silly photo on the bottom right hand that shows guy and says that veterans deserve better than as something that doesn’t work like acupuncture.

On one hand you have some good news, but on the other hand you have some… And some people supporting us like Novak can maybe Lady Gaga and others. On the other hand you have some bad headlines as well. At the same time though, the treatment landscape is really changing. There’s a lot of issues with the opioids, you know it very well, especially in the States, but also in Europe, very high numbers of people dying and if not at least coming to the ER.

But it’s not only the opioids, FDA has put additional box warnings and contraindications on the insomnia medications. You have Xanax, which is now the number two problem after the opioids.

Really?

Yeah, and of course the nonsteroidal antiinflammatory drugs that look like Advil or Neurophin, that look very innocent, but actually increased double and even more than double the chances of having a heart attack. Even more common drugs like Advil and others have have real health issues coming in with them.

That means that people are seeking out alternative. When we have the evidence with research, whether we are really interested in conducting research or not, it can actually support our case with the different organizations and with the health authorities. You can see that treatment guidelines all over are now embracing acupuncture as well when the evidence was solid enough.

You have here the American College of Physicians are clearly stating that acupuncture is one of the treatment options guidelines with clear recommendations on a first and second level that acupuncture should be one of the ways to treat chronic and acute pain. You have NICE, which is the British body of excellence, clinical excellence, recommending that treatment will be given prophylactically for migraines. You have ASCO, you know the American Society for Clinical Oncology in dosing, acupuncture for breast cancer patients.

We have the American College of Rheumatology embracing acupuncture, and now you also have the Adult Stroke Rehabilitation and Recovery using acupuncture. So when you have research, perhaps not all the doctors, perhaps not all the medical community’s aware of it, but when you have evidence bodies and health authorities listen to you, and then they recommend it and may even include it, and I’ve seen throughout this year that several insurance companies in insurance bodies in America have also included acupuncture now as one of the modalities of frequent, so that can only happen when you have good research.

Absolutely.

After all of this introduction, I’m going to go into my top three for this year. So I chose top three that are not within a typical pain and migraine and other areas that we already have enough evidence that acupuncture works and there’s no point in repeating with an additional study that may demonstrate that acupuncture works for pain. We know it does.

I wanted to show some studies that perhaps not everyone is aware that exist, and are pretty solid, and I recommend that people go and read them in full. The first one is a study from Italy that looked at the effectiveness of acupuncture on pain and functional disability for people with rheumatoid arthritis. The studies from a group of medical doctors in Rome, they included 105 rheumatoid arthritis patients that were divided to get either real acupuncture or [inaudible 00:12:53] acupuncture, which I don’t usually like, but they included that. Acupuncture outside meridians or have a wait list, so not receive any acupuncture at all, while at the same time the entire group were continuing with their own treatment, whatever they had already for the RA. Either it was a nonsteroidal drug or a disease-modifying or biologics or any other analgesics that they were getting for their RA.

They received a treatment for three weeks and they were followed for additional four weeks and the points that they use there adjusting people are short of reading the study itself, it was Triple Burner five and Goldwater 39, Hartswean Keeper seven. Just to show you when I was talking about objective and subjective measures, I know this look complicated but it’s actually quite easy to read.

You have in a solid line those who receive real acupuncture, and the dash line, those who receive control acupuncture. You can see that they were doing some auger battery and arm strength as well and quality of life and pain. They were trying to assess pain. They were trying to assess the ability of people to move their hands and to feel pressure and how much pressure they can take on their hands. Of course also asking questions about quality of life. You know all these parameters acupuncture was better than a wait list or sham acupuncture. In fact, they were also looking at the number of swollen and tender joints, and there were also significantly decrease in those who received real acupuncture.

We know that acupuncture is good for lower back pain, for knee pain, whatever. This is one of the few studies that I’ve seen on rheumatoid arthritis, and it’s good also to see that it’s not only the pain but the also the functional, mobility of the patients to do things, to do normal things we do every day. That’s the first study.

Well, that’s good. I was going to ask you to explain to the audience what control acupuncture is. I haven’t heard that.

So control acupuncture, in this case it’s the sham acupuncture. They were asking if you saw on the first slide they were using acupuncture points that were not on the meridians that were relevant to RA. So that’s one of the options. One of the issues, of course, with that type of control or what is called sham acupuncture that we’ve seen in the past it doesn’t work. When you stick a needle in someone, something happens, it talks to the brain and it tells the brain, “Oh my God, you know, something has happened. React.” So just because it’s outside of the Meridian doesn’t mean there’s no reaction. That’s what we’ve seen over the years when the original studies came 30 or 20 years ago with acupuncture, we’re comparing to what they call placebo puncture.

They were comparing to needles that are at two points that are not supposed to be relevant to the disease that we’re talking, but they did actually work in a way. And so all the ones that don’t like us and think that we’re quackery or with some sort of holistic voodoo medicine, we’re saying, “You see, it doesn’t really work.” It works, even when you put needles in a place that shouldn’t work, it does work a little bit. So this whole thing, acupuncture is just not real medicine.

When they moved into doing better controls and/or comparing to people who are continuing to just take their medicine or not receiving any additional treatment, they could actually see the real effect. That’s how, in my opinion, studies should be conducted. But in this group took the double approach. They did a sham control and they did a waiting list as well. In both cases it was working better than either. So that was a good control.

Great.

Okay, so the second study, it’s actually something, and that’s why I put two studies here, but I’m not going to go through both of them, is a phenomenon that we’ve seen over the last almost 10 years. When you do acupuncture to patients who are depressed and are taking SSRIs, the results are faster, better and with less side effects. Some of the reasons from a mechanistic point of view, people have said that if you put needles then since we have seen already the effect that needles do on increasing serotonin levels in the brain, that could relate to that, don’t really understand the [inaudible 00:17:47] of why acupuncture actually helps for patients who are depressed and are already taking SSRI, but that’s effect.

This is a study that was trying to compare manual versus electro acupuncture as an add-on therapy to SSRIs. What they did, it was more than 400 patients. 156 were taking SSRIs only. 161 were receiving manual acupuncture, and 160 patients were receiving treatment with needles, with electro acupuncture. The patients were all on the usual dose of Paxil and Seroxat statin they were taking for six weeks, and the patients received treatment over six weeks with three sessions a week, and they were followed up for an additional four weeks. The points that they were using, you can see here is GV20, the Yintang, GV16, bilateral Goldwater 20, GB14 and bilateral pericardium six and spleen six. When you look at the results, they both showed that manual acupuncture together with the SSRIs or electro acupuncture were both significantly better than SSRI.

At six weeks the response rate for the SSRIs was better. There was an early onset. The level of depression that was assessed is one of the markers as well. Side effects were lower and also the number of patients that had to have their SSRI dosage increased was lower with those who received acupuncture. So acupuncture really does good for patients. I think it’s a good thing to know because I’m pretty sure that there are quite a few acupuncturists that when the patients ask them, “Do treat depression?” or “Is it going to interfere with my therapy that I’m taking now?” The answer is clearly, “No, actually probably it’s going to work better.”

Mm-hmm (affirmative). Now, would it affect the dosage they would need to be taking?

It may affect over time. In this specific study, they actually showed that the number of patients who had to have their SSRI dosage increased over time was less when they received acupuncture, so there was no need to even go and increase your dosage. It’s only one study that actually assessed this. I wouldn’t see that as the key outcome of this study. But the fact that it’s keep on repeating yourself is quite interesting. I think that many people, we’re all very easy sometimes on treating pain because we know it works, but some of the more, life [inaudible 00:20:41] it’s good to know that if a patient or a relative asks, “Does it work with [inaudible 00:20:47] or clear with my therapy?” The answer is definitely not. It may actually even enhance it, and you may even have less side effects.

Mm-hmm (affirmative).

So that’s good news.

Yeah. Definitely.

Okay, let’s go to the third study. This study made a lot of noise in the last year because it was published in JAMA internal medicine, which is a very important journal. It was looking again at acupuncture as adjunct therapy for chronic stable angina. The reason why it caught some attention is because the results were too good or there was a community to relieve. So there was some nasty headlines I’m not going to go into, but if you just Google it yourself, you’ll see some nasty headlines on WebMD and other website of people really unhappy with the results.

Mm-hmm (affirmative).

Yeah.

Antithetical to what it should be. Instead of being happy there was something for patients, they’re more concerned about the political aspects of it.

Well, the thing is that I never really understand it because if the results were choose acupuncture, don’t take drugs, I would have understood it. But actually this studies acupuncture together with the existing drugs. So there’s no competition here. Always saying is, Let’s integrate,” or “Let’s see whether acupuncture actually even improves what the drugs are doing,” because the drugs can only do up to a certain point and they don’t even work very well. [inaudible 00:22:31] we’re not taking off the presses. Don’t worry about it.

[inaudible 00:22:36] pharmaceutical. We’re just suggesting that if you add acupuncture, you can even have better results and your patients will be happier. We’re not taking their job or their sales, but that’s the way it is. Yeah. So these were again, 400 patients. It’s a nice number. They were divided into receiving acupuncture on the disease on meridian. These are [inaudible 00:23:05] bunch on the non-affected meridian sham acupuncture, which was a not real points and no simulation and wait list. In my opinion they’ve done a little bit much [inaudible 00:23:19] after all, but the [inaudible 00:23:22] we had more patients than what they chose to do.

It was four weeks, three times a week, and then six weeks follow up. So that’s a long followup as well. You can see all in all, it’s about four months. And again, no harm to the patients. All received their anti-anginal whichever day were making them ready as recommended by the doctor. So you could be a bigger block. It could have been [inaudible 00:23:57]. So I feel safe.

Yeah.

Now, if you look at the results, you can see here the frequency of angina attacks, and you can see here that the patients who received the real acupuncture and the reduction is significant. [inaudible 00:24:14] well, attack to less those received and none acupuncture. Meridian had also some reduction, but down to 10. Sham acupuncture down to 10, and those who were on the wait list had a reduction of one attack, one and a half attack.

Now, the interesting thing is that, remember that all the patients are continuing to take their anti-angina drugs, but they don’t work. Because you can see they started with almost 14 attacks, and they ended up with about 12. When they had acupuncture, it was halved, so the number of angina attacks you had was down by half.

Like I said, WebMD, [inaudible 00:24:59] it didn’t matter, and you don’t call [inaudible 00:25:06] top cardiologists, Americans in Europe saying that this results are too good to be true. Since this study was not done in America, you never know what happened, who conducted this study and whatever the results were, made up or something. So that’s the way it is.

That’s amazing. That’s a really dramatic one. Yeah. I like that.

Yeah, and that’s a reason perhaps they didn’t like it is that you can see that since since the patients were taking the drug and it didn’t really work, they were seeking additional options, but there are no real additional options. You can go to natural path, you can go to your homeopath or I mean, or acupuncture. That’s about a few of the alternatives. [inaudible 00:26:10] do to drugs obstacle therapies. So yeah, the results are too good to be true, but that’s the way it is.

The reverb was a just occurring a lot. Alan said to ask you if you have a cell phone maybe nearby.

Near? No, no, no, it’s two rooms away from me.

Huh, okay. All right. I have one nearby, but I don’t know that that’s it. I can’t read what… Okay. So you know, with a little bit of time that we have left, can you talk about acupuncture and the research that’s relevant for the opioid crisis that we have. I mean it’s really an epidemic here. It’s so unfortunate and the politics don’t really support the real regulation of the drug companies with the pharmaceuticals that have… Not that that’s the whole root of the problem, but that’s a big portion of it, how it became so big. Can you speak about that from your knowledge?

Yeah, Alan has written something that is important. Cell phones should be off no matter where it is. Okay. It’s off. It really is off. I was a good boy before.

Yeah, so I’m just curious, is there much research for that? Things that we can give to doctors or patients? I mean, there is for pain, but what about addiction?

There is some research on addiction as well, especially the one that was done with veterans in the U.S. with the veterans’ associations and several of them. I think there isn’t enough research that has been done. That’s perhaps part of the problem, because I think in the first few years after the opiod crisis has become such a crisis that the people, you know, the American Physicians Association and others had to react to that and seek alternatives.

The first instance was for an alternative and so acupuncture would be an alternative for treating pain. And that’s correct, and that’s worked. The American ACP and also the American Medical Association, all the other associations, including a bunch of also one of the ways, one of the modalities people will notice. Then only since about 2016 or ’17 you start seeing research being developed and done now on whether [inaudible 00:29:16] in addiction.

We begin to see the results now. The results are interesting and positive, but I think the studies that I’ve seen to date are quite small, and so [inaudible 00:29:32] happy with with. It’s interesting and it’s going in the right direction and perhaps it’s even not even surprising but I don’t think there isn’t enough publications to wave and say, you know, we can also help with coming off addiction.

We can definitely do that and we know we do that, but the research is still, I think, [inaudible 00:30:00] to available. Talked about it.

Is there anything else you wanted to say in conclusion? We’ll have to have you back at another time to talk about things and get that sorted out.

I would just recommend for people to once in a while, I mean if you’re not interested in looking for research or if you don’t know where to look for it or read it, look at for example, the summaries that we are doing the evidence-based acupuncture website, because that has a lot of resources for people who don’t have the time to read or really not interested in research, it’s too complicated. [inaudible 00:30:47] and all of it is okay.

We summarized the highlight and we tried to make it accessible so that every therapist, wherever they are in the world can actually discuss it also with their patients, because we know that when patients sit in our office or lie on the bed with needles, they start asking questions for their brother, sister, mother, son, neighbor, and sometimes it’s beyond what they themselves came for. But there’s a lot of evidence out there and so if you can’t be bothered and that’s totally okay, go for example the DBA website and have a look at that, or look for research courses.

I’m sure there are in America, there’s some online as well and there’s plenty of research around that we can use and convince people. Local hospitals, local clinics. [inaudible 00:31:47] integration. No one is saying that acupuncture is better than drugs or that drugs are better that well. pharmaceutical companies are saying that drugs are better than [inaudible 00:31:58], but I think that if we integrate, it going to work really well. This is where we have integration in all hospitals, it’s really amazing, in oncology, in pain, in orthopedics and some psychiatric.

It’s working quite well. It took 10 or 15 years of fighting with the evidence. So you need to know the evidence for that.

But you know, we owe people like you and Mel Hopper Koppelman and John [inaudible 00:32:31], so many people, I can’t even name them all, but it’s really a gift, what they’re doing for the field, and we need to support that. It’s a really great organization and it’s for the sake of all of us.

So, anyway, thank you so much for coming, even though you’re in Tel Aviv and I’m in Connecticut, but thanks for taking your time to share your knowledge and we’ll hope to have you back again sometime.

Thanks so much for having me.

Yeah, I’ll just say goodbye to everyone. Again, I’m Virginia Duran, your host and my website’s LuminousBeauty.com and Gil Barzilay. You can see by his Facebook, DrGilBarzilay is it?

No, DrGilTCM is the easiest way to find it.

DrGilTCM on Facebook, and of course the Evidence-Based Acupuncture site. So thanks again, and we’ll see you after the New Year. Okay.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Heads up! Some Exciting Updates on AAC Malpractice Insurance Policy


As a premier provider of acupuncture malpractice insurance policy, your American Acupuncture Council (ACC)is constantly improving its products and services to see to it that the company gives nothing but the best service you can find in the industry today.

True to our words, we have now more coverage built-in standard and we are excited to share with you in this post each and every detail of the added coverage in your policy. So, are you excited? Without further ado, here are the specifics of your more comprehensive policy.

Now you can have the the following benefits:

  • More modalities standard
  • Upgraded customer service
  • More support for you

In addition, we have added in the policy the following:

  • Premises liability – Also known as slip and fall coverage
  • Products liability – Provides coverage for products that are FDA approved, which are sold to your patients
  • Cyber liability – Aimed at providing protection in case of data breach in your office
  • Injection therapy coverage – This is included without additional cost

Apart from the above-mentioned added benefits, you will also receive defense cost outside the limits of your liability. If the cost, for instance, US $50,000 to defend you for malpractice claim, you still have your full limit of liability intact for settlement.

And, we should not forget to mention that we now have a true consent to settle built-in to our policy standard. This gives you more power, as the policyholder, to choose whether a claim is settled or we continue to fight on your behalf.

And here’s more…

Facial acupuncture coverage is now included with no additional costs (many of AAC acupuncturists are doing facial acupuncture, so we make it sure they are insured)

For injectable substances under your policy, you must have proper and state approved training and certification in order to do injection therapy. Remember, injection therapy cannot be utilized to treat a specific condition and you must follow clean needle techniques.

We also cover pregnancy and fertility (note that your care should be in coordination with the patient’s OB/GYN medical doctor. In addition to that, turning a breech baby including labor, is also covered in the policy

An additional profession under your current acupuncture malpractice insurance policy is also covered. For instance, if you are doing massage therapy apart from acupuncture, you can get that covered under your current policy for only $24.

The premier program

This features an even greater layer of protection. With premier program, general liability increased from your standard premises liability, your products liability, and cyber liability to $20,000 from $10,000 (doubled).

All of the covered proceeding will be increased from a $30,000 sub-limit to a 50,000 limit.

All of the specified items above under the premier program are added to the policy with only $125 additional cost per year.

Have more questions about our acupuncture malpractice coverage? Contact us today to learn more valuable information straight from the source.

Call us at (800) 838-0383