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Choosing Safe and Effective Cosmetic Tools – Michelle Gellis

 

 

For today’s lecture, I am going to talk a little bit about each one of the tools, their benefits, some considerations that you might have when you’re looking into these tools, and then also safety concerns.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name’s Michelle Gellis. I am an acupuncture physician, and I am going to be doing this short presentation for the American Acupuncture Council on choosing safe and effective cosmetic tools. For your treatment space and this will be part one of a two part lecture. So go to the first slide, please.

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So a little bit about me I have been teaching cosmetic acupuncture for a little over 20 years. I’m on faculty. at Yosan University, and I have recently published a book which let’s see, you can, let’s see, this way you can see what the book looks like. It’s a hardcover book and it is called Treating the Face.

Oh, thank you. It is over 500 pages of color, Images and information about treating the face, 5L Lumen acupuncture, cosmetic acupuncture, neuromuscular acupuncture, facial motor points, scalp acupuncture, submuscular needling, facial cupping, facial gua sha, microneedling, red light therapy, skincare, and more.

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And self care and you can get the book from my website facialacupunctureclasses. com. I know a little bit about buying tools for treating the face because when I am treating patients, I have a few different tools that I use. And I have a where I actually have designed and sell tools. But I have spent a lot of time looking into different tools and devices and their efficacy and their safety.

And in order to save all of you a lot of time, I thought I would just put together some really good information on what you should look for when you’re deciding what sort of tools to bring into your treatment space. Some of the tools that I use in my treatment space that are very popular are microneedle pens, dermarollers, hydrorollers, hydroneedles, facial cups, Facial Gua Sha tools, and red light devices.

For today’s lecture, I am going to talk a little bit about each one of the tools, their benefits, some considerations that you might have when you’re looking into these tools, and then also safety concerns. So first is microneedle pens. These are relatively new devices. They’ve Been around for 20, maybe 30 years, but essentially they are it.

They call them pens because they look like a pen, and at the tip of the pen are tiny little needles that vibrate in and out, and they puncture the skin, and they cause microtrauma to the skin, and they cause microtrauma to the skin. When this microtrauma happens, it causes the skin to remodel to produce collagen, and it can be really effective for things like fine lines and wrinkles.

And the treatments are very fast. They, it doesn’t take very long, about 20 minutes to treat the entire face. You can also use these on the neck, the chest, the back of the hands, pretty much any part of the body. But you do need to be trained in how to use them. It’s not intuitive how to do microneedling.

And, They’re really just treating skin level concerns. Another concern with these is sterilization. So when we talk about safety, we’ll talk about that. Another device is derma rollers, and derma rollers are similar to microneedle pens in the way that they work. However, these are manual. Microneedle pens either run on battery or you plug them in, or some of them are both.

And these devices, you just hold them in your hand and you roll them on the skin. And they have tiny needles which penetrate the skin, which help to stimulate collagen. And, will also help to exfoliate and increase the absorption of any products that you might put on the skin. They’re not going to be as precise as a microneedle pen and they can’t always be sanitized as well.

With the microneedle pens you throw the tips out after you use them, the tip, but with the derma roller you tend to use it over and over again, not from patient to patient, but If you’re doing these as in office treatments, you can use the same device on a treatment on a patient multiple times. A HydroRoller is very similar to a DermaRoller.

As you can see here, there are tiny little needles. on this device and this glass container at the bottom gets filled with serum and you roll it on the skin and it infuses the serum right into the skin. So the benefit is you’re really combining two treatments into one. You’re getting the stimulation of collagen and you’re getting the absorption of the product but It’s really going to be limited as far as how much serum it can hold.

A hydroneedle is very similar to a hydroroller, but this is more of a stamping device, so it has these tiny little needles with a little plunger. And you feel, you fill the reservoir with serum and then you would stamp it into the skin. So it’s very precise delivery and, but you just want to use it in specific.

areas.

Facial cups are wonderful. They’re a great add on to cosmetic acupuncture treatments. They help to stimulate blood flow and qi to the face. They’re non invasive. They don’t hurt and but you do want to Make sure you get trained in using them. You don’t want to leave any bruises or cause any injury to your patient’s face.

Facial gua sha tools are made, I like the ones that are made out of jade. Jade is very much a part of our medicine but they can be made out of various different materials and they can also be made in different shapes and The benefit to using them is they can help with lymphatic drainage and they can break up fascial adhesions and they can really sculpt the face if someone has like puffiness under their eyes.

If their jawline is sagging, you can use a gua sha tool for this. Again, you want to make certain that You are properly trained.

Red light devices are Again, something that are a little bit more modern than let’s say our acupuncture needles, and they come in different forms. Here we have one that just sits on the table, and then this one is a freestanding device, and each one has its Benefits. These tend to be the ones that just go on the table tend to be less expensive.

The freestanding ones are more flexible. You can move them anywhere around and it’s just the important things to look for. We’ll talk about in a little bit, but they are pain free, they’re non invasive, and they can heal with a lot of skin level issues. And some of them even have settings for pain.

Safety first. Most importantly, when you’re looking at devices, you really want to take into account, are these devices safe as well as effective, because there are a lot of devices for sale in many places, online, on TV, at your local store. cosmetics shop or uh, wherever you shop, it seems that they have all different types of devices.

So you really want to make certain that what you’re getting is safe. So first I want to talk about microneedle pens and the things that are important. With a microneedle pen are the needles themselves, because those are the real powerhouse of the device. So the microneedle pen needle cartridge, which is disposable, The needle should be made out of stainless steel or titanium, and then so the stainless steel keeps them stainless steel keeps them strong, and the titanium keeps them strong, and very few people are allergic to it.

Check. to titanium. So it’s good if the needles are made out of that. And also the motor of the pen itself, you want to make certain those needles are going up and down at least 16, 000, preferably 18, 000 RPM, because you don’t want The device to be dragging on the skin. You want to make sure that these cartridges get firmly attached into the pen.

And also make certain your pen is CE certified for safety and reliability. And you can even check with the American Acupuncture Council. The American Acupuncture Council has approved the AcuLift Micro Needle Pen for use in the treatment room. Also, anti backflow technology means that not only do you have three connectors on the tip, But also on the inside of the pen, there’s three places where it connects and that the cartridge itself clicks on and stays in very tightly.

For Dermarollers, again, titanium, stainless steel, very important for durability and safety. And you want to make sure these needles are lined up. and that there are enough needles on the roller so that your patient doesn’t have a lot of pain. If there’s too few needles on the roller head, then they can have pain when they’re being The handle should be well constructed, should fit well, feel well in your hand, and you want to make sure that it rolls smoothly.

It shouldn’t be dragging on the skin. With the hydro rollers, there’s a lot of concerns as well, especially since you’re using these devices over and over again. So you want to make sure once you put the serum in, that it This reservoir is sealed well. Again, needles that are either stainless or titanium.

And with the HydroRollers, having them gold plated can add an additional layer of it being hypoallergenic, microbial, added durability wonderful for conducting serums and Making sure that your device has well made needles for precision and for comfort. And gold can help with the healing response. So these are all things to look for.

And then when you’re buying one of these devices, you want to make sure that it’s packaged properly, that it’s sealed and that it’s sterilized. Many of the same concerns that we have with hydro rollers, we’re going to have with hydro needles. So the material and that the. Top screws on tightly, sterile packaging, easy to clean so the top should be able to come off, you can throw it in with some sanitizing tablets, and again, the gold over titanium needles.

For facial cups, The cups that I like are the glass cups. You don’t want them to be plastic or silicone. They can drag on the face. You want to make certain that everything that’s involved here is non toxic. And cupping sets that have at least two different sized cups, because these are small smaller cups.

They’re only just for comparison, the larger cup, the opening is about the size of a dime, so they’re pretty small. With the Gua Sha tools I already mentioned, I love Jade. If you’re using Gua Sha tools that look like this, make sure they’re actually made out of jade and not green glass. They should have a smooth finish.

They should feel cool in your hand, be chip resistant. And if you can find out where they’re sourced, ethical sourcing is also a nice bonus. For the red light devices, when you’re looking at quality and safety, you want to make sure that they have a minimum of 630 nanometers. 850 is where you’re going to be getting into those pain settings consistent power.

And it should have some sort of heat management. If the device itself does get warm, which it shouldn’t, you should still be safe to touch it. And look for something that’s durable, that’s sturdy, that’s not a flimsy device. Okay, so we’ve talked a little bit about the different devices and safety.

And next time we are going to talk about some more practical considerations. ease of use, matching the tools to different skin types and different treatments, and also integrating different technologies. How do you integrate all of these different devices? So thank you so much, and I want to thank the American Acupuncture Council for this opportunity.

Again, my book is available right now only through my website in the US. If somehow you’re catching this in another country, check with your local booksellers online. We have some distribution going on internationally. Thank you so much.

 

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License Protection

Acupuncture Malpractice Insurance – License Protection

Does an acupuncturist need license protection?

Acupuncture malpractice insurance is critically important to all practicing acupuncturists.

Acupuncture malpractice insurance ensures you are fully protected with the right insurance to continue helping patients with care and confidence.

One of the several benefits of Acupuncture Malpractice Insurance is License Protection.

A malpractice complaint can escalate to the regulatory body, potentially hanging your license in the balance.

Acupuncture malpractice insurance typically includes coverage for legal representation in the event of board hearings, helping you safeguard your professional license and reputation.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!

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When To Give A Child A Smartphone – Cowan & Heller

 

 

And today we’re going to talk about a topic that comes up all the time, and that is the use of smartphones and technology in children from a Chinese medicine perspective.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Stephen Cowan and I’m happy to be presenting here today thanks to the American Acupuncture Council, very thankful that they have this opportunity, this platform. And I’m joined today by my dear friend and colleague, Moshe Heller, who teaches with me around the country on pediatrics and Chinese medicine.

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Hi, Moshe. Hello, Stephen. Nice to be here. Nice to see you again. And today we’re going to talk about a topic that comes up all the time, and that is the use of smartphones and technology in children from a Chinese medicine perspective. So let’s go to the first slide. This is an interesting question, and I believe that Chinese medicine is more than needles.

It’s a way of life and being modern practitioners for Chinese medicine and carrying that perspective, the understanding of Smartphones and tech, this powerful technology raises an interesting dialogue that Moshe and I have been having and parents ask about it, particularly with their teenagers, but I think it’s even more important to talk about it with babies all the way up.

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When is the right time to introduce a smartphone? What are the dangers, etc. Things like that. Yeah, that’s a, it’s a very big common questions. And I think one of the things that we have to understand as you mentioned here before is that we need to look at what, how can we translate what’s happening from a Chinese medicine perspective so we can help in balancing that and understand what we need to do in order to make it because Exactly.

Exactly. We can’t stop it from happening. No, the cat’s out of the bag, right? The Pandora’s box is open. You can’t make this go away. We all have smartphones. Parents are using smartphones. So it would be ridiculous to put your head in the sand and say I don’t believe in smartphones because they’re going to be here.

And there are all kinds of positives and negatives. It’s the obvious. Negatives that people know about are addiction, right? Exposure to dangerous things, pornography and violence and things that we don’t want. Bullying misinformation and, loneliness, right? These are the kind of five things that I think, We all fear when it comes to exposing young children.

Let’s go to the next slide and talk about a deeper level of Chinese medicine understanding our society. You can do the other one too. Yeah. So this idea of so much yang in our society at the expense of yin because the circle doesn’t change. If you got more yang, you got less yin. But in our case, we have both happening simultaneously.

Too much, too fast, and too little, too late. And one of the things, Moshe, you and I teach wherever we go, is the What we’ll call the sensitivity and openness of a child’s heart mind, right? This very a kind of gentle, open, innocent heart mind, body, way of consciousness that is absorbing the world.

And here we have this modern society. And I think that’s the first place we have to sensitize parents is understanding both the yin yang philosophy and understanding the nature of a child’s mind and body, right? That quality. They’re not, the classics say children are naturally more young. and more underdeveloped in their yin.

So if you add to that this sequence that we can, everybody can see here, so many things on this list of too much, too fast, that’s cumulative, that’s adding to the natural societal yang nature, right? And then couple it with too little connection, too little exercise, too little darkness, right?

You can leave lights on all night, right? Kids sleeping with lights on. Too little slow and quiet time, too little sleep, too little exposure to natural surroundings. That’s a kind of societal yin deficiency. And so it’s a lot of that stimulation. So it creates, supports that imbalance. Yeah. Yeah.

And I think your kids went to Waldorf school where they actually were very strong in holding off on screens and technology. And There’s one thing I want to just put out. There’s actually two things. One is that actually one of the things we need to think about is that looking at a screen, whether it’s an iPad or it’s a cell phone or it’s a TV, is, on one hand it really makes the feeling that the, or the parents have a feeling that it actually calms the child where the, suddenly there’s quiet, there’s nothing there’s no interaction.

They’re plugged in. But on the other hand, what is happening is all that energy goes inside and creates excessive or extreme stimulation. So it’s actually very similar to a stimulant. Oh, absolutely. And a hypnotic stimulant in that sense. But there’s another piece that’s a really good point you’re making.

As it’s going into the being, the child, there’s a natural feeding of the mind at the expense of body. So you’re creating a tension between the more yang head and the yin. body or lower part, right? So they’re not embodied. They’re so sucked into this technology because it’s so stimulating. that they’re transfixed, but it’s pulling them out of their embodiment, right?

So you’re getting this tension split of being disembodied and engaged, and it looks like he’s learning, or he loves it, or he’s, quiet for a chance, right? How many kids with ADD come to me And they say he has no problem paying attention when he’s on his video games or when he’s on his smartphone, right?

And that’s evidence of exactly what you’re saying. They’re being sucked into this very powerful technology that’s designed to capture your attention, right? There’s another component that when I mention ADD, I have seen over and over again what I call slow modem syndrome. The more you’re exposed to fast technology, The harder it is to go back to slower analog settings, like sitting in a classroom, because it’s like working on a slow modem.

You tear your hair out. You go crazy. It’s like, why isn’t this thing responding, right? And you’re being forced, after you’ve been playing for three hours on, Your screens on Roblox, on your phone, having to sit in the classroom becomes torturous, and there’s a lot of acting out behavior, distractibility, hyperactivity, impulsivity, and then they’re being medicated for that.

So yes, I think it, you’re absolutely right that if you were expecting the child to go back to the classroom after playing a video game, that seems, Extremely impossible. So one of the questions I will ask a kid when I play that out in front of the parents, I say, Let me ask you something.

Why would you want to make school more boring than it already is? And they look at me and they say, I don’t want to make it more boring than it already is. And I said the more you play Expose yourself to this technology. By default, it’s harder to go back and all of a sudden the light goes on with somebody in the family like, Oh my God, we’re actually contributing to the problem.

And so we’re opening up those ideas. Yeah, I have a question about that because I’ve been really struggling with this kind of problem that comes from exactly this point, is that I see that there’s a lot of bargaining with many of the kids that are, that the parents have an understanding that they cannot give them free use of screen time, that they will bargain and sometimes It’s almost like this kind of fighting between the parent and the child.

Oh, definitely. I see it. I earn more time, and and if you do this I see it all the time, and it’s being used as a reward or bribery, right? If you do your homework, you can do, two hours of this. I had one kid, the father was a techie, and really deep in, made a lot of money in the tech world.

And the kid He had set up these, rules, and it turned out the kid was cheating. He was a techie too and he had played nine hours of video games. And in one day and the father was like horrified, right? Nine hours where he was cheating, right? This particularly became a problem during the pandemic where kids were online for school and they were actually playing games or they were Look, I don’t want to demonize all of the screens.

They’re here to stay. It’s a way to make balance, which is what, That’s what Chinese medicine is about, finding that dynamic equilibrium of these two polar aspects of our engagement. The rule I use at home with people, with kids and families, is a one to one rule that I call the green to screen, ratio.

That for every minute that you’re on a screen in a day, You have to have equal number of minutes of time in an analog natural setting. That could be a walk in the park. It could be playing with blocks in your room, something that’s not plugged in to any electronics, right? And as long as you, because the time is limited in one day, you can’t bank the hours for later.

You It limits itself. And, so a kid who’s, I’ve had kids who said, all right, I just did two hours of exercise outside. Can I do some screens now? And I say, yeah, but there’s another rule, an hour before bed, because you don’t want to interfere with your melatonin levels. So an hour before bed, all screens are off in the house, including the parents.

They have to, Pretend to turn off their own addiction while the kids are going to sleep, because it’s not fair. And I’ll hear this over and over again if the parents don’t practice the same principle. The classic place where this is a problem is the dinner table. Screens at the dinner table, phones at the dinner table, and getting parents to break their own habits.

is critical, right? Yes, but there’s another thing that you mentioned in another talk We gave, Moshe, that is so dear to me and really important and that is when we’re asking the question of When is a good time to introduce a smartphone to a kid? Which is a big question I get asked. I think this idea that different kids have different Needs, different sensitivities, and you have to know the complexity of the temperament of a child.

For example, More fiery kids, where that phase, that element, is stronger in that kid, because we’re a complex of all of them. They’re more prone to addiction, because, I find a lot of fire kids just love scrolling through YouTubes and finding all kinds of wacky things that they can’t stop looking at, right?

Whereas, More of the woody kids are more prone to looking for pornography and violence and danger and, they’re just curious about it. I’m not blaming them. It’s part of their nature to be curious about those kind of things. Yes. Earth kids are more prone to the bullying that takes place in, in social media and to FOMO, fear of missing out, right?

They’re voyeuristic. They want to know, is anybody talking about me or are they including me? That’s a very earthy, spleeny way of thinking. So they’re vulnerable to that aspect. I think metal or gold kids are much more prone to misinformation because they’re collectors of information and data. And so they’re prone to get, coming up with the wackiest information, that we see that’s littered in the internet, some of it causing great fear and concern when it’s not even true. And then most, and probably most importantly, is the water temperament or the water within us all that is prone to alienation, aloneness, being cut off from the world because they’re so sucked in so deep.

So knowing the temperament of your child becomes a way of gauging age. When is that, knowing your kid and knowing how they’re developing and what are they prone to already helps guide you in terms of timing of introducing these things. Some people say There’s a movement in parents now called wait until 8th.

Wait until 8th, meaning 8th grade. Because waiting till puberty begins for a smartphone in particular, which is a full on computer that’s in your pocket, as opposed to what we’ll call a dumb phone, which you can use to call mom to pick you up from a basketball game or whatever. But smartphones are a very powerful computer that has access to the whole world.

So that’s one kind of global guideline. I don’t like global guidelines. I think it has to be fit to the needs of the family and the child specifically, but it’s something to think about. Yeah. And as you mentioned before, my daughter went to a Waldorf school where there’s a very strong anti media screen phone exposure till and they also talk about how to expose and the But their concern is mostly about The information that’s being you can be exposed to.

And that’s another, probably totally different talk. I find it interesting that your daughter, who’s a whiz at at IT now was someone who was not exposed early. So it doesn’t delay you in that, but in some kids, particularly in some kids, it makes it even more. enticing by restricting it.

So you have to know your child to know how you can go about doing this. Let’s go to the other, the next slide and talk about that. An important thing, I think to just also talk about that from Chinese medicine perspective, this kind of Excess energy that you mentioned that goes up to the mind being the heart shen can actually imbalance and create less fire in the lower part of the body, in the minstrel fire, and create what we might call now, in fire, right?

As we yeah, it literally, kids where their feet are cold, and their head is hot after playing these, being online for a long time, there’s a physical effect and the poor spleen gets caught in the middle, right? Which is already dealing with absorbing information in the form of food, in the form of exposure to information online.

And gets overwhelmed, right? And so it’s a setup for this quality that, Dongyuan Li Dongyuan talked about this Yin Fire mixed pattern which I think is contributing to a lot of the disorders I see both physically and mentally in children today. Yes, that that plays to another aspect, which is very interesting, I think, is that, A lot of times when we are thinking of balancing that, we should think of the Shaoyang level and Sanjiao gallbladder kind of level where it enables to shift back some of that excess top fire back down to the minstrel fire and create a Better balance with the spleen in the center.

Yeah, I you know, I talk a lot about san jiao as the Relationship organ of the body so that everybody’s relating to each other one big happy family and these the screen addiction of our society is a breakdown in those relationships. So always think of Sanjiao. Both Sanjiao points and Sanjiao concepts as part of the Xiaoyang as integral to the kind of integration of heart, mind, kidney, pericardium, this primary, uh, yin yang relationship.

And in terms of any kid that comes into your office who’s having trouble relating, whether they’re relating to friends, relating to family, relating to the school work, relating to food, whatever, anytime you think relationship, think Sanjiao. And of course, gallbladder being one of the kind of special organs.

this unique, powerful organ that, is kind of part of the extraordinary organs related to mind. So I do, you’re right. It’s really important that we have this concept in our mind when we see the effect of early exposure to powerful technological advances will hit this complex and cause a kind of upside down pattern of yin and yang.

Correct. And, I also have been noticing that one of the a lot of, one, one symptom that I see that comes up more frequently in my practice I don’t know, I know that probably you too, is that I see much more ticks. Yeah, and particularly tics of the neck, shoulders, head, face, eyes, right?

It’s all the yang aspect that’s ticking, right? Occasionally, you’ll get a hand or a foot, but usually it starts with the head. So this is a great example of that and important to approach it with this model. And one of the things, interestingly, one of the herb formulas I’ve been using for tic disorders in general, no accident, is Buchong Ichitan, right?

Believe it or not, even though you’d think, wow, isn’t that potentiating the Qi? Yes, but we’re trying, this is one of the principles of yin fire treatment is not suppressing, right? The yang, but actually improving the relationship of yang. Yeah. The idea is that the pericardium is not necessarily it’s, That deficiency is manifesting in a excess and somewhat correlates to what we sometimes in the course that when we teach, we talk about this kind of hyperactive spleen chief acuity.

That concept also comes from this idea and the importance of strengthening the spleen more so than dispersing that kind of what may seem excess. Exactly. And so the spleen, stomach, middle, burner is what BuChong means, right? Health, unhealthy. Exactly. And I think that was the brilliance of Li Dongyuan’s idea.

It’s so applicable to pediatrics. And we get into a lot of that discussion of both Sanjiao dynamics and hyperactive spleen qi, acuity. in the course. So I think this is a great example of how to see smartphone technology from a Chinese medicine perspective. So I think at this point we can And this discussion.

We’re interested in more about treating kids. And we really encourage all practitioners to be kid friendly because kids respond so quickly. It was very rewarding in your practice. And we’re doing come visit us at the Jing Shen pediatrics site where we’re doing teachings. We have online teachings.

We’re planning some in person teachings and we welcome you guys to be there. And I also want to just point out one more very important thing that I was thinking about is that I think one of the things that when we learn go back and look at the theories and how they manifest in children It actually enables you to even treat adults in a little different way.

Absolutely. Good point that we all have a child inside us and tapping into that. This is old trauma. This is the child activating the child nature, right? Longevity. All of these things, the virtues of a child, when we can tap into that and treat that in adults, it’s very beneficial. I a hundred percent agree.

Thanks, Moshe. This is why I like teaching with you because we always play off each other and remind each other of ideas. So let’s thank the American Acupuncture Council again for hosting us and we look forward to seeing you guys again. Yes. Thank you. See you soon.

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Legal Protection

Acupuncture Malpractice Insurance – Legal Protection

What is the most critical item every acupuncture practice should have?

Acupuncture malpractice insurance ensures you are fully protected with the right insurance to continue helping patients with care and confidence.

One of the several benefits of Acupuncture Malpractice Insurance is legal protection.

American Acupuncture Council recognizes acupuncture as a widely used alternative treatment, but like all healthcare professions, it carries the risk of malpractice complaints.

Acupuncture patients could file lawsuits alleging injury, infection, or malpractice after treatment.

That is why malpractice insurance should be put in place to protect your practice, as it covers legal defense costs, settlements, and judgments should a case proceed.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!

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You’ve Been Approved for 25 Visits – Now What? Sam Collins

 

 

 

But let’s talk about today’s program. Let’s talk about when you see a policy that says they get 25 visits.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Greetings, friends and colleagues. This is Sam Collins, your coding and billing expert for Acupuncture, the American Acupuncture Council, the American Acupuncture Council Network. But more importantly to you, your success is ours. We’re always here to try to make sure that you have all the best available information to make your practice thrive.

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I want you to be the best possible provider and focus on that. Allow us the chance, the Council, to be that support service for you, where we’re there to help you with all the nuances. That’s what network members get from us. But let’s talk about today’s program. Let’s talk about when you see a policy that says they get 25 visits.

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What does that really mean? Or when it says we have 40, 80, or whatever, what about some plans that it’s actually unlimited? Does it really mean that? So let’s go to the slides. Let’s talk about this when we get policies that tell us the amount of visits that someone has. What does it really mean when a policy allows 25 visits?

Does it mean they get 25 automatically? That no matter what, I hope all of you are going, well, no, that’s probably not true. What we have to have every time is it has to be medically necessary. It’s not going to be just an automatic. It’s going to be, should it come up as something that’s necessary? In other words, if a person says, I feel fine, I feel perfect, but I want to get my 25 visits.

Will the insurance allow that? And that’s where we have some difficulty because when patients have policies like these, they have the false pretense that, Oh good, that means I can come two times per month this whole year and the rest of my life. Now, as much as I would love that to be true, that isn’t always medically necessary.

So we do have to keep in mind that we need to learn to navigate and achieve the optimum utilization, make sure patients are aware. Now realize, many people have conditions. Pain and otherwise. That could require some acupuncture services that will max out those visits and could be that way, but we have to make sure, do we have it medically necessary?

Is it automatic? Does it mean they get to use it at their discretion, two per month? But what about maintenance? Will that be covered? Well, first we have to think of what is medically necessary because in order to have 25 visits, you’re always going to say they’re looking for medical necessity, something that is necessary for the patient.

And that must be delivered with defined, reasonable, and evidence based goals. Now, realize As an acupuncturist, there’s many things you can treat beyond just simple what I call the physical therapy chiropractic side, which is musculoskeletal and pain. It can go beyond that, but we still have to have evidence of the changes.

It must be based on the patient’s presentation of their diagnosis. Make sure it’s a covered diagnosis. That’s probably going to be number one. For a patient to be covered for acupuncture, you have to find out what are the covered diagnosis. By example, Aetna and Cigna have very similar covered diagnosis, but there are many more with Cigna than with Aetna.

But what about Blue Cross Blue Shield? So it’s sometimes learning that nuance. This is what we do for you at Seminars, of course. So make sure we have the diagnosis, but then also, what is the severity? What are the clinical findings that demonstrate the need for care? It says, continuation of treatment is contingent upon progression towards defined treatment goals evidenced by specific significant objective functional improvements.

Notice it says here, outcome assessment scales, range of motion. The good news is, pain, which is the number one thing acupuncturists treat, is always going to cause some dysfunction of some type. Their function is going to be less based upon their pain. So talk about when a patient says they’re having pain, even if it’s headaches, what is this headache causing you to have problems with?

Oh my goodness, I couldn’t work. I can’t work more than 30 minutes at a time. We’re had to take a day off. All these things demonstrating some type of evidence of a functional change. I think acupuncture works very well here. Think of how many types of doctors you can see, but how many can you treat with that when you leave the visit, You literally feel better.

I mean, if you go to a medical doctor with a headache, and I’m not saying this is a negative, what is a medical doctor going to do? Evaluate you and make sure it’s not nothing more severe, but then otherwise give you a script for pain medication. They call it in by the time you can get the prescription filled, hours later, maybe the next day, then you take it by then.

Maybe the headache was gone on its own or it can help. Someone comes to you with a headache. How many of you have witnessed what I call the miracle of acupuncture? that they leave going, Oh my God, I cannot believe that worked. I’m without a headache and I came in with one. That happens all the time. So we want to demonstrate that the patient has changes.

So always rely on how you document as demonstrating the number of visits. Cause 25 visits are certainly reasonable. If you can show they have a headache after a certain number of visits or time, the headache is gone or reduced. Now, can that headache return? Absolutely. So it’s not a never ending. It says certain conditions require to be co managed by a medical provider.

If you’re dealing with, some plans cover addictions, strokes. Cancer related. Well, those you’d want to be working with them. By the way, I took this directly from Cygnus coverage and it says, medically necessary services including monitoring outcomes with progress and change in treatment, with a withdrawal of treatment if the patient is no longer improving.

I mean, let’s face it, how many patients are going to continue to come to you if you’re not helping? This is the hard part because patients start to understand the value. and necessity of care. Our job is when do we demonstrate that that care is no longer medically necessary from an insurance standpoint.

I think so long as we can demonstrate there’s ebbs and flows and we’re showing improvement or can be supportive, I think we’re going to be on the right track. Just be careful. Maintenance or non covered means it’s intended to improve or maintain general physical condition. I don’t disagree with that. I think certainly healthcare should be part of that, but that’s not what our insurance is for, is it?

Insurance says Sickness or disease. So it’s not about keeping you healthy. I wish we would no longer call it health insurance. We should call it sick insurance. It says maintenance acupuncture services when significant therapeutic improvement is not expected. So it’s maintenance when it’s not expected.

Now that doesn’t mean it has to improve every time. So when someone says there’s 25 visits during that 25 visits, if we’re noticing a continuance of improvement medically necessary, the difference is, How do we demonstrate it? Are you using outcomes to do that? Are you giving me the true objective changes?

Don’t tell me or rely on the patient feels a little better. That’s certainly not going to be adequate. That’s part of it, but they feel better. How? What functional change? What objective change do we have? It says services that do not require the skills of a qualified provider, such as acupuncture, are limited to that can be practiced independently and self administered.

So in other words, if you’re just saying we’re coming in and just doing exercises. only. They’re going to say, well, why couldn’t they continue that at home? So you always want to show that it requires a skill, meaning they’re getting true acupuncture services. Home exercise services can be formed safely and independently.

It can’t be just that. Now, should exercise be part of the care plan? You bet. But I want you to keep in mind, when I go to an acupuncturist, you know what I want? Acupuncture. Chances are we’ve tried exercise. Now that doesn’t mean you’re not going to give me some better ones. And I’ll say doing Qigong type exercises, if you will, or physical therapy type, or just gym type are all helpful.

and could be part of it, but the thing that separates you is going to be the acupuncture. So keep in mind, there is something though that insurances will cover, particularly on some of these visits, what they call supportive care. And it says supportive care can be referred to as ongoing or long term treatment or care, and it may be necessary as treatment for individuals who have reached maximum benefit.

In other words, they’ve reached maximum benefit, but you notice right after you withdraw care, They begin to have a significant drop off. Now, what we want to do, make sure we’re showing, because of that drop off, they’ve been doing home exercise. They’re doing things to help prevent it, but it doesn’t do it.

So, you want to demonstrate that the patient can get ongoing improvement. with the care. When it falls off, we get them back treating again. So keep in mind what they don’t cover though is a true maintenance. Supportive is different from maintenance. Supportive is in the absence of care, it significantly drops off.

Demonstrate that objectively and subjectively. If we’re just saying it stays the same and we don’t want it to get worse, that’s a difference. That’s where this comes in. The member’s symptoms are neither regressing or improving, is considered not medically necessary. If no clinical benefits can be appreciated after four weeks of acupuncture, then why?

Now, notice what it says here. They’re initially giving everyone probably four weeks. Now, four weeks for you could be one time a week. For another person, it could be two times a week. So, keep in mind, it’s not just number of visits, but over a time period. There are some service providers who might do one visit a week.

What I want you thinking of is, if I give care, Can I show improvement? No matter how many number of visits they’ll have, they’ll allow it. I have an office, and this is not a joke, they’ve treated someone probably the last, and I’m not going to over exaggerate it, for sure the last two years, I can say for sure, and they’ve treated this person 40 plus times every single year.

Now, grant you, they have a very significant chronic condition, arthritic changes, and so forth, but they don’t treat 40 continuously. They’ll treat usually 10 or 15 per an episode. They may not see them for weeks, maybe a month, and then treat another 10 or 15. And that same thing has gone on. What they haven’t done is just treat them every other week.

Now, some people might say, maybe that’s better. Well, unfortunately, that’s not how insurance works. So we want to make sure that we can demonstrate always meaningful improvement in symptoms and objective changes. And here’s a good example of a plan like this. This is the Costco plan under it. And I’ll just have you go to the first part here.

It says changes in coverage for chiropractic services. You’re thinking, what? Bear with me and let’s read on. Currently, chiropractic services are covered as an alternative care benefit. You pay a co pay for each covered chiropractic visit, and you’re limited to a combined total of 20 alternative care notice.

Acupuncture, chiropractic, homeopath, and naturopath. Costco is very generous. So what is that telling us? Do we get 20 visits per year? for acupuncture combined with others. But notice what began this year, January 21st, they’re allowing a little bit more for chiropractic, but it’s all based on medical necessity.

They’ll allow up to 90 visits per year. So what I want to highlight is visits, if they give you 90, 20, you still have to demonstrate the patient can get better as a result of the care. That doesn’t mean we’re curing, but maybe we’re getting to a point where they remain functional. And when that dysfunction drops, We continue treating.

Be careful. I think we’re the ones that have to explain to a patient. 25 visits doesn’t mean automatic visits. 25 visits still comes back to medical necessity. So we’ve got to give our patients a financial agreement. I hope all of you are doing something like this. It’s part of the no surprise, regardless of what a patient thinks is covered.

We want to put this out there. Many insurance policies do cover acupuncture care, but this office makes no representation that yours does. Insurance policies may vary greatly in terms of deductible and percentage of coverage for acupuncture care. In other words, we’re going to do the best job we can to get your plan to cover.

We’re not promising anything. What we’re promising is good care and that ultimately you will be personally responsible for the payment of your deductible as well as any unpaid balances. We go further to say if you have insurance, we’ll bill as a courtesy. Of course we will, but payment for your deductibles if it has not been met as your responsibility.

Your copay is due as services are rendered. What we want to do is give patients good quality care. And here’s something to keep in mind. Your practice as a cash practitioner is important, but it’s even the same when it comes to insurance. Insurance pays part of it. It’s just easier for someone to come in when they have insurance that pays part of it.

I want to access that, but I don’t want to give a false sense of security. Think of it this way. When someone really needs care, they pay for it. There’s a value. We want to continue to have that value, whether there’s insurance or not, whether it’s unlimited visits, that the patient understands it. Keep in mind.

Acupuncture care works really, really well. That’s the medical necessity. But does your documentation present that? This is one of the common problems I see when I have offices I work with in dealing with when they get denials or non payments. How do we fix that? Well, demonstrate the patient made, the treatment made the patient better.

I would implore all of you, acupuncture works really well, but if you look objectively in your notes, Can you see that in an evidenced way? I’m going to recommend that you always use an outcome assessment on every single patient. Even if it’s cash, by the way. Get an outcome assessment. It demonstrates objectively how the patient is changing.

The two that I like the best are the general pain index. The other is the pain interference, the short form. The latter is the one the VA is emphasizing. If you’ve attended a seminar with me, you’ve received them. If you’re a network member, But start using things that show acupuncture works. It’s your way of putting a person on a scale and show they’ve lost weight.

Acupuncture is a phenomenal profession, but you have to make sure how do I navigate to continue to increase my patient base, which means also increasing your volume of patients by volume of income. Because ultimately, remember, you are a business provider and we’ve got to make business decisions. So I always want to be there to help you navigate that as the American Acupuncture Council does.

So until next time, my friends, I wish you the very, very best.

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Benefits of a Patient Arbitration Agreement

Benefits of a Patient Arbitration Agreement

How important is an arbitration agreement?

Arbitration is an alternative to court, where claims can be heard so when patients sign arbitration agreements, your patients agree that, if they want to bring claims against you, those claims will be heard in arbitration rather than in court.

Arbitration is more private. Instead of in an open courtroom, arbitration typically occurs at an alternative dispute center in a conference room.

Arbitration can be scheduled much sooner. This benefits you because then you do not have the stress of an open case for several years.

The case is heard by an experienced arbitrator, who understands malpractice cases, rather than a jury.

It is important to have a well-written arbitration agreement which AAC will happily provide you with.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

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