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Sam Collins for HJ Ross

Medicare and Acupuncture 2020 American Acupuncture Council

Hi, everyone. This is Samuel Collins, your coding and billing expert for acupuncture at the American Acupuncture Council, our seminars, our networks, and all that. And I welcome you to another program of To The Point. In fact, let’s do that. Let’s get to the point. My goal, as always, is to make sure to give you information that’s up-to-date, current, and keep your office practice going strongly.

So what’s going on? Well, of course, what’s going on right now, of course, is Medicare. And of course, Medicare and acupuncture has had a lot of confusion, and I want to clear up that confusion and kind of give you some insight as to where you can fit what we can do and what we can do for the future. So where are we going with Medicare and acupuncture? Well, let’s take a look, go to the slides.

So we start off with just simply Medicare and acupuncture. Always know that my email is here for you as well. But let’s talk about what has occurred for Medicare. July 15th of last year, the Trump administration proposed a plan to cover acupuncture for Medicare patients with chronic low back pain, framing it as a step that could more safely treat pain without supplying patients with opioids. And of course, this is kind of what happened because of the VA. Opioids have become a big problem. They’re looking for something else that can be helpful. So credit to that, we’re working towards a proposal.

So this is what happened in July. The Trump administration proposed this for patients with chronic low back pain, so they could safely treat without using opioids. Okay. So what does safely treat mean? Well, acupuncture. The proposal released, though, would only be for patients enrolled in clinical trials. So this is what initially happened, just clinical trials and under the National Institute of Health. In its statements, CMS acknowledged the evidence base for acupuncture has grown in recent years. However, questions remain.

So what they did was they said “We’re going to open up a dialogue,” and they allowed everyone to send in information to see whether or not it would be helpful. And the idea first, and as I was told by many people in NIH, it was solely going to be just a study. They were going to put a few people in a clinical trial. Well, after all this information, lo and behold, I put fireworks here, January 21st, what I thought wasn’t going to happen happened.

But I’ll give a note. Marilyn Allen, who many of you may be aware of, and I had spoken with a few people at NIH that said something the week before. They said, “When you get acupuncture.” They didn’t say, “If,” they said, “When.” And we thought that was a little puzzling because we thought, “Okay, it’s going to be a study. We have to see where it’s going to go.”

Well, what happened on January 21st is they made this announcement. “The Centers for Medicare and Medicaid services finalized a decision to cover acupuncture for Medicare patients with chronic low back pain. Before this final National Coverage reconsideration, acupuncture was nationally non-covered by Medicare. CMS conducted evidence reviews and examined the coverage policies of private payers to inform today’s decisions.” So what they did was they got enough information from private payers and others to just decide, “We’re going to cover it.” They didn’t need to do a study. They’re just flat out going to cover it for chronic low back pain.

So what does this mean for us? Well, the decision regarding coverage takes into account the assessment benefits and the harms of opioids. It says, “While a small number of adults age 65 or older have been enrolled in published acupuncture studies, patients with chronic low back pain in these studies showed improvements in function and pain. The evidence reviewed for this decision supports clinical strategies that include nonpharmacologic therapies for chronic low back pain.” While there is variations in indications, the bottom line is they said, “No, we’re going to cover chronic low back pain for acupuncture.”

This decision was published in a memo, if you will, and it’s the CAG-00452N, so if you want to look it up. But here’s it in a nutshell, and what it says is this. “The Centers for Medicaid & Medicare Services will cover acupuncture for chronic low back pain under section 1862(a)(1)(A),” which is the Social Security Act, that will cover up to 12 visits in 90 days covered for Medicare beneficiaries so long as the following circumstances are met.

For the purpose that means chronic low back pain is defined by Medicare means it’s lasting longer than 12 weeks, so you’ve got to make sure in the chart notes and history, this patient didn’t just wake up with back pain, but it’s some back pain they’ve had off and on for 12 weeks or greater.

It’s nonspecific that it has no identifiable systemic cause, not associated with metastatic inflammatory infections or other diseases of course, not associated with surgery, and not associated with pregnancy. Now, I will say this, I doubt we’re going to have very many 65 year olds with pregnancy, but that of course is based on some of the other guidelines.

However, beyond the 12 visits they will authorize within in the first 90, an additional eight sessions will be covered for those patients demonstrating improvement, but it says no more than 20 acupuncture treatments may be administered annual. Bear in mind that these 12 visits or initial 12 visits are within 90 days. If you use those up, you certainly could get approved for more. The exciting part here is that the acceptance and how quickly it was to deal with acupuncture and low back pain.

Now, some of you are aware, I have a chiropractic background, but technically if you look at some of the studies, by a small percentage, acupuncture has shown potentially greater outcomes for back pain than does chiropractic adjustments alone. That being said, it also indicates treatment must be discontinued if patient is not improving or regressing. Well, here’s the good news. When someone comes to an acupuncturist with back pain, generally what happens within one to three visits, they’re already showing some levels of improvement. So I don’t think it’s going to be very difficult, though you want to focus on two things: pain reduction and increase in function.

Now, in general, this is the guideline under section 30.3 for acupuncture in Medicare that never covered it. And it says, “Acupuncture,” of course, “is a selection and manipulation of specific acupuncture points.” And it says effective for dates of service January 21st. So actually, when did this begin? January 21st.

Now, the good news is yes, but there are some restrictions, and this is what most people assume that maybe an acupuncturist could bill directly. Well, let’s talk about what is the billing provider versus the performing provider? Because under this provision, this still does not give any indication that an acupuncturist can join Medicare. That’s something that’s going to require an act of Congress. But the billing provider must still be a provider that’s enrolled in Medicare. So that’s going to be a physician as defined by Medicare, which means essentially an MD. So a physician as [inaudible 00:07:08] by 1861 is going to be your medical doctors within their state requirements.

However, it’s also going to allow physician assistants, nurse practitioners, clinical nurse specialists, and other auxiliary personnel to furnish acupuncture if they meet the applicable state requirements. So remember, acupuncturists are going to fit under this auxiliary personnel, which means yes, you can work on Medicare, but under the supervision or direction of the MD as so long as the person, and this is the nurse practitioner, has a master’s or doctoral level or degree in acupuncture or Oriental Medicine by an accredited school or a current, full, and active, unrestricted license to practice in a state or a territory of the United States.

In other words, they must be a licensed acupuncturist, if not an MD. An MD can do acupuncture should they choose. Obviously, most won’t. They’re going to refer to someone. So that referral could go to a nurse practitioner, but of course, the nurse practitioner can only do it if they also are licensed for acupuncture. Therefore, this is the opportunity for acupuncturists to work within an MD setting where the MD prescribes, the acupuncturist performs, and it’s billed directly to Medicare.

Now, auxiliary persons performing it must be under, and I’ve underlined it, “the appropriate level of supervision.” Now, what’s important to see here is this distinction. The term “appropriate level” is a little bit different from what others will often state. Generally, what it’ll say is “direct supervision,” and of course, it needs supervision, but “appropriate level” doesn’t mean that you need as much intervention by the doctor, if you will, the medical doctor in order to provide the service. That’s going to still be more up to the practitioner of acupuncture.

But this can be the supervision, bear in mind, of a physician assistant, a nurse practitioner, or a clinical nurse specialist. So this certainly could be an opportunity where you may have a nurse practitioner that practices with an MD overseeing them, but then has a separate business where you work with them, either they come to your office or you go to theirs, and can furnish these services.

The bottom line is the type of supervision required was changed at the request of the acupuncture profession from direct to appropriate level. This accommodation adds a tremendous amount of latitude for collaborative agreements between LAcs and MD providers or even DOs, nurse practitioners and all. While nurse practitioners and clinical nurse specialists and physicians assistant may not practice acupuncture, their supervisory availability also vastly expands the potential for collaborative agreements, which means it doesn’t necessarily need to be an MD. It could be under a nurse practitioner, physician assistant, and so forth. So it means you don’t necessarily have to work directly for an MD but might be working in a clinic setting where there’s a nurse practitioner or other type of provider that can be registered with Medicare.

The difference here, though, is it’s obviously, an acupuncturist cannot bill directly, so you’re going to hear this term a lot called “incident to.” So in order to bill acupuncture, an acupuncturist must be working incident to this provider. So what does “incident to” mean? It means the service must take place in a noninstitutional setting, which in simple terms means not in a hospital. Number two, it must be a Medicare-credentialed physician that must initiate the patient’s care. So we have to make sure the supervising personnel, if you will, examines, determines, “Yes, I believe they can be helped by acupuncture.”

Subsequent to the initial encounter to which the physician can arrive at the diagnosis, this nonphysician practitioner, meaning auxiliary personnel, may provide the follow-up care. So then the acupuncturer does their work, and then once every thirty days or approximately thereof, this supervising person will just check to see how the patient’s improving or not improving.

Then the next step is the care must occur with direct supervision or the appropriate level. Per the Benefit Policy of Medicare, what does that actually mean? Does that mean you could have someone just give you a referral for acupuncture and you do it in your office? The answer to that is no. Direct supervision in the office setting does not mean the physician must be present in the same room with his or her aide or auxiliary personnel. However, the practitioner must be present in the office suite or immediately available to provide assistance and direction throughout the time the aide is performing the services.

So now this is going to get a little bit different here because notice it says, “Immediately available.” For instance, under auxiliary personnel such as a nurse practitioner, it doesn’t necessarily mean in the office. Under this guise, I’m going to state at this point, you want to make sure you’re working with direct supervision, they’re in the facility, and I think you’re going to be at your safest bet.

However, Medicare will begin paying for acupuncture. And I have not any practitioners yet, but I certainly have a few that are already working with the MD setting, so I’m waiting to see the bills come in.

Ultimately, this. The physician or the supervisor must be actively participating and must be working in the management in the course of care. They can’t just prescribe and not be involved at all. Both the credentialed and physician may qualify for this incident to so long as you’re employed by the group. So remember, you’re going to be working as an employee in some way to this person. You’re not going to be working as an independent contractor. In order to be supervised, you have to work as an employee. Independent contractor means it’s billed under your own name; therefore, that’s not going to fit here.

Now, is this as good as everyone was hoping or wanting? I would say not. However, bear in mind this. This was only supposed to be a study, and it started in July, but by January they decided, “Nope, we don’t need the study. We’re just going to cover it.” So I see this as neither a slight to the profession nor an error in any way. Provider types outside of Medicare are by the CMS definition of auxiliary personnel, must be supervised by Medicare providers. But remember, it doesn’t necessarily have to be an MD. This is the maximum freedom that can be granted until the Social Security Act is amended to include acupuncturists.

Now, here is the big problem for us. We need to make sure that acupuncturists, by an act of Congress, can become providers under Medicare. Once that happens, there will be direct billing, and I think that certainly will be the area that we’re looking towards that’s going to be more cost effective. The bigger issue for us, though, the power does not rest with CMS as much, it rests with our profession and dealing with Congress, meaning we need to make sure as a profession we have some type of national certification where we make sure that they can be trusted, that these services are under a guideline that’s standardized on a national level. Not to say that you can’t do things differently, but that we’re going to have to have some national standards, if you will.

The excellent news here is that they’re going to cover acupuncture. Now, some people are going to wonder, “Well, what do they mean by cover?” Well, they’re going to cover the acupuncture codes themselves, meaning they’re going to cover 97810 to 97814. And you may question, what would be the prices of these codes? Well, to give you an idea, the Medicare uses a conversion factor for their codes. The conversion factor is roughly between 37 to $40 depending on the region you’re in, and they base it on the relative value unit. The relative value unit for manual acupuncture is about 1.03, and for electroacupuncture is about 1.15, which means you can assume the first set is going to be paid somewhere in the $40-plus range, the additional sets likely in the $30 range. For many of you, that generally is going to mean what you’re seeing for VA in many instances.

This is a real great step forward, but I do want to warn that it is not for direct billing. We still cannot join Medicare. However, what about working collaboratively? What about talking to some MDs in your area where possibly you work in their office a few hours a week or even just a few hours a month, if you will, to start treating some of these patients to see how they’re doing? Remember, Medicare is a big insurer. Everyone over 65. And how many people that have Medicare probably have a little back pain? It’s a tremendous number. And what they’re trying to do is to give persons an alternative.

Here’s what I will say. Acupuncture works well. Once we start getting more and more of these services provided, you’re going to see where Medicare is going to come on board, allow acupuncturists to join and bill directly. But as of now, what about working collaboratively? So is Medicare perfect for us? No. But think of this step. Who could have imagined even a few years ago that this would have occurred?

I want to thank you for spending some time with me. Please take a note, if you go to our website, the American Acupuncture Council Network, and go to our news section, we have this information and much more on upcoming changes and things happening with coding. I suggest go there, sign up for our email service. What we provide are lots of news items.

I’m going to give you a couple of quick items that are occurring. UnitedHealthcare is requiring modifier GP on all physical medicine codes regardless of the profession. As of note for any practitioner in the New York area, New York Empire is also now beginning this GP modifier. And as I’m sure you’re aware, the VA is doing so as well. In addition, of course, things are changing for the VA. Of course, on the East Coast, they’re now using a company called OptumHealth. The West Coast continues with TriWest.

As always, we want to be the most effective place for your information. Take a look at all of our sites. And I welcome you to always come in and say hi to me. Also, coming up next week will be Moshe Heller. And I wish you all the best, and continue your practices strong. We want to be with you and To The Point. This is Sam Collins.

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Moshe Heller & Stephen Cowan

Harmonize the Earth To Treat Many Disorders

 

Hello and welcome to the show. I’d like to first thank the American Acupuncture Council for hosting this show. It’s great to be here and my name is Moshe Heller. For those of you who have seen me before here I teach, together with Dr. Cowan, a course on Chinese pediatric acupuncture. And today I’d like to speak about harmonizing the earth to treat many disorders. So let’s dive in. I hope that the slides are up.

When we talk about children especially, and we believe that children are born with a really weak digestive system and therefore the digestive disorders are usually the root of many childhood disorders. And so that’s an important thing to remember when we are treating children because although we may see various different disorders, the root cause or the reason that they are suffering from whatever, we’ll see a little later what these might be, are rooted in a weak digestive system so we have to support that in order to resolve the issue.

What we will see is since these kind of patterns of digestive dysfunctions cause different issues in the child such as accumulation disorders or exposure to foods that are not appropriate, those cause different issues of poor transformation and therefore affect the child’s ability to transform. And therefore this accumulation can cause heat and we can see that affecting the fire or the heart with overreacting and overstimulation. We can see also that it can affect the lung and cause issues of accumulation of dampness in the lung and also affecting the kidneys with cold. The cold foods can create different types of issues such as inability to resolve toxicity. And also we can affect, of course, the liver that will cause also wind and affect the emotional state of the child as having different anger issues and so on and so forth.

We can see that although the root cause is in the earth, it can affect any of the five other organs to cause issues of imbalance. I also wanted to point out and remember for those of you who have heard our previous lectures about this really important triad that we call the gastro immune, neuro triangle that each one of these parts are affected by or help to be regulated by the others. So when one part of this is not functioning correctly, then it can affect the others. We have the gastro part, which means that the gut, the digestive system, our gut biome, all that can affect our immune system and also our neurological function.

It can cause issues with either imbalanced immunity or different neurological disorders starting from having inability to focus, to even inability to communicate. So we can see that kind of triangle and really a very important triangle in treating children.

I also wanted to point out that there are many books starting with traditional books like the Pi Wei Lun where Li Dong Yuan talks about the importance of balancing spleen and stomach to resolve many, many disorders both in children and adults. This doesn’t stop at at the child. It can affect also many disorders in adults and I think that even if you are treating an adult and a really important aspect of of that is to look at their diet and see what’s going on in the digestive system to to support many of the treatment many of the conditions that you might be treating. I also wanted to point out that that Li Dong Yuan talks about another concept of what he determines is yin fire, which is a little bit like a yin vacuity of the spleen.

We don’t think of that in general, but also at the end of this I will point out an article by Steven Clavey, which is a really good source to read about this concept of a spleen yin vacuity. Also in more modern books we can see Bob Flaws in his handbooks of TCM pediatrics points out that a weak digestion is the cause for many childhood diseases such as colic, earache, cough, swollen glands, allergies and pediatric asthma and eczema. And that’s what we are going to see also as we continue. Julian Scott in his book on pediatric acupuncture points out that there are five really common patterns of illness that that are at the root of many disorders. And the interesting thing is that three of them are issues of spleen vacuity and all of them in the treatment, you will see that they’re really focused on supporting the spleen.

I’d like to stay with Julian a little bit and just to point out these five common patterns, he names them as spleen qi vacuity, hyperactive spleen qi vacuity, accumulation disorder, hyperactive kidney qi vacuity and lingering pathogenic factor. And if you look in his book and see each one of them addresses the spleen vacuity as the main treatment principle. So whichever one of these five disorders, you’ll see that spleen is something that’s in the treatment protocol.

But I want to look at two of them for this lecture. The first one of course is the diagnosis of spleen qi deficiency. So although when we see this diagnosis, we’ll see that the child will have a sallow complexion or being very pale. Their skin tones and limbs are flabby. By the way, one of the disorders that I see frequently in in my office is low muscle tone in kids and that’s very closely linked to spleen qi deficiency as of course, we know that the spleen is in charge of muscles and when the muscle tone is low, it does point for me, it’s a strong indication that there is a spleen deficiency that needs to be addressed.

The lips are pale. Another really important, very common thing that I note is that I look at the lips and if the lower lip is a little bit protruding or I call it flabby, it kind of falls forward and and a lot of times you will see that the child is drooling very easily because they’re not able to close the lips appropriately. That’s another really strong indication for a spleen qi vacuity. Of course we’ll see either frequent loose stools or constipation, diarrhea alternating. But one of the most important things is that when we have a spleen deficiency that is pure spleen deficiency, the stools don’t usually smell bad. And that’s an important differentiation because sometimes the spleen deficiency can be, or it can look like a spleen deficiency, but there’s actually an accumulation disorder and in this case the stools will have a stronger smell to them.

You’ll see that there’s also a lot of times issues of sleep. The pure spleen deficient child will prefer to sleep during the day and always have difficulty falling asleep and would all kinds of manipulations in order not to go to sleep. And another important thing to see when you have a spleen qi deficiency is that these children always have a lot of phlegm and dampness, so they’ll have a tendency to get colds, coughs and other illnesses that’s associated with phlegm or damp accumulation.

And now the really, really important issue too that needs a lot of times to be addressed is their very poor appetite and picky about food. They are the classical what we call mono diet. They only eat one thing. A lot of times it’s sweet and when I say sweet, it’s not necessarily candy or something like that, but even pasta that is called a sweet food, right? It’s something a lot of times I see they’ll only eat pasta, even not with cheese or anything, but that’s what we call a mono diet. They are not open to a variety of tastes. They’re very strict on on eating things that have a sweet property and that’s something we really need to work on, and we’ll see a little later about different things that help to open up that appetite and have a little more variety.

There’s also sometimes a tendency for vomiting and gag reflex being very easily created and we’ll see, of course, the body, the tongue will be pale. There may be a white or thick or greasy tongue coating and the pulse is usually weak or slippery. And one other thing is, especially if they’re young and below or under a two year old, I always look at the finger vein. Finger vein diagnosis is very helpful I think. And the differentiation between a spleen deficiency and something that involves more stagnation and heat will determine the shade of blue that you will see in the finger vein. As a reminder, when we look at the finger vein, we rub the finger a little bit and there are three gates. We call them the wind gate, the qi gate and the life gate. And we see how far the finger vein continues. If it passes the wind gate, it means that the pathogen is starting to affect the qi. If it passes the qi gate, it is affecting the qi. And if it is reaching the life gate, it means that it is actually life threatening, so we have to be careful of that.

But the most important thing is that when we look at the shade of the blue, if it’s a pale blue, that is considered more of a cold condition, whereas where it is more of a dark blue, then that’s a sign of heat. When it’s almost black, that’s really a sign that there’s a lot of heat going on. And if you see a black and purplish hue to it, that means there’s heat and stagnation. In this case, when it’s spleen qi deficiency, we’re talking about more of a cold condition.

When we look at treatment, the points are pretty standard and these are points we use a lot. And the important thing is that we have to understand, although they are points that are very common, they are very effective, especially with children. When we combine large intestine 10 for example, with stomach 36, we are tonifying both qi and blood and that’s a really important combination. Stomach 36, shou san li of course tonifies the qi and large intestine 10 helps to regulate the stomach and intestine and reduce digestive stagnation, which is a tendency that children have. This is a very, very important combination for kids who have spleen deficiency.

We also can consider using spleen six. It regulates and strengthens and tonifies the spleen and also regulates the stomach. This again supports this combination of large intestine 10 and stomach 36. We’re supporting it by adding spleen 6. I also really like using CV-12. It strengthens the spleen and again regulates and strengthens the function of the stomach. I wanted to point out a very helpful treatment protocol that was passed on to me by Alex Tiberi. He always used to say that when we can address our digestive capability or strengthen our digestion by using spleen one for problems with digesting fat, spleen two with problems for digesting protein and spleen three for problems with digesting carbohydrates.

These are things to remember because a lot of times you’ll see that children might have difficulty digesting fat or the parent will say every time he eats avocado, for example, you will see that his stomach is bloated or that there is some issues with bowel movements or every time they eat some type of protein. Then you can use these points appropriately to help in that digestion.

I really like the last combination that you’ll see here, which is a combination of spleen three and spleen eight for those children who really have these sugar cravings. Combining spleen three and spleen eight will help reduce sugar craving, according to Alex Tiberi, and I’ve seen it work really well throughout the years of using them.

I also wanted to remind you all of this four-needle technique. We sometimes call it the Korean four-needle technique in which when we recognize that there is a weakness or an excess in a channel or organ system, then we can use the four needle technique to support that. And sometimes you can use these four needle techniques as a take home treatment with using magnets, for example, because with magnets we can clearly create tonification or dispersion by using the bio north or bio south. And when we have the four needle technique ideas that when we have a spleen vacuity and we need to strengthen the spleen, we use supplementation on heart eight and spleen two and then we have to drain liver one and spleen one and we can do that by either leaving little magnets or by during the treatment just connecting these magnets to the points and then taking them off because heart eight for example, is a weird point to leave. I mean the child may peel it or won’t continue to leave it for the treatment and it will support during supplementing the spleen.

A lot of times the reason I like to use this combination is we’ll see that there is an imbalance between the spleen and the stomach where the spleen will be deficient yet the stomach will be excess and Li Dong Yuan talks a lot about this in the Pei Wei Lun about this kind of the stomach tends to be more excess, whereas the spleen tends to be more deficient and so you might need to combine a strengthening treatment combination for the spleen, whereas you will use a dispersing treatment for the stomach.

You can see those points all listed here and this is a great technique to use in the clinic. I also very frequently either perform or teach the parents Tuina or pediatric Tuina, and I really love this hand technique where you can see that there is actually the presentation of each of the organs at the tip of the fingers. So for example, you see here on the little finger, on the pinky, the top part is Shen Jing, meaning that represents the kidney. On the ring finger, it’s Fei Jing, which represents the lung and Shin Jing here is the heart, Guan Jing the liver and on the thumb this is where we see Pi Jing, which is the spleen.

Generally speaking, in this technique, when we do rotations, when we take the thumb and we rotate, usually with our thumb, this rotation is supplementation, whereas where we are pulling upwards, this is considered dispersion. So we can either disperse this spleen or strengthen the spleen and as we can see that the stomach is actually just below the spleen so we can disperse the stomach by pulling upwards and we can strengthen the spleen by doing rotations. I’ve noted this here and on the slide. You can see that. And the arrow is pointing downwards, but it could be upwards or downwards. It doesn’t really matter. I prefer upwards actually. And I combine that with clockwise rotation around the umbilicus, which is also a great way to support the spleen.

As in abdominal diagnosis, we know that the spleen is manifest around the umbilicus. Of course on the left side we will have the liver. On the right side, this is the lung, the heart is on top and kidney is below. I also always look at the abdomen while I’m working to see any issues and palpate it to see what I’m feeling to support the diagnosis.

I also wanted to mention one other thing is the use of tiger warmer. This is a great way to treat kids. You can create heat and pressure at the same time and they respond really, really well to tiger warmer and you can use both supplementation points. You can use, for example, when you see a spleen Qi deficiency strengthen bladder 20 or bladder 21, the [inaudible 00:26:29] of the spleen and stomach, CV 12 and stomach 36 this is a great way to work the points. We’re applying both heat and pressure and it is great way to stimulate the points and kids usually respond really well to it.

Also, you can use regular moxa salt, on spleen CV8 is a great supplementation of Yuan Qi and also this kind of connection between kidney and spleen where you can strengthen the kidneys’ relationship with the spleen by using salt moxa on the umbilicus.

Last thing when we were talking about spleen Qi vacuity of course we can use herbal treatment and there are many formulas, depending on the little symptoms that you want to address. For example, our classical strengthen the spleen formula is Liu Jun Zi Tang, although technically I always prefer to use the Xiang Sha with kids. Xiang Sha means that we have the Liu Jun Zi Tang plus [inaudible 00:28:04] and [inaudible 00:28:04] that is [inaudible 00:28:04] Xiang is the Qi moving. It helps to move the intestines, it moves Jian in the belly and that’s a great addition to this formula and Sha Ren is extremely important in promoting appetite and so it’s a really important herb, especially for those kids who have this mono diet where they are not open to to experiencing other tastes. I think of Sha Ren. Also Shen Ling Bai Zhu San, which is the best formula, I think, for spleen dampness. If you you see a damp spleen, so a combination of spleen Qi vacuity with dampness, there’s nothing like Shen Ling Bai Zhu San.It’s an amazing formula for that condition and the two main symptoms is diarrhea and soft stools and lack of appetite, low appetite. These are really the two main symptoms for Shen Ling Bai Zhu San.

Of course we can also use Gui Pi Tang, which is this kind of relationship between where the spleen is actually deficient, but the heart has some what we might see as a blood vacuity or a heart Qi vacuity with some irritability, difficulty sleeping, and the Gui Pi Tang combination addresses that kind of both heart and spleen.

Bu Zhong Yi Qi Tang, of course is for lifting the central Qi. That’s very important. And Xiao Jian Zhong Tang also is a great formula, a very simple formula for this kind of when the spleen is really deficient, the center is a week. I also want to point point out I’ve developed a combination of herbs, a line of herbs actually that I’ve called Moshen herbs. It plays on the word Moshen and the word Moshen and the word shen there is affecting the spirit. But the idea is that I’ve created a few pediatric formulas that are really helpful for… I’ve found them really effective for different disorders.

One of them I’ve called Digest and this is a combination that will address children with spleen Qi acuity and or the the next pattern that we will see, which is an accumulation disorder. It’s a formula that addresses both things and and very effectively. Please check it out on moshenherbs.com and you can read the ingredients and see how the functions of this formula. But it is a formula that I use for digestive disorders in children when those… it could be even that when I suspect that when a child comes in with eczema that I suspect comes from this weak spleen that we can use Digest to address that. And especially if they have a tendency to get asthma, for example, or a lot of phlegm disease, then we can still use Digest to resolve that.

Let’s move to the next common disorder and we call it accumulation disorder. It is pretty much similar to the concept of food accumulation in adults, but it’s manifestation in children is a little different and it is is associated with exposure to foods that are not appropriate to or are difficult for the child to digest. One of the most common reasons for an accumulation disorder, unfortunately, is the use of formula in kids. I think that the issues with the formula is that it is over rich. Therefore, it’s very hard on the digestive system and therefore it causes a lot of issues. I know sometimes we need to use it, but we have to recognize or realize that it can cause a problem. Another issue is that children are sometimes offered food too early when they’re not really ready for food and therefore that causes also issues.

It’s very common that we see accumulation disorders around six months of age. That’s when solids are being introduced to the diet. And this is a period where accumulation disorders can develop. One of the most important symptoms that I see for accumulation disorder is this redness in the cheeks. And I can almost see that, I can suspect it already when I see the patient in the waiting room and I see those two red lights as cheeks. They’re really red. I have a picture in the next slide so you will see that. And that’s a really common symptom. A lot of times you have to ask the parent, “Oh, does he have these red cheeks all the time, or is he just hot or something like that?”

A lot of times when it’s an accumulation disorder, they’re pretty much consistent. The cheeks are red most of the time. They’ll also suffer from a lot of irritability, insomnia and a lot of lingering illnesses, especially this green nasal discharge. When you see this little kid with the green nasal discharge in his nostril and that’s something that the parents are complaining about.They’ll say this child is always sick. Everything that’s around, he immediately gets it. And he immediately gets this kind of nasal green nasal discharge. That’s a another very typical accumulation disorder symptom.

The interesting thing is that this accumulation disorder pattern usually can transfer or develop into a lot of what we would categorize or Western doctors will categorize as food allergies. So we’ll see how that develops in a second. These are the main symptoms. We can see here that this kind of red cheek, you see this baby with these kind of red cheeks, looks really cute. You think this is a a healthy little kid, but actually this is sign of a problem a lot of times, especially when it’s been going on for a little bit, you’ll see that then the skin becomes a little bumpy around the the cheeks. And when you see this kind of little bumpy area as well as red cheeks, it’s pretty much a food accumulation involvement.

We can see that in babies, the reason why you’ll have an accumulation disorder is overfeeding cow milk formulas. As we said, poor sleep and and dysbiosis are really the major causes in babies. In children we look at poor quality of foods, cold, raw foods, sugars, or sugar can be a cause for an accumulation disorder and a lot of this kind of very what we call children food are usually like pizza. Amazing. A great way to cause food accumulation in a child is give them lots of pizza. That’s something that we have to pay attention to.

Definitely also a general poor eating habit and I think one of the things that we have to remember is that one of the things that’s really strengthening to the spleen is the creation of a routine of eating, so that eating at the regular times and creating this kind of a regular pattern of eating is something that is not necessarily something that we need to teach our kids. And I think that’s a problem with a lot of parents that they don’t enforce it so that the tendency is to feed children as they want or on demand as we call it, on demand feeding, where that actually sets the grounds or creating an accumulation disorder.

It’s about eating mindfully and creating these mealtimes and involving children in that process is really, really part of strengthening the spleen and preventing food accumulation. What we’ll see is this hunger with no real desire to eat. They’ll say, “I want this”, and then they won’t eat it. And then there’s this kind of sensation that you’re hungry but you don’t know what to eat. Never satisfied. Sometimes reflux. You’ll hear them eating and then they’ll have a lot of burping up of gas, these red cheeks, green stools babies. This is another really very important sign, yellow nasal discharge and congestion and also chronic ear infections, chronic cough, chronic or even asthma. Sometimes the breath sounds like a little sour, so it is affecting the stomach and you can actually smell it. Eczema, cradle cap. The skin is starting to be affected by that and a lot of restlessness, hyperactivity and sometimes behavioral issues develop from this kind of accumulation disorder. Although it starts out in the digestive system, it affects many, many areas of imbalance.

The best time to, to catch or to address this food accumulation is when the children are really young and the best treatment the Sifengwen points, the four points. And you can see their location here and the bends. I know that traditionally they’re saying that you need to prick it and squeeze it until some yellow fluid comes out. I just insert the needle in all four areas and I get great results. You don’t really need to stand and squeeze it. I also recommend to use these points at the end of the treatment so when it hurts and the baby’s not crying in the room, you can do it and have them go and that’s a really a good way to use these points.

I teach the parents this kind of a massage of the thenar eminence that helps to reduce food accumulation and then also disperse the stomach. These are all techniques that really help to resolve food accumulation. With older kids, we can look at using CB 12 and stomach 36 as we remember. Large intestine 10 also helps with this kind of regulating of the stomach. Oops, sorry about that. And another combination that I really like to use is the combination of CV10, CV12 and CV13 that helps to regulate the flow of stomach and opening and closing of the sphincters. This is a really important thing. Stomach 36 of course is a great point for stomach pain and if there’s a lot of phlegm we do need to use stomach 40. If there’s a lot of phlegm in the lung, I usually don’t start with using stomach 40. I start with using CV 22 to start kind of resolving the phlegm in the lungs and only then I will use stomach 40, so that’s another important thing to remember.

What herbs? There’s Bao He Wan. This is the classical formula for food accumulation and, as I said, if there’s a lot of them, if the spleen is deficient and there is accumulation of dampness, I always think of Shen Ling Bai Zhu San. In this case it’s mostly when there’s soft stool. So if there’s this kind of a stinky diarrhea most of the time then I would use Shen Ling Bai Zhu San. Otherwise I’ll use Bao He Wan if there’s this alternating constipation diarrhea. Then Digest, again, is the herbal formula that I developed and you can read about it in moshenherbs.com and I wanted to point out another formula that I’ve been working with. It’s called React. I called it React but it’s based on Wu Mae Wan and I know that Wu Mae Wan is usually a parasite formula, but I’ve used it very effectively for for for food allergies, food sensitivities and in general this kind of tendency to be very allergic, whether it’s allergic asthma or allergic skin reaction.

All these things are really very affected, can be addressed by the use of React, which is an herbal formula based on Wu Mei Chuan and I’ve changed it a bit to be very well used with children. Please take a look at that because it’s a very good tool to use for different types of conditions in pediatrics and also adults actually can use React in this case, especially where there’s food allergies as a basis for many problems.

I also wanted to point you to a very interesting article about this kind of spleen and stomach yin deficiency. It’s not something we see so frequently. But Stephen Clavey wrote a wonderful article about the differentiation and treatment of spleen and stomach yin vacuity, so please read it. It’s from the journal of Chinese medicine from January of 1995. I know it’s a while ago, but it’s a great article, and I wanted to point out that these are things that you will see very frequently with children is that they’ll have trouble digesting food, easily full after eating small amounts, typical right? Bloating and feeling of uncomfortable fullness after eating, loss of taste discrimination, so they only want to eat sweet things, dry lips, different type of ulcerations in the mouth.

Look at these symptoms. These are things that I see very frequently and in this article he will help you differentiate between them and the use of different formulas. So a very good resource. Okay. I think I went over time, but I’m not sure. Anyway, I want you to thank you for listening and being with me today. I have here, if you want more information about Moshen herbs, please go to moshenherbs.com and also I wanted to point out that this is the certification course that’s going to start in March, jingshenpediatrics.com.Thank you very much and I will see you again in, I think it is in February.

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AAC To The Point - Lorne Brown

The Magic Word That Gets You Committed Patients – Lorne Brown & Chris Axelrad

Lorne Brown, I’m your host. I’m a doctor of traditional Chinese medicine. I have my practice in Vancouver, British Columbia, and Canada. I’m also a CPA and an author of Missing the Point: Why Acupuncturists Fail and What They Need to Know to Succeed.

I’m very excited and fortunate to have a colleague and friend on today, Chris Axelrad. Chris is a leader in the industry. He has been the president of the American Board of Oriental Reproductive Medicine. I can tell you he knows his stuff and he shares his stuff, evident by the fact that he’s taught all around the world in US, Canada, and Europe. He’s spoken on healthyseminars.com. He’s been a presenter at the Integrative Fertility Symposium as well. This man, this practitioner follows his heart. He beats to his own drum. This is also evident by the fact that his family, his late father, his siblings, his uncles are all medical doctors, and he chose to go into acupuncture against their will and their desire. So there’s the man that follows his heart, his dream. He is very successful, and that’s why we have him on the show. He has at least four clinics, the Axelrad Clinics and growing with many associates. Now he also mentors acupuncturists so they can be successful. Chris, welcome to the show.

Thanks man. It’s awesome to be here. Appreciate you inviting me.

I want to hear about this topic that we chatted about that you’re going to share today on the magic, the magic word that gets you committed to patients. Can you start off with what do you mean by a committed patient?

Well, committed patient is somebody who shows up and is really serious about getting help. So they’re not kicking tires or just kind of looking, to see what it might be like to get some acupuncture or to get some herbal medicine or whatever. They have a serious problem. They’re seriously interested in solving the problem, and that in and of itself just lends itself to a different kind of attitude, a different kind of willingness to be led and to be really taught about the things that are going to help them to escape their problems. As opposed to patients, and I know all of us have had these kinds of patients before that are just sort of kind of showing up but then asking a lot of questions and constantly having doubts and constantly never know if they’re going to show up for their next appointment, things like that. So that’s really after a while of being in practice.

I think most of us start to realize that it’s going to be really tough to have not just a successful practice but a practice that we enjoy and a practice that we really feel is fulfilling if that’s the type of people that we’re attracting into our practice all the time, people who are just not at a place where they’re really serious about the process that we have for them. So to me is someone who’s committed.

It reminds me of one of my teachers that used to say, “The client has to want it more than you do, and the client has to work harder than you do.” You’re still showing up giving 110%, Chris, but you’re saying you want that patient not only to match it but to exceed that.

Well, here’s the thing, I mean, to a point, to a point. I think that for most, most people are just not aware of the amount of self-care and kind of work on themselves that goes into their process of healing, especially if they have a really serious medical condition. So sometimes we can’t just like in any way in my process, which has proven to be pretty successful by the fact that we do have four clinics, and I’ve trained three other people in my process and they do it pretty well. Our process is really predicated on not overwhelming people with and making them work, like they don’t even realize they’re working that hard. So it’s like this stealth kind of way that we go about it that gets them on board doing the most important things.

A lot of times they don’t realize how many things they are changing but, yeah. I mean, the bottom line is that you’re right. I mean, a patient can’t want it… If a patient doesn’t want it, we can’t want it for them. We can’t want the results on their behalf. A lot of people do make that mistake, and it’s a very draining way to go about practice because at the end of the day when you want it more than your patient wants it, you’re just going to a well that has no water in it trying to get water. So it just gets to a point where it’s fruitless.

So in this magic word, they get you committed patients. You mentioned when we have a committed patient then so they do want to do the self-care, and you have a system in place that stealth-like. So they’re making the changes and it’s not considered extremely hard work. What is this magic word you’re referring to when you say the magic word that gets you committed patients?

Well, I thought about it after I presented that idea. There’s really two magic words, but the first magic word is the name of their problem, the name of their problem that they were told by doctors, right? So I think what happens in our industry a lot is people avoid common terminology for diseases. Because sometimes maybe it feels like, “Oh, that’s not really Chinese medicine. That’s not really holistic. That’s not…” So we aren’t going to use that term. What we have to understand is that someone who doesn’t know anything about Chinese medicine, which by the way is 99.999999999 many nines you want to think about, a percentage of people in the West don’t know anything about Chinese medicine. So the terminology that we put out there if it’s not in their language and in their sort of meets them where they are, then they don’t pay attention to it.

So someone goes to a doctor and they’re told that they have, let’s say infertility, you’re in fertile. Okay, granted. I know in the fertility world there’s a lot of people who think that that’s a bad word, infertility, and I get that. The key is that to a person who has been told that by their doctor, that’s the label that has been sort of put on them and that’s the key word that’s going to get their attention when they’re starting to look for help. That’s the word that’s going to get their attention.

At same thing with, for instance, Crohn’s disease. So there’s a lot of people who want to brand themselves like, “I help people with digestive problems. I help people to have awesome digestion.” Well, no one’s looking for help with digestive problems per se. I mean, if it’s a digestive problem, what most people think of is, “Oh, a little reflux, a little upset tummy,” a little whatever. I can just go to the drugstore and spend five bucks and buy an over-the-counter medicine for that. Like I always say, if you’re competing with Zantac, Advil, Tylenol and all these things, Claritin, you’re losing. You’re going to lose because that’s not a fair fight.

When you start to call out the names of serious problems that people can’t go to the drugstore and buy a pill to fix Crohn’s disease, ulcerative colitis, not just headaches, not just neck pain but migraine, chronic, recurrent, severe, some type of severe headache; I’m not an expert in headaches but I’m sure there’s a million different terms for headaches besides migraines, or spondylosis or herniated disk, not back pain. Because again, the average person with back pain, yeah, back pain it sucks. No one likes to have back pain. At the same time, the average person with back pain is probably just taking over-the-counter meds or stretching or doing something like that.

When we start to call out real problems that have a connotation of a different level of severity, number one, when those are the words that we’re using, the terms that we’re using all the time whether it’s in our marketing or advertising or public speaking, whatever, then it connotes a different level of expertise, connotes a different level of skill and a different willingness to solve serious problems. That’s how we want to position ourselves. I mean, we don’t want to position ourselves as an accessory, as an alternative, as the cute little acupuncturist down the street that helps people relax. I mean, I don’t take that personally. Of course, I’m happy to help anybody who comes into my office.

When it comes to building a big practice, if you’re not really reaching out and offering to solve serious problems, it’s going to be a tough row. Because, again, the level of commitment. If someone comes in and it’s like their back hurts a little bit, you can probably fix that. I know for sure I can fix that in one or two treatments almost every single time, and then you just had patient come through and do two visits. It’s like, “Well, okay, now I’ve got to get another patient.” When that person goes out and just tells their buddy or their friend whether it’s a guy or a woman or a man, “Hey, my back’s better now. I went to acupuncture,” and all their only friend reference is this really easy problem that you help them fix and they tell their friend who has easy problems, “Well, guess what,” you might get a few more people in. They’re going to do three or four visits, and they’re going to quit. Why? Because they’re better, which is fine. That’s totally cool.

If we really want to have successful practice, we have committed patients that are coming back that are really working on a problem, then we have to actually use the names of those problems and not be afraid to use the big scary words like Crohn’s disease, again, getting into eczema, psoriasis. Again, infertility is a big one, endometriosis, you name it. If you call out these big problems, then people will start to pay attention and people who are really actually in need of our help. Because at the end of the day, a lot of these are chronic problems that Western medicine has no answer for. Because, as we all know, not that Western medicine is inherently bad, not that we should avoid Western medicine all together, however, Western medicine is like a sledgehammer sometimes. Sometimes you’re applying a nuclear bomb to a problem that just requires like just a basic, “Oh, no. I don’t want to use an analogy of a pistol.”

I am in Texas by the way, so you know. So you don’t need to bring a nuclear bomb to a gunfight, okay? If one little bullet will fix it, there’s no point in bringing all this power. That’s where Western medicine sometimes has a problem. That’s where we can come in and do amazing things to help people’s natural, innate healing process to kick in and fix the problem itself. The people who need that help the most are people who have had Crohn’s disease for 15 years and are on five medications, and the medications themselves are almost as bad as the condition itself. They’re really tired of that, and they really want something that’s going to give them a real way out.

When you start to brand yourself that way and you start to use those words, it brands you as an expert. It brands you as a high-level authority, and that’s what gets you the reputation and then, of course, you have to actually treat people. What I’ve found honestly is that our medicine, despite what a lot of people would tell you and even people in our own field might say, our medicine is immensely capable of helping people with these kinds of problems and in not that long of a period of time. So people will really, really start to buy into what we do more and more as we call out these serious problems and are willing to go out there and actually attack these serious problems and build ourselves that reputation of being able to solve these serious problems, so.

Let me see if I got this then I’m going to summarize what I think I’m hearing. You’re talking about a committed patient and also known as a motivated patient. So if you’re going to treat, you talked about eczema aforementioned. Eczema is something that somebody really wants to get rid of that usually. It’s more of a complicated serious problem versus somebody who got hives from eating something. If somebody’s got hives, they’re going to try something over-the-counter antihistamine and see if that would work. If somebody’s got a chronic condition, people with chronic like migraines or eczema or infertility, then looking to get good at even specialized like you’ve done with fertility is find an area where the patient is committed. So skin conditions, somebody has skin conditions especially around summertime, they’re going to want to make that clear if they’re going to put on T-shirts and shorts if it’s on their arms and legs or even on their face.

So am I hearing that right? You’re committed patient, you’re motivated patient, you’re looking for things where there’s not great alternatives for them. There’s not this over-the-counter quick fix. These are people that have chronic conditions, and they’re going to be motivated because of their condition. It’s interfering with their quality of life. They’re going to be seeking out help and a lot of these chronic conditions, although allopathic conventional medicine has done wonders. We’re alive here past age 40. It does great things. Cubed carrot is great. Some chronic conditions, Chinese medicine can treat effectively also, and we’re an option for that. So did I get that correct?

Yeah, exactly. I think it just has to do with, again, using these terms that are very specific and that connote a different level of problem. So it’d be like saying, “I treat allergies.” Allergies is a very general term most people don’t really feel. If you just say allergies to somebody, they’re going to think, “Oh, hay fever,” or just a little bit of a head cold one day taking antihistamine. When you start saying things like eczema, when you start saying things like severe allergic recurrent rhinitis or severe allergic sinusitis, I mean, again, I’m not an expert allergist, but there are lots of different conditions that are allergic conditions that we can certainly help people to balance their immune system more, help their immune system be less reactive so they may not need as much medication, things like that. But we’ve got to actually call that out.

Now the other secondary benefit of that is that if you say, “I can treat Crohn’s disease. I can help you with the symptoms of Crohn’s disease,” or, “I can help you to feel better with Crohn’s disease,” right, what does that say to the person who doesn’t have Crohn’s disease but has some type of digestive problem as well? It may not be Crohn’s disease, but maybe, I don’t know. They haven’t been diagnosed with that, but they just know they don’t feel well. They’ve been to doctors, whatever. What does it say to those people? Well, it says… It’s this kind of thing where it’s like, “Wow. If this person is offering to help people with Crohn’s disease, my problem’s going to be pretty easy for them.” Like I should definitely like check this out, right? So you kind of get this bigger benefit.

It’s called aspirational marketing, where you really call the big shot and what that does is it, and even people who don’t necessarily need that much help will still see you as an expert and someone capable of helping them.

For the practitioner, you’re going to want to have some, for me anyhow, some form of passion in treating that area. So Chris is sharing that. Use the terminology that the patient’s going to be familiar with, so be patient-centered focus. So use the terminology and the terminology will be some of the Western diagnosis they have received from their medical doctor. For example, if it’s Crohn’s that they received from their Western medical doctor, well, in Chinese medicine that is a disease category diarrhea, bloody diarrhea. This is something, it’s not called Crohn’s in Chinese medicine. However, we’re able to pattern differentiate the symptoms into your Chinese medicine and so you’re still treating the Chinese medicine pattern. You’re treating the individual. You’re not treating Crohn’s. That’s just the map that Western medicine has given that body, right, but that’s what the patient’s going to understand.

So that’s what I’m hearing. You say, Chris, is use the terminology that they’re familiar with. I’m adding that because Chris does a lot of work with fertility as do I in my clinic. We’re passionate about helping bring in healthy babies into the world and helping this population. We find it fun to work with hormonal imbalances and work with women and men wanting to have children. So it’s something that you’re going to need to have passion for because you’re going to want to do all that additional learning and studying, and you’re going to see so much of it. You’re really going to want to like it if you’re going to see that much of it.

Yeah. But I would say also I’ve gotten to a point, Lorne, for me anyway, this is just me and maybe it’s because I’ve been so heavily involved in helping people with their marketing and their practice management stuff over the last three years since I started my program. To me, the passion is seeing that smile on someone’s face when they start to realize like they found something that’s working. The fulfillment of the fertility thing is amazing to know that you’ve changed someone’s life in that way. It’s just as life-changing for someone who has suffered with a severe chronic illness for years and has not really been able to have a really good quality of life to suddenly feel empowered and realize that they’ve got something that is really truly changing their life.

So I always encourage my clients not to focus so much on the specific thing, the problems so to speak. Because sometimes we can’t decide what problems are going to come to us. I mean, it’s like the market is going in some ways make that decision as well. The main thing is to have a positive attitude and not focus so much on what you’re getting out of it and your own thrills, but focusing on like just the service aspect and certain people and empowering people. So when we’re more focused on that, then the specifics of exactly what we’re specializing in, to me, that’s what drives any successful practitioners, just the joy of knowing that you’ve changed someone’s life.

Sometimes that life change is very subtle. It’s not this really big obvious thing like a child, which is a super obvious change. Sometimes it’s a very subtle change that they’re no longer having trouble sleeping through the night. They’re waking up every day. They’re able to focus more, and that’s going to change their life in millions of ways going forward, I mean, so-

I think you hit it with the service to others. Because in the spiritual books, they talk about service to others. In the law of attraction books, it service to others. In the entrepreneur books, to be an entrepreneur, it’s about service to others. I think one in the Bible said, “Do unto others as you want them to do on to you.” It’s all about service to others. If you can do something that’s going to help the masses and it’s more about them than yourself, you’re on the right track. That seems to be a common theme in most of [crosstalk 00:22:01].

That’s it, man. So like there’s a lot of people who want to have a specialty fertility practice and maybe that’s just not going to happen because of several factors. Could be competitive factors. Could be just that in their city or their market, there’s just not enough people that have that problem to really have a whole practice revolving around that. So we’ve got to learn how to be humble and not want to make it all about ourselves and [crosstalk 00:22:34]. This is amazing that I’m helping you with this really simple, easy problem, but watching you grow and watching you overcome this. I’m not saying I’m saying this in patients, right, but just in my own mind. I mean, that to me gives me a lot of fulfillment.

I wanted to say real quick because I know we’re up against time-wise, but the other magic word that’s really important is actually a magic phrase is, “Yes, I can help you.” You need to learn how to say that even when you’re not sure, and here’s why. Because nobody’s ever sure. Even when someone goes in for IVF or someone goes in for a sinus surgery or someone goes in for to take a medication for that, as much evidence as there is that that procedure works, no one’s ever sure it’s going to work for that person until we try it. So we just say, “Yes, I can help you,” so that people will trust us and will be willing to try it out.

What I always do, look, and this is very counter what most people would say to do, but let me tell you why. Let me tell you why. I have chosen and I have realized that I always want to be the person who believes my patient can heal and be wrong. If I’m wrong, I will accept that. But when my patient is sitting here, I believe in them 100% and I’m not going to hold that back. I’m going to tell them, “Yes, I can help you. Yes, we make this happen. Yes, well, let’s do this.” I will take the hit of being wrong rather than being the person who holds back and says, “Well, I’m not sure. Maybe da, da,” and be right.

That’s not who I want to be. I don’t want to be the one that predicts or hedges against failure. I’m going to be the one that hedges for success. So you’d be surprised, man. I’ve never had a patient come back to me who didn’t get pregnant when I told them that I was really confident they could get pregnant. Honestly, I felt that way. I’m not lying. I feel that way, and we can’t control who gets pregnant. We can’t control who overcomes their Crohn’s disease or overcomes their eczema, but I’ve never had a single patient come back to me and tell me and tell me I lie to them or anything like that. In fact, I’ve had a lot of my patients who never got pregnant working with me, they still referred to me to this day. They refer people for other stuff. They even refer people to me for fertility.

So what they want from us is full effort. They want to know that we’re on board, and we believe in them. In my opinion, not one shift can bring you, I mean, at least double your referral rate if you just show up that way, because people want to know that you’re an advocate for them.

Speaking of the referrals. So you’re looking for the motivated, the committed patient, and you’re a practitioner that you feel you can help people with certain conditions you want to serve others. What are you suggesting they reach these patients to let them know they exist to get them into their clinic, this idea of the magic word to get committed patients? Do you have some suggestions for our listeners?

Well, yeah. I mean, we use a lot of paid advertising in my clinic. We’re hardcore about that. Last year, I want to say for 2018; I don’t have my books for 2019 yet, but for 2018 we spent almost $40,000 on advertising. What you have to understand is that’s for the entire year. Our monthly revenue is somewhere between 80 and $100,000, so you take that 40 grand we spent for the whole year. The point is, is that we’re spending that money and we’re paying Facebook and Google. We don’t do YouTube ads yet, but I want to be doing that this year.

To put the word out there in front of thousands of people every single day, every single day, here’s what we can help people with. Here are the things we help people with. What’s really cool about that is when you do that, you do it consistently over a period of time and you don’t like stop. That’s the thing. A lot of people make the mistakes like, “I run an ad for a month. It didn’t quite work. I’m going to stop.” Well, number one, you got to say the right thing in your ad. Number two, you can’t just advertise then disappear. Sometimes it takes six weeks, eight weeks, two months for people to see your name and get comfortable with you enough to actually take action. So you have to be consistent, especially at the outset.

What I was going to say is that we use those terms, we put them in ads so that people will see that word which applies to them. That’s like the leak in the chain that makes them stop and go, “Oh, wait, this is about me. Let me read this. Let me pay attention to this. Let me watch this video. Let me click this link and go see what this person has to say.”

When you know how to build this ecosystem of advertising and remarketed stuff and all that, you build a really powerful system to get people into your clinic. Like I said, we spent half of one month’s revenue per year on our ads. We never worry. We never ever, ever, ever, ever worry about whether we’re getting new patients. We get at least three to five new patient requests every single day, some days more, every single day.

You know what I’m doing? I’m in here treating patients. I’m at home. I treat patients two days a week. I see about 50 to 60 patients a week in two days. I have my associates. None of my associates are seeing less than 40 patients a week. One of them sees 70 patients a week, and it just rolls like that. I’ll have to check my ads every couple of weeks just to make sure they’re not getting stale, especially on Facebook. But other than that, man, I mean, it’s fun.

You’re having fun, and that’s a big part of it as well, having fun while you’re doing all this.

Yeah, it’s fun, man.

I want to thank you, Chris, for coming on and sharing. People, if they want to get to know more about some of the mentorship that you’re doing for acupuncturists on building practices, can you give us a website please?

Yeah, it’s chrisaxelrad.com. Axelrad is spelled A-X-E-L-R-A-D, so chrisaxelrad.com. I don’t have a big fancy website. Actually, the homepage is just a video, because I have a busy practice. I don’t have this whole thing, this whole big fancy operation-

His picture, it was good. I had a chance to see some of his material. So you’re right on, Chris. I know colleagues that have been doing your program and you’re transforming their practices, and I care about that because I want prosperous healers. I have a mission to help heal the planet, and you heal the planet by healing yourself, that was a self-care. So I think Chinese medicine is part of that as other modalities are as well, but Chinese medicine is part of that. It’s part of the plan. I think it has so much to offer on a spiritual, emotional, mental, physical level. So thank you for joining us.

For those you want to check out, I have healthyseminars.com is my website for Lorne Brown. I also just opened up lornebrown.com where I have conscious talk, so you can check that out at lornebrown.com. Next week, checkout To the Point. I’m at the AAC webinar series. We got Virginia Doran. Thank you guys very much.

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3 Strategies to Grow Your Practice – Lorne Brown & Jeffrey Grossman

 

 

All right. I’m glad to be back on the AAC to the point webinar, giving you practice management tips and advice. My name’s Lauren Brown and I’m a doctor of traditional Chinese [inaudible 00:01:06] CPA. I practice in Vancouver, British Columbia, Canada, at Accu Balance Walden’s Center, and I’m the founder of Healthy Seminars. Today I have a guest with us. His name is Jeffrey Grossman. He is an acupuncturist and is the founder of Acupuncture Media Works and AcuPerfect websites. So we gel well because we’re both acupuncturists with an entrepreneurial spirit. He’s been doing this since 2002. He’s been creating, sharing patient education materials, marketing tools, practice building materials and websites for the acupuncture profession. What I love about Jeffrey is that he understands that many practitioners think that marketing and sales and we’re going to talk about this today and something they just really don’t enjoy doing. However, it’s necessary because if you don’t sell yourself, who will?

His goal is to make the business of building a healthy, successful practice, fun and easy, and in a way that feels genuine and stress free. So with integrity, it is his passion to help practitioners grow their practice so that they can help more people spread the message of both the powerful health benefits of acupuncture and change the world. So we share that value that the world needs more prosperous acupuncturists to help end the suffering in the world. So let’s bring on Jeffrey Grossman. And we decided that we’re going to talk about the three strategies that he likes to grow your practice, both in slow times, they’ll basically in time. So Jeffrey, welcome to the show.

Thank you so much for having me on, Lauren. I really appreciate it. I enjoy doing these types of talks or interviews or trainings or whatever you call them with you. Because you said, we do share a similar passion and without people like us and others in the world, and helping motivate and support the profession in their business and their marketing skills. The profession I feel will struggle a little bit because we’re not bred to be business people. We are bred to be healers, right? It may have taken us many different [inaudible 00:03:05] to become the practitioner that we are today. But being an acupuncturist you also have to be a businessperson and you are by that an entrepreneur and you’ve got to wear multiple hats. That’s and one of those hats, as you know you mentioned, it’s business and marketing. That’s what we’re here to talk about today. A couple of strategies that can help build your practice in slow times or pretty much anytime.

All right, well let’s talk about this because we know there’s a yin yang relationship to help when yin yang separate or there’s a disharmony, we get disease where we die. And the same thing with our practice. If you only focus on clinical, we’re not saying not focus on clinical, you need to be an excellent practitioner. But if you only focus on clinical neglect the business, your yin and yang of your business starts to separate and you suffer in practice or you have to find a new job. So let’s start off with… you talk a lot about how to easily build a referral practice without sounding salesy. Because I think that’s where a lot of us, in the culture of Chinese medicine, we just feel uncomfortable telling people why they should see us. So can you talk a little bit about how we can build a referral practice and feel good about how we’re doing that?

Sure. Well, one of the things I teach at practice management class in Washington here and one of the things I talk about with the students is how to ask for referrals. And it’s really pretty simple and really straightforward. The biggest thing you have to do is just ask. That’s really what you have to do is just ask for the referrals. And the best time that I have identified when to ask for referrals is just when patients come off of the treatment table. Because they’re feeling different, they’re feeling shifted, they’re feeling a little more energized or a little more pain-free or whatever it is that’s going on with them may have shifted a little bit. So they’re little more available to receive this conversation.

And when patients come up with treatment table and you ask them how they’re feeling, and if you’re asking them if they’re… let them know that you are trying to build a referral based practice and that you now have some openings to receive some more referrals and if they’re willing to help you out. And I think it’s been an important conversation that I’ve had with my patients over the years is to get them involved with helping to build the practice in the community. Because a healthy community keep… a healthy practice leads to a healthy community, which leads to a healthy environment for people to live in. And its been on of the thing-

I’ll add to that Jeffrey. I want to add to what you just said for them to really apply this to the clinic. So as Jeffrey’s saying for this referral is ask for it. So basically you’re letting your inside voice come outside. Because really if a patient comes off the table and I often will do it when they say, “Oh my God, you fixed my back”, or, “My eczema is gone”, or, “You helped me got pregnant”, or whatever it is. When they are telling you how happy they are, what you’ve done, my inside voice is, “Oh great, I wish I could treat more people like you. Would you please let them know about me?”

All Jeffrey is suggesting is let that inside voice be your outside voice. Because they’ve just given you praise and so you really [inaudible 00:06:19] it this way, “Hey, I’m really glad you benefited from the treatment. If you have any family or friends that are struggling with the same thing, can you please let them know about me? Because I like treating people just like you.” All right, continue on Jeff. I just wanted to give him a [inaudible 00:06:33].

No and that’s exactly it, Lorne. That’s the conversation to have. Because the thing is, I’m going to talk about this later on too, but you’ve got these levels of patients practice, A patients, B patients and C patients. A patients are the ones that you love, that you look at your schedule and you’re like, “Yes”. Your energy is like really resonant with them and it goes up. The C patients, you look at your schedule, you’re like, “Oh, okay, I can pull this together, I can work on these people.” And I was doing a talk just to one [inaudible 00:07:04] not too long ago and I talked about this very thing and I got a bunch of giggles because people get it, they understand that there’s these levels of patients, the ones that you really resonate with and the ones that you don’t.

And those are the patients that are really willing to refer to you and that are really open to it. And a lot of times patients don’t even know that you even have the ability in your schedule to receive patients. So that’s important to even let them know that you are now able to accept more referrals, that you have time in your schedule. And again, that all goes back to just asking patients at that opportune time, when they’re feeling better, when they’re feeling a shift, and literally having a conversation with them that, “Hey, I’m really glad that you’re feeling better and we helped many people like that with the same condition that you’ve been suffering with. And if you could think any people around off the top of your head who can benefit from the type of care that we’ve been offering you, if I give you some of these cards to hand out to those people, would you be willing to give those to those people?”

So just [inaudible 00:08:18] expectations with our listeners as well, is we get that it feels uncomfortable, especially at the beginning. That’s why you’re not asking because it feels uncomfortable and you don’t want to feel uncomfortable. So just to let you know, you’re going to have to find some courage to do the ask. What Jeffrey is saying you got to ask otherwise they don’t know. And then it’s nice to do it after they have just had a great benefit and just say you would love to treat people like them if you know any friends and family, end of story. All it is is your internal voice coming into your external voice. The other expectation I want to let you know is not everybody is going to send people, so don’t take that personally, but if you don’t ask, you’re not going to get that anyhow. Any other tips for easily building referral practice? Otherwise, I’m happy to go and ask you some… pick your brain on a few other topics.

Yeah. Well, I just want to add one more thing about that. So when you start planting the seeds for referrals in your practice or anytime type of marketing for that matter, basically what you’re doing is planting the seeds and it’s not going to produce growth overnight. Every type of marketing activity that you do, every referral you ask for, every healthcare you attend, every talk you do, whatever it is that you’re putting out there in the world isn’t going to reap benefits immediately. So don’t get discouraged when you go out there and you do your health fair and no one comes in or you don’t convert people to be a first time paying patient or if you ask for referral and you’re not getting those immediately. Because again, it takes time and something that you mentioned Lorne, is it takes comfort and confidence to make that happen.

And I know a lot of practitioners are very introverted and they might not have that ability or that comfort level whether do you feel confident enough to ask these types of questions? One little insight I would love to share with you that changed my entire life of being in practice was joining Toastmasters. That shifted my existence and gave me the confidence and the ability to really probably even stand up and do this conversation today. I’ve been doing it for years and years so I feel super comfortable standing in front of a camera.

But when I started joining Toastmasters, and there’s a Toastmaster in every single city all around the world, I believe, and it just changed things for me. It gave me more confidence, I felt more assured of myself and my speaking abilities. So that’s one little tidbit I would love… if you guys are feeling unsure or not confident in your communication skills, check out Toastmasters. And check out a couple of them before you actually commit to one of them because there’re multiple ones probably within your zip code.

Good tip. Now we got about 10 minutes left cause we like these to be short, and powerful and impactful. So hopefully we can get through some of the questions I had for you. What do you recommend to position yourself as the go-to acupuncturist in your community, what advice do you have for our listeners?

Great. Well, a couple of things. I think getting out there as the go-to acupuncture is in your community you need to create a presence out there. You shouldn’t be just hiding behind your clinic doors day in and day out and just going in and leaving at the end of the day. You need to be out there, you need to be doing some health fairs, you need to be doing talks. That can really help position you as that go-to acupuncturist authority figure in your community. And, excuse me, and hosting internal events in your clinic, like patient appreciation days or end of the year holiday events and things of that nature. And one of the things that’s really important about doing any type of these external activities, whether it’s a health fair or a talk and you’re putting yourself out there, if you need something that you could be using to direct those people back into your practice.

I’ve talked about this plenty of times. We brainstormed it with probably you in the past, Lorne, but also in my practice management class, we are creating specific calls to action that get people from the outside world to step foot in your practice. And these are really important because with all the marketing that you do, you don’t want to just go to a networking event or a talk and at the end just be like, “Okay, see you good bye.” Or not have anything that you can hand out at networking events. You want something that you could literally hand off to people, whether it’s a practitioner to give to their patients or whether a prospect who might become a patient that will literally get them to step foot in your practice.

So aside from becoming… doing all the external marketing and getting your name and your face out there and being the voice of reason when it comes to health and alternative medicine in your community, it’s having something that you literally get people to take action to step foot in your practice. In the past we’ve talked about offering free mini stress reduction treatments, reduced rate clinical exams, comprehensive evaluations that are either free or low cost or something like that. So it’s something that can you easily create, there is Vistaprint out there, you can put something together, you can talk with your local printer or create a gift certificate itself. But it’s really a big piece I feel, of the marketing puzzle, that is overlooked in many practices.

So you’re suggesting, and I love this, always have a call to action and just get yourself out there? So doing talks, writing blogs, writing articles for third parties. I love your acupuncture happy hour that you recommend for that stress reduction in the clinic. And you can check of Jeffrey’s website because he’s got material on that and some PowerPoints on that idea. So it’s a fabulous idea. Patients get introduced with the minimal obstacles to come to your practice. They get to come in and have the relaxing stress free treatment is kind of a fun phrase. We call it Acubalance, my clinic Acubalance happy hour. You call it acupuncture happy hour, but it’s great. All these activities I want to remind you guys as well is, if you love what you do and you’re doing it to give rather than to get, then it’s really positive and you have a good experience and the vibe goes out to the public and the patients.

If you’re doing it to get, then you’re coming from resistance and they usually don’t work out so well, to be honest. It’s funny how that works. So you do it and it’s just that give or gain. Just having faith that it will come back to you. So you love the medicine and you want to help your community heals, so that’s the mindset. So now write an article to educate them, write a blog, an article for a third party, the happy hour, doing a talk and you’re getting yourself out there. And as Jeff said early on, a lot of these things, we call these stepping stones, as in they’re not like you do this and somebody automatically comes to your clinic, but if you do these several things and you do them over a period of time, months and years, you really get a cumulative effect, a compound effect.

So it’s not like, oh, you do a talk and you say, “Oh, it didn’t work.” Yeah, if you do one talk, you can’t assess that. Just like a patient comes to you and you do one treatment and they say it didn’t work, it doesn’t usually happen that way, right?

Right.

So it’s the same idea with this. So great idea with these call to actions.

Right. And I wanted to say one thing, one quick thing about the acupuncture happy hour. That has been in the past been one of my go-to tools to get people to come in to try the medicine and convert them to becoming first-time patients because it serves multiple purposes. It gets people in your clinic, it helps them overcome the fact these objections about acupuncture. Okay, most people have multiple objections about the medicine and it helps them overcome the fear issue that needles hurt because I use serin red, half inch needles, super tiny, super flexible in the ear, two point, point zero shenmen, right?

So they’re feeling that the problem is pain free. It overcomes their objection of does it work because they’re actually leaving the space, they’re shifted. Because I mean, I’ll ask all of you practitioners right now, if you do Point Zero Shenmen on your patient, are they going to feel different? Would they feel shifted leaving the space? They will. There’ll be on cloud nine or maybe cloud seven or getting up there either way, but that’ll help overcome that other objection. And those are the two main objections I feel like offering some type of event like that does. And it’s a great way to offer from a top or a healthcare class is come on in for free mini stress reduction treatment and a happy hour event. And then one other thing I wanted [crosstalk 00:17:00].

I love this as an objection for patients that, “Oh, it hurts”, or, “I don’t know if it works.” So this is great because you as a practitioner love the medicine and you want to help people, you want them to feel relaxed. They just have to get two points and then they feel it, experience it and you can’t describe that in words. So really, I love this happy hour in these two point Shenmen and Point Zero to really let them see how simple and how they can really experience that relaxation with acupuncture. Because a lot of people think, “How am I going to relax with needles in me?” Great idea. What’s the last last point you had there?

Oh, the last point is okay, so you mentioned this earlier that we as acupuncturists have this tremendous gift of healing, of transforming lives. I can talk about multiple people’s lives that I helped change over the years. I’m sure you can too. I mean, you’ve probably made many babies and families in the world here, right? And all of you out there, probably have experiences where you allow transformation to occur in your patient’s lives. Now my question to be hide that? Why not shout from the rooftops that this medicine is amazing because it absolutely 100% is safe, natural and effective and it shouldn’t be hidden.

So our marketing then should be standing on the laurels of the fact that this medicine is transformative, it’s amazing, it changes lives and that we have this gift from the tip of our needles that makes that shift happen. So knowing that, knowing that you are affecting change in a positive, creative way, why hide that from the world? I understand that people are self conscious and that you’re not feeling confident and that you’re not sure about what to say or communicate, but there are people out there, there are courses out there, there are ways to shift that conversation that many of us have been having all too often in our own lives that hold us back from being an amazing practitioner that we could be.

A great point. And this is that idea of marketing is salesy. So maybe just change the terminology because what you’re really doing is education. So Jeff said it so nicely, there’s people that will benefit for what you have to offer and you got into this profession because you want to help people. And so being quiet, you’re actually a disservice to your community because they don’t get to know about you. So just think of this as educations rather than you’re trying to get them in for your benefit. Think about it differently that educate the patients, if they know about you and they now understand the benefits, they get to choose whether they want to see you or not. So it’s not like they have to see you but they’ll never know about you or have the desire to see you if they don’t know about you and don’t know how you can help them.

So just call it education because that’s what marketing is, it can be just public education. Get yourself out there. Ask for referrals. If you get a compliment in the treatment room, just saying you want to see more people like you. And as you mentioned, keep investing in yourself. You talked about courses on practice management. So at healthyseminars.com we got more courses. Keep investing in yourself because that’s what’s going to make you attractive to your patients as well. Constantly build your confidence, constantly educate yourself.

And as we discussed this at the very beginning there’s a balance. You got your clinical skills, keep working on that. But we tend to not look at our business skills at all and most of us are struggling. Many people are struggling or have to find other careers and that’s not a service to the public either. So now’s the time to start to add a little bit of that, investing in your entrepreneurial skills. And so that way you can do what you love, which is treat people versus sitting in an empty treatment room.

We got to close up here, Jeffrey, any closing remarks? And [inaudible 00:20:57].

Yup, one last closing remark is thank you Lorne for having me here. I really appreciate that. The last closing remark is we owe it to our patients currently in our practice to market our practice to get out there because if we don’t we might not be in practice for very long. I’m not trying to scare anyone around this, but other people, if we don’t market our business, they’re going to find help elsewhere and maybe not the best kind of care that could be afforded them. That’s my last little insight into that. I’m sure you and I could talk for a long time about business and marketing so-

We’ll do this again on the… if you’ve seen this on Facebook, make a comment, actually what topics would you like me to have on the show? And I can do with Jeffrey if you have somebody else you want me to interview as well, post that in the comments as well. I’m happy to have other guests that you want to hear from and have a discussion with. Love to have you back again, Jeffrey, as well. I want to let everybody know that next week on the AAC to the point webinar, we have Virginia Doran, so tune into that.

Thank you Lorne.

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Ways To Find The Best Acupuncturist Business Insurance Policy


The rapid growth of companies offering acupuncturist business insurance policy is attributed to the continued increase in numbers of clinics that are seeking protection from suits, which are usually filed by patients. Along with this growth is the challenge of finding the most qualified insurance provider from a wide array of options. How do you choose one so that you can rest assured that you business is well protected?

Here are some ways that can help you find the best insurance provider available:

Search through industry-specific directories. There are quite a number of local directories you can find online. Wherever you are in the US, you can surely find a list of acupuncture insurance providers that is specific for your location. So take advantage of these online listings. They are current, comprehensive, and informative. Plus, these listings also contain reviews and ratings by customers, so you can get a good idea how reputable these insurance providers are.

Join acupuncture online community. Another good place to find important information about acupuncturist business insurance policy are online communities. This is the reason why it is beneficial to join, engage in discussion in such communities. Apart from learning from fellow acupuncturists about how they run their clinic, you can learn more about the best insurance service providers in your area.

Asking for referrals from fellow acupuncturists. Ask for some recommendations from fellow acupuncturists running a clinic in your area. They are an important source of information as well as they themselves also buy insurance protection for their business – and their reputation as a practitioner. So, expand your network, check out other acupuncturists in your area and solicit recommendations.

Search engine and social media. Search engines like Google employ sophisticated algorithm for search they seem capable of reading the mind of users. So don’t forget to search for the best insurance providers through these online platforms.

Social media is another platform where you are most likely to find some prospective insurance providers. Many insurance companies have established their online presence by creating social media pages where users can follow. This is why social media is often called the new search engines.

Looking for a reputable acupuncturist business insurance policy provider? Look no further. Amercian Acupuncture Council can provide the needed protection for your business and reputation.

Call us today at (800) 838-0383.