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AAC To The Point - Lorne Brown

Re-opening and Bringing Patients in the Door Now

Click here to download the transcript.

Thank you again to the AAC for inviting me to present on these informative webinars. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine. I am the Clinical Director of AcuBalance Wellness Center, I’m the founder of healthyseminars.com, and also the author of Missing the Point, Why Acupuncturists Fail and What You Need to Know to Succeed.

Today’s webinar, I have a special guest, Chen Yen. Many of you may know of he. For those that do not, a pharmacist by trade. Entrepreneur is her gig now. And she’s been helping health professionals for years be successful and build their practices so they can be of service to their community. Because as you know in my book, Missing the Point, when the yin and yang are out of balance, when it’s all clinical, you don’t have the business skills, even though you have the potential to help so many people, if you don’t have a running clinic, if you don’t have patients coming in, you’re not able to help them. And she’s created a business around helping people like ourselves so we could thrive and see the people that we want to serve.

And so, I asked Chen Yen to come in because she’s been sharing a lot about reopening your practice. We’ve been in isolation for a while because of COVID-19. And now as we reopen, the question is how do we invite and bring back patients into our practice, how do we build our practice. And so, what I plan to do now is I’m going to cue up a video in a moment of an interview that I did with Chen Yen. And the reason she’s not alive is right now she’s in Taiwan,. and it would have been in the middle of the night for her, for her. But again, her being and having that entrepreneurial spirit.

Just the other day, we got on the Zoom, we did this recording’s about 13 minutes. And she’s going to share with you marketing strategies that are working in this climate, some of the strategic planning that you could do now in the coming months, and then just some of the critical keys to bringing your patients back into your practice. And then after the video, I’m going to share with you what I’ve been doing in my practice at AcuBalance in Vancouver. And so I’m also going to share how we reopened and some of the things that we’re noticing and that we’re doing so we can be of service to our communities. So, let’s start that video now, and please stay tuned because I’m going to give you about five minutes after this some more pearls to support you in your reopening.

… how helpful acupuncture. You talk about how helpful acupuncture is. So, those are …

So, what are some of the marketing strategies that you’ve been sharing in your mentorship that you can share with our audience to help them, again, get their practice going and attractive again to patients that are, well, now that their practice is open. So, I’d love to hear some of your marketing tips, because I know that you got some gems.

Yeah, so I would say at first looking at low hanging fruit, and then looking for new areas of opportunity to reach potential new patients. So low hanging fruit, a couple of key things. One is how can you keep your existing patient base in understanding of how just overall even outside of these COVID-19 times the different health issues that could be beneficial to where acupuncture can help with. And then reminding people to book appointments if they want to come in. So, for example, in our opening email templates. So, you can send out emails, you could send out texts. You could also be educating or encouraging people to come in on Facebook or social media posts if it’s kosher with the laws of your state and profession to be doing things like that. And then in terms of emails, for example, it could be book your appointments.

And so, what I was going to say about emails is, first, a piece about something that educates about the issue, and then something with a call to action with a reason to come in. So, for example, it might be book your appointment now and get in for first line … I mean get yourself first in line for your choice of appointments as we’re reopening here, or it might be something like take care of yourself by putting yourself first and book an appointment, especially still as important now to take care of your health as it has ever been, or it might be that book your appointment space because of the health issue that you’ve been having that you haven’t been able to get checked out or get help with until now because we’ve been closed. So, there’s just kind of a reason why to be rebooking that that is brought up, and that can be helpful.

You could also look at collaborating with other practitioners. So, our clients who’ve been doing really well in getting referrals from other providers, whether it’s medical doctors or other kinds of practitioners, holistic practitioners, other kinds of practitioners is as they reopen, many times they had a good relationship with them even prior to opening. So, if those of you who have relationships with providers who’ve been referring you before, reaching out to those providers and reminding them that you’re there and how you could be of benefit to their patients is one way to go.

If you haven’t had a relationship with other providers before, for example, maybe you would like to be getting referrals more from MDs because medical doctors could be a great source of referrals for you. They have many patients who could benefit from what you have to offer, but many times their patients don’t really know about you or the doctor doesn’t really think about referring people to.

So, what can you do in those situations to build new relationships? So, something that I was working with one of my clients on was to create a short video. Because the thing is, doctors are really busy. Right? And so, if you’re able to create a very short couple minute video that starts to explain something about your area of expertise and some research tied into why this could be beneficial for those kinds of health issues or with helping support immunity, then that can also be sent off to a physician. And that way it’s just you’re more on the top of their awareness. So, really, the key is concise, short, and really to the point of how you can help their patients get better outcomes.

Another thing is to look at … you can look at interviewing other practitioners, too. So, in times where people are getting back into reopening, there’s a lot of opportunity for you to collaborate with other practitioners, because people still need help with their health issues, whether it’s during these times or not during these times of COVID. And so, it’s a matter of how can you continue to educate the public about different kinds of issues and what your services can really help with and your modality. And so, then being able to collaboratively interview other practitioners about, perhaps in particular, health topics.

So, looking at whether it’s interviewing medical doctors or nurses, nurse practitioners, tied into the different of health issues that you treat can also bring in more visibility for your practice. And it can automatically be an opportunity where if you’re interviewing another practitioner, you can encourage them to share that interview with their patient base, too. So, you’re ending up being able to reach more people with your message collaboratively there. So, that’s more of, I would say, lower hanging kind of fruit, because it doesn’t take up a lot of your energy and time to really set up.

And then other kinds of things that you can look into beyond that initial low hanging fruit could be writing Facebook ads. So, I’ve had clients, acupuncturists, who are running a combination of Facebook ads that are bringing them … It’s amazing the kind of return on investment that they’re getting for it right now. And it’s a combination, as far as what’s working right now, combination of Facebook Live video with using some of the strategies that I work with our clients on, being really strategic about what’s said in the video, plus Facebook posts alternating with that. And then, again, getting people educated, getting people to build that relationship with your practice. Yes, and then also having people be interested in booking.

Another thing is anything tied to speaking. So, we talked a little bit about interviewing. And whether it’s during these times or beyond these times, one thing that you’ll always have is your mouth. And one thing you will always have is what’s in between your years, which has been all the knowledge and training that you’ve garnered all over the years and the expertise that you have which could still be helping people, even if your practice was to be closed down in the fall, because we really don’t know if that might happen. And so, when you are able to continue to educate just as it were pre COVID-19 times as well, the more you’re able to educate people and reach more people. There’s still people who have a need and can benefit from your services. So, anything tied to speaking, for example, webinars, doing interviews, doing podcasts can be good online. And then as we get back into reopening, even doing small kinds of things even with just a handful of people can still be helpful to … to be helping others and your practice.

And then one thing I would say in terms of marketing wise. Whatever you do, there’s an education process involved. And a couple of quick tips in terms of as you think about … Because have you ever, whether it’s written an article or you have spoken about something, you’ve educated people about something, or you’ve done whatever, think about all the kinds of different marketing that you’ve done in the past. Have you ever felt like you have been so good with teaching people about things, but then they don’t necessarily book? So, here are a couple of questions that you can think about working into what you educate people about so that they end up getting more interested in booking and coming in.

Let me actually just show this to you also briefly, to pull this up here for you to see as well, which is … Let’s see here. So, this is the five stages of the buying process. And so, people need to first have awareness about that they actually do have a problem. And then they might be considering it and looking into different options at the next stage, but they’re still gathering information here. And then then they might be evaluating, for example, in terms of, okay, maybe this option and this option, what are the details of that and which provider am I going to be seeing. Then finally, more of the decision making and then the post-purchase evaluation.

But what sometimes we don’t think about as much is that there might be people in different parts of the spectrum, whether from problem awareness, who don’t even realize they have a problem, right, or they are further along in the process, but they don’t really understand what to look for between different providers and that kind of thing. So, whenever you’re making educational kinds of things available to people, think about what different stages that they might be, and how can you provide content or educational things that can help educate in those areas.

And one thing, also, a couple of quick questions to think about would be like, what do they need to believe about their health, or what do they need to believe about themselves? What do they need to believe about you? Because if these questions aren’t answered in a way that they feel comfortable with, they’re not going to come in, no matter how helpful you talk about how helpful acupuncture is. So, there’s just a few quick tips about as we look at marketing and reopening that are working well for our clients right now.

Chen, I want to thank you very much for those tips and points. And I think we’re going to have to get you on healthyseminars.com so we can spend more time with you, because we just got a little bit and this was quite valuable. What’s the best way for people to reach you? Because I’m familiar you have like the Introverted Visionary website and your Fill Your Holistic Practice. Can you share the best website so people can get more information and learn how to contact you, please?

Sure. You can go to introvertedvisionary.com/AAC. And so, introvertdivisionary.com/AAC. And then you can … I’m going to make available some templates that are going to be helpful for you, for example, reopening email templates that you could use for email or texts. And also, we brought up a couple of situations of what people might be concerned about with coming in. And there are other ones that I’m going to share with you as well that acupuncturists clients of ours have been experiencing. And then also like a cheat sheet for that, right? Like how do you address these kinds of common objections that people might be having about coming in as well. So, I’ll include that.

Excellent. So, to be continued, she’s going to provide us with more value. So, you just go to introvertedvisionary.com/AAC, and she’s going to have some more handouts for you to help you prepare yourself as you build up your practice again, it’s great news for most of us just to remind everybody that you’re not starting your practice over again. You just kind of took a holiday that you didn’t choose to take, and now people are getting ready to come back. And these are just great tips that you can use any time of your practice, not just after a pandemic. So, Chen, I really appreciate you making the time to tune in and share this with our audience today. Thank you very much.

Yeah, it was great to be here today. Thanks for having me here.

Great. And we’ll get you on Healthy Seminars so we can get you to expand on a lot of this and more, because you’ve got really good marketing tips. And for the introverted, because a lot of people don’t want to do public speaking or they say, “I can’t, I’m not outgoing. I can’t do this.” And I know you’re introverted and you have techniques and tools for people that want to educate, but feel I’m too shy to do that. And the takeaways here from earlier on, you talked about outreach. So, email contact, like start contacting your patients on a regular basis again. You talked about education, so keep educating them on the benefits and what you can do to support them during these times. And you talked about collaboration as well. So, collaboration is great. And some of the way you even outreach is through webinars, Facebook, emails, talks, so that’s great. So, thanks for sharing those tips with us today.

All right. So, again, thank you to Chen. And as I promised, I want to add a few more pearls for you guys as you open up your practices. Some of you are getting ready to open and some of you have. So, in my clinic at AcuBalance, and just to prepare some of those that are just getting ready to, I will let you know that it was more stressful in the preparation of getting all the PPE, all the safety equipment and policies in place than it actually was implementing it, so that’s great news. If you’re really overwhelmed about what’s going to happen, it’s nothing like … it’s much worse preparing for it and anticipating than it actually was doing it.

Now, what we did at our clinic when we started, we opened up on May 19, so after being closed for two months, and we decided … So, I’m going to share with you the attitude because it will make a difference for how you experience your reopening, and then I’m going to share with you some tips on rebuilding your practice. So, first of all, our attitude was safe, soft reopening, emphasis on safe. So, we got all of our equipment, we set up our policies, and what we did is we chose to open up our clinic at 25% capacity only. And we did this so we could be calm as we cleaned rooms and figured out how long it took getting our masks, getting the patients to sign their consent and wash their hands, all that stuff, we didn’t want to feel rushed or tense about it.

So, we really set up that first week with very little expectation for profit. We did not care, actually. Our goal was, let’s be safe and can we be of service to others? So, that’s what I invite you to have that mindset. You’re not going to have when you reopen, most people are not going to have what they had pre COVID. And so, just to have that expectation, to be kind to yourself so you can enjoy this reopening. And so, we were a soft, safe launch.

And so, that first week at 25% capacity only, it allowed us to work through our policies and see where we could streamline things. And then the second week we were open, we went to 50% capacity because we saw now how quickly we could clean the rooms properly and put patients in and out of the rooms. And a big part of the process for us was for the physical distancing. Everybody has their own room, so they’re distanced. And we’ve timed it so we don’t have a bunch of people in the waiting room. However, the key was in the clinic how the doctors are all situated so we had physical distancing. That was what the main criteria was, how is it that we’re in a clinic all day that we’re properly physical distancing as much as possible.

And I will let you know because our energy was calm, the patients that came to us … I was going to compare it to a colleague that had a different experience. We came in with the attitude of service to others. My colleague came in needy, like, “I need to be busy now,” pretty stressed. Our patients came with their own mask. We asked them to, and almost everybody came with their own mask. Now what we did is we bought cloth masks and we had surgical mass. The doctors all wear the surgical masks, our patients can choose surgical or cloth, but they must wear a mask in our clinic, that was one of the recommendations policies we have. And if a patient did not have a mask, they had two options. One is they could get a surgical mask which they take with them, $2 fee, or they could get a cloth mask. And if they leave the cloth mask for us to laundry, that it’s free. If they don’t leave it and they want their own, because some wanted their own, it’s a $5 charge. So, we just passed the cost onto our patients. We had zero complaints.

And our patients were great coming in. They were so happy to see us. The energy was great. They signed the consent. And it’s been a very positive experience for my team and my patients. And we didn’t come in like needy, “We need to see our patients.” We came in, “Let’s be of service to others. Let’s see who’s ready to come back out of isolation here in British Columbia.” Where my colleague really tried to pressure their patients to come back and was coming from neediness and they were quite stressed and stressing out their patients, their patients were fighting about the mask. It was just a totally different experience. And I believe the reason is the attitude, the vibration energy that you’re putting out, for one.

Now, when patients contact us and they’re a little stressed about what’s going on, we educate them. So, we let them know all the things we’re doing, all the cleaning, et cetera, how we’re doing the physical distancing, what we’re doing to minimize the risk. But what we’re not doing is telling them, “Oh, come, don’t worry. You’re going to be safe.” Actually, we do the opposite. If any patient comes across on the phone or email as concerned, worried, or stressed about COVID and coming to our clinic, we encourage them not to come because we know we can’t guarantee your safety. All we can do is minimize the risk as best we can, and that does not mean that COVID will be prevented. We can’t guarantee that, we cannot do that, nobody can do that.

And so, we realized half the population … I’m making up the number … but half the population will be comfortable coming into our clinic and half the population will not, but they all pretty much want to know what we were doing for safe measures. So, rather than trying to over impress them, like “You need to come in and this is what we’re doing,” we let them know all the safety measures we’ve put in place, all the systems we have in place. And they get to even see it on the back of one of the doors where they’re in the room, the door that holds the needles, there’s a checklist to show that the practitioner’s checking off all the cleaning things we do so it’s not forgotten, we have a system, and they get to see that.

But we don’t pressure our patients to come back. If their worried, we say, stay home. If you’re worried about COVID, then do not leave your house. As soon as you leave your house, you’re put at risk. And because we’re not pressuring them to come in, a lot of those patients, once they hear what we’re doing, still choose to come back. And those that are really worried, we don’t want them in the office. We don’t want that energy, that tension in the office anyhow. And so, we realized some people are going to be ready early on to come back and some people not.

The other thing I want to remind you is, it’s still the same education marketing practices you always do. People are going to come and seek you out if you are a benefit to them, if you are a value to them. So, it still goes back to the same model of just good education. Now what I think is important is to work on the stress response that your patients are going through. Because of the change in the loss of control and some loss of liberty in a very short period of time, some people consciously are aware of their anxiety and stress and some people are not. So, if you ask them first to educate them about stress and how it impacts the immune system, how stress impacts sleep. So, check in with your patients via email or phone calls, “How’s your sleep, your digestion, muscle tension or headaches? We know how it can lead to inflammation which can cause other health issues.”

So, maybe your patients, like Chen said, that first thing, maybe they’re not even aware they have a problem. So check in. Are your patient’s having sleep issues? Are they having digestive issues? Are they having muscle tension, headaches? See if they’re having these and let them know, this could be related to stress and how you can support them in reducing the stress, because we know stress, exasperates many diseases and leads to many symptoms. And so, your goal is to help them with their quality of life and to show them that you have value and you have tools.

Right now, conventional Orthodox medicine does not have a solution for COVID except for isolate as much as you can, right? Physical distancing as much as you can. And so, you can educate them on the lifestyle and things that they can do to help give their body the best chance of being healthy, radical well being. We’re great at talking about diet. So, you can set up consulates for diet and lifestyle, exercise, sleep, and meditation, acupuncture for circulation and stress reduction and hormone balance. So, there’s a lot of things that you can do to help with the radical well being.

And that way if they are out and about, at least their relationship with their environment, because that’s what we’re doing with Chinese medicine, is strong so they can hopefully handle whatever comes into their external environment, whether it’s CNN News you’re watching causing stress, or it’s a virus that’s out there, that your body is at its peak radical well being so it can deal with it as best as they can. And you can’t tell them or promise them that if you come to my clinic that you will prevent COVID or you’re treating COVID, because there’s not evidence that exists yet that you could do that. However, you can definitely help them with radical well being.

A great example is obesity. We know in general obesity leads to many health issues and diseases. And with COVID-19, we know obesity is a comorbidity. That is not a good thing to be, no matter what your age is. If you’re overweight, this is a time to lose weight. So maybe in your practice, you can start doing getting fit and healthy in the summer so people have the best chance of being healthy, whether they get any virus including COVID-19.

So, remember, people choose you because they see you have value, you have benefit. And so, first of all, do you have value and benefits? So figure out where you do, because you do. And then communicate. As Chen said, send out emails, do talks, collaborate and do stuff, and just take your time. The good news is, for most of you, this is not like you just started your practice. You had a forced holiday, as I mentioned in the video, and now you’re reopening, and people are just getting comfortable in certain places where you live to go out.

And so, read the room. Don’t dismiss their concerns or fear. If you can read the room and realize some of your patients, even though you may not be, are very concerned about this pandemic and come to your clinic. Hear them, and hear their concerns, and validate their concerns. Let them know what you’re doing to mitigate risk and be transparent and let them know that you cannot guarantee safety. And if concern or safety is their main issue, then they should stay inside. Okay? They should isolate. And if they’re comfortable going out to the grocery stores and other things that are not essential, grocery store is essential, but if they’re going out, then they may be comfortable coming to your practice as well.

And you want to keep your safe, so have your boundaries with your patients. We have some patients that don’t believe mask waring is necessary, but it’s a policy in our clinic. We don’t challenge their beliefs, whether masks are valid or not. The science as you go, as of today, the science is masks can mitigate the risk because it limits your exposure time. The amount is dosage and time. So, if you’re going to be in the room with somebody for 20 minutes, 20 minutes without a mask is much more exposure than 20 minutes with a mask, and so that’s why it’s being recommended. And in our practice, it’s okay if you don’t want to wear a mask in general and you don’t believe in masks. However, you can’t get treated in our clinic at this point in time unless you wear a mask. That’s not negotiable.

So, we have our policies, we’re strict with them. And so, I encourage you, too, to have your policies, have kindness in your heart, focus on being of service to your patients. Don’t worry about your bottom line now. In July, hopefully your practice is definitely back and you’re seeing it profitable. But if you just opened in late May or beginning of June, just be of service to people, educate them, be a value, and trust within a few weeks you will be back to hopefully 75% or more of what you were before COVID and profitable again. And therefore you can exist and be of service to your community, which this is all about.

If you’re looking for more information on COVID-19 and being back to practice. Under the healthyseminars.com website, it’s healthyseminars.com/resources., we have several past talks, verbal and acupuncture, and more coming up. We’re constantly listing them all the time. We’ve got lots of free resources for you, stuff on telehealth as well. So, do check out healthyseminars.com. And also, if you’re looking for all my assets, my clinic information, Healthy Seminars, and the conscious talks I do on lornebrown.com, go to that website, lorenbrown.com, because that links to all the things that I’m involved with.

Again, I want to thank you for listening. I want to thank the AAC for inviting me for this practice management series. Some of you don’t know, but my background before a doctor of Chinese medicine is a CPA, so a public accountant. So, I like to bring both hats to the room for you guys to share both as a clinician and then as an entrepreneur and accountant so I can share what I know with you so you can be prosperous and successful and serve your community. Stay tuned to next week’s webinar because there’s more coming. AAC’s got great webinars and they got great hosts. So, make sure you come back, like their Facebook posts, and tune into their next webinar. Thank you very much.

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Jeffrey Grossman Thumbnail

5 Actions You Can Implement NOW To Prepare To Reopen

Click here to download the transcript.

Hi, folks. Jeffrey Grossman here from Acupuncture Media Works and AcuPerfect Websites. I am thrilled to be here. Thank you American Acupuncture Council for inviting me on here to conduct a program on their To The Point live training series on Facebook. I’m really glad to be here. I’m really glad to be a participant and a presenter here. We’re going to be doing some future programs, and I’m going to be talking about creative solutions to grow your practice using simple, effective, and sleaze-free strategies. I know that marketing is something that is imperative to help you grow your practice, and I also know that as an acupuncturist, you might not be that thrilled to participate in the marketing world.

But yet as an entrepreneur and as a healer, that which you, everyone who’s watching this who’s an acupuncturist, you are both of that, you will need to participate in and embark on and embrace both hats of being the entrepreneur and the healer. My goal through this program that the AAC is putting on is to provide you with some tools moving forward to help you market your practice, attract patients, reactivate your inactive patients, and to essentially grow your practice in a way that makes you feel comfortable, that allows you to reach some of the goals that you want with growing your practice, and to achieve some of the financial goals you’re looking to obtain with helping more people in your community with this beautiful medicine.

Again, thank you American Acupuncture Council for having me here and inviting me on as a presenter. Today, I want to talk about five different actions that you can implement now to prepare your practice to reopen. I also want to talk about a couple of things that you can be doing now to pivot your practice, so when this crazy time happens again, hopefully it won’t, but my feeling is that we’ll be going through waves of what we’re experiencing now with this crazy pandemic. One of the things that I want to encourage you all to do is to consider about different ways that you can pivot your practice now so when things happen in the future, you’re already there. You’re already prepared.

You already know what to do and how to keep the patients flowing and some finances coming in based upon what you’ve doing now to prepare yourself for the future. One of the things that’s really important is that it’s important to market your practice now while the competition is low. Because a lot of people right now are pulling back their marketing dollars and all of their marketing outreach because they’re scared or they’re frightened or they want to save and conserve money. But I really feel that now is not the time to be conservative in your marketing efforts. In fact, I think you should be putting a lot more energy into that right now, and I’ll talk about a couple of things that you could be doing in order to make that happen.

One of the things I also feel is really important that you could be doing right now is to educate yourself now on what you’ve been wanting to learn in the past. Whether or not you want to educate yourself on website basics or email marketing basics or specific acupressure points or tapping techniques or things of that nature, those are some important things that you could be incorporating in your life right now during this time that we have to reset and refocus because we’re forced to stay in doors, to really tap into those things that you’ve been needing to do in your practice. Five actions that you can implement now to prepare your practice to reopen. One of the first things that I really encourage you guys to do would be to maintain your digital awareness in order to stay on top of mind awareness.

The biggest thing I want to encourage you to do right now, which many of you may have been putting off and many of you may have already been doing this already, is to evaluate your website. Now, why evaluate your website? Well, good question, because your website is the calling card that everyone is going to be looking at and tapping into whenever they hear about you. Any future referral or any future word of mouth or any type of marketing that you’re going to be doing in the future, everyone is going to be going to your website. It’s going to be important for you to take this time to use it as wisely as you can. One of the things that I suggest you do is to make whatever improvements need to happen to your website now. Here are a couple of things I want to encourage you to do.

Explore your homepage, okay? What happens when people visit your website? What is the first message that comes across to them about what you do and what you have to offer for them? Is it easy to navigate? Do you have a message that comes across to them when they hit your website? Do they know that you’re a specialist in sports medicine or a specialist in fertility or that you’re amazing in helping support immune health or that you’re really good for stress and anxiety relief? Many of you might not be specializing right now, but I encourage all of my students in my practice management class and all of the practitioners that I’m mentoring to figure out something that they can specialize in.

The reason is is because every acupuncturist is trained to be a general practitioner, which is great. We can help so many different conditions. This being a specialist means that you are able to focus your mind, your money and your communication processes and your messages on specific niches. That’s one thing I would really encourage you to do. Also, make sure that your blog posts are current and up to date. Maybe you could take some time to write a couple of blog posts now about immune health and about staying calm and about how to be productive, what points are good for immunity, what points are good for keeping you stress-free, and what points are really good for helping you stay motivated and productive. Okay?

Also, you want to check to make sure that your website has multiple calls to action. If you’ve seen any past webinars or trainings that I’ve done, you’ve heard me talk about calls to action. These are specific calls that are on your website that make people take action. Maybe you people visit your website and they might not schedule with you right away, but maybe they’ll give you their email address in exchange for a free eBook on immune health, or maybe they will click to download a low cost complementary evaluation or exam that you may be offering. On your website, you need to have multiple calls to action, little buttons that say, “Click here for this. Click here to schedule for this. Click here to download this.”

If your website doesn’t have that, I encourage you to take that into consideration. One of the first things I really want you to do is to audit your digital awareness and evaluate your website. If any of you are interested in getting a free website evaluation, feel free to put some comments in the box below the videos here and I will reach out to you. I’ll have some team members reach out to you to provide you with a free website evaluation because that’s something that we do that’s near and dear to our hearts. Okay? The next thing that I think is really important for you guys to do is to tap into some technologies now that you can learn how to use and learn how to work with your patients that you could use now and also into the future.

Because, like I said, I don’t think that this is a one and done kind of thing. I think this is the kind of thing that’s going to be coming back to us. Telehealth, that is the big buzzword these days. Doxy.me is one of the easiest platforms that you could be using in your practice. It’s really easy to set up. There’s no downloads that need to take place. Clients, they just click and they access your telehealth portal. Exploring technology is important. I think one of them would be making sure that you’re familiar with telehealth, and the other one is to do videos.

I think doing something like this where you could actually put on a camera or use your phone and sit there and educate about immune health or educate about tapping specific points for calming anxiety or stress or improving insomnia or helping to support the immune system. You have so many tools at which to educate and teach on. Don’t hold back, okay? Maybe you’re scared about getting in front of a camera or maybe you’re scared about what you should be saying. But the thing is, I feel like this whole crisis that’s been happening now, people are becoming less judgmental and you don’t need to be a model and look handsome and beautiful in order to be behind the camera.

Just showing up and being real and offering really solid content and making sure that you’re there to support your community, people will get that. They’ll really resonate that with you. I encourage you all to tap into the technology of using videos for your marketing prospects and to help grow your following. YouTube is the way to do that. There are so many different ways. You could turn on your iPhone and take a couple of videos. You could have other friends and family members or other practitioners even interview about a couple of things. One of the things I would encourage you all to do is to jot down some of the points that you know that are really great for supporting immune health, right?

You could name a few off the top of your heads, and put together a short little video. It could go something like this. Hi, my name is Jeffrey Grossman, and I want to share with you about how acupuncture and acupressure can help support your immune health in these crazy times. I’m really committed to helping people in our community to stay well and to stay healthy. Many of you might not be aware of the fact that acupuncture is really great for supporting immune health. What I want to do is I want to walk you through three acupressure points and how to use those points to stimulate immune health. That’s it. Really super simple, right? That’s one video I would definitely encourage you to do.

Also, those of you that work with herbs, what herbs are in people’s kitchen right now that can help with lung health or coughs or immune health or raising the chi in any way? I am sure you can think of some. Do a video on these kinds of things, okay? Those of you that are frightened about doing any types of video, but you want to do them, again, drop a comment below here and I’ll reach out to you because I’m committed to helping practitioners find success during this time and to overcome some of the fears that are keeping you back because this is the time to not be stagnant, right?

This is the time to tonefy and to move forward, to move your cheese so you can get out there, so when this whole thing is over and it’s going to come to an end and it looks like there’s a silver lining on the clouds right now, for many of us in the different states that we’re at. Things are going to eventually get back to normal for the most part, although there’s going to be things that aren’t going to be as normal as they are right now. I’m encouraging you to tap into these things that might make you feel uncomfortable. Because when you hit up against that wall of discomfort, you know you reached your limit, but moving beyond that is where you need to go. It’s not that hard to do. Okay?

You need support, you need some mentoring, you need some guidance, and maybe even just a short little script or some ideas on how to do that. That’s what we’re here to do and offer you. All right? Technology is really important to tap into, telehealth, putting up some videos, and also email marketing. It is the lowest hanging fruit that you have right now in your practice. Most of you that are listening to this have some semblance of an email list for your patient. Use it. All right? Tap into this knowledge. Again, if you do a video on immune health, you could use that same content to put on your website, to put on your social media pages, and to also put as an email to your patients. Because what else are you doing?

What else are they doing right now? If you’re providing solid content with them that is encouraging and engaging and inspiring, they’ll eat it up. They’ll really enjoy that. Sending emails out to your patients now is really important to stay in top of mind awareness so they don’t forget about you. Because if you’re not doing it, somebody else might be and somebody else is going to be getting in front of them. When this whole thing blows over, they might not come back to you because somebody else kind of captured their attention. Don’t lose their top of mind awareness of you. Okay? You want those people back. All right? The other thing I want to talk about, one of the other actions that you can be taking right now is to tap into your goldmine. Okay?

Now, your goldmine are the people that already know you, like you, and trust you. Those are the patients that you already have in your practice. Now, I want to encourage each and every one of you when I’m done with this video is to write a list of all of your A patients. Your A patients are those patients that you love. Whenever you saw them on your schedule, your energy raised up. You’re like, “Oh my God, I want to clone my practice with every single one of that kind of patient,” right? Those are your A patients, the ones that raise your chi. Now, your C patients, the ones when you see them on your schedule you’re like, oh my god, how am I going to do this? Okay, I can muster up that energy. It’s the end of the day. Okay, I can do this. I can do this, right?

Maybe some of you are giggling right now because you can resonate with that. Make a list of your A patients and call them. Simple conversation to have. Here it is. Hi there, Jeffrey. I am just checking in with you. I miss seeing you here at the clinic, and I just want to see how you and your family are doing during this crazy time. I also want to let you know that there are a couple of new offerings that I’ve been tapping into here at the clinic. We are now offering telehealth, and I’m hosting a class on four points to support immune health. I also want to share with you on certain specific herbs that are really helpful that you probably have in your kitchen that can help support your immunity. That’s the conversation. Just call up your A patients and just check in with them.

In my group mentoring class that I run each month, people are doing that, and the practitioners are surprised that they’re getting such a great feedback from their patients. They’re like, oh my God, thank you so much for reaching out to me. How many other doctors have reached out to you during this time? I mean, I imagine probably none. Okay? For your patients to hear from you when you’re just, “Hey, I’m just checking in and seeing how you and your family are doing. I want to let you know about some really cool offerings that we’re having here at the clinic,” that’s cool. That goes a long way. Make a list of your A patients, reach out to them with a phone call, and then with a follow-up email, simple conversation.

Really that’s all we need to have with them. The other thing I want to talk about would be consider diversifying your offers. Okay? Now, what do I mean by that? By diversifying your offers, what else can you think about that you can offer now and in future times when we might have to close our practices because of this craziness that you can offer? Can you offer herbal consult? Can you learn about EFT tapping techniques? Can you learn about specific acupressure points that you could teach more deeply and more widely? Can you learn about like breathing techniques to stimulate the chi or qigong? Okay?

What kind of off things can you offer now and in the future that you can potentially charge for, that you could teach online classes for when and if we get to this place again where you’re seeing your patients through the internet? Okay? A couple of things that you might want to consider too is offering more retail. When this whole thing is over, one of the things that you could be selling still would be herbs that get drop shipped to your patients and retail like supplements and other types of things from like Emerson Ecologics that you could drop ship to your patients. That’s a great way for you to generate a little bit of income now and to still be in top of mind awareness of your patients.

I want you to ask yourself what kinds of changes can you make today that will manifest for you now and also into the future? Because I think this is going to happen and I want you to be prepared. I don’t want you to get stuck and like become a deer in the headlights at some other point. Okay? I want you to be prepared now. Where can you pivot your practice now in order to come out of this positively in the way? Don’t get stuck. Don’t stop marketing. Don’t stop the communication process now. Stay in top of mind awareness however you can in order for your patients to remember you and to be reminded of all the good things that you have to offer them. Don’t assume that everything’s going to go back to normal because they might not. Okay?

Determine what you can do to survive and thrive during the now and also how you’ll come out of this in a powerful way and into the future. Thank you so much again for the American Acupuncture Council for hosting me on the first training that I’m working with you guys on. Thank you everyone for watching me here. You can reach me at jeffrey@acupuncturemediaworks.com or in the comments below here or even through our websites at acupuncturemediaworks.com or acuperfectwebsites.com. Feel free to reach out to me there. Make sure you join us next week for the next To The Point by the AAC. Thank you guys so much. I really appreciate it. Stay strong, stay connected, stay focused, and do not stagnate. Okay?

Do what you can now in order to manifest your future, so when this whole thing ends, you come out of this smelling like roses. Be strong. Stay healthy. Talk soon. See you next time. Bye, bye.

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AAC To The Point - Lorne Brown

Best Practices for Starting Up After COVID-19

Click here to download the transcript.

And again, thank you to the American Acupuncture Council for inviting me to host the practice management sessions on their webinars. Today we’re going to be talking about COVID-19, best practices for starting up after a full stop. I’m your host, your moderator Lorne Brown. I’m a doctor of traditional Chinese medicine, founder of healthyseminars.com, the clinical director of Acubalance. I’m a doctor of Chinese medicine in Vancouver and I’m also a CPA. And I got some impressive guests with me today as well. I got the chair and vice chair of the ASA, the American Society of Acupuncture. David Miller is a medical doctor and a licensed acupuncturist and Amy Mager is a licensed acupuncturist and they have been a voice for our profession. And since we have been in isolation, some of us are maintaining isolation, some of us are starting to go back to work part time, et cetera. There’s lots of moving pieces and we thought it’d be a great opportunity to have two great resources, Amy and David come here and answer some questions for us. Thank you both for taking the time out of your busy schedules to be on my show.

Thank you for the opportunity to encourage people to find the best resources for going back to work at our website, www.asacu.org. On the top there’s a COVID-19 resource page. You can click that. It’s updated regularly by our webmaster Z Elias and he’s happy to do this and we’re happy to have you go there. One of the most important documents we have there is one created by the board entitled, Contextualizing Essential Healthcare Providers and Essential Healthcare Services During COVID-19. And it’s an extensive document and we invite you to go there and find it at asacu.org.

On the ASA website that’s an important thing to kick off. There’s some resources that have been collected and is being updated daily. Now, first question I have because I want to get some practical tips for our group. You have the ASA website where you can check out these resources. David, we’ve been chatting a bit and I just want you to kind of elaborate and go back into what’s it going to look like for practitioners as we ease off these restrictions and return to work? What are you aware of for all the different states right now?

Right, I think that’s a great question, Lorne. Thank you. I think what’s important for people to understand is that this is not a stop or go kind of situation. This is not a you can’t practice or you can go back to full practice just like you did before any of this happened. This is a staged process and as people return to work, they are expected to take significant precautions in practice if they do return to practice.

And so the first piece of that is, when do you return to practice? And it’s important to pay attention to the guidelines put out particularly by your local authorities. Start with your local authorities, then go to your state authorities, then go to the national authorities in terms of when you should start to open up your practice because the distribution of cases of coronavirus are different depending on your location. And the thought from the governmental level is that in areas that are less densely affected, that it’s more appropriate for those people to start opening up their doors a little bit more. Whereas in places where it’s highly concentrated, it makes less sense to do that.

They’re watching for a number of factors surrounding that, including a decrease in the number of new cases, particularly occurring in the area and a decrease of the slope of the curve. But remembering that just because the curve is starting to go down, that’s just reflecting a decrease in the number of new cases occurring each day. But not that no new cases are occurring. If you have a 100,000 cases occurring on the peak, and as one doctor said, then the day after the peak, you might only have 90,000 new cases, but you still have 90,000 new cases on top of that 100,000 cases. And so don’t get over comfortable with opening your doors like everything’s fine.

What it’s going to look like is there’s going to be an expectation that you’re still screening your patients, that you’re checking to see whether they’re symptomatic, whether they should be dispositioned somewhere else, whether the condition that you’re going to treat them for really needs to be treated right now. And whether or not that patient themselves is a high risk person. Do they have diabetes? Do they have a congenital heart problem? Do they have immunosuppression? Things like that. Those kinds of patients, it’s more risky for them to leave the house and come out. There should be a relatively greater threshold to starting treatment with them. Think of this as a staged approach and it’s not all guns forward, just we’re going back to it. It’s going to be a gradual process that’s done very cautiously and is different location by location.

And is there a risk then that we go back to work and could this all happen and we get shut down or get pulled back?

Absolutely. That’s a yes. That’s a great point. And I actually really want people to take that to heart. All the predictors are that we will have a second surge. Because we have a decrease in our surge because we have done this isolation technique that lowered the number of new cases. But because this is so widespread, once we start interacting with each other again, we’re going to see a rise in the number of cases. And the question is, how high will that rise go? And one of the big reasons we have to do such an extreme sort of isolation in this case is because no one has any immunity to this. We were under prepared or under stocked in resources. And so it caught everybody essentially by surprise and we weren’t ready to manage it. But we should anticipate, we’ll be happily surprised if it’s not true, but we should definitely anticipate that there will be a second surge.

And as doctors at the national level, Dr. Fauci and other people have said, when you start mixing that with seasonal influenza, then it gets really hard because seasonal influenza is hard enough. And then you add this on top of it that when we get into September, October, November when influenza starts to rise and you can’t tell whose symptoms are from which illness, and you’ve got this compounded situation of two illnesses that are significant occurring at once, we don’t know whether or not there’s going to have to be a second isolation order.

But I think it’s really important for the practitioner community to not get caught twice, in being not prepared. I absolutely do not encourage people to hoard supplies. Don’t hoard things. Make sure there’s good distribution of supplies for people, but plan ahead also. Have a store of masks on hand. Have your gloves on hand. If there are herbal formulas that you prize more than others, have those on hand. Gradually build up your storehouses and calculate if you see this many patients per day or this many patients per week, how much of that do you actually need to to practice on a limited basis, most likely? But even on full force, how much do you need to practice? So that we’re prepared for that next time and don’t get caught without the personal protective equipment.

And then either of you or both of you, what can we do to prepare our clinics? What are some of the supplies and procedures that it looks like we’ll have to be doing? And I’ll add this that for the listeners, this can change on a day by day basis. What is it that you are seeing that is going to be kind of required? And then in your own personal thought process, what are you planning to do? Because there may be a minimum you have to do, maybe you want to do more. And so that’s kind of a two part question is, kind of what do you think is going to require of us? Their mask, patient mask, us mask and the distancing, so can you kind of walk us through what it would look like in a clinic daily?

It’s going to depend. I’m in a private clinic, David’s in a hospital and many of us practice in private clinics. In a private clinic, you’re going to want to have your gloves on. You’re going to want to text your patient to come in because normally we might have two, three, four people in our waiting rooms and that’s not going to be allowed to happen. You text patient when somebody’s in a room door closed, you’re ready for the next person to come. You preferably you open the door with a gloved hand, let the patient in, patient washes their hands and patient, if they’re not wearing a mask, you hand them a surgical mask. That’s one of the things we have to have on hand.

We’re going to need surgical masks, gloves, we’re going to need KN95 masks for us or N95 masks if you have them or can get them. We’re going to need hand sanitizer. We’re going to need Clorox bleach, things that kill COVID-19 because after your patient has washed their hands and you washed your hands, practitioners are deciding whether or not to use gloves. Then you take them into your treatment room. We are now in a situation where there’s no table warmers, no sheets. You can, unless you have a table warmer and a vinyl sheet on top of it, and you’re not going to put the vinyl table warmer on fire if you put it on top of your table warmer, no table warmers. Paper only. People often put paper in the middle of the table. Research demonstrates that if you cover the whole table, you’re better off. Instead of using a sheet, you’re going to cover your table with paper. You’re going to use a either a plastic backed paper pillowcase, or you can have plastic pillowcases and the paper plastic back ones on top of that.

You get your patients situated. It’s recommended that you not be in the room for more than 15 minutes, which is going to change our billing and coding and how many units we can apply for. When your patient leaves you, escort them out, preferably with your washed hands, gloved hands, and you open the door again so you have control over what’s going on with the doors in your space and what’s being touched. Once that patient leaves, you cannot bring another patient in until you thoroughly wipe down the table and every space with COVID-19 killing disinfectant. Make sure when you take, when you roll up the paper, you roll it up into the center so you’re not putting things into the room. When you take off your gloves, roll them inside before you throw them out. When you take off the pillowcases, roll them inside.

Make sure you have sanitation stations because your patient may or may not come in with a mask. You want to have a safe, clean place where you have surgical masks, where you have wipes, where you have gloves. What’s your patient’s comfort level? Do they need gloves on to feel safe? These are the things that I’m going to be doing and that Valerie Hops and Steve Shomo are going to be speaking to, from the CCAOM at our webinar next week. That ASA town hall next Wednesday night will be about this. We’re encouraging people to go to our website, asacu.org or our Facebook page, American Society of Acupuncturists to register for that link where you will not only gain knowledge, you’ll earn two CEUs and you’ll get to be a part of the greater discussion.

David, what do you have to add to that?

Well, I think that’s a great explanation, Amy, and it’s a really thorough picture of the types of precautions that we believe will be expected. That that level of mindfulness really will be the norm, we hope. And so, there’s just to generalize, there’s the patient flow questions that have to be managed, the patient spacing questions. There’s the sanitization questions. And so groups that are, practitioners who are used to seeing two, three, four people at a time and running from room to room, that’s going to be tricky. That’s really probably not going to be possible. You’re going to be doing more, maybe two rooms at a time maybe. But even more likely just one room.

I think unfortunately I think group treatments are going to be really hard to navigate for a little while because there’s just no way to control the airflow. There’s a sort of, almost a meme now, but a gif I guess was in the Washington Post of how a cough circulates in an airplane and, but even if you look at pictures of coughs and sneezes that they take, it just takes one person with a good sneeze or a good cough to fill the room with enough particles to infect everybody in a closed space.

Multiple people in a closed space together, it’s going to be very much counter to the efforts of limiting the spread of disease, which is, it’s a problem. It’s a real shame and a problem that I hope we can figure a way out of because that’s an amazing service. And yeah, so if you look back also too at the original ASA document that we produced on this, I think it’s still a very good resource, but we’re very much looking forward to in partnering with the, there it is, the CCAOM. Amy’s holding it up. The CCAOM document that that Valerie and Steve are putting together, which is an excellent, an excellent resource. And we’re doing that at the the ASA NCCAOM town hall, as we said a week from today. There may be some other opportunities to see them as well.

Thank you for that. That’s a great resource on ASA. I will share also that healthyseminars.com/resources. We have sections on COVID-19 and it’s more about the acupuncture and herbal approach in response to COVID-19. What practitioners are doing when people are, how they’re presenting. We’re not saying they’re treating COVID-19 but using the principles on how people are presenting. Still using Chinese medicine principles. If you’re looking for that kind of information, that’s at healthyseminars.com/resources.

If I could jump in Lorne, just for one sec. I do want to underscore that from the ASA perspective, it’s not appropriate for us to be sort of teaching you how to treat people on this. What we’re trying to focus on is really the practice dynamics of that and the sort of nuts and bolts about just how to do the practice. The actual treatment of these things, either with acupuncture and herbs, there are excellent resources and excellent lectures on this, but we can’t vet them all. We can’t endorse from a public health standpoint, some of the ideas. And so it’s just not our role as a professional organization. And we also don’t need to do it because there are excellent, excellent resources like Healthy Seminars has quite a few and others have done amazing lectures. Site for integrative oncology, has done some great lectures with Dr. Lu. We’re going to have Dr. Lee on. He’s going to be sharing more his experiences on the town hall tonight, I believe. Oh no, also a week from today with Valerie and Steve. And other vendors also have particular some really fine lectures.

It’s nice. Everybody’s coming together trying to figure out how to support the individual and again at Healthy Seminars, we’re not addressing the disease as much as we are working on the individual basis. David, so what are your thoughts on the safety for the practitioner? And so a couple of part questions here is, are we at risk of as practitioners, since there’s a lot of asymptomatic patients, is it possible we as practitioners can get it even though we’re doing these safety measures, washing your hands, wearing masks? And if a practitioner becomes diagnosed positive, they get sick, what should they do if they feel a fever, they feel a little off? What should they do? And if they test positive, what happens to the clinic? What kind of communication needs to happen? Because I think it’s likely that some practitioners are going to catch COVID if they’re treating the public.

Absolutely. And so, and this is the thing that makes this tricky is the long silent carrier stage with this too. That people can be walking around asymptomatic and be silent carriers. That it’s estimated that up to 50% of people who catch coronavirus will not develop symptoms but may spread it anyway. The chances of our contracting it are high. There’s no difference for the practitioner than the patient. We hope we’re being more vigilant about the things that we know spreads COVID virus 19, like we’re washing our hands better. We’re not touching our faces in between more. We’re being, more cautious in our interactions, in our physical distancing. But there’s nothing special about being a practitioner that should lead anybody to believe there’s not a high risk for them catching it just like there is any member of the public.

The bigger concern would also be that someone becomes a silent carrier and then also transmits it to many, many patients. Which gets to the part of your question that if you are diagnosed with COVID-19, you need to be prepared to contact every patient that you have seen over at least the past 14 days, ideally probably the last 21 days, and inform them that you have tested positive or developed symptoms. Now does that mean you gave it to them? Absolutely not. You could have picked it up five days ago, someone you saw 14 days ago, but we don’t know. If we’re being really rigorous and doing best practices, then we would contact everybody we’d seen for the last 14 to 21 days to inform them that this is what’s going on.

If a practitioner becomes ill, how they care for themselves of course is beyond scope of what we can advise. But certainly they want to do it in conjunction with their medical team and they want to be really aware that, while most people end up doing okay after infection, there are people who get very sick and decompensate very quickly and so just to not take it lightly. Don’t take it for granted, do do your self treatment, do do your self care, but make sure you have access to a medical team who can support you if things start to go south. And Amy, I know you’d like to say a few things about that.

You covered the most important pieces. The only other thing I would say is we really need to advocate for testing because when people are treating in the hospital, they are tested on a regular or semi regular basis. And we need to find that and make that available for acupuncturist because if we’re going to be seeing patients, we need to be able to be tested to verify that we are not passing the virus or carrying it nor passing it on to others.

Right. And I think it’s also important to know that testing is in a state of development right now. Tests are not 100% accurate by any stretch of the imagination. And so that repeated testing will be important when it becomes available. And the other thing is as another practitioner had pointed out or somewhere that if you’re right now using the test and you’re being tested and they’re swabbing you, if it was not terribly uncomfortable, it wasn’t done correctly because you’re supposed to swab the posterior nasal pharynx. The way back of your nose. That swab’s got to go up there and you’ve got to twist it and you got to do back of the throat, there should be some gagging, some discomfort. It was a little bit of a ni, ni, that’s not accurate testing.

Many things to look forward to. I want to play some scenarios with you guys. And again I just want to caution or put this out to our listeners is that you got to check in with your state health authorities and your state boards. And so these are just scenarios that I’m playing with and we haven’t rehearsed this. I want to know kind of your thought process.

I’m a practitioner and I get a call from a patient that says, “You saw me four days ago, Lorne and I just found out that I have COVID. I tested positive.” Do I have to go call my patients I’ve seen since I’ve seen that patient? Do I have to close my clinic until I’m tested? What would you think some of the scenario is? Because this is one of the scenarios that likely will happen and a patient’s going to call you because they’re supposed to, I just found out that had COVID. What do we do as a practitioner that are not experiencing any symptoms but know that we had treated a patient with COVID-19 five days ago?

That is a great question.

This is how my brain thinks. That’s the problem.

Yeah, absolutely right. Amy, did you want to speak to that?

Just to say that you’re going to have to do all of the things that David just spoke about. Because whether it’s you, whether it’s a patient, it’s called due diligence. And we can’t control this and we don’t know where it came from, and nonetheless we need to do our due diligence. What David said is what I would repeat.

Right. And what I would also add too, if I could, is that before you find yourself in that situation, it would be ideal to have a special consent form that you’re using during this time that explains to patients, here’s the deal. If I’m treating you and I turn positive or I am exposed or I develop symptoms, I’m going to contact you and tell you that this is what happened if I’m aware of it. And it doesn’t mean you caught it from me, it doesn’t mean this or that. But I want you to be aware that I’m being very transparent in what’s going on. And that if you’re going to accept coming to my clinic and if you’re going to accept a treatment during this window of time, you are implicitly understanding that there is a risk to doing that.

The only super complete safe thing is stay at home, complete isolation. Which is hard for anybody to do and maybe not always necessary. But otherwise, the more upfront you can be with people about what you’re going to do, then they won’t be surprised when you have to do it.

Right. Thank you, David. And Amy had to jump off. We knew she had a call, so her technology is good, but we knew she was only here for the beginning of it. What about, maybe we’ll finish off with a few couple comments or questions, but what about if you’ve had it already as a practitioner? You feel that you’re in the clear you’re immune or is there a chance that you still could catch it again possibly?

Right. Yeah, that is another one of the million dollar questions right now and the reason for that is, clearly we do develop some immunity to COVID, many people do when they get it. Because that’s the whole serum that we’re trying to gather from people to give to other people to help them get better quickly. You absolutely can develop some immunity when you have it. The problem is different people develop different levels of immunity, how robust that immunity is. Someone may get COVID and end up really not developing any lasting immunity. Another person may get it and develop a robust immunity, but you don’t know who you are in that process.

The other thing that we don’t know about is how long will that immunity last? Generally speaking, immunity is of duration because you get re-exposed to the critter over and over again throughout your lifespan. As we said with chickenpox for example, you get chicken pox, it actually lives in you, but your immune system keeps it under control because you get periodically re-exposed to it and it reminds your immune system to stay robust and so it stays under control. And when you stop getting re-exposed to it over and over again, then you start getting outbreaks of things like shingles because your immune system starts to forget to pay attention.

How our immune systems are going to end up behaving in the area of COVID, in the era of COVID, we don’t know because we don’t know if this organism is going to be around enough to reinforce natural immunity if it occurs. We don’t know if it will mutate. That can be another thing that happens is that you get immunity to a certain pathogen and then that pathogen mutates and finds a way around that. I think there may be some short term comfort in having had COVID and recovered, but don’t bank on it. We don’t know how long that immunity is going to last. We don’t know which one of us developed robust immunity versus really no immunity to it. Those questions are being studied right now by public health authorities, but it’s too new to know any longterm answers because this has only been around for a short period of time.

Great. Thank you very much. For information, I just want to remind people, first of all, actually let’s summarize a bit. Keep going back to your local health authorities, what you’re suggesting. they’re the ones that are really putting down the policies. The American Society of Acupuncture has information, healthyseminars.com/resources, we have a section on COVID as well for you guys. And just any last words? Oh, actually I do have a good question for you. What happens in my state or province if an allied health profession is being told that they can go back to work, but as an acupuncturist I cannot, should I be taking that personally?

Right. Yes and no, I guess I would say to that too. No, you shouldn’t take it personally and I think it reflects a certain, evolution of the field in terms of what people think of us for. I also want to add to your list, the NCCAOM has a great list of resources too. We’ve been collaborating with them, the ASA and then CCAOM is developing great resources as well and we’ll be releasing those shortly. Those should also be on your list of organizations to check with. This gets back to that question of am I an essential health provider? And am I providing an essential health service? And I think the particularly difficult thing with acupuncture is that we offer a very wide range of product so to speak. We offer everything from feel good relaxation sessions, which are absolutely not critical, although we want to lower our stress. We all know there’s just relaxation sessions and then we offer really critical pain control that keeps people out of the emergency room. We offer help for mood and emotional disorders that could otherwise end up in self harm or harm of others.

We really offer the range of services from sort of mild to severe. And so as you assess patients, that’s kind of the consideration you have. Now whether in your area you are considered this or that, is also, that was what was in place before COVID. And I encourage our state associations and for people in the US to join your state association and become involved in the process of advancing the field at that legislative and regulatory level. To some degree, I think the field wasn’t completely aware of before this crisis.

We are in this intersection of times where we have an extreme circumstance that has revealed chinks in the armor, so to speak. But we also need to be honest with ourselves about what service am I providing? Is it truly critical? Even if I am an essential healthcare provider, it does not mean that everything I do is essential right now. That’s just hubris. It’s nothing else. But some people are providing services that really are critical. They’re keeping people out of the emergency room, they’re helping them with mental and emotional health, they’re helping with fertility, they’re helping with things that just can’t wait. And then those services are at a higher tier of reintroduction.

I think one of the things that we’ve seen in some of the documents coming out, like from the Medicaid services is acupuncture is sort of a knee jerk reaction listed as a tier one not critical. But they are also thinking of acupuncture, they don’t know the level of patients that is often treated. And so they’re giving a very general recommendation that is a recommendation and a guideline and not a law or a strict rule. And so we just need to understand that. And that’s part of the educational process for the rest of the healthcare system in terms of the services that can be offered through our providers.

As we come to the end of this interview, and again, I want to thank you David for making the time and Amy who will be watching the rest of this later. Thank you, Amy. Basically it’s a new, it’s no longer, it’s a new normal that we’re going to be going into and I wouldn’t even think the word normal is correct. And so our expenses of treating, and this goes to everybody now who’s into health services has changed. There’s going to be increased costs to treat your patients. There’s going to be new regulations and policies are going to be changing regularly as we learn. And so it’s not like it used to be. How you treated before, be prepared to adapt and pivot and shift because it’s going to change. The volume of patients that you’ve seen may change also, be reduced because to do it safely you may not be able to do that volume until we figure out a way to do it safely.

That’s one thing because we talked about today is COVID-19 best practices for starting off after a full stop. I think one is getting your expectation set that it’s different and it’s going to be a little bit more effort and work to play safe and your volume is going to be down a bit. But priority safety, everybody. And then keep staying informed and educated and so you can do this practice safely. And so the ASA has put out great resources. You said the NCCAOM has some great resources. The California Acupuncture Association has put out great resources and at healthyseminars.com we keep putting out resources. And it’s healthyseminars.com/resources. Please keep checking these resources, get informed, and it’s changing on a daily basis.

David, thank you very much for your time. I really do appreciate you.

Thank you for having me.

Taking the time. And then everybody stayed tuned for, To the Point the American Acupuncture Council’s next webinar. I apologize. I actually don’t know who the next speaker is, however you can check out that website and you’ll see who’s hosting the next To the Point webinar. My name’s Lorne Brown. You can find more about me at healthyseminars.com and I look forward to you guys when we do our next practice management webinar. Thank you very much.

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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.

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

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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