Tag Archives: American Acupuncture Council

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Boosting Immunity to Prevent Colds and Flus

 

 

Click here to download the transcript.

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

Hi and welcome to another edition of, To The Point I showed very generously produced by the American Acupuncture Council, um, Virginia Duran of luminousbeauty.com. And I’m your host today, and we are speaking about boosting immunity to prevent colds and flus. So let’s get to it.

I just want to start with a little, um, reminder about the perspective that Chinese medicine has on boosting immunity, right. Um, because it is a little different and, uh, it, it adds another dimension of your understanding and your treatment strategy. So we have what something’s called [inaudible] it is that she, that is at the surface of the body. So it involves the skin in some cases, but also it comes out it’s your electromagnet or part of your electromagnetic field. So it’s protecting you physically as well as energetically. And, uh, you’ve probably all experienced that, you know, where you’re so run down that you can’t even really be around people that you feel like almost, you don’t have your skin on that’s severely depleted way cheap. So we want to keep that up for, for both reasons. And, um, of course there are different aspects to immunity, then more than what we’re going to talk about today in different categories of viruses.

But our focus today is for upper respiratory Lucent colds, and it’s, uh, you know, a timely subject in the Northern hemisphere. So there’s two main strategies. One is to boost your wig witchy, uh, you know, which is, you know, augmenting the immune system and also written the body of phlegm in advance of getting sick, because there’s a, um, it tests have shown that some people who have that, uh, symptom where they can’t breathe when they get a really bad upper respiratory condition, uh, there’s phlegm blocking the airways, usually old sticky Flint. So I’m going to talk about some formulas for both of those, um, as well as lifestyle tips, supplements, and, uh, points. So here we go, some lifestyle tips, you know, uh, I think that the two, the things that you can actively do are doing [inaudible] to generate your way and doing something like pranayama yoga breathing also has that effect of really building up the way she, um, of course, vigorous exercise is going to be very helpful acupuncture shown to have immune regulating effects, and you want to limit your exposure to EMS as much as possible because they’re going to affect things.

Uh, also you want to get adequate sunshine. Don’t worry so much about, you know, damaging the skin with a little sunshine. Really. We need that vitamin D. So, uh, in the winter, you could try to on a sunny day, get out and get maybe 15, 20 minutes of sunshine your face, if it’s possible, roll up your sleeves on your arms to get a little bit, um, but it’s absorbed through the skin. Um, of course getting adequate rest and good quality sleep. So you might want to think about turning off your devices and anything, uh, where you’re taking in blue, white, because it’s very stimulating and you’ll have a harder time falling asleep, or having a deep restful sleep. When you go immediately from being on your computer all night to, you know, trying to go to sleep, um, stress management, we know stress affects the immune system, right?

So many ways to do that. That’s the, you know, uh, we won’t get into that here, but I’m sure you all know ways to do that. Good nutrition. We’re going to talk about a few things specific for this, um, idea of boosting immunity with food. Uh, you want to have sufficient hydration. You think about when you, everything works better and you, your bells work better as well to eliminate things. Um, also sometimes when you get dehydrated, you start to get a sore throat, even if you’re not really sick, but it can create a little bit of heat and inflammation in the body. If you’re dehydrated and you want to avoid drafts, especially in the back of the neck, right. And, you know, for some dietary considerations, um, I really think it’s important to be dairy free or as much as possible. Um, and if you are going to have dairy stick to goat’s milk, rather than cows mark, because human mother’s milk has a very low levels of KC.

And that kissing is what they, you know, what Elmer’s glue is made of that white sticky phlegmy stuff, right? That you produce in the body when you eat a lot of dairy and cow’s milk has 200 times more cases than human mother’s milk. Goats milk only has about 20 times more cases than human mothers. Not so try to get used with, there are goat products that don’t taste as goatee. Uh, you know, you’ll, you can, you can make that adaptation if, if, uh, you really want to do this because in Chinese medicine, we’re very aware of the importance of phlegm, how much it’s a factor in creating some diseases and tumors and things like that. And disease is created along a continuum. That’s our understanding. That’s one of the great gifts of Chinese medicine. And so if you are always having dairy and you have a little drip and you have, you know, sinus things constantly and, or, you know, little residual phlegm in your lungs from something, uh, it it’s it’s has the potential of turning into more things, you know, more serious things.

Uh, so there’s a lot of immune boosting and antiviral medicinal mushrooms, my talking mushroom, you know, which is foraged in the fall. Wonderful. If you, especially, if you can get it, um, local versus the store bought things, um, that, you know, aren’t grown in nature, um, blue oyster mushrooms, also very immune boosting and nature provide these remedies that at that time of year, um, you know, she talking mushrooms, uh, you know, are especially used with herpes because it generates stomach yen. It helps with, um, uh, a stomach in deficiency, heat type of herpes. So we’re not actually going to get into those kinds of viruses, but it still has immune boosting effects. So it’s nice to put into your food more often, especially in soups, because you’ll get more out of it than more benefit out of it than just saw Tamia, probably. So I’m including a homemade chicken soup for those that aren’t vegetarian, but even if you already, you can adopt it without the, the chicken part of it, um, really good to have in your freezer at all times, because you never know when you might need it.

And when you do need it, you’re probably not feeling well enough to go out and buy the ingredients or stand up and make it for a couple of hours. So, um, I always make, you know, big pot and freeze a whole bunch of it to have now not how is another thing that is immune boosting and have some properties I want to discuss, uh, you know, it’s a fermented Japanese soybean product, but it is a specific kind of soybean. And it’s, it’s a very traditional Japanese dish. It’s often served for breakfast. Uh, it’s not so popular here. You know, the taste, it’s not that strong of a taste, but there’s a texture to it. That is a little strange that people, um, can be, uh, I have an aversion to, but, you know, just close your eyes at that’s the case. It’s so good. It’s like a natural blood thinner, which, uh, you know, as we get older, we might need we’re, you know, it’s, it’s good for all the blood stagnation we’re seeing now from people with a certain virus or, um, you know, they they’ve been jabbed.

So I would start slowly with it though, if you see that you or your patient have sublingual stagnation, distended veins under the tongue, and, you know, just start with a half a teaspoon daily, if there’s a lot and go, go on for a couple of weeks, that way then work up to a teaspoon. Then you could go up to even more. Uh, but you don’t, you want to dissolve things slowly, not, um, you know, not too quickly now for the benefits of natto, as I said, it’s immune boosting, and that’s why we’re putting it in here. Um, but also, uh, you know, it has this unique probiotic and called bacillus Tillis, and the strain was tested in an elderly population and it was compared to people taking a placebo. And the outcome was that 55% like less likelihood to suffer from respiratory infections in the nacho group. It’s rich in vitamins minerals and protein high in vitamin C zinc, selenium, copper, and iron, all important in immune function.

It has K2 and K one, which has really benefited from that K two is, is kind of amazing because it helps the calcium from depositing in the arteries, right? And there was a study that showed 50, 70%, 57% lower risk of dying from heart disease when eating foods with K2. So this is a little bit, uh, unusual. And then the K one is a natural blood thinner, and that’s going to help them prevent and dissolve blood clots. And Stacey’s very important these days. Um, so there’s probiotics and fiber in it that can also be helpful with promote preventing weight gain and optimizing, optimizing weight loss and women. You have your weight manage, uh, you know, your immune system’s going to function better.

So just to remind you for anyone that doesn’t know, generally herbs are taken on an empty stomach and supplements are adjusted with food. There’s some exceptions, but as a general rule, this Chinese herbal formula for immune boosting is fantastic. It’s called Jade windscreen, or you ping fond song. And excuse me, if my accent is not perfect, but you can see what I’m talking about there by reading the slide, um, it boosts immunity and specifically for colds and flus. So I take this one, I’m going to be around crowds of people sometimes when I’m feeling run down or I’m going to be treating patients. Um, and when you’re at more higher risk situations like a, you know, air travel and, um, it’s unbelievable how effective it is. And in fact, in 2005, there was a study published with 3,160 people that were at risk hospital workers. And during the SARS of one epidemic, then in 2003, nobody that took the pink phone sign, contracting the virus.

It’s very, very, very, very, very, very helpful. Um, now Jade windscreen, or you can find song also Astro C, which is a, um, a modified formula. This just, I think just has a little bit tiny bit of zinc and vitamin C added. Uh, but you could use any of them, but these should not be taken with auto-immune conditions. So if you have your patient have that, then you might have to find an alternative because it has a struggle, isn’t it? And that’s one of the herbs that shouldn’t be taken with auto-immune. Um, but it is a great herb. It’s also called milk vetch in English, common name or wonky. And the studies show that astragalus is a powerful immune regulator by enhancing the production of T helper and regulatory B cells. It also acts to reduce inflammation by regulating the release of pro-inflammatory cytokines. So we don’t want any cytokine storms.

Uh, so you want to have your body in a, what you would take. If you have one, that’s a different story, but this is to make you less likely to. So there’s a couple of links there where you can see research on it, if you’re interested. Okay. Now this is a, a really time tested, great phlegm, resolving herbal formula for Chen, Tom, Tom, meaning tea, or could say urchin PR, meaning pill or one. And when we say resolving phlegm, we mean getting it out of the body, but not purging it all out through your nose and not suppressing it and letting it dry up and congeal further as something, you know, some of the over the counter things for, uh, de congestions and to histamines, um, it helps your body to thin the phlegm and process it. Now it’s more for wet type Flum, but it can help when there’s some dry as well.

Some old fun, it’s a very benign it’s like citrus peel and ginger Pinella it’s neutral in nature, neither warming or cooling. So if you actually were sick, you would have to take some, you know, herbs with anti-microbial or antiviral effect. And, um, you know, maybe something that was warming or cooling. Um, so you want to have the phlegm out of the lungs in advance, cause your body does tend to produce phlegm when it gets sick in excess. And that way you’ll be, um, you know, avoiding that because that, that’s what kind of puts people on ventilators. And some people, you know, often they don’t survive the ventilator. So prevention is the best cure. All right. Now some supplements for boosting the immune system would be zinc. And we are hearing a lot about zinc. There’s a, um, holistic doctor of, you know, probably 40, 50 years named Dr.

Dietrich Klinghardt. And he talks about with his, any trans practitioners, um, all over the world. Very interesting guy. He said that he was giving his patients think supplementation and testing before and after, and it wasn’t changing their zinc levels. And then he learned, you have to give it with an eye on a four. So course atten is a wonderful Ayana for, um, when they say that hydroxy chloroquine works it’s because it acts as an eye on the Ford to get the zinc into the cell wall for the zinc to eradicate the virus. But for those of us that like to approach things, naturally, they may not want to take, um, a medication for it. They may want to take something natural, like course attend. Um, now with the course of maybe 500 milligrams, one to two times daily, and the zinc for prevention, like 15 to 30 milligrams a day, uh, and you can probably double that if somebody was sick, D three, it’s like liquid sunshine in the bottle. So it helps immunity. It also helps to lift your mood. Um, you know, there’s people who get depression, uh, seasonal affect disorder from a vitamin D deficiency. Also, of course, a multivitamin and mineral formula would be useful.

And, uh, if you’re going to have vitamin C, it should, if you can get it in a liposomal form, it’s much more bioavailable that way. And it can be used for the prevention and the treatment, um, of these things, especially with wind heat, vitamin C is classified as cold in nature. I’ve seen someone in the field talking otherwise, but I think most people agree it’s cold in nature. And, um, that is, uh, how I learned about it, uh, from Jeffrey Ewen. Now, colostrum is a wonderful immune boosting thing is the component in mother’s milk that transfers immunity to the infant. And so if you were not breastfed, this is a great thing for you to supplement with, to boost your immune system. It can be taken with, or without food, but, you know, without food, you’re probably going to get a little bit more effect, but it’s easy on the stomach.

You don’t have to worry about taking it on an empty stomach without anything. Um, and it’s okay for vegetarians. Um, there are also some good tasting colostrum lozenges, if you or your children prefer it that way. Now this last thing like the Soma glutathione, this is to open up the detoxification pathways so that they’re clear and functioning so that you will handle whatever you come across. Um, you could also use N a C capital N a C it’s stands for N acetol C-spine is a precursor to glutathione. It has an affinity to the lungs and then helps with like proteins.

Okay. Now I made up this medicinal chicken soup recipe because some of the people ask me because not only does this soup tastes really good, but you’re really getting a medicinal effect from it, which you don’t get with most store-bought, uh, chicken stew, uh, products. So in a multi gallon pot, I don’t know what size, but you know, whether it’s like a five gallon or something, we’re talking something big, something that you do corn on the cob with or something. Um, and you use the whole chicken. And I think organic’s important, um, including the skin, because that’s the part that’s actually, you know, it’s the chicken’s representation of way G so that’s, what’s gonna, um, actually convey more immune boosting effects. And the bones, uh, are very deeply tonifying, you know, even more of a DJing level. And if there are organs included in the chicken you’d buy, you could add them because, you know, they always have, uh, different properties, um, and well for about two hours or more, and depending on how big and, and, uh, your, you know, how powerful your stove is, but, you know, when it’s fully cooked, then, um, we’re going to add these other things.

But while the chicken is cooking, you want to start cutting up your ingredients to be added because, um, it could take a while to do all these things. And, uh, so after the chicken is cooked, I let it cool. Then remove it, remove the meat from the bones, which you can use or not, and you can, reboil the bones and the skin, and et cetera, to make more broth and, you know, have that frozen for when you need it. Um, so I strained the chicken broth and then add the following in a large pot. And I would, well, these for 10, 20 minutes, um, could be longer. But, um, I do these before I add the shorter cooking vegetables later. So three to four heads of garlic, yes. Heads not close. And, you know, it has antibiotic properties. It’s warming in nature tastes great. Um, a bunch of scallions GYNs are especially warming in nature, so good for very early stage flus and colds.

Um, and you know, if you’re, if your body tends to get more wind cold than when heat, or, you know, you’re in a cold climate, your body runs a little cold having, uh, you know, these alliums than garlic and scallions evenly will be helpful. So leaks are a little bit neutral to warming and they have a little bit more tonifying effects. So they’re good in general, recovering from debilitating illness or just, uh, you know, a general tonic two to three onions, good for the sinuses in particular, and having a large piece of ginger, you know, it could be the size of the small hand before you cut it up. Um, depending on, you know, again, how much you’re doing, but you want them to do this little effects of the ginger, and of course, it’s going to make you great. Uh, so with the ginger, you want to remove the peel and cut into, I do medium sized chunks. Not only is a little quicker, but it’s kind of nice to get a little chunk in your soup when you have it. Uh, so we know that ginger is quite warming in nature and it’s, uh, typically, you know, used for warming the digestion great for vegetarians and vegans. Um, but it also helps warm the lungs a little bit fresh tumeric group, because it’s so highly anti-inflammatory, but, you know, just bare mine tumor, it can stay in your clothes and it can stain your skin temporarily.

So I like to add cilantro leaves, not just for the taste, but, um, I’ll do some of the beginning and then some as a garnish, but also they are, um, medicinal and that they help the body detox heavy metals. So, you know, the, the less toxic you are, the better your immune system’s to be, but that that’s not necessary to add that, but it’s nice. Uh, I should talk you mushrooms. We talked about before being antiviral, my talking immune boosting and, you know, using fresh and locally for if possible, because the, the store-bought ones that are, you know, prepackaged. And so things are not nearly as medicinal as the real thing. So having your check-in meat is optional in the soup, but if you are vegan, you know, if you could do the chicken or, or regiment, if you could do the chicken broth as a medicinal thing, I, you know, I know some people won’t, but at least use these other ingredients for their medicinal effect and then adding towards the end.

Cause I don’t want to over cook. I might put in asparagus, you know, it has a great diuretic effect. Uh, some, some cooking green could be, you know, kale, green chard, if you had red chart is going to affect the color, um, or colors. But the last amount of kale is a really nice texture and it, it’s not too strong of a, um, cruciferous tastes in the soup. So I chop that up into medium sizes and then optionally, you could add something like green beans, uh, which are great for blood sugar, um, and doing medium-sized pieces. Um, I probably do them a little bigger than small pieces because you don’t want them to over cook. And if generally I try to do it without starch, I do it without, you know, regular potatoes, but sometimes I’ll put some sweet potatoes in to give it a little more body and a little bit of sweetness, but it’s not always necessary.

You could also use a delicate squash as a nice addition, and that’s not too starchy. So you can garnish with rush cilantro leaves and serve hot immediately before the volatile oils of the ginger evaporate. It’s really nice and then allow it to cool and freeze it. Um, and as I said, you can make a, uh, not, oh, I didn’t mention, you can make a non-conforming version of this skipping, the scallions, ginger and garlic, uh, to have, so then if you’ve got wind heat, it would be inappropriate thing. So just be sure to, you know, indicate on the containers in the freezer, which version it is.

And I wanted to get into some points for boosting the immune system. Um, certainly you may know some others, uh, I’m not going to take the time to mention the location since you can see that in that, you know, in the PowerPoints. Um, but I just wanted to quickly mention, you know, how these can be applied for boosting the immune system. So large intestine for, we all know that now there’s different locations for it. So you find it however you find it. Um, but it’s a classic point for immunity. Um, it helps remove heat. It regulates large intestine, whether there’s constipation or diarrhea, uh, it can be used. It can be needle or pressed on the opposite side where you can do both sides. You know, most people in acupuncture school learn about, you know, pressing it or kneeling on the opposite side of like a, a stuffed up sinus. Um, it’ll even if you do it the same side, it’ll, it’ll eventually clear it, but they have found in cadavers where the meridians are still alive for a few days after people pass that the large intestine Meridian and about 80% of people, probably right-handed people. Um, I’m just guessing making that assumption. The large intestine Meridian goes up one side and ends at the opposite. [inaudible]

now large lung seven is, um, also a great immune booster. We talk about it resolving the exterior dispelling when, and it’s, um, it’s just, you know, it has such a powerful effect on the head and the neck. So very, very beneficial stomach, 36 does everything, but your laundry, right, uh, strengthens the whole body, including the immune system tones, the muscles it’s digestion helps with fatigue. Um, just a good general immune point, large intestine 11 is, uh, you know, benefits immune system, but especially for clearing heat. Now this triple intestine point is a special Japanese immune point that I learned from Kiko Matsumoto. And, um, it’s also really, really good. Like most of her things are really exceptionally useful. Kidney 16 is another thing used, especially in Japanese acupuncture. So you’re palpating around the navel to find two positions on each, you know, a position on each side that, um, is perhaps sensitive. Um, you can feel if there’s something that you’re is, it feels a little tight or if something is a little bit, um, yielding and, and deficient, um, but this is very strong and deep infer, deep immune boosting. You don’t always need it for a cold and flu.

Um, and kidney 27, you know, is another great one for, uh, immune boosting deep. I mean, boosting now Sandra five, triple and triple heater, five, five, triple warmer, five, however you referred to it. Um, this helps resistance to colds and flus and can be used for heat conditions and Ren 17, right? It’s really great for so many emotional things, anxiety, anguish, depression, and we know that depression really affects the immune system. Uh, in, in fact, when you have a strong emotional reaction, like you get angry at someone or you get quite depressed, um, it really brings your immune system down and you’re prone to, especially with and getting a cold or flu in about 48 hours time. Uh, so, uh, want to keep our hearts open and that’s going to help boost our immune system also regulates the finest. So, uh, if you want to reach me for anything, you can contact me through my website, luminous beauty.com and there’s links for Facebook and Instagram. And, um, I wanted to, again, thank the American Acupuncture Council for producing the show. And next week we have Sam Collins. Uh, so, uh, until then have a good week stay calm because your immune system by.

 

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New Year, New Fees?

 

 

Click here to download the transcript.

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

Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council. And of course for you giving you another episode with, to the point from the American Acupuncture Council and malpractice carrier on keeping you up to date, what’s changing. What’s new as the coding and billing expert always want to make.

You’re on top of everything that’s going on and what the changes are going to be for next year. So let’s get started with understanding fees. So let’s go to the slides, what I want to make sure there’s a good understanding of is how do I determine fees? And so you’re going to see what I have here, the RVU update, which stands for relative value units and how that affects your fee schedule, what changes you can make at the beginning of the.

And how your fees are going to be paid. Well, let’s talk about what are our fees. When you hear this term, you see our, or usual customary and reasonable, what does that mean? Well, it’s the amount that’s paid for medical services based on your geographic area. In other words, what is usually in customarily pay kind of like houses, what’s the usual and customary for your neighborhood.

It’s based on what the houses sell for. So in that sense, that’s usually the fee that’s charged for a doctor for a service and falls within the rains that others charge within the area. It is a service deemed necessary to their current condition. But what is the usual fee? Now keep in mind that usual fee has some variances.

Are you on the upper end or Lauren? I hope that we’re somewhere in the middle because here’s my concern. Let’s say you’re charging $50 for a service. That someone, including insurance companies are willing to pay $75 for if you’re only billing it at 50, of course, what are they going to pay you 50, even though they would pay at 75.

So I want to give you some tools that help you to establish a better way of understanding your fee. What let’s understand, what is the model we deal with? There’s a course in the insurance model. And that’s the reasonable customer feed that insurance has say are the acceptable range. And of course there’s a lot of variation to that.

And of course, as you can expect, if you belong to an insurance, like say you joined blue cross or blue shield or Ash, that’s going to be a set fee, which is probably not usual and customary, but the trade-off is I joined. And hopefully you get more patients, but you take far less money, not something we’re really that tickled with and less volume can be there.

So I look at it more from the patient value. What is the service worth that a patient is willing to pay for? And this is where we have to provide the value of the service. So someone’s willing to pay. And I think this is the model that acupuncture really thrives in the American physical therapy association has indicated that they find that as soon as people have a $30.

They start losing about a third of their patients. Do you know that’s not true for acupuncturists? So I’m always a little nervous that we sometimes undercharged for what we’re doing, because we’re afraid of that amount being something that’s going to scare the patient off, but what you have to think of, what’s the value and want you to think of as an acupuncturist, think of the value for a moment.

How many of you have been to a medical. And when you went in, you’re in pain and when you left, you felt better. And I’m not saying this as a negative in a way against medical doctors, but that’s not the way they treat. Think of how many times you have a patient come in. Maybe they have a headache or back pain, and they’re not even sure acupuncture is going to work.

But then after the visit, they’re like, oh my God, I can’t believe I’m not in pain. I’m 50% better than. There’s a lot of value there. So I want us to start to think of the value of the service and how we establish rates and using something called the relative value units. The relative value unit is a value determined actually by the federal government on the cost of each medical service.

Every CPT code has a relative value. Now what this relative value does, it allows you to compare the value of one service to another. So by example, if there’s a service that has a value of one. And another service that has a value of two. That would mean that service that’s a value of two would be twice the cost.

And so one of the things I want to do with this is take the RV use to help us begin, to establish a reasonable fee for the services we provide. The development of this started way back in the eighties and Harvard, and it continues to be updated every year by CMS. In fact, it is updated already for 2022, and I’ll give you a preview of that coming up.

So here’s what I’d like. You all to do. Take a moment. And tell me, what is your fee for these four codes now, obviously you don’t have to tell me, but I’d like you to think or write them down. What do I charge for the first set of manual acupuncture? What’s my fee for the second set or additional set. How about a mid-level new patient exam?

What do you charge for that? And then what do you charge for massage? What I’m trying to point out is if I can tell you the value of any one of these servers. Based on the relative value. I can tell you what the value is for another. In fact, that’s how insurance companies decide to pay for certain services is based on the relative value of each.

So let’s take a look at what is relative value. You’re going to see here a whole page of relative values. And I put all the common codes. If you’ve been to a seminar with me, you’ve seen this, but this is the update for 2020. What you’ll see immediately is that there’s been an increase. If you notice that I put the arrow around it, you’ll notice the relative value for now.

4 9, 7, 8 1 0 is 1.16. Whereas last year was 1.06. That’s about a 10% increase. So if someone says to you, Hey, acupuncturists are having an increase in fees. Actually that’s true. And it’s based on the relative values have been increased relative value though, just compare one service to the other. So the easiest way to think of this is if you look at the relative value of 9, 7, 8, 1 0, you notice as a value of 1.16, and then the value of 9, 7, 8 1 0 is 0.87.

Now, when you look at that, you’ll go, what does that mean, Sam? Well, I’ll make it real simple this way. What if you charge and again, this may be a little high. What if you. $116 for your first set. What would be the price of the second set? $87. That’s the idea. So if you can tell me what you charge for one code, and if that code is accepted and paid by a payer, I can tell you what they’re going to pay for everything else.

Now, the good news is you don’t really have to look at that many codes. I know this list is a little. But I want you to think of what services are you billing on a regular basis? That’s all we need to look at. Don’t worry about all of them. So how would I do this? You’re going to see her on the right. I did some calculations.

Now don’t be put off by the math part of this. It’s not complicated. All you have to do is tell me, what do you charge for 9 7, 8 1 0. So now I want you all to think of that. I asked you a moment ago. What do you charge for 9, 7, 8. You’ll notice I put a charge of 65. Now you might say, well, Sam, how’d you come up with 65.

I’m just saying that’s a typical fee for a lot of acupuncturist for the first set. So let’s just say 65 was your fear is your fee to figure out the fee for every other service you don’t guess and go, well, I guess I’ll charge $10 less. Here’s what we do. We take our. And we divide it by the services relative value.

So you’ll notice that I take 65 divided by 1.16, and it gives me 56 0 3. Now 5,603 is actually not the price of something. It’s the conversion. I then take that number and take any other codes relative value. Multiply to tell me the fee of that service. So by example, you’ll notice here 9, 7, 8 1 1 has a value of 0.8, seven.

So I’d take 56 0 3 times 0.87. It gives me 48 75. So that means if my price for a 9 8 9 7 8 1 0 is 65. What should be my price for a 9 7 8 1 1? Well, I would round up to 49, but I think you get my point that way you make sure you’re not cheating yourself. And I’ve seen a lot of providers do this. They’ll build a first set of 60.

And the second set of 50, 65. Now, of course, that’s your option. You can do that, but he won’t be my concern. What if the insurance company pays you in full for the second set? What does that tell you? You’ve done with the primary code you’re billing way below. So I can do this backwards as well. If they allow 65 for the one, one, I do the same calculation the other way, and I do it the same for every service.

So think of it in simplest terms, the difference between the first set and the second set is about 30%. So if your first sets a hundred seconds, that would be 70 or in this case 65 to 48, 75 or 49. Well, the same applies with any of their code. Like you might say, well, what do I charge? Or what should I charge for an exam?

Well, you notice the relative value for 9, 9, 2 0 3 is 3.2. So I take 56 0 3 times 3.29, and it gives me 180 4 33. Now the reality here is if you look at 1.16 to 3.29, it’s not quite three times the amount, but you can see it’s pretty close. So really what you want to think of is that the price of. Exam should be three times the price of your acupuncture service based on the relative value of the service.

Now, how these relative values work, they determined that the amount of work that’s involved with each service, and that includes not only the work involved with the service, but the type of provider, what your malpractice costs are and so forth. So again, 180 4, based on a $65 price or about three times the amount would be pretty reasonable.

Well, what about other services? Have you ever built, you know, let’s say. How would I figure out my price for massage? Well, massage value now is 0.8, eight. So I’d take 56 0 3 times 0.88, and gives me 49 30. What I want to make sure is that my prices for my services match each other. I’ve seen offices, bill out some pretty large amounts for one code at a very low amount for the other code.

And my question is why are you doing. What was the purpose? Now, if you can say to me, well, Sam, I did that because I just don’t want to charge my patients as much. And you have a good reason, I’ll say, okay, because maybe that fits your neighborhood, but if you’re doing it because you don’t know, like by example, what if you charge 50, 65 for the first set and you charge only $30 for massage?

Well, you. But if someone’s willing to pay 65 for a first set based on relative value the exam, or excuse me, the price for massage would be about 50. So start to really go through these coasts and start to see that. And here’s the beauty. It increased for acupuncture. So, I’m not sure you’ve heard this or not yet, but the prices for acupuncture related to rates associated with Medicare rates, or anyone will go up next year.

Now let’s not get too excited. The rate increase is about six to 7%, but that’s well above cost of living. So, yay. Finally, we’ve got an increase. Do you know? No other profession got an increase. If you go through all the fees, actually chiropractors, medical doctors, physical therapists, all got about a three to 4% return.

Acupuncture got a 6% increase. And I think mostly because the relative values are becoming more apparent. So you’ll notice the relative value for 2021 was quite a bit less now, 1 0 6 to 1.16, you think? Well that’s 10%. Oh, no. Because remember that’s again, already up at that level. So again, probably about six or 7% to give an example of what I’d like you to do though.

Now, if you’ve been to a seminar with me, you’ve seen this RVU sheet and if you’ve never been come to a seminar or join our network, so you can get this type of information, but here’s what I’d like you to do. You don’t need to do every code, but start coming up with a competent, reasonable fee schedule.

Cause I don’t want you to. But I certainly don’t want you to undercharge. And what I find for most offices, frankly, you bill about five or six services regularly. And I would say the average acupuncturist has three to four of those that have the wrong value, which means 50% or more of the code you bill are undervalued, which means you’re just losing 50% of your income.

So what I’d like you to do is go through, do this for your ENM codes and not every code you don’t bill, all of them, acupuncture codes, probably heat like infrared or other ones. Bodyworker massage, pretty typical as well. And maybe a little bit of exercise. Now you might say, well, Hey Sam, I do some other services.

Fine. Do those as well, but realize you’re not going to do a bunch of these. And what I would like you to do with this is begin to break down the cost. So here’s an example, and this is just for California, Southern California, specifically for Los Angeles and orange county. Now this is something we do for our network members in seminar attendees every year is we give you the updated.

For Medicare, which of course means the VA. And you’ll notice there’s been an increase notice 9, 7, 8 1 0 last year was $40 and 7 cents. Now it’s 42 67. Now, is that enough to go? Oh my God, we’ve got a lot more money. No, but a 6% increase if you’re generating a hundred thousand dollars a year. Just on acupuncture codes.

That should be an additional 6,000. So you can see here a nice little jump. Now, remember these are just for the California rates. Every state, every county has their own rates. And again, if you’re a network member with me, or if you’re coming to an upcoming seminar, you will have access to all these. So, you know, the rates that way, you’re making sure that you’re getting paid the right amounts, because my concern is, if you build below these rates, what are they.

That rate. So you want to start to understand what is the value of my service, but let’s go beyond that a little bit. Here’s what I’d really like. You all to do, take a moment to create a spreadsheet, like what you’re seeing here. And you’ll notice what I’ve done is I just put some common codes for acupuncture from exams, through acupuncture, massage.

What I do with one column is put the RV use and then maybe the next column might be what’s your time of service discount. Maybe that’s your price for cash, you know, maybe. You know, five or 10% below what you normally bill, but then you have your regular rate, just regular. What I, bill insurance then of course, what I’d like you to do is go through from payers that have paid you in the last six months or a year and put down those amounts.

What does Aetna pay? Blue cross blue shield. Cigna. I guarantee you all have that. One of the things I do with network members is to go through this and say, Hey, look, let’s start creating a competent sheet. The realization. You don’t bill as many codes as you think. So you don’t have to do a lot, but go through that way.

But what if it isn’t a patient comes to you and they ask you because of course the next year we have the no surprise billing. Okay. What does my plan pay? Well, you can go to your chart and go, oh, your plan is going to pay XYZ dollars. And this is going to be your balance. What it also does though. It’s a chance for you to look to go, which of these are good or bad because as your practice begins to go into next year, what is your plan?

To really begin to maximize your office. One of the plans I would do is let’s do a survey of what is the better paying plans that we may deal with and how much are they paying now? By example, Medicare work comp are all standard fees. Most states have standard fees for that. So you can already put that in and at the very least I’d want you doing that.

So here’s an example with RV use. You can do a lot to determine your care. So by example, if you’re in the state of. The work comp rate in Texas, what they do is take this value 61 17 and they multiplied by any RVU. So by example, I can tell you exactly what the fee is for work comp in Texas for 9 7, 8 1 6.

Remember, it’s 1.16. So it’s 16% above this, or roughly close to about 67, maybe $68. Or how about if you’re in the state of Utah? What they do is use a conversion, but two different ones. If it’s an ENM code, they convert with a 56 conversion or 52 for other codes. So realize that the Medicare conversion is roughly $37 plus or minus depending on your county.

So that would be a starting point. And I’ll give an example. What if you’re admitted? If you’re in Michigan, what they do is they just simply take whatever the Medicare rates are and double them when it comes to personal injury. Now, one thing to be concerned with here is if you just double your rates on personal injury, that’s good because personal injury will pay you.

But what if you charge your other patients less? Remember you can have two different fees. So you’ve got to make a decision, even though I can charge double for personal injury. If you’re charging maybe only 1.5, that’s what you’re going to charge for them. What my suggestion is. Probably be at least 1.25 to 1.5 above Medicare rates.

Notice by example, the Medicare rates in for work comp in Michigan, they just take a conversion of 47 66. So this is where using RV use will help you. But take a look at this one. If you have a patient that’s with Boeing and particularly Boeing uses, and they’re employed with Boeing they’re blue cross blue shield, they sent a directive out this year.

What they pay is 175% of. So what if you got 90% of your patients with this plan and you’re billing a hundred percent of Medicare, you’re losing 75% of your money. Now keep in mind, maybe you don’t want to charge 175% because you still have a lot of patients that can’t afford that. So it’s going to balance somewhere, but my concern is, am I setting my fees off of my best insurance or best richest patients?

Or am I sending it off of my port? So I want to be somewhere in the middle there, but what I want more than anything is a competent fee schedule. If someone says, how did you determine your fees? You’re going to say, I use relative values to determine the value of my service. Tell me what an insurance will pay for one code, and I’ll tell you what they’ll pay for any other code, because relative values goes across the board.

As you can see here, by example in California, we’re comp is 1.2. And so simple way of looking Pennsylvania, 113% Florida, 200% for work comp. So lots of changes here that allows you to start to use this as a way to competently set up a fee schedule. And I’m going to suggest it’s the new year. Let’s start looking towards that.

Obviously, if you’re dealing with a VA patient, you’re going to get an automatic raise, but what if you don’t raise your rates? So what if you bill at last year’s rates, what are they going to pay you for next year? So you’ve got to make sure to bill the higher rate or bill your normal rate to make sure you’re getting the maximum amount out of it.

So here’s something I want to make sure everyone’s aware of. Do you know when we posted this, if you’re a member with us, you received an email on this Medicare fees. The deductible acupuncture fees increased six to 7%. Really good notice we posted this a month ago or thereabout. If you’ve not already go to the American acupuncture council network, Facebook.

And take a look at our Facebook page or in our site, just click on the new section. We update you there all types of things. The American acupuncture council wants to be your resource. We want to make sure that your claims get paid, because if you’re not getting. You don’t need our services. So frankly, we’re symbiotic.

We have to do a good job of helping you to make sure you have claims. We also offer a service. We call the network, take a look at our site, come to a seminar, be informed about information that’s coming out for you. Cause if you’re not informed about. You’re probably left behind. Take a look. We’ve got lots of live, meaning in-person seminars, upcoming, but also virtual.

So just pick the date that fits best for you because we have a vested interest in you. We want you to do well. That’s what we always give you this information. So I’m going to say thank you very much. Next week’s hosts are going to be Dr. Jeffrey Grossman. I wish you all a very good new year in a Merry Christmas, but also let’s plan and have a good prosperous 2022 see you next time.

 

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The How and Why of Physical Examination for Acupuncturists

 

 

So in general, I think the physical examination is essential to all of us, no matter what style of acupuncture we practice, especially if you’re treating any kind of pain or injuries.

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

Hi. Good afternoon. My name is Poney Chiang from neuro-meridian.net. I’m joining you today from Toronto Canada. Uh, welcome to this week’s show for the American Acupuncture Council. Uh, my guest for today is Jamie Chavez. Jaime Chavez has been a licensed acupuncturist in California since 2002, and he received his master’s in traditional Chinese medicine and 5, 4, 5 branches and has participated in internships in Beijing, China. He specialized in the treatment of a work-related injuries. He is currently the head acupuncturist in a prominent bay area. Workers’ compensation connects and works alongside medical doctors, physiotherapists and orthopedic surgeons. Jamie is passionate about the art of physical examination and integrates multidisciplinary approach in the assessment treatment of MSK pathologies. Jamie has been an instructor in several bay area acupuncture schools at both the master’s and doctoral level. It was during this time that he discovered his passion for teaching.

Jamie has had the honor of introducing acupuncture to medical residents who periodically shouted him for clinical rounds. He has been a guest lecture for Stanford physician assistant program, and it has been actively teaching physical examination skills to acupuncturist in hospital settings. Jamie continues to find joy in spreading the word about the effectiveness of acupuncture. Also, you may, in case you haven’t know, um, you don’t know, and you should, you, Jamie is also the admin and founder of the Dow, uh, Facebook group, which is discussion acupuncture, orthopedics. So it having waiting to interview, uh, Jamie for a long time. Now he’s a busy guy, our schedules just never coincided. So I’m very, very, very excited to finally be able to make that happen. And, um, and very much looking forward to this, uh, this interview. Thank you so much for joining us. Jamie,

Thank you for having me. It’s a pleasure. Yeah.

So you are, um, the, um, the very passionate about physical examination and, uh, I know, you know, a lot of people don’t do that. And so for those of us that probably need a bit of, um, motivation or, um, what is it that you can tell us in terms of what makes physical examination so important to clinical practice?

So in general, I think the physical examination is essential to all of us, no matter what style of acupuncture we practice, especially if you’re treating any kind of pain or injuries. Um, it’s a way of holding yourself accountable so that you can prove or disprove your own thinking about what you are, you know, thinking is going wrong with patient. So someone comes in with the chief complaint and you gather the data and you think something’s going on, but you have to hold yourself accountable. You have to keep yourself in check and try to, um, eliminate your own bias and, uh, basically try to get better at gaining clinical experience because we’re all researchers in the clinic. And so this is our way to do research. So we want to find things that are reproducible, repeatable, and physical examinations, that bridge, you know, for me.

That’s great. Um, I have heard you talk about, um, uh, I’ve heard that you really enjoy teaching through acronyms and mnemonics and, uh, you know, it was just, we learned by association. So it’s good to have something to kind of associate things with, um, when it comes to, um, physical examinations, is there any, uh, not mnemonics that you think would be helpful for us to, to become more comprehensive in our, um, uh, intakes or in our assessments?

Yes, there’s a ton of them out there. I mean, I’ve, I’ve gathered and tried all these different ones over the years. Um, but none of them really, uh, crossed over and applied directly to an acupuncturist. So, you know, there was, there was missing pieces or the order was not right. So I came up with a mnemonic, um, a horse, uh, H O R S E. And I’ve been sticking with that one ever since. And, um, I can explain a little bit about what each of those letters means. Um, the H is the history of the patient. So that’s, you know, their past history, which is the things they fill out on the initial intake form, but then there’s the present history, which is, you know, regarding their chief complaint, what brought the patient into the clinic to be seen today, let’s get all the data regarding that specific topic.

And then, uh, the, oh, is the, uh, observation. So what do you see from the patient? And that’s now we’re getting into the physical exam skills. So what do you see when you look at the patient? And that usually begins the moment you lays up, you know, they eyes on them when they’re in the waiting room, when you walk them back to the treatment room and then, you know, there’s other, you know, key pieces that you’re going to look for, depending on what they’re coming in to be treated for. But observations really important. I’m very passionate about observation because it’s so fast and you can see so much if you know what you’re looking at. And a lot of times we see things, we just don’t know how to interpret it. So that’s something I’ve been really passionate about over the last couple of years and just really diving deep into it, just diagnosing by looking, um, the are for horses, range of motion, which is essential.

It’s one of the most important things that anybody can start using right away, because it’s so fast and you get so much data from the patient. There’s different types of range of motion. So there’s active range of motion. There’s passive range of motion. There’s resisted range of motion, resisted range of motion could be like your manual muscle tests, right? It’s all in that frame. You know, passive range of motion could be your muscle length tests. You know, there’s many different ways to look at that. And then the S is the special tests. Um, so that’s the orthopedic tests. Some people call those provocative tests because you’re trying to basically tease out where the problem’s coming from. And then the E is explored by palpation. You know, hands-on diagnosing by touching. So each of those, you know, contributes to the horse acronym, and that is the order of operation for me.

So we talked to the patient first, and then when it comes to physical exam, we look at them, we have them go through a movement assessment and that could be active, passive, or resisted, or all of them at the same time, you know, check each one individually and you would want to do it in that order. So active range of motion is first because you want to see how willing the patient is to even move right away. You’re already, you know, gauging where they’re at when you want to do other tests down the road, and then you would do passive next. And then you would do resisted last because resistive could be provocative. It could cause pain in a patient. You always save painful tests for last, because if you cause your patient discomfort, you know, they may say, okay, I don’t want to do this anymore.

Right? Like, let’s stop the exam here. So you’d, and if they’re, if you provoke their pain, you know, it also skews your results for everything else you check, because now that, you know, they feel a little discomfort. Now, everything you check is you don’t know how valid it is. And then for us, you know, we’re acupuncturist. So what are we going to do before we stick a needle? Now we’re going to palpate. So why not do that last? Um, and that in itself, how patient is provocative, it causes pain and patients. So definitely we want to save that towards the end and then go right into our needle. Hm.

Okay. I like that. It’s like from the, from the, uh, assessment, the palpation diagnostics, and it goes transition smoothly into the actual needling component. So it’s, it’s very seamless. Um, I’ve heard of, you mentioned something called the ABCs before. Is that also a type of, uh, assessment or is that something different?

That’s another acronym. So like, you’re mentioning, I love, I love mnemonics and acronyms. Right? Um, what, what you see a lot of, and, you know, I, you know, with social media and things, you kind of get a sense for how well people are able to extract data from their patient. Um, but the ancient horse is the history. And I have an entire course just on how to do, you know, a history. You know, we could talk about that all day, but to keep it really simple, there’s key components that you have to get from your patient when they come in. And there’s tons of acronyms for this. But the one that sticks with me the most is just knowing your alphabet. Cause who doesn’t know their alphabet. Right. That’s like the basics. So it’s, but this part of the alphabet is old. P Q R S T.

If you can remember OPQ Q R S T, you can get all the data very quickly from your patient. So for example, like if you like pony, if you’re on my patient and let’s say you shoulder pain, I would ask you the O, which is, you know, when did this happen? The onset, the O is for onset. When did this happen? And how often do you feel this complaint? Is it 24 hours a day? Or does it come and go if it comes and goes, how long does it hang around before you know, those kinds of things? So that’s the O the P is palliative and provocative palliative means, you know, uh, soothing to the pallet. So something that makes you feel better. So pony, what makes your shoulder feel better? What makes it feel worse? The other part of the P is provocative. Like these are essential questions, because if you tell me it feels worse at night when you’re sleeping, I already know there’s something wrong with your sleeping position.

That needs to be correct. You know, those kinds of things. Can you tell me he feels good, then obviously you’re going to feel good when you leave. When I use infrared heat, moxa, hot pack, you know, we already know what it’s going to help. Um, so the next thing is the quality and the quantity. So, um, you know, the quality of your pain tells us a lot. Is it sharp, dull, achy, burning, throbbing, et cetera. You know, the nature of pain gives us some clues. And then we can go to the quantity, which is like zero to 10. How is your pain right now in this moment that you’re talking to me, you know? And then how is it at its worst in the last 24 hours? How is it at its best then the last 24 hours? So that’s how we could use that pain scale a little more accurately.

And then the RSM LPQ. So O P Q R the R is radiate. Does it radiate anywhere? Is your, is your discomfort localized or does it go to a different area of your body? And this is important not to lead the patient. So if someone comes in with sciatica, I don’t say, does the, does the pain radiate from your back down to the bottom of your foot? Like you wouldn’t ask, you wouldn’t lead the patient, you gotta leave the questions open. Like, does your pink go anywhere else? If so, where and how often, you know, and then T is time, is your symptoms worse during a certain time of the day, morning, afternoon, or night? If you say you keep waking up in pain, I know something’s going on with your sleeping position, or maybe you have some arthritic changes, you know, and they get better as you warm up.

So it already gives you a lot of clues, but what you see as a lot of people don’t gather that data when they present case studies and things, and in the subjective information is key. Like you already have a clue, like a very good clue of what the problem is before you ever laid hands on the patient. If you do that old PQRST. And now when you get into the rest, the physical exam, you’re again, just trying to prove or disprove your hypothesis. So if I tell you, Hey, pony, I think you have a rotator cuff tear, and this is the reason why you have these symptoms, but then you have these data points and, you know, it’s like proving a case to yourself, holding yourself accountable versus like, well, I just heard that pain there means you could have this, you know, like, or I, when I press here at Hertz, like that’s not enough data we need to, we need to be more, um, we need to, to raise the bar on our level of a practice, you know?

That’s great. Yeah. Um, I definitely think that if you, if one does a very good history, um, oftentimes, you know, with some, with enough clinical experience, you already have you already kind of starting to find out in New York, you almost, you’re just doing one or two orthopedic tests to confirm, you know? Um, so, uh, a good history taking can actually, in a way, it seems like time-consuming, people might not want to do it, but it’s actually the opposite. I think that if you did a good history taking, you end up having to hone in faster and you’re going to be, uh, maybe it’d be more, more efficient in your practice. Actually. It’s not, it’s actually the, counter-intuitive not the other way around. Um, um, like for example, um, uh, I like the accountability discussion, you know? Um, because here’s the thing, obviously, as a practitioner, we, we, we always, we sometimes deal with practitioner at patients that are more difficult to say, oh, the pain is still there.

The pain is still there. Yeah. But it’s like 10% of what it used to be. Right. So, you know, it’s, you can’t make a yes or no. You have to, you know, many ways the quantitative or qualify it. Right. It does not refer. So this is how, you know, as meditation is working, but also sometimes the patient needs help knowing that too, because to them it’s like yes or no. Right. And yeah, and now the weird thing is that, um, the opposite can happen. Sometimes they can not be getting better, but they have so much trust in you. They say, say they are better, you know, that happens too. So, so these tests go both ways. It actually helps you, you know, if is actually better than not even though the patient might say it’s better, but it actually may not be. Right. So that’s

A good point.

Yeah. I know. So like,

They don’t want to hurt your feelings. They want to say, oh yeah, you’re doing a good job, you know,

But, uh, but you know, some sometimes, you know, I mean, of course there’s the, the, this, the report is the placebo effect. You know, the attention being heard, you know, uh, you know, maybe we just, I keep putting in needles, we help them to sleep in their, you know, their stress level is better. So indirectly things have gone better, but right. But you know, maybe the range of motion didn’t get better, that sort of things. But, you know, it is, if you didn’t take the time to do these assessments, then you’d be, you know, you’re not really truly helping the patient. Right. So I, I, I’m such a big fan of, um, of, um, these, um, more objective measures and does, so I hope I have a chance to, uh, to take one of your classes in near future.

Thank you. Yeah. Likewise. Yeah. There’s, I mean, the, the objective things is amazing. Cause it’s really the whole story. Like if you just, if you don’t go, if you don’t do that, you’re missing half the story. It’s like going to the movies and walking out halfway through, you’d never even found out what the ending was. You know, like by doing these things, like you said, you hold yourself accountable, you can see the, you know, the full presentation and something that I’ve been really like, just kind of blown away is that the more you do this, you start to understand your patient, the person in front of you better, you understand how they hurt themselves. And then you, you know, as you treat them and they start to get better, you’re able to have a better picture on Tet, you know, how to teach them how to prevent themselves from getting hurt.

Again, you know, it’s like the back pain I’ve been seeing so much ridiculous at the, in the last few months, I think from all the people working at home, sitting too much and things, but it’s always like, you know, their sleeping position, their sitting position or their standing position, how they stoop and twist and things. And then if you can identify the activities for them and show them how to move a little better, it’s like, wow, these patients that have had pain for 11 months over a year, nothing’s helping them after a couple of visits, all of a sudden they just shift, you know, it’s like, wow, okay. Those are the patients that are listening to your advice, you know, and then, you know, your acupuncture treatment and or whatever treatment you’re doing is going to hold better. It’s going to have a better, uh, um, lasting effect because they don’t just go home and immediately do the thing that w was causing their injury to begin with.

You know, so those are, it’s just, it’s so it’s so vital. And before I forget too, one of the things that I think is really important as clinical experience. So I know we always talk about, you know, okay. People like to talk about how many patients they’ve seen, but I look at it as like, how many pushups can you do? You can probably do a hundred really lousy pushups, but could you do like 10 really good ones? And I think that’s the same with treating patients. Can you treat 10 patients really good? And if you can, I think your clinical experience is going to be so much more profound than treating a hundred or a thousand patients very quickly without getting all that data, getting that feedback and seeing what your, you know, your input, what your needles are actually doing. So the more you go deeper, you know, you get a richer, more fulfilling experience that, you know, it’s going to help other people more down the road, you know,

[inaudible], you know, I actually, I find, um, um, you know, a lot of times the patients that come to our practice, um, have gone through the conventional healthcare system, which is not known for spending time with their patients. Right. So how do you know you remember how many times patients say to you? Oh, you know, you, they, they say that, oh, you know, more than my neurologist or, you know, more than my surgeon. It’s not that we know more than them. It’s just that we actually take the time to ask questions and do the assessments. So, but, but for whatever it’s worth that time, that the demonstration of your knowledge and doing the testing, listen carefully, it’s actually building rapport and confidence. So they’re already ready to be needled and treat it right by you. Right. You know, that’s a, that’s a big part of, um, the efficacy. I think that, you know, yeah. Like, you know, you explain what’s going on. Why is the referring for example, right. And this is why I’m going to show you here, even though you, your, your pain is there, but I’m going to need a, you hear that, that you lay out in race, a logical progression, and th they put them put some at and comfortable with you. Right. And I think that goes a long way to, you know, that rapport building is huge.

Yeah. I think that’s it.

Yeah. And, and I think that’s one, um, value of a good history or assessment taking that is, you know, it’s not just a, you know, a left brain diagnostic thing is actually can become a right brain emotional and relationship building kind of thing.

Absolutely. I had a, um, a patient yesterday and she was telling me that she went to another acupuncturist and she had a bad treatment. And then I saw I’m naturally gathering data all the time. So I said, well, what defines a bad treatment to you? You know, I want to know, cause I don’t want to repeat those mistakes. And so, you know, basically she went in for back pain, the patient, the practitioner said, so what’s going on? You have back pain. Okay. Let’s have you lay on your stomach needles in needles out after she gets off the table. Okay. Have a nice day. Never once anything else. And I don’t, I don’t want to, I’m not saying that that’s bad. I mean, I’ve treated, been shaded by amazing practitioners that that can do that. But what I’m saying for us, you know, for the majority of people, you know, taking the time to actually figure out what’s going on with the person and letting them know that you, you know, what you’re doing is profound versus the shotgun approach where I just do protocols or recipes for every person.

And then you depend on that. So when it works great, you’re the hero. You feel so good about the experience, but when it doesn’t work, you have no idea what to do next, you know? And then it goes back to what you’re saying, like, you know, that, that rapport, but what I see as it comes down to trust, like your patients need to trust you. And if you know what you’re talking about, and you can explain it to the patient on their level, you can see that trust right away. I mean, I had a new patient yesterday. I didn’t even put needles in yet and he’s already trying to refer me people. I haven’t even treated him yet. It’s because he had four different complaints and we were able to like, okay, here’s, what’s at this. And he’s like, Hey, you know, you know where my problem’s coming from. He’s like, you know, can I send people to you? And I haven’t even treated him yet, you know? But the trust, the trust is already there.

So the take home message is that do good assessment through good history and it’ll lead to more referrals,

More trust. And not only tomorrow,

That’s talk about common mistakes that we make in our, in our, um, clinical examination, history, taking process. Uh, you know, as an instructor, you, um, must see this a lot. Can you help give us some ideas of what are some things that we can do better? Where some common examination mistakes. I thought you mentioned, for example, don’t say, does your pain start from here? Refer there. I don’t don’t coach them. That’s one. Right? Anything else that you can, you can let us know? Yeah.

Yeah. For sure. There’s a ton, obviously, you know, I’m making mistakes all the time and learn from them. But I say the number one mistake is to assume anything. Um, so if you start assuming things, you know, you don’t leave room for air and there, and as you, you know, get experience in this profession, you become very aware that nothing is always right. So you always see people say, oh, that treatment works like a charm. That treatment works every time that no, it doesn’t, you know, like there’s no, there’s no perfect of anything. So I wouldn’t jump on the thing and say, you have a rotator cuff tear based, you know, I’m certain of this for me. I like to say, well, these things suggest the possibility that this might be going on, but I could be wrong. And, but we’re going to treat it like that.

And we’re going to keep reassessing as we go. And if what we’re doing is working great, let’s keep doing it. If it’s not working, we’re probably missing something. Leave the door open for mistakes, because you’re going to make mistakes every single day. And if you’re at this level where you don’t make mistakes and you, you feel like everything works like a charm, um, you have to check yourself, you have to hold yourself accountable and get back to this understanding that, you know, there is no two people that are exactly the same. And you could be very wrong about this person in front of you. I mean, I had a person with supposedly a rotator cuff tear who had cancer in his shoulder. And it took, it took the doctors a while to figure out that there was a tumor in there, you know, but if I, I learned a valuable lesson from that experience, because if I was in private practice, he was getting better with acupuncture.

He was a swimming teacher and he was getting his range of motion, was getting better. He was getting stronger, less pain. He was doing good. Unfortunately, there was cancer in there and I did not, there was no way I would have known it. I would have thought that, Hey, okay, you’re doing good discharge you. So, I mean, never, never assume anything in this business. Um, so that’s a big mistake. I think another big mistake is to, uh, jump on a bandwagon. So you learn a couple of assessments tools, and you think that’s all there is you need to continue to go deeper. You know, it’s not one thing, you know, if you do manual muscle testing, for example, that’s a great tool, but that’s not your entire picture of that horse acronym. That’s a one little sliver and you need to incorporate as many of those pieces as you can, to develop an educational guests that support your hypothesis.

So if you only have one little sliver of information and you go, okay, you, your problem is this because you know, this muscle is weak or whatever you are missing, the bigger picture, you know? So I would say, you know, keep learning like never, never, you know, get satisfied. You got to go deep. And if you want to try to get better at something, what I found helpful for me is just pick a body part. So like, for example, I keep saying shoulder, cause it’s on my mind. But you know, if you go to the say, I want to learn shoulders, you can learn shoulders really easily. I mean, the technology is in your hand, the anatomy is in your, in your phone, just take some notes, right. But then what you need to do is just, you know, fill in the blanks of that horse.

So what kind of questions should I ask someone who has a shoulder problem? There are some specific questions that can help guide your, if you’ve got pain at nighttime, that’s a very common symptom of rotator cuff tears. When, you know, wakes you up from your sleep. It doesn’t mean you have a rotator cuff tear if you wake up from sleep. But it’s just one more data point or one more clue. You know, if you, you know, what do you see when you look at a patient who has a rotator cuff issue, what is their range of motion going to be like actively passively resisted? And then what special tests can help differentiate two competing diagnosis? So maybe there’s like, I think it’s this or this. Well, there’s going to be some tests that can be used that differentiate that. And then when it comes to palpation, that’s our, that’s our expertise.

But just know what’s underneath your finger. You got to get in there and know how to differentiate. If I pop a [inaudible] with the arm, you know, resting on some, like my hands on my belly and I press on July 15, I’m touching the supraspinatus tendon. But if my hand is out to the side on the table with my Palm to the ceiling and our press, I 15, I’m more likely pressing the biceps tendon now. So it’s just like little subtle things like that. Can, you know, they’re so basic, but when you apply them, it seems like it’s advanced, but it’s really not. Um, so those, those are some common things off the top of my head, but there are a lot of things that we do wrong and there’s still a lot of things that I do wrong, but I think maybe the, the worst thing you could do is stop learning, you know, keep being motivated because we’re helping people.

And we’re in this profession that is bridging this gap between surgery and everybody else that’s not helping these patients like we are on the frontline and acupuncture is that effective. It blows my mind every day, but we have to have a way to test how effective it is to get that experience that I was talking about that helps us to be better. And then share that information freely, freely with your colleagues. So everybody’s better. I think that is one of the best things we can do as a profession. And I hope we can get there.

Certainly I think if, um, we all up our own game by becoming better at doing assessments, it would transform the prestige and the, you know, the, uh, the reputation of our, our profession for sure. Right? Like, uh, the it’s, um, now I will run out of time, but I, I, I have to pick your brain. Okay. Um, I want you, can you share like a clinical Pearl with us? I always like to do this, something that you pay, perhaps you really good at treating, you know, you’re talking about shoulders today, anything about shoulders or something like that, that, uh, you know, some, some assessment or diagnostic advice you can give us so that we can maybe try it out, or maybe it’s something that we’re not, not thinking in that way and give us a different thinking cap to help us look at the body or assess, um, the patient, any advice for our fellow listeners and viewers today.

Sure. Um, my lead-in will be that, you know, there are, there is this like, you know, movement where people are saying, you know, special tests, orthopedic tests are not good. Those people unfortunately have not done the research. And it’s much easier to say it’s not good then to dive deep and learn it because it takes a long time to really understand all these things. And I know because I’ve been going through it. But one thing that I’ve been doing in the last year is digging in and picking apart all the research and starting to pick out, you know, tests that have been proven time after time to be effective and how effective those tests are like, uh, you know, changing your post-test probability of someone having a problem. So no orthopedic tests are not bad. Yes, they’re great. But you have to understand how to utilize them.

So a really simple clinical Pearl for shoulders is if somebody tries to raise their arm over their head, but they can’t. And they ended up shrugging their shoulder into their ear. Based on the research, they are 15% more likely to, if they, if they can do this without shrinking their shoulder, they’re 15% less likely I should say, to not have a rotator cuff problem. So people who can raise their arm easily and freely, you know, that’s, they could still have a rotator cuff issue because people are asymptomatic and so forth. But when you see somebody shrug their shoulder into their ear to try to raise their arm, what that tells you right away, is there something wrong with their shoulder? It doesn’t tell you what it is, but it’s what they’ve narrowed it down to. It’s either the rotator cuff it’s frozen shoulder, or they have arthritis in the joint so that there is a sh there’s a high probability that somebody has a shoulder issue.

If they put their shoulder in their ear to try to raise their arm over their head and they can raise it all the way. And then as a side note, let’s say, you’re that person that can raise your arm easily, but you can’t bring it down very easily. Like you have to bend your elbow to, to shorten the moment arm so that it’s not as heavy. You end up bending the arm or you support it to bring it down. That starts showing you like, okay, this person is more likely to have a rotator cuff issue. And that sign alone changes the post-test probability by 15%. So what does that mean? Wow, that’s a lot of information, but what they’ve shown is the number one risk factor for rotator cuff injuries is age. And if you’re 60 years old, you’re 25% more likely to have a rotator cuff tear.

If you come in saying my shoulder hurts. So 25% of those people have rotator cuff tears. If that person has a hard time lowering their arm, now you add to that 25%, an extra 15, and you go, oh, this person is 40% likely to have a rotator cuff tear going on. Just with that information alone. I didn’t even ask them any questions and they do it at intake. I didn’t do the other tests. Just those two pieces of information alone. He’s 40% more likely to have a rotator cuff tear. He’s 60 years old and he can’t lower his arm without bending his elbow and supporting it. So these tests, when you use them like that, they can give you some good clues to support your hypothesis.

Thank you so much. I would love that because a lot of times people look at things like under, you know, on the way up or, or, uh, doing the activation part, but they don’t look at the entire process. There’s another 50% of it is when they put themselves back into neutral position. And that, that part you mentioned where they with shortening their arm. Like if you just turn around to do your charting, you would miss that complete, right? Yeah. That’s exactly right. Yeah. So I really, I really, really watched the entire process. You know, I really read a lot, so I thank you very much. I’d love, I learned so much from you in this short amount of time that we have for today. Where can the rest of us go? If we want to find out more information about your courses, do you have any contact information, you know, website, social media, uh, work. When you go to, if you want to study more with you in the future,

Um, you can check out the Facebook group discussions on acupuncture, orthopedics, uh, Dao, D a O is the acronym to make it easy to remember. Cause I love that. There you go. So, and then I have my website it’s www.orthopedic-acupuncture.org, orthopedic-acupuncture.org.

Thank you so much, Jamie. It’s been a pleasure. It’s been an honor to finally meet you virtually face-to-face. Thank you very much. They are that. Yeah. Thank you for most of our fellow viewers. And don’t forget to join us next week, where we’re going to have my fellow host, Virginia Doran. Uh, gimme another excellent show.

 

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The Top 5 Reasons You Need A Social Media Strategy

 

 

I’m here on behalf of the AAC to provide you with some amazing content and information to help you grow your practice.

Click here to download the transcript.

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

Hi there and thank you for this opportunity to share some practice and marketing insights with you. For those of you that don’t know me, my name is Jeffrey Grossman, and I’m here on behalf of the AAC to provide you with some amazing content and information to help you grow your practice. I’m the founder and owner of acupuncturemedia works, Accudownloads and acupressure websites. And I started my practice in 98 and I had a lot of trials and tribulations and a lot of struggles. And I noticed that I had a problem in not knowing how to market my practice and how to properly communicate with my patients. And all I wanted to do was to treat people and I didn’t want to market or do any of that. Um, so the struggle was real. The struggle is real, and it took me down a path to start my companies, but that’s a longer story, best reserved for another time.

But what I want to do today is to share with you some insights and information about how to incorporate social media into your practice. But before I do that, I want to encourage and inspire you with the fact that you are an incredible resource. You’re natural healers. You know how to get people to feel balanced and healthy. We know how to, um, help people with safe, natural methods. And we change lives every single day and people need your help. They want your help. They need your services, but many people don’t even know that you exist. So I want to help change that. I want to help get you more people on your table. And that’s what these talks with the AAC are all about is to help you be seen, be heard and to ultimately bring people into your practice so that you can make more money and ultimately help more people.

So you are never alone. I want to remind you that, okay, I’m here for you. And at the end of today’s talk, or you feel like you need help getting set up or becoming focused, or if you just need a little motivation to move forward, please reach out. There are a lot of opportunities that, um, I can help you with in supporting your practice and you aren’t alone. I’ve been through this, I’ve worked with other practitioners who have been through this. So, um, use this talk as a resource, use me as a resource and just one or two simple changes, um, and aha moments from today’s talk can make all the difference for you. Okay? So let’s go ahead and get started. I want to talk with you about the top five reasons. You need a social media strategy and how to get started. Now, social media is an online marketing tool that allows you to communicate directly with your audience.

And there has never been a time in history when it’s this easy to connect with your patients. And today, every practice owner knows that it’s essential to have a strong social media presence and engage with your market online, excuse me, but few actually know how to do it effectively and get results. But the key difference between those who succeed and those who fail is simply planning. Okay? So practitioners that use social media successfully do so because they have a solid strategy in place and they take the time to plan this strategy with a big picture view, and then implement it in a systematic way. So your practice can absolutely benefit as well. And the time it takes to develop this strategy more than pays off, once you implement it and start getting closer to your practice goals. So today I would like to talk with you about five reasons, why you need a social media strategy and what you need to do to get started now first is that you have to maximize the effectiveness of your social media presence that allows you to attract the right kind of patient to your practice.

You then have to focus your energy and your time creating this strategy. So you can continue helping more people with your acupuncture treatments, right? So if you want to bring them in, you have to get in front of them consistently. All right? And then you have to know what type of content converts these prospects into paying patients. So you can make sure that your strategies actually working and that you’re reaching more of your marketing goals. And it’s important to find the, uh, the motivation to implement and post content every day. And I’ll show you how to make it a lot easier. And it’s going to be easier than you might think. And finally, you need to know what tools are important to measure your social media success. So you don’t waste your time and money on something. That’s not giving you a positive return. Okay?

Sound good. So many practitioners make the mistake of thinking that social media works like this. You log in, you check out your feed, you post some stuff, you interact with your commenters and you watch your grades gradually rise. Nice. Right? Sounds fair. But not quite. It doesn’t exactly work this way and it can, but it won’t be as effective as it can be. And here’s why if you don’t have a strategy and a plan, you won’t get any results from your social media activities. You may grow some followers by simply being there, interacting with them, but that won’t get you closer to achieving your practice goals. All your activities, including posting on Facebook or Twitter should help you get closer to your goals or it’s a waste of time. So developing a strategy first and foremost helps you link these activities with your goals. For example, if you’re using these platforms to nurture leads by sending them to your free report or your free evaluation, and just getting them to join your list, you’d post different content in a different way than you would, if your goal was to get them on your schedule directly, right?

So goals like raising brand awareness awareness, or building a base of loyal paying patients, motivating your prospects to schedule with you or stimulating more referrals or building your credibility for offers that you pitch all require you to do different things on social media. They all have different outcomes and need a different strategy and plan to get there. The first step is to identify your goals and what part of your activity will play into them. This is a key foundation of your strategy. Action steps would be to one, identify your current practice goals. Are you looking for referrals? Are you looking to double your new patients or simply increase your followers to identify what part of your social media activity plays into achieving these goals? Okay, so let’s move on to the next step. You are focused. If you develop a social media strategy, it streamlined your activities.

So you know, just what to do and you can focus on where you get the best results without the proper focus. You’re taking shots in the dark and hoping that people take the action that you want them to take. So with a strategy in place, your actions will lead them down a path to take a specific action that you want them to. For example, you may post a video and discover that it gets four times as much engagement as your text content. So this means that you need to work on your video into more video into your content mix and sharing a new video each week. So the time that you spend producing your videos will pay you back more than the text content. So one important part of any social media strategy is automation. Automation means letting a software program or app handle certain tasks and aspects of your activities.

They include things like social listening, chatbots, content, curation engagement, and also growing followers. So using software and apps to do these tasks, you, um, saves you time, saves you money, and it can really keep you focused on what you like doing. So an example of a program that you can use, like is like a scheduling software, uh, for your social media, like buffer or Hootsuite. So these are programs that can, you can post on a schedule, you set it up in advance, so you don’t have to do it manually. And it’s great sign time-saver and it it’s a task that you don’t need to do yourself each and every time. But there’s something that you need to consider with this, which is authenticity. So being authentic is the key to good social media marketing. So there are some tasks that you just can’t automate. You have to be there personally interacting with your audience.

So when you get crystal clear on your strategy, you’ve got a real plan for separating what you can and can’t be automated and using for the best results, action steps, number one, create a schedule and content strategy. So that each day, you know, what needs to be done when you sit down and log in, number two, look at social media automation tools such as buffer or promo Republic or hoot suite, and consider which ones might work best to suit your strategies. Okay. So now it’s time for reason, number three, creating content that converts ultimately will, uh, will determine your success with social media. And it’s this content that you, that needs to be engaging in. Interesting. It has to address the pressing questions and the pain points of your audience so that they will want to, like, it they’ll want to comment on it and they’ll want to share it.

So it should frame you as a helpful expert, who has a great deal of value to offer. And part of strategic planning will give you control over the content that you post. So you can decide on topics and formats and content type and create a mix and schedule so that you’re offering a variety of different types of media. And once you start posting, you’ll get feedback instantly to see which content works best. And then you can refine for even better results. And once you start, you need to maintain consistency and maintain a regular posting and marketing schedule. One way to do this is by using a service like tack you downloads, where you can find done for you, blog posts and graphics and newsletters and marketing tools at your fingertips. And it’s a great service to help support you in your strategy. If you don’t know what type of content already that you want to put forth.

Um, so what you’ll need to do is research and create a profile, uh, that will include the interests and of all of your patients, right? So that is part of engaging with your clients is to know what they want. Okay. And to know what type who your ideal patient is. And I teach this in my practice management class, and one of the exercises to map out who your ideal patient is, your avatar, who they are, what they read, what they eat, et cetera. And this becomes your intimate and, um, ideal prospect finder. So you could speak directly to them. And as part of this research, you’ll analyze your competitors and influencers and see what type of content performs best on, on their platforms. And you’ll choose some to follow and you’ll gain insights, following them to help you create your own unique content. So the result is that your content will have further reach, and we’ll be more laser focused when you have your ideal prospect in mind, as opposed to just trying to market to everybody.

You’re focused on who it is that you want to market and communicate to action steps, one identify topics, and the type of format and the content types that you want to share, and then create a posting calendar to get you started. Then this will, uh, you’ll refine this. Once you start implementing it, number two, create an outline of your ideal patient avatar and number three, perform a SWOT analysis on your competition. So you know, where, where they’re falling short, where you could step in. Okay. So this next reason is critical. And one of the best things about having a solid social media content plan is that you have somewhere to go, right? So it’s easy to get into a slump with social media where you’re not sure what to do each day, and you don’t see the results and your motivation starts to lag. But when you have a good strategy in place, you’ll know how to plan for each day.

And your to-do list of important tasks is ready to go. And this takes the work out of interacting with your audience. So you can just have fun and enjoy it. And it won’t feel like work at all, but just hanging out with your people at, you know, and that you love that you want to support in your community. And when you’re enjoying what you’re doing, this will translate to better content and more authenticity, which your audience will enjoy as well. So the best way to create daily task lists is to start big and work your way smaller and smaller. Start with the practice goals that you identify and how social media fits into each of those practice goals. And with that, and your content schedule, you can see the milestones that you have to reach into achieve in each day is a step towards each of those milestones.

You may also want to break up tasks and prioritize them. For example, first priority might be posting new content. Next priority might be replying to comments and re following people who started following you. So with leftover time, you might scroll your feed, looking for content ideas, or content to share, or spend time researching your audience. Excuse me, action steps. One, create a weekly plan for each day of social media activity and finish up each session with a list of things to do for next session to get you started. All right, so now I’ve covered most of the essential reasons why you need a social media strategy in order to get results. And the last thing we’re going to look at is how to measure the results of your strategy. So the question is, how do you know if you’re actually making progress toward your practice goals?

Right? Many practitioners don’t even have practice goals nor do they even know how their progress is moving forward. One of the most important advantages of social media strategies that you can set out a plan for monitoring the results of your actions using objective data, and you do this by setting key performance indicators that you can check regularly. For example, if you want to grow your followers, you can check how many times you’ve got new followers. You can set a goal for new followers each week. If you’re looking for more referrals, what will you do to track that? Okay, so this data will tell you whether your strategy is working and if it’s not working what you need to do to shift it and what you need to do in order to improve it, performance metrics can be tracked using analytic tools or a simple in-house spreadsheet.

And there’s programs that monitor these metrics for you, um, and, and set up and create a report for you, uh, that you could download and take a look at. So, um, your strategy also includes documenting your efforts in this’ll help you refine it and make your marketing for your social media more effective. So you can learn from your success. You can learn from your mistakes. You can learn from what worked and what didn’t work, so you can take, make your strategy better and more refined moving forward into the future. And an important factor in social media success is monitoring the improvement and the metrics of the documentation to help you do this action steps, take your practice goal and decide which metrics would help you determine whether you’re reaching it or not choose the metrics and put them into a timeframe or a spreadsheet. So you can measure and see the results regularly.

And look at these metrics, the tools, and choose which ones to use, start with a free ones or popular ones, and easy to use programs and upgrade with them as you needed. Okay. So I hope you that received some insights today. And if you’re ready to start implementing more practical steps to help you develop a comprehensive, manageable and motivating social media strategy, that delivers results reach out to me. I have a program that I’m launching over the next few weeks. So these are tips are just the starting point for you to help you focus, to get motivated for that. So if you’d like to learn more, um, I’d love to have you reach out to me. My email address is Jeffrey, J E F F R E y@acupuncturemediaworks.com and, uh, just shoot me an email. Let me know that you’re interested in learning more about social media marketing and how to implement strategies into your act, do acupuncture practice. So thank you again so much for the AAC for allowing me to come here yet again, to share some insights and marketing with you and next week, join us when Poney Chiang comes on board and share some insights and some inspirations with you. Take care, stay beautiful. Talk to you soon. Bye. Bye

 

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2 Keys to Attracting New Patients & MD Referrals

 

 

So I thought I would share, two principles, keys for attracting these patient referrals, and how to communicate with medical doctors for those referrals as well.

Click here to download the transcript.

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

I want to thank the AAC for inviting me back to host, um, to the point. And, uh, my name is Lorne Brown. I’m a doctor of traditional Chinese medicine. I have my practice in British Columbia, Canada. It’s called acrobatics wellness center. I’m also a CPA, a certified professional accountant in a past life. And I’ve written the book I’m missing the point, why acupuncturists fail, what they need to know to succeed. So I brought my clinical experience and my, um, my accounting business experience and share that with my colleagues. And I’m also the founder of healthy seminars and online platform for continued education and the chair of the integrated fertility symposium. So I love coming on here and sharing practice management tools. So you can be those prosperous healers where you’re supporting your patients. You’re experiencing abundance, you’re creating great health, and everybody’s happy for that. Um, my presentation today, and we’ll bring up that presentation now is called two keys to attracting new patients and MD referrals.

And so to build up a busy practice and to heal your communities, you need patients, they need to come and see you and want to see you. So I thought I would share, um, two principles, um, keys for attracting these patient referrals, um, and how to communicate with medical doctors for those referrals as well. So one of the keys here is being patient centric versus doctor centric in the business world. When I used to be an auditor and we’d do consulting, that would be customer centric versus company centric. And the key here is to be customer centric in our case, patient centric, creating that value for our patients being of service for our patients. And a lot of us have the right intention. We believe, we really believe that we care about our patients and we’re patient centric. Um, but I would suggest that on an unconscious level, often we are still being doctor centric.

It’s, we’re making a more about ourselves than we are about our patients. And an example of that would be our brochures and our websites. How many of us have beautiful pictures of people receiving acupuncture on our website, on our brochures make sense? We’re doing acupuncture, right? Or you think it would make sense. And it’s something that we love. Like we’re quite passionate. We love getting our acupuncture. Most of us who are practiced love, getting it and love, um, providing acupuncture. But do you ever think of what your patients see when they see your brochure? And what they see is this actually a large part of the population actually has a deep fear of needles. And so I would suggest unintentionally, a lot of us are being doctor or company centric and not customer patient centric. If we were them, we would think more about what our patient’s experiences are when they come to our website and see our brochures.

I will add that I’ve learned in my practice and I think we’re successful because we don’t really think or believe our patients are coming to us for acupuncture, what we realize. And it’s all based on your attitude and intention. We realize that our patients are coming to us for a solution. And if it happens to be requiring acupuncture needles, then, and they, and there’s research to support it, or we have case studies and competence to say that we can help them. Then they’re open to the acupuncture. If I say it’s taking Chinese herbs or receiving GWAS or cupping, um, or laser acupuncture or [inaudible] or cheek gong, they’re coming for a solution to a problem. And that’s what they’ve come to you. And it’s not necessarily that they want or need the acupuncture in their mind. They’re coming to you for a solution. And it just may happen.

That acupuncture is part of that solution. I just want to give you, so I said, I’m going to give you two key, key, um, steps for referrals. So the first one is being patient centered care and really putting yourself into your patient’s shoes, really trying to experience it from your patient’s perspective. An example in my practice at [inaudible] we’re famously known for fertility, we do a lot of reproductive health. And at the beginning, we used to have a baby pictures on our site and in our office. And we did a focus group and we learned that the patients hate seeing pictures of babies in the waiting room and on our website, we thought they would like it because it shows success and hope, right? Hey, look, look what we can do for you. But most of them say that they’re reminded of them not having a baby they’re failures.

Um, they are miscarriages that are unsuccessful ideas. And so coming into the waiting room, um, added stress and not, um, pleasure or peace to them. So again, getting into your patient’s mind and trying to understand what they want. So the focus here is B is to be patient care. And so we meant that patient centered care is about having that intention to care for your patients. However, the intention, the desire to care for your patients, or you even feeling a believe, you care for your patients is not enough. They actually need to know that you care. They have to experience it and believe it. And I’m going to suggest with you, um, I tip, can we go back to that earlier slide story? I, I that’s that too quickly. Um, I’m going to share with you, um, what I do, um, to show I care and I’m, I like to be known.

I want to be known for simple and powerful and effective tips and tools in my clinical practice and business pearls for you guys as well. So what I’m sharing with you is simple. So simple that it’s easy to be dismissed or ignored. It’s not complicated, but simple doesn’t need mean easy. Simple means anybody could do it, but it does require some discipline. And so I say here, what is easy to do is also easy not to do. And I’d like to send, check in emails or call my patients to see how they’re doing. And you can do this after our initial or after a special milestone. Um, I make a habit and using that word unconsciously, a habit of following up with my patients, um, around their pregnancy test date, um, for an IVF cycle. So I support a lot of women through their IVF.

Our clinic does not just me and we show, we go on site to the IVF clinic, the largest one here in Vancouver, BC, and provide both acupuncture, laser acupuncture on site. And I make a point to check in with them between their transfer date and the pregnancy test day, just to see how they’re doing, see if they have any questions, um, and then asking them to let me know an update when they know whether they’re pregnant or not. And so I encourage you to do that and it could be as simple as the following. I want to sh I want to give you, uh, some of the copy that you can do. It doesn’t need to be a long email. It can be tight. It could be subject line checking in, and then your copy could be hi. So-and-so I wanted to check in to see how you are doing period.

Please send me an update at your convenience and then your name and that’s it. Now the intention behind this is you want to know how they’re doing this is important because if you’re doing it, I believe intention carries some chew with it, some energy. So if you’re doing it because you want them to be your patient, I think on a subtle level, they may pick up on that. The good news is that when you do this, you create mind share. They remember you and likely often they’ll get back to you. Many of them will, and they’ll book more with you if they haven’t already. So there’s good news to doing this wherever your intention is to find out how they’re doing, because if the patient hasn’t rebooked, it could be because you resolve their issue. And so wouldn’t, you want to know that in document that in the file, you can even save the reply and they say that everything’s great.

You could ask them, um, to write a testimonial or Hey, if you know anybody else that struggling with what you struggle with, please send them. Cause as you can see, I love to treat that so simple like that. So your email is, and I’m going to show you some responses from patients that I sent this email to. I just wanted to check in to see how you’re doing. Please send me an update at your convenience. Sometimes they’ll tell you something that didn’t work. So you got to learn from their experience. So, and you may be able to correct that in that email or call them to make it right, but it’s just important to follow up with your patients. So, um, here’s an example of just two examples of what I received back from when I sent an email to patients. Now, I would say over 50% respond to my emails.

And, uh, often they’re, they’re quite nice emails, surprisingly, but good to get that feedback. And then there are those that just never respond. Um, so I sent an email checking in on this patient wanting to know, um, she had any questions and, um, I, and I asked if she could send me the results of her IVF cycle when she knows, um, she said, thank you Lauren, for the email, this is very kind of you to reach out. Remember I sit in their previous slide, they need to know you care, um, saying it or thinking it is not enough. And one way to let them know you care is by checking in via email. My blood work results came in today and it’s positive rate CG is 5 96. The nurse advised that is very good number to have at this stage. Let’s hope everything continues to go well from here.

So, you know, we’re having that relationship that trust, and this is good that she’s actually sharing this March. I appreciate your and Ryan support, Ryan and I both saw her through our clinic. Your clinic has been a tremendous part of my journey. Everyone has been so wonderful kind and professional. Thank you for providing this kind of support to women. I could follow up and say, thank you and remind you that we like to support you throughout the pregnancy. So now I can have that conversation with her. Um, so continue the acupuncture and advice about what we do during pregnancy. I could ask her if we can use her this, um, email, um, for our testimony, if it’s allowed in your, in your state or province to put it on the website. Here’s another example. I willing to respond it from her. Check-in you’re Lauren, your ears have been burning.

Your ears must have been burning because I was just talking about you and how incredibly skilled, supportive and genuinely caring you are. My hubby really enjoyed meeting you as well. And I know you really impressed him as well. So it’s showing you that we care based on their emails back. They’re showing you that little touch point, so simple to do, but again, what’s easy to do is also easy not to do. And you want to create this a habit, a lot of clinics. Um, I would recommend you doing this after the initial, if they have not rebooked. And even if they have within that week, just send in a check in email or any special milestone. It’s good to check in. And if you haven’t seen your patients for so many weeks or after two months, and you think there should be more care based on what you’re treating them for, then send in a, an email. Hi, just want to check in to see how you’re doing. Please send me an update at your convenience. So the next thing for referrals and for good medical care is, um, communicating with other health professionals. And I’m going to give examples of what we send to medical doctors. And you get a busy practice by getting referrals for word of mouth, through patients and also referrals from healthcare providers.

So the key here in anything in life to be successful, any enterprise, whether you’re a clinic, whether you’re selling widgets, whatever you’re doing is creating value for the person that’s buying your services or your products. And, um, in this case, think of, remember, we talked about patient centered care, think of the doctor as a customer of yours as well. You’re wanting them to refer to you, right? Um, so, um, think of them that way and want to create value for them because when you create value for other people, they tend to like you and want to work with you. So it’s important to find out their needs and how your relationship can benefit them. I know most of us are going to them saying, I want you to refer to me and that’s needy and that’s not creating value for them. That’s creating value for you.

And I would imagine those relationships don’t flourish or go anywhere because you started off with what can you do for me versus what can I do for you? So find out what you can do for them. I know in the Canada social system, doctors are quite busy. Um, medical doctors, um, tend not to like to treat the patients that have pharma allergy or list of symptoms. And so, you know, you can ask the doctors, what are the patients that you don’t like to see or take up a lot of your time. And so just start developing a relationship with them and finding out what kind of patients, um, you can help them with. Right? And when I say help them with in this case, um, you know, patients that, um, again, in Canada being social medicine, they don’t want to spend an hour with a patient.

They want to spend 10 minutes, maximum 15 minutes. So if a patient has a laundry list of, of, um, issues, they don’t like those. And so they would love to refer those off to people like me, where we spend an hour with them so they can see more patients. Um, I remember one doctor said, um, he doesn’t like patients that have a whole list of symptoms. And I said, well, I’m a holistic doctor. So I likes it. Patients, the whole list of symptoms. Sometimes a little humor will help as well. You want to create trust, um, and allow time to build this long-term relationship. So it is a marathon. It’s not a sprint. You don’t meet the practitioner or the medical doctor that day and then expect them to be a great referral source. It’s a relationship and over years, um, I’ve been in practice since 2000 over years, you start to develop relationships where these physicians become your champion, where they send a lot of patients to you. Um, and that could take time. But if you’re in practice today, think of yourself three years from now, what do you want? What kind of referrals do you want? And think of in three years, I want that relationship with that MD. So today start that relationship knowing that you’re going to date, you’re going to develop a relationship and over time it’s going to become a healthy relationship.

So I’m sending him a letter to the doctor. I find very beneficial and it’s good medical, um, um, medical care on your part as well. So, um, when you see a patient, send them a thank you letter for that referral. Now here’s a trick for you. Um, send them the thank you letter, even if they didn’t refer the patient to you. So when you do your initial, um, if you don’t collect it on the document, ask the patient who their primary care physician is. And so when you send a letter, um, say thank you for referring such a patient, you’re almost programming them like, oh yeah, I refer them. You know, but even if they haven’t and just let them know, you have this patient and mutual care, and I’ll share a letter that we sent to a doctor here in a moment. So I will give you a little template here that we use that you can now use.

So send them a, you know, what, they’ve come in for what your plan is, and that you’ll send them some progress report. So it’s good to send them kind of your initial findings and your treatment plan, send a revaluation, let them know, definitely refer back to the MD as well for their followup and confidently communicate with them. When you have questions or suggestions, don’t put them on a pedestal, but don’t have counterwill or make them your enemy and fight with them. Either your colleagues working mutually for this patient’s benefit. So own what you know, um, but also read the room and know who you’re talking to as well. And it’s really good medicine to have this integration. So here’s an example of a letter. I apologize, the presentation, put the bullet points there. You don’t need the bullet points, but I took out some names and some information just to preserve confidentiality, but here’s a letter to whom it may concern.

Um, Mr. X presented to our clinic AquaBounty wellness center on Wednesday, August 23rd for pain in his left knee, which he shared with related to osteoarthritis. I’m using a technique. Our clinic calls, laser acupuncture, which utilizes a class three B medical grade, low-level laser therapy in combination with electrical acupuncture. And skeeted, don’t inundate them with too much information, keep her letter short. And also it’s a good thing to remind you, at least in Canada, that when a medical doctor receives a correspondence regarding a patient, um, they’re technically supposed to put it in the file as well. So again, reminds them when they look at their file, who you are in your involvement. I give a brief education of what laser is. So education here, low-level laser therapy has been shown to relieve pain associated with main diseases and syndromes and cleaning, osteoarthritis. It implements red and infrared light to decrease pro-inflammatory cytokines promotes blood circulation and promotes tissue regeneration by increasing mitochondria ATP production through fighter, by my white fire till biomodulation.

And then I give them a two links to go to my website. If they’re really want to learn more, some doctors are going to want to know about this, and they’re going to look it up. I’ve had doctors call me after to go for lunch. Cause he wanted to know more about what we were doing. Cause they had a lot of patients that they have been trying to help with drugs, drugs, or surgery, and they still have not found relief. So they they’re looking for anything to help these patients. Um, my Mr. Patient, uh, so put your patient’s name, your Mr. Patient’s name. So whoever their name is, has received a treatment. So in this letter, just so you know, I was slow. I didn’t send it when they first came in, patient came in and I did not send the letter, but I sent it, you know, I said to the progress reports.

So sometimes you get behind. So I sent them this letter anyhow, um, after they’d been seen with seen by me for a couple of weeks, they received eight treatments, um, since August 23rd and has experienced noticeable improvement in pain reduction by his third session. So I’m showing the progress and how good this was after three treatments, they already have no pain. His current pain level is not existent. Even with strenuous activity. We have not noticed any significant reduction in swelling. So he was quite swollen, but we hadn’t seen much change in that over the past three weeks. And then I let him know. My plan is to continue to offer one or two weekly treatments until he has results from his schedule. X-ray October 2nd. Do you have any questions about our mutual care of this patient? Or if you want to communicate with me about any aspect of his care, please feel free to contact me in health. And then you give your email and name. If you’re sending it by mail, which I recommend, um, I’d say both mail and email, but put your business card in if you send it by mail.

So just remembering being successful as not doing extraordinary things, the, um, thinking about the patient centered care, sending them a check in email, writing a letter to your doctor at best, not extraordinary, right? But being successful is simply doing ordinary things extraordinary. Well, and so you want to make it as a habit and just think for the next three years, if every patient you saw, you sent in a check, an email and you sent a letter to their primary care physician, I’m just curious how many extra referrals you’ll get because the patients now know you care. And the doctors now know you exist.

Do keep in mind. It takes 20 years to become an overnight success. Really the point here is to manage your expectations and that this is a marathon, not a sprint I’m when I’ve coached my colleagues often, they’ll say I did what you said and it didn’t work. And just so you know, this response, I did what you said, didn’t work is one week after I told them what they could do. So if you’re telling me did work after a week, you’ve missed the message on building a relationship and it takes 20 years to be an overnight success. It’s a marathon, not a sprint and just create this habit and do this over time. And then after six months rafter, you’re telling me how it’s going, but definitely not after a week.

So keep this in mind. There’s two types of human suffering. This is by Jim Rowan, a nice quote. Um, look at the image on the left. You can see the fit gentleman inside this obese body drinking soda, water, it’s the pain of regret or the pain of discipline. So either way, there’s going to be some type of pain or effort. So the pain of regret or the pain of discipline. So I’m inviting you to go for the pain of discipline and write these emails. Um, I talk about what we just shared in my book as many other and many other, um, what I consider a key points in mindset and activities to help you build a successful practice. Remember as a practitioner acupuncture, you’re a business, whether you like it or not. Um, small businesses, acupuncturist are always at risk of failing because we’re small.

Just the nature of us being small businesses, lacking resources and money or people to do everything that needs to be done, puts us at risk of not succeeding and then add to it that many of us are in denial that we’re in business or don’t want to learn about business puts us even at greater risk. And so to be an effective healer, you need to have the union balance. You need to know your medicine. So constantly work on your clinical. And we do this well. We’re always putting our continued education forward and a priority. I know this from healthy seminars, seeing how many people are constantly learning. And then you have to also the other side, the young, you have to also give attention to the business side of it. And if you didn’t young or out of balance, you have disease or they separate and there’s death.

You go out of business. And so you can’t ignore the business out of your practice. And if you’re not in practice because your business is failing, unfortunately, then you’re not able to heal your community. And it’s important more than now than ever to have practitioners like you available to heal your community. So continue your healthy seminar studying on the medicine side. And I want to remind you just also study the business side so you can stay in business, have a busy practice, feel fulfilled, um, healing your communities. And if you’re interested in my book, um, there’s free shipping this month go to missing the point. book.com, make sure books in the URL. Otherwise it will go to a different website missing the point book.com. You can order a copy and have free shipping this month. And if you want to contact me, um, you can either go to healthy seminars.com.

That’s where we offer online continuing education. And I get a copy of those emails on my own, a little website called Lorne brown.com, where I interview people on conscious talks and I share, but conferences I may be involved in. So you can check me out there. There’s the website for my book, missing the missing the point book.com. And my clinic is AQI balanced.ca um, stay tuned to future AAC webinars with me. I’ll be interviewing more, um, colleagues over the, over the months and years. And I want to let you know that next week our colleague and our friend Jeffrey Grossman is going to be on to the point for this AAC webinar series. Thank you very much.

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The Stomach Sinew Channel and Low Back Pain

 

 

 We want to discuss the, uh, low back pain and the significance of the stomach channel. So let’s take a look at that first slide. Our discussion, very short discussion about this topic is going to be looking at the stomach sinew channel from above the knee and into the rib cage region and its influence on low back pain.

Click here to download the transcript.

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

Hello everyone. My name is Matt Callison. I’m here with my colleague Brian Lau and everyone. Uh, thank you to the American Acupuncture Council so much for having us. We want to discuss the, uh, low back pain and the significance of the stomach channel. So let’s take a look at that first slide. Our discussion, very short discussion about this topic is going to be looking at the stomach sinew channel from above the knee and into the rib cage region and its influence on low back pain. Um, the techniques that we’re going to be presenting here today is just something that you can routinely check for low back pain patients to see if the stomach Sr channel is a contributing factor to this person that’s coming in with chronic low back pain. It could actually even be acute low back pain to go ahead and check that as well.

So I think we should probably get going. We’ve got plenty of, of information here. Um, the first slide or this next slide that we’re going to be getting into is going to be specifically about the lateral Rapha. Now the lateral Rapha is a very significant tissue along the stomach sinew channel. That can be a contributor to low back pain. Let’s discuss this very strong fascial connection to the lateral Rafat. Um, you can see there on that lower left-hand corner of that. Call-out if you can circle that there for us. Yeah, there we go. It’s a continuation of tissue from the abdominals, the fascia from the abdominals and the thoracolumbar fascia. Uh, for those of you that know about the thoracolumbar fascia, it’s gained a lot of popularity over this last 20 years, significantly over the last decade about its importance functionally, but also in low back pain.

So the thoracolumbar fascia, it has got three layers. You have a posterior layer that covers the erector spinae. Okay. You’ve got a middle layer that’s underneath erector spinae and above the quadratus lumborum and then you have a deep layer that’s between the quadratus lumborum and the LDO. So as each one of these layers connect laterally, it becomes the lateral Rafa, the thoracolumbar fascia specifically between the poster and the middle layers. However, if you also look at cadavers, you’ll see that that poster layer also has some contributions to the lateral Rafa. It’s a communication link. It’s a segway between the abdominal fascia and the thoracolumbar fascia, and it sits right on top of the quadratus lumborum and we can be able to pal that palpate that for Osher point. So, uh, the reason why we’re talking about the latter fr right now, before we go into an overview, just such an important tissue for us to be able to consider and then farther into this presentation and we’ll get into the assessment and the treatment of it. So let’s go into the overview of the stomach channel and Brian, do you want,

Yeah, yeah, sure. So next slide. Yeah, we have, um, just a real quick introduction or re-introduction of the stomach sinew channel, if you haven’t, uh, looked at it recently. Um, the secondary channel that includes the myofascial planes, uh, of the stomach channel, there’s really two main branches. Uh, we have one that travels up the anterior lateral leg and thigh goes around the genitalia and spreads out into the abdomen. Then from there, it travels up the chest neck and face to the lower eyelid. So this is the main channel that you’re seeing in this image and this kind of, um, 3d model image here. Um, you can see primarily that main channel coming up, the midline of the thigh are a little bit, uh, lateral on the thigh. And then up into the abdominal layers up through the chest, up into the neck and up into the face, um, that kind of follows the, the primary channel for the most part.

Uh, the second channel is another branch of this that you don’t really see from this image, but we’ll have plenty of opportunities to see it in the next few slides. Um, this other branch is on the lateral kind of starts from the lateral knee, goes to the region of gallbladder 30. Sometimes it’s in that translations, they might say it and it connects the shower young. That might be another way that it’s worded, but it kind of becomes a little bit more lateral as a sort of a segue between it and the stomach channel from there. It runs to the 12th rib and ends at the spinal column. This is kind of adapted from a Vanguard translation at the link shoe, which is a particular source that I really like. Um, but, uh, all of the sources say relatively about the same thing when you look at translations. So let’s go through each of those branches a little bit more clearly and to the next line.

So if we wanted to start at the distal part, um, from the lower extremities, we can look at the stomach DJing, Jen, how it travels along the anterolateral leg and thigh. I think actually these two branches actually, uh, start in this, uh, leg region below the knee. And you can kind of look on this image for the tibialis. Anterior tibialis. Anterior is just lateral to the tibia. This is where really the primary channel of the stomach, the stomach primary channel runs along this area. Stomach 36 would be noodling directly into the tibialis, anterior and happens to be the motor point, uh, for tibialis anterior. So that’s an actual primary channel point. That’s going right through that region. From there, we could kind of follow that up, uh, lateral to the knee, into the rectus femoris, continuing to follow that stomach primary channel. But if you look at this image, we also have the extensor digitorum, longest muscles.

Um, you know, there’s several slips of those. The two, um, create a poll extension for toes two through five and especially toes two and three are part of the stomach channel. So this in some ways is sort of the beginning of that lateral branch. It’s kind of a, between the stomach primary channel and the gallbladder primary channel. It’s part of the stomach sinew channel. You have those toe two and three slips that kind of drive up toes four and five would be gallbladder send new channel, but we’re on the stomachs in your channel. That’s going to connect into the vastus lateralis and start to become that a secondary sort of a branch that more lateral branch.

All right. So let’s go back to the main branch main branch is going to run up the rectus from Morris. You can see the rectus for Morris, this image that kind of dark line on the thigh is the kind of the fascial separation between rectus Morris and vastus lateralis. So that’s in my opinion where the stomach channel runs, but that rectus for Morris that more medial muscle in that picture is going to be the sort of primary channel branch of the stomach sinew channel that then connects to the a, I S it actually connects to the a S I S or it’s fascia. And then it runs up through the inguinal ligament up the abdominal layers up the chest, et cetera, kind of following the primary channel of the stomach. Um, so in this case, what we want to focus on for today’s lecture is the abdominal fascia in particular, because we’re going to look at how that connects and wraps around to the, um, to the thoracolumbar fascia and the lateral Rafa in the stomach channel. It’s all the fascia that lives in is found on top anterior to the M rectus for Morris. I mean, excuse me to the rectus abdominis. So it’s all the fascial layers that are on top of, or superficial to the rectus abdominis. Um, part of those fascial layers in wrap around the body, following the fascia of the abdominals into the thoracolumbar fascia, into the lateral Rapha, and then connecting all the way to the spine. So next slide.

So the lateral branch on the other hand is going to be a little bit more lateral on the thigh. It’s covering the vastus lateralis, which is a pretty big muscle. That’s the fastest part, I guess, but the vastus lateralis actually covers really a lot of real estate on the lateral thigh, really going into attaching all the way to the back of the femur. Um, so it really covers the territory of both the stomach primary channel to some degree. And the, also the gallbladder, um, primary channel, the iliotibial band would be running down on top of this structure. Um, so it would be a kind of in a pretty big area, but this is the link through that lateral branch. If you follow that fastest ladder up, you can see where it communicates the chair’s fascia. It attaches to the same region as the anterior portion of gluteus medius and minimus, especially minimis. So, uh, just that, that hip joint region, you can see where those two muscles are communicating. Then from there, it’s going to continue into the thoracolumbar fascia meeting with a lateral Rafa about anything you want to add on these are,

Yeah, that tissue with Cal patient is pretty significant when somebody has a posterior tilt or an N tilt of the anonymous bone, versus when it’s a neutral pelvis, you can really tell the difference in palpation of that fibers of the anterior fibers of the minimus and the medias, like I said, with quite a change in inclination with that.

Yep. And it’s an often, we actually had a discussion on our, uh, Facebook group on sports act, a sports, um, acupuncture group. And, um, we were talking about how often this fastest ladder Alice is ropey and rigid and dense. And I think if you palpated the thigh quite a bit, you can probably notice that you do know, you do find a lot of patients that have a ton of tension in this area. Right. So let’s move on to the next slide. All right. So we have a few, uh, three, I think, cadaver images. So just the general warning. Um, this was in the beginning, we have the warning on the bottom of the screen. We’ve already had one small image, but these are a little bit closer, a little bit, um, more obvious they fill up the screen. They’re a more obvious cadaver images. So just be aware of your surroundings, you know, if you’re at a Starbucks and there’s people looking at your screen, maybe, you know, get it into a position where they can’t see it, it’s better not to view these in public, don’t share these images, um, you know, keep, uh, it’s it’s, we have to be very respectful to the donors and make sure that we don’t do anything inappropriate.

So this is an educational settings. So we have these images, but, um, but don’t share them with the general public or be mindful where you’re watching this ad. All right. So next, uh, next slide, let’s start looking at this connection. So there’s two lines on this, uh, cadaver drawn over this cadaver, and it’s just the dissection image. And then the top one, uh, which is the shorter of the two lines that’s showing the upper border of the glute Maximus and sports medicine acupuncture. We’ve referred to this as the gluteal app and erotic line. So that’s going to be more superficial than the glute medius and minimus, but I just wanted to show that demarcation, the bottom line is traveling up from the vastus lateralis. Then as it kind of makes a curve, you see it connecting into the glute medius and minimus, and then it follows right up into that, uh, lateral border of the erector spinae, which is that top portion of the line, um, that is kind of that whole trajectory of that lateral branch of the stomach, uh, send you a channel going all the way through the lateral Rapha and a moment we’ll actually see the erector spinae lifted, um, so that we can, um, get a clear view of the lateral Rafa.

One other thing to highlight from this image, you can get your bearings straight is if you go to the very top of that, um, that line, the longer line that’s, um, from there, if you go to the midline of the spine. Yep. Right in that region, we actually have the erector spinae cut. So everything above that, you’re seeing deep to the erector spinae. That’s going to allow us to lift up that little flap of the erector spinae to see the lateral Rafa a little closer. So let’s go to the next image then. And, um, this is just the lines removed, right? So see if you can find that same territory we just discussed kind of look at that trajectory of the sort of channel, like portion going from the thigh all the way up the glute medius and minimus up into the lateral Rafa. Okay.

And now let’s look at with the rector SPI and a lifted. So that would be on the next slide. So there is that little portion of the erector spinae lifted. Then you can see deep to that, to the next fascial layer and that boundary of the lateral RFA. That’s just that little, um, band that runs just lateral to the erector spinae. So again, you can follow that line down from the thigh, from the lateral thigh, going through glute medius and minimus into that lateral Rafa all part of the stomach sinew channel, that lateral branch of the stomachs, a new channel and a pretty juicy area when you’re working with a lot of chronic back problems. Right. That’s pretty sick.

Yeah. It’s pretty significant, uh, continuation from the lower extremity into that latter Rafa, you can see that line with the erector spinae lift up and the thickness of that ladder Raffa as well.

Interesting. Yeah, for sure. Yeah. Get that image in your mind though, because you’ll see some palpation coming up in a bit. Um, and this is where actually, can we go back to the previous image with the erector spinae down? Imagine you are pressing not on a cadaver specimen necessarily, but on a person, if you were pressing and you could kind of see through the skin and, um, and see that your, your pressure is going right to that lateral edge of the erector spinae diving, just deep to it, to that, uh, that boundary of the lateral rafting, that’s going to be where we’re going to be palpating. Um, so this is a, a lot of the types of things we tried to get across. Like these images come from our, um, uh, uh, anatomy, cadaver dissection lab that is on, uh, LASA right now. So these are part of, uh, you know, we have a bunch of videos and I’m really a little more thorough presentation on this, but even just looking at these images, you can kind of get an idea of, okay, if I were to press into that tissue and try to reach the next image, go to that, the next slide and reach that tissue that’s on that boundary, just deep to the erector spinae and know that, okay, that’s the lateral Rafay, I’m palpating for tension at that region.

And knowing that that’s part of the stomachs and new channels. So we have a lot of information right there that you want to take it and kind of go over that. It kind of kind of started the process a little bit, but I wanted to highlight it on the cadaver portion. So when we see it, we know what we’re looking at.

No, that’s great. This is going to be the cadaver dissections in module two anatomy, politician, palpation cadaver lab on Los OMS. But what you said, bright for the person to really understand where that lateral Rafa is, which is going to help significantly when they’re looking for Osher points in this tissue. And also when they’re palpating for, so the lateral Rapha attention test, which is going to be coming up here in just a couple minutes. So am I next? Yep. Okay. Let’s go to the next slide please. All right, here it is Latta Rafiq tension test. So you guys hear it for your notes. Um, you have this a step-by-step, you’re going to ask the patient to designate the pain level with palpation of this tissue on a scale of one to 10. Um, many people are gonna be thinking, well, you’re just palpating. The quadratus lumborum is actually the depth of the palpation.

That is significant here. When you look at the video that’s coming up next, you’ll show it it’ll show that Brian is palpating within the first quarter inch of the superficial tissue. Just touching that lateral Rapha that covers the quadratus lumborum. If we’re looking for the quadratus lumborum trigger points or motor entry point ratchet pop hitting more from deeper into that tissue. So there’s a difference in the palpation of it. A practitioner is going to attempt to decrease the tension and the pain of the lateral Raphi by using the following acupuncture, motor points, stomach 41 works great. 43 can be used on 36 being the motor point, as Brian said of the tibialis, anterior, the vastus lateralis motor points work really, really well for reducing the tension and the latter Rafiq. Um, same with the rectus abdominis points. We’re going to be covering that because there’s four different segments of the rectus abdominis motor points.

And it’s usually going to be the lower aspect that is going to be changing significantly, the tenderness of that lateral Rafa. So let’s look at this image here. You can see how Brian was talking about the, uh, channel going all the way up the vastus lateralis, going to the anterior fibers. I’m talking about the lateral image here of the patient. So you can see going up the vastus lateralis, going up the anterior fibers of the minimus, the media’s going across that iliac crest, which you just saw on the cadaver going right into that lateral Rafa right now from that tissue, the lateral Rapha is going to be following along on the poster and the anterior aspect of the abdominal wall, going to the rectus abdominis. So there’s your connection, your significant connection of the stomach Sr channel for low back pain into the latter Rafa.

And also the abdominal aspect is contribution to low back pain as well. There’s something that we’ve been talking about for a few years now, it’s called acupuncture as an assessment. Um, this is something where you can use a couple of acupuncture points just to be able to see if they will decrease the tension of a particular orthopedic examination. In this case, what you’re going to see in this next video is Brian’s going to be using a couple of points to reduce tension in the lateral Rapha. So let’s check out the ladder off a tension test and acupuncture as an assessment, let’s go to the, into the video

[inaudible].

So we’re looking at the lateral branch of the strong stomach send new channel. So the lateral branch of the stomachs and new channel from the thigh comes up through the vastus lateralis, connects with the gluteus medius and minimus, and then to the thoracolumbar fascia. So one of the key areas we look for in this lateral branch that connects them to the lumbar spine from the stomach channel is the lateral Rafa. The lateral Rapha is the meeting point is the fascial wall. That is the boundary between the iliacus Dallas’ lumborum the erector spinning and the quadratus lumborum. So those fascial planes come together in a seam at the lateral Rafa, and we’re going to go right into that lateral Rapha at a Rambo level of L three. Doesn’t have to be exact, but L three is a good landmark, and we’re going to start to palpation following the angle. So here’s the erector spinae falling off following the angle of the erector spinae down into that valley of the lateral Rapha. And we’re just looking for tension, but also palpatory pain to that. So we can ask the patient on a scale of one to 10, how that, what that pain level is with palpation. So what does that pain level there? Three by three? Yeah, it feels denser. Doesn’t feel, it feels like it’s healthy tissue. Most likely go to a different area. How about right there?

Three. All right. So can you stop bad? But if this was a big pain producer for the patient, then we would look at reducing that with distal points for this assessment and come back and how pain and see if that changes it. So primarily we’re going to be looking down with stomach channel and we can include things like vastus, lateralis, vastus, lateralis Motorpoint would be a good one to consider. We could look at, even though it’s on the gallbladder channel, the most, uh, pasture and edge of the vastus lateralis would be a possibility. So that would be in the region of gallbladder 31, and then we could follow it down also into the stomach channel, just by palpating. It feels like tip anterior has a certain amount of tension. So I’m going to use Tim anterior. I don’t know if it’ll change much based on the fact that you didn’t have a high pain aspect with the additional palpation, but let’s go ahead and work on it anyways. So we’ll use stomach 36, 1 of the motor points for tibial anterior.

Now we’ll come back to the area. So there’s two things I can look for what my palpation tells me. Does it feel like that tissue softened? And then what does the patient report in terms of pain, quality back at the same area and scale the one from one to 10? Yeah. And it feels softer to me. She says the one now, and from a three to a one, I’m having a hard time finding the exact location where I felt that tension before. Cause it feels like it’s been reduced. So other points to consider the distal stomach channel points down towards the feet, stomach 41 would be a possibility stomach, 40 stomach, 36, just based on palpation, felt like a good starting point for me. And then also looking at points along the thigh.

All right. So let’s just talk logistically about what we just saw here. So if you’re going to be treating the patient in a lateral recumbent position like that, using acupuncture’s assessments going to be really quite simple, um, you can also check the lateral Rafiq, the tension tests when the patient’s going to be standing, which is nice because you’ll be bearing and load bearing. So therefore the tissues are going to be a little bit different. Um, in that case you can check for Osher points while the person is standing. You could still go ahead and needle stomach 36, or you can use some distal points to, to see if that was start to change the tissue. You can also do the, do the lateral Rafa tension tests when the patient’s Lang prom. Now that makes it a little bit more difficult when you’re trying to be able to needle the vastus lateralis points, but we will have more access to the distal stomach channel points using stomach 45 stomach 44 stomach 43.

Those points are going to be a lot more accessible when the patient’s link prone and they will also change the tension within the lateral Rafa. And that way you can be able to plug in those points and then continue with your treatment. Um, this is going to be, um, just kneeling some Osher points within that lateral rafting. And you could see with Brian’s angle that he is angling it more toward the belly itself. Not necessarily parallel with the table, like how you would be needling the quadratus lumborum so pressing into that ladder, I Fe looking for Osher points and just tapping on that tissue. Remember that lateral Rapha is going to be a thin tissue on top of the quadratus lumborum and you might have two or three different Oscher points within that lateral Rafa. That’s going to span the region from the 12th rib all the way to the iliac crest. So let’s remember the depth of where that lateral Rafiq is. I’m trying to be able get disperse Oscher points within that region. Bride. You wanna add anything to that before we jump into the next slide?

Yeah, just that it’s um, I think I have that needle in about L three. Um, I do find that that region of L three and the lateral Rafa tends to be, um, pretty responsive and, um, you know, it’s a, it’s a good, I, I often find that is kind of the greatest tension, but for those who followed, uh, Luigi Stecco his work, um, you know, he has these really involved system where he talks about these different points, that parallel acupuncture points to some degree, but he calls them the centers of coordination. Um, and they’re like fascial unions between certain, certain regions of Paul on the muscle. Like this would probably be, I’d have to go back and look, but it’d probably be the, uh, include like the quadratus lumborum the erectors and coordinating movement between those. Um, but it’s in the fascia itself of the lateral Rafa. So this is one of his points, one of his centers of coordination, um, is that, that, uh, L three lateral Rapha mark. So kind of interesting. And I do find that that’s, I don’t know if this works super well, but I know a little bit of it, but I do find that that L three region is usually pretty predictable predictably. Um, more of the center of, of, of tension of that lateral or FFA. Sometimes when I need a lead, I have a slight inferior angle though. Like you said that 45, but, but slightly inferior.

Yeah. So predictable Osher point within that. [inaudible] so that’s great. That’s good. All right. Let’s see what the next slide is, please. All right, let’s go over the best slash motor entry points. There’s two primary for the vastus lateralis. One of them will be extra points, team food two, which is located just one to two soon, lateral from stomach 32, which would be food too. We know that stomach 32 is located six soon up from the lateral border of the superior lateral border of the patella. Uh, so following that up, make sure that you are going to be in the vastus lateralis, not in the rectus femoris. You’re going to slide over then one to two soon, um, into sheen futu, if you cross fiber, the vastus lateralis, it will often facilitate, uh, which would also be at the definition of a trigger point. Uh, if shin futu is going to be referring somewhere, then that would end up being also location of point.

Um, so this is going to be a branch off the femoral nerve going into that vastus lateralis extra point sheen food to a pretty powerful point. So it makes sure when you are kneeling it pretty slow and methodical needling, otherwise it can be a strong cheese sensation can come up really quite quickly. Now the upper fibers of the vastus lateralis, which oftentimes, um, can atrophy on many patients where it’s not really quite used, if they’re having some mechanical problems with the extension or knee flection, those upper fibers, if you divide stomach 31 and the superior border of the patella divided by thirds, it’s the meeting point between the middle and the upper thirds. Uh, you’ll definitely find an off SharePoint within that meeting point. That’s going to be another motor entry point from the femoral nerve going into those upper fibers. Um, the needle technique, that being that should actually be a little bit deeper than that, uh, should be more like, uh, 0.75 to 1.25 inches because the innervation is actually going to be more to the medial side from that femoral nerve.

So you have to go a little bit deeper into that mass lateral, so you guys would be able to make that correction. That would be great. All right. So let’s now I believe let’s go to the next slide, our rectus abdominis motor entry points here. You can see four needles on the left and four needles on the right. It’s an old bleak angle going into the rectus abdominis. The needle is starting at the spleen channel and then directing it toward the wrench channel going. Uh, th the objective here is to try to be able to get the needle to go to the poster aspect of the rectus abdominis. That’s where the innovation side is more on the poster aspect and not necessarily on the Antar aspect. We have to be very mindful to make sure that we know where the tip of the needle is going, and it’s not going past the rectus abdominis, therefore into the peritoneal cavity.

So be very, very mindful of where that needle is going, but your goal is to cross fiber, the rectus abdominis, and angle it. So it is going to be affecting more of that poster aspect. Um, there’s a great video. That’s going to be in the motor entry-point protocol. This will be in module two part of the online recordings that we have thankfully have finished. We’re coming really close to getting them all aligned. Um, it’s been over a year endeavor and what an adventure that has been I’m sure Brian can agree to that. Um, so those are available on Lassa OMS, um, the research for the rectus abdominis motor, point’s the largest diameter of these intercostal nerves. That’s going into the rectus abdominis or the ones that’s going to be located in the lower half. So that means number three, and number four, that’s on this particular slide.

So you want to locate stomach 23, which we know is going to be too soon above stomach, 25 and needle towards stomach three from the spleen channel, right? So the rectus sheets you’ll be connecting the spleen with the stomach then. So the needle is going to be going from the spleen channel toward the stomach channel, going into the motor entry point for that particular muscular segment of the rectus abdominis. I believe that particular one is innervated by the T 10 intercostal nerve. I could be wrong. It could be T 11. Um, again, but those, the research was showing that’s more of the larger diameter, um, um, uh, nerves coming across into that motor entry point. The next one to choose here would be also just below stomach 27, which we know is going to be located to super low stomach 25. That was nice about this too, is you look at it’s pretty much at the same level as the lateral Rafa as well.

So with low back pain, many times practitioners are not needling into the abdominals. And boy, you can really great get really good results by combining treatment on the back and also treatment on the front. So if you’re not treating the abdomen with low back pain and maybe your results haven’t been as good as you want to please make sure that you are going ahead and needling into these, these points, you’ll see that it actually will help significantly. And just as a side note also, um, I’ve had many patients have actually had constipation and I’ve used this needle technique and it works really quite well, more for the excess type of constipation, not necessarily for the blood deficiency type of constipation, but it’ll change Paris dialysis pretty well. All right, Brian, I think we’ve got a myofascial release technique that you’re going to be showing that’s really a great for spreading here. So do you want to introduce that?

Sure. Uh, so Matt mentioned getting better results by including the abdominal layers, especially if you’re doing these assessments and you find that, you know, somebody reports a seven out of a scale of 10 on the palpation of the lateral Rafa on a pain scale, and you need all the rectus abdominis, uh, as a, um, assessment or the vastus lateralis. And you find that when you go back and pal plate that maybe it’s gone down to a four or a three, so that’s telling you that that’s a component, you know, part of their low back pain. Maybe it’s not the primary source, maybe it is, but a component of their low back pain has to do with that tension in the thoracolumbar fascia. So sure if that, if that assessment showing improvement and why not put those needles back again as part of the comprehensive treatment and, or, and I say, and or maybe the person doesn’t have enough, cheetah include that many more noodles, or for whatever reason, maybe you don’t do the needles that you can do the myofascial, or maybe you do the acupuncture and the myofascial.

But speaking to this tension in the abdomen and possibly on the lateral quadriceps is going to be important for these patients. So this is a technique on the rectus of the dominance and it’s working, you know, the rectus abdominis has the six-pack six-pack muscle, it’s actually an APAC, but each of those little packs are there because there’s a tendonous transcription that separates one of the four segments of the rectus abdominis. Um, you know, so that, that’s what creates the six pack, but actually there’s a, uh, pack on each rib cage that doesn’t show up when people have really developed at abdominals. So it’s a, technically, it’s an APAC, but we’re going to be working in those tendonous transcriptions to free tension in the fascia. And this would not be uncommon to refer to the back, especially in the 20, uh, stomach 25 region. But let’s go ahead and look at the video for that.

So we’ll be working now with the rectus abdominis, but specifically the tendonous inscriptions of the rectus abdominis. This would be really relevant for when there’s pain at the thoracolumbar fascia, or especially at the lateral Rafa because those abdominal layers wrap around and become part of the thoracolumbar fascia and can add tension into the lateral Rafa. So in your assessment with the thoracolumbar fascia test, if you find that it reduces palpatory pain by doing acupuncture assessment at the rec fem, these would be techniques you could do after the needling. So we’re going to start at stomach 25. I’m going to use my fingers, pads and my fingers to sort of find that tenderness inscription, I’m going to sink perpendicular. Usually I find that a little bit inferior, like I’m kind of dropping in perpendicular and a little bit inferior helps to hook into that tendonous tissue, that fascial tissue, you don’t have a bone to push again. So I can’t just go straight in and resist against the bone. So I need to find a way to hook into that tissue. And this is a good, that little kind of curving motion seems to get a good hook, a good investment on that tissue. And then I’m spreading my fingers apart. So you can’t see it much. It’s a small movement, but it’s just like you’re unzipping a zipper hook in and spread.

Sometimes patients actually will feel this refer towards the back or even into the lumbar region.

You can work up to the next one, well, into the tenderness inscription sink in and spread

You can notice that as we’re working here, she’s starting to be able to take a little bit deeper of a breath, cause it’s freeing that tissue that can clamp down and resist the breath. And we’ll be at the cost of margin. I can continue to do spreading apart, or I can go up or down. If the person has a very hold in, compressed lower rib cage, I might want to bring the tissue out if they don’t have good tone in the abdominal muscles and it’s over flared, I might want to move the tissue up or I could just bread. And either way, I’m working along that costal margin,

Mindful that I don’t want to go all the way to the xiphoid. I’m just going up towards the xiphoid

One last pass. I can be at the attachment and again, spreading at that rectus abdominis attachment where the fascia starts to meet the pec major

And then I can work at the final attachment site at the pubic bone. I want to start above the pubic bone. So there’s the pubic bone I started above so that my pressure can get deep to where the rectus abdominis dives deep today, a posterior border of the pubic bone tendon, a tender area. Is that okay? And I can do a slight minuscule across fiber, or I can try to lift the pubic bone and decompress. This is another region that might refer into the lumbar region.

Right. So you don’t need to do all of those areas. You might pick and choose one or two regions. Stomach 25 is often very frequently involved. Costa margin’s frequently involved. All of it’s going to free the breathing take tension off the thoracolumbar fascia. And you can consider this technique when there’s a stomach, send you channel relationship to pain, such as facet, joint problems,

Especially a great technique to be able to use after kneeling, because it also takes pain away or soreness away from the needles as well. Um, there’s a lot more great Mahvash release techniques that we’re showing. And that’s from the assessment and treatment of the channel, send you module two, available a loss of OMS, um, really great techniques to be able to use right after the needling that can reinforce what you’re trying to accomplish with the acupuncture.

All right. It’s a slow treatment. Yeah. Yeah. It just, it’s kind of a slow, you know, you don’t want to rush through those treatments at the same time I was talking and I was teaching. So it seems like it would take a long time, but you can actually get through those, those, uh, even if you do all passes, all four passes, you can do that pretty much quicker than I was doing it there, you know, there was teaching and discussion and where and what I was doing and all that. So it seemed like it would be a long, long time spent, but not, not so much in practice.

Hi, Brian, it’s always a pleasure to be able to hang out with you and to be able to share knowledge. Thank you very much. Thanks very much at the American Acupuncture Council. Also next we’ve got, uh, Lorne Brown is going to be coming in and discussing some great things. I’m sure Lorne has been in the field for a long, long time and a great pioneer in himself. So check out Lorne next week. Thanks again to the American Acupuncture Council. Thank you very much. You guys for attending and we’ll see you again. All right. Yep. Bye-bye.