1. Adding Medical Acupuncture to a Family Practice Robert B. Kelly, MD, MS Stephen P. Flynn, MD, MPH Fairview Hospital / Cleveland Clinic Family Medicine Residency

2. Learning Objectives Rationale for acupuncture Training and Certification Description of Medical Acupuncture practice Logistics: Space, Equipment, Supplies, Staff, Scheduling, Coding, Revenue, Marketing Types of patients and primary problems Clinical results to expect Dialogue with Q&A

3. Rationale Benefits to patients –New way to treat problems not responding to usual Rx –Some patients prefer alternative Rx as initial approach Benefits to physician –High-touch unhurried creative Rx outlet –Enhance relationships with patients Benefits to practice –Reputation for welcoming alternative approaches –Patient recruitment / revenue

5. Training & Certification Helms Medical Institute “Medical Acupuncture for Physicians” course (UCLA School of Medicine affiliation) American Academy of Medical Acupuncture – requires minimum of 200 hours training American Board of Medical Acupuncture requires approved training, successful examination score, and a minimum of 500 treatments over at least two years in practice

9. Medical Acupuncture Basically means acupuncture treatment by a physician rather than licensed acupuncturist Traditonal acupuncture diagnosis and treatment Modern nontraditional acupuncture techniques –PENS, Auricular, Scalp, Others Often a combination of modalities based on the training and experience of the physician Less use of herbal therapy, pulse diagnosis, tongue diagnosis than nonphysician acupuncturists

10. Logistics Space, Equipment –Dedicated room, stationary or portable equipment –Massage table with face cradle desirable Supplies, Staff –Drapes, pillows, bolsters, needles, staff optional Scheduling, Coding –Expect 40 minutes per treatment, CPT codes Revenue, Marketing –Bill $75 or more per treatment, use the internet

11. Logistics: Space, Equipment

12. Massage Table –$250-$400 Electrostimulators –$380 (two) Point Finder –$80-$110 Room Décor –$150-up Miscellaneous –$100 Equipment Costs

13. Logistics: Space, Equipment Have bag, will needle

14. Logistics: Space, Equipment

15. Logistics: Supplies, Staff Supply costs –Needles (6-20 per treatment) at 3-12 cents/needle –Laundry of cloth pillowcases, sheets, drapes (or paper) –Batteries, Moxa sticks, Butane, Wires/clips Staff –Low overhead model (prepare room, room patients, take out needles, discharge, schedule/reschedule yourself) –Traditional model (use staff you already have to do what makes sense to you) – can see higher volume if staff take needles out and discharge patient without physician involvement

16. Logistics: Scheduling, Coding Can schedule every 40 minutes if physician uses one room and very little or no staff required Can double this if two rooms are used and staff is trained to help with removal of needles and patient education CPT Codes based on time and use of electrical stim: –97810: Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient. –97811: Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with reinsertion of needle(s) –97813: Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient. –97814: Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with reinsertion of needle(s)

17. Logistics: Revenue, Marketing If a physician did full-time acupuncture, assume –12 treatments / day for 48 weeks -> 2,880 treatments Revenue per treatment, assume $75 Cost per treatment, assume $5 (needles, laundry) Therefore physician could pay themselves about $200,000 less benefits, space, utilities, and staff expense -- low overhead model seems best for full- time acupuncture practice As add-on practice activity it can generate about $105 per hour less any incremental costs

25. Patients and Problems 37 - Mechanical Back / Neck pain 22 – Joint pain, eg. Knee / Hip / Shoulder 13 - Neuralgia / Neuropathic pain 12 - Tendonitis / Carpal tunnel 11 - Fibromyalgia / Myofascial pain 10 - Gastrointestinal / Digestion / IBS 9 - Fatigue / CFS / Autonomic Dysfunction 6 - Allergy / Sinus / Asthma Misc. : Migraine HA, Tinnitus, Bell’s Palsy, Obesity, Depression, Smoking, Infertility, ED, Incontinence, Insomnia, Anxiety

26. Clinical Results

27. Any Questions?