1. T HE I MPACT OF A CUPUNCTURE T REATMENT ON THE U TILIZATION OF O THER H OSPITAL S ERVICES AT AN U RBAN S AFETY -N ET H OSPITAL Ellen Silver Highfield Mckenna Longacre Yiing-Harn Chuang James F. Burgess, Jr.

2. Background Little is known about how acupuncture interfaces with patients’ overall utilization of health care. Even less is known with respect to vulnerable populations. Vulnerable populations are often among the highest health care users; they stand to benefit most--both medically and financially--from effective integrative care.

3. BMC Boston Medical Center (BMC) is the largest safety- net hospital in New England. More than half of the patients served at BMC have an annual income at or below $20,420, 70% of BMC patients come from under-served populations

4. Acupuncture at Boston Medical Center Started in 2004 Six clinics: Family Medicine, Heme/Onc, ID, In- Patient Pediatrics, Adolescent Center, Staff clinic Approximately 1550 treatments delivered per year

5. Does use of acupuncture by a vulnerable population affect the overall utilization of and cost health care services?

6. Methods Retrospective Chart Review Adults seen at BMC 2007-14 Medicare/Medicaid or dual eligible patients Received at least 1 acupuncture tx at BMC Analyzed total charges from the main BMC campus

7. Methods Compared total number of hospital encounters and total hospital charges 6 months before vs. 6 months after initiating acupuncture. Patients stratified by number of acupuncture treatments

8. Results

10. # Acupuncture Treatments Average Difference in Total Charges After-Before ($) 1-3 treatments+1771.34 4-6 treatments-3074.29 7-9 treatments-8967.24 10-12 treatments-4971.72 13-15 treatments-547.84 Average Difference in total Medical Charges Per Person After-minus-Before

11. Discussion Acupuncture was accessed by diverse patient populations. Among patients that received >3 acupuncture treatments, total charges decreased ($4739.58 per patient over six months, P value = 0.09) At the same time, total number of hospital visits increased This may reflect a shift towards preventative care

12. Limitations and Future Research Sample size Additional hospital services outside of BMC main campus Not stratified by diagnosis Dose-dependence Control arm Generalizability (eg cancer patients)

13. Conclusions Acupuncture appears to positively impact health care costs to patients, hospitals and insurance companies. The mechanism for these savings is unknown, but may include both improved care of patients, as well as facilitation of further integrative and preventative care

14. Further research is warranted to explore acupuncture as a financially responsible means of providing the best possible care of vulnerable patients

15. Our thanks to the providers at BMC, the integrative medicine department, our partners in the research department, and most of all, our patients.