February 8, 2016

“Physical Therapists want dry needling in their scope of practice because they want to expand their scope to include invasive procedures. They also want to be identified as primary care providers.” anonymous

Are these statements true? Let’s examine the facts. Senate Bill 6374 was referred to the State of Washington Committee on Healthcare on Jan 8 2016. The committee Chair supported the bill and believed she would have no problem advancing it out of committee and onto the next step towards passage. She needed YES votes from 6 of 11. No problem? The vote count was 6 NO and 5 YES. The bill failed to advance. Winner winnner! You can read all the exciting details on the WEAMA blog.

What went down in Washington is a familiar scenario. The California Guild and CAOMA went through a nearly identical fight last month in California (read previous blog). We were trying to win a committee vote that would advance a bill supported by the Guild and CAOMA – SB758 – out of committee. The acupuncturists working politically in WA were trying to kill SB6374 in committee. However, the two votes communicate the same message to acupuncturists and legislators in CA and WA.
 
We can do this. We can make a political impact.

Take a lesson from other professions.

We need to organize like the PTs. We need to be in the mainstream so we can build opportunities for acupuncturists who wish to earn a living wage…just like PTs, RNs, PAs and every other mainstream profession that is poised to thrive as payment opportunities for LAcs multiply.

Healthcare in our nation is undergoing the largest expansion in terms of patient access in 50 years; since the reformation of Social Security and Medicare. Professions such as nursing, PA and PT are seeking to expand their practice scopes. This is a cost saving proposition at the policy level that is being adopted by insurance companies who must follow Medicare which is the L-E-A-D-E-R in healthcare policy trends. Identifying our role in the mainstream is a winner for LAcs everywhere.

Regulation of health professions is a state-to-state matter. Our friends in Seattle have led the fight in their state. They are the South Sound Acupuncture Association (SSAA) and the Washington East Asian Medicine Association (WEAMA). This coalition won their first victory in October 2014 when they stopped a bill that would have allowed a Colorado company to teach PTs in Washington to do acupuncture, oops, I mean dry needling. The NGAOM and CAOMA are leading the fight in Sacramento. We are working together across our states, publicizing what each other does to advance and protect our profession. We will share how we do it. Dry needling is a focus issue in the state of Washington. Regulatory authority is a focus issue in California. Connecticutt is focused on malpractice insurance. This is not an exhaustive list.
 
The threats are real.

Primary Care: The Physical Therapy Association of Washington (PTWA) posted its Briefing Paper on HB2408 and SB1266 as part of its Legislative Impact Day January 28, 2016. PTWA argued PT should be classified as a primary care discipline in order to reduce co-pays for patients.

“Insurance carriers commonly classify physical therapy as “specialty providers,” resulting in a copay that is higher than the primary care copay. Surveys reveal that patients are being charged a $40 to $80 copay per physical therapy and other rehabilitation visits, which is significantly more than a primary care provider visit. Primary care copays usually range from $0 to $30.” PTWA Briefing paper

My First Reaction: LAcs in CA and WA need a Legislative Impact Day!!! Michelle Lau gets 10 to 20 LAcs who are CAOMA members to drive to Sacramento for bills sponsored by CAOMA and the Guild. I guess those are our CA legislative impact days!

My Second Reaction: Arguing that Physical Therapy – which is clearly a specialty – should be reclassified as primary care in order to lower patient copays is like arguing admissions counselors at for profit schools should be paid for every student they enroll. Oh. Wait a minute. That already has happened, been found to be unlawful, and is no longer allowed! This PT argument to become PCPs (primary care providers) will take more than lowering copays to win wide support.

Being recognized in legislation as a primary care provider would be a huge windfall for PTs. Thousands of procedure and diagnostic codes would become available to PTs. Does it make sense in terms of healthcare to identify PTs with primary care?  Perhaps. We are in an era of diminishing numbers of PCPs. Nurses and PAs are already marked to help fill in the gaps. Some acupuncturist groups represent themselves as PCPs already. Hell! I wrote a paper in 2008 suggesting LAcs could function in a PCP role. The key is primary care training must become standard of any professional training before taking on the role of a PCP.

Dry Needling: Washington Senate Bill 6374 argued that dry needling is not acupuncture because it does not include “acupuncture points and meridians.”

“Dry needling” is also known as intramuscular manual therapy or trigger point manual therapy. A physical therapist may perform dry needling only after [the] physical therapist has shown evidence of adequate education and training that includes a minimum of fifty-four hours of dry needling education and training and at least one year of licensed practice.”

My First Reaction: Why make it so easy to dispel what we do? Acupuncturists can quickly disarm the above argument by describing acupuncture as needling therapy and by placing acupuncture and what we do in the domain of functional medicine. This is not an abandonment of history or tradition. It is politically practical and intelligent.

In 2015 House Bill 1042 sought to clarify that dry needling was not in the PT scope of practice. The WA opposition was made up of SSSA, and WEAMA. So far, in CA our “A” Team is CAOMA and the Guild. As is typical among LAcs a handful of acupuncturists worked on their own time to protect the entire profession. We know the drill. However, the PTWA is well organized and well-funded – better than acupuncturists. In California we have shown how the support of Organized Labor can overcome the “old guard.” The fight is not over in Washington. PTWA is sponsoring a presentation on Feb 11 2016 titled “Why PTs are the Ideal Practitioners for Dry Needling.” A legislative update will follow.

Dry needling seems to be a singular legislative issue that draws support from acupunture groups often at odds on other issues. The oppostion to the Guild/CAOMA bill included professional acupuncturist groups and an assortment of acupuncture schoools. This is the same coalition that supported a benign California Acupuncture Board for decades and now opposes the current board with a core of members who seek to impose adherence to regulatory standards. That fight continues.

If you want to read even more (!!) about SB 6374 download the very interesting Bill Analysis with PROS and CONS. These reports are supposed to be even handed providing legislators on the committee with balanced arguments.

It is indeed time to look ahead and work together. That is definitely the Guild’s plan. Those are the FACTS.