ACUPUNCTURE CLAIMS Acupuncture regulation: A call to practitioners to clarify the facts A recent notification from the Great-West Life Assurance Company to advisors and plan sponsors described new developments regarding the submission of claims for acupuncture treatments in the provinces of Ontario, Newfoundland and Labrador. The Canadian Contemporary Acupuncture Association (CCAA) found a number of discrepancies in the document and penned a letter targeted to the insurance industry. The CCAA also wishes to disseminate the letter amongst health professionals who perform acupuncture treatments. The letter contains a clarification of the inconsistencies between the Great-West Life document and acupuncture regulations as well as CCAA recommendations to rectify the misperceptions that will, inevitably, result for practitioners and patients as a result of the document. Although the focus of both communiques is Ontario, these developments may come to have relevance for practitioners who perform acupuncture treatments in other provinces. To follow are both documents – from Great-West Life and from the CCAA – for practitioners to review. LETTER OF RESPONSE FROM THE CANADIAN CONTEMPORARY ACUPUNCTURE ASSOCIATION Hamilton, May 26, 2013 Subject: This document is intended to be freely and widely distributed among any potentially interested party, including Professional Colleges and other regulatory bodies of the professions in Ontario with acupuncture included in their scope of regulations, as well as policy makers of the health care insurance industry, and health care professionals practicing a profession in Ontario with acupuncture included in their scope of practice. To whom it may concern: This document has been produced by a multidisciplinary group of professionals representing Ontario health care professions with acupuncture included in their scope of practice. The goal of this document is to clarify the legal environment surrounding the provision and reimbursement of acupuncture services in Ontario. For years, there has been considerable confusion regarding the reimbursement of acupuncture services by third party payers. This confusion seems to have reached a peak due to the recent full proclamation of the 2006 Traditional Chinese Medicine Act on April 1, 2013. A recent communication from Great-West Life exemplifies the widespread misunderstanding of the meaning of the proclamation of the 2006 TCM Act in regards to the practice of acupuncture in Ontario. This document contains three inaccurate statements that reflect the confusion among some of the companies responsible for the reimbursement of health care claims for acupuncture services. The document reads (the underlining is ours): As of April 1, 2013, acupuncture is a regulated profession in Ontario. This means that in order to practice, acupuncture practitioners must be registered with The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. The college now oversees and regulates the profession to ensure patients receive safe, high-quality health care services. In the same order as the inaccurate statements were made, these are the facts: 1. Acupuncture is not a regulated profession in Ontario. Acupuncture is a “regulated treatment procedure” and service that 11 professions can provide legally in Ontario, each within their scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners. 2. In order to practice acupuncture in Ontario, practitioners do not have to register with The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO). Practitioners with acupuncture in their scope of practice are only required to meet the requirements of their own professional regulatory college to practice acupuncture. 3. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO), does not regulate the practice of Acupuncture in Ontario. It only regulates the practice of two new health care professions: Traditional Chinese Medicine Practitioner and Registered Acupuncturist, both of which include acupuncture within their scope of practice. To further clarify the topic, following is an extract from BILL 50, TCM Act 2006 that specifically names the seven professions (in addition to Medical Doctors and Naturopathic Doctors and persons administering acupuncture as part of an addiction treatment program) that are excluded from the regulatory powers of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, created by the Bill: Complementary Amendments to CHAPTER 27 An Act respecting the regulation of the profession of traditional Chinese medicine, and making complementary amendments to certain Acts Assented to December 20, 2006 Note: This Act amends or repeals more than one Act. For the legislative history of these Acts, see Public Statutes – Detailed Legislative History on www.e-Laws.gov.on.ca. O. Reg 107/96 19. (1) Paragraph 1 of section 8 of Ontario Regulation 107/96 (Controlled Acts) under the Regulated Health Professions Act, 1991 is revoked. (2) Section 8 of the Regulation is amended by adding the following subsections: (2) Subject to subsection (4), a person who is a member of a College listed in Column 1 of the Table is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, in accordance with the standard of practice and within the scope of practice of the health profession listed in Column 2. TABLE Column 1 Column 2 1. College of Chiropodists of Ontario Chiropody 2. College of Chiropractors of Ontario Chiropractic 3. College of Massage Therapists of Ontario Massage Therapy 4. College of Nurses of Ontario Nursing 5. College of Occupational Therapists of Ontario Occupational Therapy 6. College of Physiotherapists of Ontario Physiotherapy 7. Royal College of Dental Surgeons of Ontario Dentistry (3) Subject to subsection (4), a person who is registered to practice under the Drugless Practitioners Act by The Board of Directors of Drugless Therapy is exempt from subsection 27 (1) of the Regulated Health Professions Act, 1991 for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, in accordance with the practice of the profession. (4) A person mentioned in subsection (2) or (3) is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture only if he or she has met the standards and qualifications set by the College or The Board of Directors of Drugless Therapy, as the case may be. (5) A person is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, if the acupuncture is performed as part of an addiction treatment program and the person performs the acupuncture within a health facility. In Conclusion: With the following clarifications, interested parties could quickly correct the misrepresentation of the meaning of the full proclamation of the 2006 TCM Act, in all forms of communications and policies, specifically these facts: 1. Acupuncture is not a regulated profession in Ontario. Acupuncture is a “regulated treatment procedure” and service that 11 professions can provide legally in Ontario, each within their scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners. 2. In order to practice acupuncture in Ontario, practitioners do not have to register with The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO). Practitioners with acupuncture in their scope of practice are only required to meet the requirements of their own professional regulatory college to practice acupuncture. 3. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO), does not regulate the practice of Acupuncture in Ontario. It only regulates the practice of two new health care professions: Traditional Chinese Medicine Practitioner and Registered Acupuncturist, both of which include acupuncture within their scope of practice. These are our recommendations to the insurance industry: 1. The provision of acupuncture services (or the generic name “Acupuncture”) should not be confused with the practice of any specific health care profession in Ontario, including the new professions of Traditional Chinese Medicine Practitioner and Registered Acupuncturist. From a legal Standpoint, acupuncture is not a profession in Ontario, it is a “regulated treatment procedure” and service provided by 11 different professions, within their respective scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners. 2. The erroneous information provided to practitioners and insured people in Ontario, by several insurance companies, in various communications since April 1, 2013, should be corrected according to the information contained in this letter. 3. Since 11 professions are legally authorized to provide acupuncture services in Ontario, patients receiving the services from any one of these 11 professions, should all be equally eligible to have these health care expenses reimbursed. Otherwise, a case for discrimination could be made by any of the excluded parties. 4. Should the insurance industry decide to introduce a new category of benefits to cover the professional services provided by the two new professions (in Ontario) of Traditional Chinese Medicine Practitioner and Registered Acupuncturist, the appropriate legal description of these professions should be used to refer to these new benefits. 5. Avoid the use of “acupuncture benefits” as a synonym for the professional services provided by TCM Practitioners And Registered Acupuncturists, as “acupuncture” is not the profession of these professionals; once again acupuncture in Ontario is a service that these 11 professions can provide legally, within their scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners. For the benefit of the public of Ontario, we expect that the unnecessary confusion regarding acupuncture services reimbursement by third party payers in Ontario will be quickly corrected by the combined action of interested parties, most notably by the members of the newly created professions of Traditional Chinese Medicine Practitioner and Registered Acupuncturist, and by the members of the health insurance industry. Signed in Ontario this 26th day of May 2013 Daniel Agostinelli PT Heather MacKay PT Ravinderpal Ohson MD Chris O’Connor RMT Michael Prebeg DC David Salanki DC Christine Voldner DC SYMPOSIUM REPORT Innovations in Laser Therapy Symposium 2013 The leading researchers and clinicians in the field of laser therapy met for the second annual Innovations in Laser Therapy Symposium hosted by BioFlex Laser on Saturday, June 8, and Sunday, June 9. Over 160 physicians, chiropractors, physiotherapists, massage therapists, nurses and acupuncturists gathered at the beautiful Waterside Inn in Port Credit, Ont., for two days of engaging lectures and hands-on training that left the group excited to apply the knowledge they learned back into their practice. Dr. Fred Kahn, founder and CEO of BioFlex Laser Therapy, welcomed the group and provided an in-depth appraisal of the limitations of conventional medicine and the role that laser therapy could fill under the umbrella of mainstream medicine. His thought-provoking words and ardent message were a perfect start to the stimulating and inspiring lectures that followed. A large variety of health-care practitioners presented, including a family physician from Virginia who focused on applications for fibromyalgia. Chiropractors from across Canada spoke on patient compliance and how they integrated laser therapy into their practice. As well, a researcher from Harvard University explained the science and research behind this technology. The consensus of the day was that the applications of laser therapy were extensive and continually expanding. During the breaks, clinicians inspired one another with discussions of how quickly they doubled their patient volume as a result of the consistent clinical outcomes. With the growing aging population, chronic pain conditions, including degenerative arthritis of the neck, back and knees, and nerve dysfunction are increasingly common and there is a lack of safe and effective treatment options for patients. The presenters at the Symposium emphasized that laser therapy provides a highly effective and pain-free alternative to surgery, pharmaceuticals and other therapeutic modalities. Patients who experience the benefits of laser therapy firsthand often become passionate and convincing promoters of the technology to friends and family. Dr. Norman Doidge, psychiatrist, researcher, psychoanalyst, New York Times writer and international bestselling author, provided an inspirational talk on brain plasticity spanning from the laboratory to real-world experiences of patients. Dr. Michael Hamblin, a researcher from Harvard University, focused on the two key concepts that laser therapy can accomplish: anti-inflammatory effects and tissue regeneration. Dr. Ben Yuen, a successful chiropractor who operates the largest laser therapy clinic in Eastern Canada out of Bedford, N.S., gave an engaging and very practical talk on how to speak with patients regarding compliance issues and managing expectations. Educating the patient with regard to how laser therapy works, what it will do for their condition and the time frame for symptom resolution engages and involves the patient in their treatment program. Dr. Yuen’s humorous anecdotes and valuable approach left the audience with an improved understanding of how to obtain better clinical outcomes through patient compliance. D’Arcy Bain, a sports physiotherapist from Manitoba who oversees four clinics and manages 20 physiotherapists, discussed the benefits of laser therapy as an “all-in-one” modality that provides a clinician with a much wider range of therapeutic effects and improved clinical outcomes compared to conventional modalities. He also emphasized the advantages of combining laser therapy with the traditional R. I.C.E. model of recovery through the inflammatory phase following an acute injury. Coining the term L.I.C.E.R.S. (Laser Therapy, Ice, Compression, Elevation, Rest and Support), Bain highlighted the importance of starting the rehabilitation process within a matter of hours following an injury as opposed to starting it after several days, which will delay and prolong the recovery process. Many participants who chose to attend the Symposium stayed on to attend the Master Class the following day. This in-depth and hands-on event featured lectures on customization of protocols for improved clinical efficacy highlighting a number of interesting clinical case profiles. It also included sessions focused on laser acupuncture, how to educate the patient and a range of practice management tools. This educational event ended with an intensive hands-on session in which attendees further developed their clinical skills in applying laser therapy for particular pathologies. Practitioners left the Master Class excited to return to their clinic and apply their newly learned techniques on their patients. These highly informative Symposium lectures will be available as online webinars in the near future. Webinars from previous Symposia and International Laser Conferences are currently available for viewing at www.bioflexlaser.com. Please visit often – as new dates for Master Class topics, certification, training and other educational events are posted – or call 1-888-557-4004 for more information. Dr. FernanDa Saraga, PhD For the latest chiropractic news, events and continuing education information, visit www.canadianchiropractor.ca. NOTIFICATION FROM GREAT-WEST LIFE As of April 1, 2013, acupuncture is a regulated profession in Ontario. This means that in order to practise, acupuncture practitioners must be registered with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. The college now oversees and regulates the profession to ensure patients receive safe, high-quality healthcare services. The college has begun compiling a list of regulated practitioners, which is expected to be published on its website, www.ctcmpao.on.ca. Practising acupuncturists who want to become regulated need to successfully complete a course and write an exam in jurisprudence principles to have their names added to the list. Acupuncture also became a regulated profession in the province of Newfoundland and Labrador, in October 2012. Only acupuncturists who are registered members of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Newfoundland and Labrador are considered eligible providers of acupuncture services in that province. Practitioners in both provinces have a grace period ending July 1, 2013, to complete the registration process with their respective colleges. After this date, regardless of the date of service, any claims for treatment from non-registered acupuncture practitioners will be declined. Great-West Life will send notification letters to all plan members who have submitted a claim in the past six months for acupuncture in Ontario or Newfoundland and Labrador. For more information: Please contact your Great-West group representative.