Health

HEALTH • Fall 2016 15 Interview Survey found that 33 percent of U.S. adults reported using a complementary health approach. That's similar to the percentages for 2007 (36 percent) and 2002 (32 percent). The survey also found 59 million Americans spend about $30.2 bil- lion a year to pay for these services out-of-pocket. A study from the American Hospital Association and the Samueli Institute, a nonprofit complemen- tary medicine research group, indicated hospital interest in complementary medicine is growing. In 2010, 42 percent of the 714 hospitals surveyed reported they offered at least one complementary medical service; in 2005, just 27 percent offered those treatments. That growing interest has started to affect some of the jobs acupuncturists find themselves in, said Allison Blaisdell, an acupuncturist and vice presi- dent of the board of directors at the Acupuncture & Oriental Medicine Society of Massachusetts (AOMSM). When she started practicing back in 2003, receiving a referral from a medical doctor was rare, she said. But today, Blaisdell works as an in- house acupuncturist at two different hospitals, and receives countless referrals from community health centers to her private practice in East Boston. She is the only in-house acupuncturist at the Dana-Farber/Brigham and Women's Cancer Center at South Shore Hospital in Weymouth, a position created a year ago. "There's a real recognition of the benefits of acu- puncture and a lot of the therapies lumped in with it in the larger medical community," Blaisdell said. Tamilio-Awed also said she has seen an increase in referrals from doctors over the last year or two, which she thinks might have to do with doctors looking for new ways to treat pain in the midst of the nationwide opiate crisis. She said she encour- ages her patients -- even the ones without referrals -- to talk to their doctors, so they can learn about acupuncture themselves. "If they keep hearing from patients that they're getting better from acupuncture, eventually (some- thing) is going to click," she said. Insurance tactics In the 2012 NHIS survey, just 25 percent of respondents reported having insurance coverage for acupuncture. But things have changed quite a bit since then. Acupuncture coverage from Massachusetts insur- ers varies, said Eric Linzer, senior vice president for public affairs and operations at the Massachusetts Association of Health Plans. Some of the state's major health insurers, like Blue Cross Blue Shield of Massachusetts and Springfield-based Health New England, offer discounts for acupuncture and other complementary medical services, such as yoga or massage therapy, to their members. Last year, Harvard Pilgrim Health Care began cov- ering up to 20 acupuncture visits per year for most fully-insured members of its HMO, PPO and POS products based in New England. Harvard Pilgrim Chief Medical Officer Michael Sherman said patient demand for acupuncture services was high. "There are people with migraines, nausea, vomit- ing, or back pain who, instead of using other drugs with side effects and addiction potential, we would (much rather) ... try acupuncture, and we removed a barrier to this," Sherman said. Acupuncturists, who have to go to school and be state-certified themselves, are generally more qualified to perform the procedure than medical doctors, he said. MassHealth, the state health insurance system, started covering up to 20 acupuncture visits per year in 2014. But unlike Harvard Pilgrim, MassHealth doesn't reimburse visits with certified acupuncturists like Tamilio-Awed or Blaisdell -- instead, only a board licensed physician can per- form the procedure. Worcester-based insurer Fallon Health's approach is similar to the state's. Fallon reimburses acupunc- ture only when it's performed by a physician, and only as part of a larger health care strategy. Thomas Ebert, the nonprofit's executive vice president and chief medical officer, said the literature on acu- puncture just isn't adequate yet, though covering the procedure more extensively is something Fallon might be open to down the line. "Our understanding is still developing in Western society ... The reality is that (there isn't) any sort of rigor to the evaluation of the proce- dure," Ebert said. The AOMSM is looking to make acupuncture coverage more widespread through legislation, said Tamilio-Awed, who has served on the organiza- tion's board. A bill proposed by the society would require Massachusetts health insurance plans to cover acupuncture for the treatment of pain man- agement, post-traumatic stress disorder, substance abuse treatment, and nausea. Linzer pointed out that any laws requiring insur- ance companies to do anything in Massachusetts would only apply to enrollees on fully-insured plans, state-regulated plans which are usually adopted by small- to medium-sized employers and make up just 40 percent of private commercial enrollees statewide, according to the Center for Health Information and Analysis. The remaining 60 percent of commercially insured people in Source: 2012 National Health Interview Survey Massachusetts have self-insured plans, which are normally adopted by larger companies. A CHIA analysis of the bill found it would add between $0.38 and $0.76 on average per year to a typical member's monthly health insurance pre- miums over a five-year period. "Rather than imposing new mandated benefits, that will increase the cost of healthcare for employers, let's let employers decide what the appropriate types of coverage are for their employees," Linzer said. Integration of care Acupuncturists and complementary care pro- viders said patients can benefit greatly when both Eastern and Western treatments are used. Combining the different medical practices can provide huge relief for both patients and practitio- ners, said Lynn Gerrits, manager of the Simonds- Hurd Complementary Care Center at UMass Memorial - HealthAlliance Hospital in Fitchburg, where complementary care services are available to the general public. Grant funds awarded in 2012 also paid to expand these services to cancer patients receiving treatment on campus. "It really empowers [practitioners], and it's with- in in their scope of practice as nurses. They are very excited," she said. 33% Percentage of U.S. adults who use complementary health services $30.2B Amount Americans pay per year for complementary health services, or 1.1 percent of total health care spending 11% Percentage of adults who have daily pain 9.5% Percentage of adults who practiced yoga in 2012, up from 6 percent in 2007 25% Percentage of respondents using acupuncture who had at least some coverage for it, com- pared to 60 percent for chiropractic treatment and 15 percent for massage therapy The New England School of Acupuncture was acquired last year by the Massachusetts College of Pharmacy and Health Sciences. Classes were scheduled to begin in Worcester in September.

• Cover