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When a typical doctor or nurse goes to school, things are changing, but traditionally, [acupuncture] has not been brought up at all. How can we believe in something and understand something if we’ve never been exposed to it?
Dr. Carlos Chapa, President of the American Association of Acupuncture and Oriental Medicine (AAAOM)
The Centers for Medicare and Medicaid Services (CMS) revised their coverage in January of 2020 to include acupuncture for the treatment of chronic low back pain. This is a first in the history of Medicare services. Prior to this decision, acupuncture had never been covered for Medicare beneficiaries in any instance.
In 2004, the CMS considered acupuncture for the treatment of fibromyalgia and osteoarthritis. In both cases, however, the CMS did not find strong enough evidence to grant coverage for the use of acupuncture for pain relief in such patients. The revised Medicare coverage includes up to 12 sessions in 90 days for patients with chronic low back pain, with an additional eight sessions for individuals who show improvement, for a maximum of 20 total treatments annually.
Sounds simple, right? Well, yes and no. Don’t put your dancing shoes on just yet.
First, to qualify, Medicare patients must have chronic low back pain (cLBP). The CMS defines this as pain that has lasted at least 12 weeks, is not associated with surgery or pregnancy, and that is nonspecific. By nonspecific, the CMS states that the pain must have “no identifiable systemic cause.” This means that the pain cannot be associated with an infection or any form of metastatic or inflammatory illness, nor can it be attributed to a structural disorder such as a disc herniation, fracture, or stenosis. Actually, this is the case about 85 percent of the time in cLBP patients.
Secondly, treatments must be administered by a physician—a medical doctor (MD), doctor of osteopathic medicine (DO), or chiropractor (DC)—who has met state acupuncture requirements.
Other medical personnel allowed to administer acupuncture treatments under this coverage include physician assistants, nurse practitioners, and clinical nurse specialists. These practitioners must hold a master’s or doctorate in acupuncture or Oriental medicine from an accredited program, along with a current, unrestricted license to practice in the region.
Notably, licensed acupuncturists (LAcs) must be under the supervision of one of the aforementioned medical professionals (physician, physician assistant, or nurse practitioner/clinical nurse specialist) in order to administer treatment to Medicare beneficiaries under this coverage.
Dr. Carlos Chapa, the president of the American Association of Acupuncture and Oriental Medicine (AAAOM), graciously offered his insights into this rule change and how it’s expected to impact access to various healthcare services.
Meet the Expert: Dr. Carlos Chapa
Dr. Carlos Chapa is the founder and medical director of the Acupuncture and Integrative Medical Center in Dallas, Texas. He is a triple board-certified doctor of naturopathic medicine and holds a PhD in Oriental medicine, in addition to being a board-certified herbalist and a licensed acupuncturist.
Dr. Chapa served as a Marine medic in the US Navy for close to a decade and as an ER nurse for six years. He has been invited to learn under the guidance of world-renowned doctors of Eastern medicine, including Dr. Joon-Shik Shin, Dr. Takeshi Kitagawa, and Dr. Jan Dommerholt (seen with Dr. Chapa above) at prestigious medical facilities in China, South Korea, and Japan.
He is bilingual (Spanish/English) and completed undergraduate studies in Chinese language, philosophy, and pre-med before going onto pursue graduate work at the Dongguk University of Oriental Medicine.
Dr. Chapa found his calling while studying abroad in China and witnessing the results of Chinese medicine first hand, at which time he thought to himself, “This will change our world.”
The Growing Acceptance of Acupuncture in American Healthcare
Dr. Carlos Chapa emphasized that, while there is still a ways to go to make the CMS decision actionable for the majority of licensed acupuncturists (LAcs) or even doctors of oriental medicine (DOMs), it’s a significant step in the right direction. He pointed to the exposure the decision will afford and its importance for the practice of acupuncture:
It’s been used for thousands and thousands of years. . .When a typical doctor or nurse goes to school, things are changing, but traditionally, [acupuncture] has not been brought up at all. How can we believe in something and understand something if we’ve never been exposed to it?
Dr. Chapa went on to explain his own dismissal of the practice prior to learning more about it. As an ER nurse, both in the military and in a civilian role, he said he thought he “knew everything” because he had six years of medical experience. He shared the reaction he had when people came into the ER asking for alternative treatments like herbs and acupuncture: “It’s’ kind of embarrassing, but I used to roll my eyes. I was not familiar with it, so, in a way, it was my ignorance. I just blew it off—and I think that’s most people when we don’t understand something.”
The turning point came when he began studying the Chinese language as an undergrad. As a Spanish-speaker with Cuban and Mexican heritage, Dr. Chapa said that he wanted to stand out as an applicant to medical school. He explained:
A guy named Carlos speaking Spanish is not a big deal compared to a guy named Carlos speaking Chinese. So, I started studying Chinese language for fun. In doing so, I [became] fascinated with the language and the culture, and I ended up going to China.
Dr. Chapa did not foresee the impact his experience in China would have on his life. He had just gotten out of the military and was eager to visit hospitals and see the differences in medical facilities there versus the U.S. He shared,
Believe it or not, it’s the same: the ERs, the operating rooms, the ICUs. But they incorporated Eastern medicine. There wasn’t a true integration, but it’s complementary. So if the patient has back pain, she will get pain medicine, but she’ll also get maybe massage, or chiropractic, or acupuncture at the same time.
He was particularly fascinated by the treatment of patients with strokes. He described the allopathic treatment for stroke victims, explaining that if it is caught in time, a clot box is administered. “It’s medicine,” Dr. Chapa explained, “It’s delivered within 24 hours, but if it’s past that, you’re just going to give the patient blood thinners and get them into physical therapy. That’s it.”
He continued, “In Asia, they’ll do that, but they’ll also do acupuncture, herbal medicine, and psychological therapy. If you’re the main provider for your family and you have a stroke, mentally, consciously, and subconsciously, it’s going to affect you. Whenever a patient or person has a stroke, it affects the whole family.”
The clincher? Dr. Chapa reported that he saw results in days that usually take months of treatment using allopathic or Western medical practices alone. The experiences he had in China were life-changing, and it was in those moments—seeing results that he had never seen before in any other medical setting—that set him on the path to a career in Eastern medicine. He recalls saying to himself, “I don’t care if it’s not part of our system; it has to start somewhere.”
Dr. Chapa is now the founder and medical director of two acupuncture and integrated healthcare centers. In highlighting the significance of the CMS decision to cover acupuncture for cLBP patients, he emphasized that while views vary within the medical and alternative healthcare communities, there is growing acceptance:
Politics aside, it just shows that there’s value. It shows that it’s been validated. It shows that it’s been proven to work—that it’s not just a simple placebo taking effect. There’s nothing wrong with a placebo. The difference between a prescription medicine and a 100 percent placebo, as far as results go, we’re talking about single digits. . .[But] I think it’s a step [in] the right direction to showcase the power of Eastern medicine, especially acupuncture.
Acupuncture as an Alternative to Addictive Pain Medications
The Center for Disease Control reported in 2018 that opioids were involved in almost 47,000 deaths, 32 percent of which involved prescriptions. Increasing access to alternatives to prescription opioids for pain management, especially within the population of older adults, was cited in the reasoning behind the CMS decision to cover acupuncture for cLBP patients. Both the health and human services secretary, Alex Azar, and the CMS principal deputy administrator of operations and policy, Kimberly Brandt pointed to the opioid crisis in their statements on the CMS decision in January 21, 2020 press release.
The American Academy of Medical Acupuncture has concurred, stating that “given our collective experience and clinical knowledge, the American Academy of Medical Acupuncture (AAMA) strongly supports the scientific findings that medical acupuncture can play a crucial role in fighting the opioid crisis.” It has endorsed, along with the American College of Physicians and other organizations, acupuncture as a “front-line treatment” for pain.
Dr. Chapa spoke enthusiastically of the potential for the treatment of pain with acupuncture. He explained, “Patients with chronic, chronic pain are not the ideal patient for most doctors because you only have limited treatments. That’s one of the reasons we have this whole opioid issue going on that’s so strong. It’s like heroin’s twin brother.”
And he is certainly one to know. Chalking it up to “being in the wrong place at the wrong time,” Dr. Chapa was shot—not during his active military service, but just after finishing a meal at Dave and Buster’s with his family in February of this year. Espousing his belief in integrated healthcare, he explained, “There’s no such thing as ‘This medicine is better than that medicine.’ It’s what is needed at that time—and for emergencies, of course, allopathic medicine is number one. I’m not going to go to an acupuncturist when I’m bleeding and there’s bone and tendon and ligaments and whatever else.”
So, after sustaining a gunshot wound to the leg, Dr. Chapa was treated at the ER and given hydrocodone for pain, which he took for the subsequent two days. He supports appropriate and necessary medical care, but regarding the use of narcotics for pain management, he admitted, “ I don’t think I’ll ever do that again because I do not remember those days at all.”
Medicare & Acupuncture: What Comes Next
When asked about the new Medicare coverage of acupuncture for chronic lower back pain, Dr. Chapa deferred to the American Society of Acupuncturists (ASA) who were present at the signing of the January CMS decision. He added,
My understanding is that we have to start somewhere. We went from nothing to something. For me, it’s progress. I think it’s like putting your toe in the water, and seeing how it works. Part of it that no one likes to talk about is the fact that there is a business aspect to this—that there are a lot of people who want a piece of the pie.
Pain is the name of the game. Once again, Dr. Chapa sees the future of coverage for acupuncture to continue its focus on pain, citing that this is where the need lies within our current medical practices—the solution for pain within allopathic approaches, other than surgical intervention, lies in medication. And this brings with it concerns about side effects and a growing alarm for the dependency, addiction, and overdose that has claimed over 450,000 lives since the first wave of the opioid epidemic began in the 1990s.
Dr. Chapa sees the treatment of musculoskeletal issues to alleviate neck, shoulder, and joint pain to be the next logical areas of Medicare coverage. He shared that the hospital where he did his training, Jaseng Hospital in South Korea, treats over one million patients a year from all over the world, with over 90 percent success rate in using non-surgical, non-pharmaceutical treatments for spinal disorders.
Stateside, he pointed to hospitals like Walter Reed in DC, where they combine chiropractic, acupuncture, and dry needling: “They do a lot of different techniques, and it’s working,” he explained.
Reporting on the Annual Substance Use Disorder Symposium hosted by Walter Reed at the National Institutes of Health, Barnard Little cites “alternative treatments for pain including acupuncture, meditation, exercise, TMS, hypnosis, sleep therapy, spirituality, therapeutic movement (tai chi), yoga, as well as nutrition and herbal therapies.”
Asserting his belief that all medical professionals want to see their patients find relief from what ails them, Dr. Chapa shared, “I think it’s only a matter of time [until] a lot of these doctors are going to start recommending [acupuncture]. Cause at the end of the day, it’s the result.”
Licensed Acupuncturists: Looking to Become Approved Medicare Providers
What about the multitudes of licensed acupuncturists, who are not approved Medicare providers? The issue remains: why give Medicare coverage for acupuncture—but only for medical doctors who are licensed acupuncturists—when, according to Dr. Chapa, “Not even one out of a thousand practitioners have that dual license?”
Until there’s an act of Congress, acupuncturists cannot bill for treatment by themselves. They have to be working either with or for a medicare provider who is a medical doctor, a DO, or a chiropractor. Dr. Chapa shared,
I can honestly say 99 percent of the practitioners that I’ve known throughout all of these years, not one of them did this for the money. You know most of us are a passionate group: some of us are a little hippie, some of us are more medical, bio-med trained. But, you know we’re doing this for the patient—and the last thing we want to do is get involved in politics.
As the director of a high-volume clinic with two locations, Dr. Chapa is in different circumstances than the majority of practitioners. He is currently in the process of hiring a physician so that they will be able to see Medicare patients; however, he points out, for individual acupuncturists, this is not a financially viable option. Regardless, Dr. Chapa remained firm in his optimism. “Over time, I think this is going to be a great thing.”
We hope so, too.
Cevia Yellin is a freelance writer based in Eugene, Oregon. She studied English and French literature as an undergraduate. After serving two years as an AmeriCorps volunteer, she earned her master of arts in teaching English to speakers of other languages. Cevia’s travels and experiences working with students of diverse linguistic and cultural backgrounds have contributed to her interest in the forces that shape identity. She grew up on the edge of Philadelphia, where her mom still lives in her childhood home.