Big news! CMS will cover acupuncture. In January of 2020, the Centers for Medicare and Medicaid Services (CMS) approved a national payment rule for providers who treat patients with acupuncture. Acupuncture is a key therapeutic approach in traditional Chinese medicine, especially for pain management. This is a major recognition of an alternative therapy that millions of people believe in. On the surface, this move by CMS seems to have taken far too long, since several commercial insurance companies already cover some level of acupuncture-related care. But generally speaking, CMS is very careful in terms of waiting to see what the data says – and there is a fair amount of supporting data, described in this review paper that CMS cited in their decision rule.
To be fair, there is still the open question of whether acupuncture is truly effective, and can provide pain relief beyond the placebo effect. And there are naysayers! But science may not be the biggest (or best) driver of CMS’ decision to approve payments for acupuncture.
The use of prescription drugs for pain management is a huge contributor to our nation’s opioid epidemic. And by consequence, alternative forms of pain management are receiving a lot of attention right now. That means if the effect of acupuncture is actually a placebo, then that is okay, so long as doctors prescribe fewer opioids, and fewer people get addicted to opioids.
There is an interesting provision in the acupuncture payment rule – the number of treatment sessions is initially capped at 12, and can go up to a maximum of 20 sessions per year, but only if the the patient believes it’s working. Under this provision, patients are determining the value of acupuncture. It makes me wonder if Medicare would someday cover a wide range of alternative treatments under this framework.
At this time, CMS payments for acupuncture are limited to chronic lower back pain. And that’s a significant restriction when we consider the different ailments currently being treated with acupuncture – ranging from pain in the head, neck and shoulder, to psychological conditions such as anxiety and depression. Acupuncture is also used for palliative / end-of-life care, which can be better than opting for major surgery with a low chance of survival. On that note, I share a friend’s story with terminal cancer in this post. It’s unclear if CMS will broaden coverage for acupuncture in the near future.
Consumer driven healthcare. Rather than debate whether acupuncture really works, how it works, or its usefulness in treating other ailments, I’d prefer CMS simply give consumers what they want. The demand for acupuncture is clear – a survey found that 14 million people have tried acupuncture in the US. Practically speaking, CMS could provide broad coverage for acupuncture treatments through accountable care organizations (ACOs).
The ACO is a network of providers (clinicians and hospitals) that assumes responsibility for delivering healthcare services to a defined patient population. The ACO must manage the healthcare spending for that population and ensure quality health outcomes. Importantly, if healthcare spending goes above expectations, the ACO must pay back the difference to CMS – this is known as risk-sharing.
Instead of a one-size-fits-all approach to health coverage, ACOs could determine the appropriate level of acupuncture services for their patient populations. Through risk-sharing, the ACO has skin in the game, and would make that decision based on several factors:
(1) The consumer demand for acupuncture.
(2) The direct benefit of acupuncture – do patients report substantial relief from body pain, anxiety or depression?
(3) Any secondary benefits of acupuncture – does the ACO observe declining opioid use, opioid-related emergency visits, or lower overall healthcare spending?
Alternative medicine is huge and growing, and we need to start thinking about how to integrate alternative treatments into value-based healthcare models like ACOs and bundled payments for episodes of care.
~ James
