Dr. Wai Low performs acupuncture at his office in the Queen Emma Building. Low estimates 200 to 300 of Hawaii's licensed acupuncturists are actively practicing.

Piercing Hawaii's acupuncture market

By Lyn Danninger

As health care consumers have become more interested in alternatives to standard medical therapies in recent years, insurers nationwide are including such treatments as acupuncture, chiropractic and massage therapy either as a standard medical benefit, a supplement to their basic medical plan, or as a discounted service for members.

In some ways, acupuncture is still one of the least understood disciplines of the range of complementary therapies now being offered.

It was once considered the exclusive province of practitioners of Eastern medicine who were trained in China. It has moved increasingly into mainstream Western medicine, but because of its long history, it retains a certain mystique.

Acupuncture came to the attention of the West during former President Nixon's historic trip to China in the early 1970s when one of the people on the trip fell ill with acute appendicitis. An appendectomy was performed and acupuncture was used for pain control. Word about acupuncture's effectiveness spread and a number of studies were conducted.

At one time, practitioners of acupuncture and Eastern medicine in the U.S. were those who had either come from China having learned the practice there, or those who went to study there.

But now with increasing acceptance from insurers, physicians and consumers, the number of accredited U.S. schools teaching traditional acupuncture techniques has grown to more than 40, with another 10 in the process of accreditation.

A needle is topped with a bundle of dried herbs, which is burned, allowing the heat to move down the needle into the muscle.

A growing number of physicians nationwide have also incorporated medical acupuncture into their practices.

In acknowledgment of that trend, universities, including the University of Hawaii's John A. Burns School of Medicine, are starting to offer education on complementary therapies, including acupuncture, as part of their medical school curriculum.

Hawaii's two largest insurers, Hawaii Medical Service Association and Kaiser Permanente, began offering complementary benefits, including acupuncture, several years ago, in response to member demand.

Both companies contract with American Specialty Health, a mainland company that specializes in setting up and overseeing alternative therapy networks.

Another local insurer, HMAA, has included alternate therapies as part of its basic medical plan since 1990, said company President Arnold Baptiste Jr. As many as 20 visits per year with an approved provider are covered under the plan, Baptiste said. Plan members are responsible for a small co-payment.

It's been a popular benefit, he said.

"We do have large numbers of members who go. I would say that it's been a big selling point for our health plan," he said.

At Kaiser, about 800 employer groups out of 6,500 have added alternate therapies to their medical benefit plans, said Jan Kagehiro. The company also offers a discounted program to members who do not have coverage through an employer.

"We've seen interest grow from the beginning when we first began in 2000, which is interesting since for an employer, it adds to the cost of the plan. Obviously there is great interest in these complementary forms of therapies," Kaiser spokeswoman Jan Kagehiro said.

However at HMSA, the company found that after an initial flurry of interest when the services first became available, employer requests for such coverage have tapered off, most likely due to a desire to hold down rising medical costs, said HMSA Vice President, Cliff Cisco.

Still, about 10,000 of the insurer's 600,000 plus members have coverage for alternate therapies, including acupuncture, chiropractic care and massage therapy, he said. HMSA also offers a discount program for members who do not have access to an employer-sponsored program.

Both worker's compensation and no-fault insurance also cover such services. But, echoing physicians, acupuncturists said the reimbursements from these programs hardly cover the cost of treatment.

Costs for acupuncture vary, but a first consultation generally runs about $75, with follow up treatments ranging in price.

Dr. Wai Low, left, and student intern Sumiko Ikeda make electrical connections to acupuncture needles for electrical stimulus treatment.

Those acupuncturists who participate with insurers must also submit a treatment plan for approval after the first five visits for a particular illness or injury, said acupuncturist Wai Low, who has a practice downtown on Queen Emma Street and at the Honolulu Medical Group.

Whether the greater usage of alternative medicine nationwide is due to recognition from insurance carriers, greater public awareness or physicians more willing to suggest alternatives to their patients, demand is clearly growing.

State records show there are 470 licensed acupuncturists in Hawaii. The numbers have grown steadily every year, rising 24 percent since 1997.

Low estimated between 200 and 300 of Hawaii's licensed acupuncturists are actively practicing. Of that group, between 70 and 80 practitioners provide contracted services for Hawaii's health insurers, he said.

Low said acupuncture is now one of the fastest growing professions in the United States. Hawaii has three accredited schools of acupuncture, which require four years of academic study. In the last two years, the state has issued 84 acupuncture licenses to new graduates.

One of the schools, on the Big Island, works closely with North Hawaii Community Hospital. The president of the college, Dr. Robert Smith, taught physiology at the University of California, Davis, medical school before moving to the Big Island.

The school also offers community clinics three times a week where student interns are supervised by licensed faculty members, Smith said.

Acupuncture's strengths are particularly apparent in treatment of chronic illnesses and pain management, areas where Western medicine may only be able to offer medications or a surgical alternative, Smith said. Unlike Western medicine, acupuncture takes into account the entire body, rather than just focusing on specific symptoms, he said.

"It's also about bringing the body back into balance so different organ systems are working well with one another," he said.

At Kaiser Permanente, osteopath Dr. Marie Patten is familiar with how acupuncture can work side by side with traditional western medicine.

Before moving to Hawaii, Patten headed the Department of Physical Medicine and Rehabilitation at Kaiser's Roseville clinic in California. Rather than contracting out services, the clinic had several physicians who incorporated medical acupuncture into their practice as well as a team of acupuncturists on staff. It has been offering acupuncture for about eight years, she said.

Patten said acupuncture's popularity has grown.

"I think people found it intriguing, but also a little scary. They're also wary about the needles used. But I think people now know more about it and trust it more," she said.

It's also less costly than a traditional visit to a physician's office, so it's no surprise health insurers have expanded benefits to include it, she said.

"The main reason is that it helps, and is not harmful. People also like it because it can help them to avoid taking medications," she said.

Still, acupuncture is not without controversy. There is a dispute between Hawaii's physician and acupuncturist communities about the amount of training required for physicians who want to incorporate acupuncture into their medical practice.

Thirty-seven states have no additional requirements for physicians beyond the usual licensing requirements. Another 12 require that a physician undergo between 100 and 300 hours of training. In Hawaii, the law requires that physicians practicing acupuncture must have about 2,100 hours worth of training.

Those interested in changing the law put forward legislation this session that would amend requirements to bring them closer to prevailing standards on the mainland. The bill's progress has been halted by the Senate committee on Commerce, Consumer Protection and Housing.

Physicians argue medical acupuncture is within their scope of practice and its oversight does not need to fall under the state Board of Acupuncture -- something the acupuncturists want. Moreover, the doctors say that type of acupuncture they practice is a European version, referred to as medical acupuncture.

In recent testimony at the state legislature, officials from the Hawaii Medical Association said:

"Medical acupuncture is a European version of acupuncture that has been around for two hundred years. It does not generally include Chinese herbs but rather is integrated into the European style of medicine. A number of medical doctors in Hawaii are more than qualified to practice medical acupuncture along with other procedures."

But some acupuncturists argue physicians should complete the same regimen of training they have undergone.

Low takes a more moderate view. "We'd like (physicians) to do (acupuncture) and at least have some training and certification," he said.

American Specialty Health
UH John A. Burns School of Medicine

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