Read on if you've asked me this and found it suspicious that I didn't have anything to say. Otherwise, move along, there's nothing to see here.
I had a bit of a reactionary rant here, but having had a chance to think about it, making money and being honest are not mutually exclusive things. They kind of are right now, since I am honest to a fault and have only been in business for a few years. I could promote the attention grabbers, like face lifts and weight loss. I could make promises. I could take cases that are out of my scope according to the rules of the Texas Medical Board. (I've had classes in Orthopedics, and chances are if you sprained your ankle or had some other acute trauma, a doctor is just going to ice it, wrap it, and give you meds anyway. But the rules say aside from chemical dependency and chronic pain you have to have seen an MD first.) But I don't, because I have always been someone who plays by the rules.
If you've bothered to at least google it, you know that acupuncture is thousands of years old, used to be primary medicine, has been double-blind proven on back pain, has as good or better track record than western techniques on infertility, yadda yadda yadda.
If you've read my website, you may have gleaned that I've literally had the lame walk and the blind see, though I wouldn't promise it every time. If you read the small print on drug disclaimers and surgical consent, you'll see that modern medical techniques don't promise it every time, either. Sometimes I get extraordinarily lucky like that, but I do attribute it to luck when it is. For most maladies, it helps to some degree. Sometimes it works better than others. It's a therapy. That's how therapies are.
You don't know me, you have no reason to assume I have a good character. I graduated second in my high school class, cum laude with a double major from Vanderbilt for undergrad, kicked around corporate for a while, and was president of the student council when I finished my masters degree. Yes, doing this requires a few years of graduate school, national board exams, and a license. So that tells you I'm smart, not necessarily that I'm trustworthy, but I really am.
I was known as the brutally honest nerd in my family, rather than as a people person, so there was plenty of laughing and pointing when I decided to go into business for myself. I cannot stress enough that there is no way I'd sell something I didn't believe was helpful. So when I pause after you ask, "Does it really work?" it's not because it doesn't. It's because if I believed it didn't, the very idea is so unthinkable to me that I can't help but consider it a character assassination, a rather pointed one, right in my face, and it takes me a moment to recover from such a grievous insult.
I'm sure it's just one of those conversational things and isn't meant to be personally insulting. But if you think about it (and it's been said plenty enough times for me to think about it a LOT and figure out why it bothers me so much), it is a direct attack on my integrity, which is something I might develop a sense of humor about when I'm more secure as a person and have been in business for a decade or so. Check back with me in a few years on that.
Thursday, October 1, 2009
Wednesday, September 9, 2009
Do you barter?
Hey, as the clothing artist I just booked realized, it never hurts to ask. I know times are tight. I have bills to pay, so not all the time, but let me know what you've got, and I may have a use for it.
I got the chance to talk to Katherine Clapner at the First Sunday farmers' market at Bolsa this week. She's opening up a storefront in Bishop Arts in November. I hope we become great friends!
I got the chance to talk to Katherine Clapner at the First Sunday farmers' market at Bolsa this week. She's opening up a storefront in Bishop Arts in November. I hope we become great friends!
Thursday, August 27, 2009
The insurance thing
I get a fair amount of calls that start and end with, "Do you take insurance?" Healthcare is also somewhat in the public eye these days, so I thought I'd give you my thoughts. The question I have is, "Does your insurance take me?" Do you have a current policy that pays for acupuncture? If you don't know if you have insurance, don't ask me if I take it, right?
I used to be a corporate kind of gal, and I was pretty ignorant about insurance until I had to look into buying it on my own and then on the other side of things, think about billing it as a provider. I always figured if it wasn't covered, there was no use getting the treatment/consult or shopping around, because surely an in-network provider would be most cost-effective and have the most skill. Anyone not accepting BCBS or whatever my job provided must be a hack. This couldn't be more untrue.
When practitioners don't deal with insurance, it says nothing about their healing skills and might say something about their office management skills. I say might, because it may be that the practitioner is not staffed to do paperwork. It also may be that the practitioner has decided that insurance is not good for the practice. Dealing with insurance can be a full time job. I was in my third year of business before I even found any instruction on how a practitioner might go about billing insurance.
Everyone should have the right to healthcare, but healthcare providers also should have the right to make a decent wage. Can you imagine there would be enough people wanting make a career out of healthcare if this was not the case? While some practitioners do inflate the range of "decent," lots of us just want the middle class lifestyle expected of a trained professional. In these times, even that may be a bit much to ask. As a business owner still in the first few years, I'm pretty happy about survival.
Anyway, healthcare is expensive. You are not just paying for your doctor's expertise, time, student loans, and current lifestyle. You are paying for rent, clinical supplies and equipment, lab work, administrative personnel, office supplies, licensing fees, malpractice insurance, advertising, and everything else that goes into running a business. Because if money is exchanged, it is a business. And all of these expenses can really add up.
So, you have insurance, in case something happens. As a consumer, the idea is to balance as closely as possible the copays and premiums against the cost of care if you were uninsured. But remember how I said if money is involved it's a business?
Insurance is a business. They are in the business of collecting more money than they pay to healthcare providers, since they also have rent, personnel, and office equipment to pay for. They hire mathmeticians (yet another expense) to calculate how much you will probably use and base your monthly premiums to be about as much more as you might be able to pay.
You might catch a cold over the course of a year. Or you might break your arm. Or you might have surgery or cancer treatment. If you only see a doctor once, insurance doesn't lose a ton of money on you. If your cancer treatments are several thousand dollars a day, and you've already hit your out of pocket cap, insurance is going to have to pay out a bit. Where do they get the money? Some of it from the monthly payments of people who didn't get terribly sick, which is why nobody thinks they can get decent coverage at an affordable price.
The insurance company stays healthy by collecting more and also by paying less. There is a fresh horror story every day of "but I thought it was covered" in conventional medicine about life saving treatments. My field has thousands of years of empirical evidence, but for only the few conditions that have had modern scientific studies does it have a shot at coverage. And as with anything insurance covers, what does it pay? Not the full tab, and if a provider is in-network, that provider is never seeing the balance.
It's business. My overhead is low, so my prices are low, and I question how lucrative the "how soon and with how much effort can I wring a payment from the insurance company?" game would be to my bottom line. Really, or yours as a consumer. Of the colleagues I know who bill insurance, they say it's a great way to get people in the door...when the majority of the population have jobs, disposable income, and insurance that covers acupuncture. For the condition treated. If you tell me your back hurts, and part of my point prescription covers back pain, I can code for back pain, but I'm not going to lie about it.
I know I'm losing business by not billing insurance and by not being on in-network provider lists, but I suspect I would have neither the patient volume nor cash-flow needed to stay in business if I depended on insurance referrals and reimbursements. One of these days I'll figure out how to integrate insurance into my practice (setting costs, sending claims, figuring out what to do when it's not covered/claims denied), but for now I'm concentrating on helping my current patients and having something of a life outside the office.
I used to be a corporate kind of gal, and I was pretty ignorant about insurance until I had to look into buying it on my own and then on the other side of things, think about billing it as a provider. I always figured if it wasn't covered, there was no use getting the treatment/consult or shopping around, because surely an in-network provider would be most cost-effective and have the most skill. Anyone not accepting BCBS or whatever my job provided must be a hack. This couldn't be more untrue.
When practitioners don't deal with insurance, it says nothing about their healing skills and might say something about their office management skills. I say might, because it may be that the practitioner is not staffed to do paperwork. It also may be that the practitioner has decided that insurance is not good for the practice. Dealing with insurance can be a full time job. I was in my third year of business before I even found any instruction on how a practitioner might go about billing insurance.
Everyone should have the right to healthcare, but healthcare providers also should have the right to make a decent wage. Can you imagine there would be enough people wanting make a career out of healthcare if this was not the case? While some practitioners do inflate the range of "decent," lots of us just want the middle class lifestyle expected of a trained professional. In these times, even that may be a bit much to ask. As a business owner still in the first few years, I'm pretty happy about survival.
Anyway, healthcare is expensive. You are not just paying for your doctor's expertise, time, student loans, and current lifestyle. You are paying for rent, clinical supplies and equipment, lab work, administrative personnel, office supplies, licensing fees, malpractice insurance, advertising, and everything else that goes into running a business. Because if money is exchanged, it is a business. And all of these expenses can really add up.
So, you have insurance, in case something happens. As a consumer, the idea is to balance as closely as possible the copays and premiums against the cost of care if you were uninsured. But remember how I said if money is involved it's a business?
Insurance is a business. They are in the business of collecting more money than they pay to healthcare providers, since they also have rent, personnel, and office equipment to pay for. They hire mathmeticians (yet another expense) to calculate how much you will probably use and base your monthly premiums to be about as much more as you might be able to pay.
You might catch a cold over the course of a year. Or you might break your arm. Or you might have surgery or cancer treatment. If you only see a doctor once, insurance doesn't lose a ton of money on you. If your cancer treatments are several thousand dollars a day, and you've already hit your out of pocket cap, insurance is going to have to pay out a bit. Where do they get the money? Some of it from the monthly payments of people who didn't get terribly sick, which is why nobody thinks they can get decent coverage at an affordable price.
The insurance company stays healthy by collecting more and also by paying less. There is a fresh horror story every day of "but I thought it was covered" in conventional medicine about life saving treatments. My field has thousands of years of empirical evidence, but for only the few conditions that have had modern scientific studies does it have a shot at coverage. And as with anything insurance covers, what does it pay? Not the full tab, and if a provider is in-network, that provider is never seeing the balance.
It's business. My overhead is low, so my prices are low, and I question how lucrative the "how soon and with how much effort can I wring a payment from the insurance company?" game would be to my bottom line. Really, or yours as a consumer. Of the colleagues I know who bill insurance, they say it's a great way to get people in the door...when the majority of the population have jobs, disposable income, and insurance that covers acupuncture. For the condition treated. If you tell me your back hurts, and part of my point prescription covers back pain, I can code for back pain, but I'm not going to lie about it.
I know I'm losing business by not billing insurance and by not being on in-network provider lists, but I suspect I would have neither the patient volume nor cash-flow needed to stay in business if I depended on insurance referrals and reimbursements. One of these days I'll figure out how to integrate insurance into my practice (setting costs, sending claims, figuring out what to do when it's not covered/claims denied), but for now I'm concentrating on helping my current patients and having something of a life outside the office.
Tuesday, July 28, 2009
Fear
First, a shoutout to Stephanie Gonzalez at the Skin and Body Solutions Day Spa. I am enjoying my eyebrows!
I guess magazines have this problem, and certainly with as long as I've been reading Dr. Weil, I've seen plenty of repeats. I tend to forget that just because I've published on a subject doesn't mean people aren't still going to be uninformed. Speaking of magazines, I am getting really tired of how the concept of trying acupuncture is portrayed like, "REALLY?!?!?! OMG!!!" in the media. I suppose I'm a little out of touch, but is the knee jerk emotion to my field really utter revulsion? That is...at best, not terribly great for my self-esteem...
I've gotten 4 cancellations in the last day, so I have a little time to write. One reason is fear. Given my height and frame, I have to admit, the concept of people being scared I'm going to hurt them is pretty funny.
So, a few reality checks:
ZOMG NEEDLES ARE GROSS AND WILL HURT LOTS!
I use sterile, single-use filiform needles. Filiform means there is a point, rather than a cutting edge, and they are solid. I've been sewing lately and can definitively say that acupuncture hurts a lot less than forgetting to use a thimble. You'll feel some of the needles go in and come out, more or less depending on the anatomy of the puncture site. Mostly, people forget the needles are there a few seconds after they've been inserted. If you don't feel anything, then your body is too weak to generate a response, and that is no good. Anyway, acupuncture is about energy flow. Energy does not flow in a body that is clenched tight. So unless I did it wrong (and if I did, tell me, I'll fix it, it should not feel uncomfortable), it's more your fear of the needle than the needle itself that is preventing you from relaxing and letting flow happen.
ACUPUNCTURE DOESN'T WORK ANYWAY:
I hope you say that about drugs, because the standards to get a drug on the market and put an "Ask your doctor about ___" campaign on tv? Something like 20% efficacy, according to this month's Prevention, which could mean doing nothing for 80% of the test group. I don't know that a practice would endure for thousands of years on a 20% success rate.
IT ONLY HELPED FOR A DAY, SO IT MUST BE WORTHLESS:
I never claimed that I could make someone with two broken legs cast aside his crutches with a single treatment. Acupuncture is a medical therapy. You didn't get sick over 30 minutes, so one nap on my table is unlikely to cure you. That doesn't make what I do worthless. A course of antibiotic tablets is not worthless just because you have to swallow them every several hours for a period of time instead of getting a single injection.
I'M A [INSERT RELIGION], SO I CAN'T USE/BELIEVE IN ACUPUNCTURE:
My favorite teacher likes to say, "Doesn't matter if patient doesn't believe! They have no choice but to feel better! (Unless you picked the points wrong, and I'm teaching you how to pick the points.)" I question a god who actively does not want you to try to improve your health with a millennia-old system of practices that doesn't directly support or detract from Him. Does your god frown on the use of aspirin because you don't know each chemical pathway that leads to reduction of inflammation?
I KNOW NOTHING ABOUT IT, SO IF I USE IT I WILL PROBABLY DIE:
(Seriously, this came from an article in last month's Acupuncture Today.) Do you have a degree in medicine? Do you say that about going to an MD? Have you taken a look at magazines/the internet/your library? It's not like information about what I do is unavailable, and I love to answer questions. I'd much rather spend time talking to you than to have you make an appointment one day and cancel the next out of fear.
I like MDs, by the way. I like MDs, DOs, DCs, and NDs, and like me, an L.Ac., they all have their own area where their methods are particularly appropriate. I went to graduate school for four years, passed five national board exams, and have a license from a division of the Texas Medical Board. They regulate me to make sure I won't kill you. Know this, anyway: for most conditions (excluding chronic pain, weight control, and substance abuse, basically) I am required to have on file that you have seen a medical doctor in the last 6 months. If you aren't getting better within 30 days or 20 treatments, I am required to refer you to a medical doctor. The public puts their confidence in MD, therefore the law makes them the last authority. But the law also put in place standards for me, all of which I have passed.
There were medical doctors in my classes, and one of them asked a surgical colleague about potential injuries. She was told there was pretty much no way we could inflict permanent damage with the size of our needles. Some of my patients are on warfarin, an anti-clotting drug. A friend of mine is on it, and because of that, she just bought her first electric shaver. So, in this case, acupuncture is a more acceptable risk than many common grooming methods. Still scared? *sigh* Well, I tried...
I guess magazines have this problem, and certainly with as long as I've been reading Dr. Weil, I've seen plenty of repeats. I tend to forget that just because I've published on a subject doesn't mean people aren't still going to be uninformed. Speaking of magazines, I am getting really tired of how the concept of trying acupuncture is portrayed like, "REALLY?!?!?! OMG!!!" in the media. I suppose I'm a little out of touch, but is the knee jerk emotion to my field really utter revulsion? That is...at best, not terribly great for my self-esteem...
I've gotten 4 cancellations in the last day, so I have a little time to write. One reason is fear. Given my height and frame, I have to admit, the concept of people being scared I'm going to hurt them is pretty funny.
So, a few reality checks:
ZOMG NEEDLES ARE GROSS AND WILL HURT LOTS!
I use sterile, single-use filiform needles. Filiform means there is a point, rather than a cutting edge, and they are solid. I've been sewing lately and can definitively say that acupuncture hurts a lot less than forgetting to use a thimble. You'll feel some of the needles go in and come out, more or less depending on the anatomy of the puncture site. Mostly, people forget the needles are there a few seconds after they've been inserted. If you don't feel anything, then your body is too weak to generate a response, and that is no good. Anyway, acupuncture is about energy flow. Energy does not flow in a body that is clenched tight. So unless I did it wrong (and if I did, tell me, I'll fix it, it should not feel uncomfortable), it's more your fear of the needle than the needle itself that is preventing you from relaxing and letting flow happen.
ACUPUNCTURE DOESN'T WORK ANYWAY:
I hope you say that about drugs, because the standards to get a drug on the market and put an "Ask your doctor about ___" campaign on tv? Something like 20% efficacy, according to this month's Prevention, which could mean doing nothing for 80% of the test group. I don't know that a practice would endure for thousands of years on a 20% success rate.
IT ONLY HELPED FOR A DAY, SO IT MUST BE WORTHLESS:
I never claimed that I could make someone with two broken legs cast aside his crutches with a single treatment. Acupuncture is a medical therapy. You didn't get sick over 30 minutes, so one nap on my table is unlikely to cure you. That doesn't make what I do worthless. A course of antibiotic tablets is not worthless just because you have to swallow them every several hours for a period of time instead of getting a single injection.
I'M A [INSERT RELIGION], SO I CAN'T USE/BELIEVE IN ACUPUNCTURE:
My favorite teacher likes to say, "Doesn't matter if patient doesn't believe! They have no choice but to feel better! (Unless you picked the points wrong, and I'm teaching you how to pick the points.)" I question a god who actively does not want you to try to improve your health with a millennia-old system of practices that doesn't directly support or detract from Him. Does your god frown on the use of aspirin because you don't know each chemical pathway that leads to reduction of inflammation?
I KNOW NOTHING ABOUT IT, SO IF I USE IT I WILL PROBABLY DIE:
(Seriously, this came from an article in last month's Acupuncture Today.) Do you have a degree in medicine? Do you say that about going to an MD? Have you taken a look at magazines/the internet/your library? It's not like information about what I do is unavailable, and I love to answer questions. I'd much rather spend time talking to you than to have you make an appointment one day and cancel the next out of fear.
I like MDs, by the way. I like MDs, DOs, DCs, and NDs, and like me, an L.Ac., they all have their own area where their methods are particularly appropriate. I went to graduate school for four years, passed five national board exams, and have a license from a division of the Texas Medical Board. They regulate me to make sure I won't kill you. Know this, anyway: for most conditions (excluding chronic pain, weight control, and substance abuse, basically) I am required to have on file that you have seen a medical doctor in the last 6 months. If you aren't getting better within 30 days or 20 treatments, I am required to refer you to a medical doctor. The public puts their confidence in MD, therefore the law makes them the last authority. But the law also put in place standards for me, all of which I have passed.
There were medical doctors in my classes, and one of them asked a surgical colleague about potential injuries. She was told there was pretty much no way we could inflict permanent damage with the size of our needles. Some of my patients are on warfarin, an anti-clotting drug. A friend of mine is on it, and because of that, she just bought her first electric shaver. So, in this case, acupuncture is a more acceptable risk than many common grooming methods. Still scared? *sigh* Well, I tried...
Monday, April 20, 2009
sit-ups might change your life
Brought to you by the one hundred pushups guy is two hundred sit-ups. Now, I find these exercises to be incredibly repetitive, boring, tedious, and difficult. However, I'm also a numbers nerd, and working the program and seeing myself getting stronger has been great!
I'll be honest, I really wasn't going to bother with the sit-ups. I just really hate them. However, a patient and my sister serendipitously convinced me that I have to do the challenge.
I've talked before about how breakouts in my chin/jaw area are an early warning to get my head off my hand or be in a world of hurt from TMJ. I was on the phone with my sister, relating how I've told my migraine/acne patient to not adopt the Thinker pose quite so much. And she said, "You need core muscles, otherwise you're going to use your hand to prop yourself upright."
Dammit. I really really really hate situps. I'm in fact, putting off starting the 200 until I've completed the 100. But I will do it, because despite this giant zit under my jaw, I can't seem to stop with the head in hand.
What about you? Do you suffer from headaches? TMJ? Back pain? Break out on the lower half of your face a lot? Join me in the challenge, because I can't do this alone!
I'll be honest, I really wasn't going to bother with the sit-ups. I just really hate them. However, a patient and my sister serendipitously convinced me that I have to do the challenge.
I've talked before about how breakouts in my chin/jaw area are an early warning to get my head off my hand or be in a world of hurt from TMJ. I was on the phone with my sister, relating how I've told my migraine/acne patient to not adopt the Thinker pose quite so much. And she said, "You need core muscles, otherwise you're going to use your hand to prop yourself upright."
Dammit. I really really really hate situps. I'm in fact, putting off starting the 200 until I've completed the 100. But I will do it, because despite this giant zit under my jaw, I can't seem to stop with the head in hand.
What about you? Do you suffer from headaches? TMJ? Back pain? Break out on the lower half of your face a lot? Join me in the challenge, because I can't do this alone!
Peer support
I haven't been able to avoid this newslet bit, "ARE YOUR FRIENDS MAKING YOU FAT?!?" Well, my friends are kicking off trying to move it in the opposite direction.
The same dude who made a McDonald's run because one of the guys had never heard of a McGangBang posted to our email list about his need to incorporate exercise and a better diet into his life. As we're all nerds, a spreadsheet is in the works for whomever wants to follow along.
The one hundred pushups challenge has been sweeping my corner of the blogosphere as well. (91 at last count, booyah! I started several weeks ago collapsing around 16.) Peer support can make or break attempts at a healthier lifestyle. So if you're trying, speak up. You might be surprised.
The same dude who made a McDonald's run because one of the guys had never heard of a McGangBang posted to our email list about his need to incorporate exercise and a better diet into his life. As we're all nerds, a spreadsheet is in the works for whomever wants to follow along.
The one hundred pushups challenge has been sweeping my corner of the blogosphere as well. (91 at last count, booyah! I started several weeks ago collapsing around 16.) Peer support can make or break attempts at a healthier lifestyle. So if you're trying, speak up. You might be surprised.
Tuesday, April 7, 2009
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