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Pain Management

Acupuncture Moving Mainstream in Workers’ Comp

Washington State pilots the use of alternative treatment for lower back pain.
By: | September 12, 2017 • 4 min read
Topics: Workers' Comp

The acceptance of Eastern medicine as an alternative treatment for injuries continues to move west, with Washington State piloting the use of acupuncture to treat a specific occupational injury.

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The state’s Department of Labor & Industries (L&I), which oversees its state-run workers’ compensation program, first began exploring the idea of covering acupuncture services back in 1996, and revisited the idea nearly a dozen times since then.

In 2016, L&I formally requested a pilot program based on a systematic review of the use of acupuncture to treat lower back pain, conducted by the Washington East Asian Medical Association (WEAMA). The program, which launches Oct. 1, will run for two years and will enroll up to 150 qualified acupuncturists.

Leah Hole-Marshall, a medical administrator at L&I, said that before the WEAMA review, the agency didn’t have enough literature to review to support acupuncture’s use as a viable treatment.

The WEAMA review found that acupuncture outperformed usual care in nine out of 10 clinical trials, and performed statistically significantly better than usual care for pain in 10 out of 11 trials.

The Washington state trial will cover five acupuncture visits for lower back pain and allow for an additional five sessions if there is documented clinical improvement in the patient’s pain.

Injured workers must be referred for acupuncture treatment by their attending physician and be treated by one of the agency’s accepted providers.

The agency has already received more than 200 applications from acupuncturists interested in participating in the pilot.

Hole-Marshall says the agency will not be reviewing the effectiveness of the acupuncture treatments, but will examine the effectiveness of communication between attending providers and acupuncturists, and identify any possible red flags.

“We’re looking at whether there are any unanticipated consequences … and mostly how acupuncture fits in a workers’ comp system focused on functional recovery,” she said.

Acceptable for Pain Relief

In the past two years, both the American College of Physicians and the National Institutes of Health have supported the use of non-drug therapies, such as acupuncture, for the treatment of low back pain.

Dr. Robert Goldberg, chief medical officer, Healthesystems

The Joint Commission, which accredits nearly 21,000 health care organizations, recently revised its pain management standards to require accredited hospitals to provide non-pharmacological pain options, such as acupuncture provided by licensed independent practioners, by Jan. 1, 2018.

As a workers’ compensation benefit, acupuncture is covered in 29 states and Washington, D.C. In Ohio, the state’s Bureau of Workers’ Compensation (BWC), began covering the use of acupuncture for treating workers’ comp covered injuries in the late 2000s. The Ohio workers’ comp system, a state-run program similar to Washington State’s comp program, currently covers up to two hours of acupuncture for workplace injuries, with treatments billed in 15-minute increments.

Although the number of acupuncture treatments billed has declined in the past five years, the bureau billed 16,057 15-minutes treatments in 2016.

“Patients have to be partners in treatment and it’s pretty hard to get compliance with forms of treatment that patients won’t accept,” — Dr. Robert Goldberg, chief medical officer, Healthesystems

California approved the use of acupuncture as a legitimate form of treatment for workplace injuries in the 1990s, in part because its large population of East Asian immigrants, as well as a significant percentage of people in the state interested in non-Western treatment, noted Dr. Robert Goldberg, chief medical officer at Healthesystems, a national workers’ comp pharmacy and ancillary benefits provider.

While he said it’s hard to argue against offering acupuncture as a treatment because of the low risk and cost, he noted that there are medical and sociocultural barriers to widespread use among workers’ comp patients.

“Patients have to be partners in treatment and it’s pretty hard to get compliance with forms of treatment that patients won’t accept,” Goldberg said. He also noted that there is still limited evidence of acupuncture’s efficacy, particularly for uses outside of treating lower back pain.

However, he sees the use of acupuncture increasing with more physicians and individuals looking at active forms of treatment, such as acupuncture, yoga and biotherapy, as an alternative to opioids.

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Though very few studies have been published showing a link between the use of acupuncture to reduce opioid dependence, Goldberg expects more of these to be forthcoming.

In 2016, a clinical trial published in Mayo Clinic Proceedings found that acupuncture effectively managed pain for individuals suffering from lower back pain and osteoarthritis of the knee.

In August, the Patient-Centered Outcomes Research Institute Board of Governors approved $5.7 million in funding to explore the use of nondrug strategies, including acupuncture, to treat Oregon Medicaid recipients who suffer from lower back pain.

Angela Childers is a Chicago-based writer specializing in health care and business management. She can be reached at [email protected]

More from Risk & Insurance

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The Profession

Curt Gross

This director of risk management sees cyber, IP and reputation risks as evolving threats, but more formal education may make emerging risk professionals better prepared.
By: | June 1, 2018 • 4 min read

R&I: What was your first job?

My first non-professional job was working at Burger King in high school. I learned some valuable life lessons there.

R&I: How did you come to work in risk management?

After taking some accounting classes in high school, I originally thought I wanted to be an accountant. After working on a few Widgets Inc. projects in college, I figured out that wasn’t what I really wanted to do. Risk management found me. The rest is history. Looking back, I am pleased with how things worked out.

R&I: What is the risk management community doing right?

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I think we do a nice job on post graduate education. I think the ARM and CPCU designations give credibility to the profession. Plus, formal college risk management degrees are becoming more popular these days. I know The University of Akron just launched a new risk management bachelor’s program in the fall of 2017 within the business school.

R&I: What could the risk management community be doing a better job of?

I think we could do a better job with streamlining certificates of insurance or, better yet, evaluating if they are even necessary. It just seems to me that there is a significant amount of time and expense around generating certificates. There has to be a more efficient way.

R&I: What was the best location and year for the RIMS conference and why?

Selfishly, I prefer a destination with a direct flight when possible. RIMS does a nice job of selecting various locations throughout the country. It is a big job to successfully pull off a conference of that size.

Curt Gross, Director of Risk Management, Parker Hannifin Corp.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Definitely the change in nontraditional property & casualty exposures such as intellectual property and reputational risk. Those exposures existed way back when but in different ways. As computer networks become more and more connected and news travels at a more rapid pace, it just amplifies these types of exposures. Sometimes we have to think like the perpetrator, which can be difficult to do.

R&I: What emerging commercial risk most concerns you?

I hate to sound cliché — it’s quite the buzz these days — but I would have to say cyber. It’s such a complex risk involving nontraditional players and motives. Definitely a challenging exposure to get your arms around. Unfortunately, I don’t think we’ll really know the true exposure until there is more claim development.

R&I: What insurance carrier do you have the highest opinion of?

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Our captive insurance company. I’ve been fortunate to work for several companies with a captive, each one with a different operating objective. I view a captive as an essential tool for a successful risk management program.

R&I: Who is your mentor and why?

I can’t point to just one. I have and continue to be lucky to work for really good managers throughout my career. Each one has taken the time and interest to develop me as a professional. I certainly haven’t arrived yet and welcome feedback to continue to try to be the best I can be every day.

R&I: What have you accomplished that you are proudest of?

I would like to think I have and continue to bring meaningful value to my company. However, I would have to say my family is my proudest accomplishment.

R&I: What is your favorite book or movie?

Favorite movie is definitely “Good Will Hunting.”

R&I: What’s the best restaurant you’ve ever eaten at?

Tough question to narrow down. If my wife ran a restaurant, it would be hers. We try to have dinner as a family as much as possible. If I had to pick one restaurant though, I would say Fire Food & Drink in Cleveland, Ohio. Chef Katz is a culinary genius.

R&I: What is the most unusual/interesting place you have ever visited?

The Grand Canyon. It is just so vast. A close second is Stonehenge.

R&I: What is the riskiest activity you ever engaged in?

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A few, actually. Up until a few years ago, I owned a sport bike (motorcycle). Of course, I wore the proper gear, took a safety course and read a motorcycle safety book. Also, I have taken a few laps in a NASCAR [race car] around Daytona International Speedway at 180 mph. Most recently, trying to ride my daughter’s skateboard.

R&I: If the world has a modern hero, who is it and why?

The Dalai Lama. A world full of compassion, tolerance and patience and free of discrimination, racism and violence, while perhaps idealistic, sounds like a wonderful place to me.

R&I: What about this work do you find the most fulfilling or rewarding?

I really enjoy the company I work for and my role, because I get the opportunity to work with various functions. For example, while mostly finance, I get to interact with legal, human resources, employee health and safety, to name a few.

R&I: What do your friends and family think you do?

I asked my son. He said, “Risk management and insurance.” (He’s had the benefit of bring-your-kid-to-work day.)

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]