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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

More from Risk & Insurance

Risk Management

The Profession

As a professor of business, Jack Hampton knows firsthand the positive impact education has on risk managers as they tackle growing risks.
By: | April 9, 2018 • 4 min read

R&I: Who is your mentor and why?

Ellen Thrower, president (retired), The College of Insurance, introduced me to the importance of insurance as a component of risk management. Further, she encouraged me to explore strategic and operational risk as foundation topics shaping the role of the modern risk manager.

Chris Mandel, former president of RIMS and Risk Manager of the Year, introduced me to the emerging area of enterprise risk management. He helped me recognize the need to align hazard, strategic, operational and financial risk into a single framework. He gave me the perspective of ERM in a high-tech environment, using USAA as a model program that later won an excellence award for innovation.

Bob Morrell, founder and former CEO of Riskonnect, showed me how technology could be applied to solving serious risk management and governance problems. He created a platform that made some of my ideas practical and extended them into a highly-successful enterprise that served risk and governance management needs of major corporations.

R&I: How did you come to work in this industry?

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From a background in corporate finance and commercial banking, I accepted the position of provost of The College of Insurance. Recognizing my limited prior knowledge in the field, I became a student of insurance and risk management leading to authorship of books on hazard and financial risk. This led to industry consulting, as well as to the development of graduate-level courses and concentrations in MBA programs.

R&I: What was your first job?

The provost position was the first job I had in the industry, after serving as dean of the Seton Hall University School of Business and founding The Princeton Consulting Group. Earlier positions were in business development with Marine Transport Lines, consulting in commercial banking and college professorships.

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

Creating a risk management concentration in the MBA program at Saint Peter’s, co-founding the Russian Risk Management Society (RUSRISK), and writing “Fundamentals of Enterprise Risk Management” and the “AMA Handbook of Financial Risk Management.”

A few years ago, I expanded into risk management in higher education. From 2017 into 2018, Rowman and Littlefield published my four books that address risks facing colleges and universities, professors, students and parents.

Jack Hampton, Professor of Business, St. Peter’s University

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

The Godfather. I see it as a story of managing risk, even as the behavior of its leading characters create risk for others.

R&I: What is your favorite drink?

Jameson’s Irish whiskey. Mixed with a little ice, it is a serious rival for Johnny Walker Gold scotch and Jack Daniel’s Tennessee whiskey.

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

Mount Etna, Taormina, and Agrigento, Sicily. I actually supervised an MBA program in Siracusa and learned about risk from a new perspective.

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

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Army Airborne training and jumping out of an airplane. Fortunately, I never had to do it in combat even though I served in Vietnam.

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

George C. Marshall, one of the most decorated military leaders in American history, architect of the economic recovery program for Europe after World War II, and recipient of the 1953 Nobel Peace Prize. For Marshall, it was not just about winning the war. It was also about winning the peace.

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

Sharing lessons with colleagues and students by writing, publishing and teaching. A professor with a knowledge of risk management does not only share lessons. The professor is also a student when MBA candidates talk about the risks they manage every day.

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

Sensitizing for-profit, nonprofit and governmental agencies to the exposures and complexities facing their organizations. Sometimes we focus too much on strategies that sound good but do not withstand closer examination. Risk managers help organizations make better decisions.

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

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Developing executive training programs to help risk managers assume C-suite positions in organizations. Insurance may be a good place to start but so is an MBA degree. The Risk and Insurance Management Society recognizes the importance of a wide range of risk knowledge. Colleges and universities need to catch up with RIMS.

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

Cyber risk and its impact on hazard, operational and financial strategies. A terrorist can take down a building. A cyber-criminal can take down much more.

R&I: What does your family think you do?

My family members think I’m a professor. They do not seem to be too interested in my views on risk management.




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