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

Mohegan Gaming’s director of risk management recognizes the value of the people around her in creating success.  
By: | February 20, 2018 • 4 min read

R&I: What was your first job?

I was a margin clerk in financial futures at Kidder Peabody & Company.

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

While I was at General Dynamics working in HR, the opportunity to transition to risk management was afforded to me. I was very fortunate that the risk manager at the time took a chance on me and taught me so very much. Coming from a manufacturing facility with multiple unions helped prepare me for any situation.

R&I: How has your experience in human resources helped your career in risk management? What do the positions have in common?

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I believe my HR background has helped my risk management career immensely. Both areas are interrelated. People are fundamental to accomplishing goals and people can help or hinder those results. Human resources is tasked with bringing in and nurturing the right people, and risk management is tasked with keeping them safe.

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

Education, keeping up with industry trends and having resources available to better prepare organizations. There is always something new or a new way to view a situation.

Mary Lou Morrissette, corporate director of risk management, Mohegan Gaming & Entertainment

R&I: What kind of resources can risk managers bring to the table?

Data and analytics have come so far, and the systems out there are able to drill down into good quality information that can be used more effectively.

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

Within the community, we all understand the role of risk management, but getting organizations to understand the importance of considering risk during the strategic decision-making process as opposed to treating it like an after-thought can be a challenge. Risk should be involved in day-to-day operations — not just when a problem arises.

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

San Diego. The proximity to the city, community and culture was great.

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

The emergence of cyber security.

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

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Catastrophic events, both natural and manmade, are becoming more of a norm of late. We need to look at analytics and the role they play in understanding these disasters and subsequent losses to help organizations prepare, manage and recover from these types of events.

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

We have always valued relationships. We have a few long-standing partners that immediately come to mind. FM Global, Great American and Safety National have all been immensely important to our company and our growth.

R&I: How much business do you do direct versus going through a broker?

All through a broker.

R&I: Is the contingent commission controversy overblown?

If you have trust and faith in your broker and they have full disclosure, then yes, it is overblown. But I have seen the cost of hidden commissions and the effect on the bottom line.

R&I: Who is your mentor and why?

I had a mentor early on in my career in HR, Marie Haggerty. She instilled in me the mindset to speak up and be heard and not to shy away from an adverse opinion but to be strong in my convictions.

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

Being awarded FM Global’s Highly Protected Risk award in 2011. The award is granted when a location has no human element recommendations, no uncontrolled high-risk exposures and no other major loss exposures. Mohegan Sun has worked hand-in-hand with FM since 2000 on loss prevention recommendations and improvements. Our engineering team as well as our fire department have been instrumental in our ability to achieve this award. We have always tried to meet or exceed the advice we receive from FM’s engineers. This has made our property better protected as well as helped to keep our premium in line.

R&I: How many e-mails do you get in a day?

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Too many!

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

I only read nonfiction and personal development books. Katie Couric’s “The Best Advice I Ever Got: Lessons from Extraordinary Lives” is one of my favorites.

R&I: What is your favorite drink?

Coffee and water.

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

The Pearl Harbor memorial. I love history and to stand over the Arizona was humbling.

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

Parasailing.

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

That I can make a difference in either a safer workplace or on the bottom line, and that every day is different. I love the diversity of what I do and the constant change and ability to continue to grow and learn.

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

I definitely get the deer in the headlights look when I tell people what I do — I don’t think any of my family or friends truly understand it.




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