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Inspirational Weekend with Shellie Goldstein, L.Ac
Chinese 'cosmetic' acupuncture has a history that dates back beyond the time of Sun Simiao and is still relevant today. In a recent survey by the NCCAOM, 62% of acupuncturists have had their patients ask about Cosmetic Acupuncture! This is a field of acupuncture that is in real - and growing - demand.
Shellie Goldstein has been a pioneer in our profession since before acupuncture was legal in New York State. She graduated from TSCA in 1991, when the college was still in Connecticut, and before she could get a license in NY. Between '91 and licensure in '92, she spent some time in China learning the power of 'cosmetic acupuncture' through direct clinical study.
For the past 25+ years, she's been refining the practice of cosmetic acupuncture and presented a thorough introduction to the professionals in attendance this weekend.
Participants had the chance to learn through lecture, demonstration, and direct clinical practice the capabilities and some basic techniques of cosmetic acupuncture.
The beauty of this weekend wasn't only in the 'appearance,' but also in the substance. Shellie presented the material with a sense of holistic wellness that maintained the integrity of Chinese Medical principles and concepts. It was an inspiring weekend and students left with skills and abilities that they can put into practice on Monday.
Don't worry if you missed this weekend - as you can see in the pictures, we're producing a video that will be available as an online course in the coming weeks. We'll announce that soon.
Chinese Cosmetology Gets A Face Lift (by Shellie Goldstein, L.Ac)
by Shellie Goldstein, L. Ac
Chinese Cosmetology (Mei Rong) has a well-documented and venerated history dating back to 221 BC in the Qin Dynasty. Chinese medical physicians were employed to perform acupuncture and dispense herbal medicine for Empresses and Emperors' concubines to enhance natural radiance, delay signs of aging, and maintain a youthful and lustrous appearance. Available at that time to only the wealthiest, this imperial secret was a holistic regimen designed to preserve beauty and maintain health.
The modern application of ancient Mei Rong, known in this country as Cosmetic Acupuncture, AcuFacial, Constitutional Facial Acupuncture, Facial Cosmetic Acupuncture, or Facial Rejuvenation Acupuncture, is now recognized as an alternative or adjunct to well-established beauty enhancing services such as Botox™, fillers, and surgery. Currently the third most popular specialty among U. S. acupuncture professionals, the results of a 2014 NCCAOM 'Acupuncture Facial Rejuvenation Certification Needs Assessment Survey' revealed that based on acupuncturists responses, 62% of their patients inquired about cosmetic acupuncture services for the purpose of appearance enhancement.
As practitioners of Chinese Medicine we are aware that patient complaints are generally linked to other imbalances stemming from an underlying pattern of disharmony. For example, those presenting with allergies and digestive issues experience relief when addressing Spleen dampness. Menstrual problems and headaches can be resolved by treating Liver Qi stagnation. Chronic low back pain and fatigue can be greatly reduced by strengthening Kidney Yang.
The symptoms for consumers seeking cosmetic acupuncture ie: sagging face muscles, wrinkles, and aging skin at the onset may appear seemingly different, however the educated Chinese Medicine practitioner soon realizes that the underlying patterns of these disharmonies are one and the same. In keeping with the philosophy of ancient Mei Rong, modern practitioners of cosmetic acupuncture also view an imbalance in the Zang-Fu Organs, Meridians, Qi, Blood, and Fluids as the core of cosmetic related complaints. Sagging face muscles (and digestive issues) are generally an issue of the Spleen. Repetitive muscle contractions leading to wrinkle formation (and headaches) can be resolved by treating the Liver. A Kidney Yang deficiency is ultimately the root cause of most advanced cosmetic as well as general aging complaints.
Equally, if not more important, is the relationship between the dissatisfaction of ones exterior appearance and their underlying emotional upheaval. In our youth-driven culture, there is the pervasive misconception that our external appearance determines who we are, based on how we are perceived by self and others. When faced with the visible signs of aging, this overwhelming misunderstanding can easily create mental and emotional chaos and undermine ones self-image. Acupuncture opens the door to inner contentment, personal satisfaction, and self- acceptance. As practitioners of cosmetic acupuncture we have the skills to empower our patients to not only look and feel better but to also gain the wisdom needed to accept ones self for who they are and not just how they look.
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Shellie Goldstein is a licensed acupuncturist in FL and in NY, educator, author of Your Best Face Now: Look Younger in 20 Days With The Do-It-Yourself Acupressure Facelift (Avery Publishers), and the creator of Touch + Glow: The Beauty Enhancing Acupressure Facelift Kit. She has been broadcast on National Television shows such as Good Morning America, Telemundo, and Martha Stewart. Her renowned AcuFacial technique has been featured in over 50 National and International magazines, and local publications. Shellie offers distance learning and live cosmetic acupuncture courses around the country. For more information about her upcoming April 1-2, 2017 course in NYC, NY go to http://hamptonsacupuncture.com/continuing-edu/ or call 212.388.0800.
click here to learn more and sign up for Shellie's course: Advanced Cosmetic Acupuncture, April 1-2, 2017
2017 Patsy Roth Scholarship Recipient: Javier Picayo
Congrats to Javier Picayo, this year's recipient of the Patsy Roth Endowed Scholarship!
Javier is a second-year TSCA student who is simultaneously completing a Masters in religious studies at Union Theological Seminary (affiliated with Columbia) and teaching Afro-Caribbean Religions at CUNY Hunter. Javier was an actor before coming to acupuncture school and is interested in working and supporting immigrant communities. He recognizes his connection to his Cuban roots and feels empowered by the traditions of his community.
Javier is a Manhattan-native, but he intends to head to Brooklyn to work with TSCA grad Leo Bierman ('15) at Brooklyn Integrated Acupuncture in some way. Time will tell for Javier, but if you ever get the chance to meet him, you'll be inspired by his presence and gentleness.
Congratulations again to Javier. We celebrate you and we celebrate Patsy's incredible contributions to TSCA and the profession of acupuncture.
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The Patsy Roth scholarship was established by a class gift from the class of 2016 and endowed in perpetuity by college. The criteria for the recipient are: a student in their second year who shows a commitment to community service and social justice.
City Acupuncture Master Class at TSCA
TSCA was honored with a Sunday-morning master class in how to build and thrive a community acupuncture practice, facilitated by Robbie Benhuri, founder of City Acupuncture, and Kate Henderson, co-founder of City Acu Bed Stuy.
We gathered as about 20 TSCA alumni, students, and alumni from PCOM to join for the interactive workshop. The discussion flowed through the morning, covering topics like practice management, business development, designing the perfect space for you, sustainable business strategies, and details like pricing, insurance billing, and software utilization. One of the big takeaways was clear: when running a business, it's a different skill set to being a great practitioner, one that needs development, training, and support. Robbie and Kate emphasized the importance of business coaches and mentors, and of strategic thinking as business owners.
The power of the medicine is inherent to the work we do, but the ability to reach people in the way we want as a practitioner is dependent on our ability to get them in the clinic and coming back. Robbie and Kate laid out elegant ideas and shared their experience and wisdom. All in all, it was a very uplifting event that left the group with confidence that they could open and run a successful practice.
Thanks to Robbie and Kate for bringing their expertise and enthusiasm!
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Hands-on Dietary Therapy at TSCA
On a cold March day, with the winds of a changing spring whistling outside the 13th floor, Ross Rosen, JD, MSTOM, L.Ac presented an incredible system for pulse diagnostics of the digestive organs and some fundamentals in Chinese dietary therapy. After morning lecture and a break for lunch, it was hands on for the rest of the day - feeling the pulse positions of the stomach, spleen, liver, gallbladder, esophagus, stomach-pylorus, large intestine, and small intestine.
Ross brought his years of study and practice in pulse diagnostics and helped get it into the hands of the thirty acupuncturists who were there. Participants finished the day practicing a pulse diagnosis and dietary treatment suggestions for a peer patient.
TSCA thanks Ross and all the participants for their presence, hard work, and enthusiasm.
If you're interested in learning more about upcoming continuing education at TSCA, please click here. Our 2017 - 2018 program calendar will be announced soon!
Alumni Spotlight: Mary Elizabeth Wakefield, L.Ac
Mary Elizabeth Wakefield, TSCA class of 1999, just got back from Tokyo, Japan, where she appeared as the only invited presenter from North America at the first International Facial Acupuncture Summit, convened to establish standards and practices for facial acupuncture education and practice worldwide.
In addition to maintaining her own private practice in New York City, she's committed to teaching, research, and writing. She's taught more than 5,000 students in courses around the world, written an incredible book (Constitutional Facial Acupuncture), and is working on another book as we speak. And, as if being a world-renowned acupuncture educator isn't enough, she also is an opera singer and still performs!
"I'm grateful for the varied and comprehensive training at Tri-State," Mary Elizabeth professed during our conversation. To emphasize the power of her Tri-State education, she shared a short story about being invited out to ACTCM in San Francisco to teach facial acupuncture - and things they had never seen or heard of before. She shared her knowledge about trigger points, working with muscles and palpations, and working distally with Dr. Seem's style of acupuncture and Japanese and Vietnamese meridian work. They were surprised and impressed to see acupuncture beyond TCM!
Mary Elizabeth is a passionate educator. She was named AAAOM Acupuncture Educator of the Year in 2005 and has developed more than 20 courses in facial acupuncture, including the International GOLD STANDARD FACIAL ACUPUNCTURE® Certification Program, a 2-year Masters Level Certification in Facial Acupuncture which has run successfully twice at Northwestern Health Sciences University in Minnesota. She credits a lot of her clinical capabilities to the training she received from Dr. Seem, specifically muscle structural training and meridian therapy, and to her training with Kiiko Matsumoto and others.
She has also developed her own product line of Oriental medicine based topical herbal and other preparations, including 5 Element Planetary essential oil blends and gem elixirs, for practitioners of facial acupuncture and other related modalities, Muse L' Herbal USA.
Alexis Bennett, also a graduate of '99, shared that Mary Elizabeth "brings a lifetime of experience into a cohesive, artistic harmony of grounded knowledge, practical application, and spiritual connection for students drawn to her obvious passion for this work. Always innovating and supportive, Mary Elizabeth incorporates all of the gifts of a strong woman and shares that openly with the world."
And she's more than a practitioner, she's also a pioneer for the field - if you do facial acupuncture and enjoy malpractice insurance coverage for it with the AAC, you can thank Mary Elizabeth for that! She was part of the negotiating team to get AAC to cover acupuncturists, playing the integral role of treating the lawyer who made the final decision at the CSOMA Conference in San Francisco! After the treatment went perfectly, the process moved forward! Brilliant!
There's so much more to share and celebrate about Mary Elizabeth. Please visit her website if you'd like to learn more. She's currently working on her next book with her partner, MichelAngelo, called Vibrational Acupuncture: Integrating Tuning Forks with Needles, which will be a synthesis of years of study in sound healing and acupuncture.
Mary Elizabeth, we celebrate and honor you! You make us proud to be TSCA Alumni with you!
Alumni Spotlight: Luke Hamilton, L.Ac
Luke Hamilton just called from Peru, where he's spending another month treating remote villagers in collaboration with a local NGO called DESEA, which works to provide people with low-cost water filters. He's visited Peru seven times in the last four years, going back to the same villages over and over again in order to develop a continuity of healthcare for the people there.
"It's been great," Luke shared, "we've been able to set up acupuncture clinics and see people year after year. We've been able to watch some of the children grow up and there is a familiarity amongst everyone."
Luke graduated from Tri-State in 2006 and in 2009 began volunteering with the Global Alternative Healthcare Project, which was started by Frank Butler. Most recently, in September, Luke traveled to provide the Standing Rock Sioux Tribe and their supporters with free medical services as they stand in defense of their land and water against a potential oil pipeline project.
Adam Cantor, another TSCA Alum shared his story about working with Luke: "Luke and I met in martial arts class and quickly became friends upon getting to know one another. When I bruised several ribs in training, Luke, already a seasoned acupuncturist, knew just how to help me regain mobility and comfort where my PCP was of no help. It was that very treatment that sparked my interest in Chinese medicine. Luke answered all of my questions about becoming an acupuncturist and a few short months later, I was enrolled at TSCA." Adam went on to apprentice Luke in his clinic for two years and now has his own busy practice on Long Island.
Here's a video of Luke doing his work in Peru
Luke, we celebrate and honor you. You make us proud to be Tri-State alumni with you!! Good luck!
- - - If you know a Tri-State grad who is doing some amazing work, please nominate them for our next Alumni Spotlight! Email the Office of Alumni Services to begin the conversation.
TJA Program Off To A Strong Start
The TSCA Traditional Japanese Acupuncture program held its first weekend intensive, Essence of Japanese Palpation And Needling, with Atsuki Maeda, DAOM, last weekend. This is a special post-graduate program for Tri-State that grants students both post-graduate credits (NY State Education) and NCCAOM CEUs.
Each weekend can be taken as an individual module and the next one is in less than a month. Click here to learn more and sign up.
In Memoriam, Gail Reichstein Rex, class of 1995
TSCA is saddened to announce the passing of one of our Alum, Gail Reichstein Rex, class of 1995. Gail was a classmate of, and remained a dear friend of, our recently retired Patsy Roth. Those of you who knew Gail know her big smile, generous heart and passion for Chinese Medicine. Her book "Wood Becomes Water: Chinese Medicine in Everyday Life" (1998) remains an important contribution to our profession. On August 17th, Gail suffered a brain aneurysm and passed away suddenly, at age 51, while in her acupuncture office in Vermont. She leaves behind a seven year old son, Orion, and a devoted husband, Robert Rex. Gail's family needs our help. Please consider showing your support by contributing (any amount) to a GoFundMe account set up for Orion's education. It would mean so much.
Alumni Spotlight: Suzanne Hill, M.Sc, L.Ac
Suzanne graduated from Tri-State in 1999 and has led a busy clinical practice in New York City since. She's now opening a satellite office in Hudson, NY, a few hours north of the city. We connected with her to hear a little about how to stay busy and inspired.
She shared three practices that she credits to her success:
1. Meditate every day: develop your inner wisdom
2. Live by example
3. Read. Read. Read.
Ultimately, "it's about supporting patients on their path," Suzanne shared when we talked about her philosophy of practice. She found that patients wanted to heal, but were unable to make certain changes in their lives away from behaviors that got them into their current disease or illness. How to support the consciousness that enables life changing decisions and behavior became part of the treatment. With that, she began suggesting her patients find a meditation practice.
After a few disappointing referrals and suggestions for patients to find meditation programs, she took matters into her own hands. About ten years ago, she led her first meditation retreat upstate and has been leading regular retreats and weekly meditation classes in New York City for three years now. Through teaching, she finds that she's able to connect to a patient's desire to shift, transform, and grow, and the regular meditation practices nurture those changes.
Through her experience, Suzanne suggests that practitioners "live a clean life yourself. Your patients enter into your energetic frequency. You have to lead by example." For Suzanne, as many other clinicians have probably discovered for themselves, patients take their lead from the practitioner's personal practice - if we exercise, they will be more likely to exercise; if we meditate, they'll meditate; if we can heal, they can heal, etc…
One of Suzanne's mantras is "always keep educating yourself." Even after 17 years in practice, Suzanne reads and studies for at least an hour per day. She shared that she read close to three hours per day when she first started because she wanted to "develop a clearer understanding of things" and there was never a shortage of medicine to study and learn about.
Suzanne, we celebrate and honor you. You make us proud to be Tri-State alumni with you!! Good luck!
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Alumni Spotlight: Ben Fleisher, L. Ac, CZB
We're excited to feature Ben Fleisher, class of 2010 as our second Alumni Spotlight!
Ben is an entrepreneur as much as an acupuncturist - in addition to his NYC acupuncture practice, Ben is a co-founder of Body Local, a networking organization that supports hundreds of wellness professionals, and is building an integrated wellness center in Woodstock.
Ben came to acupuncture from a massage therapy background. He tried to transition his work and his patient population from massage to acupuncture, but "It didn't actually work super well." He shared that "it took me a good 3-4 years…" before he was able to be a full-time acupuncturist. In the process, he studied Zero Balancing and evolved his own comprehensive style that is mostly influenced by KM acupuncture and Zero Balancing. He now works in Midtown at a multi-disciplinary practice.
In the process of transitioning his business from working as an LMT in spas to working in his own private practice, Ben found that his professional life was becoming a little isolating. He shared that "I found that I really missed the community and camaraderie that I had with the spa-team that I was a part of. I wanted to keep the financial prosperity and freedom of having my own practice, while maintaining the community of working as part of a larger institution." He tried some professional networking groups, but found that they weren't really the community he was looking for.
From here, Body Local was born - and in the past few years has organized hundreds of events for thousands of participants. TSCA has begun partnering with Body Local, sending 9 alumni to the recent Midsummer Networking party and TSCA is about to host our second event at school, this fall.
Fidelina Morales, L.Ac (TSCA class of 2011) is a member of Body Local who thinks that this organization has been "an invaluable asset" to her business development. She gives credit to Body Local, that "this community has provided me with guidance necessary to grow as an entrepreneur through building relationships with other professionals."
Ben is constantly evolving and allowing others to grow with him. His latest endeavor is Woodstock Healing Arts - an integrative wellness center that is going to offer functional medicine with a Cardiologist and an OB/GYN, Acupuncture, Chiropractic Medicine, and more. He wanted to "create a center out of the spirit of Body Local: a team approach towards providing excellent care."
Ben, we look forward to seeing you continue to thrive and elevate the profession with your enthusiasm, creativity, and innovation. You make us proud to be Tri-State alumni with you!
Alumni Networking at a Rooftop Wellness Party
Last night, July 27th, TSCA Alumni attended the 4th Annual Body Local Midsummer networking party for healthcare professionals. There were hundreds of people there, dozens of vendors, and plenty of food and fun. Alumni spanning 3 decades of graduates!!! were there (90's, '00s, '10s) and all had a great time. They literally had to turn off the music to get us to leave.
Major News for Acupuncture in America
Dear Tri-State Community,
I'm writing to you at a historic moment for our profession: the Bureau of Labor Statistics (BLS) has just announced that it will - for the first time - include Acupuncture as a recognized profession in the United States. Acupuncture used to be classified as a 'modality' under other healthcare professions, but beginning in 2018, Acupuncture will be classified as an independent profession and receive its own Standard Occupational Classification (SOC) code: 29-1291.
This is monumental.
What this means for Acupuncturists
We are now a federally recognized profession in the United States of America for the first time in the history of Acupuncture. According to the ASA, "this status provides a foundation for inclusion of Acupuncturists as a professional group in numerous federal programs, including loan repayment opportunities, work with Veteran Affairs, and national insurance endeavors."
What this means for your Patients
This has the potential to open the door for hundreds of thousands of people having access to acupuncture through their health insurance or other federally funded programs.
Below, you'll find the full letter from the Acupuncture Society of America (ASA), which has links to more information and articles. We've worked for eight years to reach this goal and it is a significant achievement to elevate our profession.
Dr. Dennis Moseman
Dean of Studies
Tri-State College of Acupuncture
Letter from the ASA….
Dear Colleagues:
It is with great excitement that we announce the successful achievement of a distinct occupational code with the United States Bureau of Labor Statistics!
This project began before 2008 with an initial attempt to achieve classification, but could not be achieved initially. The opportunity to submit for distinct codes only occurs every 8 years. In 2014, NCCAOM, under the guidance of CEO Kory Ward Cook and committee leadership of David W Miller, MD, LAc; Iman Madj, MD, LAc; and Dennis Moseman, DC, LAc, as well as with critical support from NCCAOM Deputy Executive Director Mina Larson, Jennifer Stone, LAc; Bryn Clark, LAc, Eugene London, LAc, and the NCCAOM research committee, this packet was submitted to the BLS for consideration: https://drive.google.com/file/d/0B4CFzCUCHmtcQnJXckhrNzV2UWs/view?usp=sharing
On July 22, 2016 we received word that Acupuncturists were assigned the unique code: 29-1291.
This status provides a foundation for inclusion of Acupuncturists as a professional group in numerous federal programs, including loan repayment opportunities, work with Veteran Affairs, and national insurance endeavors. For a thorough history of this work as described by Kory Ward Cook and Mina Larson, please see http://www.acupuncturetoday.com/mpacms/at/article.php?id=32861. NCCAOM also has more information on their website at http://www.nccaom.org/bls/.
The American Society of Acupuncturists is thrilled to see this milestone achieved. Many state and national associations also gave feedback on the BLS submission, and together as a community we position ourselves to move forward with solid footing. For more from the BLS and to find the specific links to their announcements, please see http://www.bls.gov/soc/2018/soc_2018_definitions_changes_tracked.pdf and http://www.bls.gov/soc/
The Board of the ASA
ASNY Update
Shared from Viktor Krystufek, L. Ac, who is on the board of ASNY:
ASNY has been very busy working in Albany this past legislative session, as well as in other arenas around the state. Here are some of our tasks and gains:
PASSED! - Legislation that adds LAc's to the list of providers that treat NYS injured workers under the Workers' Compensation system. This is the 3rd time that this bill has passed both the Senate and the Assembly and ASNY is currently working on ensuring the governor's signature into law.
DRY NEEDLING - ASNY has had several meetings with NYS Department of Education to continue to protect NY against the growing threat of dry needling performed by Physical Therapists. ASNY uncovered Columbia University's DPT program illegally teaching the technique to their students and sprung into action. We are forming a statewide task force and are currently looking for duly licensed providers with an interest in combating this threat to reply. Physician Assistants, Nurses and Chiropractors who are also LAc's are still needed.
ASNY BOARD ADDITIONS - ASNY is excited to welcome 5 new board members to our team of volunteers. Lisa Sumption, Viktor Krystufek, Mona Lee-Yuan, Julie Juhyun Cho and Bryan Isacks bring new energy and fuel to move forward.
HERBAL SCOPE - ASNY worked with Assemblywoman Deborah Glick the Chair of Higher Education to make legislation that adds herbal medicine into the LAc scope. The legislation passed both houses and is awaiting to be signed into law. More to come…
PDA EVENTS - With 50+ events already this year, visit ASNY.ORG often to see what's ahead for the second half of the year!
ESSENTIAL HEALTH BENEFITS - ASNY had introduced a bill successfully in both the Senate and Assembly which requires acupuncture to be included in healthcare plans. We are hopeful for this legislation next term. Sponsors included Assemblyman Ron Kim and Senator Diane Savino.
CONSUMER ALERT - ASNY insisted that Groupon remove a 100% online acupuncture training certificate that does not qualify participants to sit NCCAOM board exams and encourages illegal practice without proper training. If anyone ever encounters similar please forward to us.
ASNY is committed to the advancement, growth and preservation of the acupuncture profession and values your membership to allow for these actions.
Alumni Spotlight: Kate Henderson, L. Ac
We are proud to honor and highlight Kate Henderson, TSCA class of 2007, as our first Alumni Spotlight!
Kate is a co-owner and manager at the brand new City Acupuncture Bed Stuy, the third in the franchise of City Acupuncture offices and already a busy practice in an underserved neighborhood in the heart of Brooklyn. She acknowledges that "it was quite a long journey getting to open City Acupuncture Bed Stuy," but clearly the work paid off.
When Kate graduated, she was promptly met by one of the worst economic recessions in recent history. Like many acupuncturists, she quickly learned the hard way that rents are high and it's hard work to build a practice, especially in that economic climate. She tried building a private practice, and supplemented that with working in a number of different acupuncture facilities, mainly community, private, and no-fault clinics. In her private practice, she found that at about $100 per treatment, her patient population didn't reflect the diversity of her city or community. And that didn't work for her.
Kate began to connect with POCA (People's Organization of Community Acupuncture) and got clear on what she cared about: delivering acupuncture to people who needed it, not just people who could afford boutique service. After experimenting with a 'community day' in her private practice, she quickly realized that there was a demand for this in Brooklyn.
Sonya Tsuchigane, TSCA class of 2013/15(OM), who is a "rockstar" (according to Kate) at City Acupuncture Fulton Street worked with Kate at City Acupuncture had this to say about Henderson - "Kate is a refreshing solution for acupuncture in NYC and is committed to both the development of acupuncturists and patients wellness. Her clinic is a much needed addition and will be booked before you can say, "ashi!"
The journey to opening City Acupuncture Bed Stuy was long and hard. "It's been a wild ride," Kate shared, "but it stretched me." She offers to others, "sometimes you really have to put it out there to make it happen." She recently connected with Rob Benhuri, founder of City Acupuncture, and discussed franchising. The two worked out an agreement and now have a model for how to franchise a community acupuncture clinic for New York - a unique city that needs a unique business model. The two will be teaching a workshop at TSCA in the fall - stay tuned.
Kate, we celebrate and honor you. You make us proud to be Tri-State alumni with you!! Good luck!
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New Office Of Alumni Affairs
As our community of alumni grows to nearly one thousand graduates, there is an opportunity and a responsibility to support and nurture this community. More than that, there is an opportunity to thrive as a community of professionals and colleagues who are changing the way people view and receive healthcare in this country. Rooted in our traditions, we are a profession of pioneers.
Tri-State is growing and evolving and our community of alumni deserve support and active enrichment, professionally and inter-personally. This is our intention with the new Office of Alumni Affairs.
We intend to build relationships amongst current students (future alumni), students and alumni, and amongst alumni themselves through targeted programming, events, and collaborations.
Patsy Roth Retirement & Scholarship
As some of you may know, Patsy Roth, L.Ac has officially retired from teaching at TSCA. Patsy joined faculty in 1995 and has since served as a teacher, Dean, and clinic supervisor. She has been a constant force for strong clinical practice training and a reliable source for a great story telling and a laugh that brightens the halls at Tri-State. She'll continue to focus on her private practice in years to come. We thank Patsy for her years of service to this institution and for her invaluable presence in our hearts and community.
In honor of Patsy's retirement, a scholarship has been created in her name. It was started as the class gift by the class of 2016, doubled by TSCA, and Dr. Moseman has announced that it will be endowed for years to come. The $1,500 scholarship will be awarded to second year students in their spring semester based on a combination of factors: merit, need, and an essay that focuses on their experiences in service, whether volunteer, military, or anything else.
Please join us in congratulating, appreciating, and honoring Patsy in her historic tenure.
Start an Integrated Health Care Business
In New York State a licensed professional can only bill for the services that they are licensed to provide. As an acupuncturist I may only bill for acupuncture. I can rent space in my office to another licensed professional but I cannot bill for the services that they provide, unless I am licensed in their profession.
An integrated health care business, which can bill for the services of different professionals, such as a chiropractor, physical therapist, acupuncturist and a massage therapist is possible. In New York State certain licensed professionals can agree to form a joint business entity, a Professional Service Limited Liability Corporation (PLLC). The PLLC can legally bill for any of the professional services that its owners are licensed in.
New York Department of State's Division of Corporations, State Records and Uniform Commercial Code describes the requirements for establishing a PLLC in NYS in this link:
The NYS Office of the Professions gives further information about the requirements for forming a PLLC in this link:
Links to the NYS licensed professions that may form a PLLC are:
Athletic Trainer
Clinical Laboratory Technician
Clinical Laboratory Technologist
Creative Arts Therapy
Dental Assisting
Dental Hygiene
Histological Technician
Licensed Clinical Social Work
Licensed Master Social Work
Licensed Practical Nursing
Marriage and Family Therapy
Massage Therapy
Medical Physics
Mental Health Counseling
Nurse Practitioner
Occupational Therapy
Occupational Therapy Assistant
Ophthalmic Dispensing
Physical Therapy
Physical Therapist Assistant
Polysomnographic Technology
Registered Physician Assistant
Registered Professional Nursing
Registered Specialist Assistant
Respiratory Therapist
Respiratory Therapy Technician
Speech-Language Pathology
Online resources are available to use in forming a new business, but it is advisable to consult an attorney and / or certified public accountant regarding the formation of a business.
Interview with Sharon Sherman, L.Ac.
On average, how many patients do you see per day and per week?
I see anywhere from 35-45 people weekly.
How did you develop and maintain your customer base?
I think retention is all about providing exemplary customer service. It takes a lot of effort/time/money to find new patients, especially when you are starting out. My recommendation is that when you have patients come to your practice, provide the best customer experience. Details matter. Spend time at the beginning of every day to make sure that your office and your mindset are in alignment to give the best possible impression. This creates retention.
Acupuncture, by no means, will be the "fix" for everyone and everything. However, if someone has a pleasant, meaningful encounter in your office that is built on intentionality and rapport, there is a very good chance they will still recommend you to others based on their positive experience.
Extend yourself and every clinical encounter to be an ambassador of Oriental Medicine.
Sharon Sherman, L.OM., D.OM.
Overview Evaluation & Management (E/M) Coding
The following PDF provides an overview of Evaluation & Management (E/M) Coding (pdf)
Regulatory & Risk Management Resources
OSHA Sample Management Plans
- OSHA sample management plans, including Bloodborne Pathogens, Hazard Communications, and Respiratory Protection.
- Medical and Dental Office guide to OSHA compliance
OSHA Bloodborne Pathogens Standard
- Code of Federal Regulations for the OSHA Bloodborne Pathogens Standard (Note: link does not include the Needlestick Safety & Prevention Act, which adds additional Bloodborne Pathogens Standard requirements.)
- OSHA Bloodborne Pathogens Fact Sheets
- Summary of the Needlestick Safety & Prevention Act
OSHA Hazard Communication Standards
Material Data Safety Sheets (MSDS):
- M Phais Alcohol Prep Pads
- PDI Sani Cloth Germicidal disposable wipes
- CaviCide Disinfectant Solution
- Purell Instant Hand Sanitizer with Moisturizer and Vitamin E
- US Department of Health and Human Services Household Products Database - Health & Safety Information on Household products (from manufacturer MSDS)
HIPAA Privacy & Security Rules
- Summary of the HIPAA Privacy Rule
- Guidance on the Privacy Rule
- Summary of the HIPAA Security Rule
- HIPAA Guidance on the Security Rule, including administrative, physical, and technical safeguards, policies, documentation requirements, and advice for small providers
- Notification requirements for breach of unsecured protected health information
- Link to a (non-governmental) summary of security provisions in the HITECH Act, which modifies the HIPAA Security Rule
Risk Management
Sample Business Associate Agreement Provisions
A "business associate" is a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information. A "business associate" also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. The HIPAA Rules generally require that covered entities and business associates enter into contracts with their business associates to ensure that the business associates will appropriately safeguard protected health information. The business associate contract also serves to clarify and limit, as appropriate, the permissible uses and disclosures of protected health information by the business associate, based on the relationship between the parties and the activities or services being performed by the business associate. A business associate may use or disclose protected health information only as permitted or required by its business associate contract or as required by law. A business associate is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of protected health information that are not authorized by its contract or required by law. A business associate also is directly liable and subject to civil penalties for failing to safeguard electronic protected health information in accordance with the HIPAA Security Rule.
A written contract between a covered entity and a business associate must: (1) establish the permitted and required uses and disclosures of protected health information by the business associate; (2) provide that the business associate will not use or further disclose the information other than as permitted or required by the contract or as required by law; (3) require the business associate to implement appropriate safeguards to prevent unauthorized use or disclosure of the information, including implementing requirements of the HIPAA Security Rule with regard to electronic protected health information; (4) require the business associate to report to the covered entity any use or disclosure of the information not provided for by its contract, including incidents that constitute breaches of unsecured protected health information; (5) require the business associate to disclose protected health information as specified in its contract to satisfy a covered entity's obligation with respect to individuals' requests for copies of their protected health information, as well as make available protected health information for amendments (and incorporate any amendments, if required) and accountings; (6) to the extent the business associate is to carry out a covered entity's obligation under the Privacy Rule, require the business associate to comply with the requirements applicable to the obligation; (7) require the business associate to make available to HHS its internal practices, books, and records relating to the use and disclosure of protected health information received from, or created or received by the business associate on behalf of, the covered entity for purposes of HHS determining the covered entity's compliance with the HIPAA Privacy Rule; (8) at termination of the contract, if feasible, require the business associate to return or destroy all protected health information received from, or created or received by the business associate on behalf of, the covered entity; (9) require the business associate to ensure that any subcontractors it may engage on its behalf that will have access to protected health information agree to the same restrictions and conditions that apply to the business associate with respect to such information; and (10) authorize termination of the contract by the covered entity if the business associate violates a material term of the contract. Contracts between business associates and business associates that are subcontractors are subject to these same requirements.
This document includes sample business associate agreement provisions to help covered entities and business associates more easily comply with the business associate contract requirements. While these sample provisions are written for the purposes of the contract between a covered entity and its business associate, the language may be adapted for purposes of the contract between a business associate and subcontractor.
This is only sample language and use of these sample provisions is not required for compliance with the HIPAA Rules. The language may be changed to more accurately reflect business arrangements between a covered entity and business associate or business associate and subcontractor. In addition, these or similar provisions may be incorporated into an agreement for the provision of services between a covered entity and business associate or business associate and subcontractor, or they may be incorporated into a separate business associate agreement. These provisions address only concepts and requirements set forth in the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules, and alone may not be sufficient to result in a binding contract under State law. They do not include many formalities and substantive provisions that may be required or typically included in a valid contract. Reliance on this sample may not be sufficient for compliance with State law, and does not replace consultation with a lawyer or negotiations between the parties to the contract.
Sample Business Associate Agreement Provisions
Words or phrases contained in brackets are intended as either optional language or as instructions to the users of these sample provisions.
Catch-all definition:
The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.
Specific definitions:
(a) Business Associate. "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean [Insert Name of Business Associate].
(b) Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean [Insert Name of Covered Entity].
(c) HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.
Obligations and Activities of Business Associate
Business Associate agrees to:
(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;
(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
[The parties may wish to add additional specificity regarding the breach notification obligations of the business associate, such as a stricter timeframe for the business associate to report a potential breach to the covered entity and/or whether the business associate will handle breach notifications to individuals, the HHS Office for Civil Rights (OCR), and potentially the media, on behalf of the covered entity.]
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;
(e) Make available protected health information in a designated record set to the [Choose either "covered entity" or "individual or the individual's designee"] as necessary to satisfy covered entity's obligations under 45 CFR 164.524;
[The parties may wish to add additional specificity regarding how the business associate will respond to a request for access that the business associate receives directly from the individual (such as whether and in what time and manner a business associate is to provide the requested access or whether the business associate will forward the individual's request to the covered entity to fulfill) and the timeframe for the business associate to provide the information to the covered entity.]
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity's obligations under 45 CFR 164.526;
[The parties may wish to add additional specificity regarding how the business associate will respond to a request for amendment that the business associate receives directly from the individual (such as whether and in what time and manner a business associate is to act on the request for amendment or whether the business associate will forward the individual's request to the covered entity) and the timeframe for the business associate to incorporate any amendments to the information in the designated record set.]
(g) Maintain and make available the information required to provide an accounting of disclosures to the [Choose either "covered entity" or "individual"] as necessary to satisfy covered entity's obligations under 45 CFR 164.528;
[The parties may wish to add additional specificity regarding how the business associate will respond to a request for an accounting of disclosures that the business associate receives directly from the individual (such as whether and in what time and manner the business associate is to provide the accounting of disclosures to the individual or whether the business associate will forward the request to the covered entity) and the timeframe for the business associate to provide information to the covered entity.]
(h) To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.
Permitted Uses and Disclosures by Business Associate
(a) Business associate may only use or disclose protected health information
[Option 1 – Provide a specific list of permissible purposes.]
[Option 2 – Reference an underlying service agreement, such as "as necessary to perform the services set forth in Service Agreement."]
[In addition to other permissible purposes, the parties should specify whether the business associate is authorized to use protected health information to de-identify the information in accordance with 45 CFR 164.514(a)-(c). The parties also may wish to specify the manner in which the business associate will de-identify the information and the permitted uses and disclosures by the business associate of the de-identified information.]
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information
[Option 1] consistent with covered entity's minimum necessary policies and procedures.
[Option 2] subject to the following minimum necessary requirements: [Include specific minimum necessary provisions that are consistent with the covered entity's minimum necessary policies and procedures.]
(d) Business associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164 if done by covered entity [if the Agreement permits the business associate to use or disclose protected health information for its own management and administration and legal responsibilities or for data aggregation services as set forth in optional provisions (e), (f), or (g) below, then add ", except for the specific uses and disclosures set forth below."]
(e) [Optional] Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.
(f) [Optional] Business associate may disclose protected health information for the proper management and administration of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures are required by law, or business associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies business associate of any instances of which it is aware in which the confidentiality of the information has been breached.
(g) [Optional] Business associate may provide data aggregation services relating to the health care operations of the covered entity.
Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
(a) [Optional] Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate's use or disclosure of protected health information.
(b) [Optional] Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate's use or disclosure of protected health information.
(c) [Optional] Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate's use or disclosure of protected health information.
Permissible Requests by Covered Entity
[Optional] Covered entity shall not request business associate to use or disclose protected health information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by covered entity. [Include an exception if the business associate will use or disclose protected health information for, and the agreement includes provisions for, data aggregation or management and administration and legal responsibilities of the business associate.]
Term and Termination
(a) Term. The Term of this Agreement shall be effective as of [Insert effective date], and shall terminate on [Insert termination date or event] or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement [and business associate has not cured the breach or ended the violation within the time specified by covered entity]. [Bracketed language may be added if the covered entity wishes to provide the business associate with an opportunity to cure a violation or breach of the contract before termination for cause.]
(c) Obligations of Business Associate Upon Termination.
[Option 1 – if the business associate is to return or destroy all protected health information upon termination of the agreement]
Upon termination of this Agreement for any reason, business associate shall return to covered entity [or, if agreed to by covered entity, destroy] all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form. Business associate shall retain no copies of the protected health information.
[Option 2—if the agreement authorizes the business associate to use or disclose protected health information for its own management and administration or to carry out its legal responsibilities and the business associate needs to retain protected health information for such purposes after termination of the agreement]
Upon termination of this Agreement for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall:
- Retain only that protected health information which is necessary for business associate to continue its proper management and administration or to carry out its legal responsibilities;
- Return to covered entity [or, if agreed to by covered entity, destroy] the remaining protected health information that the business associate still maintains in any form;
- Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as business associate retains the protected health information;
- Not use or disclose the protected health information retained by business associate other than for the purposes for which such protected health information was retained and subject to the same conditions set out at [Insert section number related to paragraphs (e) and (f) above under "Permitted Uses and Disclosures By Business Associate"] which applied prior to termination; and
- Return to covered entity [or, if agreed to by covered entity, destroy] the protected health information retained by business associate when it is no longer needed by business associate for its proper management and administration or to carry out its legal responsibilities.
[The agreement also could provide that the business associate will transmit the protected health information to another business associate of the covered entity at termination, and/or could add terms regarding a business associate's obligations to obtain or ensure the destruction of protected health information created, received, or maintained by subcontractors.]
(d) Survival. The obligations of business associate under this Section shall survive the termination of this Agreement.
Miscellaneous [Optional]
(a) [Optional] Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.
(b) [Optional] Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.
(c) [Optional] Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.
Reference: www.hhs.gov
Electronic Medical Records
An electronic medical record (EMR) contains the standard medical and clinical data gathered in one provider's office. Electronic health records (EHRs) are broader in scope, going beyond the data collected in one provider's office to include a more comprehensive patient history. For example, EHRs are designed to contain and share information from all providers involved in a patient's care. EHR data can ideally be created, managed, and consulted by authorized providers and staff from across more than one health care organization. The federal Department of Health & Human Services is rapidly encouraging general adoption of "Certified EHRs" that are capable of this.
As medical care grows more and more complex, a greater and more seamless flow of information within a digital health care infrastructure, created by electronic records, is expected to enhance the way care is delivered and compensated. This idea has been promoted by the Obama administration, with strong bipartisan and industry support. Aided by provisions in the HITECH Act (part of the American Recovery and Reinvestment Act of 2009), the Department of Health and Human Services is offering financial incentives to hospitals and physician practices that can achieve what it calls "meaningful use" of certified EHRs by certain dates. Providers who fall behind in achieving meaningful use will eventually receive lower reimbursement rates for treating Medicare patients.
Links to more information on Meaningful Use:
Health care organizations are moving rapidly to digitize new and existing patient records to improve efficiency, reduce costs, enhance patient care and meet the government's goals for adopting Electronic Medical Records. While the EMR promises great benefits, such as quickly and effectively providing access to the right records throughout the treatment cycle and across a health system, information management also poses great challenges, especially in the area of compliance. Paper records must be scanned, converted to digital, and managed throughout the process in a manner that is secure, compliant1 and cost-effective.
HIPAA compliance plays a critical role in document conversion and the transition to electronic records. Document conversion, by itself, is a straightforward process. Documents are scanned in a digital format and transmitted directly into the EMR system. However, the conversion process raises many complex issues related to compliance. For example:
- How will you store electronic records in a way that makes them accessible, compliant and affordable?
- Will you be able to maintain retention and destruction schedules that meet regulations and your own requirements so you store only the records you need to store, whether paper or digital?
The HIPAA Privacy Rule is intended to ensure that Protected Health Information (PHI) is not used or disclosed inappropriately or without the patient's general consent or specific authorization. The Security Rule is specifically designed to protect PHI that is used and stored electronically (ePHI). Both aspects of the rule apply to document conversion. HIPAA rules cover three broad areas of activities to ensure secure records storage:
- Administrative Procedures: Operational processes and procedures, such as training, workflow, and the release of information, to ensure that information is always handled according to policy. This section of HIPAA also requires a contingency plan, also known as a disaster recovery plan (data backup and archiving services).
- Physical Safeguards: Physical controls, such as locks, access to keys and supervision, to protect against unauthorized physical access.
- Technical Safeguards: Data-related information systems and associated controls, such as database security, network protection and user authorizations and passwords, to protect data from software intrusions and attacks.
Administrative Procedures: HIPAA requires that PHI and ePHI be protected and secured throughout all stages of document conversion. This means that documented procedures for operational processes such as training, workflow and contingency planning must be put in place to ensure that information is always handled according to policy.
EMR software or services must meet this requirement in several ways:
- Physically restricting access to customer public health information during transit, conversion, storage and disposal of both the original paper documents and the converted electronic records.
- Electronically tracking and maintaining an auditable log of all tasks and operations performed.
- Providing tools to manage how employees access digital records, as well as workforce training and management: HIPAA requires training of workers who handle PHI.
- Contingency planning for document conversion and implementation of disaster recovery services. These may include centralized management of information and back up systems, as well as maintenance of an auditable trail of all activities related to document conversion.
Physical and Technical Safeguards: HIPAA requires safeguards for data-related information systems and associated controls, such as database security, network protection and user authorizations and passwords, which protect ePHI and control access to it. Processes should be in place to safeguard data at all stages of document conversion. Furthermore, HIPAA requires documentation that records are protected throughout their lifetime, up to and including their destruction.
Technical safeguards include:
- Firewall and virus protection.
- Secure password protection.
- Role-based access rules, so users can access only the software and data to which they have been granted access.
- Unique user IDs to identify and track user identity.
- Direct integration with major EMR systems or delivery via a secure FTP site.
- Health care data encryption, or a form of data security whereby electronic medical records are disguised so that unauthorized users may not read or make sense of them.
In addition, document conversion may require additional safeguards to protect information integrity, such as:
- Automated contrast, brightness and threshold adjustments to optimize image quality.
- Multi-feed detection to prevent page overlaps and missed images.
When designed and implemented well, EMRs offer significant benefits toward improving overall quality of care, increasing care efficiency and reducing healthcare costs. Thus, selecting an EMR system is a critical decision and a significant planning task. The Regional Extension Centers (RECs) thus recommend the following steps in transitioning to EMR:
1. Assess Your Current Practice
The assessment should look at the current state of the practice.
- Are administrative processes organized, efficient, and well documented?
- Are clinical workflows efficient, clearly mapped out, and understood by all staff?
- Are data collection and reporting processes well established and documented?
- Are staff members computer literate and comfortable with information technology?
- Does the practice have access to high-speed internet connectivity?
- Does the practice have access to the financial capital required to purchase new or additional hardware or software?
- Are there clinical priorities or needs that should be addressed?
- Does the practice have specialty specific requirements?
2. Envision the Future
The next EMR implementation step is to envision the future state of the practice. What would the practice leadership like to see different in the future? More specifically:
- What will be different for the patients?
- What will be different for the providers?
- What will be different for the staff?
3. Implementation Planning
- Analyze and map out the practice's current workflow and operating processes.
- Map out how EMRs will enable desired workflows and processes, creating new workflow patterns to improve inefficiency.
- Create a contingency plan to address issues that may arise throughout the implementation process.
- Create a project plan for transitioning from paper to electronic medical record keeping.
- Identify concerns and obstacles regarding privacy and security and create a plan to address them. It is essential to emphasize the importance of privacy and security when transitioning to EMRs.
4. Software Comparison
After establishing the practice's objectives and planning how electronic record keeping will affect workflows, the leadership can determine what to look for when considering and selecting an EHR system. The following are several considerations for EMR software comparison:
- Look for CCHIT certification **This certification ensures that the system or software has been reviewed by the federal government and has passed the minimum requirements for security. Certification further indicates, since the price of EMR can be substantial, that the software has sufficient financial backing to remain in business.
- Understand if and how a vendor's product will accomplish the key goals of the practice. Look for software that will allow provider input in establishing unique templates and patterns.
- Clarify start-up pricing before selecting an EMR system (hardware, software, maintenance and upgrade costs, option of phased payments, cost to connect to health information exchange (HIE), customized quality reports).
- Define implementation support (amount, schedule, information on training, communication efficiency).
- Clarify roles, responsibilities, and costs for data migration strategy.
- Consider server options (client server, application service provider (ASP), software as a service (SAS)). A note on ASP capability- Particularly for practitioners that do not have an IT person on staff, having a secure third party service host the software, take care of the upgrades, handle the support, and manage the back-ups for a monthly fee is a recommended way to go to EMR.
- Ability to integrate with other products (practice management software, billing systems, and public health interfaces). Note- It is essential that the EMR system have the ability to connect with most practice management systems. Being able to use HL7 (Health Level 7) protocols for transferring information, for example, is the gold standard in the healthcare field.
- Privacy and security capabilities and back-up planning.
- Vendor's stability and/or market presence in region.
- Cost to connect to Health Information Exchange (HIE)- Consider costs of using legal counsel for contract review verses open sources through medical associations.
Find additional guidelines to structure and complete EMR/EHR implementation contracts with vendors
Add Western Herbalism to Your Practice
Tri-State College of Acupuncture has paired up with ArborVitae School of Traditional Herbalism to offer current students and alumni a comprehensive education in Traditional/Western Herbalism.
There are two ways to learn:
1) Classes & Events: ArborVitae will host community classes & events that span a broad range of topics and are open to the public. Classes vary in duration, and will be taught by local instructors as well as expert national and international teachers and practitioners. New courses are added regularly.
2) Professional Herbal Studies: ArborVitae offers a 1 year program in Family Herbalism and 3 year program in Clinical Herbalism.
The first year program offers over 320 hours of instruction in the foundations of herbal care. Students in the program will receive a comprehensive introduction to the art and science of herbal medicine. Using a holistic approach, instructors will cover a range of material that is rooted in North American herbalism and incorporates a range of other traditional approaches to health. Students will learn holistic anatomy & physiology, field botany and plant id, medicine making, traditional nutrition, first aid, energetic assessment, Vitalism, and more. The first year experience is detailed on the ArborVitae website at http://arborvitaeny.com/year1/
The first year program can be taken as a standalone course, or as the first in the three year clinical program that ArborVitae will be offering. Classes will be held weekly on Tuesdays and one weekend per month, at the Tri-State College of Acupuncture, 80 8th Avenue @ 14th street, as well as at a variety of outdoor spaces. More information on class dates can be found at http://arborvitaeny.com/year1-logistics/
Apply by July 1st and receive a $300 discount off of your tuition!
Human Resources Links
Acupuncture Practice Employee Manual
Example Employee Manual
For a growing business it is vital to have clearly stated policies and procedures. If the time has come to hire employees, then you will want to draft an Employee Manual. Download this 48 page example employee manual for guidance.
Notice of Privacy Practices (Example)
Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
We are required by law to provide you with this notice to explain our privacy practices with regard to your health information. This document describes how we may use and disclose your protected health information (PHI) for treatment, payment, healthcare operations, and other purposes permitted or required by law. Your rights with respect to your protected health information are also described in this notice.
Effective Date
This Notice of Privacy Practices became effective on [DATE] and was amended on [DATE].
Right to Amend This Notice
We reserve the right to change the provisions of our Notice of Privacy Practices and make new provisions for the privacy of the protected health information we maintain. If we make a material change, we will post the amended notice promptly on our website: http://[YOUR_WEBSITE_HERE]
What is Protected Health Information (PHI)?
Protected health information is individually identifiable health information we obtain or generate in providing our services to you. Such information may include documenting your symptoms, examination results, test results, diagnoses, treatments, and applying for future care or treatment. It also includes billing documents for those services.
Types of Uses and Disclosures of Protected Health Information
We will use and disclose your protected health information to provide, manage, and coordinate your care and any related services. We will also disclose your protected health information to other providers whom we may consult or coordinate with in your care, such as obtaining the input of a specialist.
We will use your protected health information to obtain payment for services provided. For example, we may provide protected health information to a health insurance company or to a business associate to obtain payment for your treatment.
Healthcare Operations
We will use your protected health information for the management functions of our office. For example, your protected health information may be used in quality reviews, outcome evaluations, and staff performance reviews. Additionally, your protected health information may be used as necessary by business associates who provide us with services such as legal services, accounting services, insurance, and training programs.
HITECH Amendments
HITECH Breach Notification Requirements
We are required under the HITECH Act to notify each individual whose unsecured PHI has been (or is reasonably believed to have been) accessed, acquired, or disclosed due to a breach. Our Business Associates have a similar duty under this Act. Unsecured PHI refers to private information that is readable by unauthorized individuals. Secured PHI is encrypted to be rendered unreadable, unusable, or indecipherable to unauthorized individuals. We will notify you by first class mail within 60 days of our discovery of such an event.
HITECH Restriction of Disclosure
Under the HITECH Act, if you pay out of pocket in full for services, you can require that the information regarding those service not be disclosed to your health insurance plan, as no claim to them is involved.
HITECH Access to Electronic Health Records
Under the HITECH Act, if we maintain electronic health records in one or more designated record sets, you have the right to obtain an electronic copy of your PHI, and you may by written request have us send your record electronically directly to another party. We may only charge you the labor cost for this service.
HITECH Expansion of Accounting Disclosures
As of January 1, 2014, the HITECH Act requires us, on your written request, to provide an accounting of all disclosures made using electronic records of your PHI to carry out treatment, payment, and healthcare operations. This accounting requirement is limited to the three year period prior to the request. We will provide you with an accounting of such disclosures made by us, and a list of our business associates including their contact information, who on your written request will be responsible for providing you with an accounting of their disclosures of your PHI.
HITECH Prohibition on Sale of PHI
Under the HITECH Act, neither we nor our business associates may receive direct or indirect remuneration in exchange for your PHI without your prior written authorization, unless that exchange meets one of the limited exceptions allowed by the Act.
HITECH Subsidized Marketing Limitations
Under the HITECH Act, we are restricted from most types of subsidized marketing communications to you that encourage you to make purchases, without your prior written authorization.
HITECH Fundraising Limitations
Under the HITECH Act, if we send a fundraising communication to you, we must also offer you an opportunity to opt out of future fundraising communications.
Other Ways We May Use and Disclose Your Protected Health Information
Appointment Reminders
We may contact you by telephone, postcard, or email to remind of appointments. Please let us know if you do not wish to receive these communications.
Communication with Family
We may use and disclose relevant portions of your protected health information to your family member, relative, close friend, or other person you identify as being involved in your care or payment for care. In an emergency or when you are not capable of agreeing or objecting, we will use and disclose your protected health information as we determine is in your best interest. We will inform you after the emergency and give you the opportunity to object to future disclosures to family and friends.
As Required By Law
We will use and disclose your protected health information when we are required to do so by federal, state or local law. We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, or as directed by court order.
Food and Drug Administration (FDA)
We may use and disclose to the FDA your protected health information relating to adverse events with respects to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Health Oversight Agencies
We may use and disclose your protected health information to appropriate health oversight agencies for health oversight activities.
To Avert a Serious Threat to Public Health or Safety
We may use and disclose your protected health information to public health or legal authorities permitted to collect or receive the information for the purpose of preventing or controlling disease, injury, or disability. We may disclose your protected health information to public authorities as required by law or regulation to report abuse or neglect.
Worker's Compensation
We may use and disclose your protected health information to Worker's Compensation or similar programs that provide benefits for work-related injuries or illnesses, for your compensation.
For the purposes of research that has been approved by an institutional review board and uses established protocols to ensure the protection of privacy of health information, we may use and disclose your protected health information to researchers.
If you are an inmate of a correctional institution, or under the custody or a law enforcement official, we may use and disclose to the institution or its agents, or to the law enforcement official, your protected health information necessary for your health and the health and safety of other individuals.
Other Uses Or Disclosures Not Covered By This Notice
Other uses and disclosures besides those identified above will be made only by your written authorization. You may also revoke an authorization you previously provided.
Your Health Information Rights
The health and billing records we maintain are the physical property of our practice. The information in those records, however, belongs to you.
Request Restrictions on Uses and Disclosures of Your Protected Health Information
You have the right to request a restriction on how we use and disclose your health information for treatment, payment, and healthcare operations. For example, you might request non-disclosure of a treatment to a family member or other person involved in your care. Another example is given under the HITECH Restriction of Disclosure clause. Your request must be made in writing to the Privacy Officer at our office. We are not required to grant all requests but we will comply with any request we do grant, except for emergency treatment.
Receive Confidential Communication
You have the right to request the ways we communicate with you to preserve your privacy. For example, you might request we only call you at your work number, or by mail at a certain address. Your request specifying how we are to contact you must be made in writing to the Privacy Officer at our office. We will accommodate all reasonable requests to communicate with you by alternate means or at alternate locations.
Inspect and Copy Your Protected Health Information
You have the right to inspect and copy the protected health information we maintain about you in our designated record set, which includes medical, billing, and any other records used for making decisions about you. Any psychotherapy notes are by law not available for inspection or copying. The HITECH Act, as previously noted, expands this right to include access to electronic health records in an electronic format. To inspect or copy your protected health information, submit a request in writing to the Privacy Officer at our office. We will respond within 30 days. We may charge you a fee for copying or mailing, but may only charge for labor costs for electronic transfers of health records.
Request an Amendment to Your Protected Health Information
You have the right to request that we amend your medical information if you feel it is incomplete or inaccurate. You must make this request in writing to the Privacy Officer at our office, explaining what information is incomplete or in error, how it should be changed, and the reasons for the change. We are not required to grant all such requests. You may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.
Receive An Accounting of Disclosures of Your Protected Health Information
You have the right to request a list of disclosures of your protected health information that were not for treatment, payment, or healthcare operations. Your request must be in writing, addressed to the Privacy Officer at our office, and must state the time period (not greater than 6 years) for which you request an accounting. Under the HITECH Act, as previously noted, you may request an accounting of all disclosures made using electronic records of your PHI to carry out treatment, payment, and healthcare operations, limited to the three year period prior to the request.
Obtain A Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice. Copies are available in the reception area of our office, and you can always ask us for a copy.
Our Responsibilities
We are required to abide by the terms of this Notice. Among other duties, we are required to maintain the privacy of your health information as specified by law and regulation; to provide you with a notice of our duties and privacy practices; to notify you of certain breaches of privacy; to notify you if we cannot accommodate a restriction or request; and to accommodate reasonable requests regarding methods to communicate health information with you.
File a Complaint
If you believe we have violated your privacy rights, you may file a written complaint within 180 days of the suspected violation, addressed to the Privacy Officer at our office. Please provide as much detail as you can on the matter. We will never retaliate against anyone for filing a complaint.
You may also file a complaint with the Secretary of the United States Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201; phone(202) 619-0257; toll free (877) 696-6775.
If you have questions, would like additional information or assistance, or want to report a problem regarding the handling of your information, please contact our Privacy Officer. [NAME] at [TELEPHONE_NUMBER] during our normal office hours. Or you may contact the Privacy Officer in writing at:[ADDRESS].
Interview with Richard Stillo, L.Ac.
Length of time in practice?
6 years
Big lessons learned? Hardest lessons learned?
In many cases, patient perception is more important than therapeutic results with regard to practice success. Take insurance (out of network) no matter how much you hate it.
How many patients per week? At beginning of practice and now?
Beginning of practice - 5/wk, now 70 to 100/wk.
How long to build practice?
2 years.
Initial overhead cost? Bank loan?
$25,000, no bank loan.
Salary? Fees for service?
No salary, just draw. $125 for initial tx, $75 for follow-up tx.
Previous profession?
Information Technology management.
Marketing tools - which if any were most effective?
Website, newspaper (effective only for ethnic communities).
Specialities ? (Conditions)
NAET for allergies (works great), sports medicine, pain management.
Logistics of your practice - office mgr, assistant?
No office help, just two acupuncturists.
Cell phone only or business land line?
Just cell phone.
Building your business- speaking engagements? Health fairs? Referral network? Which worked best?
Seminars in office; health fairs did not work; lectures to groups did not work.
Take insurance? No fault?
Out of network insurance.
Provide education services?
Not explicitly, but educating patients all the time.
Prescribe herbs other supplements or products?
Did you have a grand opening?
Practice solo or with other practitioners?
With my partner.
Contact with colleagues? Mentor? Peer review?
My partner, several peers from TSCA.
How many CEUs do you take?
A lot.
Who is your target population? Demographics?
Chinese community, allergy patients.
Top 3 conditions you treat?
Allergies, back pain, neck pain.
Slow season? Busy season?
No set pattern.
Who covers your practice? Vacation, sick days holidays?
No one, we close the practice. But never more than 3 or 4 days at a time.
Any supplemental income unrelated to acupuncture?
Online booking?
Great idea, but not yet.
Where are your patient records? Electronic?
Paper, in office.
Cancellation policy? How do you enforce?
Not enforced. Not much of a problem.
Supply inventory - cost ? And items?
I don't track inventory.
Go to resources? Lhasa, kamwo… .?
Labrix for bio-identical hormones, and Desbio for homeopathics.
Interview with Dr. John Hamada, DC, L.Ac.
Where are you located?
Pennington, NJ
When did you graduate, and did you have an intention to specialize in a certain field?
I graduated in 1998 with no specialty, but wanted to integrate my chiropractic practice from the start. The clients I had at the beginning were pretty much across the board. Later I took a secondary interest in Lyme disease, cancer, and occupational health. Now I'm looking more into working with cancer patients.
When did you start your chiropractic business and how did that work alongside acupuncture?
I started chiropractic in '84, and later when I integrated acupuncture in '98 it was a smooth transition. Now my practice is about 50/50 between chiropractic and acupuncture.
How much are your fees and how long are your appointments?
Initial visits are $125, follow ups are $70. I schedule in 20 minute blocks of time.
How much did you need to start your business?
I already had an existing chiropractic business. I can't remember the exact number but it included enough for rent, first and last month etc., tables, office equipment. At first I had 2 chiropractic tables, then added 2 acupuncture tables. I would say maybe about 20K would be a reasonable estimate so as to include 2-3 months rent as back-up.
How did you initially get your clients?
Location is important, and then I did local flyer distribution and neighborhood networking. I didn't advertise in the paper. Once you've established comfort in practice, then you can contact medical practitioners. Coming right out of acupuncture school, it's a tougher sell. You really need confidence and experience to talk to doctors and get them to want to be involved. Once I was established, existing clients brought in new clients via word of mouth. I think it would be good to ask your patients to find the new patients for you.
Is there a strategy behind not having a website?
I'm actually working on it now, I've just been busy and haven't gotten to it as much as I would like to. I think I was a little late on the internet, it must be a generational thing.
Do you deal with insurance and if so, what challenges have you faced in that area?
Yes I do take insurance, it's actually a large part of my business. I would say about 80% of my patients use insurance for chiropractic, and 50% for acupuncture. I have someone working on the paperwork for me now, but I would say in the beginning you should do it yourself to learn the nuances of the system. Where we're going in healthcare I think it's an important thing to learn. I typically get reimbursed 80% of my fees. In NJ, many state workers have coverage so that helps.
How do you keep your medical records; paper or electronic?
Since I started I have been keeping paper records, but am now transferring to electronic records. It's a slow process, but it makes sense for the future.
What was your biggest mistake in practice?
That's hard to say, but I think it would be getting off focus.
What advice do you have for new graduates?
Just get out there and start doing it. What you do right after you graduate is not what you will be doing 10 years from now. It's an evolving process.
Constructing a mission statement
Useful links to help you when constructing a mission statement for your acupuncture practice:
Support Your Marketing Claims with Research
1997 NIH Consensus Statement on Acupuncture
What does current research indicate about the effectiveness of acupuncture for a particular disorder? Search the National Library of Medicine's database
Research article: Acupuncture use among American Adults
U.S. Census Bureau demographic data
Check out your local department of health for publication of local vital health statistics.
For example: http://health.westchestergov.com/statistics
European Acupuncture Licensing and Education
Reviewing these articles gave me a better understanding for how Acupuncture is taught, practiced and licensed in Europe.Part of my interest in doing this research is because I lived in Berlin, Germany as a child and with enough effort I could probably get EU citizenship through my mother who is natively German.
The first article, "A comparison of Acupuncture History, Education Practice and Licensing in Europe and the United States," summarizes history and education practice focusing on Germany and Austria. By early 16th century, Acupuncture had reached Europe through Portuguese, Danish, Dutch and French missionaries, traders and physicians. In the beginning of the 19th century, acupuncture was an experimental experience. Not until the 70s did the practice begin to establish itself, largely through the work of George Soulie de Mourant whose scholarship and diplomatic employment to China (1901-1917) allowed him to publish articles and French translations of Chinese and Japanese texts. Also, Professor Dr. Franz Huebotter after spending time in China published work on Chinese medicine that unfortunately never became popular or useful to German physicians. By the 20th century, clinical acupuncture co-developed with biomedicine. Georg Bachmann MD studied French acupuncture and brought the practice to Germany. One of his students, Professor Dr. Johannes Bischko, a surgeon from Vienna, established the practice in Austria.
Acupuncture training is only offered to physicians in Germany and Austria. Whereas Great Britain and the Netherlands offers education comparable to the US. The standard education comprises of 120 theoretical hours and 25 practical hours. There is one written and one oral exam and a Diploma in Acupuncture can be earned. Austria accredits 1500 out 5000 acupuncturists, however in Germany, the Physicians' Association does not recognize accreditation, so any MD could practice. By 1998 30,000 were practicing Acupuncture in Germany resulting in two German Medical Associations of Acupuncture to restructure the education standards.
The ETCMA : European Traditional Chinese Medicine Association represents approximately 10,000 practitioners in 14 countries. The purpose of the organization is to promote wider recognition of the practice, exchange information about education and statutory regulations. Lobbying EU institutions to influence health care policy is also a priority as is facilitating research. The site contains studies on herbal medicine and acupuncture. Full members include mostly Northern European countries : Belgium, Czech Republic, Denmark, Finland, France, Germany, Ireland, Israel, Netherlands, Norway, Poland, Sweden, Switzerland and the UK.
I also did a brief search for Acupuncture and licensing in Greece. Requirements are as follows:
- should be a medical doctor, dentist or veterinary doctor
- should attend acupuncture training, at least 300 hours
- should be a member of local med association
The three Acupuncture Associations are: Medical Acupuncture Association of Northern Greece; Hellenic Medical Acupuncture Association; Panhellenic Medical Acupuncture Society
So, if I wanted to pursue practicing in Europe, I would have to get a medical degree (or "should" in Greece). And this postulates the notion that BioMedicine is the foundation and Acupuncture is a technique, which as we have learned is not necessarily the best application of knowledge. Acupuncture and Chinese Medicine are whole systems of medicine that need to exist in their own right. We battle this notion with Medical Acupuncturists here in the US, and with PTs who wish to practice trigger point dry needling.
China imported biomedicine and has created hospitals with both divisions to a largely complimentary degree. Yet I believe the difference and understanding in China is that traditional medicine has deeper roots than biomedicine and is more respected and on par with how biomedicine works.
Quality Management Resources
National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
Articles on acupuncture treatment outcomes
NCCAOM Code of Ethics
State Acupuncture Associations
NCCAOM-approved Continuing Education resources
Dealing with Difficult and Upset People
In any walk of life whether it's in relationship with your significant other, family, friends, colleagues, patients or even complete strangers there's bound to be some conflict. The truth is, difficult people are everywhere and there's no hiding from them; there's no job where you won't encounter a few from time to time. Within any business practice there are relationships between the clients or patients in the case of acupuncture, colleagues, vendors and employees. In any of these relationships the dynamics can be stressful to say the least and when you have a difficult personality or upset person or difficult, upset person it can feel unbearable.
In the book, "Dealing with People You Can't Stand" by Dr. Rick Brinkman and Dr. Rick Kirschner they discuss ways in dealing with difficult people and conflict that may arise in one's life whether it's personal or professional. They begin by introducing the reader to the "people you can't stand" in the first chapter with the "most unwanted list" which describes the "behavior patterns that sane people resort to when they feel threatened or thwarted, which represent their struggle with or withdrawal from undesired circumstances(Brinkman, Kirschner, 3) The idea behind getting to know those you can't stand (as Kirschner and Brinkman put it) is to familiarize yourself to better understand difficult people and possible reasons as to why they may be acting out a particular behavior pattern. This will in turn allow the reader to arm themselves with knowledge and emotional intelligence to make a choice in how they react to the situation. Your attitude is everything in heated moments of conflict.
There is no way to pinpoint every single type of difficult personality and behavioral pattern, but here is a list of the 10 most common along with your goal and action plan in dealing with those difficult personalities and behavioral patterns.
1. The Tank
Pushy and ruthless, loud and forceful, aggressive, or with the quiet intensity and surgical precision of a laser, the Tank assumes that the end justifies the means. Expect no mercy.
Your Goal: Command Respect without becoming a tank yourself
Action Plan
Step 1: Hold your ground; stay put and hold your ground, neither running away nor gearing for battle.
Step 2: Interrupt the attack; the best way to interrupt people, whether they are yelling or not, is to evenly say their name over and over again until you have their full attention.
Step 3: Quickly backtrack their main point; once you have a Tank's attention, backtrack the main accusation. Backtracking sets a good example of listening with respect, and it conveys that you have heard the Tank.
Step 4: Aim for the bottom line and fire; the attention span of a Tank is extremely short, so you have to cut to the chase as fast as you can. Preface your bottom line with your ownership of it, by saying, "From my point of view," or "The way I see it." This prevents your shot at the bottom line from restarting the war.
Step 5: Peace with Honor; never close the door in the Tank's face. You must leave the door open as it gives the Tank room to back off. When the accusations of Tanks are untrue, their perceptions unrealistic, or their demands unfair, you must redirect to a peaceful solution by offering them the last word, but you decide where and when.
2. The Sniper
This covert operator identifies your weaknesses and uses them against you, through sabotage behind your back or well-aimed put-downs in front of the crowd.
Your Goal: Bring the Sniper out of hiding.
Action Plan
Step 1: Stop, Look, Backtrack; interrupt yourself, and bring all your activity to a complete standstill. Scan for the Sniper, and then backtrack whatever they said. There is a great deal of power in interrupting yourself. Whether you're one-on-one or there are witnesses present, self-interruption brings all attention to bear on the Sinper, incluing the attention of the Sniper. Whenever you follow a Sniper's interruption with a quick backtrack of the offensive remark, that's equivalent to catching a bullet in midair and letting it fall harmlessly to the ground. The nonverbal message is "You missed me."
Step 2: Use the Searchlight Questions:The intent question; "When you say that, what are you really trying to say?" The relevancy question; "What does that have to do with this?"
Step 3: Use the Tank strategy if needed; if the Sniper becomes a Tank and starts accusing you of being the case of this or that problem, no problem. It is important to use the Tank strategy to command respect not only from the Sniper but those who witnessed the attack.
Step 4: Go on a grievance patrol; if you suspect someone is holding a grudge against you, but you're not certain, go on patrol and see what you can scout out.
Step 5: Suggest a civil future; Whether private or in the public, finish the interaction by suggestion an alternative behavior or the future. Example: "In the future, if you have a problem with me, come talk to me about it one-on-one. I promise to hear you out."
3. The Know-It-All
This person knows 98% of anything. Just ask! Know-It-Alls will tell you what they know- for hours at a time – but won't take a second to listen to your clearly inferior ideas.
Your Goal: Open the Know-It-All's mind to new ideas
Action Plan
Step 1: Be prepared and know your stuff!
Step 2: Backtrack Respectfully; Be warned: you will have to do more backtracking with Know-It-Alls than any other difficult danger zone behaviors. They must feel like you have heard and understood the "brilliance" of their point of view before you ever redirect them to your idea.
Step 3: Blend with their doubts and desires; you must show how your idea factors into he Know-It-Alls specific criteria for what they believe to be the "right" idea.
Step 4: Present your views indirectly; use softening words like maybe, perhaps, this may be a detour, bear with me a moment, etc. Use plural pronouns like we or us. Use questions instead of statements. As you ask your questions, include how the Know-It-All's doubts and desires will be handled if he or she acts on your ideas and information.
4. The Think-They-Know-It-All
These characters don't know much, but they don't let that get in the way. Exaggerating, bragging, misleading, and distracting, these legends-in-their-own-minds pull you off track.
Your Goal: Give their bad ideas the hook
Action Plan
Step 1: Give them a little attention; Backtrack to their comments with enthusiasm. Acknowledge positive intent rather than wasting your time with their contact.
Step 2: Clarify your specifics.
Step 3: Tell it like it is.
Step 4: Give them a break.
Step 5: Break the cycle; break the escalating cycle by doing two things: Use the gentle confrontation to tell them the truth about the consequences of their negative behaviors, and actively look for and notice what these problem people are doing right, and give them credit where credit is due.
5. The Grenade
When the Grenades blow their tops, they're unable to stop and shrapnel hits everyone in range. Then the smoke clears, the dust settles, and the cycle begins building to a critical mass again.
Your Goal: Take control of the situation.
Action Plan
Step 1: Get their attention; to get people's attention when they are losing control of themselves, call their name, raise the volume of your voice so you can be heard through the explosion, and wave your hands slowly back and fourth in front of you.
Step 2: Aim for the heart; Show your genuine concern for these problem people by saying what they need to hear. By listening closely, you can determine the cause of the explosion, then backtrack while reassuring them of your concern.
Step 3: Reduce the intensity.
Step 4: Take time off for good behavior; there's absolutely no point in trying to have a reasonable discussion about the cause of the explosion while a Grenade has adrenaline still coursing hotly through his bloodstream. So this is the time to take time out and to let things cool the rest of the way down.
Step 5: Prevention: find the pin and don't pull it.
6. The Yes Person
Quick to agree, slow to deliver, the Yes People leave a trail of unkept commitments and broken promises. They please no one, the Yes People over commit to please!
Your Goal: Get commitments you can count on.
Action Plan
Step 1: Make it safe to be honest; make the communication environment a safe one, so that the tow of you can honestly examine whether promises being made for the future will be promises kept.
Step 2: Talk honestly.
Step 3: Help them learn to plan.
Step 4: Ensure Commitment; Ask for their word of honor, ask them to summarize the commitment, get them to write it down, set weird deadlines, describe negative consequences.
Step 5: Strengthen the relationship
7. The Maybe Person
When faced with a crucial decision, the Maybe People keep putting it off until it's too late. But there comes a point when the decision makes itself. Then it's nobody's default but their own.
Your Goal: Help them learn to think decisively.
Action Plan
Step 1: Establish and maintain a comfort zone; remember when you are dealing with people in the get along quadrant, intensity drives them deeper into the wishy-washy behavior. Even if you could intimidate Maybe People into making a decision, they would probably change their mind ads soon as they were pressured by someone with a different agenda. To help them think clearly, you must develop a comfort zone around the protest of making the decision. Instead of pushing them too hard to make a decision, you're going to take your time and be as considerate as you can possibly be.
Step 2: Surface conflicts and clarify options; patiently explore, from the Maybe Person's point of view, all of the options and the obstacles involved in making the decision, as well as any people that might be adversely affected by the decision. List for word of hesitation like probably, I think so, pretty much, that could be true, and so on, as signals to explore deeper.
Step 3: Use a decision-making system; draw a line lengthwise on a piece of paper and divide the page in half. Put one of your choices at the top and list all the pluses below and all of the minuses on the other side and then repeat the process for each option.
Step 4: Reassure them, and ensure follow-through; once the decision is made, reassure the Maybe Person that there are no perfect decisions, and that the decision is a good one. Then to ensure follow through, stay in touch until the decision is implemented.
Step 5: Strengthen the Relationship; promote the idea of a better future for the both of you as a result of their honesty with you.
8. The Nothing Person
You won't know what's going on because they tell you nothing! No verbal feedback. No nonverbal feedback. They seal their mouths and stare past you as if your not there.
Your Goal: Persuade the Nothing Person to talk.
Action Plan
Step 1: Plan enough time; hostile Nothing People may push you up against your deadline. You need information badly, they've got it, you want it, and so they won't give it to you. For this reason, protect yourself if possible by planning ahead.
Step 2: Ask open-ended questions.
Step 3: Lighten it up; when nothing else is working, a little humor carefully used can go along way.
Step 4: Guess; If the Nothing Person remains silent and nothing else has gotten results, or you want an alternative to Option 3, try guessing why they are silent. Once you've come up with an idea suggest it to the Nothing Person and watch for a reaction.
Step 5: Show the future; sometimes, the only way to get Nothing People to talk is to take them out of the moment and into the future. There they can see the consequences of the continued silence, and perhaps they can find enough perspective and motivation to open up.
9. The Whiner
There's a plan for their lives, but they're not in it. Instead, they wallow in their woe, whine incessantly, and carry the weight of the world on their shoulders.
Your Goal: Form a problem solving alliance.
Action Plan
Step 1: Listen for main points; we recommend you listen with paper and pen in hand so you can write down the main points of the complaint. Whiners love this because it shows them that you are listening. This will help you backtrack and clarify.
Step 2: Interrupt and get specific; Take command of the conversation through a tactful interruption. Then ask clarification questions to get the specifics of the problem, because generalizations are rarely solvable.
Step 3: Switch the focus to solutions; Once you begin to get specific about Whiners complaints they find themselves face-to-face with the specifics of a problem. Ask them "what do you want?"
Step 4: Show them the future; when people have been feeling helpless, it is helpful to give them something to look forward to.
Step 5: Draw the line; if none of the above works with the Whiner then drawing the line on the interaction is a necessity.
10. The No Person
They say that "what goes up must come down." And what comes down must never be allowed to get back up again. Doleful and discouraging, they drive others to despair.
Your Goal: Transition to problem solving.
Action Plan
Option 1: Use the Whiner strategy; your first option for dealing with negative people is to use the Whiner strategy in order to get them to be specific. No People, like Whiners are adrift in a sea of generalizations.
Option 2: Use them as resources; No People can potentially serve two valuable functions in your life: they can be your personal character builders, and they can serve as an early warning system for problems. If you want to have some fun, the next time your No Person starts to overwhelm you with negativity, place your hand gently on their shoulder, look them in the eye, and say "Thank you for the wonderful work you're doing." It will probably confuse them, it may stop them, and you'll probably feel better for messing with them.
Option 3: Buy some time; No People tend to operate in a different time reality than other people. Any effort to rush them to a decision will force them to slow down.
Option 4: Go for the polarity response; the single worst thing you can do with a No Person is try to convince them that things are so bad. This forces them to polarize more deeply into their negativity. But when you meet them at the edge of their polar response, and go just a little further, the only way they can stay negative to your negativity is to go positive.
Option 5: Acknowledge their good intent; if you are willing to project good intent onto negative behavior. No People may come to believe it themselves"(Brinkman, Kirschner, 4-189).
As stated earlier, it is nearly impossible to list all the possible conflicts, difficult personality types and behavioral patterns, but this gives people a place to start. Sometimes difficult personalities are actually incredibly good at their jobs and if you can learn to work with that particular personality type then it could be a relationship well worth the effort. Sometimes it might not be, especially in the case of patients; perhaps the patient is dangerous to continue working with in certain situations. This is something acupuncture practitioners have to consider and then determine what constitutes a possible danger in working with a patient. It could be that this person could cause legal troubles, or headaches too big to contend with or even a person who suffers from an ailment that is outside the practitioner's scope of practice or level of comfort. Whatever the issues, this is something all acupuncturists should take time to consider before starting a practice and then continue to hone as they have more experiences within practice.
Work Cited: R. Brinkman and R. Kirschner. 2012, The McGraw Hill Companies, United States.
Pricing Products & Services
In order to establish what your pricing products & services should be, follow the below exercise.
Step One: Who's My Competition?
Always do a thorough competitive landscape study of practitioners in your area.
- What are they offering in terms of services?
- What are they offering in terms of products? For each competitor practitioner be able to know: Product, Price, Positioning, Claims, Location. Also include online retailers such as Amazon for products. Map it out. Try using this plotting technique for Steps 1 & 2 to determine where you are in relationship to your competition.
Step Two: Who Am I?
Ask yourself, relative to other professionals in my area – what am I offering and what is my point of difference? Establish your positioning as a business.
You will want to ensure you are in a competitive price point for your marketplace and educational / experiential background or offer some other value proposition that is unique to your product or services. What sets you apart to charge the price that you do?
Step Three: What is My Pricing Model?
Option A: Standard Retail Pricing Example:
Note: Cost of Goods (COG) averages 10-15% of sale price depending on industry COG includes, packaging, raw materials, labor, overhead
The Manufacturer has done the competitive research and can only sell their product, Herbal Magic to their retailer, the acupuncturist at $10. Their COG is currently $1.50, making them a profit of $8.50.
The Retailer (The Acupuncturist in this scenario) has also done a competitive analysis and will be able to sell to the customer at the MSRP (manufacturer's suggested retail price) of $20 – 100% markup The Acupuncturist / Retailer makes a profit of $10.
If the competitive research would only support the Acupuncturist to sell at $18, they would be making less of a profit but could continue to support their sales goals.
Option B: Variable / Amortized Pricing Example
Herbal Magic has expanded their product line to 3 products, all which have varying COG due to their high natural content.
Therefore the Manufacturer will sell to the acupuncturist following their standard COG formula of maximum 15% (as indicated above).
Product A COG $6.00 Product B COG $3.00 Product C COG $1.50
$40 sale price $20 sale price $10 sale price
The Acupuncturist decides to carry the entire new Herbal Magic line but can only sell to patients at a maximum of $30 /formula despite, having to buy Product A from the manufacturer for $40!
The Acupuncturist decides to amortize the profits over the sales of all 3 products by charging $30 / for each formula.
Caution: You must ensure that you sell enough of Product C in order to make up for carrying Product A. You will do this through your forecasts and sales plan.
Step Four: Purchasing Your Wares
When purchasing from a supplier as an acupuncturist – there are 2 things that may happen:
- The supplier may offer to sell to only practitioners at wholesale cost who in turn sell to patients. This is the scenario where the above standard retail or variable / amortized models would apply.
- The supplier may have their own retail outlets and only sell to practitioners at a mildly discounted rate of 5-10% depending on volume (1). This scenario, you would not be making much of a profit, but would be able to supply your patients with the convenience factor of purchasing from you.
Step Five: Set Sales Goals
Some practitioners are uncomfortable with the idea of 'selling.' Instead think of supplying your patients with the tools they need in order to improve their health and reach their treatment goals.
By providing each client with an herbal formula at $30/patient/month You see an average of 30 patients/week = 120 patients/month You followed the above standard retail formula and earn a net profit of $15 / patient.
This equals a modest $1800 additional dollars of no pressure sales a month or approximately $21,600/year.
By not recommending a formula / product – you are leaving $$$ on the table!
Step 6: Disaster Strikes! Considering Variables: Quantities, Natural Disasters, and Discounting, Oh My!
Quantities: If your business if going gangbusters… Congratulations! You may be in a position to bargain. By building good relationships with manufacturers in terms of quantities and ordering regularity, you may be able to negotiate your purchase price.
Natural Disasters: Keep in mind natural products such as herbs and essential oils can have volatile raw material pricing that can be dependent on 'acts of god' such as weather, crop yields, supply chain issues, tainted batches, regulatory changes.
For example: 3-4 years ago – Rose oil skyrocketed from $1Million / Kilo to $2Million / kilo due to a Rose shortage in Bulgaria. If selling Rose oil is a cornerstone of your income, you need to have a contingency plan to deal with unanticipated events.
Pricing Transparency: Be transparent with your pricing to avoid any confusion. Many healthcare professionals provide a price list on their website or posted in their office in order to avoid any confusion from the patient / customer's standpoint.
Here is a good resource for healthcare pricing – although it does not include acupuncture, it will give you an idea of what other healthcare practitioners in your area may be charging.
Discounting: Avoid Discounting! Discounting encourages people to constantly seek out a deal or negotiate with you. They may only come to see you when there is a 'sale.'
Instead offer a Gift w. Purchase or Token of appreciation. Discounting devalues a business, your wares, and your name. By offering a gift you are rewarding loyalty and purchasing which will grow your business.
(1) Based on a small inquiry into some suppliers for acupuncturists. For example: Crane, Kamwo
Sources: Catherine Craig – self knowledge – Estee Lauder Companies Product Development and Marketing Sept 2005 – Nov 2010
Business & Self-Employment Tax Information
The IRS has come helpful information on business taxes and Self-Employment, Social Security, and Medicare Taxes
Budgeting, Bookkeeping & Virtual Assistants
Learn more about budgeting & bookkeeping software on Forbes.com, read a great article on virtual assistants, and check out http://zirtual.com/.
Insurance Billing Seminars - Spring/Summer, 2013
The American Acupuncture Council is offering Insurance Billing Seminars in Spring and Summer of 2013. The seminars will cover:
- Health Care Reform & Essential
- Health Benefits
- Coding
- Cash
- Insurance Billing Protocol
- Managed Care
- State Specific Rules and Regulations
- Workers' Compensation
- Personal Injury
- Third party and attorney lien claims
- Front Office Protocol (Basic Version Only)
There are both Basic and Advanced seminars. What differentiates the two seminars is the pace and depth of the presentation. The Advanced presumes an existing knowledge of billing, whereas the Basic presumes only a minimal foundation.
Learn more about the seminars, including dates, locations, and costs here >
Free Webinar - Core Entrepreneurial Skills
Acupuncture Today is offering a free webinar on entrepreneurial skills for healthcare practitioners on March 7, 2013. Learn more about Introduction to Core Entrepreneurial Skills for the Health Care Professional here.