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Dear OAA members and friends,

We would like to thank Dr. Fruehauf, NUNM, our OAA volunteers (and employee!), and you, the attendees!  Here's the decent recording of the excellent presentation Dr. Fruehauf gave.  

It's a little rough due to some technical difficulties we experienced, and we're sorry about that!  We think it works in the recording for the most part and we appreciate your patience with our learning curve and some technical hurdles.  

Speaking of technical difficulties, many of you were unable to log into the "meeting" at first because of our former attendee cap of 100.  We paid extra to Zoom to up our limit to 500 several days in advance.  We thought that would be the end of it, but of course that wasn't to be.  Our excellent administrative assistant Erin jumped in to help us change some settings which it turned out needed to be changed to allow our 500 attendee limit to become a reality.  It seems as if Zoom expected we would know that innately.  We signed up well over 200 registrants and at the peak got over 150 in the "room."  We're extra sorry for those that couldn't attend the meeting as it was cast live, but the consolation prize is this video (link below)!  

Please forgive my brief introduction as well.  I tried several times to do an introduction before I actually hit record, and lost connection several times over a two or three minute period due to our connection issues!  Hopefully our technical difficulties are now forever done.  

https://zoom.us/rec/play/tcB4c-6rp243SNKUtQSDVqQsW47sLf2sgyRKqPIMzE-0VyICOwDyYbMQMLBvkUQrAeA9xBzD2jq9XitP     


Thanks for your patience with us and support of one another and the Oregon Association of Acupuncturists. 

Yours,

Ross McCallum, LAc
OAA President

OAA COVID-19 Information Sharing Workgroup
Wednesday, March 25, 2020


This initial event was designed as a meeting for us to help support one another in these trying times, whether the attendees are intending to stay open or not.  Our questions were designed for one another to help answer among ourselves.
  1. What are each of us hearing about and doing to help support ourselves and our families whether we are closing or not?  Are you getting SBA loans or unemployment, for example?    
     
  2. If we are staying open (or if we want to open again any time soon), what are we doing to keep our patients, our families, and ourselves safe?  For example, what can we do if we don't have any proper protective equipment (PPE)?  
         

Chat Room with Beth as Facilitator

Discussion Points

  • Small clinics. Integrative. How can the Board create cohesive conversation. What are we doing?
  • Facebook can be disheartening
  • Taking care of self, keeping up with checkin in with patients, as able.
  • Most clinics not open, per group via hand-raise
  • Some allowing call in for picking up herbs
  • Based on CSOMA call guiding patients, is still E&M billing possibility, versus ACU or physical medicine intervention
    • 99421 (7 - 10 mins)
    • 99422 (10 - 20 mins)
    • 99423 (max)
  • These are telemedicine E&M codes only
  • Looking up under workman's comp, to see how and if they apply
  • Not successful in being paid in the past, but times are a'changing
  • If seeing patients OK to bill office visits
  • Folks in this break out are a mix of cash and insurance
  • One model is to waive co-pay. Inform insurer, try to bill E&M codes, and a bit of wait and see. State guidance welcome.
  • AAC guidance is to bill, but mindful of marrying their advice to state guidelines
  • PPE and minimum guidance for sole proprietorships, lots of questions
     
Seeing Patients
  • Seeing one at a time based on extreme medical need, avoiding clinic waiting room, consider liability, what is appropriate PPE??
  • Patients are pushing when can they come in, hard to say no. Going by relationship.
  • Consider distal versus local treatment, but still how do you limit contact?
  • Open doors for people, to avoid door handles
  • If you feel like it's solid, keep seeing them.  You can only reduce seeing regulars with chronic conditions so much
  • It's an individual decision
  • If patient is there, what is the protocol? They show up asking for service, what do you do?
  • Folks are looking to guidelines for in patient visits through first week of April
  • Mention COVID is SARS, not the flu, and it helps to reframe need for distancing and rescheduling
  • For those treating what is the PPE?
  • Recording for CSOMA call yesterday should be made available
  • Questions about lease and rentals. Hearing about being paid in full. Some asking to pay at end of year. Some are being referred for disaster loans.

Chat Room with Tracy as Facilitator
Our discussion revolved around checking in with all practitioners about how they are doing and what is happening with their practices. It was a very respectful discussion.  All practitioners shared openly and most expressed their gratitude about being able to connect with other acupuncturists during such a unique time.

Here are some key points that camp up:

  • Of the group all but two acupuncturists were closed to seeing patients
  • Many continue to prescribe herbs to their patients
  • One practitioner has begun doing telemedicine but using her mind body medicine and functional medicine training mostly
  • There was a wide range of opinions on the idea of telemedicine, with many practitioners struggling to determine how it would feel authentic to them
We did discuss telemedicine on the following questions were brought up:
  • What platforms for telemedicine are currently available?
  • How do we work as a profession to get telemedicine included in our scope of practice on a permanent basis?
  • Since we can't bill multiple units for telemedicine how doo we bill so that it is a financially sustainable model for us?
  • As many of us are very "hands on" with our patients how do we use telemedicine in a way that supports our style?

All the practitioners who shared are concerned about when they will be able to return to seeing patients and wondering what that will look like. How will they be able to safely treat patients?

Chat Room with Mary Jean as Facilitator
We mostly discussed moving our practices to Telemedicine and sharing ideas around how to do that, how much to charge, ideas for working with patients, marketing it to patients, etc. For those that have done some visits they report that patients have enjoyed the sessions.

How To Set Up:
  • Some have started to see patients.  Billing out E&M codes and collecting copays and trying to determine how much to bill if insurance does not cover the visit.
  • Discussed how much to charge for cash? One is doing a sliding scale for cash patients.
  • One person is offering different session lengths and different charges for those
  • One developed a symptom questionnaire to be filled out prior
  • Recommend to tell patients to have phone ready in case connection is lost
 

How to Market Telemedicine to Patients:

  • Recommend to ask patients to put down personal experiences and testimonials so can share with other patients
  • Contact those patients who you think might be interested directly and let them know you are offering this service
Ideas on working with patients: 
  • Do guided acupressure with the patient and then send them point protocols
  • Acupressure for immune and stress
  • Do guided acupressure with the patient and then send them point protocols
  • Acupressure for immune and stress
  • Show them how to gua sha - can use a butter knife handle, etc.
  • Guided visualizations
  • EFT
  • Qigong

Lastly, briefly talked about resource ideas and one mentioned to ask the landlord to reduce rent by 30% to 50% to be paid back at a later date.

Chat Room with Liz as Facilitator
Our conversations began with information on what services have become available/may become available for income recovery, as well as business assistance, before moving on to questions with regards to telemedicine.  Momentarily we discussed the future of acupuncture/herbs in Western healthcare settings.  Whether to remain open or not was a mixed bag. 

What assistance is available both for the individual and business:

  • Bill this morning was signed. Most of 'us' are self employed. Bill says if you've made $75,000 or less in 2018, you get full $1200. $500 per child (I believe this number may have changed?) Unemployment is 13 weeks longer.  SBA may have loans, with a small chance to not repay, if money used to continue paying someone's salary for payroll. If you are paying yourself through payroll or another (S corp?) this is a maybe.
  • Everyone even if independent providers who did not pay into unemployment can apply for unemployment during this crisis
Telemedicine:
  • Why can we only bill RETURN patients E&M? All the practitioners seem to have this
  • Who is currently allowing it?
    • Pacific Source will not
    • Prov and BCBS will
    • Moda unkown - supposed to send link out

How can we promote our telemedicine?

  • Malvin contacted everyone he'd been seeing regularly about herbs and chats were available
  • Offering classes, quigong, offering instruction on how to do acu current/gua sha
  • Knight is selling packages/gift certificates looking for support. Can ask for donations
  • Knight also is filling a Loss of Business Claim with insurance company - long shot - Anya was told no this was not an option in her own research
  • Online portal with telemedicine - organizes info and has billing function - Anya uses PRACTICE BETTER out of Canada
  • If any practitioners find themselves hard up upon returning to practice, Anya has room in her clinic and may have room to negotiate oncoming acupuncturists

The future of Acupuncture in the Western care system?
  • Malvin - Clark Howard said in the near future when front line medical people are completely exhausted we may be accepted as a part of the front line care team. If we can get trained up, we could become an important part of care. Who can we reach out to?
  • Douglas Wingate is at OSHU, what other connections do we have?
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