The IHPC board elevated the importance of Equity, Diversity and Inclusion (EDI) at its January board retreat by creating a Standing EDI Committee. The committee will ensure that IHPC is consistently working to build a diverse and inclusive organizational culture and membership and that it is advocating on behalf of all people, eliminating barriers to health and health justice. The committee will be chaired by Sharad Kohli, MD, who will be working with the Partners for Health to recruit additional committee members. The board focused much of its time in the retreat on restructuring of the organization to improve its effectiveness and expand its representation of integrative health professionals. IHPC Executive Director, Tracy Bowen, notes that the current structure limits the number of member organizations. The proposed new IHPC Assembly will allow for an unlimited number of members that meet IHPC’s criteria for professional associations. Under the proposal, a smaller and nimbler IHPC Board would be voted in by the Assembly. “There was broad consensus and support for this, and I am excited for this evolution of IHPC,” said Bowen. The proposed changes will now be honed and finalized by the Restructure Workgroup and presented to the IHPC leadership and board for approval. The Workgroup is hoping to present the final details on the restructure as early as April of this year. Bowen and David Fogel, MD, provided an update on the just formed IHPC Capitol Hill Outreach Team that includes Bowen, Fogel and Mary Jo Hoeksema, IHPC’s new Government Relations support. Bowen and Fogel reported that near-term focus will be strengthening, expanding and educating the Congressional Integrative Health and Wellness Caucus. “We’ve generated renewed enthusiasm with the Caucus co-chairs Congresswomen Chu and Walorski and their staffs, and we are developing plans with them for the Spring and onward,” said Bowen. Fogel and Bowen are working to increase the size of the Caucus and reported that they have started meeting with several Congressional offices and have already added Congressman Jamie Raskin as a new Caucus member. The group discussed ways to support Capitol Hill Outreach efforts, including reaching out to Representatives to invite them to join the Caucus, and explored legislative priorities for 2020 and beyond. The IHPC board also elected new Co-Chairs Sharad Kohli, MD and Gerard Clum, DC. The pair replaces long-time chair Len Wisneski, MD, FACP, who will remain on the IHPC board. Dr. Kohli currently works as a primary care physician at People’s Community Clinic, a Federally Qualified Health Center in Austin, Texas, where he is developing an integrative pain management program, and was previously a leader of the Partner for Health organization Integrative Medicine for the Underserved (IM4US). Since retiring from the presidency of Life Chiropractic College West, Dr. Clum has worked as Presidential Liaison for External Affairs at Life University. He has also been appointed the director of The Octagon, a think-tank sponsored by Life University. In addition, he serves as a consultant and expert witness in matters related to chiropractic practice and care. Other newly elected members of the executive committee include: Margaret Erickson, Ph.D., RN, CNS, APHN-BC, who will serve as Vice Chair. Erickson has been CEO of the American Holistic Nurses Credentialing Corporation (AHNCC) since May 2000 and has practiced holistic nursing for almost 40 years. Stephen Welsh, DC, FICA, who will serve as treasurer. Welsh is an active member of the International Chiropractors Association (ICA) and the Georgia Council of Chiropractic (GCC). He has more than twenty years’ experience in financial, technical and administrative services supporting a successful chiropractic practice with his wife, Dr. Claire and daughter Dr. Kristen. The board also elected three new At-Large Directors including: C Leslie Smith, MS, MA, LAc, MD, Integrative Medicine Director, Culinary Medicine Assistant Professor SIU School of Medicine, who will serve on the Communication Committee. David Fogel, MD, who will work on advocacy on Capitol Hill. Laura Farr, Executive Director of the American Association of Naturopathic Physicians since 2017- and 15-years’ experience with the naturopathic profession, who will work on public policy. IHPC wishes to extend its deep gratitude to the outgoing At-Large Directors for their years of excellent service: Coquina Deger, of a Partner for Health representing Bastyr University, Ron Duskin of AIH, and Susan Luria, former director of University Hospitals Connor Integrative Health Network in Cleveland.
Moving IHPC policy goals forward takes ongoing and consistent effort with all hands on deck and boots on the ground. That is why IHPC has announced its 2020 Capitol Hill Outreach efforts will include a new collaborative partnership with David Fogel, MD, founder of the groundbreaking integrative clinic Chi Health Care. He will be teaming up with Tracy Bowen, IHPC’s Executive Director to bring his unique background in integrative healthcare and help IHPC to build and support the bi-partisan Congressional Integrative Health and Wellness Caucus. He will also help advance targeted federal legislative priorities, such as expanded coverage for Integrative Health and Wellness in CMS Medicaid, Medicare, Veterans, Pain Management; the Social Determinants Act; and research funding for integrative health and wellness. As a pioneer in the concept of integrative medicine, Dr. Fogel is uniquely qualified for this new advocacy role. A native of Washington, DC, his background in alternative and integrative practice stems from a boyhood experience in martial arts, which set the stage for a lifetime of interest in eastern philosophy and an openness to the idea that western conventional culture is not the only way to see things. Fogel did go to medical school but quietly experimented with alternative approaches like acupuncture as far back as the 1970s. He started his first integrative center in the late 90s, and he says this gave him the first taste of the power of a team-based interdisciplinary approach. Unfortunately, this early effort struggled financially because of the poor reimbursement standard, so Fogel went back to private practice in internal medicine with a specialty in mind/body psychotherapy. But his interest in the integrative model remained and he continued to refer his patients to alternative practitioners as his own form of collaborative care. Fast forward to 2011. A local philanthropist in Gaithersburg, Md., approached Fogel about opening a new integrative center. His first thought was to decline because of his experience with the discouraging financial prospects, but then reconsidered. Fogel asked the group to fund a study, in which he and a team of healthcare professionals would look at existing integrative centers and discover what made them successful. “Based on that study, we put together a model using different parts of what we’d seen,” he said. “An important part of that was the new value-based model that was just coming on the scene. Fee-for-service is a horrible incentive. It makes much more sense to incentivize keeping people well.” The research also taught them that most centers were surviving with grant money or by bypassing insurance reimbursement altogether, which made integrative care largely accessible only to the elite and affluent. Because the new clinic, name Chi Health Care, had a generous grant, Fogel, serving as the CEO, made it open to all insurance including Medicare and Medicaid and developed a sliding scale for people who were under ensured. “The exciting part of the practice was that it exposed us to a whole new segment of people who knew nothing about integrative medicine,” he recalled. The clinic also explored the culture of an integrative primary care practice looking not only at what it did for patients but staff as well. “Our model was not just about teaching practitioners to meditate or eat better, but looked at how they interacted with each other,” Fogel explained. So many clinics had different practitioners under one roof but they were all doing their own thing, he added. “Our model paid and required practitioners to collaborate. So we actually got better health outcomes at a lower cost, with fewer hospitalizations, lower pharma use and fewer ER visits when compared to conventional practices.” Sadly, after six years in practice, value based payment reforms which were central to the business model, hadn’t matured to a level to make the clinic financially sustainable and David made the difficult decision to close the clinic in 2019. When asked why he thinks the concept of integrative medicine is still such a tough model, Fogel cited the need for ongoing and extensive education. “In some ways, even though there is a lot of information and evidence that people are using an alternative-based lifestyle approach to health, I don’t think, in general, people understand much about the integrative approach. Small segments of the population and physicians do get it, a growing number of people are trying acupuncture, but they don’t understand how powerful and cost-effective a collaborative approach is.” The rest, he added, comes down to the counterintuitive resistance from pharmaceutical companies and just plain old ignorance. “Many medical societies including the one here in Maryland are still opposed to naturopathic doctors getting prescribing rights. People also don’t know that NDs get the same curriculum as allopathic doctors. So lots of education still needs to happen,” he said. With the closing of his clinic some of Fogel’s time and resources remained available through his nonprofit Chi Health Care, which led him to connect with IHPC. Fogel sees IHPC strategic goals of building the Congressional Caucus and supporting the broader applications of integrative care for the opioid crisis as critical. “That is one message to bring to folks on the hill,” he noted, “that integrative medicine is not just for pain but also an approach for addiction treatment.” While Fogel is a newcomer to policy work, he believes that he and IHPC’s executive director Tracy Bowen make a good team. “Tracy has the background in policy work and I bring my passion and clinical experience to it.” The bottom line, he added, is that “I feel like this is something I am supposed to be doing. While it was painful to close the clinic, I can use the tools and messages I have gained to get out there and help make integrative care a key part of health care.”
The Integrative Health Policy Consortium (IHPC) will hold its annual board retreat next month. On January 23-26, 2020, the board will gather at Life University in Marietta, Ga., to discuss a restructuring of the consortium’s governance, as well as legislative priorities of their Partners for Health organizations. As a fast-growing not-for-profit corporation that has built a vital network of professional organizations who are bringing integrative health care to the forefront in the U.S., IHPC depends on its members to help determine this ongoing work and strategy. If you have any pressing issues that you would like to see addressed, please connect to the leadership site on the IHPC website or contact IHPC directly via email at email@example.com. IHPC is comprised of 28 organizations and institutions and 12 at-large national experts representing more than 600,000 state-licensed and nationally certified healthcare professionals. They are the regulated (licensed or nationally certified) providers of integrative medicine, holistic nursing, chiropractic, acupuncture, naturopathic medicine, public health, certified professional midwifery, massage therapy, nutrition and homeopathy. IHPC is a trusted voice on Capitol Hill. It was founded in 2001 at the request of legislators who recognized the need on the Hill for a national organization representing the consensus voice of the integrative healthcare community, aligned around wellness, health creation and choice. IHPC is championing the Congressional Integrative Health & Wellness Caucus and functions as a critical watchdog of the federal agencies overseeing America’s health and health research needs. IHPC envisions a world with no barriers to health and is focused on removing barriers to health and promoting a healthier world that incentivizes health creation for all individuals, communities and the planet.
The Academy of Integrative Health and Medicine’s (AIHM) annual conference is well known for many things, including an outstanding speaker program and prestigious awards that recognize deserving individuals in the integrative health community. But this year the real highlight of “People, Planet and Purpose” was about making new connections with other similar movements to look at the bigger questions of how to create a healthier world. The big takeaway from the October conference, according to AIHM Executive Director Tabatha Parker, ND, is “how do we integrate our movement to start to think more strategically and thoughtfully partner with other like-minded movements, like sustainable agriculture and organic products.” Parker noted that a key discussion during the four-day event was a panel featuring Zach Bush, MD, a triple-board certified physician, who has also worked to bring about radical change in big farming, pharma and Western medicine; Jeff Tkach of the Rodale Institute, who is responsible for expanding the institute’s influence to heal people and the planet through regenerative and organic agriculture; and David Bronner, the cosmic engagement officer (CEO) of Dr. Bronner’s Soap, a leading natural personal care brand that has pushed the envelope in standards for GMO labeling, hemp farming, organic certification and fair trade. The session looked at how integral sustainable agriculture and organic products are to integrative health. “We have come a long way in bringing our groups together around health and health policy work and education. But we are now starting to see more crossover into other areas that are also trying to change the system. The transformation of health care is embedded in a larger transformation taking place in our society,” she said. Another highlight of the meeting for Parker was the gathering of different leaders from the many integrative health organizations including IHPC, Integrative Medicine for the Underserved (IM4US), the Academic Consortium of Integrative Medicine and Health (ACIMH), Academic Collaborative for Integrative Health (ACIH), and the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM), among others. “A couple of these organizations have brand new executive directors, so we met face to face for the first time. It was great to spend time with them and discuss how to support each other moving forward into 2020 and beyond,” Parker said. The awards program is another way the association brings together people who have forged new trails in the area of integrative health. In keeping with its titled theme “People, Planet and Purpose,” the group presented three key awards including the lifetime Achievement Award (People), which this year was given to Daniel Asimus, MD, (a past IHPC board member); the Visionary Award (Planet), which this year went to one of the headline speakers, Deepak Chopra, MD; and the Change Maker Award (Purpose), which was presented to Liza Goldblatt, Ph.D., past chair and founding board member of ACIH for her work in the world of acupuncture. The awards are always very special, Parker said, because they are presented by the previous year’s winners, and most of the time the recipient is not aware they are getting the award. “So it is a surprise and a very special way to say thank you to the leaders of our community who have been working for decades to change health care.”
While a nonprofit organization’s life blood is its members and the passion behind its grassroots movement, it is also vital to acknowledge the importance of an executive director who works tirelessly to connect the dots and keep all the moving parts in order. With that in mind, IHPC is pleased to introduce Tracy Bowen, who was chosen from a list of nationwide candidates as its new Executive Director. A seasoned nonprofit executive, Tracy has been hard at work since early September applying her experience in coalition building, advocacy, government affairs, communications, strategic planning, organizational development and fundraising, among other things, on behalf of IHPC. Equally important, Tracy brings a passion for the mission of IHPC, which was sparked by her experiences during her first career as an emergency medical technician and has been nurtured through a lifelong commitment to integrative and whole person health. “I am honored to be a leader of IHPC at this time when its dedicated professional members are uniquely positioned to change national and state policies that will advance integrative health and wellness for all Americans,” she said. Prior to joining IHPC, Tracy worked independently as a consultant and strategic advisor for numerous organizations including Center for a New American Dream, Campaign for a Commercial Free Childhood, Sustainable Water Resources Roundtable and Institute for Sustainable Infrastructure. Tracy spent 12 years as Executive Director of the Alice Ferguson Foundation, growing the organization ten-fold and launching the highly successful multi-sector, cross-jurisdictional Trash Free Potomac Watershed Initiative. Tracy began her career in Washington, D.C., where she currently resides, as a political fundraiser on Capitol Hill. She holds a B.A. in International Relations from Michigan State University’s James Madison College and a Certificate in Nonprofit Management from Georgetown University. “Tracy is enthusiastic, extremely passionate regarding integrative health, and possesses the experience and talent required to carry out the vision and mission of IHPC,” said IHPC Board Chair Leonard Wisneski, MD, FACP. “We are quite fortunate to have her as our Executive Director.”
In what is being called a great first step by the integrative health community, Congress has proposed bipartisan legislation to help manage costs and improve outcomes for Medicaid recipients with help on a state and community level. The Social Determinants Accelerator Act introduced in July 2019 proposes planning grants and technical assistance to help communities address non-medical needs that are linked to health, such as food security, employment and housing stability. The proposed legislation, which has been endorsed by groups like the American Hospital Association and Aligning for Health, an association working to address such social determinants to health, suggests a growing recognition among political leaders that good health encompasses more than just addressing disease states and that social determinants like income equality, poor public transportation, and housing instability can also impact health and well-being.1 The new bill is a positive first step, according to Margaret Chesney, professor of medicine and former director of the Osher Center of Integrative Medicine, at the University of California, San Francisco School of Medicine, as well as a special advisor to IHPC. “This bill provides opportunities to reach out and encourage Congress to consider the importance of health in general and highlight a very important problem—that in many cases health is determined more by zip code than genetic code. Where we live, the schools in our neighborhood, the availability of low cost healthy fruits and vegetables, the presence of safe spaces to be outdoors, are all major determinants of our health status and longevity.” While the bill is a step forward, it doesn’t go far enough, she added. The focus of the bill is more on addressing individual social needs such as food insecurity or lack of transportation. Facilitating access to these services is helpful but falls short of addressing the on-going needs. Actually addressing social determinants requires looking at the policies that create the conditions which lead to poor health, according to Sharad Kohli, M.D., IHPC Policy Committee co-chair. “Integrative clinics,” he noted, “including many federally qualified health centers, are uniquely situated to address all of the factors that influence health including working on an individual clinical level with patients using both conventional and complementary health approaches, by directly working with patients to address their specific social needs, and by advocating for policy change that can lead to healthier communities.”2 There are integrative medicine clinics and programs, for example, that not only strive to combine the best of complementary and conventional care, but also to help individuals, families and communities create social and physical environments that are conducive to health. Perhaps we can build on the interest of lawmakers in this bill to help them move toward taking bolder steps to address social determinants of health. Though the legislation recognizes the importance of communities and hospitals linking people to existing available resources, there are still significant gaps to address in these programs. For example, Chesney noted, the recent water problem in Newark, N.J., where the city delivered cartons of water to certain points in the city where contamination was a problem, but seniors in three-story walkup apartments couldn’t access it. And the fact is, Americans are not getting the most efficient and cost-effective healthcare. Statistics show that among industrialized nations – Japan has the highest longevity – at 84.2 years and their health care cost is $4,766 per capita. In contrast, the U.S. life expectancy is 78.6 years and our health care costs are $10,586 per capita, more than twice that of Japan.3 “If we want to address the extremely high cost of healthcare, which is more than $10,000 per capita and our mortality rate, which is increasing rather than decreasing, then we have to look at the whole picture and need to make it possible to have a healthy lifestyle,” Chesney explained. If people have to take three buses across town to get to the food bank, that is not going to address the need. A better approach is to place food banks in hospitals. Chesney noted the preventative food pantry program at Boston Medical Center. “You see the doctor and get your recommendations for diet, say for diabetes, and then you go down a few floors and get the recommended food from the food bank. That is integrative medicine!” “Groups like IHPC are in an ideal position to advocate for bold ideas to help create healthier zip codes,” Chesney added. One such idea, she highlighted is the Morehouse Community Health Worker Training Program4 for High School Students and Young Adults, which offers youth skills that can be directly translated into a meaningful job and a career path for their lives. At the same time, these youth learn positive health skills that they can share with their peers and families. And that, Chesney added, will engage them in helping to change the world in which they live. References Castrucci BC, Fielding J, Auerbach J. Social determinants of Health—health isn’t just bugs and bacteria. The Hill. 4 2019. Castrucci BC, Auerbach J. Meeting individual social needs falls short of addressing social determinants of health. Healthaffairs. Jan. 16, 2019. Organization for Economic Co-operation and Development, 2019. oecd/healthstat/life-expectancy-at-birth.htm and Data.oecd/healthres/health-spending.htm. Morehouse School of Medicine. Community Health Worker Training Program for High School Students and Young Adults. https://www.msm.edu/Education/PipelinePrograms/hscommunityhealthworker.php
HHS Pain Management Report offers unprecedented potential to support advancement of integrative pain management protocols
The recent release of Pain Management Best Practices Inter-Agency Task Force Report from the U.S. Department of Health and Human Services (HHS) is an unprecedented opportunity to shed light on the potential of integrative and non-pharmacological approaches to pain management, according to the Integrative Health Policy Consortium (IHPC). Although the nation has been justifiably focused on the action of the pharmaceutical industry that has helped to perpetuate the opioid crisis by promoting drugs for pain that have known potential to cause addiction and harm, this report has received far too little attention, the Washington. D.C.-based non-profit organization said. “This document paints a path forward to effectively address pain with a multidisciplinary strategy utilizing non-pharmacologic approaches,” said IHPC Policy Committee co-chair Sharad Kohli, MD. “Many of the therapies recommended are not only safer, but more effective than opioids, will prevent unnecessary deaths, and will improve the quality of life for the millions of Americans currently suffering with pain.” The report identifies gaps and inconsistencies in pain management and offers recommendations for improving pain management best practices. The task force emphasizes key non-pharmaceutical centered approaches to improve the lives of patients living with acute and chronic pain. They include individualized patient-centered care fostering a therapeutic alliance between patients and clinicians and multidisciplinary approaches using one or more treatment modalities and the biopsychosocial model for pain care. The report also considers special patient populations and comorbid conditions that accompany complex pain. The Task Force also recommended that the Centers for Medicare & Medicaid Services (CMS) and other insurers align their reimbursement guidelines with these findings. The Inter-Agency Task Force Report is a welcome addition to the pile of reports generated by government agencies in the context of the opioid overdose syndemic, noted Robert Twillman, Ph.D., an IHPC at-large member and pain management psychologist at St. Luke’s Health System in Kansas City, MO. It is notable, he added, that the work resulting in the document was done by a select group of individuals directly involved with pain management in one way or another, and that it included a broad spectrum of such individuals, as mandated by the SUPPORT Act for Patients and Communities. “Asking those ‘in the trenches’ as people with pain, health care providers, and policymakers to survey the landscape and make recommendations for where we go from here is exactly the way such exercises should be carried out,” Twillman said. “Couple that with robust opportunities for public comment, both online and at the Task Force’s meetings, and you have a document that stands out as an example of the way things should be done.” The Task Force’s recommendations span five broad treatment approaches to pain management: Medication, Restorative Therapies, Interventional Procedures, Behavioral Health Approaches, and Complementary and Integrative Health. They are reinforced by four cross-cutting themes critical to all treatment approaches: Risk Assessment, Stigma, Access to Care and Education. It represents a philosophical and cultural shift to addressing chronic and acute pain by using Complementary and Integrative Health Protocols, IHPC said. It is gratifying, Twillman added, to see the task force recognize these ideas because previous guidelines and policies have given little more than lip service to these notions. “Many times non-pharmacological treatments for pain are recognized as preferred first-line therapy, but recognition of the tremendous access barriers to that kind of care is rare,” he said. “Those of us in the field know all too well how difficult it is for most people with pain to access non-pharmaceutical care, and for the Task Force to fully recognize this and recommend changes to coverage policies to promote access is very important.” Twillman sees this report as a tremendous opportunity for the field of integrative health and medicine. “It is a foot in the door that is enabled by the country’s tremendous problems related to the opioid misuse, abuse, overdose, and overdose death syndemics,” he said. The tremendous opportunity here for integrative providers to demonstrate the value of these interventions can’t be ignored, and the integrative health community needs to do everything in its power to leverage this report to improve access, Twillman added. “Any time a good report is issued, we talk about not letting it just gather dust on a shelf, and far too often, that is exactly what happens. I’m not sure we’ve ever had an opportunity like this, and we can’t allow it to go unrecognized.” You can read the full report and visit HHS’s accompanying toolkit here
Pain Insights, Inc. announces a comprehensive market research study conducted among 1,044 patients with moderate-to-severe chronic pain and measured patient views/satisfaction/outcomes on the use of opioids, non-opioids, OTCs, and non-pharmacologic therapies for treatment of chronic pain. The report, published in July 2019, updates “Harmonizing Clinical Practice and Clinical Guidelines in the Management of Chronic Pain: — From the Patient Perspective” published in June 2017. The updated report also looked at the impact of recent guideline recommendations on patient/practitioner views regarding opioids, the uptake of medical marijuana/cannabis, utilization of non-opioids and opioids for post-surgical pain (inpatient/outpatient). Among the study’s key findings: Patients currently taking an opioid for chronic pain declined from 59% to 48% in the updated study; approximately one in five patients with chronic pain indicated they have tried medical marijuana/cannabis as part of their pain therapy; and moving forward patients are recommending a broader approach that can be tailored to individual needs and include pharmacologic, non-pharmacologic, cognitive and spiritual support. Read more here http://www.paininsights.com/tracking-pain-in-america
Group medical visits are exceptional methods delivering critical components of integrative health care for treating and reducing the risk of a wide variety of chronic diseases, particularly in underserved populations. A Special Focus Issue on Innovation in Group-Delivered Services is published in The Journal of Alternative and Complementary Medicine (JACM), a peer-reviewed publication dedicated to paradigm, practice, and policy advancing integrative health. The Special Issue was developed in partnership with Integrative Medicine for the Underserved (IM4US) and Centering Healthcare Institute. The issue was led by Guest Editors Paula Gardiner, MD, MPH, University of Massachusetts Medical School (Worcester, Mass.), Maria Chao, DrPH, MPA, University of California, San Francisco, and Marena Burnett, Centering Healthcare Institute (Boston). The issue includes two editorials, four commentaries, a systematic review and eight original research articles. The broad diversity of contexts that are conducive to review are featured, from applications in federally qualified health centers to integrative oncology, and with themes ranging from the growing movement for community acupuncture to a commentary exploring the special ingredient that group brings. Read more here https://medicalxpress.com/news/2019-07-group-medical-access-advance-heath.html
A proposed study from the Centers for Medicare and Medicaid Services (CMS) on acupuncture for chronic low back pain represents what the IHPC Partner for Health, American Society of Acupuncturists (ASA), called a massive step toward incorporation of acupuncture into national health care. The goal of the CMS work is to conduct studies in the age group covered by Medicare, in order to determine if the evidence for acupuncture’s effectiveness in this specific group is sufficient to include it under general Medicare coverage. Once the studies are completed, the data will be analyzed to determine whether to cover acupuncture for low back pain in this population. While it is a step in the right direction and good news that acupuncture is being studied at this level, the ASA does have some concerns, according to David W. Miller, MD, L.Ac., chair of the group’s Board of Directors and a private practitioner at East-West Integrated Medicine in the Chicago area. “Our main concern is that licensed acupuncturists be explicitly included in the process, and that the service they provide be clearly recognized.” The association asked its members to provide comments to CMS by Aug. 15, asking that the section regarding “auxiliary providers” be changed to more clearly name “Licensed Acupuncturists or state equivalent.” The group also asked members to request that the supervision required during the study period be done only by medical doctors. The current language states that other practitioners such as Physician’s Assistants, Nurse Practitioners, and Nurse Specialists can also provide supervision. The ASA does not see this as appropriate, given that these practitioners do not typically have the training required to supervise acupuncture practice, unless they themselves are also legally trained as licensed acupuncturists, Miller noted. Supervision by other licensure types does not have any legal precedent and does not add in any way to the safety or quality of the trials, the group said in a statement to members. ASA cautioned members to remember in their comments that this is a groundbreaking moment for this type of study, and some error in concept is inevitable. In general, the acupuncture community is thrilled that CMS is moving in this direction. This type of access will allow millions of American seniors access to this effective, non-pharmacological option for pain control. This care may be a significant component in boosting quality of life for Medicare recipients, and decreasing our national opioid dependence.