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Occ-health program incorporates it into PT
Integrating acupuncture with conventional physical therapy and work hardening has been both a medical and financial success for Good Samaritan Occupational Health Services in Avon, MA, according to its medical director, Robert P. Naparstek, MD. The on-site acupuncture program was initiated in January 2000.
"I had always wanted to do this," explains Naparstek, whose first exposure to acupuncture was as a rheumatology/immunology fellow in 1983-84. "The medical center was downtown near Chinatown. I met interesting people from Hong Kong and Taiwan, who invited me go downstairs to their storage room, where I met their cousin, who was a renowned master in acupuncture." When patients left, he adds, it would be with smiles and bows, and they often left their canes behind.
"Since then, I have always wanted to have the opportunity to do some integration [of acupuncture] with occupational health," Naparstek notes. From time to time he sent patients to acupuncturists, and some of them were able to get off of drugs like Percocet. "I did not do any formal measures, but I noticed anecdotally that there was improvement," he reports.
In 1995, Naparstek became medical director at Good Samaritan’s occ-health services. And in 1999, he became involved with the New England School of Acupuncture, a prominent institution in the region. "I felt it was now or never. I had significant autonomy, so I got an acupuncturist I had met through the school to come talk with us about integrating it into our program, and what kind of MMI [maximum medical improvement] we could reach with acupuncture." After that, he says, "I just basically did it."
The setup was fairly simple. Naparstek brought in the acupuncturist, Nicole Stockholm, MAc, LicAC, of the New England School of Acupuncture, to see patients on Tuesdays and Thursdays. The rest of the team comprised Naparstek and Good Samaritan’s physical therapist. The facilities were fairly large, with two rooms devoted to acupuncture. "We gave Nicole all the support she needed, the rooms, heat lamps — we’d even buy her needles," Naparstek notes. "In other words, we’d cover all the overhead and then we’d split the money."
Most of the patients came from corporate clients. About 50% were workers’ comp cases; the rest of the patients were billed direct. Acupuncture was not covered by their insurance, but the fees were reasonable — $86 for the initial visit and about $40 per follow-up visit. "The total cost of an average course of acupuncture is less than that of an MRI," Naparstek points out.
Factors such as strength and range of motion were measured regularly to assess patients’ progress. "Patients’ healing rates improved, he notes. "Acupuncture was clearly making a big difference in terms of numbers of lost days and getting people back to work."
He cites one case in particular to illustrate the important role acupuncture has come to play in treating patients. This particular patient worked for a nearby company that makes black electric tape. He regularly carried 50-pound barrels of toxic powder that easily can be inhaled, dumped the power, mixed it, and put it into special kilns. "He was an immigrant from Portugal — uneducated but intelligent, a low-wage individual who was a heavy smoker," Naparstek recalls. "He was complaining of pain in his left arm. Because he was left-handed, he moved the barrels more with his left arm, so I felt it was logical to look for an ergonomic cause. But I could not isolate a tendon, bursa, muscle, or joint as the source of pain."
His next thought was a possible cardiac problem, since the patient was a smoker. "I even sent him to our cardio department for a stress test, but that was normal," he says. Finally, the patient visited with the acupuncturist who interviewed him along with Naparstek. "He finally confessed that he had been under a lot of stress — he had lost his wife to breast cancer and was feeling very sad and overwhelmed," says Naparstek.
In the type of acupuncture Stockholm practices, there are a number of points associated with emotions and meridian lines. "She said the patient was terribly Yin deficient, and his lung meridian was profoundly blocked — that there was Chi stagnation, which she says is almost always associated with grief," Naparstek recalls. She began treating him, and he got "unbelievable relief [within two to three treatments]," he adds. "He started crying for the first time; he really grieved."
The patient ended up having nine to 10 appointments, went through the work hardening program for two weeks to regain strength, and then was back to full duty. "Acupuncture really does tend to stimulate the emotional issues associated with injury," says Naparstek. "People who are injured feel humiliated at work and become angry. Once they started talking about it and getting acupuncture, they no longer had symptoms."
Naparstek says he also is using acupuncture for his chronic patient resolution (CPR) program. "This is for chronic workers’ comp cases, where people have been out three to five years. We assert that managed care has not worked, and we make a deal with the adjusters: Give us six months, and we promise to state an MMI.’ This really suspends managed care for six months."
In CPR, acupuncture is a key part of the program, being used in combination with aquatic physical therapy, medical office visits, work hardening, and clinic psychology. "We treat them as aggressively as we can and then reach an MMI," he says. "We have had 30 people moved back either to full-time work or permanent modified duty, and acupuncture has played a huge role."
Naparstek is having some success with the insurance representatives, but there’s still work to be done. "I tell adjusters it will reduce future risk and free up reserves. That appeals to some, but others just do not want to give up authority," he says.
Using acupuncture in physical therapy (PT) and work hardening also benefits the insurer, he adds. "These stories are great examples of how dealing with emotions can help heal injury, push a person out of PT faster, and close the claim. I argue with the insurance companies that this something that is ridiculously cheap, and it works." It also can help prevent the large number of iatrogenic gastrointestinal bleeds that result from overprescribing anti-inflammatory agents, asserts Naparstek. "Acupuncture is cheap, it’s safe, and it works," he points out. "Hopefully, because we have reams of data on this, we will be able to publish our experience in the near future."
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