Explaining the Locate-a-Clinic rules in detail

 

So we made some changes to LOC last week. Let's go over them, and explain the meaning behind the rules as they are in many ways the heart of POCA and CA. In doing this you should also read Michelle's piece as what I am writing here is a companion to that one. I will be going into some detail here because a lot of people seem to have some misunderstandings.
 
First: the ultimate purpose of Locate A Clinic is to define what a Community Acupuncture clinic is. We understand that the term "Community Acupuncture", which was first defined by us, has come to be used by all sorts of  expensive clinics as a desperate attempt to attract patients. It doesn't work, of course, because expensive is expensive no matter what else you label it, and most people don't get acupuncture when it's expensive.
 
But acupuncturists, like a drowning person, will latch onto anything that could save them and so they grab the term Community Acupuncture (CA). Thus the intent of the rules of LOC are to define CA as something specific and something real. Let's start:
 
All clinics must have at least three days and twelve hours per week where they use a group or community treatments space.
This opening sentence is pretty straightforward, I hope. We put this into LOC when we started allowing what we call hybrid clinics-clinics that are part community acupuncture (CA) and part boutique acupuncture (BA) or private room acupuncture where the fees are much greater. And so since POCA started several hybrid clinics have joined us-and we welcome them!
 
Now there are all sorts of hybrid clinics out there and we wanted to attract those that sincerely use CA as a genuine part of their practice as opposed to those who just wave it around as a loss leader. Yes, unfortunately there ARE those out there; we know because we hear stories from patients about booking appointments in a community setting and then getting a sales pitch (or a "prescription") for an expensive private treatment; and we have seen clinic websites that say they do community acupuncture on alternate Tuesdays from 4-5pm in months ending in R that also coincide with a blue moon; and we feel that clinics that do this are errant, unscruplous, questionable, sly, crooked, deceitful, perfidious, shameless, shady, slippery, and shifty. Yes, I just had fun with a thesaurus. Moving on...
 
When having group or community treatments, the following criteria must be met:
 
  • All Fees should be listed on the front page of the clinic’s website or on a page clearly devoted to clinic fees. Good business tip: put your fees on the front page of your website and on your business cards. Your fees are a major factor in attracting patients.

There's two parts to this rule, which we just added this week. Before we came along (we=CAN and now POCA),  acupuncture clinics routinely did not list their prices. Why? Because they were damn high and most people without insurance, i.e. most people, could not afford them so the acupuncturists tried to emphasize other aspects of their practices. That's still true for BA clinics everywhere: if you have to ask you probably can't afford it.

 

CA, by contrast, is meant for anybody with an income and we want everyone to know that fact. We believe in transparency and so people visiting our websites should know right off the bat what its gonna cost them if they make an appointment. 

 

The other part of this is that it is basic business sense for CA clinics to list their prices front and center on their websites, their business cards, and everywhere they advertise because for most people in this country acupuncture = expensive and unaffordable. We here at POCA are trying to change that perception. Also we CA clinics need lots of patients to keep our doors open --  so we need to remove any ambiguity we can. If people know we are cheap and effective, they wil tell their friends and family about us and that's the best kind of advertising there is. 

 

  • Adopt a sliding scale between $15-50 with the low end no higher than $20.

Okay, this is the big change from last week. First, a little history: the price scale here is the exact same that we had on CAN. But when POCA took over, some of us (read me) thought it would be a good idea to relax our price structure a bit and allow more hybrids in. The hybrids part remains but we realized that we needed to put back our old price structure. Why? Because  $25 is a long way from $15 and too many patients couldn't afford those clinics who priced themselves just within the upper limits of the requirements.

So in essence we were creating two tiers of clinics when we tried to set the bottom of the sliding scale at $25.  It's important to realize that clinics with a low end of $20 are missing out on patients that come to clinics with a low end of $15; and of course clinics with a low end of $25 are also missing out on patients that come to clinics with a low end of $20. As far as we can tell, you can't really make up in money what you lose in volume, and we don't want to encourage what we see as self-defeating price structures.

 

Two of the basic tenets of CA are that 1) most anyone with an income should be able to afford a visit and 2) they should be able to come back often enogh to get better. Put those together and you get one of our favorite basic sayings here in POCA land: frequency trumps cleverness. We understand that it is hard for acupuncturists to understand this as they were taught the opposite in their education, but we have found that to indeed be the case. And since the acu-schools do such a lousy job preparing their graduates to be successful at running their businesses, we have to make sure that what we require here in POCA lines up with what we have found to be true in our businesses. 

 

  • Tips may never be solicited either verbally or in written form.

This is new too in reaction to some clinics actually asking for tips on their website. CA clinics shouldn't have to rely on tips and if they are doing it right, they don't need to.

 

  • Herbal consults and all other modalities: cupping, bleeding, moxa, etc are charged at the same rate as the community clinic if they are performed in the community clinic. To be clear: adding modalities in a community clinic does not increase the price of the treatment. For instance needling and cupping a person in the community clinic is still subject to the sliding scale as explained above.

At acu-school, we are taught all sorts of methodologies besides needling. They are all interesting. In our CA practices we have figured out a couple of things about them:

 

1) Frequent needling is usually all that a patient needs to get well. Needling is very fast too, enabling the acupuncturist to see a large number of people and thius make a profit. So a CA practitioner does not need to use those other modalities if they don't want to. 

2) But they can use those modalities if they really want to. The main question with these other modalities is do they take too much time? A simple example: if a practitioner does a full body massage and spends 60 minutes with the patient, then they HAVE to charge more than our sliding scale to make ends meet. From our experience, bloodletting and herbal patents are the two modalities that can be fairly easily incorporated into a CA practice- again if the practitioner wants to. Cupping is also done at some CA clinics though it can be a little more time consuming. Moxa is more time consuming still so is not done so much. Preparing herbal formulas, including figuring out a unique formula and/or mixing the herbs or granules ourselves takes too much time. Fortunately there are all sorts of patents on the market including granular formulas if the practitioner is inclined to use herbs. Finally massage and gua sha are only very rarely done since they are so time consuming. 

 

We understand that at this point acu-school students are taught all of these modalities and are intrigued with many of them. But in running a CA clinic, what is good for the patient comes first, and that means an effective treatment done quickly at a price that allows the patient to return as often as needed.

 

  • If a flat-fee is charged, that fee can be no higher than $25.

We also lowered this down $5-back to what it was with CAN. The same reasoning applies here as to the lowering of the sliding scale bottom end. 

 

  • For first time visits, a consultation fee of no more than $15 can be assessed. This fee needs to be displayed next to your standard fees and on your front page and/or fees page of your website.

This remains the same as before but deserves a little explanation. When CA first started there was a thought that the first treatments should be priced higher, like $60. The reasoning behind that was that for the first visit the acupuncturist would be spending a lot more time with the patient and so to make up for that extra time more money should be charged. But we found that in reality we don't need to spend much more time with the new patient. Most of the extra time that a new patient requires is the filling out of the basic paperwork, for which the acupuncturist does not need to be present, but which can mess up a tight schedule if not done quickly enough or if the patient does not arrive on time. The elaborate intakes that were taught in acu-school, often lasting one hour or more, are just not needed. An extra five-ten minutes is more than adequate for an acupuncturist to understand a patient's reason for wanting treatment on the first visit. So we settled on charging a little more, usually $10 though in some cases $15, as a middle ground to reflect the true costs on the practitioner's time. 

 

  • For clinics that have private treatments for some patients, there is no private treatment requirement in order to gain access to group treatment. Nor can a clinic recommend private treatments at a higher rate for any condition after the patients has started community clinic practice. This means that a clinic cannot require or recommend private treatments at a higher rate for any condition.

This is for hybrid clinics to ensure that their patients can always use their CA option at an affordable price. We believe, and experience has proven it true, that standard CA practice is just as effective as any BA practice and so there is no need for "difficult cases" to require more elaborate and expensive treatment. We welcome hybrid clinics that meet our LOC rules -- and we welcome them because they meet our LOC rules.

 

We are most interested in protecting the CA part of the hybrid practice. We also recognize from experience that hybrid practices can be unstable because the two parts of them are working at cross purposes with each other. The BA part emphasizes lots of one on one time with the acupuncturist doing lots of modalities with the patient. (At least in theory. We know of many BA acupuncturists who do the exact same thing in their treatments as any CA practitioner, they just charge more and they do it in private rooms.)  There's an emphasis on wowing a patient. With CA, the emphasis is on seeing a lot of patients, of being efficient with one's time and cutting right to the chase. So not surprisingly, hybrid clinics often change to all CA or all BA after some time because it's just easier on the practitioner. Furthermore, most hybrid practices stay small, which is not what we encourage either; CA clinics become more stable only as they treat more and more patients.

 

  • No proof of income is required or requested by the clinic. A notice to this effect must be placed near the listed prices. The notice can be flexible. Examples: No Income Verification required, or Pay what you can afford, or The choice is yours, or You choose what to Pay. Clinics work with the POCA members charged with maintaining Locate-A-Clinic to come up with appropriate wording.

Again, this is to ensure transparency with prices.

 

  • We strongly discourage the use of Income Guidelines as there seems to be no evidence that they increase income and may actually repel patients. No clinic can require patients to sign a statement saying that they read and understand Income Guidelines. Nor can clinics recommend to their patients in any way how much they should pay within their sliding scale.  This is true for written or verbal recommendations or explanations. This includes no explaining of how the sliding scale works other than to say that patients can pay whatever they want within the sliding scale as noted in the paragraph right above this one.

Income guidelines are another thing, similar to charging $60 or more for a first visit that were thought to be needed when CA first started. Unlike charging high first visit prices, however, Income Guidelines have hung around and more than a few clinics use them though almost always in only an advisory way to help patients figiure our what to pay on their sliding scale. 

 

The problem with Income Guidelines is that they are too simplistic. They stem from the fact that CA prices are very cheap and acupuncturists can get to thinking that some of their patients are paying "less than they could or ought to". The classic example of a patient who drives to the clinic in an expensive car and who is talking about going on expensive vacations and who has a well paying job, yet who pays only $15 or $20 a visit is what Income Guiidelines are meant to address. 

 

A patient may make a lot of money and drive a fancy car but they may also have expenses that require a lot of money. A basic example from my clinic is the college professor married to a psychiatrist who has supports her aunt in cancer treatments and her mom with Altzheimer's and so actually has little money left over for acupuncture and so pays $25/treatment rather than the top of my sliding scale of $35. The point is people have all sorts of special circumstances that the Income Guideleines don't address and it would take way too  much time and effort to assess what every person can pay in theory. So the idea is to let a patient pay what they are comfortable in paying, no questions asked and no guidance given. 

 

Income guidelines may, by the logic above, drive some patients away because they so little address their lives and their income. Now we don't ban Income Guidelines-yet. That could happen in the future. But what we are wary of is the practice at some clinics of getting patients to sign a piece of paper with the Income Guidelines on it, which is a subtle way around the "pay what you want within our sliding scale" aspect of CA clinics. That's a no-no. 

 

What's that? You don't know what I mean when I say Income Guidelines? You've never seen an example? Count yourself blessed. And, no, I am not gonna give you examples here. 

 

 
ONE OF THE MAJOR BENEFITS OF MEMBERSHIP IS PROPRIETARY INFORMATION.  BECAUSE OF THIS, NO REFUNDS ARE AVAILABLE AFTER ANY MEMBERSHIP IS PURCHASED.
 
So there you go. Any questions? Anything I left out you are still wondering about? Just put them in the comments.
This story was posted on January 16 2012 by Skip.

Comments

  • January 17 2012 at 2:46 AM
    donnajoon writes:

    I like it.  I like it a lot.  But I’m sure that isn’t a surprise.  I’m not exactly quiet about my opinions.

      0 likes
  • January 17 2012 at 5:00 PM
    Ed Layton writes:

    Acupuncture is as foreign to most of our patients as business is to most acupuncturists.  Sticking to what works, keeping it clear and simple, is a great way forward. Nice post Skip.

      0 likes
  • January 18 2012 at 12:19 AM
    Justin DeVaull writes:

    Nice post.  For new POCA members, having less guesswork is a good thing.  The framework itself is comforting to both patients and practitioners.  The exposition on (CA) v (CA & BA) clinics is great and persuasive for members to focus entirely on CA.  Cheers!

      0 likes
  • January 18 2012 at 4:58 PM
    Karen Grosskreutz writes:

    POCA clinics that signed up before 1/15/12 met POCA’s original guidelines.  They have been grandfathered in until their renewal date, at which time they will have to meet POCA’s Current LOC Guidelines. 

    When a clinic changes their prices or hours, please contact POCA so that we can note it on the LOC listing and in our database.

    Thanks

      0 likes

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