NCCAOM CEO discusses trends in acupuncture, integrating in medical teams

Photo Cred: Ryutaro Tsukata/Pexels

By Bill Reddy, LAc, DiplAc

Mina Larson, MS, MBA, CAE, chief executive officer (CEO) of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), has been devoted to the organization for well over a decade. She has served on its advocacy and policy committee, as well several efforts, including as a subject matter expert in the national job task analysis survey.

While she started out pursuing a law degree and worked as a staffer in the California legislature, as well as in the communications and executive office of former governor of California Pete Wilson, Larson has served in many capacities within the NCCAOM, and held the position of deputy director for seven years before replacing Kory Ward-Cook, PhD, as CEO in 2019.

As CEO of the NCCAOM, Larson is working toward integrating acupuncture services into the United States healthcare system. We sat down with Larson to discuss current trends in acupuncture, how licensed acupuncturists can integrate as part of a medical team in hospitals and beyond, as well as the community acupuncture model.

Integrative Practitioner: What is the current state of affairs in acupuncture field in the United States?

Larson: We are at a pivotal time in our profession. In 2020, [the Centers for Medicare and Medicaid Services (CMS)] announced that Medicare would cover for acupuncture for chronic low back pain. This announcement was really well received because acupuncturists have worked hard over the last decade or so to gain federal recognition. Although the decision had some limitations, it was a start for us in terms of working to gain Medicare recognition, as a certified provider, and there’s a lot of work that we have to continue to do.

Our primary mission at the NCCAOM is public safety and creating the national certification examinations so that we can ensure that our practitioners have met competency standards for the practice acupuncture, herbal medicine, and east Asian bodywork. We accomplish that through our examinations and our certification programs. We are the only national certifying body for the profession of acupuncture in the U.S. Currently, 46 states plus the District of Columbia require either our certification or the passage of our examinations as a prerequisite for state licensure.

With that said, we have a strong duty to the states in partnering with them to uphold the standards of acupuncture practice through our rigorous examination process. The states’ mission is also tied to public safety and protecting the people of their state by relying on our examinations and certification process.

The NCCAOM also advances national board-certified practitioners through public education and advocacy. To do that effectively, we partner with the American Society of Acupuncturists (ASA) as a federation and membership organization that empowers state associations to join together to promote the profession.

Integrative Practitioner: What do you see changing for acupuncturists as a result of these efforts?

Larson: We’re starting to see more recognition for licensed and certified acupuncturists. We’re starting to see many more integrative medicine centers, hospitals, and employers hiring licensed and nationally certified acupuncturists. We’re also beginning to see the fruits of our labor through the work that we did with the U.S. Bureau of Labor Statistics (BLS) starting in 2007 [through a decision in 2017], a decade-long process to ensure that the [agency] recognizes licensed acupuncturists. Before that time, the practice of acupuncture was a modality under chiropractic medicine and nursing, versus now where acupuncturists now have their own [Standard Occupational Classification] code. This [allowed] federal government agencies to classify acupuncturists to collect, calculate, and disseminate data on our profession.

The [BLS decision] opened the doors for other federal recognition, such as in 2018, the United States Department of Veterans Affairs (VA) made a decision enabling the VA to hire national board certified and licensed acupuncturists.  As a result, a licensed acupuncturist who holds NCCAOM certification can now work within the VA healthcare system. Our work is definitely not done. We’re still working [on several efforts, including] toward inclusion within the U.S. Department of Defense. We want to make sure that acupuncturists are compensated at a General Schedule (GS) 12 or higher based on education and training.

Integrative Practitioner: Can you share a little about hospital-based acupuncture practices?

Larson: Another highlight of what’s happening within our profession is that acupuncture in the past five to 10 years, has become more integrated in the U.S. healthcare system. Throughout the country, many hospitals and particularly university teaching hospitals have opened up integrative centers, where acupuncturists are becoming part of the team.

Doctoral programs are being offered in many of our [Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM)] accredited schools throughout the country. These programs enable acupuncturists to gain more biomedical education to be prepared to work within hospital oncology, orthopedic, and other departments. It’s a very exciting time for our profession, as we see acupuncturists being integrated and working alongside physicians, nurses, physical therapists and other healthcare providers.

Integrative Practitioner: How can the acupuncture profession help stem the opioid crisis?

Larson: Before the [novel coronavirus (COVID-19) pandemic], one of the biggest health crises that plagued our country was the opioid epidemic. This was an epidemic that really catapulted acupuncture and acupuncturists into the healthcare system. This issue was a truly bipartisan in that both Democratic and Republican members agreed to work toward a solution.

Whether it’s rural states or urban states, Democrats or Republicans, a lot of members of Congress and leaders in healthcare, were asking for help. Insurance companies were asking for help and this is where acupuncturists can provide a viable solution by showing we have evidence-based research that acupuncture can not only treat and manage pain, but can also treat substance abuse.

Acupuncture is a portable medicine—we can go anywhere throughout the country not only to treat the person that is dealing with the pain and substance abuse, but also their family members. The amount of research that’s being conducted and collected at hospitals, Medicaid programs, and insurance companies can help inform the policy and decision makers in developing policies for acupuncture treatment for both substance abuse and for pain. Thus, before the [COVID-19] pandemic, this was a major focus within the integrative health world, particularly with the results of outcomes of acupuncture for pain.

Now that we are entering the post-COVID-19 pandemic phase, the opioid epidemic has gotten worse. Clearly, this is even a more pivotal time for us to really be working with policy and decision makers to make sure that acupuncture services are accessible to everyone.

Integrative Practitioner: Has the COVID-19 pandemic changed or shaped the acupuncture field?

Larson: One of the ways that acupuncturists were able to reinvent their business model or practices was through telemedicine or telehealth. Obviously, acupuncture treatment itself was difficult to provide during the early days of the COVID-19 pandemic, but many acupuncturists were able to use telehealth to offer Chinese herbal medicine, as well as dietary and other consultations for their patients. We hope to be able to expand on these services once full Medicare recognition is gained for acupuncture services so that acupuncturists can practice telehealth in a greater capacity and beyond state lines.

Integrative Practitioner: How do acupuncturists stand out in a crowd of healthcare providers?

Larson: One of the selling points of acupuncturists in showcasing their medicine is its safety profile, which is reflected in our medical malpractice insurance rates, which average $75 per month. That figure is much lower compared to nurses, physicians, and other healthcare providers. Acupuncture services have a proven lower safety record than conventional medicine.

Hospital administrators are very aware of liability, and for acupuncturists, its virtually nonexistent.  Traditional Chinese herbal medicine also holds an impressive safety record where adverse events are low and deaths are rare in the U.S. Compare that to conventional care, where more than 100,000 Americans die annually due to the proper use of medication. If you add iatrogenic deaths, that figure more than doubles.

Integrative Practitioner: Acupuncturists are expanding into hospital systems, but where else are they currently working?

Larson: When acupuncture first started becoming prevalent in the U.S. about 30 or 40 years ago, the majority were what we call sole proprietors, or practitioners who work within their own business. Through NCCAOM job analyses, the demographic data we collected found more acupuncturists working in integrative settings, but also looking for salaried positions. This new phenomenon has increased every time we conduct a job analysis and collect information about our practice settings. We see acupuncturists in group settings and hired by an employer, not just hospitals or cruise ships and clinics, but also large companies such as Google, Facebook, and others that are hiring licensed and certified acupuncturists to be able to work within that setting to help their employees, whether it’s structurally or treating particular ailment, or preventative care. This is a trend that we’re seeing more and more, and we are really excited to see as U.S. employers are recognizing that general health maintenance and disease prevention, active lifestyles, and healthy diets make their employees more productive, while taking less sick time off.

In addition, as I talk to young people that are entering the field, we are encouraging them to be able to not just open up to a sole proprietorship business but to also look into working in an integrative setting or working in corporate settings. Again, the main focus is to increase access to acupuncture services throughout the U.S. The more acupuncture is offered in diverse settings, from employer based or clinical based in hospitals to cruise ships or community acupuncture clinics, the greater exposure we have to a broad spectrum of Americans.

There is another type of acupuncture service that is lesser known where acupuncturists volunteer their time, and money, to be able to provide treatments to those in need. Acupuncturists Without Borders [AWB] is an organization that provides acupuncture services to survivors of natural disasters in the U.S., such as hurricanes and tornadoes, and even internationally. Acupuncturists are also there to treat the first responders that are involved, and they are specifically trained in trauma medicine, and are able to really help those in need that would never be able to have access to this medicine. That’s something that many acupuncturists are providing their time, energy, and resources to be able to offer this type of work for the public.

Integrative Practitioner: Could you tell us a little bit about the community acupuncture model?  

Larson: Community acupuncture is growing in popularity, particularly in underserved urban areas. It’s a business model where acupuncturists offer a sliding scale [for their acupuncture services] to allow a more affordable option to many individuals, especially those in underprivileged, unrepresented communities, or for those who have limited income. This model has been incredible in terms of being able to provide access to many communities who would never have access to our medicine.

Community acupuncture continues to grow, and many students choose to practice in this model to be able to provide greater access to these communities. This model does not just increase awareness of acupuncture services in underprivileged communities, but it is also being able to help those that are in need that do not have resources like insurance or to be able to pay for acupuncture services.

More states are recognizing the importance and need of bringing acupuncture services to their state, particularly through programs like Medicaid, workers comp, and other state funded programs.  There are currently 14 states that have Medicaid programs that cover acupuncture services. One of the most important outcomes of these states is that some are able to collect important practice data, including efficacy and cost effectiveness data, which is needed when we’re working with the federal government for Medicare [coverage]. It is hopeful that more and more states will be able to add acupuncture for Medicaid services. ASA has been working with state associations through their committee work to empower them in this initiative to add coverage for acupuncture services to Medicaid programs.

Integrative Practitioner: In your opinion, what is the future of acupuncture looking like in the U.S.?

Larson: The future for acupuncture services and acupuncturists in the U.S. looks very positive, as more and more consumers choose to be the masters of their own healthcare. Consumers are able to choose the healthcare team that they want and often times choose an integrative approach for having physicians working with acupuncturists and other integrative medicine practitioners for the overall health services. That is demonstrated in many integrative medicine centers that are popping up throughout the country, as well as consumer demand.

It is crucial that we continue to do outreach with federal agency representatives who support acupuncture services and ask for more research dollars demonstrating the efficacy of acupuncture, herbal medicine, and other integrative medicine fields. Most importantly, as many Americans seek care from acupuncturists, we must educate the public about the importance of choosing state licensed national board certified acupuncturists to further distinguish ourselves from others who have completed abbreviated acupuncture training. All the above results in creating more access while enabling consumers to continue to choose the healthcare team that they want to be able to provide their care.

Editor’s note: This interview has been edited and condensed.