Vermont Medicaid Acupuncture Pilot produces positive results and possible action
November 21, 2017
by John Weeks, Publisher/Editor of The Integrator Blog News and Reports Editor’s note: This analysis article is not edited and the authors are solely responsible for the content. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Integrative Practitioner. In mid-2016, the Vermont legislature made a $200,000 research investment in acupuncture to support its potential value as a covered service in pain treatment for the state’s Medicaid population. Of chief concern was opioid abuse. The report to the legislature of the outcomes are now in. On the headliner outcome, 38% of those on opiates were able to decrease them during the trial. The legislative move was action focused and on a tight time frame. The research team, led by Robert Davis, MS, LAc, a co-president of the Society for Acupuncture Research, chose a pragmatic, uncontrolled, prospective intervention design . In a presentation of the results at University of Vermont Medical Center, Davis began with data about the study participants. On PROMIS self-report scales at the beginning of the study, physical function was quite low, in the 10th percentile. On seven others that looked at complaints, the percentiles were quite high. These ranged from Social Isolation at 63rd percentile up to Pain Interference in the 94th. Fatigue, anxiety and depression were all above the 82nd percentile. Notably, the study did not limit patients to a certain type of pain. Instead, to increase the “real world” generalizability of the data, it included a heterogeneous group of patients with chronic pain as well as other comorbidities. The 156 patients who were enrolled (71% female) could receive up to 12 visits (average 8.1) over the 60-day period of the trial. Care was provided in a real world setting in the offices of 28 licensed acupuncturists. Thirty-eight percent of the subjects completed the whole series of 12 visits. Nearly three-fourths had at least six. Such fluctuations reflected the real-world intentions. Key findings on the effect on pharmaceutical usage were that of the nearly one-third of the subjects on opioids when the trial began, 32% decreased their use. Of those using any pain killer, 57% were able to decrease their use. The patient self-reports on the PROMIS measures showed significant positive improvement across all 8 measures. In addition, the trial produced valuable practical data in an array of other areas that bode well for an increased role for acupuncture:
- given the quick sign-up for the pilot, clear evidence of interest in the Medicaid population in using acupuncture;
- similarly, comfort with medical doctors in referring patients for acupuncture; and
- availability of licensed acupuncturists to provide services at the pilot project’s rates ($125 for initial visit and $65 for follow-up visits).