Working Class Acupuncture: Revolutionary Business Model Creates Access, Fosters New Business
Written by John Weeks
Working Class Acupuncture: Revolutionary Model Creates Access, Fosters Business Potential
Summary: Lisa Rohleder, LAc, and her partners at Portland, Oregon-based Working Class Acupuncture argue that the best way to integrate acupuncture into the health care of US citizens is to radically restructure the practice. They recommend a sliding scale ($15-$35), high volume practice which is delivered in community rooms. Rohleder and her group feel they have proved the model and are now rolling it out the model nationally through development of a Community Acupuncture Network which already boasts 19 members. Rohleder suggests that the approach may not only be a "remedy" for acupuncture's access issues, but also for the problems many licensed acupuncturists have in creating live-able incomes through acupuncture practice.
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WCA's assertive logo
As Lisa Rohleder, LAc, began trying to make sense of the business of professional acupuncture, she witnessed two distinct phenomena. First, she observed that a huge percentage of the working poor and even the middle class of people in the United States cannot afford to pay for acupuncture treatment when individual appointments cost $65-$200. Second, Rohleder observed that over 50% of graduates of acupuncture schools abandon practice without ever figuring out how to make a living at it.
What's wrong with these pictures? The price-point for an acupuncture treatment seemed to her to be related to both problems.
Founders Skip Van Meter, LAc, Lupine Hudson and Lisa Rohleder, LAc
The clinic which Rohleder's co-founded, Working Class Acupuncture, was born of a belief that these huge problems for the acupuncture profession could be resolved by a radical restructuring of acupuncture delivery. Happily for Rohleder - and she thinks for her profession - the restructuring would not require anything new to acupuncture, just changes that are mostly new to the commercial practice in the United States.
"The solution," Rohleder states, "involves going back to the way acupuncture is typically delivered in China, in a community room." The practitioner can then see more patients per hour. Each patient can then pay less, as low as $15-$20 per treatment. Bingo: Those interested in acupuncture can have a treatment for "as little as a cost of a co-payment." Or, in the words of one of their community members and clients, a visit to the neighborhood bar.
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Working Class Acupuncture's Community Acupuncture Model
Key Elements of the Business Strategy
Cost of an acupuncture
treatment
Sliding Scale, $15-$35
Requirements to
pay low end ($15)
None. trust system
.
Average payment
$18/visit
Total treatment recliners
20, in groups of 4
plus 2 treatment tables
Patients seen per hour
3 to 6-8
per LAc
Patients per day,
per LAc
20-40
Revenue/day (@ 30 patients)
per LAc
$510
Revenue/wk at 4 days
per LAc
Approx. $2000
Revenue/year (@ 50 weeks)
$100,000
Start-up overhead
Simple community space,
homey, fewer walls,
sinks, etc; recliners
for care delivery
Monthly overhead
Low: no insurance related
infrastructure; just
rent + receptionist +
low cost supplies
Acupuncturist income
after expenses
$35,000-
$65,000
Based on experience at Working Class Acupuncture,
Portland, Oregon
_____________________________
Income Characteristics of the Model
On the Working Class Acupuncture site this model is described as "a low-cost, high-volume business
strategy designed to make health care affordable." The low rate to the patient-client does not necessarily mean that the practitioner suffers. The economic model for the practice at Working Class Acupuncture, extrapolated from Rohleder's own experience with the practice, suggests the potential of a gross of $50,000-$100,000 per year.
Two patients in receiving treatment
Sharing the practice, as Rohleder does, creates opportunities to lower the principal overhead of rent and reception. Hiring an acupuncturist for additional days or patient over-flow ($15-$20/hour, the going rate for acupuncturists in group-focused addiction services), can also increase income. The annual return to the individual acupuncturist would then run $30,000 to $60,000, depending on the model.
The model appears to have its value, especially given the unfortunately high percentage of acupuncture school graduates do not make this kind of money, and eventually abandon their practices. But would it work in the hands of a person less impassioned than Rohleder? Toward Replicability and a "Community Acupuncture Network"
"Our goal is to create a
national network of acupuncturists who are committed to making acupuncture
affordable and accessible using a sustainable community business model."
- Lisa Rohleder, LAc
I first learned of the model last spring through a notice in the weekly e-news from the AOM Alliance. I contacted Rohleder. She said they weren't ready yet for an article, but would be after a planned October meeting, which was to be the founding meeting of the Community Acupuncture Network (CAN). She contact me then with an email which read, in part:
"I have noticed that on your blog that
you have mentioned in several contexts the issue of how to make complementary
medicine financially accessible to more people. We strongly believe that
insurance is not the answer, and we have an alternative solution.
"Our goal is to create a
national network of acupuncturists who are committed to making acupuncture
affordable and accessible using a sustainable community business model. We just had our first conference, 40
acupuncturists from 22 states, and I think we are making good progress toward
our goal. We're having another conference in February due to an overflowing
waiting list for the first conference."
Then Rohleder made a request:
"In fact, I am
writing to ask you a favor. We just wrote a book about this issue, and I was
wondering if you would be willing to review it on your blog. We are hoping that
it will spark some long-overdue discussion about CAM, class, and access. It
will probably be controversial, but we think that's a good thing. The title is The Remedy: Integrating
Acupuncture into American Healthcare, and it's available online (by clicking here)."
A Book That Promises That it is a "Remedy"
Boiler maker and biker Gary, a WCA patient
Rohleder, a maxima cum laude graduate of respected Quaker-founded Bryn Mawr College prior to acupuncture training at theOregon College of Oriental Medicine, showed a good marketing instinct in sending me a copy of the book. I found the volume a page-turner as a pointed critique of the evolution of the AOM field in the integration era. I also found it fascinating as an observation of the classist, tendencies of other natural health and integrative medicine fields, often mimicking the behavior of the conventional medical system whose net product they deride. This brief review of Rohleder's book from former AOM Alliance executive director Michael McCoy, PhD, gives a sense of the thin volume's depth and reach:
"Lisa Rohleder's new book, The Remedy: Integrating Acupuncture into American Health Care,
offers the perfect blend of passion, practicality, and cogent argument.
This book is essential for anyone who wants to see a better, simpler,
and more powerful way of practicing and receiving this ancient 'peasant
medicine.' In a few simple pages, Rohleder offers a commanding vision
that can transform, not only American health care, but our broader
society as well. Her book threatens the status quo, our stubborn
classist notions, and unchallenged assumptions about what is important
to the practice of health care. Read this book if you wish to see how
it can all be made to work, for a change!"
A visit to the Working Class Acupuncture center, which Rohleder operates with her spouse Skip and co-founder and business partner Lupine Hudson found both the passion and the sense of community on display. Hudson, who jokingly said that she has "no title here but 'comrade,'" easily shared details of the business model. Hudson, Rohleder and third partner Skip Van Meter, LAc are each choosing to limit their individual income to $35,000 in 2006 "to help fund the revolution," as Hudson put it, with money that could otherwise have been taken as income.
Controversy
The model is the subject of some controversy in the AOM field.
Isn't this like treating the indigent or addicted, through ear-acupuncture protocols? Won't it be a likely burn out for practitioners. Rohleder underscores that the target population is not the indigent, but rather income-earning members of the community who are unlikely to be able to afford cash payments. She reinforces that the structure WCA chose is a for-profit business model.
But people won't want the group settings. Here Rohleder posits that, in fact, the one-to-one, high time-cost of a typical Western practice is actually an outgrowth of a classist system. She writes believes that in fact many working people may be more comfortable "coming in with a friend or a family member," or having other people around.
The low price point devalues acupuncture practice. Rohleder points out that her clients don't seem to hold this view. She wonders who a high price point serves if patients can't afford it and practitioners can't make a living at it.
Is it HIPAA compliant? Rohleder says that they understand that they are clear by staying out of insurance coverage, keeping communication to a minimum and not having electronic communications with patients.
Will the care be as good? Rohleder argues that the low price point allows the number of visits which people typically receive, in China, for their care. She asserts that the community environment can establish "a collective magnetic field which makes individual treatments more powerful."
Comment: The WCA model is one of the most exciting recent developments in the business of integrated care.
Hospitals What might the in-hospital applications be? (It's been done: Kaiser Northern California and Banner/Arizona are among the healthcare institutions offering some group acupuncture treatments.)
Employers How about employer worksite delivery opportunities?
Other Disciplines Are there ways that other disciplines can make better use of community settings? How about the lifestyle changing educational and therapeutic components of naturopathic, chiropractic and integrative medicine? What would a model look like which was based in community delivery but built in one-to-one care around the edges?
Then, of course, with this approach, one can dodge the significant issues involved in seeking insurance coverage.
Readers of the old hard-copy Integrator
will know that I am a longtime proponent of group-focused, or community
room-based services - not just for education, but for delivery of
clinical care. Some of the best scientific literature in the field was
developed from therapeutic regimes structured around group processes.
Notable here are the strategies of Dean Ornish, MD, Herbert Benson, MD, Eileen Stuart, PhD, RN, and Jon Kabat-Zinn, PhD.
Meantime, Kaiser and other HMOs are also having positive experiments
with the use of group services in conventional treatment, sometimes
structured as DIGMAs (Drop In Group Medical Appointments).
Are there ways that other disciplines can make
better use of community settings
for delivering care?
How about the lifestyle-changing
educational and therapeutic parts of ND, IM and DC practices?
The Economic and Therapeutic Logic of Group-Focused Services
The logic behind group-focused services is compelling. First, the potential benefits from cost, efficiency and access. Groups may also be more appropriate than individual treatment at times. Adult learning theory suggests, for instance, that the group medium is often better than individual treatment for working on life changes. Then there are the positive side effect of stimulating a sense of community and connectedness through the patient's engagement in a group process. This positive side effect may be especially valuable in a culture, such as ours, which can foster isolation.
The WCA and CAN suggest there is another, tangible beneficiary. They argue that this model can be a remedy for the business challenges many acupuncturists face when most are competing for the same high-end, cash-paying, boutique clientele. We can only know if this is a remedy when we see whether a model created by its founders can flourish in the hands of their students. If the answer is yes, and the Community Acupuncture Network thrives, acupuncture may well have found a sublime way to serve consumers, and serve our communities without the substantive changes to practices often promoted by participation in insurance coverage.
Meantime, one complaint, which I voiced to Rohleder and her group, is that like many promoters of revolutionary paradigm shifts, the WCA team tends toward polarizing. A reader can think that their "remedy" is being promoted as the acupuncture profession's one true path. Yet even if the WCA model should spread throughout our communities, there will still be a place for a different kind of acupuncturist who wishes to work in a hospital setting, or who enjoys the process of taking time and working deeply with an individual patient, or who wishes to apply his or her skills to adding AOM's benefits to close collaboration with other practitioners in integrated clinic environments. Community-oriented acupuncture can easily cohabit time and space, even, with conventional models.
I will return to this theme, and model, going forward. Be nice if someone would help set up a small outcomes project to evaluate how the patients are doing in this model. Please send your comments, relevant experiences and ideas. How might group work more effectively in integrative practice? In naturopathic medicine?
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