CLEVELAND, Ohio--Starting January 1, more than 108,000 Ohioans on Medicaid who have diagnosed low back pain or migraines will be able to see an acupuncturist for pain management. The change in policy is part of an effort to reduce the number of unnecessary opioid prescriptions and overdose deaths in the state that arise from treating chronic pain with addictive drugs.
For the past year, Ohio has been one of six states in the country to cover acupuncture treatments for Medicaid patients, but only when offered by a doctor. Starting tomorrow, Medicaid reimbursement will be open to licensed non-physician acupuncturists who register as Medicaid providers.
The agency hopes that expanding access to the treatment, a centuries-old pain-relief technique that involves inserting hair-thin needles into the skin at specific points, will save money over time on addiction treatment and other costs related to opioid use.
Practitioners and their patients say it's about time more people had access to the proven and safe, but expensive, non-drug therapy, and that more insurers should follow suit.
Expanding access
Since October of 2017, Medicaid patients with low back pain or migraine diagnoses have been able to receive acupuncture from Medicaid physicians trained to provide the treatment. Less than one-half of 1 percent of eligible Ohio patients, about 485 so far, have taken advantage of the treatment option.
That could be because there are few doctors in the state trained in acupuncture, likely less than 200, based on available estimates. Of these, 23 doctors provided 2,981 treatments to Medicaid patients through November 29, according to Ohio Medicaid.
Starting January 1, patients also will be able to see licensed, non-physician acupuncturists who register as Medicaid providers. There are about 250 acupuncturists licensed to practice in Ohio, according to the State Medical Board. Ohio Medicaid expects about half will enroll as Medicaid providers, in addition to about 60 chiropractors who will sign up to obtain an acupuncture specialty.
With nearly 200,000 eligible patients likely to benefit from multiple treatments, there's a big market for new providers.
"This will really change the number of people who are practicing, and allow more institutions to offer acupuncture," said Jared West, president of the Ohio Association of Acupuncture and Oriental Medicine, and an acupuncturist who practices in Warrensville Heights. West is helping providers navigate the Medicaid registration process and has advised the state on reimbursement and other issues.
Dr. Maya Myslenski, a pediatrician who practices in the emergency department at MetroHealth Medical Center, has been offering acupuncture to her patients for a variety of ailments for more than two years. It helps patients with both acute and chronic pain, anxiety, and some stomach ailments, she said.
"A lot of our [Medicaid] patients can't afford to go to private offices for treatments," Myslenski said. "I'm beyond thrilled about treatments being covered for them."
Gaining acceptance, weighing the cost
As the opioid crisis has mounted in Ohio and across the country, the case for increasing access to acupuncture and other alternative treatments for chronic pain also has picked up steam.
In Ohio, the move to cover acupuncture for chronic pain conditions began in earnest in January of 2016, when Gov. John Kasich's Cabinet Opiate Action Team (GCOAT) released a guideline for the management of acute pain outside of emergency departments. The guideline said that non-drug therapies such as acupuncture (as well as physical and massage therapies, biofeedback and hypnotherapy) should be considered as first-line treatments for acute pain. The Governor's team also encouraged Medicaid to further research and review acupuncture.
Then in January of 2017, the Joint Commission, the not-for-profit organization that certifies hospitals have met certain safety standards, changed its pain management standards to require that accredited hospitals provide nonpharmacological pain treatments.
Around the same time, the American College of Physicians issued new guidelines for the treatment of low back pain, which recommended that doctors treat patients with non-drug therapies first, including acupuncture.
Dr. Mary Applegate, medical director of Ohio Medicaid, said the agency hopes that offering acupuncture as a pain management alternative will lead to cost savings over time, and that Medicaid's research found the greatest degree of effectiveness for acupuncture in controlling symptoms for low back pain and migraines.
The state's guidelines for managing pain provide more, safer treatment options, including acupuncture, which could help reduce opioid overdose deaths and addiction over time, she said.
Myslenki agreed: "I think that what we are going to see now is as more and more patients try acupuncture for pain and find it helpful, we'll see a further decrease in the number of prescriptions written for opioid medications. I think acupuncture has a big role here as a tool in this fight."
Paying for the treatment has always been a problem for patients. Medical insurance only rarely covers acupuncture, and it's expensive. Treatments cost between $70 and $100 per visit, and most people need several over the course of weeks.
Neither Medicare nor the Veterans Administration cover acupuncture.
West said the research on acupuncture has become much clearer in recent years, both on how well it works and how it can save money.
"There are some really big, recent studies that clearly show that acupuncture is not only comparable to Western medicine in how effective it is, but it's safer and it's cost-effective," West said. "In chronic low back pain, you can save money over the long-term, give people just as good care and they're not getting addicted to pain medication."
It costs the insurer between 70 cents and $1 per month, per policy, to add acupuncture coverage, West said. "It just doesn't make sense not to when we're spending $1 billion a year in Ohio on addiction treatment."
Strong demand
Ohio was the sixth state to cover acupuncture for Medicaid patients. The other five are California, Oregon, New Jersey, Massachusetts and Minnesota. Maine and Vermont are considering whether to cover the treatment for their Medicaid patients after completing pilot studies testing its effectiveness.
Robert Davis, a South Burlington acupuncturist who led Vermont's pilot testing acupuncture for back pain, said the study showed strong demand for the treatment among Medicaid patients.
"We had a waiting list in pretty short order," said Davis. Pain, sleep disturbance, fatigue, functioning, depression and anxiety all improved for patients in the pilot study, he said. While historically most people who use acupuncture as a treatment have had higher-than-average income and education levels, the Vermont study suggests this is only because they're the ones who could afford it, Davis said.
Vermont is still considering the results of the pilot, which were released in October, but Davis believes change is on the way there, too.
"It may take another year or so, but I do think it's going to lead to a change in policy," he said. "The opioid crisis has helped the establishment catch up a little to research on acupuncture. There's been a big change in attitude in terms of openness to this sort of thing."
West hopes that in Ohio other insurers will follow Medicaid's lead. And that more conditions will soon be covered.
There are eight conditions that can be treated with acupuncture with good evidence for effectiveness, according to a recent meta-analysis, including neck pain, osteoarthritis of the knee and postoperative pain.
"It's great to have Medicaid [offer it], but that's fewer than a million people, and there are millions out there who really should have more options for their care," West said.
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