Jason: October 15, 2019, 5:14pm
Most of my patients pay at least in part with insurance. As I rapidly shift to almost all Sa’am treatments (1-2 units),
from mostly Japanese acupuncture (2-4 units), reimbursements are going down fast. I have continued doing
additional “harmonizing” needle sets either before or after the Sa’am treatment. It buys me time to make a
diagnosis and/or watch for adverse reactions. But that is less necessary every day. I’m thinking I’ll have to give up
accepting insurance.
Also, I’m considering a new Sa’am-specific consent form. And, of course, treatment times will have to be adjusted.
That might mean setting separate appointments for herbs.
What changes have people made to the logistic side of their practice, especially insurance billing?
Daniel #2October 15, 2019, 5:56pm
Great Questions. I work in a different country – so your insurance question is not relevant to me . . . BUT you do
raise the overall very interesting issue that moving to a different and distinct ‘style’ of acupuncture does not only
have diagnostic and skill-related implications, it also brings up many implications related to business, clinical
logistics (scheduling, patient record keeping, forms, etc) . . . .
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KristinWisgirda: October 15, 2019, 6:18pm
Jason:
I have continued doing additional “harmonizing” needle sets either before or after the Sa’am treatment.
Doing other treatments with Saam definitely can muddy the waters as you are trying to learn the system and also
learn your patient.
My understanding is that doing treatments after the Saam treatment can dilute or distort the effect of the clear
message you are delivering with Saam.
If I am unsure of my diagnosis I may do something manual -gua sha, cups, channel palpation- to buy me time
and/or gather more information. I never do any of these after Saam needling, for the reasons stated above.
On the business side, your model has to match your medicine. I can easily see more patients each day and have
more time to fill and think about herbal rxs, though I tend to prescribe less because Saam is so effective and I want
clear feedback with Saam.
Jason: October 15, 2019, 7:57pm
Doing other treatments with Saam definitely can muddy the waters as you are trying to learn the system and
also learn your patient.
I think I got this idea from an early case study podcast in which Toby said it was okay since it’s just harmonizing,
but maybe I misunderstood. Still, I tend to agree with you, and have been doing this so mildly that it’s almost silly.
That’s why I was surprised this topic hasn’t come up. If you take insurance, switching to Sa’am sooner or later
requires a big change in how you get paid. Unless somebody has another idea.
KristinWisgirda: October 15, 2019, 8:14pm
Jason:
Toby said it was okay since it’s just harmonizing,
Maybe he politely said it was ok, kind of like- you practice this the way you want but to the detriment of your
ability to get clear feedback.
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amyjenner: October 16, 2019, 12:26am
I have use 1 or 2 units and just divided up the needles accordingly. I am thinking about just using 1 unit and setting
the price for the 97810 to be the full price of a treatment
Jeffrey: October 16, 2019, 7:42pm
amyjenner:
I am thinking about just using 1 unit and setting the price for the 97810 to be the full price of a treatment
I like this thinking. I dont accept insurance. However, I dont think that any practitioner should be penalized
financially by the 15 min increments that were used or not. It is obviously a draconian method of measure that was
put into place by chiros doing acupuncture ( if I remember correctly). Multiple disciplinary practitioners can move
their patients from one modality to another in a single visit.This allows for higher billing options for them. It kinda
aligns itself with double blind vs case studies in that there are less variables to consider even though CMed doesnt
draw from this “one size fits all” paradigm.
Jason: October 16, 2019, 8:40pm
I am thinking about just using 1 unit and setting the price for the 97810 to be the full price of a treatment
You must be talking about billing out of network? Do they just pay what you charge? I’ve been in network for
years, so I don’t remember how that works.
amyjenner: October 16, 2019, 10:57pm
I am not “in network” with anyone on the advice of my biller. I can set the price. They have some formula they put
it through, depending on insurance company and the policy. They generally pay 80% and the patient has a copay
(which varies according to policy). With the insurance billing, you can charge a bit extra for the extra work of
dealing with all the paperwork and hoops. They say %15 above your day of service rate. That works fine as long as
there is a copay. There are a few that don’t copay, like retired teachers and veterans, in which case it is not quite
enough. Honestly, I have been fiddling with the numbers to make it work out so that I end up with the day of
service fee at the end of the day. One of the bigger issues actually is how you do your SOAP notes. They obviously
have to match your billing and you have to account for the time you bill for by noting clock time. That is why it
would be so much easier for me, even though I spend 45 minutes with each person, to just bill for the 1st 1516/01/2024, 11:59The Business of Sa’am – Qiological Community
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minutes (which is actually 22 minutes of clock time). Anyway, the insurance thing is a major hassle and i have
seriously considered getting out of it all together.
ngmatthews: October 4, 2021, 5:15pm
On the business/insurance side, I agree. I used to do very complex Japanese treatments and bill for 2-4 units, but
with Saam, I only bill for 1. However, since I don’t do a lot of insurance it has not been very important till now.
AARP Medicare Advantage United Healthcare now gives a patient 18 visits of acupuncture per year at a cost to the
patient of only 10 per tx. The fee they set is 50 ( I assume that is for 1 unit), and 70 for a first visit (1 unit of Ac
plus short eval). SO Saam fits perfectly into this system. I am using exclusively Saam with these folks, and with
cash pay clients still charging my usual fee for what is usually 2 units. When doing Saam with a cash pay client, I
also will spend a lot more time sitting and talking with them, or doing channel palpation or even a little tui na at the
start of the tx to expand my activity at the visit.
Like Kristin, I have shortened all my office visits to 45 min now, begin my day later and now have more time for
my own self care and other activities that used to cut into my clinic time. It is working out well.
michaelmax: November 12, 2019, 9:06pm
I don’t take insurance… well, actually in Missouri, insurance doesn’t take me.
I remember years ago when living in Seattle of at times adding a few needles after 15 minutes because it probably
would not hurt the patient, but it most assuredly hurt my bottom line to NOT do it. I never liked doing those extra
needles and not proud that I let the “system” determine my treatment. Lucky for me, I don’t have that issue now.
As to doing just Sa’am. Like @KristinWisgirda says and I agree, it helps you to learn the system faster as you get
clearer feedback on your treatment.
As to changing times or office fees. I do have some extra time now, but fees are the same. They are not paying for
time or number of needles, they are paying for clinical results. Which are better than ever.
The insurance game is tricky. Keep us posted if you find some innovative solution!
Daniel: November 13, 2019, 2:07pm
My ‘business challenge’ has nothing to do with insurance. With these (Sa’Am) treatments, a significant proportion
of my patients are getting better in fewer treatments so my ‘business’ (number of patients / income) is actually
declining!!! I have often made the remark to people . . . there is a common misconception that if a practitioner is
busy and hard to ‘get into’, the assumption is typically made that they must be good!! In fact, the opposite is quite
likely if you think about it. They are ‘hard to get into’ because their patients are not getting better.16/01/2024, 11:59The Business of Sa’am – Qiological Community
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ngmatthews: October 4, 2021, 5:15pm
I agree about volume going down. Sometimes I wonder if it could also be other factors, but my volume has
significantly reduced since incorporating Saam.
Here comes my dissertation, apologies if you already know these things, but I hope that by sharing I can be of
some support because I think we all go through the same things.
This business challenge brings up the issue that I have observed over nearly 30 years of practice, which is that
sometimes coming for acupuncture is about getting cared for, listened to, and attended to by a skilled and
compassionate practitioner. That is really valuable for folks. For a lot of my long term clients, this is why they
come, not just to have symptoms go away. I think that is the kind of client that we all enjoy working with; someone
with whom we’ve developed rapport and gotten past some of the prickly parts at the beginning. It is also a lot more
efficient working with these folks because managing expectations is no longer such an energy drain.
Of course for new patients, their goal is to have symptoms relieved; often they are not really motivated to use
natural medicine for long term health benefits. Converting them from people putting their toe in the water to people
committed to using OM for health promotion is a constant challenge. The greater number of my new patients leave
after 3-4 treatments if they have not had a miracle cure, no matter what words I tell them over and over about what
to expect and what works best. The financial stress of attending treatments, the complexity of their problems, and
their desperation for a miracle all contribute to this. I think Saam is advantageous because it can do so much so
quickly when we get it right. But if we don’t get it right, it can be frustrating for both clinician and patient.
In the early days of my practice I saw the pattern that patients thought that more needles was more care. I saw the
temptation to give in to that and do what was often too much. Looking back I know I overtreated probably a few
thousands of patients. There was a lot of CYA acupuncture going on in my treatment rooms. That was until I had a
system to really evaluate the results of my treatment and a protocol that gave instant feedback to patient and
practitioner (Kiiko style, and now Engaging Vitality). There is also such an interesting contrast between what the
patient notices and reports and what the clinician senses through exam and gathers through interview.
Just yesterday I was talking with someone about the fact that patients come back and complain about what is not
yet better, and often do not notice what is gone. It takes skillful record keeping and communication to continue
showing them how they’ve benefitted from care, and this is critical for choosing an accurate treatment approach
and helping convert patients to long term clients rather than testers of the modality.
Back to the business of Saam: it seems to me that doing shorter treatments is better for my schedule and energy
availability. That is good. However when we get people better faster, we need better marketing approaches to deal
with what is called “churn” in the business world. “Churn” is the people who are coming in and out all the time. If
we look at the percentage of churn that makes up our day/week/month/year, it is, at least in my practice, fairly
high. Probably complies with the 80/20 rule, come to think of it (actually I think the testers make up less than 80%
of my time). This signifies a couple of things. One is my failure to convert experimenters into long term users of
OM for health. Another is the fact that there are just a lot of people out there wanting to “try” acupuncture to see if
it works. They come with complex, sometimes serious problems and don’t tend to be very patient with the process.16/01/2024, 11:59The Business of Sa’am – Qiological Community
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So Saam is perfect for them because it shows them that our medicine is effective. It will also help them make more
referrals.
Ultimately people are on their healing paths. We are all searching around for things all the time to improve our
lives. The patient, to a large extent, controls the treatment plan, no matter what we do. Earning their trust and
educating them about what we can do is a constant process and requires a number of different approaches to be in
use at all times.
I believe that in the long run Saam will increase practice volume because of its effectiveness. I think Toby was
running a few rooms at one point in his practice. And the short term shifts in practice volume might be challenging
on the way to getting there.
michaelmax: November 16, 2019, 1:17am
ngmatthews:
The greater number of my new patients leave after 3-4 treatments if they have not had a miracle cure, no matter
what words I tell them over and over about what to expect and what works best. Th
My experience is similar. Regardless of my expectation setting people are going to give it 2-3 treatments and if
they’ve not gotten something like the miracle they had in mind… then they write it off and stop coming. This is
reality. And really, if I was looking for help with something and the practicer said “you’ll need 10-12 treatments
before we know if it helps for you or not” then I’d figure they did not know what they were doing, or their methods
were far less than spectacular, or they were in it the money. If you can “show me” (sorry, I am after all a resident of
Missouri) that your methods are helpful, then I’m in, but if you tell me what my experience should be… my
bullshit detector goes off.
I’m fine with people having this expectation. And with Saam I’m often able to deliver enough of what they want
that they decide to stick around for more.
ngmatthews:
In the early days of my practice I saw the pattern that patients thought that more needles was more care.
I think to some degree it is still that way for most people.
They have an issue and say “load me up with needles doc.” All those Internet pictures of pretty people with lots of
needles does NOT help. And it does not help that here in the US we think “more is gooder!!” I constantly remind
people about that great story of “enoughness” we all read as children… Goldilocks and the Three Bears. Just right
is just right. And with the Saam. I’m pretty confident that when patients say “what, just four needles and none in
the area that hurts?!?” I can say “watch this…” And then come back in 25-30 minutes and they indeed have had
something shift.
ngmatthews:16/01/2024, 11:59The Business of Sa’am – Qiological Community
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Just yesterday I was talking with someone about the fact that patients come back and complain about what is
not yet better, and often do not notice what is gone.
This used to drive me bat-shit crazy. Now I realize that the best healing happens when people fall back into their
“natural state” and have a kind of amnesia about the problem that brought that in. Of course, this is not so good for
business, because rather than say “that acupuncturist cured my back pain” they just go back to their life without a
thought as to why they are better. That in my mind is the best healing. The second best is when they feel better and
they credit you for doing it. Yes… it’s good for business, and for referrals. But maybe a lower level of healing.
And I think patients come by that “amnesia” honestly. It is, after all, hard to pay attention to something that is NOT
there.
ngmatthews:
This signifies a couple of things. One is my failure to convert experimenters into long term users of OM for
health.
I don’t think it is our job to “convert” people to longer terms patients. I think we can invite. But it’s better to leave
the choice to the patient. I think invitations are actually more powerful than prescriptions.
ngmatthews:
Ultimately people are on their healing paths. We are all searching around for things all the time to improve our
lives. The patient, to a large extent, controls the treatment plan, no matter what we do.
Yes, I agree. And so if we can help them along that path, work in tandem with them about the “treatment plan.” I
suspect they go further with us. Unless they are the kind of people that like to be told what to do. But I’m not
particularly keen on being the manager of their decisions. I like to invite people to check in with their own
experience, and the reality of what the treatment has done for them, and then let them chose the next steps.
ngmatthews:
I believe that in the long run Saam will increase practice volume because of its effectiveness.
As Toby says, and I agree… people want clinical results. Help that to happen and the rest will work itself out. And
here’s the other thing… If I feel like I’m not helping someone, then I want to send them to someone that might be
of more service. I’ve found that having that conversation about “I’m not sure I’m being helpful to you…” has often
resulted in patients wanting to stay the course. They appreciate the honesty.
michaelmax: November 16, 2019, 1:34am
Daniel:16/01/2024, 11:59The Business of Sa’am – Qiological Community
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there is a common misconception that if a practitioner is busy and hard to ‘get into’, the assumption is typically
made that they must be good!! In fact, the opposite is quite likely if you think about it. They are ‘hard to get
into’ because their patients are not getting better.
oh boy @Daniel, i think you might be right and this really messes with my internal dialogue.
Jason: November 16, 2019, 3:28pm
Great to hear from all of you. In the past, when I’ve transitioned between different styles some logistics had to
adjust, but this is almost like a different line of work altogether.
Although I don’t really feel like I have a handle on Sa’am yet I seem to be going all in, partly because it’s
undeniably uniquely potent and partly because I have to make a choice about this payment issue. I’ll be submitting
claims out of network and charging a “middle way” fee at TOS. It’s not an easy choice because the majority of
people here do have decent coverage. Asking them to pay out of pocket is like asking them to pay twice. But I’m
betting on Sa’am. I think my market will be those who’ve tried other acupuncturists and have heard about
something different; and those who don’t have coverage. The latter would normally go to community acupuncture.
Hence, the middle way approach.
Jeez, I hope I get good at Sa’am soon!
adambroder: November 16, 2019, 7:58pm
Jason:
Also, I’m considering a new Sa’am-specific consent form.
What would be different about this form?
Jason: November 16, 2019, 8:32pm
Basically, that there may be adverse outcomes which show up later, and if any occur they agree to return ASAP.
Jeffrey: December 4, 2019, 9:35pm
This has turned into such an interesting thread I had to jump in, but where to start?!16/01/2024, 11:59The Business of Sa’am – Qiological Community
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ngmatthews:
I agree about volume going down. Sometimes I wonder if it could also be other factors, but my volume has
significantly reduced since incorporating Saam.
@ngmatthews, I cant say for sure, but I think that Saam has little to nothing to do with with patient load.
We all go through our own various cycles, feelings of inadequacy to being on top of our game and everything in
between. Sometimes our life situation draws our attention in other directions, and or other seemingly visible or
invisible forces take command of our time/energy. All the while we think “my practice should be doing this or
that”. I could go on and on but hopefully this brings some perspective. Those are the times for me when reading
old notes, hitting a book or two, working in my pharmacy and or dealing with other aspects of my practice/ clinic
seem to lift my attitude, and often, bring flow back into my schedule. Really! never has any attempt at advertising (
as infrequently as I have tried long ago) produced any fruit! I now figure, If my phone is working, website working
and I’m paying attention to my practice, that’s all I can do. This is not from the Saam doctrine ;-)))