Notice of Privacy Practices

20 Jul 2013 Leave a comment

by Elene in News for patients Tags: , ,

The following is a standard HIPAA-compliant summary.  Every patient is offered a copy at the initial appointment.  You may also request a printed copy at later appointments, or simply copy it from this site.  The main point is that I pledge never to use your private information in any inappropriate way!

This notice describes how health information about you may be used and disclosed and how you can get access to this information.  It is effective April 14, 2003, and applies to all protected health information contained in your health records maintained by us.  We have the following duties regarding the maintenance, use and disclosure of your health records:

(1) We are required by law to maintain the privacy of the protected health information in your records and to provide you with this Notice of our legal duties and privacy practices with respect to that information.
(2)  We are required to abide by the terms of this Notice currently in effect.
(3)  We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and records that we have and continue to maintain.  All changes in this Notice will be prominently displayed and available at our office.

There are a number of situations in which we may use or disclose to other persons or entities your confidential health information.  Certain uses and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices.  These include treatment, payment, and health care operations.  Any use or disclosure of your protected health information required for anything other than treatment, payment or health care operations requires you to sign an Authorization.  Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization.  Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure.

We will attempt in good faith to obtain your signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.

Treatment:  We will use your health information to make decisions about the provision, coordination or management of your healthcare, including analyzing or diagnosing your condition and determining the appropriate treatment for that condition.  It may also be necessary to share your health information with another health care provider whom we need to consult with respect to your care.  These are only examples of uses and disclosures of medical information for treatment purposes that may or may not be necessary in your case.

Payment:  We may need to use or disclose information in your health record to obtain reimbursement from you, from your health-insurance carrier, or from another insurer for our services rendered to you.  This may include determinations of eligibility or coverage under the appropriate health plan, pre-certification and pre-authorization of services or review of services for the purpose of reimbursement.  This information may also be used for billing, claims management and collection purposes, and related healthcare data processing through our system.
Operations:  Your health records may be used in our business planning and development operations, including improvements in our methods of operation, and general administrative functions.  We may also use the information in our overall compliance planning, healthcare review activities, and arranging for legal and auditing functions.

There are certain circumstances under which we may use or disclose your health information without first obtaining your Acknowledgement or Authorization.  Those circumstances generally involve public health and oversight activities, law-enforcement activities, judicial and administrative proceedings, and in the event of death.  Specifically, we may be required to report to certain agencies information concerning certain communicable diseases, sexually transmitted diseases or HIV/AIDS status.  We may also be required to report instances of suspected or documented abuse, neglect or domestic violence.  We are required to report to appropriate agencies and law-enforcement officials information that you or another person is in immediate threat of danger to health or safety as a result of violent activity.  We must also provide health information when ordered by a court of law to do so.  We may contact you from time to time to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Others Involved in Your Healthcare:  Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.  If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.  Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Communication Barriers and Emergencies:  We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.  We may use or disclose your protected health information in an emergency treatment situation.  If this happens, we will try to obtain your consent as soon as reasonably practicable after the delivery of treatment.  If we are required by law or as a matter of necessity to treat you, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your protected health information to treat you.

Except as indicated above, your health information will not be used or disclosed to any other person or entity without your specific Authorization, which may be revoked at any time.  In particular, except to the extent disclosure has been made to governmental entities required by law to maintain the confidentiality of the information, information will not be further disclosed to any other person or entity with respect to information concerning mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted diseases that may be contained in your health records.  We likewise will not disclose your health-record information to an employer for purposes of making employment decisions, to a liability insurer or attorney as a result of injuries sustained in an automobile accident, or to educational authorities, without your written authorization.

You have certain rights regarding your health record information, as follows:
(1)  You may request that we restrict the uses and disclosures of your health record information for treatment, payment and operations, or restrictions involving your care or payment related to that care.  We are not required to agree to the restriction; however, if we agree, we will comply with it, except with regard to emergencies, disclosure of the information to you, or if we are otherwise required by law to make a full disclosure without restriction.
(2)  You have a right to request receipt of confidential communications of your medical information by an alternative means or at an alternative location.  If you require such an accommodation, you may be charged a fee for the accommodation and will be required to specify the alternative address or method of contact and how payment will be handled.
(3)  You have the right to inspect, copy and request amendments to you health records.  Access to your health records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding to which your access is restricted by law.  We will charge a reasonable fee for providing a copy of your health records, or a summary of those records, at your request, which includes the cost of copying, postage, and preparation or an explanation or summary of the information.
(4)  All requests for inspection, copying and/or amending information in your health records, and all requests related to your rights under this Notice, must be made in writing and addressed to the Privacy Officer at our address.  We will respond to your request in a timely fashion.
(5)  You have a limited right to receive an accounting of all disclosures we make to other persons or entities of your health information except for disclosures required for treatment, payment and healthcare operations, disclosures that require an Authorization, disclosure incidental to another permissible use or disclosure, and otherwise as allowed by law.  We will not charge you for the first accounting in any twelve-month period; however, we will charge you a reasonable fee for each subsequent request for an accounting within the same twelve-month period.
(6)  If this notice was initially provided to you electronically, you have the right to obtain a paper copy of this notice and to take one home with you if you wish.

You may file a written complaint to us or to the Secretary of Health and Human Services if you believe that your privacy rights with respect to confidential information in your health records have been violated.  All complaints must be in writing and must be addressed to the Privacy Officer (in the case of complaints to us) or to the person designated by the U.S. Department of Health and Human Services if we cannot resolve your concerns.  You will not be retaliated against for filing such a complaint.  More information is available about complaints at the government’s web site, http://www.hhs.gov/ocr/hipaa.

All questions concerning this Notice or requests made pursuant to it should be addressed to Elene Gusch, DOM at EleneDOM@aol.com or (505) 255-0373.

What if you’re afraid of needles?

08 Jun 2013 Leave a comment

by Elene in Blog, Info for patients Tags:

First, please don’t worry!  Most people find acupuncture to be quite painless.  I’m extremely sensitive myself, and I’m used to working with patients who are sensitive or nervous.

If you still decide that you’d rather not have needles at all, again, don’t worry.  We can treat you by doing contact needling, touching a blunt silver needle (kind of like a small knitting needle) to the surface of your skin.  Or I can treat points by touching with my finger, or by taping on small metal pellets.  Magnets are another possibility.

We can also treat you with energy work in a more general way, without using the system of points, but acupuncture points are so helpful that I think you will prefer to have them involved.  I usually teach patients points they can press to treat themselves at home, too.

There are lots of possible ways to reach your goal of feeling good and having a body that works the way you want it to.  Let’s find out what will work best for you.

*

Medicare Covers, but Also Does Not Cover, Acupuncture

29 Nov 2021 Leave a comment

by Elene in Blog, Info for patients, News for patients Tags: , ,

Executive summary: Medicare sort of covers acupuncture for low back pain, but coverage is so limited as to be meaningless for most patients unless they have certain Medicare Advantage plans.

Every year, the fine folk at Medicare send out a thick book about coverage to all beneficiaries. The 2021 book contained extremely misleading wording about coverage for acupuncture. A person who didn’t know better would come away with the impression that they could get at least 12 covered sessions of acupuncture for chronic low back pain.

Except that’s not really the case.

Quite understandably, lots of people have called acupuncture offices trying to set up treatment and expecting to pay only small copays. Sometimes, when the office staff explain that we can’t make that happen, they get really upset. Sometimes they call Medicare, get further wrong information, and come back even more upset. A colleague in another state reported recently that a patient became loud and violent in her waiting room, abusing the staff and insisting that the acupuncturist had fraudulently taken his money when she treated him.

I think we can all agree that having violent tantrums in health care offices is generally not OK. It’s also not OK for a major government agency to give people totally wrong information, and I don’t blame anyone for being annoyed at that.

This mistake is likely not intentional, though. The regulation is written in such a mystifyingly nonsensical way that the people promulgating the information may have honestly failed to understand it. I’m willing to give them the benefit of the doubt to a certain extent.

Here’s what’s really going on:

In early 2020, a decision was made by the Powers That Be at Centers for Medicare & Medicaid Services (CMS) to add Medicare coverage for acupuncture for one well-studied condition, chronic low back pain. I don’t know precisely what the tipping point was that made this happen, but over many years there had been agitation from our profession and popular demand from patients, numerous positive studies, and recommendations from other government entities such as NIH to promote the use of non-opioid treatments for pain. Whatever it was, Medicare finally budged, and it even specified that those wielding the needles had to be licensed to do acupuncture. That is, such providers as physical therapists doing dry needling would not be included.

Here is the CMS decision memo describing the new coverage and the reasons it was chosen:

https://drive.google.com/file/d/1hoSyfCBMSXrjbIQRNA29S1NQmfFuLEzP/view

I must say that it’s a carefully and clearly written document. Some of the conclusions in it are astonishing, however, such as the contention that there is no convincing evidence for the use of acupuncture for osteoarthritis.

The trouble is that acupuncturists are not Medicare providers. We are essentially invisible to the Medicare system. There is no pathway for us to sign up to be providers, so we cannot bill for our services. In order to do this supposedly covered low back pain treatment, we must be supervised by a Medicare provider such as an MD or NP, with our treatment being “incident to” their care, and we must have billing done under that person’s name and get reimbursed through them.

This means that only acupuncturists who work in hospitals or mainstream medical clinics have any chance of this actually getting coverage to happen. It means, therefore, that there are hardly any acupuncturists who can provide treatment under Medicare. And I hear it’s been very difficult for even those few to ever collect payment.

This is an insane and completely unsustainable situation, but while we’ve been focused on the pandemic, it has gone on for nearly two years without any improvement that I know of. (And Medicare members who need help for something other than low back pain are out in the cold entirely.) Acupuncturists cannot become Medicare providers without Congress changing the law, something our profession has been trying to get them to do for a couple of decades now. So that is where our efforts are directed, but it does nothing to help patients in the near term.

Insurance companies have responded in some cases by adding similar coverage that allows patients to go to regular acupuncture offices. Different plans use different strategies, so if this includes your insurer, I can’t tell you anything about your specific plan. I can tell you that in central New Mexico, Presbyterian Senior Care has long covered acupuncture (though a limited number of sessions per year and with low reimbursement) for most if not all conditions, and Blue Cross Blue Shield and United also have some plans with reasonable or even quite good coverage. Presbyterian also now covers 12 sessions for dual eligibles, people with both Medicare and Medicaid, who are among the most vulnerable in our population. In most cases Medicaid gives no coverage at all for acupuncture— mostly because the lack of Medicare coverage means no federal dollars are available— so this is a small but significant step forward.

Despite its severe limitations, that CMS decision early last year was a sea change, much more than the baby step it has been in practical terms. Only a few years earlier, there was a petition to the federal government asking for Medicare coverage of acupuncture, which gained over 100,000 signatures and thus required a response. The response CMS gave was utterly dismissive, stating that acupuncture was not necessary or effective for any condition. This came from a milieu in which the government itself was sponsoring research on acupuncture and our work was becoming more and more common, accepted, and proven, so it felt like a painful and bizarre slap in our faces. And it made the sudden reversal at the beginning of 2020 all the more stunning.

(In contrast, the VA not only covers acupuncture but employs acupuncturists in its facilities, so you can see how far behind CMS is.)

Here is a memo from CMS to providers. This document doesn’t make it clear that acupuncturists cannot be Medicare providers, so it seems to me that it adds still more confusion. I suppose the providers to whom it is directed already understand this, though.
https://www.cms.gov/files/document/mm11755-national-coverage-determination-ncd-3033-acupuncture-chronic-low-back-pain-clbp.pdf

And here is a benefits summary for 2022 for a group of Presbyterian plans, which a number of my patients have:
https://contentserver.destinationrx.com/ContentServer/DRxProductContent/PDFs/177_0/2022%20Senior%20Care%20HMO%20Plans%20Summary%20of%20Benefits.pdf

You can see that there is a listing for “Medicare covered” acupuncture as separate from “Routine” acupuncture, but zero explanation of what that means or how many visits are allowed under that section. I assume that members receive a more complete description of their coverage as well, but this almost guarantees that they will be confused.

(You can also see that there are two tiers for chiropractic treatment. This, too, reflects what is covered by Medicare and what is not, but the typical reader would never know that from the way it’s worded.) 

I doubt you’ll be surprised to hear that we Doctors of Oriental Medicine were never told that Presbyterian was allowing any extra “Medicare covered” sessions— or even that the allowed “Routine” sessions had been increased from 20 to 25. A patient of mine found out about it quite recently and let me know. For those with severe, chronic problems, 25 treatments a year may not be enough, so this could be a real help.

I’m cautiously optimistic about the future of acupuncture access, but when people talk about Medicare for All, I advocate for Something Better than Medicare, for All.

You can help acupuncturists to become Medicare providers by learning about HR 4803, the Acupuncture for Our Seniors Act, and contacting your representative. Much more will be going on with this in the coming year.

https://www.asacu.org/wp-content/uploads/Medicare-Recognition-H.R.-4803.pdf

Delta Blues, or how I spent my summer not being able to take a vacation

25 Aug 2021 Leave a comment

by Elene in Uncategorized

Elene Explores

We still need all of these layers.

When I started writing this post, I was planning on a straightforward update on the current situation with the delta variant (sorry, I couldn’t resist the obvious title). And then a 13-year-old killed a classmate at a local middle school for no discernible reason. And then the Taliban took back Afghanistan.

The murdered boy was trying to talk his killer out of continuing to bully his friends. He stood up to him with words, doing exactly what most of us would teach our kids to do, what my daughter would do, what I would do. The right thing.

Going into Afghanistan was never the right thing. I remember writing “Can you say ‘quagmire’?” back then. Three quarters of Americans thought this war was a great idea. I was part of the other quarter. I take no pleasure in being right in this case…

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Don’t “Panic,” But We’re Not Done with This Yet. Not Even Close.

01 Jul 2021 Leave a comment

by Elene in Uncategorized

Elene Explores

Best New Mexican conspiracy theory. The booster has microguacamole.

Last week we got the news that a little girl, under 10 years of age, died of COVID-19 in our state. Because of privacy concerns, all we know is that she had underlying conditions and was hospitalized. Kids her age are of course not being vaccinated as yet, one more reason we still need to be careful. This is not over, not by a long shot.

I started writing this post in early April, then ended up working on other matters and putting it off for an unconscionably long time. Many things about the pandemic have become clearer since then, while others have become muddier still.

At that time a few months ago, COVID-19 was doing its maximum damage in India, and Brazil was not far behind. There were still influential voices referring to the pandemic as a “panic,” implying that…

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Mask Confusion, Mask Destruction?

03 Jun 2021 Leave a comment

by Elene in Uncategorized

Elene Explores

This part at least is clear!

 

I’m just coming off a session of attempting to de-freakout someone about a misleading vaccine scare article. I’ve had it with the antivaxx disinformation crew, and then I’ve also had it with the “science-based” bunch who poo-poo everything that doesn’t fit their narrow field of vision, like the guy I was reading a few minutes ago who insists that chiropractors aren’t doctors. I’ve had it.

I bet you’ve had it too.

Let’s take a deep breath, get a cup of tea, and survey the current state of play in our pandemic reality.

 

Are you confused about where, when, and whether to wear a mask now, or whether they help at this point? Of course you are. The current guidance is about as confusing as anything in the past 15 months has been, though I don’t know how it could be stated much…

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Sorting Medical Fact from Fiction, Part III: Give Me Liberty AND Give Me Death

01 Nov 2020 Leave a comment

by Elene in Info for patients, News for patients Tags:

Elene Explores

Patients have been asking me about “herd mentality,” which they then quickly correct to “herd immunity.” Herd mentality we’ve got plenty of. Herd immunity, not so much. In fact, it’s unclear whether widespread, lasting natural immunity to COVID-19 is even a biological possibility. It may turn out to be only a mirage.

But as the pandemic drags on and we are all getting weary, some of us are worn down enough to entertain some pretty crazy notions– or to take cynical advantage of our weariness.

The Great Barrington Declaration came out on October 4, made a splash, and is still being talked about. This is a letter which calls for letting the virus essentially run wild among the younger and healthier members of the population, in order to bring about a theoretical herd immunity, while in some way protecting those who are at high risk. It’s named for Great Barrington…

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Sorting Medical Fact from Fiction, Part II: We Need Therapy

01 Nov 2020 Leave a comment

by Elene in Info for patients, News for patients

Elene Explores

About the time I began writing this, at the annual meeting of our New Mexico Society for Acupuncture and Asian Medicine, we heard a presentation from David Riley, MD about how to write case reports for publication in medical journals. That brought home to me how much goes into each published study that we read and how slow and incremental the scientific process can be.

At the same meeting, one of my senior colleagues went into a passionate rant about how the SARS-CoV-2 virus was engineered as a bioweapon and we are at war, hydroxychloroquine was great, we should all go to Fox News and Newsmax to get The Truth, and most stunning of all, that President Trump was the highest order of doctor because he saved the lives of the people of America by instituting a travel ban.

The rest of us sat there and gazed bemusedly at our…

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Sorting Medical Fact from Fiction, Part I: The Two Earths

01 Nov 2020 Leave a comment

by Elene in Info for patients, News for patients

Elene Explores

No, not the Silurians.

A couple of decades ago, a friend introduced me to the work of a person who was then known as Anna Hayes. Supposedly her teachings were “downloaded” (not channeled, she said) from a galactic council of aliens who were trying to be helpful to humanity and fight other aliens, including that perennial mainstay the reptilians, who were working to keep us confused and divided. Following her and doing the practices she taught was supposed to raise people’s vibratory states and allow them to rise above these malevolent influences and create a better reality.

Some of her practices appeared to be worthwhile for one’s health. Some of the very, very dense verbiage involved was obviously crap. And a lot was so hard to understand that one might not be quite sure. There was one contention she had that keeps coming up in my mind, though: a prediction…

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When We Used to Dance

01 Nov 2020 Leave a comment

by Elene in Blog Tags:

Two Halloweens ago.  I haven’t been part of a live performance since February this year.

Dance is a huge help to my mental and physical health.  Although it’s not quite the same, there is still plenty going on with dance classes and performances in the virtual world.  I encourage you to move to music in any way that inspires you.  There’s nothing better for body, mind and spirit!

What Are Viruses? In a Way They Are Us

14 Apr 2020 Leave a comment

by Elene in Blog, Info for patients Tags:

Elene Explores

Coronavirus structure. An artistic response to the last SARS epidemic, in glass. https://www.lukejerram.com/glass/gallery/sars-corona-virus

At the beginning of the year, I wrote about the goddess Kali, having no idea how soon she’d be coming after us.

I also wrote about the interconnectedness of everything on the planet and everywhere, and how the dichotomy of humans vs. nature is false.

It turns out that even the dichotomy of viruses vs. us is false. We all learned in school that viruses are tiny beings that exist in a strange twilight zone between the living and the nonliving, and that they can’t reproduce without using the machinery of plant or animal cells. I hadn’t followed that thought to its conclusion, which is that since viruses must build themselves out of the materials of our own cells, they are in a sense made out of us. They, too, are inextricably entwined with ourselves.

This came…

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Have You Been Saddled with a Garbage Can Diagnosis? by James Rolwing

11 Aug 2019 Leave a comment

by Elene in Uncategorized

This stuff does happen often. Sometimes it’s just plain hard to pin down what’s really going on, but often there is a lack of attention and thought.

Pattern Release Energetics

This is the second part in a series that focuses on “garbage can diagnoses” (see Part I for a more detailed description of what constitutes a GCD.)

TMJ: (properly known as temporomandibular joint disorder) “My doctor/dentist says I have TMJ.” Gawd, I wish I had a dollar (nickel adjusted for inflation) for every time I’ve heard this one. Of course, they never follow up this statement with how it’s being treated, because most practitioners don’t know what to do with this condition besides give you a mouth guard. Great, now I can play hockey without losing my teeth, but my jaw still hurts. This GCD could include everything from jaw clicking, locking, joint pain, and nighttime clenching and grinding.

The importance of the jaw in overall health can’t be overstated. Because of the intense concentration of nerve receptors in the jaw that monitor proprioception–the body’s ability to sense…

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