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Timely Topics: CMS Reevaluates Acupuncture Coverage for Chronic Pain Sufferers

Pain and more importantly chronic pain, are conditions that can develop from being injured. Many who are injured have an expected acute pain reaction. But when appropriately treated, the injured party recovers, and life goes on. However, for some the pain continues to persist even after the injury heals and functional recovery is achieved. In the mid-1990s, some  professionals in our medical community became concerned pain complaints were not being taken seriously. During this time pain evolved from being a symptom, to becoming the diagnosis. Drug manufacturers noted the concern of their marketplace and addressed the concerns of the medical community by developing more potent, faster and longer lasting pain medication. This set the stage for the opioid crisis we have all witnessed in recent years.

Pain is not a new phenomenon. Injured and seriously ill patients have always required treatment for pain. I frequently deposed a psychologist who operated a pain clinic and provided non-pharmacological treatment of pain. As we know, psychologists cannot prescribe medication. When he thought medication was necessary or appropriate, he consulted with his patient’s medical doctor to let that doctor’s expertise determine if the prescription medication was necessary and appropriate.

The psychologist offered and provided talk therapy, typically cognitive behavioral therapy in individual and group settings. I think about him when I read about the opioid problem facing our country. His comment that resonates with me today was: ‘What would he (his patient) do if he were on the prairie?’ In short, his patient is living in modern America with access to medication that wasn’t available years ago. How did our forefathers survive when stricken with debilitating pain? His contention was that they struggled through the pain and employed other less intrusive and potentially harmful options.

In his blog Managed Care Matters, Joe Paduda reports on surveys that he has conducted, demonstrating that the opioid spend in workers’ compensation has significantly decreased in recent years. This should be viewed as a positive step by all in the workers’ compensation community, and should correlate with fewer injured workers becoming addicted or even dying from medication causes. He rightfully observes however, the biggest foreseen problem is how these patients will find other ways to handle their pain, or as my psychologist friend repeatedly observed—what would they do out on the prairie?

CMS in their January 4, 2019 MSA Reference Guide instructs in section 17.3 that Medicare Set-Aside funds may only be used to pay for expenses Medicare would normally pay for. Examples of what are not appropriate are then listed. The first on the list of non-allowed examples is acupuncture. In a directive issued this week, CMS proposed covering acupuncture costs for Medicare beneficiaries diagnosed with lower back pain who are enrolled in approved studies. This reevaluation by CMS demonstrates an awareness that as the opioid crisis is addressed, it is imperative the medical community and those struggling with chronic pain be allowed to explore less harmful and viable treatment options.

Acupuncture might be an alternative. CMS’ directive makes clear this is not an outright adoption of acupuncture as an option. They are testing the waters and if the testing is fruitful, and acupuncture is demonstrated to be an appropriate treatment for low back pain, it might be fair to assume payments for the treatment will be allowed.

This willingness to evaluate and consider acupuncture might signal a new consideration to allow other less traditional modalities as viable alternatives to the pharmacological solution that has caused so much harm in recent years. CMS’ acupuncture directive is a positive but cautious step forward. Ametros supports this decision and hopes something good comes of it for injured parties suffering with chronic pain.

3 thoughts on “Timely Topics: CMS Reevaluates Acupuncture Coverage for Chronic Pain Sufferers

  • It’s long overdue for CMS to consider and allow options other than those promoted by the pharmaceutical industries and the AMA. The Maine WC act allowed for spiritual healing as I recall, and I don’t recall an instance where it was abused (or even used?) People generally don’t waste their own time, money and subject themselves to extra hassle or pain if it’s not productive.

  • I’m an injured worker with chronic pain. Due to my severe reactions to many medications, I can take nothing for pain- and Dr.s don’t prescribe pain medications. I have yet to receive settlement, but No money was allocated for medication or surgery that of course requires medication.

    Acupuncture is my ONLY pain relief and I rely on that to keep me mobile. I hope CMS will offer Acupuncture for those of us who have no other pain relief options.

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