Risk Management for Acupuncture Hospital Practices

Risk management is a major concern of hospital physicians and administrators for good reason. Hospitals in the U.S. operate within an overly litigious society and are generally big targets for lawsuits. This article will address managing the risks associated with adding licensed acupuncturists to your hospital staff.

One compelling reason to effectively manage risk is the fact that providing allopathic medical care in the hospital setting is inherently risky. According to a research analysis published in May 2016, medical error is now considered to be the third leading cause of death in the United States¹.  It’s no wonder that hospitals in the U.S. tend to be amongst the most risk-averse institutions on the planet.

The good news is that adding licensed acupuncturists to your hospital staff does not add commensurate risk to the organization. Let’s consider the cost of malpractice insurance as a measure of risk for a moment. 

As a California-licensed acupuncturist, my malpractice insurance runs less than $1000 per year. If your medical center employs surgeons (as most do in some capacity), then you will probably realize that “…in California, a surgeon can expect to pay anywhere from $22,000 to $34,000 per year,” for malpractice coverage.²

The logical conclusion is that acupuncture is safe, or malpractice coverage would cost a lot more for its practitioners. The Mayo Clinic website states, “The risks of acupuncture are low if you have a competent, certified acupuncture practitioner.”³ 

This raises the question of who is and who is not competent and certified to practice acupuncture. Licensed acupuncturists receive a minimum of 3200 hours of training (in California) as a prerequisite for licensure. Licensed acupuncturists are the practitioners of choice for hospital settings because we typically receive the most training in this specialized field.

Other practitioners such as medical doctors, chiropractors, naturopaths, nurse practitioners, physical therapists, and osteopaths may practice acupuncture under the guise of “dry needling.” 

The one thing they all have in common is that, unless they have sought out comprehensive training, licensure, and experience in acupuncture, I would not consider employing them in my hospital acupuncture clinic. Utilizing a non-licensed acupuncturist in your hospital to provide acupuncture service has the potential to greatly increase your risk.

Here are my top strategies for safely onboarding acupuncturists at your hospital.

1. 1. Credentialing. Be sure that your candidates are who they say they are. The credentialing procedure at my hospital takes about 6 weeks to complete and is very thorough. During the process, everything on the candidate’s resume is double-checked, a Department of Justice background search is conducted, personal and professional references are called, and licenses and certifications are verified.

1. 2. Provide new hires with hospital privileges. Even if the acupuncturists you aim to employ deliver treatment in an outpatient setting, it’s still a good idea to provide him or her with hospital privileges. You never know when a patient or family member will request acupuncture treatment during their hospital stay. It’s much smoother to get approval from leadership for inpatient treatments when it’s your employee with hospital privileges already in place.

1. 3. Create written policies & procedures. This will help create clearly defined roles for practitioners and support staff. These will be specific to the practice of acupuncture, so feel free to engage the help of your staff acupuncturist in drafting these documents. What should I do if a fire alarm goes off during clinic? This should be anticipated and dealt with formally in advance. Of course, some questions can only be considered only after the fact, and then later put down formally for use by the department. Keep on your toes for opportunities to fill out your policies & procedures based on real-world experiences in the clinic.

1. 4. Hire only the best acupuncturists. Find practitioners who have a doctorate-level education such as D.A.O.M. or Ph.D. degrees, or the willingness to complete one concurrently. Kaiser Permanente wants candidates with an average of 2-5 years of experience in clinical practice. There will be hundreds of applicants for job postings because these positions are still rare and fiercely sought after. You’ll be well-positioned to select the cream of the crop.

1. 5. Watch closely during the 90-day probationary period. Observe your new hires closely and determine where any problem areas appear, if any. Resolving potential issues before they occur is preventative and proactive. This strategy allows you to reduce the risks of poor service and inappropriate medical care before they have a chance to occur.

1. 6. Provide adequate malpractice coverage. Licensed acupuncturists working in a hospital or medical office building annex should carry a policy covering $1 million per incident, with a $5 million annual aggregate limit.

I am convinced that the acupuncture procedure itself is safe. Not once have I seen a serious adverse effect as a result of my acupuncture needling, even after having personally delivered approximately 30,000 treatments in a hospital setting. 

“Acupuncture indeed has a relative risk that is low,” says Arya Nielsen, Ph.D.⁴ The risks associated with the acupuncture needling procedure can be summed up very quickly:

• Residual pain at needling sites
• Bleeding and/or bruising at needling sites
• Infection (rare)
• Pneumothorax (rare)
• Organ puncture (even more rare)

Any acupuncturist worthy of a medical license will employ the industry-standard Clean Needle Technique5, which effectively negates the risk of infection due to acupuncture needling. Due diligence allows us to avoid the other risks, above.

As I mentioned in my first article, The Permanente Medical Group, Inc., has employed licensed acupuncturists since 1980. Kaiser Permanente has seen for a long time that the benefits of utilizing acupuncture in the hospital setting far outweigh the risks. They continue to do so to this day and show no signs of slowing down.

This article is the third in a series designed to provide potential “acupuncture champions” with the information, perspectives, strategies, and tools necessary to successfully integrate acupuncture into their own clinics and medical centers. 

I hope you have found this information useful. If you have questions or comments about anything covered (or not covered) in this series, please post a comment below.

• ¹ BMJ 2016;353:i2139
• ² Accessed online 6/15/2016 at https://www.trustedchoice.com/professional-liability-insurance/medical-malpractice/
• ³ Accessed online 6/16/2016 http://www.mayoclinic.org/tests-procedures/acupuncture/basics/risks/prc-20020778
• ⁴ http://www.pacificcollege.edu/news/blog/2015/04/27/science-acupuncture-safety-risks-harms-and-ancient-goodness
• ⁵ http://www.ccaom.org/downloads/7thEditionManualEnglishPDFVersion.pdf