Payers Lag On Acupuncture Coverage Despite Rising Utilization

January 13, 2022 - Although acupuncture utilization has grown in recent years, only half of acupuncture visits had any form of coverage in 2019, according to a research letter published in JAMA Network Open.

The researchers analyzed acupuncturist visits in Medical Expenditure Panel Survey (MEPS) data from 2010 to 2019. Their aim was to uncover the total cost of the visit, the annual out-of-pocket healthcare spending for these visits, the portion of these visits that were covered under the patients’ insurance plans, and the percent of out-of-pocket costs.

The majority of the participants were female and nearly six in ten were White individuals.

“Half of respondents reported no insurance coverage for acupuncturist visits in 2018-2019, and most spending occurred out of pocket,” the researchers found.

At the beginning of the study timeframe, approximately four in ten acupuncture visits had some amount of coverage (41.1 percent). Almost ten years later, nearly half of all acupuncture visits had some insurance coverage (50.2 percent).

The overall number of survey participants who had at least one acupuncture visit in a year increased over time.

In 2010, 0.4 percent of the respondents had visited an acupuncturist at least once that year, but by 2019 that figure rose to 0.8 percent of participants. The mean number of acupuncture visits per person in 2010 was 5.4 visits per year but at the end of the study period it was 8.2 visits.

The increase in visits and utilization of acupuncture may be tied to expanded coverage, the researchers suggested based on the results of previous studies.

Not only did the number of acupuncture visits rise, but the level of spending on acupuncture also grew. Acupuncture treatment costs rose from $593 in 2010 to $1,021 in 2019. However, while the cost of the acupuncture therapies did impact out-of-pocket spending, the increase was not significant.

The rise in the number of acupuncture treatment did prompt an incline in patients’ out-of-pocket spending on these visits. However, the increase in out-of-pocket costs was not significant, rising from a mean of $375 in annual out-of-pocket spending to a mean of $554 by the end of the study’s timeframe.

“Insurers have cited an inconsistent evidence base as a reason behind coverage decisions, yet acupuncture has been shown to be effective for various pain conditions that are not always covered,” the researchers explained.

The tie between expanded coverage for treatments and increased utilization may also be evident in the correlation between Medicaid expansion and opioid overdose deaths. 

States that expanded their Medicaid programs saw their overdose death rates decline six percent. Researchers suggested that increased coverage of substance use disorder treatment, such as medication-assisted treatment (MAT), may be responsible for the decrease.

At the federal level, healthcare coverage is moving slowly toward greater acceptance of acupuncture.

In January 2020, Medicare finalized a rule providing coverage for acupuncture treatment, particularly for chronic lower back pain. At the time, Kimberly Brandt, principal deputy administrator of operations and policy at CMS, said that this measure would help reduce dependence on opioids and that acupuncture could be a key tool in the fight against the opioid epidemic.

However, this rule strictly covered acupuncture for lower chronic back pain. It was not a blanket affirmation of the treatment.

“The results of this study indicate that insurance coverage for acupuncturist visits has increased, but most costs are paid out of pocket. Insurers should be encouraged to cover safe, low-cost, and evidence-based approaches to comprehensive pain care, including acupuncture therapy,” the researchers concluded.

The opioid crisis sometimes motivates payers to think outside of the box when it comes to treatment and prevention solutions. 

For example, Highmark Health workers started a grassroots support program for payer employees who were living with or knew someone living with substance abuse. The program aimed to reduce stigma internally and resulted in a ceremony for International Overdose Awareness Day and had the potential to form a speakers bureau.

In 2019, UnitedHealthcare increased access to chiropractic care and physical therapy benefits as an alternative to opioid treatment for pain.

Still, acupuncture treatment coverage lags behind as payers gather more evidence around its efficacy.