Acupuncture use is increasing, but many insurers do not cover it
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Even though the number of patients who visited an acupuncturist about doubled from 2010 to 2019, and insurance coverage for the treatment increased, most patients continued to pay out of pocket, according to recent data.
“Any decrease in opioid prescribing [for chronic pain] is a welcome public health trend,” Molly Candon, PhD, an assistant professor in the department of health care management in the Wharton School, director of the associate fellows program in the Leonard Davis Institute of Health Economics, and research assistant professor of psychiatry in the Perelman School of Medicine at the University of Pennsylvania, told Healio. “Still, opioid overdoses and deaths continue to increase. The fact remains that chronic pain affects over one in five adults in the U.S. and is very expensive to treat. Our results suggest that inadequate insurance coverage may serve as a barrier to safe, effective and cost-effective pain care.”
In a research letter published in JAMA Network Open, Candon and colleagues examined insurance coverage for acupuncture visits between 2010 and 2019 using data from the Medical Expenditure Panel Survey. Adults who responded to the survey reported acupuncture use and demographic information. The researchers’ analysis focused solely on respondents who reported at least one acupuncturist visit during the study period.
Occurrence of acupuncturist visits
The proportion of respondents who reported an acupuncturist visit increased from 0.4% in 2010 to 0.8% in 2019, according to Candon and colleagues. Of the 1,344 acupuncture users, 68.6% were women and the mean age was 51.9 years. Also, 57.1% of the users were white, 18.7% were Asian, 15% were Hispanic and 6.3% were Black.
Costs associated with acupuncturist visits
The total annual amount paid for acupuncturist visits increased from a mean of $593 (95% CI, 460.29-725.7) in 2010 to 2011 to $1,021.57 (95% CI, 806.32-$1,236.82) in 2018 to 2019. Annual out-of-pocket costs also increased, from a mean of $375.51 (95% CI, 286.12-464.9) to $554.26 (95% CI, 383.54-724.99). However, the increase was not statistically significant, according to the researchers. The increase in out-of-pocket costs was largely attributable to an increase in acupuncturist visits among users, from a mean of 5.4 visits (95% CI, 4.2-6.6) per person in 2010 to 8.2 visits (95% CI, 6.4-9.9) per person in 2019.
The share of acupuncturist visits with any insurance coverage increased by an average of 9.1 percentage points (95% CI, 5.6-12.7), from a mean of 41.1% (95% CI, 38.1-44) in 2010 to 2011 to 50.2% (95% CI, 48.3-52.1) in 2018 to 2019. Meanwhile, Candon and colleagues observed that the percentage of costs paid by respondents out of pocket, with or without insurance, decreased by an average of 9.4 percentage points (95% CI, 12.5 to 6.3) from a mean of 66.9% (95% CI, 64.4-69.3) in 2010 to 2011 to 57.5% (95% CI, 55.8-59.1) in 2018 to 2019.
Despite an increase in insurance coverage for acupuncturist visits, the researchers noted that about half of respondents reported no insurance coverage, and most spending was paid out of pocket.
“The more that acupuncture is covered by insurance, the more viable it will become for chronic pain patients,” Candon said. “It’s worth noting that the cost for an individual acupuncture session was between $100 and $125 in most years. This amount is similar to (or even cheaper than) the cost of other interventions such as physical therapy.”
Acupuncture as a form of pain care is recommended by several governing bodies, including the U.S. Agency for Healthcare Research and Quality, FDA, NIH and the Joint Commission, “which begs the question of why insurers don’t cover it more,” she added.
Perspective
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Anita Gupta, DO, MPP, PharmD
Acupuncture involves the insertion of thin needles into the skin as specific points on the body. It is thought to relieve pain and enhance the healing process by releasing endorphins, the body's natural pain killer, and affecting serotonin levels in the brain. It is most commonly used to treat musculoskeletal pain such as neck and back pain, nausea, migraine, anxiety, depression, high BP, allergies, female infertility, fibromyalgia and osteoarthritis.
Studies have shown that severe side effects from acupuncture are infrequent. Only a few studies have explored its potential ability to reduce the use of opioids during and after surgery. One 2016 study found that surgical patients treated with acupuncture had less pain and used fewer opioids on the first day after surgery. A 2020 study of veterans undergoing hip replacement surgeries found similar results. The veterans who received traditional acupuncture during their procedures reported less pain and less anxiety.
As the opioid crisis continues during COVID-19 and the omicron surge, surgeons and health care professionals have been working on the frontlines, vigilantly searching for evidence-based ways to treat pain effectively during surgery. Opioid use for pain management during and after surgical procedures is a known driver of opioid use and overdoses. Reducing opioid use during surgeries is critical to reducing the risk of long-term opioid use in patients. The CDC reported a record 93,000-plus overdose deaths last year — a 29% increase from 2019's record-breaking death toll. Overdose deaths from opioids rose from 50,963 in 2019 to 69,710 in 2020. Philadelphia recorded 1,214 overdose deaths in 2020, according to the city’s Department of Public Health. That total, the second-highest in city history, was a 6% increase from 2019. Of the deaths, 86% involved an opioid such as heroin, oxycodone or fentanyl.
Several studies recently suggest that giving patients acupuncture can reduce their pain, leading to fewer opioids for postoperative pain. However, further research is needed to confirm the long-term benefit. Whether acupuncture also has a role to play in the operating room hasn't been well defined. In one study, researchers found that 65% of study patients who received acupuncture during total knee replacement surgeries only needed a low dose of opioids — 15 oxycodone pills or less — for postoperative pain or none at all. By comparison, that was true of just 9% of knee replacement patients outside the study.
References:
Acupuncture before surgery may reduce pain, opioid use. https://www.medicalnewstoday.com/articles/325609. Accessed Jan. 18, 2022.
How acupuncture can relieve pain and improve sleep, digestion and emotional well-being. https://medschool.ucsd.edu/som/fmph/research/cim/clinicalcare/Pages/About-Acupuncture.aspx. Accessed Jan. 18, 2022.
Philadelphia groups addressing impact of opioid crisis receive $10,000 grants. https://www.phillyvoice.com/opioid-crisis-philadelphia-overdose-deaths-kensington-harrowgate-fairhill-grant-funding/. Published July 15, 2021. Accessed Jan. 18, 2022.
Wu MS, et al. PLoS One. 2016; doi:10.1371/journal.pone.0150367.
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