Friday, September 25, 2015

The Sponsor Issue--Acupuncturists and their Hospital Sponsor

The Hospital Sponsor issue
revised and updated 12.08.2015

keywords: credentialing, privileging, hospital admin, PCMs, peer record review, supervision, licensed independent practitioner (LIP), ACAOM-accredited programs

related topics:  dual-licensees, professional practice evaluation (FPPE, OPPE, peer record review), recognition as an LIP

The Ideal Hospital Sponsor Relationship for an L.Ac.

To get started in a hospital, it has been the experience of successful hospital-practice L.Ac.s to date that they need a Sponsor.

A sponsor is a hospital physician, already established at your medical center, who is willing to support you to be hired.  This person advocates for you through the credentialing process.  This may even be the same person who writes your position description (job duties).  The Sponsor takes on responsibility for you and your potential for better or worse. 

The sponsor understands hospital culture, navigates it easily, and protects you from the political intricacies while mentoring you to work within it.

Ideally, you have more than just your Sponsor who advocates for you at your hospital.  It is your job to make your Sponsor’s “advocacy” as easy as possible.

Eventually, the ideal is that the hospital will see what a wonderful asset you and your medicine are and more L.Ac. providers will be hired and incorporated in more departments and areas of patient care and admin and research.  And someday, enough that an Acupuncture/EAM department may be useful, if such is the case that the hospital is large enough to have physical therapy department or a psychology/behavioral health department.

How are Hospital Sponsors/Advocates grown or cultivated?

Unknown.  There is a wide variety of examples.

However, one common thread I hear through all these shared stories and experiences is that they (sponsors) believe in what we do.  Usually through personal experience or from hearing and seeing positive feedback and results from patients who receive care from an East Asian Medicine Practitioner/Acupuncturist.

Some physicians have also taken a medical acupuncture course or auriculotherapy course.  This is not, however, the majority.

A small number of sponsors are also L.Ac.s.  These are our rare MD-L.Ac.s or DO-L.Ac.s or ARNP-L.Ac.s.  For easier terminology, I will call them “dual-licensed L.Ac.s”.

Peer Record Review, LIP, and the Sponsor

L.Ac.s, as licensed independent practitioners (LIP), require only administrative supervision, not practice supervision.  L.Ac.s can, by education and training standards, receive practice supervision from someone of the same level of ACAOM-accredited education, another L.Ac.  This is consistent with being an LIP.  LIPs, in the hospital setting, must participate in peer record review, a professional performance evaluation standard (FPPE/OPPE).  If an L.Ac. is the only L.Ac. at a facility, this is a challenge.  See related posts on Who supervises the work of an AcupuncturistPeer Record ReviewOccupational Code, and the Meridians article.  

The Sponsor, if he is a dual-license L.Ac., could also be the peer reviewer, by virtue of his ACAOM-accredited training and L.Ac. licensing.  This would be a work-around until more L.Ac.s could be hired.  See Dual-licensee post for more information.

Example of Hospital Sponsor relationship

A PCM with a medical staff appointment (usually a physician) at a medical center takes an interest in wanting to hire an L.Ac.   This person will hereon be called the “hospital sponsor”. This usually comes from one (or more) of the following motivators:

  • Interest in non-drug pain management options (possible push from Joint Commission’s standard if med center has a pain management program)
  • Interest in integrative medical therapies
  • Has had patients request Integrative Medicine (IM) therapies, particularly acupuncture, and is interested in bringing related staff on-board as employees to help fill the need and patient requests
  • Is interested in a PCMH model that incorporates IM
  • The state’s interpretation of the Affordable Health Care Act includes insurance coverage of acupuncture as practiced by L.Ac.s  [affordable health care act post/worker’s comp coverage of acupuncture post]  
  • Great need (or interest) in medical center for non-drug treatment option such as acupuncture that decreases ER return rates, inpatient hospital stay length, and surgery recovery statistics [see Allina example of incorporating EAMPs/L.Ac.s in the ER]  

Hospital Sponsor is Innovator and Synergist, more than your average Administrator
The hospital sponsor is usually a physician who has some administrative time allowed in schedule or is incredibly motivated.  The hospital sponsor will next do one of the following:

  1. Request to hire one L.Ac., in her area of hospital.  For example, the hospital sponsor is main provider at a OB clinic and wants to add an L.Ac. to her staff.
  2. Request to hire multiple L.Ac.s as part of a creation of a specific Integrative Medicine (IM) clinic or healthcare system-wide creation of IM clinics, such as for pain management and/or IM rehabilitation clinics

Among other things, the hospital sponsor will have to do the following:
Get idea approved by hospital admin
Create a position description for the L.Ac.
Create a hiring package with HR for the L.Ac.
Create a credentialing package for L.Ac., working with the credentialing department
As part of hiring process, present credentialing packet and drafted delineation of clinical privileges to the hospital credentialing committee on behalf of the soon-to-be hired L.Ac. employee

When working with Credentialing department specialist to create packet, the following is often helpful:
Useful items when working with the credentialing department and credentialing committee:
The state’s scope of practice for practitioner
Position description created for L.Ac.

Once L.Ac. is hired, and if she is the first L.Ac. ever to be hired by this medical center, the hospital sponsor:

Works with the L.Ac. to develop basic SOP (standard operating procedures) based on her industry standards and experience. 

The L.Ac. is able to direct her hospital sponsor to her national standard organizations to find the best and most current standards and regulations that may apply.  Contact your national EAM/AOM standard organizations and see your EAM/L.Ac. Hospital practice group on social media for examples.

IM = integrative medicine
PCMH = patient-centered medical home
L.Ac./EAMP = state license titles for Acupuncturist.  "Licensed Acupuncturist (L.Ac.)" and "East Asian Medicine Practitioner (EAMP)".  Most common state title is L.Ac. 

Read more about how to Get Your Foot in the Door of Hospital-based Practice: First Steps, a new (2019) publication on the website and its companion resource, The Workbook

related blogposts: 

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