Who’s sticking it to whom?
That was my first thought when I saw how much money the county, which is self-insured, paid out in acupuncture claims last year.
Certainly, it seemed a bit odd that those claims, filed by only 221 of the 3,600-plus people covered under the county’s insurance plan, amounted to more than $1.2 million during the 2016 fiscal year.
Even odder that all of those county employees were seeing the same acupuncturist. It’s not like there’s only one practitioner here in Vero Beach.
More than a million bucks in one year – of our tax dollars! – for a couple of hundred people to receive acupuncture treatments?
The Indian River Medical Center billed the county only $1.6 million for treating employees during that same period. The Sebastian River Medical Center was paid only $560,000.
How did acupuncture costs get to $1.2 million?
Here’s how: Those 221 patients accounted for more than 8,200 visits, which, if you do the math, averages out to nearly 40 treatments per person at an annual cost of almost $5,500.
Now, get this: The entire $1.2 million went to Dr. Jill Jaynes’ Absolute Integrated Medicine, located in the Bridgewater Building on Indian River Boulevard.
“That jumped out at us, too,” said Suzanne Boyll, the county’s human resources director.
Before you start firing off complaints to your county commissioners, you need to know that Boyll didn’t take over the human resources department until July.
In fact, it was Boyll, upon learning of the unusually high number of acupuncture claims, who looked into the situation last fall and promptly informed commissioners of her alarming findings.
“We had already completed the process for the coming year’s plan, which was effective Oct. 1, when someone brought the matter to my attention,” Boyll said, adding that the county had received a June report revealing a significant increase in claims for acupuncture treatments.
Boyll said she researched the records and discovered the claims paid to Jaynes’ practice had quadrupled over a four-year period, primarily because more county-insured patients were seeking treatments more often.
“There was a steady, progressive increase,” she said, “so I started looking at our options.”
The problem, as she learned, was that Absolute Integrated Medicine billed the insurer but did not require patients to cover any of the costs of the treatments.
In other words: There was no co-pay.
“What we had heard – and what was confirmed at the county commission meeting – was that this practitioner waived the co-pay,” Boyll said. “When that happens, the treatments are essentially free, so there’s no reason for people to not go as much as they want.
“Think about it,” she added. “If you have to pay [something] out of your own pocket, you’re more likely to think twice about whether you really need to go. The co-pay is a mechanism that helps minimize the insurer’s obligation.”
Boyll said her research revealed that the frequency with which Absolute’s patients seek treatment is far greater than patients of other area acupuncturists who require a co-pay.
According to Absolute’s website, treatment costs range from $30 for a “community acupuncture” session to $85 for a private acupuncture session. There is an “initial intake” charge of $105 before the first private acupuncture treatment.
However, if you divide the $1.2 million paid to Jaynes’ practice for the 8,200 visits, the average claim was for more than $140 per treatment.
When Boyll took the matter to the commissioners, several of the county’s 1,600 employees attended the meeting and said Absolute’s acupuncture treatments had cured and prevented health problems.
In response, the commissioners voted to place a cap on covered acupuncture claims, limiting patients to 26 visits per year with a maximum annual payout of $1,500.
The cap, which goes into effect Feb. 1, is expected to save the county nearly $900,000 a year. Had it been in place in fiscal 2016, the cost of the acupuncture claims would have plummeted from $1.2 million to $331,500.
“It’s a step in the right direction, but it’s still a high number,” Boyll said. “If a proper co-pay were required, we wouldn’t be anywhere near $330,000. That’s a lot of money. So we’re monitoring this situation very closely, and we’ll make further changes to the plan if we need to.”
