After reading my column last month, when I expressed shock and concern that one local acupuncture practice was able to collect more than $1 million in claims from the self-insured county during the 2016 fiscal year, Jill Jaynes offered me a free treatment.
She wasn’t trying to stick it to me – though, as the owner of Absolute Integrated Medicine, which apparently enticed county-insured patients by waiving co-pays, she wasn’t at all pleased with what I wrote.
She was making a point.
“Do you really think people show up three or four times a week to get fine shafts of steel intricately stuck in their bodies because they like it?” Jaynes said. “No, they do it because it works.”
Maybe it does.
Despite the many sports-related aches and injuries I’ve endured through the years, I’ve never been treated by an acupuncturist – and for the very reason Jaynes stated: I have no desire to become a human pin cushion.
I have friends who’ve fully embraced the benefits of acupuncture and say their lives are better for it. I have other friends who’ve undergone treatments and didn’t get much out of it.
Yet, I must admit, I was tempted by Jaynes’ no-charge offer, especially after my pro-acupuncture buddies assured me it wouldn’t hurt. But, again, I couldn’t get past the thought of those “fine shafts of steel.”
Hundreds of county employees and their family members, however, had no such fears during the 2016 fiscal year, Jaynes said.
“My office alone provided more than 600 county-insured patients with treatments, many of them more than once a week,” Jaynes wrote in a Dec. 19 letter to county commissioners.
“This included the insured members and their dependents.”
County officials, however, say only 221 of Jaynes’ county-insured patients filed claims – and those 221 accounted for more than 8,200 visits, which, if you do the math, averages out to nearly 40 treatments per person during the year at annual cost of almost $5,500 apiece.
In fact, if you divide the nearly $1.2 million paid to Jaynes’ practice for the 8,200-plus visits, the average claim exceeds $140 per treatment.
And, oh, by the way, County Administrator Jason Brown sent me documents showing that Jaynes’ practice collected more in claims during the 2016 fiscal year than any other non-hospital, health-care provider.
The Indian River Medical Center billed the county $1.6 million for treating employees during that same stretch, while the Sebastian River Medical Center was paid only $560,000.
It was no surprise, then, that after Suzanne Boyll, the county’s human resources director, saw the numbers and discovered claims paid to Jaynes’ practice had quadrupled over a four-year period, the commissioners voted in December to cap coverage for acupuncture treatments, starting Feb. 1.
County-insured patients are now limited to 26 visits per year with a maximum annual payout of $1,500.
Jaynes defended her billing practices.
She said the county has made her the scapegoat for its failure to properly monitor and regulate its health-insurance plan, which, until this month, allowed patients unlimited access to acupuncture treatments.
Though she would not allow me to quote her in print, Jaynes said the county’s numbers, as they apply to her practice, are misleading.
She argued that it is absolutely not possible that she collected more in claims than Indian River Medical Center.
Jaynes, who grew up in Vero Beach and founded what has become a thriving practice in 2002, said the county’s billing numbers for Indian River Medical Center were for its fast-care clinic, not the overall hospital.
Brown stood by the numbers in the documents provided by Florida Blue, which manages the county plan.
“Our total expenses for the year were $14 million,” Brown said. “That’s everything – hospitals, doctors’ fees, office visits, prescriptions, medical supplies … That’s every dollar we paid out.
“I don’t understand how one medical practice of any sort could bill for more than the Sebastian River Medical Center,” he added.
“The most we paid to any single cardiologist was about $50,000. So to pay more than $1.1 million to an acupuncture practice?
“Does that make sense to anyone?”
Brown and Boyll said the problem was that Absolute Integrated Medicine, an out-of-network provider, 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.
That meant patients could seek treatment, free of charge, as much as they needed or wanted. The county was picking up the check.
“Some people were going 200 times a year,” Brown said.
Jaynes, whose practice offers five acupuncturists and 11 treatments rooms in the Bridgewater Building on Indian River Boulevard, said she often waived the co-pay for patients experiencing financial hardship.
“Acupuncture benefits have been an advantage to your employees,” she wrote to commissioners, “many of whom have only recently seen an increase in pay since 2007 and are, in general, paid substantially less than other counties and municipalities.”
In her letter, Jaynes also argued that acupuncture treatments actually replace other more expensive health-care services that often require “prescription medications, tests, primary-care and specialists visits, surgery and the like.”
She also urged commissioners to “factor in increased productivity in the workplace, paid sick-time reduction and the potential to reduce adverse effects and addictions to prescription medications commonly used as the only method for western medical doctors to treat chronic and/or severe pain.”
For the record: When Boyll asked the commissioners to discontinue coverage for acupuncture at the Dec. 20 meeting, several of the county’s 1,600 employees attended the meeting and said the treatments they had received at Jaynes’ practice had cured and prevented health problems.
That’s why the commissioners opted to cap the coverage, rather than discontinue it.
Coincidence or not, Jaynes decided shortly afterward that, as of Jan. 1, she would no longer accept Florida Blue insurance.
County employees and their dependents must now pay up front, then submit their claim to the insurance company on their own.
Brown, however, said county officials, along with Florida Blue, are still reviewing Jaynes’ billing practices. He said the Florida Office of Insurance Regulation is aware of the matter, as is the State Attorney’s Office.
“We’re continuing to look at it,” Brown said.
Jaynes, a former Florida State Oriental Medical Association board member who said she has taught seminars on insurance billing, seemed unfazed by the county’s actions.
She said she has committed no crime, and no one has put forth any evidence that she has.
But not everything that’s wrong is illegal.
Truth is there’s plenty of blame to go around. Some blame Jaynes for waiving co-pays; others blame county employees for taking advantage of free ride. But they didn’t allow this to happen.
The county did.
Someone wasn’t paying attention and it cost the county’s taxpayers more than a million dollars.
Jaynes said Absolute Integrated Medicine remains very successful and continues to grow, having added nearly 60 new patients since this story first made headlines last month.
They’re paying $105 for their initial intake visit, then either $85 for a private treatment session or $30 for a community acupuncture session. And they’re paying up front.
I’m not one of them, though.
I’m sticking with my chiropractor.
