Group Acupuncture Model in a Cancer Institute: Improved Access and Affordability

Evidence points to benefits of acupuncture for symptom relief of cancer and its treatments. Mitigation of pain, hot flashes, neuropathy, and improvements in sleep and anxiety are reported in the literature. ^{1 –5} However, accessibility of acupuncture remains a challenge for cancer institutions. Barriers include treatment cost, limited patient knowledge of the benefits of acupuncture, inadequate treatment space, and access to licensed acupuncturists with oncology experience. However, these barriers can be reduced by the group acupuncture model. Extant research has discussed the features of group acupuncture, ^6,7 and group acupuncture's impact on cancer patients' symptoms, ⁸ yet the implementation of group acupuncture for cancer patients has not been well described. The purpose of this commentary is to describe the successful transition from an individual to group acupuncture model at one cancer institute.

Initially, acupuncture was provided as individual sessions. This model soon proved inefficient with longer wait times and provider unproductivity during no show appointments. Inspired to explore a transition from individual to group acupuncture, the administration team, oncologists, patient advisors, and acupuncturist partnered to develop a group acupuncture model. The model combined concepts from group acupuncture ^8,9 and shared medical appointment including provision of patient education and counseling, physical examination, and intervention to groups of patients concurrently treated by a health care clinician in a single session while maintaining attention to individual needs. ^10,11 Although group acupuncture became the delivery model in the oncology center, individualized care remained available at a primary care site in the system. Patients self-refer and self-select group or individual acupuncture depending on personal preference and ability to pay.

In the group acupuncture model, patients pay a set out-of-pocket fee for service upon arrival, which is half of the cost of individual appointments. Those with insurance coverage for acupuncture are encouraged to file for reimbursement, whereas philanthropic support is available for patients with financial need. Importantly, the need for philanthropic support decreased from 92% in 2014 to 16%–24% in 2017–2018. It is surmised that the lower more affordable cost of the service has reduced the philanthropic support needed. Philanthropy is only provided for the group appointment option.

At the start of the visit, patients sign an agreement stating they will respect other patients' privacy. Appointments are staggered in 15-min increments to allow the acupuncturist to perform a personalized assessment and treatment plan before moving to the next patient. Treatment is provided in a recliner chair in a large quiet room that accommodates four to six patients. The room and recliner chairs are sanitized for infection prevention. Patients receiving active cancer treatment have laboratory values monitored, with parameters set for safe treatment (i.e., Absolute Neutrophil Count of 1000/mm³ and platelet counts of 50,000/μL).

Videos with soothing nature sounds and music are played in the background. Patients are supported by pillows and offered mylar blankets and recorded guided imagery meditations using an iPod and earbuds. Patients requiring language translation initially meet in a separate room to maintain quiet in the treatment space. Pre- and postsymptom assessment data are collected at each appointment, along with satisfaction surveys at first visits. During a 4-h acupuncture appointment, up to 12 patients can be treated, including new and follow-up visits. Utilization volumes and financial impacts of the transition from individual to group acupuncture models are presented in Table 1.

The group model began with a 4-h appointment period per week in 2014 and incrementally expanded to meet demand. In 2017 and 2018, the total number of patient visits for shared acupuncture grew to 1450 each year. Sessions are now offered 2 full days, with additional expansion planned in 2019. Wait time from referral to the first acupuncture appointment has decreased from an average of 25 days in the individual model to 14 days in the group acupuncture model.

Although the group acupuncture model provides improvements in access and affordability, the team has responded to challenges specific to this care delivery model (Table 2). Overall, the group model improved access and affordability for patients. Our institution plans to use this delivery model as the foundation for current and upcoming research studies including examination of longitudinal pain response to acupuncture and symptom mitigation for cancer-related symptoms such as hot flashes and neuropathy. With adequate structure and resources, other health care institutions can adapt this model for improved accessibility and affordability in providing acupuncture services, whether in oncology or other departments.