WCA Numbers Part Two
the low end of the sliding scale -- and beyond
One of the goals for this newsletter is to create financial transparency around WCA’s, and POCA Tech’s, operations. (Other posts in this series are here and here.) What are the financial nuts and bolts of making acupuncture and acupuncture education affordable and accessible for more people? I know some people think talking about money is boring, but I think it’s like a fairy-tale task: to make the invisible, visible.
We’ve unpacked the question of why WCA doesn’t bill insurance as a strategy for making acupuncture affordable. (God, I hope we’ve said enough about that; see Intro, Part One, and Part Two.) If you’re an acupuncturist or a patient who benefits from insurance that covers acupuncture (especially if it’s any variety of Medicaid), please let me reiterate: I’m glad that’s working out for you, truly. It just doesn’t work for us. WCA’s approach isn’t for everybody.
(Given what I’m about to lay out in this post, that’s a spectacular understatement.)
There’s no one right way to practice acupuncture, there’s no one right way to receive acupuncture, and there’s no one right way to make acupuncture accessible; there are only possible ways. WCA loves exploring what’s possible. Of course there’s a price to pay for wild experimentation in the marketplace. We’re willing to pay it, though, because experimentation offers a different kind of value — not only to us as we go to work every day, but also to the community. What does the opposite of rationing look like? There aren’t many places in public health, or adjacent to it, where you can try out answers to that question.
And that’s my intro to talking about how WCA wiggles around its own sliding scale of $20 to $40 per treatment — because paying $20 per treatment is not affordable for many people, especially those with chronic illnesses or chronic pain. If you’re new to the topic of community acupuncture, you might be amazed at how upset people get (in all kinds of different ways) about very low cost treatments. If you’re wondering why comments aren’t enabled on this newsletter, the main reason is that I don’t have time to moderate them — and dear Lord, I would need to if I wanted to write about how often people pay less than $20 for acupuncture at WCA (hang on, you’re about to find out).
I’m sure at least one person is thinking, why even HAVE a sliding scale if you’re going to be so loose, okay flexible, about the low end? Fair point. It might make more sense if you could be a fly on the wall during a shift at WCA, which would let you witness how many people show up to community acupuncture because they’re truly desperate. Also, we know from experience that every so often, acupuncture literally saves somebody’s life, often somebody who doesn’t have much disposable income. And finally, WCA’s perspective is that the economics of healthcare in the US are thoroughly broken and we, a small acupuncture nonprofit, are in no position to fix them — so we might as well do something that cheers us up. Being flexible about money in order to treat a lot of people makes us happy. Life is short!
So I’ll get on with this post.
In WCA’s last Finance Retreat, we agreed to do some data mining in order to answer some questions for ourselves. Sara, Sonya and Erin dug into our records and pulled out a sample: two months’ worth of information about how many treatments WCA delivers for less than $20, separate from the acupuncture we provide through relationships with our organizational partners like CODA and CareOregon. The designated months were February and May of 2023. Some numbers are rounded.
The answers were a surprise to us (and we’ll be talking about them in our upcoming Finance Retreat):
Free (including May Day, which WCA celebrates by providing free acupuncture all day, plus first treatments in the student clinic, which are always free): 815 treatments
Treatments provided to WCA volunteers, who get unlimited acupuncture as a perk (more about that in a minute) and also “non-paying patients” (this category includes WCA staff, plus their friends and family); 500 treatments
In those two months 30 people paid a monthly rate and 24 people paid a weekly rate. It was too complex to break out the details but some common examples are $20 or $50 a month and $5 or $10 a week, with people getting treated multiple times per week for a period of time. For example, somebody who makes their living doing landscaping who gets injured and can’t work until they recover, so they’re getting treated every day.
In the $1 to $5 range (many of these were in the student clinics): 1320 treatments
In the $6 to $10 range: 60 treatments
In the $11 to $19 range (POCA Tech student clinic rates are $10 to $20): 1175 treatments
For a grand total of around 4000 treatments, in two months, provided under the low end of the sliding scale.
For context, in 2023, WCA clinics (not counting CODA) were providing about 900 treatments a week. So out of the 8 1/2 weeks represented by February and May of 2023, almost half of the treatments provided were below $20. These numbers are separate from WCA’s quarterly bulk-rate sales, where people can buy treatments at the rate of 5 for $85 dollars, or $17 per treatment. In other words, a LOT of the acupuncture that WCA provides is available for less than $20 per treatment. Maybe more than half.
How these flexible payment arrangements get worked out is probably too much to get into in this post; the short version is that it’s a collaborative process between patients and acupuncturists in the context of treatment planning. WCA doesn’t do any kind of income verification.
Okay, now let’s talk about WCA volunteers and the difference between solidarity and charity, a topic that’s dear to my heart.
WCA handles its front desk operations mostly via volunteer receptionists, a dedicated crew of 30 to 40 people, plus POCA Tech students. WCA volunteers donate their time and skills as a way of supporting WCA’s mission in the community. A perk of being a reception volunteer is receiving as much acupuncture as you want. This is not a trade. (Hi, Internal Revenue Service!) Some nonprofits express their appreciation by giving their volunteers free mugs with the organization’s logo; WCA gives its volunteers lots of acupuncture. The main reason is that outside of going to acupuncture school, one of the best ways to learn about acupuncture so that you can communicate about it to other people is to get a lot of it yourself. Making sure that the people who staff WCA’s front desk have plenty of first-hand experience with acupuncture — as well as WCA’s clinical operations — is a low-key marketing strategy that pays off every day.
Do some people decide to volunteer for WCA because they need more acupuncture than they can pay for out of pocket? Of course. WCA exists because we believe our community needs and wants acupuncture. Our volunteer program represents one more strategy to enact that belief, one more way to explore the opposite of rationing, and an additional layer of involving the community in WCA. Sometimes people use it as a stepping stone to paid employment elsewhere. And having a volunteer greet patients is a great way to level hierarchy and make our clinics welcoming.
WCA’s volunteer program is an example of an organizational system that earns its keep. A few hundred treatments a month is a great investment, not only in volunteer appreciation and word of mouth marketing, but in cultivating WCA’s future workforce. Quite a few POCA Tech students started out as reception volunteers. (Thank you, volunteers, we love you.)
The dominant paradigm for acupuncture in the US is that it’s a limited resource that should only be available through the services of a highly trained, highly compensated, highly specialized professional. Once again, I’m not saying that’s wrong. Some patients want to see an acupuncture doctor one on one and some people want to BE that acupuncture doctor. Some of those people don’t like the idea of acupuncture being given out in large quantities, no questions asked, by a bunch of community acupunks in t-shirts and jeans.
But WCA isn’t part of that professionalized paradigm and we’re not trying to be. We’re going for something entirely different, something lively and interesting (at least to us). An experiment in solidarity: what happens if we act as though there’s plenty of acupuncture for everybody? We love to play around with the concept of value. We love including lots of people in our exploration of what’s possible, regardless of how much they can pay: it isn’t a burden to include them, it’s the whole point. I understand that people have strong feelings about what acupuncture should cost and what acupuncturists should get paid, but WCA isn’t in the business of shoulds. We just want to be transparent about that.
Stay tuned for more about trade-offs, systems that earn their keep (or not), and WCA numbers.