Dr. Nell Smircina of PIQUE Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Luke Kervin, Co-Founder of Tebra
Authority Magazine
11 min readOct 1, 2021

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Focus on chronic disease: We saw a hyper focus on the actual COVID 19 virus during the pandemic, but seriously missed the discussion around underlying conditions and the impact chronic disease plays in patients’ prognosis. Not addressing underlying health issues and the impact they have on patient outcomes is doing our patients a disservice. We have chronic disease and illness in this country which has killed more people than COVID, but we place a fraction of the emphasis on actually healing chronic disease.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. Nell Smircina.

Dr. Nell Smircina, DAOM, L.Ac., Dipl. OM is an advocate, educator and practitioner with a focus on the integration of acupuncture into America’s standard of care. Dr. Nell is the President of CSOMA, California’s oldest state acupuncture association and serves on the Advocacy Committee for the American Society of Acupuncturists. As the Director of Development for the American Acupuncture Council, she actively works to support the profession through many strategic initiatives.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I have always been interested in healthcare and went from an interest in strictly western medicine to a desire to do something more integrative once I started working in the healthcare field. I noticed there were huge gaps in care for patients, and as a chronic pain patient myself, was looking for options. I didn’t know anything about acupuncture at the time, but had tried everything conventional for my pain. Even as young as I was at the time, I knew that seven years of chronic pain from a gymnastics injury was not a way to live. There was an acupuncturist working in the office I was at, and many of my patients were getting great results from treatments with her. Honestly out of desperation, I tried it, and within a few treatments I had pain reduction that actually lasted. Upon researching acupuncture a bit more, I began to understand it’s one modality that is part of an entire system of medicine. This system of medicine gave me answers to many of the questions I was searching for with my current career. I wanted to better understand why people heal differently and don’t always fit into the molds of protocols I was so familiar with. Starting a new career that was more focused on integrative care and the utilization of acupuncture would allow me to address many things a patient was experiencing rather than zeroing in on just a symptom. I wanted to focus on the root cause of issues a patient was experiencing.

Can you share the most interesting story that happened to you since you began your career?

I recently was given the opportunity to work with my mentor. Not my clinical mentor, but my life and advocacy mentor, Marilyn Allen. I set an intention when I completed my masters program, before even starting the doctorate, that I would one day be in a position where I would do more than one on one patient care. The integrative medicine industry needs more advocates, and I knew even just out of school that I had the passion and skillset to be in that role for acupuncture. My mentor is already an incredible advocate and has done so much for the Acupuncture profession. When I graduated I asked her who was going to do the important work she was doing, and asked how I could be that person. She jokingly will tell people today that I said to her I wanted her job. Six months ago, I was given the opportunity to switch my primary focus from one-on-one patient care to expanding my practice to include other practitioners, all so I could be in a role alongside my mentor. This role now allows me to affect the profession on a larger scale and give opportunities through my practice to excellent practitioners who are very focused on patient care. The interesting piece of this is the manifestation or speaking goals into existence. It’s thrilling to be able to look back and say you set an intention years ago that has come to fruition.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

When I first started out, I would often refer patients to other providers, as I still do now. I have a colleague who has a very different practice than I do but is an incredible provider. I referred a patient to him that I had been treating without prefacing the fact that the treatment experience would be very different than it had been at my office. He was surprised to go from a spa like environment to a gym like environment for the same treatment of acupuncture. I learned the importance of managing expectations and having transparency with patients around every aspect of their care.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“What’s on my plate is what I ordered”. I can’t even tell you where I first heard this, although I have used it plenty of times now in coaching others and as a reminder to myself. I’m a big believer in acknowledging things happen for us rather than to us…and that mindset shift is incredibly empowering. We all are accountable for things that come into our lives. Even if it’s unexpected or not welcomed initially, there is always something in a situation we can control, even if it’s just our reaction.

Are you working on any exciting new projects now? How do you think that will help people?

Through my work at the American Acupuncture Council, I have the privilege of working with my mentor, Marilyn Allen, to further initiatives for ICD11 codes with the WHO. ICD11 codes are diagnostic in nature, and we currently use ICD10 in the US. The next change globally will be ICD11, and what is special about these codes for more integrative providers is that there will be double coding. This will include a Western medical diagnosis, which we already utilize, but also Traditional Medicine disorders and patterns paired with that Western diagnosis. This elevates Traditional Medicine professions, like Acupuncture, by putting our diagnostic criteria alongside other standard of care practices. My hope is this enhanced recognition will lead to better access to care for patients who desperately need our services.

How would you define an “excellent healthcare provider”?

A provider who can resist the temptation to fall into the “day to day” and stay focused on their why can be excellent. I truly believe most providers get into healthcare to really help people. There are much easier ways to make a good living without going into mounds of debt and committing to the level of study and length of schooling needed to be a provider here in the US. With that type of workload, it can sometimes be difficult to stay focused every day on what brought you into this field. Having a true passion for that why of helping others (every single day) allows you to stay focused on exceptional patient care.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Our system had the same struggles as many others: capacity, difficulty disseminating information and the variation of information put out (which creates confusion). With so many different rules and regulations on a local, state and national level, it was easy to get confused. Where we really struggled is not giving many options for treatment outside of the standard of care. Some countries were able to better provide additional options for patients and promote those options much better than we have over the last two years.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

The uptick of telehealth utilization and options to reach providers was something very positive that came out of this time and will continue to be a big part of healthcare moving forward. Some relaxation on telemedicine laws really allowed patients to have better access to care without the barrier of needing to be seen in person. We’ve seen some great procedures and new platforms come out during the last two years, and I believe patients will want to have this option moving forward, even as we transition out of the pandemic.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. Focus on chronic disease: We saw a hyper focus on the actual COVID 19 virus during the pandemic, but seriously missed the discussion around underlying conditions and the impact chronic disease plays in patients’ prognosis. Not addressing underlying health issues and the impact they have on patient outcomes is doing our patients a disservice. We have chronic disease and illness in this country which has killed more people than COVID, but we place a fraction of the emphasis on actually healing chronic disease.
  2. Emphasis on preventative healthcare — not just sick care: If there had been more of a focus on improved health and wellness rather than the sick care model we have in the US, we would have seen different outcomes with the pandemic. Billions of dollars are spent on the model of if you’re sick, you get a pill, or are told to wait until things get worse to treat whatever ails you. Putting more of an emphasis on prevention of disease would change the above issue regarding chronic illness in our country.
  3. Non-pharmacological options as a necessity for treatment: Patients should have access to information to be properly educated on their many options for treatment, especially if standard practices have side effects, like opioids for example. A great start on something like this that is already in place: Florida passed a law in 2019 which requires all physicians (with some hospital-based exemptions) to provide patients with an educational packet on all non-opiate options for pain relief before prescribing opiates. Over the counter medications as well as modalities such as acupuncture and chiropractic care were listed on the packet, with details to educate patients on each option. This type of education should be happening on a larger scale, and for health issues beyond pain relief.
  4. Better insurance coverage/reimbursement for treatments outside of the standard of care: There are many options patients have for the treatment of health concerns, but often insurance does not cover them, or covers them in such a limited capacity that it makes it difficult for healthcare providers to be in network with insurance. There are patients who would like to utilize acupuncture, chiropractic care, naturopathic medicine, etc., but their insurance does not provide the same benefits for those customized options as it does for more standard protocols.
  5. Inclusion of more modalities of treatment within the standard of care: Ultimately it is difficult for patients to access options for treatment that are outside of the standard of care. Until more integrative options are available within the standard of care, I don’t think we will see true change in the healthcare system. For example, I work with many post-surgical patients and utilize acupuncture as a modality for optimal recovery. Patients may have an elbow surgery and not be able to undergo physical therapy for a month or two. What can the patient do in that window? Patients are given pain medication, but often no proactive options to assist with their recovery. I think every patient who has surgery should be told that they can immediately get acupuncture, which would speed up recovery, decrease pain and inflammation, improve circulation and wound healing and improve immune function to lower the risk of infection.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

We’ve seen a decrease in family practice and primary care providers. It’s a difficult landscape for them with how insurance reimbursement so often plays out. I think having better reimbursement for doctors so they aren’t forced to take less time with patients in order to cover costs would make a huge difference. It would also improve patient care.

How do you think we can address the issue of physician diversity?

Having more incentives for physicians to treat in different areas of need, such as student loan forgiveness and appropriate payment (given the investment these doctors made in their education) would help.

How do you think we can address the issue of physician burnout?

This again seems to go back to appropriate reimbursement for services rendered. Physicians are often working many hours seeing patients at a very high volume in order to cover costs. Also having self-care modalities available on site for physicians in major medical centers would be extremely beneficial, and would create additional exposure for options that could help their patients too.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

There would need to be a serious shift in the way we look at healthcare in this country. A pivot from sick care to wellness would need to occur. We’re very reactive. To be more proactive, individuals need to be more educated on their health and options available and would need to better advocate for themselves. Corporations would need to offer better benefits to their employees which should include self-care modalities and better work life balance. Leaders would need to shift out of the paradigm we are currently in where insurance companies and the pharmaceutical industry’s money is what talks. Most importantly, we all would need to have an openness to such a dramatic change.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I want to see more integrative modalities, specifically acupuncture, in the standard of care. We need patients to have access to as many opportunities as possible to benefit their health.

How can our readers further follow your work online?

Linked in: Dr. Nell Smircina or at piqueBH.com

Thank you so much for these insights! This was very inspirational, and we wish you continued success in your great work.

About the Interviewer: Luke Kervin is the Co-Founder and Co-CEO of PatientPop, an award-winning practice growth technology platform. PatientPop is Kervin’s third successful business venture. Prior to co-founding PatientPop, Kervin co-founded and was President of ShopNation (acquired by Meredith Corporation) and was the first executive hire at StarBrand Media (acquired by POPSUGAR).

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Luke Kervin, Co-Founder of Tebra
Authority Magazine

Luke Kervin is the Co-Founder and Chief Innovation Officer of Tebra