MANCHESTER – At Andy Wegman's acupuncture clinic in the city's Millyard district, the core of his practice is based as strongly in economics as it is in the age-old principles of Chinese medicine.

Wegman -- who has practiced acupuncture for several years -- realized the traditional pricing structure for acupuncture services was aimed at the highest earners. With typical market rates for acupuncture ranging between $50 and $150 a session, the prices put treatment out of reach for most people.

But that's not the case at Manchester Acupuncture Studio, situated at 400 Bedford St. The clinic offers a sliding fee scale based on the income of its patients. Prices start as low as $15 for patients earning less than $20,000 per year, and go up to $35 for those making more than $50,000 per year. The results wouldn't surprise anyone familiar with a graph of a supply and demand curve: as the price has fallen, more people have paid for the service.

"We're here to do acupuncture. We don't want to turn anyone away. We want to accommodate folks," Wegman said recently at his comfortable studio, where the average fee paid for one acupuncture treatment runs about $19. An additional $10 fee is assessed at the first visit for paperwork.

"That's fine for us. That's what we're expecting. We're not putting out a sliding scale there hoping everyone will pay $35," Wegman said.

Wegman knows full well how the traditional American model for the service works -- for seven years, he worked as an acupuncturist at a local physician's office. The office's rate for his services was $60 per hour, and he saw perhaps 25 patients per week, he said.

Wegman opened his clinic in July, and by last August, Wegman said, he was personally seeing 100 patients a week. Things got so busy that he had to hire two part-time acupuncturists to help him -- and the clinic is up to 130 patients per week. He expects that to eventually rise to 160 patients per week soon, when one of his part-time acupuncturists will become full-time.

Acupuncture

The traditional idea of acupuncture, in the minds of some, is where a patient is put in a room, stuck in the back with lots of needles, and left to lie there.

But that's not how things work at Wegman's clinic. Clients are treated in a group setting, and needles are typically applied on the arms or legs -- from the elbows down to the hands, or from the knee down to the foot. Occasionally, they'll apply needles to the ear.

Wegman, 37, and his staff are licensed acupuncturists, meaning they've not only passed national competency exams but have studied for years at their craft. Wegman, for instance, holds a master's degree in acupuncture from the New England School of Acupuncture in Watertown, Mass. It took him three years of study and training to go through the program.

"Strictly speaking, acupuncture is the systematic placement of sterile, one-time use needles -- hair thin, I might add -- at particular points in the body that are known to exact effects on the function of human beings," Wegman said.

"Using an acupuncture needle is like playing a saxophone -- you can play it in all different sorts of ways," Wegman said. "It's part of a whole medical system."

A different model

The business model on which Wegman's clinic operates isn't new. Here in the United States, it was originally started up, he said, by a clinic in Portland, Ore., called "Working Class Acupuncture."

Nor is the idea of a sliding fee scale new to medicine in general: back in the Middle Ages, it was not unusual for doctors to charge the wealthy more for their services than the poor.

In America's modern health system, that's not how things generally operate. Wegman said an acupuncturist will generally charge what he can get for his services, while treating each patient in individual treatment rooms. But the "community acupuncture" model, where patients are treated in a group setting and fees are variable, is more common elsewhere.

"In many parts of the world, it's done in this manner," Wegman said.

One way the clinic keeps down costs is through not accepting insurance, although it will gladly provide receipts for patients whose insurance covers acupuncture treatments. This is not a major issue for the clinic, as some of its patients don't have health insurance, while for others, the cost of treatment is about the same as their insurance co-pay.

"We don't accept insurance. It's cash, check or charge," Wegman said. "(That is) one of the things that allows us to keep our costs low, because we don't have to shuffle insurance paperwork or hire someone to do that."

(Patients wondering about insurance coverage should check their policies and contact their insurers to see if acupuncture is a covered treatment. For instance, according to CIGNA's Web site, the insurer will generally cover acupuncture treatments if a patient is suffering from nausea or vomiting associated with pregnancy or chemotherapy. However, many of its benefit plans specifically exclude paying for acupuncture treatments.)

The business model also allows Wegman more time to spend with his patients, and patients have more time for their treatment. Aside from the clinic's operating hours, there is no hard-and-fast rule regarding the time one can spend in treatment -- a difference from the old model, where a patient might get an hour's worth of time.

That comes in especially handy since many patients sleep during their treatment. If Wegman has a patient being treated for insomnia, for instance, and he finally falls asleep, he doesn't have to wake the patient up after half an hour because he needs the room.

A start-up's growth

Wegman's start-up costs were minimal. He started the clinic with about $6,000, much of which was spent on the disposable needles he uses, cotton balls and alcohol. The furniture for the office, which feels more like a living room than a doctor's office, was bought on the cheap or was donated.

"We were able to do it without loans," Wegman said. "Start-up costs were really modest."

"We watched our budget just in terms of what we picked up. My idea in opening the clinic was not for it to be an ostentatious place," Wegman said.

So far, response to Wegman's clinic has been positive. Not only has he had to hire more staff, he's also hoping to soon expand the clinic's hours.

The clinic is open from Tuesday to Saturday. Hours are 10 a.m. to 7 p.m. on Tuesday and Thursday, 9 a.m. to 1 p.m. on Wednesday and Friday, and 9 a.m. to noon on Saturday.

"We're psyched about it. It's awesome," Wegman said. "It's exceeding expectations for sure -- but it hasn't been overwhelming, at least most days."

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On the Net:

www.manchesteracupuncturestudio.org