Julie Onofrio

If we are not at the table, we are on the menu.

October 15, 2019 By Julie Onofrio Leave a Comment

If you are not at the table, you are on the menu is a political saying that supposedly comes out of WA DC in about 2000 with no known origin. I first heard it said that the Alliance for Massage Therapy Education Conference (I think in about 2010) in Tuscon AZ by John Weeks, publisher/editor of the Integrator Blog News and Reports.

What it means is that if you/we don’t have a seat at the table with the insurance carriers, insurance commissioners, hospitals, doctors, nurses, legislators in every state, legislators in WA DC – we will be on the menu. You will have other agencies, politicians, insurance companies creating policies, rules, laws and you won’t have a say in creating allowable fees, benefits and policies. For example: one of the biggest issues we are having currently in WA state is that the insurance companies are drastically reducing allowable fees. The insurance companies set allowable fees using formulas that consider the amount of work the provider does(time and intensity), liability insurance costs and practice expense data. The insurance companies do not have any data on practice expense from the massage profession so they just guess and use their own data. We haven’t had any association representing us with the insurance carriers.

In terms of having massage therapy covered by health insurance, it is clear that there is a movement calling for massage therapy to be involved in fixing the Opioid epidemic.

Comprehensive Accreditation Manual for Hospitals: The Official Handbook of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), updated in August 2000, recommends massage as a non-pharmacological therapy that can be used successfully in pain management.
The Joint Commission (PDF) has been mentioning massage therapy in their reports in 2015, 2016 and 2018
The ACA 2010 provided an opportunity for massage therapists to organize and demand coverage of massage therapy.ABMP on the ACA

ABMP believes Section 2706 provides additional justification for insurance companies to reimburse massage therapists. For example, when massage therapy is a covered benefit of a health plan, it is not uncommon for an insurance company to reimburse massage provided by a physical therapist, chiropractor, or osteopathic doctor – but not massage therapy provided by a massage therapist. Evidence shows that massage therapy, especially when performed by a massage therapist, is a cost-effective delivery method of health care.

Integrative Healthcare Policy Consortium – calls for massage therapy

When a massage therapist treats any health condition covered in an insurance plan (e.g., back pain, neck

pain, etc),the massage therapist is eligible for reimbursement, so long as that provider is licensed by his or her state and can treat the condition within his or her scope of practice.

AMTA of course said they did not want massage therapy to be covered under the ACA. See Laura Allen’s blog post. citing that 50% of their members did not want that to happen. What about the other 50% that did?

ABMP wrote a position paper supporting massage therapy. -“A comment on the Prevention Strategy of the National Prevention,Health Promotion, and Public Health Council December 2010

January 2012: The Integrative Health care Policy Consortium (IHPC) Announces State-by-State Campaign for “Correct Implementation” of Section 2706 (The integrator blog – http://theintegratorblog.com/index.php?option=com_content&task=view&id=858&Itemid=1)

IHPC Launches Campaign with Former WA Insurance Commissioner Deborah Senn to Secure Non-Discrimination (Section 2706) announcing a critically important campaign to help implement the ACA.

Section 2706 of the Affordable Care Act of 2010 promises “non-discrimination in health care.” The provision was lobbied by the American Chiropractic Association and the Integrated Healthcare Policy Consortium (IHPC) and championed by U.S. Senators Tom Harkin and Barbara Mikulski, MD. The intention was to honor citizen choice by broadening access to non-MD providers. Of greatest interest to Harkin and the duo lobbying organizations are those classified as licensed complementary and alternative medicine practitioners.

2011: 42 percent of hospitals are using complementary and alternative therapies (AMTA statistic).

2012: The Hospital-Based Massage Therapy task force (HBMT-TF) was formed within the Academic Collaborative for Integrative Health (ACIH, formerly known as the Academic Consortium for Complementary and Alternative Health Care). The purpose was to explore the need for a set of standards or competencies, gather information about current standards for the field, and possibly develop HBMT-specific competencies that could be shared with all interested parties, particularly hospitals, massage therapy educators, and massage therapists in the field. HBMT-TF membership consisted of MK Brennan, RN, LMT (ACIH CWG member), Dale Healey, DC, Ph.D. (ACIH EWG co-chair), Carolyn Tague, MA, CMT (ACIH EWG member), and Beth Rosenthal, Ph.D., MBA, MPH (ACIH Assistant Director).

Massage Magazine: Hospital-Based Massage Therapy: A Call for Competencies

Hospital Based Massage Therapy: A Call for Competencies

2013: 51% of AMTA members do NOT want massage therapy covered by health insurance, while 49% do.

Feb 2013: The Integrative Health Care Policy Consortium (IHPC) creates a blog for integrating massage into health care. https://ihpcmassage.wordpress.com/

07/10/2013: Laura Allen’s Blog reports that Diana Thompson, well-known author and leader in the massage profession, wrote a letter to AMTA requesting support for the ACA and integrating massage therapy into health care.

“With the exception of the massage representative from the AMTA, all the clinical speakers were excellent and very supportive of the ACA and interested in doing everything possible to support coverage by practitioners within their discipline. These clinicians expressed similar concerns regarding the ACA and how it may or may not affect CAM services. There were also clinical examples provided about how the ACA may positively impact certain disciplines, particularly NDs who provide primary care… On a side note, I am very concerned about the position of the AMTA…”

AMTA: Supporting Massage Therapists for the Affordable Care Act (or Not?)

August 2013: The AMTA’s approach to the Affordable Care Act is still undecided and the organization has taken limited action. https://www.amtamassage.org/articles/1/News/detail/2805/amtas-approach-to-the-affordable-care-act

“The American Massage Therapy Association (AMTA) understands there has been much discussion and debate about the Affordable Care Act (ACA) and the potential role for massage therapists that it might provide within health insurance based third-party reimbursement. Similar debates are taking place among other health care professionals as the ACA presents many challenges for everyone involved in health care, from professionals to consumers. While the law was enacted more than 3 years ago, it continues to be debated, analyzed and scrutinized. Meanwhile, the law has evolved and implementation will continue to evolve, especially as states determine their approaches to it.”

June 2014: IHPC letter to Centers for Medicare & Medicaid Services Department of Health and Human Services calls for the inclusion of massage therapy in health care under the Affordable Care Act section 2706. https://www.amtamassage.org/uploads/cms/documents/ihpc_6.5.14.pdf

2014: Diane Mastnardo creates Massage Northern Ohio Practice-Based Research Network.

2014: Integrative Health Policy Consortium www.ihpc.org (IHPC ) creates www.covermycare.com to help implement the Affordable Care Act section 2706.

2015: Over 125 hospital-based programs listed on the Society for Oncology Massage website. http://www.s4om.org/health-care-professionals/hospitals-incorporating-oncology-massage

September 2016: Hospital-Based Massage Therapy Task Force Presentation 2016

https://integrativehealth.org/hbmt-ewg-cwg

https://integrativehealth.org/hbmt_competencies

July 19, 2013. Kahn’s keynote speech at the Alliance for Massage Therapy Education conference as reported by Massage Magazine, noted that “We get in each others’ way as a profession,” she said. For example, “There are people really concerned [about working in the health care system], they don’t want to take insurance and have someone 20 miles away … tell them how many sessions they can do [on a client], and so they’re going to say we shouldn’t go there.“I want to say, you shouldn’t go there if you don’t want to deal with those problems—[but] if you don’t want to do that, let’s figure out a way you don’t have to and I still can,” she added.Another barrier to moving through the doorways of opportunity, Kahn said, is the lack of a clear, articulate voice in Washington representing therapeutic massage “and helping policymakers and the public underhand how we can fit into the new health care system in a an expanded way.”

2017: AMTA Fact Sheet (https://www.amtamassage.org/infocenter/economic_industry-fact-sheet.html) reports:

“Massage therapists and consumers favor the integration of massage into health care.

Nearly two-thirds of adult Americans (64 percent) would like to see their insurance cover massage therapy.⁴
The vast majority of massage therapists (97 percent) believe massage therapy should be considered part of the health care field.^”

Feb 2017. American College of Physicians recommends massage therapy for back pain.

Sept 2017. The National Association of insurance commissioners have asked for it to be used to battle the drugs. (See the letter PDF)

“When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe

effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.”

October 24, 2018, the President signed into law: H.R. 6, the “Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or the “SUPPORT for Patients and Communities Act,” which addresses the opioid crisis by reducing access to and the supply of opioids and by expanding access to prevention, treatment, and recovery services. Passage was overwhelmingly bipartisan (98-1 in the Senate and 396-14 in the House). (www.ihpc.org newsletter)

October 2017: The inaugural Integrative Pain Care Policy Congress was an invitation-only meeting that brought together approximately 70 leaders from 50+ organizations. They represented the full scope of licensed and certified healthcare professionals involved in pain care, along with insurers, regulators, people with pain, researchers, and policy experts. AMTA was invited but has not reported on whether or not a representative attended and what happened. https://www.integrativepainmanagement.org/blogpost/1677160/294358/The-Integrative-Pain-Care-Policy-Congress-Why-We-Came-Together

2018: AMTA Fact Sheet (https://www.amtamassage.org/research/Consumer-Survey-Fact-Sheets.html) claims:

Massage for Health and Wellness:

“67 percent of individuals surveyed claim the primary reason for receiving their last massage in the previous 12 months was medical (41 percent) or stress (26 percent) related, according to the 22nd annual consumer survey sponsored by the American Massage Therapy Association (AMTA).”

September 4, 2018: AMTA announces the organization reached out to Medicare advantage plans asking them for coverage of massage therapy.

November 28, 2018: CMS announces up to 270 Medicare Advantage Plans will include massage therapy in 2019.

2019: New Hampshire Bill proposal. HB 610-FN http://www.gencourt.state.nh.us/bill_status/billText.aspx?id=131&txtFormat=html&sy=2019&fbclid=IwAR2X1kg6FALvSkN6FfnkWLxNelzvyN8Gf9kRNBqmdlVfWDjFmEFP9KE_uGw

“When patients seek treatment for any of the myriad conditions that cause pain, a health care practitioner shall refer or prescribe to a patient any of the following treatment alternatives, when applicable, before starting a patient on an opioid; chiropractic, physical therapy, occupational therapy, acupuncture, massage therapy, and/or osteopathic manipulation. “

“2 New Section; Coverage for Nonopioid Treatment for Pain; Individual. Amend RSA 415 by inserting after section 6-w the following new section:

“415:6-x Coverage for Nonopioid Treatment for Pain; Individual. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for the costs of options to patients for evidenced-based non-opioid treatment for pain, including but not limited to*, chiropractic care, osteopathic manipulative treatment and acupuncture treatment. Policies issued pursuant to this section shall not have annual or lifetime numerical limits on visits for the treatment of pain. Reimbursement, coinsurance, copayment, and deductible amounts for pain management care utilizing chiropractic, acupuncture, and/or osteopathic manipulation shall be determined as a service under the Patient Protection and Affordable Care Act of 2009, as amended, definition of rehabilitation and habilitation.”

**”including but not limited to”–We need to make sure it says massage therapy!

2019: Virginia Bill Proposal: https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3419/

2019: Oklahoma Bill Proposal: http://www.oklegislature.gov/BillInfo.aspx?Bill=HB+2652&session=1900&fbclid=IwAR3un4CZr0oHNWwloMCwbReEwCd6P0E31dqYx-svYRiO454GdI4l2N6qMrU

“Any health plan, including the State and Education Employees Group Health Insurance plan, that is offered, issued or renewed in this state on or after January 1, 2020, shall provide coverage for complementary and alternative medicine.”

2019: Bill in Maine: http://www.mainelegislature.org/legis/bills/bills_129th/billtexts/HP025501.asp

“This bill clarifies that massage therapists and massage practitioners are health care practitioners and that massage therapy is a health care practice. It prohibits unlicensed persons from claiming to provide procedures that are described as “massage,” “bodywork,” “body therapy,” “manual therapy,” “neuromuscular therapy,” “touch therapy” or “myotherapy” or related terms.”

2019: Bill in North Carolina. Bill Summary for S 544 (2019-2020)

Bill: ESTABLISH NON-OPIOID TREATMENT ALTERNATIVES. (https://lrs.sog.unc.edu/bill/establish-non-opioid-treatment-alternatives)

PART I. NON-OPIOID DIRECTIVE FORPROVIDERS OF PAIN MANAGEMENT 12CARE13SECTION 1.1.G.S.90-106 reads as rewritten: 14″§ 90-106. Prescriptions and labeling. (a3) Limitation on Prescriptions Upon Initial Consultation for Acute or Chronic Pain. –A Upon the initial consultation and treatment of a patient for acute or chronic pain, a practitioner, as a first line of treatment, shall provide the patient with a referral to, or a prescription for, any of the following alternatives to targeted controlled substances, when appropriate: (1) Acupuncture. (2) Chiropractic care. (3) Massage therapy. (4) Occupational therapy. (5)Osteopathic manipulative treatment. (6)Physical therapy.

AMTA 2019 Massage Profession Report (highlights):

“Approximately 47.5 million people had a total of 214 million massages in the U.S. in 2018, compared to 47.1 million people having a total of 179 million massages in 2017. “

“Massage therapists supported the integration into health care, with 95% believing massage should be integrated with health care. But how that integration looks varied greatly. The two most prevalent ways therapists preferred to see health care integration was by having massage prescribed or referred by health care providers, or by having massage therapists work on a team with other complementary practitioners.”

“The primary reason consumers obtained massage continued to be for medical, health and wellness purposes, or for stress reduction. Sixty-two percent of massage consumers had a massage in 2018 for health or medical reasons. Of these, 41% had their last massage for a health or medical reason. Sixty-six percent of massage consumers got a for relaxation/stress reduction in 2018, with 26% getting their last massage for this reason.”

“Consumers continued to believe in the efficacy of massage:

Eighty-eight percent of consumers agreed that “Massage can be effective in reducing pain.”
Eighty-eight percent of consumers agreed that “Massage can be beneficial to your health and wellness.”
Seventy percent of consumers agreed that “Massage therapy should be considered a form of health care.”
Sixty-seven percent of all consumers said they have or would recommend massage to a relative or to someone they knew in 2018.
Thirty percent of consumers expected to get a massage in the next 12 months.”

“The number of massage therapists receiving insurance reimbursement increased in 2018Twenty-five percent of massage therapists were reimbursed by insurance for massage, up three percent from last year. Insurance reimbursement includes multiple types of insurance, not only health insurance. For practicing massage therapists, 11% were reimbursed by health insurance (either private payer or public system), 8% by auto insurance, 5% were reimbursed through workers’ compensation, and 2% accepted other insurance reimbursement.”

“The 2018 AMTA Industry Survey provides information on insurance reimbursement for auto, medical, workers’ compensation and other insurance.
Insurance reimbursement makes up between 12% and 28% of the total revenue for the average therapist that accepts insurance. Those that accept private payer medical insurance having the highest percentage of total revenue from insurance, and those that bill workers’ compensation insurance have the lowest percent of total revenue from insurance, consistent with 2017 data.
Depending on the type of insurance, the average amount of reimbursement received varied widely”

“The average amount of reimbursement increased for auto and worker’s compensation insurance increased last year and declined for medical and “other” insurance. Insurance reimbursement is determined by each state and health care policy and not all states permit insurance reimbursement for massage provided by a massage therapist.”

March 2019: The Veterans Administration lists massage therapists as Health Technicians, allowing the VA to hire massage therapists. See the VA Handbook for complete details (Document number 005/108: Staffing – Appendix G56 Health Technician (Massage Therapy) Qualification Standard). https://www.va.gov/vapubs/Search_action.cfm?formno=&tkey=&dType=2&SortBy=issue&sort=desc&oid=0&fbclid=IwAR148-S0ux6V2aQj1CrYppE1JIxV66VTH4BNRMLfg4WQpVWX7S01wvOMIWk

(It took over 15 years to make this happen. Now that it’s official the VA accepts massage therapy as a valid method of treatment, my guess is that having their insurance cover massage will be next. The VA has created a definition of massage therapy—something the massage profession has failed to do.)

May 2019: In 2016, the Comprehensive Addiction and Recovery Act of 2016 was passed and created The Pain Management Best Practices Inter-Agency Task Force. The purpose of the task force was to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain. The U.S. Department of Health and Human Services oversaw this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense.

The result is a new report on pain management best practices that includes calling for the use of massage therapy. The U.S. Pain Foundation has created a toolkit for taking action. https://uspainfoundation.org/advocacy/inter-agency-task-force-toolkit/

IF this does not get us moving, I don’t know what will.

Let’s get to the table.

Whether you like it or not, whether you want it or not, massage therapy will most likely be covered by health insurance….eventually….or so it seems with so many calling for it’s use. The thing is that we are not at any table at all. We do not have associations stepping up to the table to be our voice. It is important to start having these conversations NOW so that the massage therapy profession can bring our message to the table and create what we want as far as benefits and allowable fees. We need to be at the tables in each state with insurance commissioners, health care insurance carriers, and in state capitals where laws are being created. Otherwise it will be too late and we will be handed the leftovers.

To be at the table means that the massage therapy profession needs to attend meetings with State Insurance Commissioners offices, be talking to state and national health insurance plans and be involved in all efforts to help combat the Opioid epidemic. To get to the table requires making connections like the one that started it all here in WA State. The Insurance commissioner back in 1992 was Deborah Senn, who also had an office assistant who was also a massage therapist (Lori Belinski – now Lori Grassi who is the executive director of the WA state chiropractic association and lobbyist for the same group).

We need legislators in office at the state and national level that support massage enough to create laws that will make it so massage therapy is covered by health insurance. We need state and national lobbyists and political action committees. WA State has one of the of the only Political Action Committees that I know of in the US – the WA Massage Alliance for Health (www.wamah.org). We also have a person in the house of representatives, Shelly Kloba, that has been a massage therapist for over 20 year and sponsored a bill in 2017 on prior authorization.

There are some that also say that we need to up our education standards before anything can happen with insurance companies and laws…but I personally think that it is more an legislative effort because of watching what has happened here in WA. When the Every Category Law was created, WA MT’s were only required to have the minimum of 500 hours of education which was the norm at that time and still is the basis for licensing in many states.

Do we need more evidence as many MT say? I personally don’t think so based on what I have seen. We do have enough evidence right now to get started. More is coming out every day. We don’t have to wait any longer.

We just need people to step up and sit at the table for us.

State legislators that support massage therapy
State insurance commissioners that are willing to create laws that include massage therapy like the WA Every Category Law
Health care specialists (Lawyers, healthcare executives) who know how to deal with insurance companies to negotiate contracts and help us determine the best ways to talk to insurance companies. Do we need physicians networks or clinically integrated networks like some hospitals/physicians are moving to so that they can negotiate contracts while also providing health care services that are paid based on their results (values based care) instead of just fees for services?
Massage awareness networks that work to educate doctors, legislators and insurance carriers on just what massage therapy can do. (It is clear to me that the insurance companies still see massage therapy as a burden and think that they have to pay out the $25k or more for surgeries or thousands in drugs rather than using massage to eliminate those costs.) We do not have enough data on things like how much is massage therapy saving the insurance companies. The only thing we do have is the report from AMTA on Integrative Care and Pain Management.
Political Action Committees for every state and One National one. PAC’s raise money to help get the right candidates into office that support massage therapy.

Learn to bill insurance NOW so you can start to understand the issues at hand and start learning about how insurance works so we can have more therapists and clients behind the people we get at the table. There is power in numbers. 350k + massage therapist and their clients = ??????????

Make extra income through creating a website

August 26, 2019 By Julie Onofrio Leave a Comment

One of the things I have in place to supplement my income as a massage therapy is creating websites related to massage therapy – like this one. My first site was www.thebodyworker.com (Now defunct) that I used to just put my notes from massage school online. The way it came about was that I a was having health challenges that kept me from working. At the time it was just a hobby to keep me busy when I felt bad. I started it in 1999 or so and didn’t know anything about creating sites. It made me about $120,000 over 10 years from ads which isn’t bad for doing nothing but writing pages of content. That was back in the day before Social Media.

From there I somehow found an ebook called Make Your Site Sell, by Ken Evoy and learned more and more about the possibilities of creating income from a website. Today that ebook has worked itself into a whole online business creating system and website builder – SBI! (Solo Build it! previously Site Build it!).

I used SBI! to create my second big successful website – www.massagetherapycareers.com (which I sold in 2008 for enough to live on for one year and the owners crashed it into the ground! The completely changed the content and made it into a sales site for massage schools. Smiling all the way to the bank 🙂

What would you do a site on?

What are your hobbies, interests, passions? What do you know a lot about? What are you an expert at or what are you an expert at doing?

Massage, some aspect of health, knitting, soccer, stock trading, gardening, dog training, destinations, your local community….. you name it. It can be made into a profitable topic…somehow….someway.

The way it is done is to take these hobbies, passions, interests and expertise and start with brainstorming your topic through a comprehensive process of keyword research. (Using proprietary software included with SBI.) The software gives you an idea of how many searches there are for that word compared to how many sites there are that provide that information. It also takes into consideration possible ways to make money.

Don’t think you have anything worth writing about?

Think you don’t know how to write?

Think again. Don’t let your old fears get in your way.

Every time I see things in happening around me, I can think of a website that would help and that I would love to do. Some of my massage related ideas are:

A website on each type of pain condition that I see like hip pain, neck and back pain…etc
A general website on Pain and the science of pain
A website on all of the research on massage therapy that takes each study step by step and analyzes it and then explains how massage therapist can use this information.
How to start and run a massage school
How to teach couples massage classes to the public to make money doing that and to build your massage business too.
How to start and run a mobile massage business.
How to start and run a franchise
How to start and run a massage therapy co-op.
A directory of local massage therapists (use WordPress plus the SBI plugin for WordPress)
A directory of local CE classes. (use WordPress plus the SBI plugin for WordPress)
A travel site on high end spas. use WordPress plus the SBI plugin for WordPress)
A site on books on massage for therapists
A site on all of the various online scheduling apps/systems and reviews of them all.
Your massage school notes. (Buy my site – www.massageschoolnotes.com to get a good start)
A site that talks about the issues of being a male massage therapist.
A website that deals with the issues of sexual assault, illegal massage businesses and human trafficking issues and that promotes massage therapy.
A website on REAL massage. (https://amta-wa.org/page/REAL_overview) REAL massage is :
- Responsible – REAL massage therapists recognize the honor of responsibility that comes with providing people with massage.
- Ethical – REAL massage therapists are bound by best practices conveying ethical business sense.
- Accountable – REAL massage therapists thrive in accountability to, and encouragement of, one another as we help each other grow our businesses to reach their potentials.
- Licensed – REAL massage therapists in WA states are licensed through the Department of Health, being recognized as healthcare practitioners.
A website on hospital based massage – how to start and run a program in a hospital. Look into reviving the Hospital Based Massage therapy network. (http://hbmn.com)

Non-massage related ideas:

I feel really concerned about the plastic thing… the pictures of plastic in the oceans and all over and how we got this way and what we can do about it. I don’t know anything about it but it is worrisome and would take some reading and research.
I love reading books and keep thinking I should do a site on some aspect of reading – – not sure what aspect…but I am sure I could find it.
A website on feral cats living in barns.
A local directory for your city/town/county for locals or for tourists. (use WordPress plus the SBI plugin for WordPress)
A travel site on your favorite beaches or ski resorts. (use WordPress plus the SBI plugin for WordPress)
A website on hiking the Pacific Crest Trail or Appalachian Trail

I can hear your objections already…. aren’t there enough websites on those topics? There are never enough GOOD ones let alone GREAT ones. Just look at the sites out there. Most are getting so spammy with ads popping up all over and having stories that you have to click 100 times to see all the images just to get to the one important thing…. We need better websites that inform and educate.

Take a look at these case studies and this list of results and list of websites using SBI for proof.

How do you make money with a website?

In the early days, I made the most of my income from Google Adsense. Putting Google ads on my site. How much? Well it got up to about $2000 a month before 2009 when Google made big changes in their search algorithms. Since then I have started writing ebooks and am not getting back to working on a few sites that will have more Adsense ads and affiliate income mainly through Amazon associates program.

You don’t know anything about creating websites?

You don’t have to. SBI! provides EVERYTHING you need to know about how to use their proprietary software and if you want to use WordPress, they will help you will all that too with a complete action guide for each type of software. (WordPress just released their 5.0 that includes a block by block builder which will have a big learning curve.)

EVERYTHING? Yes Everything.

How to choose a topic
How to choose the best domain
How to set up your home page
How to create pages so that search engines will find them
How to use Social media – Facebook, Twitter, Pinterest, Instagram to build traffic
How to write (anyone can learn!)
How to make money
How to create products
How to sell other people’s products (Affiliate Income)

How long will it take?

It’s a process. It takes as long as it takes. It won’t happen overnight and it isn’t a get rich quick thing.

It is building an online business – one that could supplement your massage income and make you money while you do massage and take you into retirement. (I have so many plans for other websites that I can play with in ‘retirement’, I can hardly wait!)

Veterans Administration Recognizes Massage Therapists

June 27, 2019 By Julie Onofrio 3 Comments

The Veterans Administration has recently announced their Qualification Standards for hiring massage therapists (Health Technicians) and created the GS (General Scale) pay scale for massage therapists.

This is big news for the massage profession. It has taken over 20 years for the VA to create a category in their system to allow massage therapists to be hired as massage therapists. So now massage therapists can be hired by the VA to work in their health clinics and be paid wages and benefits. While this is amazing in itself, it is the fact that the VA has created a job description along with educational standards that are required for the job… something that the massage profession has failed to do for itself in the US – EVER!

When other powers that be, start to define the profession for us – we lose control over our future. While the VA has done an excellent job with the language and requirements, this should have been done by the massage profession – namely the AMTA.

About the Jobs

Should you now be looking for jobs at the VA? Yes! Check the USAjobs.gov website. Search for Health technician, Massage therapist

How much can I make? Check the payscale for your city/area.

That payscale seems pretty low and a 40 hour work week would be too much for a massage therapist. This is just the beginning. VA/Government jobs also comes with health insurance, vacations, sick pay, and pensions!

About the Standards

You can read the full job description and standards on the VA Website – See the 5005/108 Staffing – Appendix G56 Health Technician (Massage Therapy) Qualification Standard or just download the PDF from here.

Here are the details:

COVERAGE. The following are requirements for appointment as a Health Technician (Massage Therapy) in the Veterans Health Administration (VHA). The requirements apply to all VHA Health Technicians (Massage Therapy) employed in the GS-0640 series. Massage Therapy is the practice of manual assessment and manipulation of the superficial soft tissues of skin, muscle, tendon, ligament, fascia, and the structures that lie within the superficial tissues. The Health Technician (Massage Therapy) occupation provides clinical services that address a vast array of problems impacting the health and function of a diverse patient population. The work requires the application of knowledge of therapeutic massage concepts, principles and practices, and encompasses a large variety of modalities from Western and Eastern traditions. Massage Therapy promotes circulation of blood and lymph, relieves muscle tension, and can induce a general relaxation response, alleviate pain and anxiety, promote sleep, reduce stress, and enhance the general sense of wellness. Employees in this occupation may utilize appropriate tools and the external applications of water, heat, and cold to enhance therapeutic benefits. Employees in this occupation incorporate knowledge of various systems of anatomy, physiology, and pathology to apply a plan of care for those with a variety of soft tissue dysfunctions, stress related conditions, and imbalances.

(1) Health Technician (Massage Therapy), GS-5 – Entry Level
(a) Education, Experience, and Licensure. None beyond the basic requirements in paragraph 3.
(NOTE: See exception to licensure/registration/certification requirement in subparagraph 3.c. above.)
(b) Assignment. Health Technician (Massage Therapy) at this level perform basic massage therapy services under close supervision. The technician functions independently in applying basic massage services. Basic massage therapy includes, but is not limited to effleurage (stroking), petrissage (kneading), tapotement/percussion, friction, vibration, passive and active stretching, and draping. The Health Technician (Massage Therapy) is responsible for changing linen between clients, refilling oils, cleaning massage table/chair/arm rest, and providing a clean, calm environment. The Health Technician (Massage Therapy) promotes and educates patients in the health and wellness benefits of massage, and develops therapeutic relationships with patient/family/significant others by demonstrating sensitivity and respect for a patient’s personal beliefs. Deviations from regular procedures, unanticipated problems, and unfamiliar situations are referred to the supervisor for a decision or assistance. Any unusual patient interactions are documented and immediately reported to the supervisor. Some assignments at this level include developmental duties involving more progressive care, designed to prepare the Health Technician (Massage Therapy) for promotion to higher grades. Such duties would be performed under close supervision.
(2) Health Technician (Massage Therapy), GS-6 – Developmental Level
(a) Education, Experience, and Licensure. In addition to the basic requirements, candidates must possess one year of experience equivalent to the GS-5 grade level, and demonstrate all the KSAs below:
(b) Demonstrated Knowledge, Skills, and Abilities
i. Skill to provide massage techniques including draping, using the appropriate tools, supplies, and equipment based on the needs of the patient;
ii. Knowledge of anatomy, physiology, pathology, therapeutic effects, and evidence based practice of massage therapy;
iii. Ability to work with an interdisciplinary team in a health care setting;
iv. Knowledge of all patient safety procedures, rules, and regulations as they pertain to a clinical environment; and
v. Ability to effectively communicate verbally/non-verbally and in writing (through a variety of modalities).
(c) Assignment. Employees at this grade level serve as developmental Health Technicians (Massage Therapy) and perform treatments which are routine and standardized in nature. The Health Technician (Massage Therapy) provides treatments in various inpatient and outpatient settings, in accordance with applicable policies and procedures. Health Technicians (Massage Therapy) perform a substantially full range of duties, but receive guidance and directions regarding unfamiliar or unusual situations for more complex patient issues.
(3) Health Technician (Massage Therapy) GS-7 – Full Performance Level
(a) Education, Experience, and Licensure. In addition to the basic requirements, candidates must possess one year of specialized experience equivalent to the GS-6 grade level performing massage therapy and demonstrate all the KSAs below:
(b) Demonstrated Knowledge, Skills, and Abilities
i. Ability to assess the physical and mental status of patients (including history and physical assessment), interpret the appropriate information to identify each patient’s population-specific needs, identify indications/contraindications for massage, develop the plan of care, and monitor their response to treatment;
ii. Ability to use various communication techniques to encourage and educate individuals and groups to enhance massage therapy outcomes;
iii. Skill in developing and maintaining strong interpersonal relationships; and
iv. Ability to advise staff and students in massage therapy practices.
(c) Assignment. At the full performance level, Health Technicians (Massage Therapy) independently assess the physical and mental status of patients. The Health Technician (Massage Therapy) takes complete patient history and performs a physical assessment. The Health Technician (Massage Therapy) interprets relevant clinical information to identify each patient’s population-specific needs, identify indications/contraindications for massage, and develop the plan of care. Health Technicians (Massage Therapy), at this level, are responsible to perform massage therapy services with complexity higher than the developmental level. The Health Technician (Massage Therapy) performs duties with limited supervision and seeks assistance from the supervisor in urgent or emergent circumstances. The Health Technician (Massage Therapy) evaluates patient responses to treatment and documents responses to treatment, by maintaining accurate records in an electronic environment. The Health Technician (Massage Therapy) coordinates follow up massage therapy as necessary. Health Technicians (Massage Therapy), at this level, serve as consultants to the health care team in the evaluation and treatment of the patient. Under routine academic oversight, the Health Technician (Massage Therapy) assists with clinical supervision of massage therapy students.
(4) Health Technician (Massage Therapy) GS-8 – Advanced Clinical Level
(a) Experience. In addition to meeting the basic requirements, candidates must possess one year of progressive experience equivalent to the GS-7 grade level. In addition, the candidate must demonstrate all the following KSAs:
(b) Demonstrated Knowledge, Skills, and Abilities
i. Skill in providing advanced massage techniques using the appropriate tools, supplies, and equipment based on the needs of the patient;
ii. Knowledge of anatomy, physiology, and pathology relevant to massage therapy within specialty population(s);
iii. Ability to modify massage therapy techniques based on an understanding of specialty populations, and various clinical/environmental settings;
iv. Knowledge of teaching methods and learning principles;
v. Ability to conduct research and quality improvement activities, related to massage therapy; and
vi. Knowledge of complementary integrative health, and holistic health principles.
(c) Assignment. For all assignments above the full performance level (GS-7), the higher-level duties must consist of significant scope, complexity (difficulty), variety, and be performed by the incumbent at least 25% of the time. At this level, the Health Technician (Massage Therapy) provides a full range of complex treatment procedures and modalities, which may include, but are not limited to reflexology, injury rehabilitation, lymphatic drainage, neuromuscular therapy, myofascial release, and/or craniosacral work. The Health Technician (Massage Therapy) is responsible to provide massage therapy services for specialty areas, such as pain management, poly-trauma, surgery, traumatic brain injury, palliative care, neurology, orthopedics, geriatrics, cardiology, pulmonary, rheumatology, spinal cord injury, mental health, and oncology. The Health Technician (Massage Therapy) assists other staff through education and as a member of an interdisciplinary health care team. The Health Technician (Massage Therapy) is a subject matter expert responsible for mentoring other Health Technicians (Massage Therapy) who participate in educational and research activities. The Health Technician (Massage Therapy) provides education in massage techniques to patients, caregivers, and employees. The Health Technician (Massage Therapy) contributes to identifying, collecting, and analyzing aggregate patient care information, to ensure safety and quality of care.
(5) Lead Health Technician (Massage Therapy), GS-8
(a) Experience. In addition to meeting the basic requirements, candidates must possess one year of progressively complex experience equivalent to the GS-7 grade level. In addition, the candidate must demonstrate all the following KSAs:
(b) Demonstrated Knowledge, Skills, and Abilities
i. Ability to delegate tasks and responsibilities;
ii. Ability to manage staffing requirements, workload priorities, and coordinate the work of the unit;
iii. Ability to provide staff development and training; and
iv. Ability to review and monitor data to ensure all records and reports are complete and accurate.
(c) Assignment. For all assignments above the full performance level, the higher-level duties must consist of significant scope, complexity (difficulty), variety, and be performed by the incumbent at least 25% of the time. The Lead Health Technician (Massage Therapy) monitors workload, provides input on performance, resolves daily workplace issues, and maintains efficient workflow. Assignments at this level include, but are not limited to: ensuring coverage of all areas of responsibility; conducting clinical reviews to assess the quality of work; providing input to staff that includes changes in policies and procedures; creating and maintaining employee work schedules; orienting and providing on-the-job training for new and current Health Technicians (Massage Therapy); and ensuring all training requirements are met. The Lead Health Technician (Massage Therapy) reviews and analyzes aggregate patient care data, to ensure safety and quality of care.
(6) Supervisory Health Technician (Massage Therapy), GS-9
(a) Experience. In addition to meeting the basic requirements, candidates must possess one year of progressively complex experience equivalent to the GS-8 grade level. In addition, the candidate must demonstrate all the following KSAs:
(b) Demonstrated Knowledge, Skills, and Abilities
i. Ability to provide the full range of administrative and supervisory duties which include, but are not limited to: assignment of work, performance evaluations, selection of staff, and recommendation of awards and/or advancements;
ii. Advanced knowledge of massage therapy across multiple areas of practice, and the demonstrated ability to provide guidance to staff massage therapists;
iii. Knowledge of how massage therapy integrates with other health care disciplines;
iv. Ability to assist in matters related to policy development, equipment requests, and workload analysis; and
v. Ability to delegate authority, evaluate and oversee people and programs, accomplish program goals, and adapt to changing priorities.
(c) Assignment. For all assignments above the full performance level, the higher-level duties must consist of significant scope, complexity (difficulty), variety, and be performed by the incumbent at least 25% of the time. The Supervisory Health Technician (Massage Therapy) is responsible for the supervision, administrative management, and direction of Health Technicians (Massage Therapy). The Supervisory Health Technician (Massage Therapy) has full administrative and professional responsibility for planning and directing the activities for the service or equivalent unit. Typical duties include: making work assignments, monitoring the staff’s clinical performance, conducting performance appraisals, and other clinical and administrative responsibilities, as assigned, to ensure that the mission of the service and the medical center has been satisfied. The Supervisory Health Technician (Massage Therapy) develops policies and procedures for the work unit, and contributes to the promotion of complementary and integrative health services. The Supervisory Health Technician (Massage Therapy) is responsible to review aggregate patient care data and take appropriate actions to ensure the safety and quality of care.

What does this mean for the future of the massage therapy profession?

Now that the VA has clearly defined standards of education and create a clear job description, many more may follow.

Will Medicare/Medicaid recognize massage therapy?

Will more health insurance companies recognize massage therapy?

Will more hospitals, hospice centers, cancer centers and rehab centers recognize massage therapy more and use the standards and job descriptions for their programs?

You betcha!

Follow this important thread for more info.

ICD -10 codes for Massage Therapists

May 25, 2019 By Julie Onofrio 11 Comments

Yes ICD -10 codes are here and there is a lot of information that you will need to know. International Statistical Classification of Diseases and Related Health Problems codes are created by the World Health Organization and are used around the world. They are diagnosis codes that are used when doctors prescribe massage so you will need to be up on what is going on.

The next version – ICD-11 are already on the way. In May 2019, ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States. In January 2022, Following endorsement, Member States will begin reporting health data using ICD-11. (WHO timeline)

ICD-9-CM codes were 5 digits

First digit is alpha (E or V) or numeric
Digits 2-5 are numeric
Decimal is placed after the third character
14,000 codes

ICD-10-CM codes are 7 digits and there are 69,000 codes to better capture specificity.

Digit 1 is alpha.The two main category of codes massage therapists will see most of are the M and S codes:
- M = musculoskeletal or connective tissue condition
- S = injury or consequences of external causes
Digit 2 is numeric
M00-M25 Arthropathies
(M00-M03) Infectious arthropathies
- (M05-M14) Inflammatory polyarthropathies
- (M15-M19) Arthrosis
- (M20-M25) Other joint disorders
- M40-M54 Dorsopathies
- (M50-M54) Other dorsopathies(M45-M49) Spondylopathies(M40-M43) Deforming dorsopathies
- M60-M79 Soft tissue disorders
- (M60-M63) Disorders of muscles
- (M65-M68) Disorders of synovium and tendon
- (M70-M79) Other soft tissue disorders
- M80-M90 Osteopathies
- M91-M94 Chondropathies
- M95-M99 Other disorders of the musculoskeletal system and connective tissue
- S00-T14 – Injury
  - (S00-S09) head
  - (S10-S19) neck
  - (S20-S29) thorax
  - (S30-S39) abdomen, lower back, lumbar spine and pelvis
  - (S40-S49) shoulder and upper arm
  - (S50-S59) elbow and forearm
  - (S60-S69) wrist and hand
  - (S70-S79) hip and thigh
  - (S80-S89) knee and lower leg
  - (S90-S99) ankle and foot
  - (T00-T07) involving multiple body regions
  - (T08-T14) unspecified parts of trunk, limb or body region
Digits 3–6 are alpha or numeric
For “M” and “S” category codes, the side of the body is indicated. Generally:
1 = right
2 = left
Note: There are a variety of different methods for denoting bilateral locations
Decimal is placed after the third character
7th digit is a special extension code that will be alphabetical and is required for injury codes that start with S.

A: Initial Encounter – Patient is receiving active care. You can use A on multiple claims for the same condition – it really isn’t just for the first encounter. “A” code for initial encounter is used for all sessions related to the “active” treatment for the symptoms called out in the ICD10 code.
D: Subsequent Encounter – After patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Rehab therapy is usually considered to be part of the healing and recovery phase. The “D” code is used for subsequent treatments to check on the patient/client after active treatment is completed.

S: Sequelae — Complications or conditions that arise as a direct result of the condition that are caused from the direct result of an injury or condition.
Fractures have a different extension code than other conditions based on open vs. closed, routine vs delayed healing, non-union or malunion.

ICD-10 codes will provide specific locations for injuries. They will also document chronic or acute pain issues. The new codes are much more specific and will provide us with much more information about diseases and their treatments which will help with health management and research.

Since these are diagnosis codes and massage therapists can not diagnose clients, the codes will come from the doctor. The doctor may or may not write the actual description of what the code means so you may have to look the code up to know what it means. It is best to get the actual code from the doctors so that you can put the same code on the bill as the doctor does to tell the insurance that you are working on the same condition. Often times there are a variety of codes that can be used for one condition so it is important to know which one the doctor is using. There are many free code look up databases online. See ICD 10 Look up from CMS.

Here also are some common orthopedic codes that are used for rehabilitation

M54.2 Cervicalgia
M50.01 Cervical disc disorder with myelopathy, occipito-atlanto-axial region
M50.02 Cervical disc disorder with myelopathy, mid-cervical region
M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
M54.30* Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40* Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side

There are specific codes just for pain. It has been previously said that massage therapists can use pain codes to bill the insurance without a prescription. I have never seen a health care plan that does not required massage to be medically necessary which means a prescription is needed. Pain needs to be carefully diagnosed to rule out more severe injuries or conditions like heart attacks, kidney stones etc. Here are common pain codes:

Shoulder — M25.511 (R), M25.512 (L)
Upper Arm — M79.621 (R), M79.622 (L)
Elbow — M25.521 (R), M25.522 (L)
Forearm — M79.631 (R), M79.632 (L)
Wrist — M25.531 (R), M25.532 (L)
Hand — M79.641 (R), M79.642 (L) (excludes fingers)
Hip — M25.551 (R), M25.552 (L)
Thigh — M79.651 (R), M79.652 (L)
Knee — M25.561 (R), M25.562 (L)
Lower Leg — M79.661 (R), M79.662 (L)
Ankle — M25.571 (R), M25.572 (L) (excludes foot/toes)
Foot — M79.671 (R), M79.672 (L) (excludes toes)
Thoracic Spine — M54.6
Low Back Pain — M54.5

As you can see, these codes are much more specific so that will give you so much more information and tracking the codes will provide data for various conditions to see what therapies work best.

There is much more to billing insurance then just putting an ICD-10 code on a bill. Learn to bill insurance and see my plan to get massage therapy covered by health insurance in every state in my book : Massage Insurance Billing.

Other resources:

CMS Provider resources

World Health Organization

Originally written Aug 6th 2015. Updated Jan 30 2016, Updated 05/25/2019

Save

Google Business Listing for Your Massage Business

May 24, 2019 By Julie Onofrio Leave a Comment

Google Business Listings is a business profile on Google that also gets you on Google Maps as well as search. With more people searching on maps these days, this can be very helpful in getting and keeping clients.

The thing about people finding you on Google is that people are searching for massage there which means they are looking for someone to give them massage. This is ideal to start with. You aren’t randomly looking for clients like you are when you are on a social media site.

Head over to Google Business.

Sign up or sign in. Check to see if your business is listed on Google.com/maps first. If it is, you can claim the business. If you already have claimed your business, you can login to Google Business. and make sure your profile is accurate and keep it up to date.

You can also maximize Google Business by adding photos of your office and store front and posting to your listing daily.

Join my Facebook Group to get help with your Google Business Listing and building your massage business.

Educating Massage Clients

May 18, 2019 By Julie Onofrio Leave a Comment

Educating Massage Clients is one of the best ways to create awareness and acceptance about massage. Education is not talking at people telling them about massage, about what you can do and why they should get a massage. The root word of Education is the Latin word educare, which means to “draw out.” To educate, therefore, means to draw out something that fundamentally is already there. In the process of education, you actually become aware of yourself. In most of our standard examples of education like in public schools and in massage school it becomes just a memorizing of information and a regurgitation of that information. It isn’t education.

To educate clients and potential clients it is more about building a relationship with them. It is about setting aside your own agendas to even get a massage appointment and showing a real interest in them. It begins with asking people questions to find out their needs. Then if you find that their needs match what you have to offer you can then easily talk about what massage can do for them.

I have heard a few massage therapists say things like ” I have sent many letters over the years to doctors and others trying to educate them and it didn’t work.” While I don’t know for sure what was in the letters I would guess that it wasn’t educating and it was more about them. It might have been more along the lines of presenting information that the recipient wasn’t interested in.

To educate others you need to forget what you know about massage – all the big terms, the name of the muscles and things like that. The ‘Curse of Knowledge” from Chip and Dan Heaths Book “Made to Stick” says:

Once we know something it is hard to imagine what it is like to not know it. Our knowledge has cursed us. And it becomes difficult for us to share our knowledge with others, because we can’t really create our listeners state of mind.

Make sure your website and communication is about the client and what is in it for them. So often massage therapists make the mistake of making everything about themselves. Assume that people know little to nothing about massage and what it can do until you find out otherwise. Keep it simple and in plain English.
You need to understand what your client/potential client wants. They start with saying they want to feel better or be out of pain – but why? So they can play a sport better? So they can play more with their kids? So they can enjoy their work, home life, vacation? Ask questions to get to their why? Tell them how you will help them solve their problems and help them achieve their goals.
People want to know that you are the expert and can handle whatever health issue that they have and that you will be able to do the right thing to help them. Let them know that you understand by sharing a story about other client situations (without names or client ID) or let them know a story about you. You are the EXPERT! People want to know that. Google wants to know that too! Google wants your website to be good enough to pass their E-A-T guidelines that were just released by Google in 2014 and recently updated

E-A-T (“Expertise, Authoritativeness or Trustworthiness”
Believe in what you do. Understand what you do. Be always learning about what you do. But more than that, make sure you know how to express that belief without sounding like a used car salesman.

Example: I started my business renting a room out of a health club in downtown Seattle. I used to sit at the front desk and greet club members and hand out towels and locker keys. One guy would go out running when he was there and he did his stretching by the front desk and would stop to talk. He kept saying “Oh I need to get a massage someday” etc etc but never would book. One day I asked him why he was running so much – did he have a personal goal or was he training for some event. Turns out he was training for a marathon. When I was able to make the connections to how massage could help him run better and train better, he signed up for a massage….not just one massage… but one massage a week for about 10 years.

Yesterday on Facebook I saw this post from the Real Housewives of Beverly Hills show that showed just how much people do not know about what massage is and who massage therapists are. We have lots of work to do.

Educating massage clients and potential massage clients

Originally written on June 5 2010. Updated May 18, 2019