Special Facebook Group ( https://www.facebook.com/groups/massageishealthcare) for massage therapists wanting to have massage therapy covered by health insurance and be a part of healthcare.
What is Health Care Integration? Quite simply, integrated care models are health professionals and institutions that provide services to patients work together to share information and coordinate care. Diana Thompson, in her book Integrative Pain Management says:
There is presently a large scale, international movement toward integration of conventional medical approaches to pain treatments and management with other modalities outside of the medical domain. This growing movement is called Integrative Healthcare.
The movement is calling for massage therapists to step up and become a part of healthcare to help treat pain and help combat the Opioid Epidemic. Massage therapy can help with pain, can help with the treatment of injuries and various pain conditions as well as provides preventative and wellness care.
There are many definitions to Integrated Health Care and many different steps to implementing integrated care models.
WHO calls it Integrated service delivery and defines it as “the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.”
Duke Integrative Medicine defines it as:
Integrative Healthcare is an approach to care that seeks to integrate the best of Western scientific medicine with a broader understanding of the nature of illness, healing and wellness. Easily incorporated by all medical specialties and professional disciplines, and by all health care systems, its use not only improves care for patients, it also enhances the cost-effectiveness of health care delivery for providers and payors.
A practical strategy, integrative medicine puts the patient at the center of the care and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. Treating the whole person addresses both the patient’s immediate needs as well as the effects of the long-term and complex interplay between a range of biological, behavioral, psychosocial and environmental influences are addressed. This process enhances the ability of individuals to not only get well, but most importantly, to stay well.
Massage therapy can be a big part of achieving those goals…if only we could get our act together as a profession.
WA State Massage therapists have been a part of healthcare since about 1999, when the insurance commissioner at the time made a law called the Every Category Law that required health insurance carriers cover massage therapy for medically necessary massage. In the beginning, it went fairly well as we learned the ropes of credentialing, clinical massage, billing and getting paid. We basically learned as we went. In the last 7 years or so, things have started going downhill with the allowable fees going lower and lower and more paperwork such as prior authorizations are being required. The carriers are walking all over us—mainly because we do not and have not had a seat at the table. (In the beginning there was an AMTA-WA healthcare integration committee to help with the changes.) The lack of advocacy in WA State is slow going and lacks the financial and legislative support that is needed. AMTA WA still has a lobbyist, but it isn’t enough.
The Call for Massage Therapy
I have been tracking the various calls for massage therapy from across the US in another post – If we are not at the table, we are on the menu. From what I see, it seems like it is only a matter of time before massage therapy is covered by health insurance in every state. The COVID-19 Pandemic is also wrecking havoc creating more stress, pain and all of the other things that go along with social distancing, creating a spike in the number of people using Opioids.
We are not ready.
The lack of leadership around many issues is apparent. AMTA would have been my choice of the association with the best chance of helping on this issue but more recently they have failed the profession with the Pandemic as well as their many years of pulling back— the reduction of state chapter fees, the closing of chapter Units, the move to slate voting as compared to voting freely for your choice of board members, chapter board leaders being ‘fired’ for various reasons across the US., and the lack of transparency about what they are doing and who they own. (AMTA also owns Massage Today. They are also basically supporting NCBTMB financially as well as getting past AMTA board members to now be NCBTMB board members as well as hiring a past AMTA Executive Director to be the NCBTMB Executive Director. )
What needs to be done.
These are some of the things I have thought of and discussed with others. There have been a few attempts to create another national association and there is also now talk of many working to unionize the profession.
- Find out if your state considers massage therapists to be healthcare providers. It is usually designated by law meaning that if you are not recognized as healthcare providers, your state will have to pass a law to make it so. That will of course require a lobbyist to work with legislators to find someone who will write and sponsor the bill and then it has to pass. Here is my list so far where I have information on whether massage therapists are considered to be healthcare providers in your state.
- Create Model Legislation similar to the Every Category Law (the law that we have in WA State that has allowed massage therapists to be able to bill health insurance since about 1999 or so) to be introduced into each state legislature which means we need to have a strong lobby and strong advocacy in each state. (Here is more on the history of healthcare integration for massage therapists in WA State.)
- Research and investigate whether or not we need to create true Board Certifications in Clinical Massage, Hospital Based Massage, Oncology Massage and Sport Massage. Right now we only have the NCBTMB board certification and that is not much more recognition than what you have with a state license. The NCBTMB is creating something called specialty certifications where specific teachers or schools have their own specialty certificate. The problem with this is that it only lets one teacher or school be the certifying body whereas there are many different paths of education that are being left out. About 5 years ago, I had heard that this was just the first step to creating true board certifications but see no forward movement in making it so. More specialty certifications are being created. We need true board certifications in Clinical Massage (and stop calling it Medical Massage), Hospital Based Massage, Sports Massage, Oncology Massage and a few others. Read about the CE Conundrum too. If needed, figure out how to create them. The NCBTMB who would be doing this is broke.
- Create CE requirements that mandate that each massage therapist stay up to date on laws, rules and regulations in their state and also stay up to date on the latest research.
- Support for evidence informed massage therapists. Create a website/app that will have all the research that we have about massage and analyze each study to determine it’s validity and what the study actually says. Provide ideas for how this can be used in a massage business or for legislative efforts. (So far the research that we have does not show how or why massage works or if it works. At best it looks “promising”. (How many research studies does it take to show something works or is true? I don’t know.) Massage therapists can have evidence informed practices but not yet evidence based because the evidence is still lacking.
- Work to get entry level education moving to evidence based theories along with requirements based on competency rather than hours of education. The Entry Level Analysis Project (www.elapmassage.org) started the process.
- Work on licensing portability. State licensing laws vary so much that portability is very difficult. We need to start looking at different models for creating portability like the Nurse Licensure Compact.
- Create standards for massage school teachers and CE teachers. (AFMTE working on this with their massage teacher certification program.)
- Our main associations need to work together more. Many are duplicating each others efforts. They have been meeting but there are no reports or results. AMTA, ABMP, AFMTE, NCBTMB, COMTA, FSTMB, MTF.
- Research massage profession statistics more accurately to find out where we are at and where we want to go. ABMP used to do this but now only AMTA does in their massage industry reports each year but their statistics are often confusing and they don’t add up.
- Our best plan right now would be to approach legislators, insurance commissioners, insurance carriers and others to include massage as healthcare and make it so massage therapists can bill health insurance with the call for massage therapists to help in the Opioid Epidemic. There are so many opportunities right now that are being passed by. We are not at the table. If we are not at the table, we are what is on the menu.
- We missed a very big opportunity to be a part of healthcare when the Affordable Care Act was passed. Section 2706 provided language that could be used to include massage therapists, but our associations were not able to act on it. Massage therapy wants to be healthcare.
- Create a plan for reviving the massage profession and bring more students into schools.
- Research the number of Black, Indigenous and People of color and other populations such as LGBTQ to start the process of increasing the number of BIPOC in the profession.
- Put an end to prostitutes doing business as massage therapists. Look into how establishment laws are adding to the problem or helping the problem. What kind of laws do we need to stop this?
- Remember, getting massage therapy covered by health insurance is ONLY for medically necessary massage meaning you will need to have a doctor prescribe massage and it needs to be some injury or condition that massage therapy can help with. The insurance companies define medically necessary massage using these terms:
There must be a Loss of Function AND Pain.
You must restore and improve function.
It does not cover maintenance massage therapy.
See more specific definitions for medically necessary massage from WA Health care providers on my other website—www.wamassagenetwork.com
- Learn to bill insurance. In most states you can bill for workers comp and car accident related cases. Many states also have a few plans that are covering massage despite not having laws that make it so. You have to check. Learning to bill will help you learn the challenges and see what help we really need from our associations and help get us to the table with the insurance carriers.
- Be careful what you wish for… billing insurance in WA State has been a downhill battle. In the beginning the pay was great ($80-$120 per hour) but the allowable fees have gone down to $59-$80 per hour and more and more restrictions are being put on the sessions with many requiring prior authorizations. We do not have associations at the table advocating for us. One thing we need to be doing are surveys that track massage business profit and loss numbers to show how much massage therapists actually make. That data is used by insurance carriers to set allowable fees. When they do not have it coming from an association or reliable data source, they use their own data to set allowable fees.