Insurers signal changes to Massage Therapy Claims

Insurers have been signalling for some time they have concerns with claims for massage therapy. Recent podcasts and blogposts from Greenshield Canada and Benefits Canada may imply significant changes are coming.

Specifically:
1) Insurers acknowledge MT provides short-term pain relief. They want comparative studies to demonstrate more or less efficacy compared to exercise, a yoga class, mindfulness practice or “a nap”.
2) Insurers are skeptical of a broad scope of practice not linked directly to evidence or measured outcomes. They want treatment guidelines that estimate costs of treatment plans and deliver tangible benefits to claimants.
3) Insurers demand services claimed to be evidence-based and demonstrate efficacy.
4) Insurers imply claims reimbursement can contribute to exploitive business models geared to maximizing financial gain rather than better health outcomes. They want measures taken against fraud and exploitation

Without provincial health plan coverage of musculo-skeletal injuries, citizens rely heavily on employee benefits provided by their employer. Good insurer relations are key for massage therapists to ensure continued access by their patients. The MT profession needs to come up to speed and galvanize its representatives to ensure good insurer relations.

Regarding “up to speed”, following are a number of resources – from most recent to archived – to help you understand and articulate the issues, make informed statements when speaking to colleagues, and to ask your advocates in your professional association to act.

Insurers Signal Change in Massage Therapy Coverage (podcast) (June 2019)
https://www.massagetherapycanada.com/podcast-episode-4-insurers-signal-change-in-massage-therapy-coverage/

Insurers Question the Value of Massage Therapy…A Signal of Changes to Come? (May 2019)

Consider the Insurer’s Perspective (February 2019)

Can Massage Therapists Improve Relations with the Insurance Industry? (podcast, February 2019)

Manage Massage Therapy’s Reputation in the Marketplace (June 2015)

Report on Health Benefits Misses the Point (May 2015)

Claims Crisis in Health Insurance (September 2013)

Insurance Coverage for Massage Therapy: Going…going…gone? (July 2012)

Think Differently, Earn More

Perhaps you’ve plateaued. You’re working as hard as you can and you’re concerned your hands are going to give out. Is it about working harder, or thinking differently?

I’ve had the privilege and pleasure of interviewing a number of RMTs over the years that applied novel delivery-of-care models, or found ways to scale up the number of patrons they provide care to. With that increased ability to serve also comes an ability to earn higher than average incomes.

In the RMTAO Massage Therapist Earnings Survey, 2013, the average annual income in 2012 was $42,771 from all sources.

Yet look closely…the highest income reported was $220,000. What was the latter practitioner doing that generated over 5 x the average RMT income?

You may gain some insights from reading about these 5 RMTs and how they approached things differently. Enjoy.

Therapists Who Mean Business

Scale Up: Beyond Your Delivery-of-Care Model

This RMT is Laser-Focused

Tools, Team & Technology: Incorporating Variables that can Transform Your Practice

Can a Delivery-of-Care Model Be RMT-Centric? Yes Indeed!

10 Years on

How government policy, technology, corporate capitalization, user demand for convenience and integration will shape Massage Therapy Care

Please note, this is a draft article for Massage Therapy Canada magazine for which I’m soliciting input. What have I called correctly, in your perspective? What have I missed? Please share your perspective in the feedback space below…and thank you!

What does the future hold for the profession?  While no one can know for sure, forecasting based on best available information – and a little intuition – can yield a look-see for what is trending.  Forecasting can guide practitioners to fortify against risk, design their practices to remain relevant and identify new opportunities.  Forecasting is essential for regulators, professional associations, training colleges and other stakeholders for resource allocation and planning for contingencies in addressing the needs of their members/students.

Here’s my speculation for the next 10+ years to come in the massage therapy profession in Canada.

Advent of Health Technology:

The fields of bio-technology, robotics and artificial intelligence impact all aspects of our lives.  While current massage devices appear crude, advances are being made in sensate machines that detect pressure.  Robotics are incorporated in a variety of sophisticated applications like surgery and, linked with artificial intelligence, will foray into the bodywork space. Mechanized touch providing pressure and stretch to a stiff body can be applied daily and cost-effectively and will increasingly be employed in rehabilitation and assisted movement.  This won’t replace the personalized human touch provided by skilled practitioners but augment it.  Watch for DIY (Do-It-Yourself) applications to bodywork continue to expand.

Technology will be incorporated in patient safety, security and quality of outcomes. Virtual Reality (VR) will expand the cognitive and sensory experience of health care applications.  VR can enhance massage experience, but also modulate pain in the brain.  People will adopt more sophisticated bio-sensors in all their activities, measuring heart rate, blood pressure, and stress response.  I believe we’ll see increasingly sophisticated data generated on physiologic effects of massage in real-time.

Personalized and Convenient Care:

Massago provides convenient, on-demand massage services in Toronto, Ottawa, Kitchener, Calgary and a growing list of Canadian cities.  Patrons use a phone app to arrange same-day appointments at home or alternative location, choose from a variety of massage service types, pay for service and the rate their massage experience. Technology verifies patron identity for the security of the practitioner.  Massago aggregates user feedback to build best practices and improve user experience over time.

While Massago addresses the on-demand market, CEO Allan Skok shared users build a preference for an excellent practitioner and are willing to postpone an appointment several days to get their practitioner of choice.    I expect technological improvements to lighten and strengthen portable massage tables, make hydro/electro-therapies novel and portable to augment services.

Antithetical to the always-on, technology-saturated social and work environments we occupy, expect the values of embodiment and mindfulness to drive massage experience.  In addition to virtual reality integration, I expect massage practitioners to work in tandem with practitioners of psychotherapy (who perhaps incorporate legalized psychedelic drugs) to address deep-seated trauma, promote higher consciousness and a sense of embodiment.

More Populations Served:

Massage therapy already serves a number of market sectors: rehabilitation, spa/wellness, holistic/integrated care, palliative care, athletics and work performance on-site.  Adopting a bio-psycho-social model of care, greater research literacy and capacity, and if the profession can galvanize on government/insurer/media advocacy, we may see massage therapists incorporated in mental health, public health, home care and intensive rehabilitation programs.  Massage therapy may prove especially helpful in socially marginalized populations – the poor, indigenous, victims of domestic violence, refugees, the elderly and disabled. 

Government funding and efficiencies may drive individual disciplines to work collaboratively together – for example in home care, a physiotherapist or nurse, massage therapist, personal support worker and social worker.  Massage therapy will continue to be valued as an antithesis to the felt effects of aggression, violence, workplace stress, sensory overload and trauma.

Increased Accountability Demanded by Third-Party Payers:

Insurers want accountability in claims.  They want customers to use benefits judiciously and expect health practitioners to work efficiently within financial constraints and demonstrate efficacy in outcomes.  Increasingly insurers may only fund services that are evidence-backed.  Insurers have the ear of employers regarding cost-savings and efficiency in purchasing employee benefit plans.  We may see massage therapy services positioned in higher cost, add-on premium insurance products, which will reduce the number of employers signing on.

A shift to an employee spending account with a suite of options puts the user in charge of spending, hence greater scrutiny and accountability by the user for how benefit dollars are invested.  Insurers may look to WSIB and auto-insurance service fee schedules and apply downward pressure on practitioner compensation for all their insurance products.

Watch for insurers to incorporate user reviews to determine preferred providers to work with, insurer control over spending and citizens actively engaged in sourcing their best health and wellness options.

Corporations and Capitalization:

The wellness industry is valued at $4.2 trillion globally[1][2].  Massage therapy will continue to be popular, and corporations will continue to capitalize on market demand.  Watch for growth in corporate employers of practitioners, high profile locations in commercial real estate hubs, strong branding and messaging, and vigorous recruiting of practitioners.  Also watch for branded methods/customized protocols designed and promoted towards marketplace pain-points – similar to the many types of yoga and fitness products now available. 

How do you see the future playing out? What else is trending that will affect the massage therapy field?

Please comment below or on the Facebook page.


[1] https://interestingengineering.com/3d-printed-skin-could-finally-give-robots-a-sense-of-touch

[2] https://www.globalwellnesssummit.com/2018-global-wellness-trends/ 00000000


MT Schools can provide a much-needed forum for the profession

MT schools are institutions of training, knowledge transfer, professional and subsequent personal growth. Could they become more? In a profession riddled with isolation, slow progress on key issues and a divisive identity crisis, practitioners can return to schools for evening discussions to advance dialogue and debate the profession sorely needs.

It’s a natural fit to return to your Alma Mater, engage colleagues and former instructors on sticking points plaguing the profession. Or if you’re no longer living near your old college, any MT school could open it’s doors in the evening to become a mecca of deep, thoughtful, respectful discussion on all-things-massage. Perhaps live-streaming could be incorporated for those at a distance.

There is currently no gathering place for Massage Therapists to regularly engage, at length, on matters of interest and livelihood. MT schools can provide the brick-and-mortar structures for gathering, and nurture existing students in their critical thinking.

I recently attended a gathering at my training school, Sutherland-Chan, in Toronto, Ontario. Although Ian Kamm, presenter and SC instructor, let with mostly lecture and a final Q & A, it held the seeds of possibility.

I’ve included a summary of my thoughts, and you can read reflections on the evening by SC instructor Bruce McKinnon as well.

What say you…are existing MT schools the solution to professional isolation and stagnation?


Consider the Insurer’s Interests, Perspective and Experience

In mid-December 2018, Andrew Lewarne, Executive Director of the Registered Massage Therapists’ Association of Ontario (RMTAO) met with Greenshield Canada (GSC) representatives David Willows – Chief Innovation and Marketing Officer, and Ned Pojskic, Leader of Pharmacy & Health Provider Relations.  Lewarne requested the meeting regarding a provocative Autumn 2010 news post on the Greenshield Canada website, Elephant in the (Waiting) Room https://www.greenshield.ca/en-ca/news/post/the-elephant-in-the-waiting-room.

Lewarne expressed “firm objection to the article’s false and misleading messages and emphasized the important role of massage therapy in health care.”[1]  Willows and Pojskic agreed to adjust some of the inflammatory wording but declined to remove the post.  Promisingly, the GSC pair took RMTAO materials highlighting research in massage therapy, and agreed on future meetings which include RMTs with higher level education and research perspective.

On the heels of the RMTAO objection, Deetria Egeli, RMT and board member with the Registered Massage Therapists’ Association of British Columbia (RMTBC) submitted a January 4th, 2019 letter to address the angst suffered by RMTBC’s membership on this same issue. https://gallery.mailchimp.com/d386e1f0c4cfc3315ec6794a8/files/224a0ad8-a18a-4944-afa8-ad91569a4acc/Greenshield.Letter_D.Egeli_.pdf?fbclid=IwAR3RT_tSRpVv3TxE1mSiNxBGpMVBgUZw92_WLnBunWMMygayrVFxbEKTuko

Egeli’s letter reflected her perspective as a practitioner, highlighting populations she has served and conditions treated, with an emphasis on her rigorous education and training.  Egeli provided several examples of massage therapy research, and posed the question to GSC, “(have you asked) why patients value massage therapy?”  Egeli challenges the “deliberate and discriminatory” statements made by GSC in the Elephant post.  Egeli assures the insurers, “I do not see anyone for hedonistic purposes”….

Read the full article plus seven other helpful links and a podcast on the subject at the Massage Therapy Canada website.

[1] The Friday File, RMTAO, December 14, 2018

Emerging Issues Facing RMTs in 2019

As we begin 2019, I suggest it prudent we take a look at emergent and critical issues facing massage therapists.

Insurer Discourages Customers from Utilizing Massage Therapy Benefits

At the end of 2018, we witnessed another ploy by Greenshield Canada (GSC) to discourage its customers from using their massage therapy benefits. This bait-and-switch tactic positioned as a moral dilemma was designed to engender guilt – if I use my paid-for benefits to utilize massage therapy, then I’m taking GSC’s resources away from paying for expensive pharmaceutical treatments. In effect, I’m denying someone else care if I consider my own.

Greenshield makes it clear they don’t think much of massage therapy, despite it being one of the most sought-after and used benefits their plans offer.

Sure, we all love a good massage. It’s relaxing, it soothes our sore muscles, and sometimes (just sometimes) it’s as good as a really good nap. But on the hierarchy of health needs, we’re going to go out on a very well-researched limb and say that massages fall significantly below life-sustaining miracle drugs.https://www.greenshield.ca/en-ca/news/stories/the-elephant-in-the-waiting-room?fbclid=IwAR3PzUjhXxE7e1umgKS2aAVobiWAODBmhKCG7TCiAn6-hZuBo7j-tUxi4HU

Never mind that the Ministry of Labour cites MusculoSkeletal Disorders (conditions RMTs can positively affect) costing employers hundreds of millions of dollars affecting tens of thousands of citizens https://www.labour.gov.on.ca/english/hs/pubs/pains/index.php

GSC appears to dismiss these conditions in favour of resource-intensive conditions affecting far fewer citizens.

Insurer Threatens Removal of MT Benefits

In another post We Spend More on Massage Than Mental Health Services…Time for a Change?, GSC propose dropping massage therapy coverage as part of a SmartSpend initiative.

“Massage. GSC’s most popular and costly paramedical service is removed as a core benefit in order to re-invest significant funds in the more serious health challenges noted above.”

GSC via the Toronto Star took opportunity to criticize chiropractic and physiotherapy as well as massage therapy in a 2015 article https://www.thestar.com/business/personal_finance/2015/04/13/the-rise-of-the-three-amigos-of-health-care.html?referrer=https%3A%2F%2Fwww.google.ca%2F.

It appears GSC is increasingly hoping to discourage customers from making claims against insurance products customers have paid for. Read my rebuttal here https://www.massagetherapycanada.com/opinion/report-on-health-benefits-use-misses-the-point-2569

Clearly there’s a conflict of interest here…the company that takes in the premiums can boost revenues by discouraging or denying claims. Is it OK for the fox to guard the hen-house?

I sympathize with Greenshield’s cost concerns. They must take in premiums from their customers, then cover operational and marketing costs, staff and executive salaries before they cover claims.

Certainly, in the current system there is ample opportunity for waste and abuse. However insurance may be an outmoded and expensive way of reimbursing health care services…there’s a lot of money paid in premiums not directly benefiting GSC’s customers.

Health spending accounts and government tax credits put the money in your hands, and pressure health care providers to be diligent with their treatment plans. Supplementing tightly-controlled provincial health plan spending with these accounts/credits might better address the needs of Canadians, while keeping everyone involved accountable.

Insurer Believes People are Like Automobiles

Another area to watch related to GSC, the concept of sectional therapy. GSC announced they will now be collecting data on the primary treatment area. This may be the harbinger to future claims approval linked to treating only the symptomatic areas of the body, rather than considering global bio-mechanical dysfunctions or the body-mind / psycho-social connection for the whole person.

People would be treated like automobiles – replacing a muffler, changing a tire – instead of the complex human beings we are. GSC claims adjudicators without health care credentials or an assessment of the individual would be determining breadth and scope of care.

We should ask, “Are insurers part of the health care system? If so, what guides their decision-making processes when approving or denying care claims?”

Is there a threat to RHP self-regulation?

A recent Globe & Mail article is critical of the chiropractic regulator https://www.theglobeandmail.com/…/article-calls…/… The authors maintain the regulator is not doing enough to stem false or exaggerated claims made by their member practitioners.

Tim Caulfield, research chair of health law and policy at U of A has been an outspoken critic of self-regulation for naturopathic practitioners. https://www.cbc.ca/…/researcher-wants-oversight-of…

Caulfield questions whether granting regulation to professions without rigorous evidence gives the public a false sense of confidence.

In “Self-Regulation is shielding bad doctors, not protecting patients” the Toronto Star editorial board state “Once again, doctors have shown they can’t be relied on to properly regulate their own profession. It’s time for the provinces to force the matter through legislation that more clearly defines what it really means to regulate the practice of medicine in the public interest.” https://www.thestar.com/…/self-regulation-is-shielding…

It appears that every year at the RMTAO AGM, the CMTO registrar shares that self-regulation for RHPs is uncommon now in most countries, and its days may be numbered in Ontario.

Given what we are seeing in these other professions, what do you think is the future is for RMTs and self-regulation?

Media Coverage for Misconduct Allegation Increasingly Sensationalist

Media coverage for allegations of misconduct by RMTs contains strong authority images (police cars, badges), cites allegations not yet proven, and rarely mentions MT as a regulated health profession.
https://www.massagetherapycanada.com/regulations/are-rmts-disproportionately-vulnerable-to-allegations-of-sexual-misconduct-4169

If MT was Infused into Publicly Funded Health Care, Would We Be Ready to Serve?

This year representatives from the Registered Massage Therapists’ Association of Ontario (RMTAO) petitioned government to consider MT in health care applications for individuals with chronic pain, palliative care and home care. https://secure.rmtao.com/default.asp?id=1151&article=103

If the wish was granted, and MT were able to work in these integrated health settings:

Are RMTs prepared and properly trained to work with contemporary western medicine practitioners in these integrated settings?
Can we expect service fees to drop to WSIB and auto-insurance service fee levels (about 30-40% below RMTAO’s recommended fee schedule)?
Would you be prepared to work at that level of pay?
What other regulatory and operational requirements would accompany the privilege of working in the system?

What other issues do you see emerging?  How would the issues listed here affect your day-to-day practice?

Please post your comments below

Quick Tool to Measure 4 Variables Essential to Quality of Life

What impact does your massage therapy have on the people you care for? How do you measure that impact? Would you like a tool that can?

Massage Therapists often use functional measures (muscle length and strength, joint range-of-motion) which are helpful in providing some information. Yet, these outcomes fail to provide sufficient context regarding a person’s quality of life experience.

Imagine: What if an MT could measure – with every session – the impact of her/his care on 4 variables: pain relief, mood, mobility and vitality? What if collecting this data could guide an MT as to the efficacy of their care in affecting particular conditions and populations?

What if there was an international databank, that collected and analyzed the data from all practitioner sessions, based on meaningful, subjective feedback from our patients/clients?

“Massage therapy is found to be 83% effective in middle-aged adults suffering headaches.”

What if government policy and health care funding were shaped and directed based primarily on the client/patient experience?

Here’s a sample survey you can print and handout, or send to your patients/clients electronically in advance of your session together. Make sure to follow up at session end and see how the ratings have changed based on your massage therapy. Record them for a few weeks and analyze the results.

See what you can learn about your client’s/patient’s practice experience.  Let me know how you make out by leaving a comment below.  Thank you!

Art of Anatomy

How do you learn and appreciate anatomy?  Did you use the Anatomy Colouring Book, or doodle, or find some other way to get it to stick in your memory?  Can we use illustration to provide better representation of what we feel under our fingers, to give the public an in vivo look into the engagement of hands-to-body?

Calling all amateur anatomical illustrationalists out there…share your artwork!


Patient/Client Experience: What the Data Says

How well do your patients/clients respond to care?  How do you know?

We all hope we are doing a good job, and that people have a wonderful experience.  However, we may not hear back on an adverse reaction, the level of reduction in symptoms, or an unexpected benefit (reduction in anxiety, better sleep quality) that a person may experience as a result of our session together.

Perhaps you can consider designing a survey, like the example below I did on SurveyMonkey.

With a free service like SurveyMonkey (upgrade to paid premium service is available) you can dig deeper into the experience and outcomes of those you provide care for.

SurveyMonkey provides a variety of formats for answers  – checkbox, multiple choice, slider-scale, text box – so you can design a survey to solicit feedback anonymously.  You simply provide the survey link by email after each session, and stop in to analyze your results every week.

Can you imagine the anecdotal evidence the profession would gain if we all applied surveys?

I’m running a survey for 6 weeks to gain some valuable insight.  If you conduct a survey, please comment below and let the community know of your interesting findings!

 

 

Preventing Brain Drain: Opportunities and Challenges for RMTs with Higher Education

Attending the RMTAO’s 2017 Educator Day at the Education Conference, I watched with interest the response to moderator Pam Fitch’s question, “who in the room has obtained a master’s degree or PhD?” A small number of hands in a room full of educators went up. With so few attaining this level of education, I wondered about the opportunities and challenges for RMTs who advance their education.

A visit with Donelda Gowan – a doctorally-prepared massage therapist and recipient of the RMTAO’s research award – confirmed concerns that highly educated RMTs face barriers in sharing knowledge. Donelda is adamant highly-educated RMTs must be supported in injecting knowledge and perspective gained back into the field – assisting its growth and professional culture. In her RMTAO research award acceptance speech, Gowan emphasized, “Massage therapy research must be informed by Massage Therapists.”

Highly educated RMTs may feel pressure to leave massage therapy in pursuit of research and academic positions in related fields. Such a “brain-drain” and limited opportunities for research and knowledge transfer should concern us all in limiting the growth and potential of our field.

I invited a group of six RMTs with high academic standing – some educators, others researcher or practitioner status – to address the following questions:

1. What opportunities exist for RMTs that pursue higher education?
2. What barriers remain to advancement in the MT field, particularly in education, research or influencing community health and social policy?
3. How can stakeholders in the profession support opportunities for practitioners attaining higher education?
4. How can your talents, experiences and education be most effectively used for the advancement of the profession?

At the table we had Beth Barberree, Trish Dryden, Cathy Fournier, Donelda Gowan, Ania Kania-Richmond, and Martha Brown Menard

Read the full article