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 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)

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?


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

Your Practice, By Design…and You Are the Designer

Are you overwhelmed with the operations-side of running a practice?  Have you inherited a mixed bag of useful practice tips coupled with antiquated and even incorrect guidance?

Would you benefit from a how-to manual from start-to-finish, coaching you along the way in the development of your practice?  Can you use a resource that bridges to the higher level you aspire to?

Building on my 28 years of experience in practice, coupled with speaking to hundreds of practitioners across North America, I’m putting together a progressive Practice Operations workbook for massage therapists.

Each module provides theoretical constructs, real-life examples and reflective exercises to move you forward while honouring your past.

The best resource, of course, would be designed by you…for you.  Even if you’ve been in practice for many years (and perhaps especially for you), I want to reconfigure your feelings of isolation and frustration.  If you’re closer to the entry-level part of practice, all the better.  You can start off on the right foot and fast-track your progression.

Here’s what I need from you:  Have a look at this rough outline.  Would this progressively meet your needs, at whatever stage you’re at?  What specifically would you like to see included in the program?

What have been your practice challenges?  What pearls of wisdom would you like to share with others?

Entry-Level: Practitioner Physical and Security Needs

1) Profile – We start with you.  Reflective exercises tease out personal and professional talents that demonstrate your unique competence, experiences and skillsets as you lay the foundation upon which to build your professional career.

2) Provisions – Account for all assets you bring to the table – capital, contacts, business competence as commitment to see it through.  Evaluate if you have sufficient resources to launch your own practice, or would instead excel apprenticing in an established enterprise.

3) Purpose, Passion, Position in the Marketplace and Workplace – What do you bring to the marketplace?  Why does your product/service matter?  What populations do you serve?  What is your role in the workplace?  What are the values that guide your practice?  We drill down to your core beliefs so you can best position your practice launch.

4) Product, Pricing and Place – Define your “product” and how it will be packaged and presented.  Consider pricing theory and strategies while you contemplate the place (sector/delivery-of-care model) you will incorporate in your practice.

5) Promotion – Learn how to recruit prospective patrons, retain them for the long-term, reward patron behaviour that builds your practice, and re-serve (serve again) those patrons who would buy more from you.

6) Profit – Track key financial metrics, build financial competence, nurture growth and positive cash flow.  Unless your practice is just a hobby, you’ll need profit for growth, contingency and retirement.

Established: Professional Esteem, Relationships and Processes

7) and 8) Practitioner Relations – What role do you play in working with others?  What are your expectations?  Theirs?  Before you sign on the dotted line, consider the implications of the business agreement you’re entering into.  Learn how to strengthen relationships with your work mates and support staff.  If you’re a business owner, effectively scale up to incorporate practitioners into your enterprise.

9) Perspective – Comprehend the extrinsic factors that influence your practice viability – government policy and funding, insurance industry and gatekeeper health practitioner relations, public and media endorsement, competitors and profiteers.  Explore the profession’s culture and essential stakeholders as they exercise influence on your practice.

10) Promises and processes – Set practice policies and processes that deliver on your quality of care.  Consider regulations and laws that govern your practice.

Actualized: Professional and Personal Maturation

11) Potential – Evaluate and entertain delivery-of-care models, discuss how to use tools, team and technology to reduce strain while increasing work capacity and income potential.  Consider how to generate other sources of income.

12) Public & Private Good – Consider your contribution to public health and wellness initiatives, while nurturing the private good in your own well-being.

Write me with your suggestions at don@dondillon-RMT.com.  Let’s elevate the profession together.

What Market Sector Do You Work In?

Salutations my fellow practitioners!

I need your help.  I’m working diligently on a considerable update to the 2010 book Massage Therapist Practice: Start, Sustain, Succeed.  The thoroughly revised manual will have 12 modules, building from entry-level practice to upper-level practice development.

MTP coverI’ll release a table of contents for the book soon, but for now I’d like to get some feedback on the section called “Place”.

Place is one of the 4 variables in the marketing mix theory (the others being product, pricing and promotion) and I’m attempting to capture the nuances between different workspaces / market sectors served by massage practitioners and how services are delivered.

Specifically I write about design differences between the market sectors, plus upside and downside of working in each.  I would greatly appreciate feedback on the following short document to see if I’ve missed or misrepresented anything.  Click here ymtp_place

Write me at don@MassageTherapistPractice.com or visit the Facebook discussion at https://www.facebook.com/Massage-Therapist-Practice-222743724456748/

Thank you in advance for your time and consideration.

don

p.s.  I promise my face will not be on the cover this time…it will be tucked away in the book somewhere, much smaller, hardly noticeable.