Greetings Massage Therapist/Practitioner!

Sharing draft intake and assessment templates in the previous post, I’ve had several RMTs graciously send in their templates for your perusal.  Please have a look at templates by Dan Carell (intake and treatment), Claire Tonack (intake) and Jan Scott (intake and treatment).

Thanks to these RMTs for helping to generate further reflection, discussion, debate…and eventually better processes. Here again are my intake and initial assessment templates for your review.

New topic: I’ve been receiving more inquiries re: electronic charting and on-line practice applications.  I’ve been approached by several software developers wondering how to improve the software to make it more functional to RMTs/LMTs.

Are you considering a jump to a practice management system in digital format?  What programs have your reviewed?  Your impression?  What criteria would your ideal program have? Please share your thoughts below or post on our Facebook page.

My first post in the Massage Charting Method Collaboration (MCMC) described problems in the current practice of charting for massage therapists, and I presented arguments and guidelines in its formation.  I received very helpful feedback on the proposed case history template via social media and direct email and incorporated some of those changes here.

I have a second template to share for your perusal – the RMT initial assessment.  The RMT initial assessment template allows you to capture the essential information from the case history template, blend it with information gathered from your further questioning and create a comprehensive symptom picture you can use to determine your course of treatment and identify any contra-indications to care.

The purpose of this template is to weave together the patient/client’s reported symptoms and goals, your observations and assessment, and outcomes from treatment based on your benchmarks – all on one page for easy review.  This page ideally is fastened to the back of the case history template so all this comprehensive information is stored on one page.

There are added advantages to this template over existing practices as well.  You’ll see prompts on the left side of the page to ensure you’re asking all the important questions, with questions particular to yellow/red flags (see Neuromusculoskeletal Examination and Assessment by Petty/Moore) to immediately identify risk of harm to the patient/client and lessen practitioner liability from performing an inadeqate case history.

Also presented under the Objective and Assessment portions are seven relevant and measurable benchmarks for massage practitioners to gage improvement (outcomes) from their interventions.  I’ve added mood as a variable, given the mounting research showing a beneficial outcome of massage therapy on mood.  Most of these measures are rehabilitative/medical in basis but we’ll need to add further benchmarks to consider the wellness goals (that is, not necessarily disease-based) of the patient/client.

If you’re an RMTAO member, you can read my article 7 Ways to Measure Massage Therapy Interventions to learn more about these benchmarks, or wait for my next post where I’ll elaborate on how to document these.

Please sign up for our blog and post your comments on the proposed templates below, or join in the discussion on Facebook.  We’ll make RMT charting better…together.

Charting for massage therapists is a big problem.  There is minimal uniformity in capturing, analyzing and recording patient/client data, varying regulations from multiple authorities to comply with, no standard approach to benchmark or outcome measure soft-tissue dysfunction, and the multiple sectors served – spa, rehab, massage-centred, human performance/workplace wellness – require different charting benchmarks and outcome measures based on different intentions.  In my presentation of this material for almost 10 years, I’ve found charting to be a source of angst for many massage therapists.

I propose we use the power of social media to create that standard, to work through the issues and to arrive at a comprehensive, effective charting methodology applicable across all sectors served.  Hence the Massage Charting Method Collaboration (MCMC).

I propose the following guidelines for the MCMC:

1. Meaningful to massage therapists – MSK/myofascial focused, with secondary (as opposed to primary) representation of orthopedic/neurological measures
2. Applicable to all sectors served – spa, rehab, massage-centred, human performance/workplace wellness
3. Effective (captures the necessary and important information) and efficient (saves time, eliminates waste)
4. Prevents harm to client/patient or practitioner – screens directly for red or yellow flags/contra-indications to care and ensures practitioner’s records are defendable
5. Simple and clear – removes unnecessary medical and legal jargon, and captures only what is necessary for treating that patient/client population
6. Electronic-friendly – methodology easily transfers to electronic record-keeping format

I’ve provided a case history form for your perusal.  A treatment note form will follow shortly.  Please give it a trial and send your feedback on any improvements that can be made.  I’d prefer you use my blog so everyone can see your feedback, but also feel free to comment on social media or email me at don@MassageTherapistPractice.com.  This topic is a thorn in the side of many massage therapists…thank you in advance for your contribution to fixing the problem!

p.s. Reference CMTO record keeping standards http://www.cmto.com/cmto-wordpress/assets/cph_6.pdf and http://www.cmto.com/cmto-wordpress/assets/cph_14.pdf

Recently I was honoured with One Concept’s Massage Massage Therapist of the Year award.  Normally I’m quite comfortable speaking in front of large crowds, but the enormity of being recognized in this way, and some challenges with the microphone function deflated the impassioned speech I prepared.  This is what I’d wish I’d said….

Dear colleagues, friends and supporters of the massage therapist profession.  It is my honour and privilege to receive this award.  There are many in this room equally deserving of this award, and I stand on the shoulders of giants.  My efforts have built on the efforts of colleagues past and present.

I would like to speak for a moment on our gracious hosts for the conference, One Concept.  This group – composed of Monica Pasinato-Forchielli, Lorna Pasinato, Scott Dartnall, Robyn Lynn Donovan-Green and Dr. Andria Hoda – are trail-blazers.  When the original conference – the Massage Therapy Canada Conference – was to be cancelled by then organizer and publisher Jill Rogers due to a personal health issue, Monica, Lorna and Scott swept in with just 4 weeks to go to save the conference.

They carried the torch for successive conferences and added Robyn and Andria to support the emerging theme of a Canadian-wide conference.  One Concept invited our American cousins to both speak and participate (up to this point Canadian and American massage practitioners rarely worked together), and then ventured into one of the largest marketplaces in the world to host the American Massage Conference.  These cheeky, audacious Canadians did this despite established and competing organizations.  This year in the spirit of CAM (Complementary and Alternative Medicine) collaboration, they invited our chiropractic sisters and brothers to an integrated conference – the Canadian Massage and Chiropractic Conference.

One Concept doesn’t wait for permission or policy.  They, as my wife Cheryl (who is a job developer, employment advisor and is entrepreneurial-minded) would say “See a need, then fill that need”.  In this climate of unfavorable government health care and taxation policy, unmovable insurance reimbursement, skeptical public and media opinion, territorial gatekeeper health disciplines and their ambitious assistants, and profiteers and exploiters that would take advantage of the popularity of massage, One Concept sees a need, and is filling that need.

Our profession needs to organize, self-examine and take steps to form our own present and future circumstances – not have them dictated to us.  Our professional associations, training colleges and regulatory bodies seem stymied in this, but One Concept is not waiting…they’re getting ‘er done!  And, we as practitioners, suppliers/manufacturers, educators, publicists and writers, training schools, professional associations and regulatory bodies, we are all benefactors of One Concept’s audacious work.  We all owe them a large debt of gratitude.

As for me, I’m often asked “How”.  “How do you do it Don?  How do you teach across Canada, write books and articles, and engage in social media regularly?”  Not to mention family (my wife Cheryl, sons Gabriel and Noah, and our whippets Max and Balto), home responsibilities, and of course my practice.  Practitioners often assume I don’t practice any more, but of course I practice…it’s my favourite thing to do!

To answer the question, I believe you can manage “how” when you’re passionate enough about something.  I wish more people would ask me “why”.   I do all the extra work I do because of the practitioners that have approached me privately over the years – in person or by email – that are  struggling to make a living, and their bodies.  Their bodies are breaking down from the care they’re providing others an they’re looking for some way to keep working, to make it through.

Increasingly I’m approached by massage therapists-turned-business-owners brokering opportunities for other practitioners, but complain that the political culture of massage doesn’t support them.  They ask why our culture perpetuates that the lion’s share of the service fee goes to the practitioner – despite capital and risk sustained by the business owner – and why the business model we’re encouraged to follow is unsustainable for the owner.  By encouraging unsustainable business models we’re actually harming our practitioners and those that would provide opportunities for them to work.

So for all those practitioners, you are my “why”, and I will continue to work to improve your circumstances.  Tonight I share this award with you.

Thank you.

We asked “What can a massage practitioner do to recession-proof their business?”.

John W. Corry, RMT
Do a talk! While it is true that many people are terrified of public speaking, generating a conversation about Massage Therapy to a target group of people that interest you AND have near-recession proof occupations and benefits can provide “bread ‘n butter” clients!

Ten runners at a running/shoe store, 6 pregnant couples at their midwife company, your local firehall, 15 RN’s at every floor of a hospital!! (weekly “In-service” meetings). The staff at your dentist’s office,  the stressed teachers at your child’s school….

Jenn Hewitt, RMT
My advice is to develop strong professional relationships with local doctors and lawyers. These professionals are fabulous referral resource for RMT’s.  My clients regularly return to their doctor or lawyer with evidence based results from their massage treatments.

If an RMT can make a doctor’s patient/lawyer’s client feel better, those professionals are more likely to refer clients to your clinic.  I have not had any slow-downs during the recession. In fact, we have hired another RMT to handle the over-flow.  I also do not experience any seasonal slow-downs that many other RMT’s report.

Lily Starling, CMT
I have built a thriving practice in the midst of the recession in a little less than 18 months. I’ve hired three ICs, and between us we have over 500 clients.

Online booking (I use FullSlate but Timecenter is also a great one, and Genbook has integrated analytics) is the foundation of my practice.  It pulls 7-10 new clients into my practice every week without me having to talk to them on the phone. We’ve completely circumvented the need for a receptionist, at least at this stage in our growth.

The real key is that online booking captures a trend in communication and ease of booking. I give people the option of NOT having a conversation on the phone with a stranger, or waiting for a call or email back to schedule or confirm an appointment.  Consumer communication is moving into the world of technology and away from strictly verbal communication (for good or ill).  On-line booking allows people to book with us 24 hours a day, so we capture a lot of night owls and early risers who book before and after appointments.

Nathalie Roy, RMT
I never experience a lack of business. My secret is simple: I do a consultation, I assess the problem and I treat it with the best of my knowledge and abilities. Back pain will never run away in an economic recession.

In my long-time experience of receiving care from RMTs, regardless of what province I am in, I found very few RMTs take the time to properly consult and assess before treating. The pattern looks like this: Short consultation, hop on the table and rub the boo boo.

Most of the time, they don’t even book the next appointment!  Oh yes, sure my back muscles feel thight, but what is the (cause of the) problem??  When you don’t address the client’s problem, you are not raising remedial massage therapy to the level our profession deserves.

Don’t be afraid of doing your pathological test, to assess the range of motion of a joint, to address an associating condition….Get out of your confort zone.  Mark those findings in your chart, measure the progress, establish a treatment plan…in short, apply what you learned in school to your practice.  (After all), anybody can do a relaxation massage.

In time of recession, people will cut on relaxation massage because it is viewed as a luxury. When you are in pain, you are not viewing your treatment as a luxury but as a necessity.  If you can demonstrate in your practice that – in collaboration with your client – you can make a real and enduring difference in their quality of life, they’ll follow you no matter what and they’ll refer you all the time.

Joanne Scott
I have had a closed client list for years,
I work very hard, stay current and spread the love.
I have a passion, it is to heal.
I am the queen of self care. The message flows if you walk it .
I can focus, and my best tool is listening.
Intake can lead the way to a path of restoration and health like nobody’s business.

(BTW I love how Joanne ends her emails, “There is NO rush, Take a nice deep breath”…very good advice for all of us.)

Bob Jensen, LMT, RMT
My practice has really taken off since the recession began in the U.S.  I’ve gotten so busy that I actually had to stop accepting new clients in April 2011.  I increased my fees in Nov. 2011 and still find myself fully booked for weeks (and sometimes months) in advance.

So here’s my tip:  Focus your practice on working with clients who are in pain and don’t forget to give them ideas on how to correct their issues.  People in pain are willing to pay out of pocket to get relief.  They’ve been to one doctor after another seeking relief and have probably gotten a different diagnosis from each practitioner.

Each doctor treated the symptom, but usually not the underlying cause of the pain.
Personally I feel it’s because too many “specialists” have become too specialized and miss the larger picture. Most of my clients suffer from repetitive stress injuries or poor posture due to their profession. I work to relieve their pain but also educate them on ways they can make changes so their bodies begin to make the necessary corrections and the pains disappear.

Of course I know human nature… clients will slip back into bad habits and return yet again for additional treatments. It keeps me very busy.

Darlene Mapp, RMT

My business considering the economic situation is doing really well. It wasn’t about a year and a bit ago, but we have experienced an upward shift. I believe I am doing as well as I am mostly because I fell in love with my profession again.

I have been a therapist for 12 ½ years now and about 2 yrs ago I started to resent my work and certain aspects about it such as the lack of vacation time, lack of control over when clients wanted treatment the most, the fact that it can be so physically demanding on me when I have other parts of my life that are just as demanding and require my energy. I started to see a decline in client return. I was in a slump and was starting to get really agitated and bothered by the stuckness I felt. I was trying so hard to find other employment that would allow me to still continue with my business and yet be complementary to what I was doing. There really wasn’t any change until my attitude changed and I began to look at my situation from a different perspective. With some soul searching questions I discovered what I really wanted and needed and then started to take action.

I have for a long time wanted to take my 200 hour certification in Yoga, which I am now in the midst of. This in itself has opened up so many doors. Let me explain. I have worked with breast cancer survivors since 2004. The Breast Health Program here in Saint John had approached me about working with breast cancer survivors to help improve their ROM and pain levels. I absolutely love working with this group of women (and men…I have had one come through the program). When I took the leap (most financial leap) to taking my Yoga training my intention was to develop and teach a program for BCS.

In my Yoga teacher training I have met two lovely BCS’s and together are working toward offering a yoga program for women with cancers. I am now looking at other aspects to be added to my existing massage business that will bring me closer to working with this demographic that I enjoy so much. Things started to fall into place when I finally let go of the resentment and negativity and focus on the things I could do and positive points of my career and life. Since asking myself the hard core questions about what I really want to see happen in the short and long term with my business and then taking the plunge, I now have a renewed energy and passion for what I do. I believe this is the biggest reason my business has experienced an upswing. I have more desire to put the work into what I need to do to manage and grow the business. This has all had a positive snowball effect! I can honestly say I am excited about my massage career again…great place to be!

Jim Smyth, RMT

1. Review your existing files and phone clients who have not been in for a while. If you are uncomfortable phoning send a reminder card, or send an e-mail, or just send a card.

2. Now is the time for advertising. Use the most cost effective method but get your name out to the general public.

3. Send regular updates to doctors or other professionals who have referred clients to you.

4. Send Thank You cards to anyone who refers someone to you.

5. Book your clients next appointment before they leave your office. If they are unable to book, confirm that you will follow up in 2/3 days – and do the follow up.

Good News for a Change!  I received a private email from an RMT who was wondering if there’s any good news about the profession.  Plenty!  Here are just 10:

i) Popularity.  With estimates suggesting 35% of Canadians had tried massage therapy*, some US hospitals incorporating massage therapy for patients on-site, and massage ranked as the number two CAM application (behind chiropractic) in public utilization, we stand far better in public opinion than many other health disciplines.

ii) Size – with over 10,000 RMTs in Ontario and estimated 20-25,000 RMTs across Canada (and 10x this number in the U.S.A) there are a lot of us.  In fact our profession is larger than chiropractic.  If we could harness the will of all those RMTs we could really do something dynamic.

iii) Proof – research studies continue to support massage therapy in the relief of pain and MSK dysfunction, but other applications in mood/depression, improved sleep and palliative care expand the health care benefits of massage therapy.

iv) Staying power – massage has origins in numerous cultures, thousands of years of history and has survived wars, plagues, natural and economic disasters…it’s just not going away.

v) Endorsement – massage therapists are endorsed by many gatekeeper health disciplines, athletes and celebrities, and even some members of government and the insurance industry…not to mention all the people of various vocations and situations we provide care for on a day-to-day basis.  They love us!

vi) Supplement – massage therapy services are supplemented by many employee benefit plans and for low-income populations in British Columbia under health care services.  Worker’s compensation, autoinsurance…there are a number of ways people can lower the cost of access to RMT care.

vii) There’s a strong opportunity to collaborate with other Complementary and Alternative Medicine (CAM) professions in government lobbying, insurance reimbursement negotiations, training and public/media relations.  See my article http://www.massagetherapycanada.com/content/view/1857/

viii) Multiple delivery models – you’ll find massage therapists working in rehab clinics, spas, fitness/athletic clubs, workplace wellness programs and RMT-specialized workspaces.  The marketplace needs massage in a number of settings and this creates very interesting and potentially lucrative opportunities for RMTs!

ix) Inexpensive – dollar-for-dollar, massage therapy intervention costs less than many more invasive procedures.  If health care was privatized, we’d see cost-sensitive patients flocking to RMTs for greater bang for the buck (and shorter recovery times).

x) Alliance – the Canadian Massage Therapist Alliance represents 6 provinces and one territory, with mandates to advocate for RMTs’ interests to the insurance industry, forward research initiatives and support regulation.  Once this organization is fully supported by all the provincial RMT associations, duplicity of services will decline and benefits to all RMTs will go up.

So, here are 10 great things to enjoy and appreciate about our profession.  What can you add?

(1) http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/complementary-alternative-medicine-in-canada-2007.pdf (see page 4)

This time, like all times, is a very good one, if we but know what to do with it.
– Ralph Waldo Emerson

The encroachments on the health of your RMT practice are insidious, malevolent and gaining momentum.  We need a frank discussion to debate, to plan and to take action.

Please review the first chapter at http://www.mtcoach.com/MTP_IntroChptr1.pdf and weigh in on the subject.

What do you see as the opportunities for RMTs now and in the future?  How can we mitigate the threats?  A collective coming to the table is necessary…and we’ve saved a seat for you!

You may have heard the story of the man who dreamed of riches. He sold his beautiful home and farm, which had a pristine river running through, and took the equity off to invest in the world to make his fortune. Sadly, he lost it all in failed get-rich-quick schemes, and lived the rest of his life in poverty. The purchaser who bought the farmer’s land found glistening stones in the pristine river. These stones turn out to be diamonds! Indeed, the man who dreamed of riches yet died tragically needed only to look in his own back yard to find wealth.

Do you, like the man in the story, constantly look “out there” for more business, when in fact you may be missing the diamonds? Your diamond mine can be found by cultivating your existing business and adding more value.

Start here. Sit down with a printout of the contacts in your practice database and assign a value to each name.  The most valuable contacts are assigned an “A”.  A’s are people who have referred at least one other person to your business. Write a “B” beside the names of people who come frequently for treatment – at least 10 or more times a year. People who come infrequently for treatment – less than 10 times a year – are assigned a “C”. “Q” is assigned to patients/clients you haven’t seen in years, or are deceased

Your retention goal is to turn “B”s (frequent patients/clients) into “A”s (referral sources), and “C”s (infrequent patients/clients) into “B”s. To keep the “A”s referring, value them highly and reward them well!

Consider the following strategies towards your end goal. Add value to all your treatment visits. Make people feel well cared for, and clearly show your interest in them. Provide a small bag of Epsom salts to every new patient/client on their first visit. Customer relation studies show that receiving a small gift, even an inexpensive pen, establishes a stronger bond with a new or potential customer.

Provide useful information via a quarterly newsletter – for example, when to use hot or cold to treat an injury. List causes and possible remedies of common musculoskeletal problems such as back pain, TMJ dysfunction and carpal tunnel syndrome.  Your advice will instill in your clients or patients confidence in your knowledge and ability, make these conditions less frightful and give hope of relief.

Confirm all appointments the day before (almost everyone appreciates a reminder) and follow-up if a normally frequent patient/client has not been in for a while. Pay attention to the interests of your patients/clients, and if you find an article she/he might enjoy, pass it on or refer them to the source.

Send a thank-you card for every referral, and consider more substantial gifts for people who refer often. You might provide a vial of Olbas Oil or muscle liniment, an extra 15 minutes of treatment, or some other small expression of gratitude.

Referral sources save you a tremendous amount of time and money by revealing their faith and confidence in you to other people. It pays to show appreciation for that confidence. This is not “buying” someone’s favour or some type of kickback…that would be abusing the practitioner/patient relationship dynamic. There’s no “if you give me this, I’ll give you that” solicitation in this gesture, just simply a token of appreciation that says “Thank you for supporting my business.”

Don’t forget to ask for more business! Give a few business cards to everyone following the successful completion of their treatment plan (when their confidence in you in the highest) and say, “I have room for a few new patients. Please pass this card onto someone who might benefit from care as much as you have.”  People like to be helpful, so recruit them to help you help more people!  Remember the ABCs of retention, and you’ll discover a diamond mine right in your own back yard.

– from the book Massage Therapist Practice: Start, Sustain, Succeed!

Massage therapists rely heavily on various types of insurance coverage to fund care for patients. Employee health benefit plans, claims for auto insurance and worker’s compensation are all potential sources of funding for massage therapy treatment. In a survey commissioned by the College of Massage Therapists of Ontario, 75 per cent of patients or clients use employee workplace benefits to pay, or partially pay, for their care.

With job-related stress accounting for an estimated $16 billion in Canada ($300 billion in the United States) and repetitive strain injuries (RSI) estimated to affect one in 10 Canadians, massage therapists have an opportunity to position themselves as allies with industry in keeping claims for workplace injury – and ancillary costs in lost workdays, turnover and employee dissatisfaction – down.

Despite the impact of these workplace-related illnesses, many employee benefit plans are being scaled back. Employers are wanting reliable outcome measures and proof that their invested dollars are yielding healthier, more productive employees. Coupled with an increase in massage therapy insurance fraud, RMTs are at risk for losing a major source of funding for patients.

(read the remainder of this article, including the actions of the Canadian Massage Therapist Alliance, online at Massage Therapy Canada here)

I was reflecting recently how much I loathe the insurance industry after the WSIB (Workplace Safety Insurance Board) denied yet another patient of mine from receiving care in a legitimate claim. The reason provided to the claimant (not to me when I called) was that massage therapy was “to provide comfort” but had no rehabilitative value.

The claim was denied – despite the fact the employer paid fees to the WSIB in good faith to provide for its workers in case of injury. I suspect this is just one of many legitimate claims deflected and deferred by drone adjudicators not interested in the recuperation and well-being of claimants, but instead with mandates to save costs and deny claims if at all possible.

If the WSIB would release its claim-denial rates, I suspect the rates would be 40-60%. What’s more, I suspect insurance adjudicators routinely deny claims hoping a large percentage of claimants will give up and go away.
I suspect this is a tactic used throughout the insurance industry in whatever calamity the industry is promising to save us from – auto accident claim, workplace injury, life insurance, disability, mortgage or credit card repayment, home damage, etc. You put us at ease, promising to take care of us in time of worry. Well insurance industry, you fall far from your promise.

If I sound harsh, it is because I have a long-standing “hate-on” for your industry that arbitrarily, as far as I can tell, makes decisions that negatively impact and unnecessarily stress people’s lives.

Take auto insurance for example. Now, how did you convince the government that claimants in auto insurance cases should drain their workplace benefits (paid in good faith by employers) before auto insurance benefits are accessed? Why are employers forced to cover costs that have nothing to do with the workplace? As mighty as corporations and as influential as small and mid-sized businesses can be, they obviously don’t have as much power as you. These businesses against their will are complicit in your cost-savings scheme.

What other product or service can be sold without promise of delivery? If I buy a car or dry-cleaning service, a pair of shoes, dinner at a restaurant, a health care service, I expect to receive what I’ve paid for. Yet your claimants can never count on receiving what they’ve paid for. You take their premiums and when a claim is made you put up your policies, stating why you can’t fulfill your promise. Why are citizens purchasing a service in good faith they can’t be guaranteed to receive?

I know I can’t currently dismiss you and have to find some way to work with you. I just wanted to tell you – as a health care provider who provides ethical and effective care to customers you are obligated to serve – that you suck.