In early January I sent a letter to the Registered Massage Therapist Association of Ontario (RMTAO) outlining my concerns of several chronic deficits in operations http://massagetherapistpractice.com/letter-to-rmtao-fortune-favours-the-bold/.  In June I received a response from the RMTAO that I’ve pasted below with my additional comments.

I’m hoping you’ll read the response below, gather your thoughts and respond directly to the RMTAO.  Find a list of the directors and staff at https://secure.rmtao.com/about/association_contacts or email direct at info@RMTAO.com.

Dear Mr. Dillon,

 Thank you for your letter received January 1^st, 2013. The Board values the input it receives from members. It is through this ongoing input that we can understand the needs and concerns of our members and better address the issues facing our profession. We encourage all members and non-members to communicate their thoughts to us.

The RMTAO continues to strive for increased communication from its members. There are a number of exciting initiatives in development that we hope will indicate that the voices of the members have been heard. You may have noticed one of our initiatives recently which was a short survey was sent to all members. We hope that activities like this will allow members the chance to express their valued opinions.

You raise several issues in your letter that we would like to address. Firstly, you suggest that the cost of membership to the RMTAO be increased significantly and that the current model is not financially viable. At the most recent Annual General Meeting, the association’s Executive Director Bryn Sumpton presented the 2012 financial report in which he indicated that the RMTAO is currently operating at a surplus and that membership continues to rise. Both facts indicate financial viability and sustainability.

Thank you, RMTAO board members, for responding to my letter.  You are correct I suggest the RMTAO raise fees four-fold, to be in line with other RMT associations, so the RMTAO can effectively meet the needs of RMTAO members.  For example, the RMT associations of British Columbia (MTABC) and Saskatchewan (MTAS) have significantly higher membership fees than the RMTAO, despite having far less of a pool of members to draw from.

The RMTAO does not have sufficient resources to provide essential services to its members.  Essential services include: public and media relations and protection against exploiters; gathering, collating and sharing industry information; advocating RMT interests to government, the insurance industry and gatekeeper health disciplines; and collaborating with other RMT associations and like-minded professions to advance research, regulation/policy and reasonable, unfettered compensation in invoicing insurance programs.   The RMTAO does offer opportunities for securing preferential rates on products and services, and professional development courses, but these could be expanded considerably with a larger staff and more resources.

The RMTAO surplus in 2012 of $143,000 was surprising – given the aggregate deficit of $76,000 reported in 2010/2011 and the consequent hiring an executive director and additional staff member.  It is curious how the RMTAO created a surplus with just a marginal increase in membership while adding two staff members.

In your celebration of the financial report and membership rising, I encourage you to look carefully at your numbers.  The RMTAO did enjoy a boost of 1000 additional members from 2009 to 2010 – after the Strategic Plan was announced.  It appears member optimism faded however when the plan did not materialize, and RMTAO growth in 2011 was 500.  It was even less in 2012 at about 370.

In 2011 when the RMTAO membership increased by 500, CMTO active members grew 1600…in effect the RMTAO is not capturing the hearts and minds of the majority of new graduates.   If RMTAO active membership (as of Sept 30, 2012) is 4371 and CMTO membership is 10,800 at the end of 2011, RMTAO representation is about 40% of all RMTs in Ontario. Compare this to BC or SK RMT associations who boost 80% representation of RMTs in their province.

Again, without sufficient resources the RMTAO cannot effectively advocate for the interests of its members.

Further, you suggest that the number of Directors of the Board is cumbersome and ineffective. We would like to point out that serving as a Director of the RMTAO is a volunteer position. There are numerous committees required for continued operation of the Board. Reducing the number of Board members would in fact increase the amount of time individual Directors donate, thereby becoming an onerous task and slowing the progress of all the various aspects of the work. We would like to note that currently the Board is operating below the authorized number of Directors allowed according to our by-laws. The Board believes that as representatives of the entire membership it is important to include the many varied voices to provide for a balanced and well thought out viewpoint on all the issues being considered.

I understand the governance model the RMTAO is employing, and I suggest this is the main problem. The RMTAO should not place the important job of representing RMT interests across the province on the shoulders of a large volunteer board.  A small, action-oriented board and a large paid-staff contingency can do a much better job.  MTABC for example has 9 board members (one is past-chair) and 9 paid staff to carry out the direction by the board.  Compare the RMTAO volunteer board at 14 with only 3 paid staff.  And despite MTABC membership fees 4+times higher than RMTAO fees, the MTABC retains 80% of RMTs in their province – compared to 40% in Ontario.  BC RMTs purchase membership because the value of membership is clear.  Your operations model is the problem, not the cost of your membership.

A large board deliberates excessively and is slow to move initiatives forward.  A streamlined board takes its cues from its membership – not itself.  It makes well-counseled but expedient decisions and directs staff – via the Executive Director – to carry decisions out. I argue the organization structure of the board and its governance structure is not serving its members interests.  As an example, I challenge you to show proof in the last 7 years (since Andrew Parr, Executive Director resigned) where the association has effectively provided the essential services I’ve listed above.

I suggest the board not be attached to its governance model, but instead actively serve both the immediate and long-term interests of its members.

The individual mandates of the RMTAO are ever evolving as with any organization. Overall, it acts as an advocate for the profession. The Board believes this can be achieved in a number of ways. The decision to not belong to the CMTA, as an example, is something that has been a focus of discussion on several occasions. Shortly, a position statement will be published detailing our current decision. Among the reasons for declining to be a member is the view that the financial obligation of membership is not warranted until the CMTA can provide clear goals with a comprehensive and accountable organizational structure.

The Board believes that it can continue to act to support the profession on a national stage through other avenues. This can be done through letters of support to other provinces, taking an active role in the development of national competency standards and accreditation, and the support of other Regulated Health Care Professionals to name a few. The decision to turn down membership with the CMTA was not taken lightly, nor is membership in it viewed as the only way in which we can maintain a national presence.

I have spoken to representatives of other RMT provincial associations, and they cannot understand the RMTAO’s position to deny collaboration with the Canadian Massage Therapist Alliance (CMTA).  The CMTA serves 7 member provinces – British Columbia, Alberta, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland/Labrador and Prince Edward Island – and the North West Territories.  The CMTA’s primary objectives are: i) preserving and improving insurer relations ii) supporting regulation in all provinces and iii) organizing research initiatives.

The CMTA has represented the member provinces for the last five years at the conferences of the Canadian Life and Health Insurance Association (CLHIA), and the Canadian Health Care Anti-fraud Association (CHCAA).  CMTA representatives Brenda Locke, ED MTABC and Lori Green, ED MTAS have gathered information from insurers regarding their concerns with massage therapy claims.  In response, the CMTA has actively invited non-participating provinces to get involved in improving insurer relations, and designed a standard RMT receipt at the request of insurers.

However without a unified collaboration by all provinces and territories, the RMT insurance strategy appears fractured and a clear message regarding evidence-based practices or cost-effectiveness of massage therapy care, incoherent.  The province with the largest number of RMTs – Ontario, is not a member.  Embarrassingly, despite very limited resources the RMTAO appears to suggest it can forward these national initiatives alone.

An historical perspective – then Ontario Massage Therapist Association (OMTA, precursor to RMTAO) Executive Director Andrew Parr expressed concerns with the financial structure of the CMTA in 2005 and advised the OMTA (RMTAO) board to halt the OMTA’s involvement.  Under Parr’s direction the OMTA attempted later to form a coalition with Manitoba, which subsequently failed.  RMTAO members should be informed that, since then, CMTA representatives have openly welcomed and encouraged the RMTAO to explore both the CMTA’s mandate and financial structure, and earnestly wishes Ontario – the province with the largest number of RMTs in Canada – to collaborate on initiatives beneficial to RMTs across Canada.

We have an insurance crisis on our hands.  In Ontario in the last decade we’ve witnessed the insidious increase of denial of RMT treatment plans in auto insurance and WSIB (worker’s compensation).  More recently, there’s anecdotal evidence to suggest insurers are denying employee claims for RMT services under their workplace benefit plans.

According to the original CMTO survey, 74% of patients/clients pay for massage therapy services with some type of insurance program.  Progressive and aggressive undertakings by insurance companies to prevent fraud and discourage claims for massage therapy care will have devastating effects on practitioners.

Bottom line…the RMTAO cannot pursue RMT interests provincially or nationally without shared resources and collaboration.  The passive “letters of support” and the proclamation that the RMTAO “can maintain a national presence” is grounded, I suggest, in rhetoric and not reality.  Please consider the vigorous objections you’ve received at every RMTAO AGM in the last 7 years as well as in social media and commit to collaborating with the CMTA on national RMT interests.

We hope that you find our response to your satisfaction. Again, we would like to thank you for your comments and your candor. The RMTAO is continually looking for volunteers and ambassadors and we would welcome you to encourage members to contact our office. We would also like to see more active involvement and development of our Community Based Networks should you wish to consider helping further.

Yours truly,

The RMTAO Board of Directors

As you know I’ve been one of the RMTAO/OMTA’s strongest advocates in my professional tenure.  I have promoted the importance of professional association membership in my speaking and writing campaigns across Canada.  I am adamant now more than ever that the RMTAO must examine its path and processes and align them tenaciously with those of its members.

With the release of Report on the Massage Therapy Census 2003, commissioned by the College of Massage Therapists of Ontario – my sense of urgency to address the pressing issues of our profession has grown desperate.  Since then I’ve written extensively and have been welcomed by RMT associations and schools across Canada to speak about the threats against viable RMT practice – specifically unfavourable government health care policy and taxation, stonewalling by the insurance industry, skepticism by gatekeeper health disciplines and profiteers who would exploit the popularity and value of massage therapy.  I’ve discussed the implications of a down economy on discretionary income and workplace benefit plans, and hence on the direct financing of massage therapy services.

While I’ve received sincere interest in these topics, and despite best evidence that the profession is facing serious challenges to its existence, I’ve been unable to move those that have the authority and resources to improve the lot for RMTs in Ontario and in fact throughout Canada.

If you check your records you will find I am perhaps one of the most decorated volunteers the OMTA/RMTAO has.  I’ve received two Hands of Thanks, the President’s Award of Merit and the Ken Rezsnyak Award of Merit from the OMTA for my volunteer efforts over the years.  I’ve represented the OMTA/RMTAO in discussions with the health professional coalition regarding auto insurance, with representatives from the insurance industry, and the WSIB.  I’m also one of the organizers of our successful Niagara RMT community-based networks.  Despite my apparent contributions to the profession, I have failed to move the board to consider the weight of their actions, or particularly, inactions.

I feel greatly disappointed and frustrated that at this most urgent time, the RMTAO seems increasingly less capable to deal with the aggressive threats to viability of RMT practice.  I will continue to do my part to rally RMTs across Ontario to push for an effective association that will consider the big picture, take into account the real threats facing viability of RMT practice and forge strong relationships and share resources to ensure the longevity and viability of massage therapist practice.

See you at the next RMTAO Annual General Meeting.

Respectfully,

Donald Quinn Dillon, RMT

There you have it my colleagues.  I’ve fought hard to push for RMTAO reform for the betterment of all RMTs in Ontario, and you can judge the RMTAO’s response for yourself.  If you believe the RMTAO can do better, if you think your interests can be better represented, then you need to make your voice heard.  Come to the next RMTAO AGM or sign your proxy to a fellow member that can represent your values.

Nothing is going to change until you change something, and if your practice, your livelihood, your profession is important, then you need to get off the sidelines and make your voice heard.

This is your livelihood, your vocation, your profession.  Only through sheer volume of response can RMTs hope their professional association will take the steps necessary and urgent to support viable massage therapist practices.

I’m counting on you.  dqd

Recent discussion on Facebook suggests massage therapist claims are facing increasing scrutiny by adjudicators of employee workplace benefits.  Paid for by the employer, employee health benefits are considered part of the employee’s salary and accountability for presenting and defending suggested treatment plans and intended health outcomes falls to the massage therapist.  It’s the employee and employer…not the insurance adjudicator, who should decide whether to seek massage therapy and proceed with a treatment plan.

 Massage therapists – and indeed all providers who bill for compensation against these plans – should feel extremely uncomfortable about non-medical administrators approving or denying claims from plans financed not by the insurance company, but by employers and their employees.  Insurance adjudicators are largely not medically trained and cannot make judgments about necessary care.  There’s a conflict of interest – insurance companies are motivated primarily by profit…the more claims denied or reduced the higher profit margin to the insurance company for administering the plan.

Insurance is pervasive – home insurance, mortgage insurance, life insurance, disability insurance, auto insurance, health and dental insurance, commercial and professional liability insurance…there’s even insurance to ensure you can pay your credit card, or if your big screen TV dies.  Insurance was created to mitigate risk – to spread risk of loss over a large number of clients and pay out claims against some form of loss.  The insurance company brokers this transaction and receives a commission for administering the plan.  Logically, the fewer claims the insurance company has to pay out, the more profit it makes.

Government appears to favour auto insurers and WSIB (worker’s compensation) over providers, sympathizing with the insurance industry’s complaints of fraud and escalating costs.  Insurers are increasingly concerned with fraud – as we all should be – and have taken great steps to prevent it.  It appears, however, insurers are pushing beyond plan administration towards a decision-maker or gatekeeper role.  This means adjudicators not trained in health science are determining whether a claimant will receive care, what type of care and how much.  Insurance companies post record profits while providers experience increasing downward pressure on their fees.

Here’s a recent post by a massage therapist on Facebook,  ”I treat clients at a software company 1-2 times per month and now my work there is on hold because almost all of my clients at that office are currently being audited….One employee (shared) his submissions were declined for massage and chiropractic at another office… The employees are very frustrated right now, (they experience) crazy deadlines, work overtime constantly and sit at computer 8-12 hours per day… They all need treatment just to maintain work productivity.” –  H.C., RMT.

This RMT went on further to say the company’s human resource manager is having difficulty getting her calls to the insurance claims adjudicator returned.  How have we allowed insurance companies to demand premiums up front, then arbitrarily decide to pay claims or not?  What other product or service can you purchase that you’re not guaranteed to receive the benefit of that product/service?  What are corporations, businesses, employees and consumers not shouting loudly against such practices?

I’ve written previously on initial steps the insurance industry has taken to preclude massage therapy claims http://www.massagetherapycanada.com/content/view/2061/, on the reports of massage therapy claim fraud http://www.massagetherapycanada.com/content/view/1706/ and how I suggest the insurance industry’s practices are intentional and deplorable http://massagetherapistpractice.com/insurance-claim-manipulation-a-problem-more-insidious-than-fraud/.  You may also appreciate my particularly frank criticism of the insurance industry’s practices http://massagetherapistpractice.com/dear-insurance-industry-you-suck/

No question, the massage therapy profession contributes to the problem.  We lack treatment guidelines and evidence-based practice showing efficacy and effectiveness in treating a variety of common problems experienced by workers.  We’re small and disorganized, lacking a consistent public and media relations platform to spread news of the benefits of massage therapy.  We need to correct these things, and to create solid relationships with the insurance industry so employers and their workers can receive the health benefits they’ve paid for.

There’s no question that the insidious attempts by the insurance industry to deny claims and exclude massage therapy service coverage is one of the most serious threats facing the massage therapy profession today.

I encourage you to get on the phone, right now, with the executive director or president of your massage therapy professional association.  Tell them you’re very concerned about this problem and ask them what concrete steps they are taking to meet this challenge.

Insurers cite rampant insurance fraud and declare escalated costs due to over-billing providers and pain-focused, manipulative claimants.  I don’t doubt unscrupulous providers or claimants are a problem, yet I wonder if the practices of insurance companies themselves are contributing to a larger concern…one that threatens the very integrity of care where a third party pays for therapy.

In a recent discussion on social media, I shared how an insurance adjuster and I engaged in a very congenial conversation “across the fence”.  The adjuster asked why – despite the Financial Service Commission of Ontario (FSCO) Professional Services Guideline (PSG) “maximum hourly rates”http://www.fsco.gov.on.ca/en/auto/autobulletins/2012/Documents/a-03-12-1.pdf  – would I submit an invoice for my regular fee.  She was genuinely concerned that the claimant would bare the difference and couldn’t understand why I wouldn’t work at 2/3 my standard fee.  “Doesn’t your regulatory body mandate this?  Don’t RMTs know the fee schedule?” she inquired.

I maintained a friendly discussion, sharing my experiences both representing the professional association at insurance negotiations, providing assessment in Designated Assessment Centres (DACs), and as a practitioner working with auto-insurance claims for many years.  I didn’t ask, but perhaps I should have, “If you showed up tomorrow and your employer expected you to do the same work at 2/3 pay, would you?”  This is the essential point that the Financial Services Commission in apparent collusion with the insurance industry during the 2010 changes to auto-insurance in Ontario seemed to miss…practitioners set fees based on market forces and in consideration of operating costs and profit/loss parameters.  An imposed, arbitrary fee schedule doesn’t eliminate these considerations, and in fact only spurs providers to game the system and look for other ways to make ends meet.

It appears that “maximum hourly rate” has been translated by the insurance industry and their government cohort to mean “the practitioner should not bill more”.  I’ve been privy to RMT discussions where insurance adjusters in fact chastised the RMT for billing their standard rate, discouraged the claimant for paying a co-payment, and complained to the RMT for even considering such practices, suggesting they were in some way unethical.  Insurance industry pundits appear not to account for the practitioner’s operating costs or break-even point…although the insurance industry’s posted record-breaking profits seem to indicate they are well aware of their own.

Further, the PSG states, above the section re: Maximum Hourly Rates that “Insurers are not prohibited from paying above any maximum amount or hourly rate established in the Guideline.”  So how is the practitioner acting unethically in billing their standard fee if the insurance company has within its ability to pay it?

A shout-out to the insurance adjusters out there – providers working in this insurance system risk having claims denied, have to prepare extra paper work and wait 30 days or more for payment, while in the non-third party marketplace patients/clients are willing to pay full fees without risk or wait required of the provider.  The current system provides real dis-incentives for providers…don’t be surprised if you don’t get the behavior you had hoped for.

WSIB (Worker’s Safety and Insurance Board) holds even more uncertainty in my experience, and is even more closely tied with government operations.  In the last 3 work injury claims I’ve applied to WSIB for, all have been turned down flatly even though they were legitimate work injuries.  Reasons cited,  “The claimant took too long to file (3 weeks) so it can’t be work related” and “Well they’re already working with a physiotherapist so they don’t need massage.”  No exploration into my findings, no questions re: my clinical rationale…just a flat “no”.  http://www.wsib.on.ca/

Further, the WSIB has worked into policy that a provider cannot bill the patient the difference between what the WSIB pays and the provider’s regular fee schedule.  The provider if they accept the case must as well accept the loss.

Let’s turn for a minute to the real inequity auto insurance forces on employers paying for employee benefit plans.  Auto insurance regulation requires persons injured in an auto accident to supplement their care first through worker benefit plans.  This means those benefits are unavailable for the reminder of the benefit cycle for other work-related health concerns the employee may have.  Auto insurance premiums are paid by the claimant…why are employers implicated in paying the initial bill?  Why are employers not screaming?  I imagine every Chamber of Commerce, every small and mid-sized business, every corporation and all their employees would have something to say about this policy.

Provider professional associations play a role in advocating members’ interests to government, the insurance industry and gatekeeper health professions to ensure opportunity to bill for rehabilitation services.  Reimbursement despite legitimate claims is not automatic, and in some cases must be fought for.  The Canadian Massage Therapist Alliance http://www.crmta.ca/?page=10 has as a primary focus meeting with the “Canadian Life and Health Insurance Association, the Canadian Health Care and Anti-fraud Association and individual insurance companies on issues of mutual concern.”

Should RMT associations across Canada pool resources in support of the CMTA, work accomplished would be exponential.  Despite requests by members at every Annual General Meeting, the board of the Registered Massage Therapists of Ontario repeatedly decline the opportunity to be involved.

The insurance industry presents as a health care hegemony, maintaining in some cases untrusting and manipulative relationships with both providers and claimants, spinning fraud and abuse to an ill-informed public and media.  Claimants and employers pay insurance premiums dutifully and expect some compensation when calamity strikes.  A “Good Neighbour” the insurance industry is not.

What would be a better solution? i) Ensure an automatic level of compensation in both auto insurance and WSIB that can proceed immediately for the patient’s interest.  Auto insurance has the Minor Injury Guideline, which in many respects is a good model. ii) Allow claimants to pursue further funding through litigation against the offending party if their cases are complicated iii) Allow claimants access to the regulated health provider of their choice, limiting bottlenecks and power differentials currently employed in a gatekeeper-driven model iv) Ensure transparent accountability by insurance companies, providers and claimants v) Do not dictate fees, but require measured outcomes and intermittent reports to show progress.

A more radical approach is to employ health and insurance trusts where forced-spending on behalf of citizens towards their personal costs are then are directed by the claimant as they see fit.  No large, profit-centred insurance industry determining access to care, no claims denial or years of litigation and appeals trying to get fair treatment, and an information-savvy citizen putting their dollars where they are best invested.  What do you think?

The 2009 joint RMT strategic plan between Ontario’s RMT professional association, regulatory body and training colleges was launched 4 years ago with much fanfare.  Unfortunately the announced and much celebrated union seemed to fall apart soon after, with each organization pursuing its stated goals somewhat independently and without regular report.

Massage practitioners feel disappointment over this failed attempt most acutely these days, given the economic climate and threats to RMT practice viability I’ve written of previously.  This last four years were a real opportunity to pool resources, collaborate and get some real work done and the opportunity has been squandered.

The strategic plan announced a lofty vision, but I think it’s objectives were intangible and hard to measure.  “We’ll put an astronaut on the moon within a decade” Kennedy said, and every American could focus on that goal.  The 2009 RMT Strategic Plan for Ontario was less tangible, and perhaps that was one factor in its failure.  The other – a seeming disinterest by the decision-makers and stakeholders in collaborating in the trenches together to get this very important work done.

I suggest an alternative plan – tangible, clearly defined, and doable within the realistic confines our profession faces in this economy and as a health care service.  The outcomes can be clearly measured, and collaboration amongst stakeholders/decision-makers is essential to execution of the plan.  From my recent article in Massage Therapy Canada:

Cultivate thought-leaders
I think we should focus on bringing our brightest together in a physical or virtual symposium to discuss the key issues: finding viable business models, determining how to support RMTs-turned-business owners; learning how to manage multiple identities/market sectors served; ensuring the quality of training colleges, accreditation and interjurisdictional competencies; mitigating incredulity with government, insurance industry, gatekeeper disciplines and pubic/media; and advancing regulation and research. The objective of this think-tank: put forth tangible solutions to address core profession issues head on.

Involve all stakeholders
Once initial recommendations are formed, we would share the findings with massage practitioners across the country for their reflection, input and to enrich the plausible solutions put forth. Educators and training school administrators, regulators, researchers, suppliers, publishers and employers would all be invited to help us shape our direction.

Get to know ourselves
We need to poll practitioners across the country on key benchmarks – net income levels, work capacity compared to actual workload, type of practice/market sector served, age, gender, rural or urban, perceived obstacles to work (physical, business or manual/technical expertise, resources), years of practice and employment status – employee, self-employed or business owner of group practice. We will need a lot more information regarding the health and demo/psychographics of our practitioners if we are to support them in building practices.

Ensure resources for professional associations
In order to function at optimal levels, our associations need to hire great support staff and ensure sustainable funding for operations. Associations can pool resources and leverage power to obtain preferred pricing for member services/products, launch a national public/media relations campaign, offer excellent professional development programs, support research, exert political influence on government health-care and taxation policy, improve insurance industry and gatekeeper health practitioner relations while dealing with exploiters and profiteers, and continue to poll members as to viewpoints, professional practice benchmarks and emerging expertise.

Collaborate
RMT association representatives would identify shared resources, craft strategic plans and take initial steps to actualize the objectives in tandem. Inherent in carrying out the strategic plan is the convention that common operations can be better served through national collaboration rather than reinvent-the-wheel, “made-in-so-and-so” policies.

Raise the bar on education
We need to support training college accreditation, compliance with inter-jurisdictional competencies and health-care regulation and support evidence-based practice. Admittedly, we need to dovetail these objectives while acknowledging the diversity of practice and holism of philosophy that constitute massage therapy’s identity. We are not physiotherapists or chiropractors . . . our rich, interwoven, multifaceted history requires a different future than other professions.

Provide a hand-up to practitioners
We should continue to strengthen RMT practice with mentoring, semi-annual virtual symposiums and community groups. RMT practice can be isolating – RMTs must get together more for dialogue and debate. The eventual and hoped for result . . . innovation and evolution.

Join forces
Eventually the organized and united massage therapy profession could consider partnering with major CAM professions and corresponding industries in fitness and wellness to exponentially increase marketplace presence and power. Common objectives include training and education, research and developing evidence-based practice, lobbying government and insurance industry for more favourable policies and compensation, and financing strong public and media relations. Combined efforts would help to position health and well-being as a societal ethos . . . something that is part of the culture and fabric of society.

What do you think about this strategic plan?  I would love to read your thoughts.

dqd

Dear colleagues,

I have submitted a letter to the Registered Massage Therapist Association of Ontario (RMTAO) requesting their urgent consideration of four initiatives I believe essential to the good health and future of the profession.  The board has received my letter and has promised a critical review in the upcoming early March meeting.

I wrote this letter because I, like you, rely on a strong professional association to advocate for massage therapist interests and provide essential services.  Although established for almost 22 years now, I still rely on the professional association to support me in providing my craft and earning my livelihood, and ensuring the same opportunity for the practitioners that follow.

I believe in this economic climate and its associated challenges that bold moves are necessary.  Our profession simply isn’t keeping up with the rapid changes happening in and to our industry, and I’m calling on our elected board of directors to consider strong and clear action in four areas.

For my arguments to carry weight, the board needs to hear from many RMTs, both from within Ontario and broad, as to how important these initiatives are for massage therapists everywhere.  Please consider sending your support in an email to info@rmtao.com, or if you’re an RMTAO member you can find the RMTAO officers at https://secure.rmtao.com/connect/with_rmtao/connect_with_rmtao.htm

Your practice, your profession, your livelihood.  Please send a positive, affirming message today.

Here are my recommendations:

i) Better Use of Knowledge-Capital:   We have articulate, brilliant thought-leaders in this profession with foresight and hindsight…and we’re squandering their gifts.  We have entry-level practitioners with energy and new ideas, and we’re not channeling their enthusiasm effectively.  Our profession faces serious threats and it needs to create organized opportunities for exchange.

Along with the down-turn in Ontario’s economy, massage therapist practice is ravaged many threats to viability, including unfavourable government health care and taxation policy, insurance claim denial and reimbursement issues, territorial gatekeeper health disciplines (and their ambitious assistants) and profiteers and exploiters who would cash in on the popularity and funding (via workplace benefit plans).

We read in social media RMTs are finding it harder to access and service claims in auto-insurance and WSIB.  RMTs are experiencing more claim denials and resistance from gatekeeper health professionals asked to authorize treatment plans.  Insurance fraud and a paucity of credible research leads to skepticism from insurance adjudicators.  These threats are emerging, insidious and imminent and a profession-wide discussion and response is long past due.

We need to tap into our profession’s thought-leaders and employ them in think-tanks in addressing the core issues.  We need town-hall meetings, virtual symposiums and social media to hear from open-eyed front-line RMTs in daily practice as to their experiences and struggles.  We need to engender two way communication, dialogue, debate and ultimately action towards looming threats and plausible opportunities.

ii) Collaborate with RMT Associations (and eventually) Kinship CAM Professions – the Canadian Massage Therapist Alliance has as its mandate to foster research, build relations with insurers and support regulation in the Canadian massage therapy profession.  Its membership includes 7 provinces and 1 territory.  The province with the largest RMT representation – Ontario – is not a member.  With a national body, resources could be pooled in public and media relations, preferred pricing in products and services for members, education and training, advocacy to government, insurers and gatekeeper health disciplines.

Further, we can consider building formal relations with kinship CAM (Complementary and Alternative Medicine) professions chiropractic, naturopathy, and acupuncture/ traditional Chinese medicine – all pursuing similar objectives in education and training, public and media relations, favorable government policy and fair insurance claim reimbursement.  Collaboration could achieve far more than the current modus operandi of acting unilaterally, and should be considered a primary objective in the RMTAO’s strategic plan.

iii) Make Operations Sustainable – The decision some years ago to lower RMTAO membership rates to attract members gained a marginal increase in membership but left the organization with a short-fall of resources (deficits in 2010/2011). [1]  With scant resources, the RMTAO can employ only three staff members, while the board is over-weighted at 14 volunteers.  Compare this to the Massage Therapist Association of British Columbia (MTABC) who, with a smaller number of RMTs to draw from, posted generous income over expenses[2], twice the operating budget of the RMTAO, and maintain a staff of nine.

Remarkably, the MTABC retains 80% of all BC RMTs as members (RMTAO’s retains 41% of all RMTs in Ontario) despite the fact the MTABC membership fee is four times more.  I propose the operations model is not sustainable, and the association in unable to serve the needs and expectations of its membership.  I suggest tripling the membership fee for the 2013 year to bring in needed resources, reduce the board to 6 members for faster decision making, and increase the staff to six to better implement board directives.

iv)  Collect, Collate and Share Professional Data– RMTs have minimal information about the profession to make business decisions or measure efforts against benchmarks.  The RMTAO can poll members annually and collect information such as:

• age, gender, location, years in practice
• sector served (spa, rehab, CAM, workplace wellness)
• estimated work capacity/week, and average workload/week
• annual net income (line 236 of tax return, after business expenses but before personal income taxes deducted)
• other sources of income earned a) within RMT profession b) in a non-related field
• employment status:  employer/business owner or employee/contractor RMT
• qualitative Qx: a) Do you enjoy your work? b) Have you any health effects from work? c) Do your earnings provide for you, or do you need more than your current income for basics? d) What are the core problems/issues facing the RMT profession?
• read annual report RMTAO Y N?  CMTO Y N?

This information can be captured, collated and then shared to help RMTs make better business decisions and provide essential information for prospective RMT students or those close to graduation.  Better yet, the RMTAO can join with the regulatory body (CMTO) to collect essential information across a broad scope of the profession.  This service alone would be a clear advantage of RMTAO membership.

Thank you for your time and careful consideration.

Don Dillon, RMT

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.