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.

I’m hearing rumblings from RMTs about requests to confirm patient/client visits, producing treatment plans for workplace benefit claims (previously unusual), and patients/clients who confirm their benefit plans are being scaled way back. Insurers are seeking to reduce fraud and protect employers from escalating costs, and these means more accountability on the part of providers…including massage therapists. What are the implications for RMTs who, according to the 2003 study commissioned by the College of Massage Therapists of Ontario, show 3/4 of patients/clients use workplace benefits to pay for care? According to Karla Thorpe, Associate Director of Compensation and Industrial Relations, employers are not eliminating plans but they are tightening up.

“If costs cannot be contained, the long-term sustainability of employer-sponsored benefit programs will be in jeopardy. So how are employers responding? Are they drastically cutting benefits? The short answer is no. Instead, organizations are focusing on doing a better job of communicating the value of benefits to employees and enhancing employees’ understanding of the cost implications of their behaviour—perhaps causing employees to think twice before changing their glasses’ frames or heading for a massage.”
http://www.conferenceboard.ca/insideedge/2010/april-2010/apr12-rising-benefit-costs.aspx

Always trying to stay ahead of the curve, I’m planning to write an update on RMTs’ reliance on workplace benefit plans and how recent shifts in consumer and insurer behaviour are affecting their businesses. What’s your experience? Is it getting harder for you to be compensated by third party payers? Please joint the discussion on Facebook https://www.facebook.com/#!/groups/8195862171/ or write to this blog. Thank you.

“A picture is worth a thousand words”.  I think it beneficial to size up the direct, external threats to massage therapist practice.  Perhaps this image will spawn a grassroots of support and democracy towards tangible solutions.

i) Government health care and taxation policy is unfavourable to massage therapists.  Despite regulation under the same act as physicians, nurses, physiotherapists and other disciplines, massage therapists are not covered under the provincial health care plan.  Worse, taxation on massage therapy care at 13% is onerous to patients and at competitive disadvantage with main competitors physiotherapists and chiropractors.

ii) Massage therapy care is currently covered – partially or fully – under many workplace benefit plans.  These plans were inacted post World War II where there was a surplus of work and limited supply of skilled workers.  The Baby Boomers saw huge increases in salaries and benefits, and have enjoyed unparalled wealth in North American history.  However, massive inflation met those salary increases and relocation into major cities with subsequent generations having far less discretionary income to work with.  We may expect a reduction in workplace benefits throughout a number of industries/sectors.

[A  surplus of educated and skilled workers = decline in company’s need to offer workplace benefits to retain workers].

According to some surveys, 75% of RMT patients/clients rely on workplace benefit plans to cover their care.  With a reduction or elimination of benefits, viability of RMT practice is in jeopardy.  Further, there appears arbitrary and sometimes adversarial access by RMTs to insurance compensation schemes for worker’s compensation and auto insurance claims.  Additionally troubling, massage insurance fraud is gaining more attention.  RMTs are looking for reliable funding but may find access to these sources tenuous.

iii) Gatekeeper health disciplines determine whether massage therapy treatment plans are approved or denied.  RMTs rely heavily on positive relationships with these gatekeepers.  However, RMTs are one of the few health care disciplines without a degree-level program and sufficient evidence-based practice/research.  As well, most RMT professional associations are under-resourced to properly position their members as health care providers.  Our profession lacks credibility as such with gatekeeper health disciplines.  To be recognized fully as a health profession, we’ve some decisions to make.

There is a move in health care to reduce reliance on well-paid physicians and nurses and shunt comparable work to physiotherapists, pharmacists and nurse practitioners.  These  latter three disciplines received increases in scope of practice in Ontario within the last two years.

In addition to accomodating the shift from high paid physicians and nurses to well-trained but lower paid health care disciplines, there is an additional shift to pass workload onto assistants – PT/OT assistants, pharmacy assistants and nursing assistants or personal support workers.  This further lessens the cost of delivering health care.

My question: will PT/OT assistants be taught basic massage technique to provide under the auspices of the physiotherapist, at a profit to the employer physiotherapist?  Would physiotherapists continue to refer to RMTs if they had lower-paid assistants in-house?  Would the public, funneled directly into physiotherapy care rather than less-resourced small massage therapy practices, be aware of the difference?  Time will tell, but the incentives are certainly there.

iv) Profiteers and exploiters – poor quality training facilities, discount packagers, non-regulated posers – take advantage of massage therapy’s popularity.  These malevolent benefactors directly impact RMT quality of care and reputation, RMT income levels and leveraging opportunities, insurance fraud and treatment plan denial rates, and public and media perception.  Disorganized and fragmented in resources and focus, the massage therapy profession is particularly vulnerable.

We’ve named the problem – who’s got a solution to put forth?

The great enemy of the truth is very often not the lie – deliberate, contrived and dishonest – but the myth – persistent, persuasive and unrealistic.
Belief in myth allows the comfort of opinion without the discomfort
of thought. ~ John F. Kennedy

As a profession, what myths are we entertaining?  Are we comforted in our opinions, while we avoid the discomfort of thoughtful reflection and constructive debate?

Timothy Ferriss said “Your success depends on the number of uncomfortable conversations you’re willing to have.”  I want to have an uncomfortable conversation with you, and with all RMTs.  I want to shake up professional complacency, antagonize arrogance and challenge RMTs to move off their spot and reposition bodywork and complementary/alternative medicine at large as an ethos…a value desired and cultivated in society.

Here are some myths that I challenge:

“We should be accepted by medical doctors and insurance adjusters as readily as physiotherapists and chiropractors.  We know more than they do!”

“My patients won’t pay for my assessment.  They just want to get on the table.”

“Professional associations charge too much/I don’t need to be a member.”

“I can do both spa and remedial massage in my practice.  The marketplace isn’t confused.”

“People may go to (unlicensed practitioners, regulated practitioners providing massage) but that’s not real massage and they won’t go back.”

“We can keep operating as we have always been (despite unfavourable government health care and taxation policy, problematic insurance compensation for services, gatekeeper health disciplines hiring assistants to compete with RMTs, negative public and media perception and exploiters/profiteers at the education or employment level) and there’s no reason to change.”

“Professional associations should keep their fees low, rely on volunteer board members to carry the load and avoid too much investment in public relations, building alliances or providing practice management services to their members.”

“I’m better off working for myself.  I earn more than if I worked in some established business.”

“My patients/clients expect me to provide 55 minutes of hands-on care each time.  I’m stuck with this model of service delivery.”

I’d love to know what you think.  Please post your myths or arguments.

How does the public and other health professionals see massage therapists?  How likely are they to trust RMTs with their care?  How likely are gatekeeper health professionals to refer?  Here I report on some of the survey’s findings, with take-away action steps at the end.

“As part of the strategic plan for the profession, the College of Massage Therapists of Ontario, the Heads of Massage Therapy Programs in Community Colleges, the Ontario Council of Private Massage Therapy Colleges, and the Registered Massage Therapists Association of Ontario initiated and completed a survey to understand the profession’s credibility. The purpose of the Credibility Survey was to establish an understanding of the creditability of the massage therapy profession from the perspective of the public and other health care professionals.”

Of the general population, 1122 people were surveyed, with another 417 health care professionals specifically.

RMTs received a 72% favourable response by the general population, and a solid 92% by physicians and nurses, with dentists close behind at 91%.  RMTs faired better credibly than chiropractors (65%) and kinesiologists (49%).  Eighty-three general public respondents feel RMTs are “very competent”, however only one in four health care professionals surveyed would advocate on behalf of RMTs.  Advocacy is defined in the survey as “the propensity to speak highly of a profession without being prompted.”

RMTs at 44% ranked behind physicians (55%) and physiotherapists (51%) by public respondents when asked who they would choose to treat a soft tissue, muscle or joint problem.

Two in five general public respondents have received massage therapy treatment in the past, and over half receive RMT care once/year or even less often.  Younger respondents and those with higher education are most likely to seek massage therapy care.

Main reasons for seeking massage therapy: back or neck pain, general muscle pain/tension, and because of a physician’s referral.  Public respondents are more likely to seek massage therapy care for injury and pain (78%) as opposed to maintain their health (22%).

Interestingly, when asked to choose between two opposing statements, general public respondents see massage therapy as “an extra” (67%) rather than “a necessity” (32%).  What’s more, they see massage therapy as “about fixing a problem” (65%) rather than “about prevention” (35%).  Perception was split down the middle between seeing a massage therapy session as “a medical visit” or “a spa visit”, and health professionals surveyed perceived the same.

Three out of four health care professional respondents would recommend massage therapy to patients with whom they interact.  An encouraging 84% of health professionals surveyed agree that massage therapists are important partners in health care, with 72% believing RMTs are a credible source of health information.

Of the health professionals surveyed, 40% have recommended massage therapy to a patient in the past.  Of those who have not, the main obstacle is not knowing enough about massage therapy (46%) or not considering massage therapy an effective treatment (32%).  Sixteen percent stated they did not know an RMT to recommend to.  Over half (60%) consider RMTs to be their peers, and 76% are very or somewhat likely to recommend massage therapy to their peers.

My take-aways from the survey:

i) Massage therapists are seen generally as favourable and credible
ii) The public uses massage therapy infrequently (once/year or less), and considers a physician or physiotherapist over massage therapist in seeking treatment for muscle and joint problems.
iii) Massage therapy is seen more often as an intervention to pain and adjunctive “extra” as opposed to a strategy for disease prevention and wellness “necessity”.
iv) Both the public and health care professionals view the dual identities of massage therapy equally as a rehabilitative/medical intervention, or a spa service.
iv) Perceptions by health care professionals are generally favourable although only one in four would advocate – ie: recommend without being prompted – for RMT care

Massage therapists and their advocates/associations can do more to extend positive public and media relations regarding massage therapists, and support research and evidence-based practice to enlarge perceived effectiveness of massage therapy care in a rehabilitative setting.

RMT 2010 Public and Health Professional Credibility Study    https://www.cmto.com/pdfs/CredibilitySurvey.pdf