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News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
February, 2001, Vol. 01, Issue 02
Massage and Medicine?
By Cliff Korn, BS, LMT, NCTMB
I hope everyone found last month's issue of Massage Today informative and stimulating. Our profession is really coming into its own. In one of my volunteer roles, I recently had an opportunity to attend the International Spa Association Conference in Las Vegas.I was surprised to see that one of the "up and comers" in the spa world is the medical spa! Speaker Dr. Andrew Weil speculated that it was only a matter of time before there would be insurance coverage for spa services. He felt that the spas of tomorrow would be filling the void from all the small community hospitals that are now going bankrupt.
I'm wondering what all of you massage therapists employed in the spa industry think? Do you see a need for the medical spa? How about all of you therapists who work in a clinical setting now? Would you feel threatened by an expansion of medical spas?
These questions bring up another thought on massage and medicine. I see more and more attention being paid to the advent of insurance companies and third-party "middleman" companies establishing networks of massage therapists into "affinity" groups. They are calling these networks "approved providers" or other such terms which indicate to target markets that therapists within the particular network are credentialed to a standard, or have otherwise passed a vetting process, to provide superior care to a consumer.
One of Massage Today's columnists writes a monthly column on working within the insurance/managed care world. Another has written on the perils of becoming involved in that world. I am grateful that they both are contributing to this publication, as it clearly demonstrates several divergent choices we can make within the touch therapy field.
In this article, I'd like to explore further the role of these networks in our future. The networks are developed for two types of programs: benefit and access. Benefit programs are the traditional health coverage plans that provide specific benefits to subscribers. They include types of conditions covered, copayment criteria, number of treatments allowed per year, etc. These programs usually require providers working within the plan to obtain prior treatment authorization, and to agree not to charge their clients more than a predetermined copayment or deductible. Therapists working under a benefit plan are paid according to an agreed-upon "fee schedule." The number of benefit plans including massage therapy is negligible.
Access programs are not designed to pay for covered benefits. Consumer subscribers can be treated for any condition (or no condition at all) and pay out-of-pocket for the bodywork sessions. Prior authorization is not likely to be required. Therapists working under an access plan are paid by the client at a rate that is discounted from the rate charged for non-subscribers. Access plans are growing at a steady rate. Some would say they are growing at an alarming rate!
The rest of my examination of this phenomenon will consider the access plans only. The benefit plans have not yet reached enough critical mass within the massage field to warrant more than theoretical discussion; and in fairness, if they are going to pay for a service, they have a right to determine what it is that they are willing to pay for. I hope to look at the access plans based upon the credentialing process used to select therapists to populate their provider networks; the fairness to massage therapists and bodyworkers (the approved providers); and the integrity/honesty used to market their services.
I begin by suggesting that the very fact that this discussion needs to take place at all is good for our profession. It means that we have obtained enough economic "critical mass" to catch the interest of outsiders as a potential for enhancing their profitability. The determination still has to be made, however, as to whether or not this enhances the profitibility of the massage and bodywork profession.
Credentials: The word brings mixed reactions from practitioners. Some regard credentials as professional collector's items the more obtained, the better while others see them as an excuse by others to overstate dubious qualifications by virtue of a framed wall decoration. All of the access programs I have seen populate their networks by a selection process. One, in its brochure to massage therapists, states: "We are committed to educating the managed care industry on the value of massage therapy and assisting managed care companies and employers in offering high-quality massage therapy networks."
To me, that statement means that the selected participants are credentialed to a standard, so that the standard measures equal "high-quality" in differing geographical areas. The selection process of some involves a site visit from a review committee. Most involve a questionnaire outlining training and specialization. All want to know that a prospective provider is practicing legally within a jurisdiction. None (that I have seen) are very forthright with the actual "checklist" used in their selection criteria. The assumption I am left to make is that inclusion in a particular plan's network, in and of itself, is to be considered a credential.
Fairness. A fairly common theme among massage therapists is that they enjoy a fair amount of autonomy in their practice. Many enjoy working for themselves setting their own rules, prices, and hours, and establishing who they will take as clients and how they will interact with them in a session. A common thread in the arguments I hear against massage regulation and/or national certification is that an outside party is pushing an agenda or establishing its definitions and procedures in the practitioners' business. From my viewpoint, this argument holds for access plans in spades! One marketing brochure lists as a reason for a massage therapist to join: "Reasonable fee schedules for participating massage therapists." I ask, reasonable to whom?
This same plan caps fees that participating therapists can charge at $45. I see massage fees across the country ranging from $30.00 to $120.00. Is a cap of $45.00 reasonable? Certainly not to many. Another clause in the services agreement of an access plan company states, "Participating Massage Therapist shall provide an appointment for a Participant within seven (7) days of receiving a request for appointment." Now I don't know how busy your practice is, but a new client in mine will routinely have to wait three to four weeks for an appointment. If they need a late afternoon timeslot, they'll wait longer than that. Is it fair that I should have to see more clients per day than my (old!) body can comfortably handle to meet the contractual requirements of an access plan? Is it fair that I should not see full paying, private-pay clients so that I can meet disounted-rate clients on a short notice?
Another clause of the same agreement states, "Participating Massage Therapist agrees to furnish Access Services to Participants of any Payor upon request, . . ." Is it fair that this would likely preclude a practitioner specializing in maternity massage or battered women massage or gender specific massage from client determination?
Integrity/Honesty. Finally, I question the marketing tactics of the network-building firms. One touts: No fees to participate - No application fee - No membership fee - No recredentialing fee - No provider education fee - No onsite office evaluation fee. Why, I ask, should anyone charge a fee when they are requiring me to heavily discount my charges? They further say, "Access programs encourage members to utilize participating massage therapists. Member pays massage therapist directly. Massage therapist offers modest discount (25% off retail charges)." Really, this was in their marketing brochure! In most professions a 3% income increase is considered modest. Why is it that a 25% decrease in income should be considered "modest" to massage therapists?
OK, so my biases have been showing! The fact is that these programs aren't going away anytime soon. The names associated with plans like this are Blue Cross, Kaiser Permanente, Prudential, Aetna, CIGNA, Zurich, etc. Certainly individual therapists and the professional associations can, and should, educate those establishing networks in the issues that support growth of massage therapy. I think a colleague of mine put it best when he said:
"From what I've seen, we can only beat them, join them or ignore them. I don't think ignoring them is what we want to do, and I do not know how to beat them. My conclusions are simplistic, but how much energy should we invest in fighting this trend? I don't think we can stop them from going forward with this service, so maybe we can ride along with them and influence their standards."
So what do you think?
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be published in a future issue of Massage Today. Please send all correspondence by e-mail to
, or by regular mail to the address listed below:
Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.
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