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Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
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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