resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
August, 2005, Vol. 05, Issue 08
Medical Massage: Facts, Fiction and Frustration
By Rebecca J. Razo
The questions surrounding medical massage have plagued the profession for years, and yet clear-cut answers remain elusive: What exactly is medical massage? Who can practice it? What constitutes a medical massage therapist? The list goes on and on.
Next to regulation and national certification, medical massage could very well be the third most divisive issue in the profession. Although the medical massage controversy has been bubbling below the surface for years, it wasn't until recently that the lid was blown off the proverbial medical massage pot, and what's been simmering below is not pleasant: hostility, frustration, misunderstandings and misinformation have all contributed to the increasing dissent and fragmentation over an issue in desperate need of attention, direction, definition, and, most of all, unification.
First Things First: What Happened in Pennsylvania?
The most recent controversy surrounding medical massage began when the Business League for Massage Therapy and Bodywork (BLMTB), a Montana-based advocacy group, called attention to a Pennsylvania class-action lawsuit that it believed could irreparably harm the practice of massage therapy nationwide.
In Oct. 2004, Pennsylvania massage therapist Tracey Roberts, who is also the state chapter president of the United States Medical Massage Association (USMMA), filed a class-action lawsuit against State Farm Automobile Insurance for denying payment under Current Procedural Terminology (CPT) Code 97140 (manual therapy techniques) for massage services rendered. The suit alleges that the plaintiffs "were denied [payment] solely because they were not licensed physical therapists."1 At press time, the case was in the process of being settled in favor of the plaintiffs, and a Declaration and Settlement Agreement had been written in which both sides agreed to the following terms: "It is hereby ORDERED, ADJUDGED and DECREED that State Farm Mutual Automobile Insurance Company ("State Farm") may not, as a policy, practice, and procedure, deny bills submitted under the CPT Code 97140 solely on the basis that they are being submitted by a medical massage therapist and not by a licensed physical therapist."1 Under the terms of the agreement, "defendant State Farm has agreed to reconsider any denials of CPT Code 97140 for the four (4) years prior to Oct. 13, 2004, which denials occurred solely on the basis that the massage therapist was not a physical therapist."1
The BLMTB called attention to this suit when it discovered that David Luther, founder and president of the USMMA, issued a statement in USMMA's online Spring 2005 newsletter indicating that USMMA filed the lawsuit and that Luther was working with the attorney to define the term "medical massage therapist":
Luther also owns the Medical Massage National Certification Board (MMNCB), which offers the Medical Massage National Certification Examination (MMNCE), and The Medical Massage Office (TMMO), a company offering medical massage training and seminars. (At press time, Luther was in the process of selling TMMO.)
Fearing that Luther was attempting to define and monopolize the term "medical massage therapist," the BLMTB wrote an open letter to warn the massage profession about the potential implications of the lawsuit and David Luther's involvement: "This move to 'legitimize' the [MMNCE] without a) the suitable infrastructure (lacking credentialing of the NCCA/NOCA or like agency and lacking sufficient numbers of credentialed therapists), b) clear conflict of interest...and c) without discussion among the various stakeholders is detrimental to the entire profession."3 Additionally, the BLMTB wrote a letter to Mark Bernstein, the judge presiding over the case, in an attempt to persuade him to change the term "medical massage therapist" to "massage therapist" in the settlement agreement, and to advise him that the profession as a whole has not categorically defined the term medical massage.4
In the days following this initial flurry of activity, the USMMA removed the paragraphs referencing the lawsuit from its site at the request of the plaintiff's attorney, Dan Levin.5,6 And in a telephone interview with Massage Today (MT), Levin disclosed that Luther's online statements slightly mischaracterized the USMMA's role in the suit, including the fact that the USMMA filed the lawsuit; according to Levin, USMMA was never technically listed as a plaintiff. Levin was quick to add that he doesn't believe Luther's statements were made to intentionally mislead the profession, and further noted that Luther was indeed one of several people consulted about the case and had a hand in constructing some of the language contained in the Settlement Agreement.5-6
Levin also emphasized that the case was never about defining terms. "The settlement does not define what a medical massage therapist is," he said. "The purpose of the settlement is [so] that State Farm Insurance will not deny providers who submit a bill because they are massage therapists and not physical therapists." Levin also said that the case does not define what constitutes medical massage therapy, noting that it would "not [be] appropriate...we'd be legislating then, exposing massage therapists to more problems."6
But the BLMTB, unconvinced that the settlement language is without consequence to the massage profession, reaffirmed its position in a second letter to Judge Bernstein:
At press time, the term had not been changed.
The BLMTB further believes that the suit has the potential to cause problems down the road for all massage therapists who want to bill insurance. "The language [could allow] the insurance company to downcode anyone who is not a 'medical massage therapist' and since there is no standard as to who or what one is, the insurance company is well within its rights to downcode because the practitioner can't prove they are a 'medical massage therapist.'"7
And what about David Luther's attempts to define a medical massage therapist as one who has passed the MMNCE, which is administered by the organization he owns? To Luther, the answer is simple. In an interview with MT, Luther spoke candidly about his reasons for wanting to see massage therapists certified as medical massage therapists before they are allowed to bill insurance, and why passing the MMNCE should be a requirement. "Patients deserve to know they are going to a competent massage therapist," he said. "Doctors deserve to know that they are referring to a competent massage therapist; insurance companies should know they're paying for [a] curative cause; and massage therapists deserve the distinction and recognition if they've worked to become medical massage therapists.5
"Look at Whitney Lowe, Erik Dalton, Judith Walker DeLany, James Waslaski, Aaron Mattes, and Paul St. John," he continued, "and tell me [why] it's fair to have the same recognition for all massage therapists, especially those with no schooling, only home study schooling, or just 100 hours of schooling. Many [massage therapists] are wonderful massage therapists, but many of them have no business practicing medical massage or billing insurance."5 In short, Luther believes that patients are acting on the assumption that a massage therapist who can bill medical insurance also understands medical conditions. In his opinion, a true medical massage therapist is one who can "validate a pathology. Unfortunately, massage therapists get so little of that in school."5
And why limit the practice of medical massage to those who have passed the MMNCE? Because, according to Luther, it is currently the only national medical massage exam undergoing the NCCA/NOCA (National Commission for Certifying Agencies/National Organization for Competency Assurance) certification process, which would make the MMNCB "the only national certifying entity for medical massage to be nationally credentialed." The exam "tests for knowledge that a massage therapist should [know] before giving an aggressive treatment on a patient" he said.5
When it comes to insurance billing and massage therapy, however, Vivian Madison-Mahoney, Florida State Massage Therapy Association (FSMTA) Insurance Committee Chair and a pioneer in the field of massage therapy and insurance reimbursement, vehemently disagrees with David Luther. In Madison-Mahoney's view, all massage therapy services are deserving of insurance reimbursement and could be considered medical massage when prescribed by treating physicians for a medically necessary condition. "Some state laws recognize massage therapy as therapeutic," she says. "If massage is therapeutic, then therapeutic is medically necessary. The doctor prescribes massage therapy services for a specific diagnosis because he/she knows the patient's medical needs. The doctor prescribing massage services understands that massage is medically necessary; therefore, a massage therapist should be reimbursed by insurance for the treatment."8
And Patricia Cadolino, president of the New York State Society of Medical Massage Therapists and facilitator of the Nurturing Touch massage program in the neonatal intensive care unit for the last seven years at Stony Brook University Hospital in New York, notes that if massage therapists were required to take the MMNCE in order to practice medical massage therapy, she'd be out of a job. "I think as massage therapists, we need to keep in mind our scope of practice, stick to the universal precautions and contraindications when massaging clients, whether it be in a spa, private practice or hospital setting. Remember, we are not allowed to treat or diagnose clients.9
"I do, however, agree with setting higher standards in education," Cadolino continued. "But I feel that it would hurt our profession to set such a drastic precedent telling insurance companies only to accept claims from medically certified therapists."
How does Madison-Mahoney respond to Luther's assertion that patients expect that massage therapists who can bill medical insurance are also competent to adequately perform massage? "It's like 'let the buyer beware,'" she said. "Not all massage therapists are going to be effective for a specific condition just like not all doctors or physical therapists are going to be effective for that patient, but they can still bill insurance. Insurance companies will not reimburse anyone if the patient does not continue to show signs of improvement. I've had massage therapists straight out of school who have had more repeat clients/patients than some of those who have had more extensive training," she continued. "All massage therapy is therapeutic, and a relaxing massage can be medically beneficial."8
While Vivian does not believe that one must be a "certified medical massage therapist" to perform massage therapy or bill insurance, she does endorse continuing education and advanced training. "I agree that training is important, absolutely. The more training one has, the more the [massage therapist's] subconscious has to work with to provide effective treatment to the patient." She believes simply that "a massage becomes a 'medical massage' when performed via a prescription written by a treating physician for a diagnosed medical condition."8
The Elusive Definition of Medical Massage
For years, a number of well-known massage therapists have utilized the term medical massage therapy in practice and in continuing education seminars. And some therapists, who may or may not call themselves medical massage therapists, are indeed practicing massage in hospitals and medical offices. Yet, there still has not been an industry-wide consensus on what exactly constitutes medical massage therapy.
According to Medical Massage Practitioners of America (MMPA), an organization that offers medical massage educational seminars, medical massage is "result-oriented, and the treatment is specifically directed to resolve conditions that have been diagnosed and prescribed by a physician. The therapist may use a variety of modalities or procedures during the treatment, but will focus that treatment only on the areas of the body related to the diagnosis and prescription." The MMPA further believes that "all forms of massage therapy can be therapeutic when applied by a skillful and knowledgeable therapist; therefore, medical massage is not limited to any particular specific technique."10
According to the American Medical Massage Association (AMMA), "medical massage should be defined by the application of science and research to manual medicine, and not by popular opinion, or franchised methods of massage."11 Included in the AMMA's definition of medical massage for its members are several key points, including that "medical massage is a system of patient care and treatment that is based on the medical model," and "the medical massage therapist will treat specific connective tissue problems with techniques and protocols directed at achieving a measurable clinical response in the patient, and in achieving patient care objectives."12
Still, despite these definitions, the American Massage Therapy Association recently issued a press release titled, "Profession Has Yet to Define Medical Massage Says AMTA," in which it stated the following position:
"The American Massage Therapy Association Board of Directors is writing to state boards regulating massage therapy advising them that the massage therapy profession has not yet agreed upon a definition of the term 'medical massage'...AMTA is currently gathering information from stakeholders both within and outside the massage therapy profession to inform the process of defining what could be called 'medical massage.' AMTA believes that it is premature, at this time, for any action to be taken regarding 'medical massage' until the profession has an inclusive discussion, leading to agreement on definitions and place in the spectrum of massage education and practice."13
And a recent letter from AMTA's general counsel to the plaintiff's attorney Dan Levin issued the following statement affirming the AMTA's position: "No state legislation has defined the term 'medical massage therapist,'...neither has the massage therapy profession agreed upon a definition of the term 'medical massage.' Therefore, it would be premature and improper to use this phrase in a settlement because of the potential restrictions that might result for massage therapists who have not chosen to designate themselves by a term with no accepted meaning."14
Clearly, the profession remains at odds when it comes to defining medical massage therapy. Only time will tell what is in store for the future of medical massage and whether the massage therapy community can come to the table with open minds and in the spirit of unity to determine what is best for the people that really matter: the patients.
Editor's note: Several articles and letters presenting a range of perspectives on medical massage appear in this month's issue.
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