resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
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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