resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
January, 2006, Vol. 06, Issue 01
"Incident To" Issues
By Cliff Korn, BS, LMT, NCTMB
Are we professional, or not? Should those who choose to practice under the term "massage therapist" have the option of being considered a health care provider? Are we part of a "profession" that can benefit or be harmed by the actions of outside organizations/professions? Can, or should, we politicize the work we do by letting regulators know our opinions?
Your answers to these questions likely will determine your comfort level with this monthly editorial.For the record, I answer all of them affirmatively. I'm hoping enough of you do, too, and will let your feelings be known about something that has insidious downside implications for segments of our profession.
I am speaking about the ruling the Centers for Medicare and Medicaid Services (CMS) issued to prohibit Medicare reimbursement for therapy services provided "incident to" a physician's office visit. As of July 25, Medicare will pay physicians for physical, occupational and speech pathology therapy performed in their office as an incident to service only if it's done by a licensed therapist (or an assistant therapist supervised by a licensed therapist). When CMS uses the term "therapist," they now mean only physical therapists, occupational therapists or speech and language/hearing pathologists. Previously, Medicare paid physicians for incident to therapy services even when other providers, such as massage therapists, athletic trainers or physical therapy aides, performed it. However, Medicare no longer considers physician supervision of these auxiliary providers to be sufficient. Under the new rule, physicians are not permitted to bill Medicare for therapy services performed by athletic trainers, kinesiologists, therapy aides, therapist assistants, massage therapists, or any other non-therapist professionals.
It appears to me that we, and many other professions, were out-lobbied by other groups. The December 2004 issue of PT Magazine had an article entitled, "Physical Therapists Win Change in Medicare 'Incident To' Rules." The PTs of the world seem happy with the law changes. It seems like such a simple thing on the surface - a ruling that says physical therapy must be performed by a physical therapist. That makes sense, doesn't it? I think massage therapy should be performed by a massage therapist, too! As they say, though, the devil is in the details, and the definition of what constitutes "incident to" therapy adversely affects many massage therapists. As you well know, there is a significant difference between the performance of "physical therapy" and the delivery of "physical medicine."
This issue has been on the radar screen for several years, but the "blip" was not a bright one because CMS was reporting that the proposed changes merely were a clarification of existing CMS policy, and it was required by a 1997 statute. A quick Web search brings much information suggesting this hardly was accurate. My own reading indicates a significant change in policy, as opposed to just a clarification.
Massage Today columnist Vivian Madison-Mahoney writes, "I attended the recent press event in Washington, D.C., where Coalition members spoke out and expressed their concerns on how the recent Medicare ruling has affected them. This ruling limits only PTs, OTs and SLPs to provide therapy to physician patients where Medicare is reimbursing for the treatment." She goes on to state, "Doctors everywhere are feeling the sting of this ruling in that they are not allowed to decide what treatment, and who is best to provide it, for their patients. Therapists and other qualified providers who have been allowed to provide treatment 'incident to' physician's services for the past seven years are now out of work across the nation due to this ruling.This includes nearly 1,200 lymphedema therapists who are mainly massage therapists, in addition to thousands of other qualified providers and massage therapists who treat other conditions for the Medicare patient such as musculoskeletal conditions."
So, how did this ruling occur? Was there a great expression of concern from physicians and patients? Apparently not, since many physician groups, including the American Medical Association, joined a coalition to try to stop the ruling! The AMA formally stated, "The AMA urges CMS to withdraw its proposed changes for incident to physical therapy services and re-issue a new proposal in a later proposed rule after consulting with all affected physician and other health professional organizations"
The National Athletic Trainers Association went so far as to file suit to stop the proposed change, but their suit was set aside. There are some 23 different professional groups who have formed The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services (www.coalitiontopreservepatientaccess.org/).
My concern, and the primary reason I am bringing this to your attention, is not because so many massage therapists get reimbursed by Medicare; they don't. I find this issue important because so much of what happens with Medicare filters down to the private segment. I am very concerned that the commercial insurance carriers will find this an attractive way to limit payment for currently covered services. This increases profits for the three select therapy groups, as well as the insurance carriers, to the detriment of the public and all other care groups who otherwise are qualified to perform the services. It also undermines the patient/physician contract, as neither will be able to choose the best provider for a specific service. Make this a personal issue - see yourself, a parent or another loved one as a Medicare recipient in need of postsurgical lymphedema treatment. Now, decide if you'd rather have the treatment performed by any PT (because it could be reimbursed), or by a massage therapist specifically trained in lymphatic drainage. Medicare patients who seek "therapy-incident to" services from anyone other than a physical therapist, occupational therapist or speech/language pathologist might be denied coverage.
I strongly urge you to visit the Web site listed above and read the links listed under "Coalition Information." Then contact your professional associations to see what they are doing about this. Follow up by getting involved personally, and make calls to your congressional offices and let them know what actions you'd like taken. It's my opinion that CMS should revise its current ill-conceived "incident to" policy and revert to the one that since 2001 has stated that "any individual" can provide therapy services. What do you think?
Thanks for listening!
Massage Today encourages letters to the editor to discuss matters related to the publication's content. Letters may be published in a future issue or online. Please send all correspondence by e-mail to , or by regular mail to:
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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