resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Make Every Day Mother's Day
May is a special month for many reasons. After a long, harsh winter, spring is at last in full swing. Memorial Day helps us honor those who have fought and fallen in the name of freedom.
If Your Pro-Chiropractic Governor Resigned, Would You Be Prepared?
John Kitzhaber, MD, recently re-elected to a historic fourth term as Oregon governor, has resigned among alleged ethics violations by his fiancée' and first lady, Cylvia Hayes. I developed a personal friendship with John and consider him a good friend.
Talking to Patients About Medial Branch Neurotomy (Part 2)
Even when lumbar facet denervation (medial branch neurotomy) is successful, relief is rarely complete or permanent. Smuck, et al., reviewed 16 articles and found the average duration of >50 percent pain relief for an initial procedure was nine months.
Functional Impingement of the Hip (Part 2): Rehab Exercises
I find functionally impinged hips that don't move properly on so many of my patients. (See part 1 of this article for a description of the condition.)
Trouble in the Wellness Waters?
Call me old-fashioned, paranoid or just old, but I do remember graduating from chiropractic college in the late '70s in the midst of the Wilk v AMA lawsuit.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Apple Takes a Bite Out of Research
The more than 700 million iPhone users have just been given the opportunity to "do their part to advance medical research."
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
News in Brief
Dr. Frank Nicchi Receives Award at ACC-RAC; Sherman College Expands International Influence.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Applauding a Legacy of Leadership
Founding Palmer West President, John Miller, DC, HCD (Hon.), FICA (Hon.), a 1954 graduate of Palmer College of Chiropractic, passed away March 8, 2015 at age 83.
Teach Your Patients About External Healing Applications
Since the skin is the body's largest organ, and is able to respond to both internal and external stimulations, communicate sensations to the brain, protect the body, breathe and even excrete toxins, it can be an excellent source of healing.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
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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