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5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
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.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
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.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
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.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
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.
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.
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.
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.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
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.
June 14, 2004
Teaching Unethical Business Practices Must Stop
By Ed Denning, MEd, LMT
It is time to stop teaching unethical business practices to massage therapists. Those who teach the unethical business practices outlined below do so to capitalize on the greed of massage therapists who do not think about the consequences of their behavior.Those consequences are now beginning to exact a price, which all massage therapists will pay.
Unethical Teaching of Code Selection
One of the teaching practices I am talking about is the inclusion of highly questionable Current Procedural Terminology (CPT) Codes. Many more codes than is appropriate are presented in literature and seminars. These folks carefully point out that the massage therapist is responsible for selecting the correct code (which means that the authors or seminar prenseters are not liable for what they teach), then list a large number of codes, most of which no massage therapist is qualified to use.
Those they teach are encouraged to interpret for themselves the meanings of the codes and whether they are qualified to use them. In most cases, the selection of a code is driven not by the meaning of the code and the massage therapists' qualifications, but rather by the fee that code pays.
The result of that kind of teaching is significantly higher fees and much greater income for the massage therapist, which is what drives the massage therapist to resort to questionable coding decisions. Did you know that an indentation of wording in the CPT coding manual carries with it an addition to the definition listed?
Did you know that a semicolon has a meaning, which is different than a comma when reading the codes? If you do not know those things, then you are incapable of using the American Medical Association's (AMA) CPT coding manual correctly. Stay out of it.
Certain insurances in Colorado are now restricting the number of CPT codes that a massage therapist may use to one code. They are also setting a specific maximum amount that can be claimed for that code. This is occurring because 95 different codes had been used by massage therapists making claims to their company. There are only three codes that the vast majority of massage therapists are able to use. That is not opinion, that is fact. The insurance companies are protecting themselves from unprincipled abuse on the part of the massage therapists. The massage therapists have abused those companies because of what they were taught.
Unethical Teaching of Fee Setting
Fee setting is a complicated and imprecise subject. One of the ways some teachers abuse this imprecision is to not include some very important information in their teaching. There are books that list every CPT code. They include information on usual and customary fees for service. The one I have organizes information in this way:
Except for Medicare/Medicaid, there is no set fee for 97124; each fee is for a unit of 15 minutes.
When you take into account the number of years of training, the overhead of the professional office, insurance to practice, and other miscellaneous costs of doing business, the physician has a right to charge a fee significantly higher than the massage therapist. And yet some who teach about fees would choose the $84 fee as though that ought to represent the usual and customary fee.
Realistically, a physician's usual and customary is higher than that of a massage therapists. Fifty percent of the physicians charge less than $40 for that service; therefore, a massage therapist's fee most certainly ought to be below $40.
Another small problem: If I tell you what the fee is for a service, then I have committed price fixing; that is i1llegal anywhere. We must each set our fees according to our own set of values and conditions. There is no legally correct fee. You could charge $150 per unit, and it would be legal to do so. So, why not choose the higher numbers?
Unethical Teaching of Business Practices
Consistency is the principle by which you can judge whether your business practices are within an ethical framework. Do you always charge the same fee for the same service? Please note: the amount charged is not the issue, it is the application that counts.
Which of the following should be charged a different fee than the others?
The answer, of course, is that they should all be charged the same fee. Can you make exceptions? Of course. I was a former teacher. Perhaps I wish to provide a special discount to teachers. I need only be up front regarding my prejudicial behavior toward teachers. My fee differential ought to be readily available for all to question.
What about insurances? An insurance company's client is an individual. Individuals all ought to be treated the same according to the example above. But there are additional expenses to billing insurance. Shouldn't we be able to charge a higher fee due to the higher expenses? The answer is "Yes".
However, there is no CPT Code for that expense by a massage therapist; therefore, it is not now possible to charge insurances for that work. Be patient. Such codes will be forthcoming.
There can be a large difference between legal and ethical. Helping to place that gap in perspective is the concept of "usual and customary." When trying to determine what is the usual and customary fee for a massage therapy service, you would want to know what a particular service would cost the average customer. Not the discounted price or special price, but the amount which the customer parts with before going out the door.
Earlier I asked a question: Why not choose the larger number? This had to do with the fee schedules that are published by the AMA.
The reason you don't charge the higher number is because it does not represent your "usual and customary" fee honestly and accurately. You choose a number that represents the reality of your behavior. No tricks with wording or fancy ways to sidestep an honest appraisal. If a cash customer would always pay $55 for a service then that is the "usual and customary" fee. Apply the "usual and customary" concept to the figures from the AMA and live with it.
Acceptable Ethical Models To Command Higher Fees
How can you earn a higher fee and avoid all of the previously mentioned problems? Actually for some it is quite easy.
There are many more ways to earn substantial incomes as a massage therapist. All of them require dedication, perseverance, education, good judgment, personal growth and hard work.
Ending Unethical Teaching
Ed Denning is a licensed massage therapist in Ohio. He is coordinator of the massage therapy program at Stark State College of Technology, and also serves on the Massage Therapy Advisory Committee of the Ohio State Medical Board.
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