"Using" Medical Massage
BS, LMT, NCTMB
May 29, 2009
"Using" Medical Massage
BS, LMT, NCTMB
May 29, 2009
Regular readers of Massage Today know that I give my opinions freely. I've been doing so as long as Massage Today has existed. (I think this is my 52nd editorial.) Sometimes I write about things that are, in my mind, detrimental to the profession; other times I write about things I have found uplifting and beneficial. I much prefer the latter, but frequently get bombarded with things that seem so incredibly stupid to me that the uplifting and beneficial topics get pushed further and further back in the pile of topics to write about. Such is the case this month.
I have in the past written about "Medical Massage." Search massagetoday.com and you'll find not only my editorials (most recent being www.massagetoday.com/archives/2004/10/09.html), but a slew of other articles on the benefits or perils of "Medical Massage."
The players looking to be involved or control "Medical Massage" are growing exponentially. Two organizations in particular appear to be posturing to make themselves the only "official" players in the game. Both the United States Medical Massage Association (USMMA, formerly the American Medical Massage Therapy Association, or AMMTA) and the American Medical Massage Association (AMMA) are each calling themselves the biggest, best and largest organization representing medical massage therapists in the whole wide world.
Actually, they both indicate on their Web sites that they are so altruistic as to represent the interests of all massage therapists, not just ones practicing in the medical side of the business.
The USMMA site says:
"The USMMA's founder is David W. Luther, an author and lecturer on medical massage insurance reimbursement. He is also the owner of The Medical Massage Office & Associates, which prides itself on superior instruction in Medical Massage and advice about insurance billing. The USMMA is a natural extension of The Medical Massage Office & Associates, reflecting David's innate concern for the welfare of the Medical Massage community. David believes that the USMMA will be a great benefit to everyone in the industry, including patients, doctors, associations, schools, insurance companies, government agencies, and, of course, therapists. Make no mistake about it. The primary function of the USMMA is to fight DISCRIMINATION, DOWN CODING, PRICE FIXING, PIGEON HOLING, AND ALL OTHER INJUSTICES that beset the path of the Medical Massage Therapist."
- USMMA Mission Statement www.usmedicalmassage.org/mission.php.
"The AMMA has established as its mission, 'To promote manual medicine training within the allied health industry, by establishing professional programs for education and examination,' but beyond this, the AMMA has sought to establish itself as an organization founded upon the universal principle of Unity. It all of its efforts and doings the AMMA will always attempt to promote professional unity, to serve the common good, and to uplift and support the efforts of all massage therapists. The AMMA has never sought to selfishly attend to its own vested interests, but across the U.S. the AMMA has joined with all massage therapists of good will. The AMMA has repeatedly stated and will continue to act upon this statement, 'The AMMA will never support any legislative effort that undermines the practice of massage therapy by any massage therapist.' The AMMA embraces our professional diversity, while working to support our professional unity, and in working towards the common goal of improving the massage profession for everyone."
- Press release. "Defining Medical Massage - The American Medical Massage Association," May 2005. www.americanmedicalmassage.com/news/amay2005.html.
A cynic's hat may sit comfortably on my head but I think that the rhetoric from both of these organizations sounds more like marketing than anything else. I believe the sales term is "puffery," which means greatly exaggerating the benefits of a product with the intent of capturing a prospective buyer's interest. Puffery is frequently entertaining but consists of promotional claims that no one out of diapers takes literally.
My intent here is not to ridicule the two organizations, because both have tangible benefits to those choosing to align themselves with one or the other. Both can provide guidance and solid principles for succeeding in a complex niche of our profession. Don't think for a minute, though, that these or any other individuals or organizations out there that can make a buck off the term "Medical Massage" is without an agenda!
As example, the USMMA recently filed a class-action lawsuit against State Farm Insurance Company in Pennsylvania for "down-coding" CPT code 97140 (Manual Therapy) to 97124 (Massage Therapy).* The case was apparently settled out of court and David Luther, speaking in his newsletter stated:
"The judge came back to us and asked, 'What is a medical massage therapist?' We answered that they would be a Nationally Certified Medical Massage Therapist (NCMMT) through the Medical Massage National Certification Board [emphasis mine]. We tried to add another clause: 'Or, a member in good standing with the United States Medical Massage Association (USMMA).' "
- "Spring 2005 Newsletter from David Luther." www.usmedicalmassage.org/news.php.
Note: Do you believe it? The USMMA had the audacity to suggest to a judge that only members of its association or people who have taken its 'week-long intensives' should be allowed reimbursement for manual therapies. I think the situation is best summed up by someone whom I see as one of the great critical thinkers of our profession. I will reprint his letter to the editor of here in its entirety.
A letter was recently circulated by David Luther and his company, The Medical Massage Office (TMMO) regarding a class-action lawsuit against State Farm Insurance Co. on behalf of massage therapists who had been unfairly discriminated against in the reimbursement practices by State Farm. Mr. Luther's efforts to stop unfair practices of down-coding by insurance companies are a benefit to the massage community at large and hopefully indicate a new chapter of recognition for the benefits of our services by third party payers. However, in the process of arriving at the settlement with State Farm, Mr. Luther and his organizations have exceeded the boundaries of fair practice.
In talking about the decree to be issued by the judge in the case he states: "The actual decree, signed by the judge, is due in the next 30 days. Note that the declaration says that they must pay a 'medical massage therapist' - so the judge came back to us and asked, 'What is a medical massage therapist?' We answered that they would be a Nationally Certified Medical Massage Therapist (NCMMT) through the Medical Massage National Certification Board (MMNCB). We tried to add another clause: 'Or, a member in good standing with the United States Medical Massage Association (USMMA),' but this will not be included in the decree."
Asking for a judge to define a medical massage therapist this way without any background knowledge of the issue is highly problematic. Mr. Luther is the head of the USMMA, the seminar company TMMO, which provides the education "package" necessary to qualify for the exam, and also started the MMNCB which administers the exam. The conflict of interest in these relationships is all too obvious.
Recognition of the MMNCE [Medical Massage National Certification Examination] as a valid certification exam is highly questionable. In an effort to gather more information about how the test was constructed I attempted to contact members who were listed as being on the advisory board that developed the exam. Of the seven I contacted, three had no idea they were on an advisory board, two said they had nothing to do with the creation of the exam, and two more never responded. In addition, I attempted to find out more information about the content validity of the exam.
The project coordinator for the MMNCB stated that they define medical massage as: "The clinical application of manual therapies applied to a patient that has been diagnosed, prescribed and referred to a medical massage therapist by the patient's treating physician."
This definition places importance on who refers/prescribes the treatment but says nothing about what medical massage actually is in terms of clinical knowledge, skills, or abilities. I asked the MMNCB project coordinator if their definition of medical massage was due to their emphasis on insurance reimbursement, but I never got an answer.
I personally have no opposition to multiple certification examinations or credentials being available in the marketplace. However, I think if the MMNCB, TMMO, and USMMA want to hold the only entry ticket into insurance reimbursement and medical massage (even though the term has not been operationally defined by the profession), a higher standard of accountability needs to be displayed.
Whitney Lowe, Director
Orthopedic Massage Education & Research Institute (OMERI)
Here, here, Whitney! The profession owes you a round of applause for following up on this issue and making those phone calls and sending those e-mails.
Both the USMMA and the AMMA, with their own definitions of "Medical Massage," are now critical of the American Massage Therapy Association (AMTA), which recently issued a press release stating:
"The American Massage Therapy Association (AMTA) 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'. The association believes that information on this term and the issues surrounding it are unclear for massage therapists, massage schools, regulators, employers, healthcare facilities and the public."
They further state, "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."
- Press release. "Press release has yet to define medical massage says AMTA," Apr. 22, 2005. www.amtamassage.org/news/042205defined.html).
I hope AMTA truthfully includes the "profession" in its discussion, including the AMMA and USMMA, since those organizations have more history and background information than most. If the discussion is kept in-house or with limited interaction with the diverse components of our field, I fear the AMTA will cause more harm than good, as it will actually encourage more attempts to grab market share through inappropriate legal action and decisions. The longer this argument continues, the more likely that there will be irreparable harm.
Maybe I have a tendency to look only at obvious or simple solutions, but according to my trusty Webster's New World College Dictionary, both terms in question are already defined. Cobbling together the most likely definitions, "Medical Massage" is defined as "Rubbing or kneading a part of the body, usually with the hands, with the objective of treating, curing, and preventing pathologies, relieving pain, and improving and preserving health." How hard was that?
The August issue of Massage Today will have a more in-depth article concerning the issues I've mentioned in this editorial. Since there are precedents here that can affect a large part of our profession, I ask you to "stay tuned."
Thanks for listening!
*Two days after this article went to press, Massage Today received new information verifying that this lawsuit had not been filed by David Luther, et al., but by an individual massage therapist, Tracey Roberts. David Luther and the USMMA became involved independently, and neither he nor his organization are named subjects in the lawsuit.
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