• Read your contracts
• Read the Billing and Treatment Guidelines for each insurance company.
• Insurance companies can ask for their money back even after a year or more.  Be prepared.
• Know what you can and can’t do.

Then the attorney for AMTA WA – John Peick (www.peicklaw.com)  spoke about the many issues in doing business as a massage therapist in WA.  The highlights:

• WA MT can’t get involved in running groupon discounts or amazon.com local offers because it is considered to be a violation of the kickback laws that are set up here in WA.  See Rebating Law 19.68 RCW REBATING BY PRACTITIONERS OF HEALING PROFESSIONS
• If you are setting up a LLC for your business, the proper category is to be a Professional Service Corporation (PS) or a Professional Limited Liability Company PLC
• There is a big problem with mis-classifiations of massage therapists as employees or independent contractors.  Splitting fees is illegal here in WA.
• Non-compete clauses may serve to restrain trade which is a bigger issue.
• Sliding scales are not allowed if you bill insurance companies because you must offer the same discount to everyone including the insurance companies that you bill.  Geico was said to be calling companies undercover and asking if you run a discount and then denying payments.
• It is a false claim if you bill two different rates for your cash clients and your insurance clients.     RCW 48.80 HEALTH CARE FALSE CLAIM ACTChapter 48.30A RCW INSURANCE FRAUD
• What can happen?  5 years, $5,000 fine per incidence.
• Claiming you didn’t know won’t help you.
• Sexual misconduct issues: suggesting you stop seeing the client so you can date is not allowed as per WAC 246-16-100(1)  
  

  (m) Suggesting or discussing the possibility of a dating, sexual or romantic relationship after the professional relationship ends;

  (n) Terminating a professional relationship for the purpose of dating or pursuing a romantic or sexual relationship

• Even after 2 years have gone by, you may not be able to date a client under the 9 other factors in WAC 246-16-100(5)
• Using Social Media sites such as Facebook create a Potential HIPPA violation.  Use with caution.  Don’t let clients comment or post on your page.  Insurance companies are also scanning sites and using information posted to deny claims (that last part was something I learned elsewhere -not from this meeting).
• Billing errors – write down the time you spend when working on clients in your chart notes.  No discount plans allowed no matter how you want to explain it.

David Matteson (www.early-edge.com)

Obamacare is on it’s way.  It is one of the largest changes in over 70 years and no one has a clue how to implement it.  AMTA WA is working with the insurance commissioners office but there is still so many unknowns.  We are walking with the devil and we wonder why everything is going so badly. Are we just taking insurance so that we don’t have to market our practice?   We need to be a business person, a massage therapist and a political activist.

Exchanges are being set up by each state.  WA State is way ahead of everyone else.

What is healthcare anyway?  Healthcare as we know it today is about keeping people sick.

We do have the largest group of practitioners behind doctors nationwide so is there a chance we could make a difference?

How do we stay a part of healthcare and keep what we do best – being of service and treating people – not the diseases?

Labor and Industries – L&I is undergoing an update to their system

Healthways/Whole Health Networks covers Cigna, Aetna and Corvel which is a combination of auto insurance companies.

Premera Blue Cross/Lifewise WA

•     Requires specific prescription that you have to fax to them before billing.  See forms section:  Massage Therapy Prescription

Regence Blue Shield List currently closed from what I understand

First Choice Health

You can use www.officeally.com for free to bill these companies directly electronically.

Currently,  the Office of the Insurance Commissioner is working on creating the health exchange system for WA State to fulfill the requirements of the Affordable Care Act that requires that massage be covered.

You can also bill massage services for car accidents.  Start with making sure that the client has personal injury protection benefits in their insurance plans.  That will cover the costs up front up to whatever limit they have on their policy making it so that you can get paid right away and not have to wait until the case settles.

One Year to a Successful Massage Therapy Practice (LWW In Touch Series) – Laura Allen’s book!  If you don’t know who Laura is yet – start with this book and find her online at www.lauraallenmt.com  She is one of the leaders in the profession and also has a few other books out – one on the business aspects of massage.  Read my Full Review of One Year..

Business Mastery:  for Massage Therapists and other somatic practitioners.  This is one of the leading books that is required in most massage schools.  Written by Cherie Sohnen- Moe and in it’s 3rd Edition, this book tells it straight on.   Read my full review of Business Mastery…

Effective FREE marketing for the solo massage therapist – Short kindle book from a massage therapist – Jess Weagle

The Enviable Lifestyle: Creating a Successful Massage Therapy Business

Building Your Ideal Private Practice: A Guide for Therapists and Other Healing Professionals – By Lynn Grodzki- mainly for psychologists but really applies to the massage profession.

Marketing Massage: From First Job to Dream Practice   by Monica Roseberry.  I actually prefer the first edition of this book but this is very helpful too.

Fill Your Massage Practice 101 – OK I just found this right now when looking through books on amazon.com.  It is by Eric Brown of www.bodyworkbiz.com.  This book is his complete  online program that he has at www.bodyworkbiz.com.  He has been around online for quite some time and has very prominent in the chair massage world.  He has put together the American Massage Conference which is all done online each year.

Ebooks

Five Steps to Owning your Own Mobile Spa Business - by Helen Hodgson

Books I haven’t read but look interesting:

The Ultimate Massage Marketing Blueprint: Massage Marketing Tips to Build a 6 Figure Practice Within 1 Year

Marketing Your Chair-Massage Business: A step by step, simple, effective guide to building a chair-massage practice

Success from the Start: Business Principles for Massage Therapists

How to Start a Home-based Massage Therapy Business (Home-Based Business Series)

Massage school teaches us to “fix” people-plain and simple.  Learn this and that about anatomy and physiology and how massage works so that you can fix that pain, help soothe that stress and help make people feel better.   When you work with insurance and injuries the goal is to ‘fix’ the problem.  We work hours and hours, putting our heart and soul into helping and fixing.  We love being  the hero (or sometimes called rescuer!)   We learn that applying massage in various ways will help tissue heal, will help reduce pain and tightness.   So with all of our hard work and they go out and trash their bodies again and again.  Or they don’t change their desk set ups like we said.  Or they don’t rest, ice and stretch at home to continue on with all of our hard work and time.    Yes….so frustrating!!!!!!

It just feeeeellllsss sooooo very, very great to help and fix!  We need our fix of fixing and helping!  It helps us feel good about ourselves.  It helps build self esteem and self confidence.  It is so powerful to be that good!   It feels so good to be that good!

In massage school I was given this book called How Can I Help? Stories and Reflection on Service

I read it back then (circ 1987) and didn’t really think much of it.  It didn’t really mean much.  I wasn’t a helper.  I just wanted to do massage.   10 years later, burned out, frustrated by so many client not getting better because I was telling them all of my best stuff and doing all of my best work.  Fed up with clients not showing up and all of the other things that go on in the business of doing massage.   It wasn’t feeling good anymore.

We gotta fix this up right away.  We gotta call this person for advice. It’s tricky because this impulse may arise from genuine empathy, but the form of action is compulsive. Often what is happening is that ‘we gotta’ get rid of someone’s pain because it is hurting us too much.

I also received this article somewhere along the line – In the Service of Life by Dr. Rachel Remen.

When we help we may inadvertently take away from people more than we could ever give them; we may diminish their self-esteem, their sense of worth, integrity and wholeness. When I help I am very aware of my own strength. But we don’t serve with our strength, we serve with ourselves.

Hmm…. I started getting it little by little.

When I have posted that article on Facebook though, some people get confused.  They only know services as in restaurant service.  Oh boy!  How did this get lost in massage school?

Then I found a few articles (Go to the bottom and see Caretaking) by my now supervisor – Jack Blackburn.   I needed to know more.  I signed up for a class with him at the AMTA WA convention and the rest is history.  12 years later of regular supervision and peer group meetings and I am still getting it more and more everyday seeing in all of the great discussions online.

In all helping professions it is necessary to discern whose needs are being met; the practitioner or the client… this is a major reason for supervision.

Whose needs are being met when I tell someone what to do – for their own sake of course! (sarcasm!)

How do you tell when it is your needs being met at the time?  How do you stay aware?  There isn’t any one solution.  There isn’t any one answer.  It will be a process of learning and becoming more self aware.

I also remember a great line from Diana Thompson from a class on SOAP charting:  “When you point a finger at the client saying, you should do this and this and this to get better, three fingers are pointing back at yourself!”

Giving advice and especially un-asked for advice is always more about the advice giver than the receiver.  Always?  Well I guess not when I tell someone to drop and roll because they are on fire!  Is that advice?

Parker Palmer (A Hidden Wholeness: The Journey Toward an Undivided Life
) also has a great quote on this: If you take my advice, you will surely solve your problem.  If you take my advice but fail to solve your problem, you did not try hard enough.  If you fail to take my advice, I did the best I could.  So I am covered.  No matter how things turn out, I no longer need to worry about you or your vexing problem.

Why do people not listen and do what they are told?  Being told what to do often brings up so many old issues of authority and fighting to be their own person, free from authority.   People don’t want to be scolded or forced into doing things.  People want to solve things for themselves.  They want to feel heard and feel respected for who they are.  When you give advice – it puts you up higher on the power differential making the possibilities for transference increase.   In contrast, when you work together on achieving a goal – a pain free back/neck or whatever- you learn to set goals together.  In listening to the client, you can also find out what they can and want to do.  If you are telling them things to do and they aren’t doing it, you are most likely telling them what YOU alone think and not what the team of you and the client can make happen.

As a massage therapist, most of us probably got here because we just want to help others.   Helping is the very first countertransference issue that needs to be looked at when becoming a massage professional.  Why do you want to help?  In what ways do you help?  How does it make you feel?   I created this questionnaire (on my other site -www.massageschoolnotes.com) from all of my years of studying and reading on helping professions and what it means to help.  Because many of the reasons why you help is to make yourself feel good and to feel valued and to feel important.  Now there isn’t anything wrong with that but when you do it for that reason only, it often will get in the way of what the client needs most.  It gets in the way of the therapeutic relationship that puts the client needs ahead of your own needs.

So how do we move toward being of service and away from fixing?  How do we become more aware of our needs behind fixing and giving advice?   It won’t happen overnight. It most likely will always be with you in your career in massage no matter how long it goes for.  It is just something that needs extra compassion and acceptance and awareness.

There is one thing you can do to start understanding clients more and start working WITH them in setting the goals for treatments.  It starts with doing a thorough intake interview and finding out about them.  Learning to empower clients in their healing is a very different path.  Instead of focusing on the dysfunction think of it as following the ‘path’ of the signs and symptoms into a deeper healing.   Start working to figure out what your clients can do and help them achieve that!  Start focusing on their strengths instead of their weaknesses.    The clients are really the true experts in their health and healing.   To really get to that, the therapist needs to set aside their own knowledge and start being curious.  Listening is central to the process. When you listen you are not thinking about what you might say, you aren’t thinking about a story you might share on a similar topic – listening means not giving advice but really showing the person that you heard what they said.  Often listening is really the first and possibly the only thing they really need!  Can you set aside your agendas and assessments to really listen?   (It won’t happen overnight!  It is a process!)  Can you really just be compassionate and share their pain with them – which is the true meaning of compassion?

The book Interviewing for Solutions (Psy 642 Introduction to Psychotherapy Practice)
is very helpful in giving new insights into the intake process and working with clients to get to solutions that clients can achieve.

Supervision and participating in peer groups can provide a place to get your own needs for being listened to yourself outside of your business.   Having a good self care program that includes things like having the money you need to take care of your own needs, taking vacations, taking time to enjoy your own life – these are all good tips too.

So that’s my advice and I am sticking to it!  What is your advice?

I personally have been hesitant to try online scheduling for a few reasons. I prefer talking to potential clients because I really need to screen them when they have insurance especially.  I also have so many regular weekly or every other week clients who have standing appointments (the same day at the same time) and they text me when they have to cancel.  Online scheduling seems like more of a problem for these people -or at least that is how it is looking to me.

The other problem with choosing an online scheduling system is that it is SOOOOO  overwhelming because there are so many of them and they all do different things and they have different price plans and features.  It is impossible to compare them all and really pick the right one for your business without trying them all one by one.  And that is what I am currently doing.

So far I tried Genbook, but it didn’t work well with my Android Phone.  That is one of my requirements.  You really have to figure out what you need and what can help your business the most.  Here are some other things to consider:

• Do you want the ability to take credit cards to secure the appointment and reduce/eliminate no shows?  This will also create another barrier for clients in making appointments so it is a toss up as to whether to use it or not.
• Do you have a computer at the office (I don’t!) that you can use for scheduling or will you be using your phone or tablet to set up the system and make all of the appointment/schedule changes you need to make?  If you are using only your smartphone, then the system really needs to have a mobile website or app for you to use.  Other systems are just too cumbersome to use.
• How do you want to get notices of appointments that are made and canceled?  Text and email are your options.  Which one will work best?
• Will you be using this for all your regular clients too?  You will have to set up each client in the system.
• How much are you willing to pay?  The prices vary from free to I have seen like $79 a month but that probably includes more than just a booking system.
• Will you need a system to screen clients and ask them questions before or when they book?  Is there information you need to know, like I need to know what insurance they have if they have it and if they have their prescription.  Many insurance companies here will tell people that they don’t need a prescription and I won’t take anyone that doesn’t have one so with the contradictory information, some people just think it is OK because the insurance company said it was OK.
• Will you be able to easily update your schedule from wherever you are -like to take yourself off the schedule or book a client who has called or that you run into in person somewhere?  Again a mobile website or app is necessary.
• Is there just you or do you need to have it so employees/Independent Contractors can access the scheduling?  How many people will need to have their own schedule?
• How easy is it to reach support?  Some only have email support and not live, phone support.

So I would recommend that you start with the companies that your association have networked with that provide you with a member discount.  For ABMP members it is  FullSlate.  AMTA offers discounts with Genbook. 

Also most companies will let you have a free trial which is good for you to see how it really works and if it will work for you.   Look at the actual process that people go through to make appointments – is it easy to follow and figure out how to make appointments?  Some are much better than others.  How many clicks does it take to make an actual appointment?

So after a few trials so far, I am settling into FullSlate – mainly because it was just the first one that worked with my phone.
There are also many, many others.  Here are a few:

Schedulicity.com , www.appointment-plus.com , www.bookfresh.com,  www.mindbodyonline.com,    www.bodyworkbuddy.com.  

Free:  www.clickbook.net

Some other things that I thought was that everyone would just start using this and it would make it so I wouldn’t be answering and returning phone calls.  That is not true so far.  People are still calling.  I am not sure if they don’t clearly see the button for booking even though I have it in about 3 different places or what it is.   I had people calling on Sunday when I don’t work and I have my hours clearly stated and set up accordingly on the scheduling system.  People will still call! and email!  I am not sure how much it is really cutting down my work time either.  I have to always remember to check the thing and also if I have an opening that doesn’t get filled, I have to remember to block it out.  I usually will leave early or go run errands when I don’t have an appointment.

I have always thought that it was sad that touch is being lost so much in the world and when I have studied the history of massage and how massage was always a big part of various communities with things like women in the family teaching their sons how to do massage so they could massage their pregnant wives now being lost to expensive massage services.   I have also always thought that it was such a weird thing to charge money for when massage should really be done on each other.  I have always thought it was such a strange thing that people so willingly jump on the massage table to be touched by complete strangers.   Since massage school in 1987, I always thought that if everyone got a massage once a day that there would be world peace.  Well I have been trying to make a dent in getting more people to experience touch,  I am realizing that teaching massage to couples and others who want to learn is going to be a better way to approach this.   Anyone can really do a massage.

I started with teaching massage to others right from the beginning of my career but it was always for community groups for free or for a regular client who was in dire need and wanted some family member to know more so that they could be helped in between sessions.  I also have taught some mothers how to massage their kids, but it was always just a complementary service mainly for really regular lifetime clients.

I also had a regular follower, Carl Nelson, back when I first started my site in about 2000 or so, who was doing massage in his local church group, write an article on how to do the massage in a church group.

So when Gary and Tiffany Blackden, who are fellow massage therapists who I found because of our love of using Site Build it! to create websites, put together and ebook on how to teach a class to couples and others, I became hooked!    I put together a page for my office website and because my website gets such high traffic (about 200 people a day) it was easy to get my first class participants.  After I taught the class, I was really shocked to see how fun it was and to see how well people really catch on.  It was a very rewarding experience, much more so than even just doing a massage in my experience.   So I was wanting to know more and learn more and got the opportunity to assist in a couples class with one of the local experts – Joe Levine of www.poweroftouchworkshops.com .   He had 3 – 3 hour workshops set up on a Saturday (and every Saturday!) for 6-7 couples at a time!   He did it a little different and actually taught the women how to do more of a lomi lomi massage or mainly to just use their forearms and apply more pressure to the guys.  I thought he was crazy at first, but it really worked out.  In general, the women are not able to give deeper pressure.  When it came time to teach the men how to massage, he taught them more of a Western style Swedish Massage technique which again worked out great.  He also got out some hot stones and had people just hold them in their hands and use a little on the back.

So really, you will have to figure out what you will be teaching people based on the skills you know and find out what is easiest for people to pick up and learn.

This can go way beyond just couples massage.   It can be for friends, family members, massage for mom/dad.  It can be massage for people with cancer if you are skilled in working with cancer patients.  It can be massage for people with fibromyalgia or other diseases and conditions that you work with.   It can be a specific area of the body- back massage, foot massage, head massage.   Think about teaching regular self massage classes also like specific classes for headaches or carpal tunnel or something for a lunch time event or after work happy hour type of thing or even in an open house event.  You can do classes with seated massage just using a conference room with chairs and a table and use pillows to sit people upright.

So  Start with the Ebook/DVD from Gary and Tiffany Blackden of www.professionalmassagenetwork.com.  Start with teaching classes to just one couple at a time.  That might even just be enough for you to help get your schedule filled.   When you get a couple in for a two or three hour class and just charge your regular hourly rate, it can be a good way to fill up your time faster.   If and when you want to move to classes with multiple participants you will need to have some of these things in place:

• Check to also see if you need extra liability insurance.
• Have class handouts on the things you talked about in the class.
• Create a new intake form that is geared toward the couples.
• Have a way to follow up with people who take the class.  I had people fill out a large body chart and kept it and then wrote some notes on it for each person to remember when they worked on the other person and mailed it a few days later after the class.  I also included a $10 off coupon for a massage with me that they could use or give to anyone.
• Sell the workshop through gift certificates – especially for Valentines Day, Christmas, Birthdays and Anniversaries.

Some of the issues that I can see already are simple things like getting them undressed and dressed and on the table in the group setting.  You will have to get creative with that.  In the class I saw, they just had the women step out of the room and all the women were left to get undressed and on the table.  You also may get some people who just don’t want to be there.  Sometimes it is just one person who really wants the other to come in and learn so that they can massage them!  Some people are also very awkward with their hands and bodies.  You might just have to spend extra time with them or just leave them on their own.   In the end, they will get as much out of it as they can.  Another thing to deal with is couples becoming more romantic with each other.  You will have to deal with that with each unique situation.  Mostly it is really harmless, but I did see a discussion on Facebook of someone saying a couple was engaged in really romantic relations in between sessions.   This is just an FYI to know about what might happen.

So here are the basic steps you will need to take:

• Read the couples massage ebook and watch the DVD
• Create a plan for your class.  You will need an intake form, handouts, oil/lotion samples/supplies, sheets or decide if you want them to bring them, massage tables, a way to make a table on the floor to show them until they get a table.
• Create a page on your website about the class.  Have a way for them to buy it in a gift certificate or direct instructions on how to schedule the class.
• Create a marketing plan for your class.
• Teach a few individual massage classes or as many as you need to feel comfortable and work your way up to a few couples or a large group.
• To get a large group, this is where groupon or livingsocial.com works best.  You can increase the price of the class and then sell it at the discounted rate through these services and get your classes filled.
• Create a mailing list or a members only section on your website where people can get more handouts or watch videos.
• Sell the couples massage video on your website through the affiliate program and make extra money.
• Sell massage tables, lotions, oils, bolsters on your website through affiliate programs and make additional income while you teach the classes.  www.amazon.com is best for this.  You can sign up to become an associate for free and they will help you create the links to put on your site.  When people buy through the links, you get paid.  You will also need to create a policy page and follow their rules for being an affiliate.  You need to put up an FTC policy that says that you make money through affiliate programs and list them but amazon.com also says you need to add a special disclaimer to your site.  (I have to find that exact info.!)

Should you accept tips as a massage therapist?

Some say Yes and some of course say No.  Which is best for you and your business will depend on your own values and needs but it is important to also look at your relationship with money.  Money is always such a hot topic for massage therapists I think mainly because they struggle to make money for the most part.   Money is the one thing that EVERYONE has in common.  It is where we project our own feelings of self worth and acceptance.  The meaning we give money comes from our early lives and watching our early caregivers talk or NOT talk about money.  We project all our meanings onto money when money in fact really means nothing.  It really isn’t worth anything.  It is just a math problem to figure out for your self so that you have money or you don’t.

Tipping in history was a way to show gratitude and ensure future service.  (See a previous post on tipping a massage therapist on my other site.) With massage that may or may not apply.  When people are there on vacation, they won’t be coming back.   Tipping is more common in the restaurant industry where servers are often paid less than minimum wage.  Their livelihood depends on their level of service.  Higher end restaurants with higher priced food items will of course make a server more since people tip on the amount of the bill.

Tipping can also be a sign of transference on the clients part.  They feel better because of your work – or so they think.  They want to give you more and they want to please you.  Some may even want preferential service like being able to get in for a massage even though your schedule is full or they may want something like extra time or extra care.   There probably is some transference going on in the process of tipping for every client.  The thing is how you handle your boundaries around your services and let them know that the tip is for saying thank you and not preferential treatment.  You can do that through setting your hours and keeping them , keeping on time with your sessions and staying true to your values.

The case for NO Tipping:

• We are medical professionals.  Doctors and dentists don’t accept tips.
• It makes clients uncomfortable.   They don’t know whether to tip or not or how much to tip and they don’t want you to feel slighted if they don’t tip because they just might not have enough cash or something like that.
• It makes you uncomfortable as the massage therapist.
• You are the owner of the business and charge top dollar for your massage.  (The average rate for a massage is about $64 last I heard.) Charging above that sets you apart from all of the low cost massage places.   Clients should not have to tip on top of higher fees.
• Tips are spiritually degrading. (From one of my Facebook discussions on tipping.)

This argument that we are medical professionals is futile.  Yes, Some massage therapists are medical professionals and many states license massage therapists as medical professionals, but the thing is that we don’t get paid like doctors or dentists.  The insurance companies also pay them and they charge $300 for a 10 minute visit.  Until we are paid that rate, then you can’t really compare massage therapists to doctors or dentists.  I often thing that maybe we should start moving towards a tipping your doctor policy and wonder if they would finally get it.   Some massage therapists are not medically oriented – they are more service oriented and work in a spa or resort.   People who are employed at franchises depend on tips and their jobs pay so low with the idea that they will be paid a fair wage in tips.

Tips don’t have any meaning except for Thank You and Make sure I get that service again in the future.  Money does not have anything to do with spirituality or being a good person.  Money is just a way to take care of yourself and your family.

The case for tipping:

• Tips are the way people who work at franchises, bump up their income to something almost reasonable.
• Tips are just a way the client has of telling you they appreciate your services.
• Massage is a service industry and people like to reward good service.

How to set your own tipping policy:

Whether you want to accept tips is totally up to you and how you want to run your business.

Tipping should never be expected.  If it gets to the point that you do feel resentful if you are not tipped, it may be time to raise your rated in general.

If your work depends on tips, having a clear policy posted in public can help reduce the uncomfortableness of the whole process.  Having envelopes at the front desk or in the massage room or letting clients tip on the credit card, can also ease the situation.

In some ways, the whole tipping issue may be adding to the lack of clarity of our role in the massage profession.  People don’t know when or who to tip and it adds many awkward moments to many massages.  I hope one day that we can be all on the same page and be paid well enough by the insurance companies, employers and charge enough in our private massage practices so that tipping will be forgotten.

Looking at the reasons why tipping makes you uncomfortable, can be a clue to many other beliefs about money.  Start with going through this money autobiography to start taking a deeper look at the things you project onto money or the lack of money.

Buy Now!

2013 will be a big year for the massage profession and massage therapists.  One of the major things we will have to be working on as a profession is whether or not massage will be covered on health insurance plans in every state under the Affordable Care Act which goes into effect in 2014.

This is what I know right now:

Every state is required to create a health insurance exchange system that will allow people who do not have coverage to get health care insurance.  The federal government is giving money to each state to create their exchange systems.  States have until Feb 2013 to decide if they want to create their own exchange system.  If they don’t choose to do so, they will default to the federally facilitated exchange system.  Here is a map of which states are doing what from the National Conference of State Legislatures.

Here is the main section of the law that will allow MT to bill health insurance:

SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.

(a) Providers- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

(b) Individuals- The provisions of section 1558 of the Patient Protection and Affordable Care Act (relating to non-discrimination) shall apply with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage.

There are also other sections that apply to massage.

SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME.

SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL

SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN.

SEC. 5101. NATIONAL HEALTH CARE WORKFORCE COMMISSION.

You can read them all at www.theintegratorblog.org  which is the blog of John Weeks who is also with the The Academic Consortium for Complementary & Alternative Health Care.

There are many things we do not know :  How will massage fit into the exchange systems?  How will this law affect the current health care plans?  I would assume that it would also mean that massage therapists will only be considered if they are licensed as a health care provider.   There are also things that can be done to get the insurance commissioners offices to recognize massage.  Do we even want to be included in health care?  Are we ready as a profession?

While here in WA we already are contracted health care providers and have had many challenges with things like having benefits reduced and also the amount that they pay.   One of the problems is that we will have to be much more organized as a profession in order to be able to negotiate with health insurance companies.  There are over 300,000 massage therapists in the US which would make an impact if we could all come together over this.  The other thing is that this might be happening whether we are ready or not.  It is important that we get to the table and start talking to the insurance commissioners and the federal exchange system.  If we aren’t there at the table , they will dictate what will happen.   It is better to be at the table than what is on the menu.

Get Involved:

Contact Your Local AMTA Chapter to see what they are doing and get them working on the issues in your state.

Use this paper created by AMTA WA  and submitted to the WA State Office of the Insurance Commissioners to help prove that massage works.

The Integrated Healthcare Policy Consortium (IHPC) is the main lobbying champion for integrative healthcare delivery.  The ACCAHC Clinicians’ and Educators’ Desk Reference will help you explain massage to the insurance commissioners.

Update Feb 9, 2013

The Integrative Healthcare Policy Consortium (IHPC) has hired Deborah Senn (who was the past insurance commissioner in WA State who made it so massage was covered under health insurance and made it so massage therapists could be contracted providers) to work to get massage and alternative medicine covered under the new Affordable Care Act.

Blog by IHPC for massage therapists

IHPC for massage therapists Facebook Page

I have to say I have had my ups and downs but appreciate it all.

This year I ventured out of my comfort zone and got out from behind the computer to continue having more in person gatherings of massage therapists through meetup.com .  My vision is to have a place where every massage therapist in the Seattle area can go to get free or low cost CE and also find support for whatever is happening in their practice/career in the form of peer supervision groups.    Peer Supervision is really what has helped me stay in business so long as a massage therapist.  I found peer supervision about 12 year ago after reading a series of articles by Jack Blackburn  (Read the articles on caretaking) who is here in the Seattle area and then I took a class from him at the AMTA WA Convention.    If you don’t know about supervision, I will be writing about it more this year but here is some info on it for now.  It isn’t coaching or telling you what to do.  It is having a safe environment for you to explore your thoughts and feelings and get clear about your boundaries which can help you get more in alignment with your values.  When this happens,  your business/career usually is much easier to create and deal with the many challenges.

In March, I released my second book  – Insurance Billing 101 for Massage Therapists.  What a project that was!  I would have never in a million years ever thought I would be publishing books.  My first book – A Career in Massage – Is it for you?  came out in Nov 2011.  That was just one book I had to write.  It actually was an ebook since 2002 when I started my second website www.massagetherapycareers.com (which I sold in 2008 for enough to live on for a year! The site also does not have any of my content on it.  They were just buying my traffic rankings which was made possible because I was using Site Built it.)  I converted that information into a new site – www.massage-career-guides.com  which is still a work in progress.  It is part massage school directory and part resources for helping people to decide if they want to become a massage therapist.

Also in early March, I had the opportunity to attend a free seminar put on by ABMP on how to teach research literacy to massage school students with Michael Hamm teaching.     He is a really great teacher if you ever get a chance to take a class with him or meet him.  I thought I had written a post on that class but can’t seem to find it.  One of the really nice things about this class and meeting Michael is getting to talk to him about the rift that seems to be happening in the massage profession over research.  There are many massage therapists and others who are on Facebook always talking about research and the latest evidence who are saying things like “reiki, reflexology and craniosacral therapy don’t work, there isn’t any such thing as toxins, and talking about evidence based medicine and how massage should be working towards this model.   It was very refreshing to hear that he does craniosacral therapy and loves having discussions about the so called lack of evidence that it works.  It was a really great experience to see that research can be compassionate!  It sometimes doesn’t seem that way -following the many massage therapists out there on Facebook who are so focused on research that many take it personal.  The researchers comment back saying that they are taking it personally too when massage therapists refuse to practice only evidence based massage.  I did have a chance to go to the research conference here in Seattle a few years ago and meet the researchers and talk to some of them. I have to say I am even more confused after reading the book “Massage Therapy Research : Integrating Research and Practice by Chris Moyer (one of the only researchers that I can understand what he is saying besides Tracy Walton ).  The book talks about all of the latest research that we have on massage and talks about what it really shows.  Basically we don’t know anything about massage or how or why it works according to this book.  There is some research that we have that he says – it looks promising for supporting massage or explaining how it works.  So I don’t get it – according to this book, we don’t have any evidence that massage works or why it works.  And frankly – why do most massage therapists even want to care about research .  The evidence of what works is seen everyday in our practices.   I think what we need is a comprehensive resource guide to understanding research – something that takes each study apart and analyzes it to say if the research study itself was sound and what it is really saying according to what was found and how the massage was applied and who did the massage and things like that.  It will also include help for how to use this in your practice when talking to doctors or clients or insurance companies.

At the end of April, I attended one day of the AMTA WA Convention to get the latest information on what is going on in healthcare here in WA.   I am always so surprised that the room in not full to capacity with every massage therapist in WA State there.  There are so many things happening in WA State right now because of the Affordable Health Care Act that every MT that bills insurance or ever wants to needs to get involved.  I was so shocked after attending just a 2 hour presentation that I had to come back the next day and start talking to the AMTA board members to see what is going on more in their organization.  I had only planned on attending the one day but had to go back.   I talked to many people that day and decided to jump on board helping AMTA WA.   I got started helping out WAMAH.org , our political action committee.   I have to say, it didn’t go very well.  I had written an article for the AMTA WA journal on why we need to donate money to the organization which then gives donations to politicians to make them more aware of massage.   I think it will take actually more talking to people in person on this one to get money out of them!  So look out!

In June, I ventured off to Tuscon to attend the Alliance for Massage Therapy Education Conference.   This was a big deal for me – traveling out of state and to a conference that was out of my league!  I don’t really know much about what is going on in the schools so I wanted to go to see what I could learn and I have to say I learned a lot!  Here is my post conference report on my other site.  I got to meet Ryan (aka Massagenerd.com and still looking for that picture that shows we really met in person!  We have been online pals since about 2000 with our websites!), Laura Allen and a bunch of others who I have only met online.

(Ok and it still shocks me how people know me from my websites when I go to these conferences.  It is confirmation that people do read these sites!  Sometimes I forget that because it is so one sided – me just sitting here on the computer typing away with a cat under my chair, the horses playing outside and the roosters next door crowing!)

Oct. brought me to Buffalo NY for a little family visit and I had planned on going to the Canadian Massage Conference for a day or so but things just didn’t work out for that.  I was sort of on vacation and didn’t want to talk massage.  I did go for lunch and talked to a few massage therapists I knew and had a difficult situation arise from putting m foot in my mouth – but oh the lessons learned!  Ever have one of those moments! LOL! Where would we be without the difficult stuff???

At the end of Oct, I got to visit with the AMTA WA volunteers and sit in on their leadership training weekend!  What a committed and caring group of people!  It was my first time going so I felt a little out of place because everyone knows each other from working together for so long but it was so fun to meet everyone and I again learned so much!  One of the volunteers – Dari Lewis taught a little class on how to do supervision peer groups which I absolutely loved.  It was actually the icing on the cake for me to continue on with my meeup.com groups and promoting peer supervision groups.

I have been sort of coasting since Mid – Nov and taking some time away from my massage business only working 2 days a week and only seeing a few clients each day.  I have some minor health issues I am working out (nothing to worry about!) I have been working on my websites and working on getting my next ebook (which you can buy now in PDF format only) into book formats – Websites that Work for Massage Therapists.   I have some more books and meetups planned for next year so stay tuned and maybe a few convention/conference appearances!

How was your year?  Here is a handy little guide to get you going thinking about how your year went.  It is really great for getting some perspective and helping to get focued for the New Year!

Year in Review  (PDF)

How to Create a Mobile Spa Business

massage concept.  It is adding the many options of spa procedures to the list of services and doing this in the comfort of the clients home.  You can do body scrubs, body wraps, manicure/pedicures,  couples massage, foot/hand treatments,  hot stone, and paraffin treatments all in the comfort of the client’s home! It is great for wedding parties or any other special occasions where women (and I would guess Men too!) just like to get together.

Helen Hodgson of www.servethegoddess.com and www.howtocreateamobilespabusiness.com,  now has created a mobile massage empire and is now sharing her secrets and methods with everyone in her new Ebook : 

5 Steps to Owning Your Own Mobile Spa Business: Reach more clients, have more freedom and flexibility.

She also was voted one of the best massage therapists by Allure Magazine and was featured in Massage Magazine, Vibe Vixen and Chill Out LA. She has also been on TV and the radio – NBC, The Benefits of Massage, E Channel, Discovery Channel and MTV.

I like the title right off the bat.  I have always been a fan of Work Less/Play More!

The other thing that I really like about this Ebook/Program that it was created by Helen as a way to solve a problem.  She started working at a spa early in her career and working long, hard hours and realized that there had to be a better way.  One of the things that she always heard clients saying was that they wished that they could all be in one room (for like a bridal shower or other group celebration gathering).  She also kept hearing that they didn’t like having  to deal with all the hassles of getting to the spa, parking, checking in and the organization of the spas.  She put the two together and created the Mobile Spa Concept – taking spa services to people’s homes.  The other part involves also hiring other people to help do the work and make her life even easier.   She discovered by hiring others, she could reach more people with massage and spa services while also providing people with jobs.

The first thing to do is to start where you are and start simply.  You don’t have to hire 10 people and offer 10 services.  See if you can team up with nail technicians or other professionals and create a team.  You can also jump right in and hire a few people  – and Helen explains how to do that too.  You’ll need a business name, a website for your business and have a plan for marketing your business.  It will help to create a niche for yourself so you can do more targeted marketing.  You will need to create your list of services, fees and figure out what you need to charge when you travel and things like that.  But don’t worry, it is all explained in the Ebook.

You can purchase the Ebook Alone or you can also get the additional coaching package from Helen Hodgson!