The Future of Massage/Bodywork In Healthcare

I had the pleasure of attending a symposium called The Future of Bodywork: Surviving Corporate Healthcare last night put on by Jack Blackburn and the Trillium Institute in conjunction with Brian Utting and the Pacific Northwest School of Massage and wanted to share my impressions and insights as we move forward in WA State as health care providers.

Deborah Senn, our past insurance commissioner who created the ‘Every Category Law of Providers”  (WAC 284-43-205) was the first to speak.

“Patients want us in the healthcare system!”  According to studies done by David Eisenberg in 1990 and in 2001, 40% of the US wants complementary and alternative medicine (CAM) as a part of their care.  80% don’t tell their doctors that they do!   CAM providers are the future of healthcare.  Massage therapists are CAM providers!  (My Heal-wa.org seems to be down so I can’t find the studies!  www.heal-wa.org is a resource that WA State LMP’s have that allows us access to research papers for free!)

In 1993, Senn created the Every Category Law as a part of the 1993 Health Care Reform Act.   Two years later, that act was repealed but luckily the Every Category Law remained in tact.  Nine insurance companies sued the insurance commissioner and over the course of 3 years, the battle ended in the 9th Court Circuit of Appeals decision to keep the law intact followed by the US Supreme Court decision in Jan 1999 to deny the Writ of Cerioriari leaving the Ninth Circuit Court of Appeals to stand.

(1) Issuers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits, as defined in WAC 284-43-878 and RCW 48.43.715, for individual and small group plans; and as covered by the basic health plan, as defined in RCW 48.43.005(4), for plans other than individual and small group

What does this mean?

There is legal precedent to have this happen in every state if someone/some organization/some group would just stand up and help to implement it all.

2010 and the Affordable Care Act comes along with section 2706 which I have previously written about in 2013 Getting Massage Covered by Health Insurance  which states is based on non-discrimination:

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.

2706 applies to all plans and all carriers.  That means that it should apply to ERISA Plans too (See US Dept. of Labor Explanation) – you know those plans like that of Microsoft and other large companies that create their own insurance plans for their employees and hire other companies to mange them.   So why aren’t those plans currently paying?   The question was never proposed or answered.

Senn is also a professor at Yale (or was it Harvard…I can’t remember) teaching insurance and she has her students doing the research of finding out which states are implementing 2706 and which are not.  It depends on what states have chosen to implement their own system or to use the Federal Healthcare system.  Her findings so far is that no states are implementing 2706 — so whats a massage therapist/CAM provider to do?

The only group I know of who is working on this is the IHPC (www.ihpc.org).  They hired Senn briefly to start the process but are lacking in funding to go much farther right now.  See Alert: IHPC Launches Campaign with Insurance Commission Deborah Senn to Secure Non-Discrimination
They have just created www.covermycare.org to help get the process rolling.

In my opinion, the massage organizations have fallen behind in this across the US.  Of course the exception is AMTA-WA which has been on this since the ACA and 2706 was made into law.  They hired Diana Thompson and a team of researchers to write a paper to show the WA State Insurance Commissioner that massage was indeed part of the 10 essential benefits. (See Summary of Evidence: (PDF) Massage Therapy is an Integral Component in the Affordable Care Act?s Essential Health Benefits )

 New Massage CPT Codes for all!

Susan Rosen who is a massage therapist in WA State and is an active member of AMTA-WA and AMTA National who was also instrumental in helping to integrate massage into health care under the Every Category Law.  She is currently working on the new CPT codes for Therapeutic Interventions for body Structure and Function through the American Medical Association Current Procedural Terminology (CPT) Health Care Professionals Advisory Committee (HCPAC).

Yes folks 97124, 97140 and 97112 are going far far away….they will be ‘crosswalked out’ (which I don’t know what that means yet!)   The new codes are NOT public knowledge yet and if she told us, she would have to shoot us!  (I was so lucky to be involved in the testing process so I have seen the codes and the same applies!  I feel like I am part of a secret group! Frankly the first thing I said after the study was holy crap – and had many thoughts of moving to a total cash practice but that was just the shock of all the changes….or maybe not!)

The codes are being set by a workgroup of practitioners from PT, OT, and Athletic Trainers.

The codes will be based on the level of complexity of the clients condition and the clinical decision making process, comorbidities and complexity of how you approach a clients care.  Comorbidity is  the presences of other diseases and conditions, like having diabetes and having a hamstring pull.   Physician codes already do that.  The date for the release of the codes is Jan 2016 but Rosen was skeptical that the date could be met.    When the new codes do come out there will be much to do in working with the insurance companies to set the allowable fees.

Also article on CPT codes in AMTA-WA Journal (PDF)  by Susan Rosen (Page 22).

Rosen recommends we continue to improve our communications and networking with other healthcare professionals to help bring us into this new age of healthcare.

Michael Hamm was the MC and also one of the speakers.  His background in research and teaching made me think more about what we need to do to start communicating better with clients and other healthcare professionals.  It is also about how can we preserve our authenticity in the face of the grueling insurance companies.  We need to start talking about meaningful activities.  When does a client actually know the are ‘better’?

Marissa Brooks who is a past member of the State Board of Massage and currently Director of Health Improvement Programs for the Health Benefits Trust talked more about what she sees happening in healthcare.

Glynn Desmond is one of the AMTA National Member at large and also the owner of the Monroe Therapeutic Massage Clinics around the Seattle area, helped clarify why we don’t have much say in what insurance companies pay us.  Hospitals have much more negotiating power because of the size of the organizations.  If massage therapists try to rebel and fight the system, the main option is to leave the network but the insurance companies don’t really care as they will get more massage therapists to fill their spots.

Questions and Answers

The main questions were around what can we do to get the insurance companies to pay us more and also to get their lists open so that more can become providers.  There is no answer really other than it takes money…we need to hire more attorneys and lobbyists and people to stand up for us.  We do have the AMTA WA who has been doing this consistently through the many years but it just takes more money.

The AMTA WA did get their lawyer to look into the issues with Care Core in limiting the number of treatments they approve through the pre-authorization process which limits sessions to 4- 6 sessions no matter what the condition – if they fell down the slopes skiing or just tweaked their shoulder brushing their teeth- the number of sessions is the same.  Personally, I find the pre-authorization process frustrating but I can also see that it is limiting maintenance massage which is not paid for by health insurance companies.   I do not know how they have come up with the number of sessions that it takes to heal various conditions which is something that needs to be explained.  Senn mentioned that the acupuncturists were also looking into this and I do know that the chiropractors were fighting this without success.  Senn recommended that we contact the Office of the Insurance commissioner with our concerns and most importantly have your clients who are frustrated with the pre-authorization process contact them too.  A fax blitz is recommend if we could ever get our act together! (oh but it looks like they have taken their fax number off of the website – I wonder if it was after someone fax-blitzed Senn!) .

As far as getting them to pay us more…well we can’t approach insurance companies through AMTA-WA or any organized group as it will violate anti-trust laws around fee setting.   There is always talk that a Union is needed for that but when most MT are self employed, I am not sure how that would work.

The other thing is to get any further in healthcare we will most likely need more education requirements.  It is “Lucky” really that we are able to do what we are doing with only 500 hours of required education for licensing.  The State Board of Massage has been talking about increasing the hours of eduction so we will have to get involved in that.  You can keep up to date with everything that is going on with the Massage Board by signing up for their listserv and by going to the meetings (but I am sure you all do that now anyways – right?)

What else can you do?

If you are in WA State:

• Join AMTA-WA or make a donation to AMTA-WA
• Get involved in the government relations committed of AMTA-WA
• Get involved with one of the AMTA-WA Units to keep informed of what is going on
• Write to the Insurance Commissioner and keep them informed of the issues
• Contact your provider representatives of the insurance companies you are in network with
• Get your clients involved to contact the insurance companies and the insurance commissioners
• If you are looking to get on the provider lists, call or contact the companies weekly.
• If you are looking to get on the provider lists, start with the current provider list of massage therapists and contact each one of them and ask if they are still accepting new clients. Keep track of who is and also keep track if providers have moved or left you area.  Contact the insurance companies with this information.

If you are out of WA State and want to be able to bill health insurance:

• Contact your local AMTA chapter to see if they are doing anything to implement 2706 in your State.  If they are not doing anything, see if you can start a committee to do so.
• Contact your States Insurance Commissioners office and ask them what needs to be done to get 2706 implemented and start working with them to implement it.  You will need to hire attorneys and lobbyists to get involved, so it is best to start with AMTA to get organized as they have more influence in this area.
• Start your own organization like they have in HI to start getting integrated into Healthcare.  See Hawaii Massage Association – Run Away from 2706 (They have other issues with 2706 concerning native healers who would also be included in 2706 and thus would be able to bill for insurance.)
• Start learning how to bill insurance.  In most states you can bill for car accidents and workers compensation.  You can purchase my ebook on this for starters and join my private Facebook Group to start learning what needs to be done to bill.
• Start working with Doctors, Physical Therapists, Chiropractors, Naturopaths and join with them in for improving patient care and also for organizing to work with insurance companies.
• There are already many businesses providing insurance for their employees that DOES cover massage.  BCBS of IL does for starters.  That is without having laws in place.   Start finding out if you can bill certain insurance plans in your state.  Join my group Massage Practice Builder on Facebook to start sharing information.
• Vote and elect an insurance commissioner that will work with you to implement 2706 or that supports massage therapists.  I asked Deborah Senn about 5 years ago what needs to be done in other states and she just said that they need someone to stand up for them like she did.
• Get involved with IHPC  and their cover my care program and find out what we can do to support them and move this forward – $$$ /Time
• Learn the history of  health care integration how it came about in WA State and learn from them/with them through AMTA.
• Contact AMTA National to see what they are doing as far as hiring a National Lobbyist Team and Attorneys and to get more money and assistance to the State Chapters.
• If you are an AMTA member, you need to vote to make sure the right people are there to lead us into the future.
• Get involved someway, somehow, some time.   (A comment was made at the symposium that there were a lot of familiar faces there.  The same people are most ALWAYS involved and (my insight here) the complainers just keep complaining.)

The evening was jam packed with information but I have to say not much was news and there is still much to figure out.  We need to keep the discussions going on this throughout the state.   You can join me at our local NW LMP Support Group at www.meetup.com or continue this at the AMTA-WA Convention in April 2015.

Why do I keep pursing this with so many challenges?  There is power in numbers…what if massage could be the first response to pain, injuries, diseases and other conditions?

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