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One Massage Therapist’s Perspective on Massage Therapy Ten Years From Now

By: Vivian Madison-Mahoney
2008 Massage Therapy Hall of Fame


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Vivian Madison-Mahoney knows first-hand the challenges & problems you face beginning your massage practice and incorporating medical referrals and accepting insurance for payment. She began just like you. After about a year of working out-calls at the rate of 6 to 8 (full hour or more) treatments a day, she opened a massage therapy practice that specialized in injury, disability, physician referrals, & insurance related cases.

She is a regular columnist for “Massage Today” Magazine. She also writes articles for the “AMTA Florida Chapter Journal" Newsletter and the FSMTA's “Massage Message" Magazine and advises these associations about insurance related issues.

I have been asked to provide “my opinion” on where I see the massage therapy profession 10 years from now. I think it would be interesting to hear others perspectives on this as well. How would you answer this? We all know, anything foreseen or predicted can often be changed with our thoughts and the actions we take.

How do I see Massage Therapy in 10 years? It is truly up to us!! Throughout the years I have often asked myself, “where will massage be in the future?”

Because I am not a visionary or psychic, nor do I pretend to be, what you will get here is strictly from my own perspective and personal observations.

Having been a licensed massage therapist for nearly 24 years, I’ve watched tremendous changes and the phenomenal growth that has opened so many new and exciting opportunities for massage therapists and bodyworkers. I’ve personally viewed and experienced escalation in the professionalism of massage therapists, in our training and in our ability to work with other professionals.

Over the years we’ve opened countless new doors, gained respect and admiration from top professionals such as physicians including chiropractors, attorneys, hospitals and insurers, insurance company‘s auditing and fraud investigative departments, and last and most importantly, the public from all walks of life. It has been the average people who for the first time have experienced the benefits of massage that has created much of the extensive growth in our profession. We have all worked long and hard turning around what once was considered massage only for the wealthy or considered other than what we would deem professional, to now making massage therapy the health care and wellness procedure of choice by thousands of people.

Things swiftly improved for massage therapists’ as open-minded physicians began referring their patients out to us. Massage therapists were successfully supplementing their income by direct billing some insurance for their services. I saw the level of training escalate beyond basic Swedish massage to where we could learn multiple and varied techniques and procedures that benefit all sorts of medical conditions for our clients/patients.

I’ve witnessed and participated in the outstanding growth of insurance acceptance by massage therapists. This opening created new and varied positions to increase earning abilities while helping more people improve their health and medical conditions, all while learning about massage therapy for the first time because their physicians ordered massage for them through a prescription for these services. I even experienced insurance companies willingness to referring their subscribers or worker’s compensation claimants to massage therapists. We were on a roll, growing and expanding upwards and outwards!!

In the past couple of years or so I began to see quite a different turnaround. While what I mention below is not the norm it is a rapidly growing trend.

I hear from massage therapists from across the country stressed out and complaining about the following issues: “Physician’s hiring with minimal fees while the physician bills excessive amounts for massage therapy services, that spas are overworking them, that physicians are dictating to independent contractors what type of treatment session they are to provide such as body areas, time and location”. They state that, “physicians, including chiropractors, are not paying them, or not paying what is due or when it is due, or that physicians are no longer referring patients to them because they are keeping massage within their own offices, or that they (the massage therapist), refer patients to physicians who in turn refer the same patient to another massage therapist or else they retain the patient in their own office for massage services.

They say, “insurance companies are denying, delaying or reducing their claims, that cash flow is sluggish or they don’t know how they’ll continue in this business, that there’s an over abundance of therapists because too many schools are graduating new students in their area.” And the list goes on.

I hear employers complaining that massage therapists are not as reliable or as efficient as they used to be in years past, or that they want more money and want to do less work for it, or that they want to tell their employer how they should run their business.

I thoroughly recognize and we all appreciate those noble massage therapists who have always done it right, who are successful, and who have worked hard to help raise the image of massage. It is not those therapists who are being referred to herein.

I hear clients complain that the massages received are nowhere near like they used to be. They complain of disproportionate fees, stating that they can no longer afford massage therapy and will have to just suffer the pain instead of enjoying the benefits they used to enjoy. Patients say they, “request a therapist outside of their physician’s office but are made to receive treatment from the physician’s therapist.”

How do I see Massage Therapy in 10 years? It is truly up to us!! As time goes on I “see” us sitting on a fence. If we do not keep this service within the reach of everyone, if we limit to only those with big bucks, if we don’t make investments in continued learning in both hands on techniques and how to work with legal and medical cases, if we become complacent in our treatment to our clients, (I’ve received a few massages myself that were far from worthy of payment, let alone repeat business or referral) and if we allow the above, we are heading down a road of want, need and despair. We all know it only takes a few bad ones to spoil it for the profession. Who is to blame? How do we change it? Where do we start? Can it be changed?

Regarding Insurance Billing and Working With Physicians: In almost every case where therapists consult with me and provide documentation I can show them where their own mistakes or lack of knowledge in the insurance realm caused the problems they experienced. As for where I see the insurance aspects? If therapists continue to bill insurance without having and following proper education, insurers, employers and physicians will see us as knowledgeable about what we are doing. Ultimately they will lose respect for us. Insurers will find ways to eliminate us from direct reimbursement where we are now enjoying those benefits. And where we are still trying very hard to be included in reimbursement (in most health care policies) we will be dead in the water before we get off the ground.

Regarding working with physicians: Sometimes we need to realize when we depend on others for our income we must understand that they have astronomical overhead expenses to meet including payroll. If we don’t like the arrangements, then we must consider owning and running our own businesses. When we own our business we see it from a different perspective. Sometimes it takes sitting down with the employer/physician and explaining your situation and working things out. When it comes to independent contractors, do you have a solid, attorney reviewed contract that’s a win-win situation for all involved? Another thing, as long as there are therapists who are willing to work for minimal pay there will be employer’s willing to hire.

I foresee that because of the economic situation currently facing our country, the average person will not be able to obtain our services unless and until things change for the better. It’s the average men and women who, when they could afford massage or those covered by insurance, actually came out in numbers to make massage therapy more well known across the country. Accepting insurance, if and when possible will help more of the average people to obtain massage services. Lowering fees will help and providing top notch service will help because they will see that massage benefits are worth the money even if they have to do without some other impending needs or desires.

No, not everyone will be hurting in the future: There are those who have been in business for years and who have solidly built their businesses. They have taken the time and invested the money to obtain the training to build a reputation. I always say, “Build a reputation and your business builds itself.” It’s the majority of therapists I worry about if things keep going in the directions I have been seeing lately. Massage Therapy will return to where it was many years ago, only available for the wealthy.

What about insurance coverage in the future? I thought by now with the reputation we began to build that more health insurers would open the doors for massage therapists. Here is what I see when it comes to insurance coverage. I see the need for our National Massage Associations to stand up for us, to work towards requiring insurance to cover massage therapy for those therapists who wish to participate and to help those clients who need massage but who do not or cannot receive it either because of financial reasons or because of lack of knowledge about our services. I see the need for our National Massage Associations to help open doors so that we can help the thousands of Vets who will be returning from war who will desperately need “touch” therapy, to help those who are in pain, and recovering from surgery. They need to once again open doors for us to provide lymphatic drainage treatments to those who desperately need it, to cover the services of the infirmed, disabled, ill and those in Hospice dying in pain or in rehab centers or nursing homes needing to be “touched” to health.

These are the reasons for the need to increase insurance coverage directly to licensed, trained or certified massage therapists or bodyworkers. If not our national massage therapy associations maybe we need to form another association that will focus on these specific needs. An association whereby we can unify and train employers on the true benefits of massage for them and their employees, to help them to reduce medical costs within the workplace. We need to educate employers how they can help employees prevent repetitive injuries, to keep them on the job to reduce workers’ compensation claims all by including massage therapists as directly covered providers (always with a physician’s prescription).

Where do I see massage therapy 10 years from now? It is up to you and me. What are our united goals? Where do we want to take massage therapy in 10 years? What will each of us do and how can we work together towards reaching those goals? How do YOU see massage therapy in 10 years?

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