Manual Therapy on Trial. But why?

​There has been a lot of discussion regarding many manual therapy interventions and efficacy. Forever. As of late, these questions have come from insurers, which has made many therapists worried about their ability to continue to nurture practices that allow them to make a living. Whether insurers will or will not drop massage therapy, or any other “paramedical” expense, is not the focus of this piece, but rather HOW manual therapists can position themselves so that they are valued.

What's the deal with the money bits of all this?

Here are my thoughts...

   It's expensive for insurers to pay out when you use up all your healthcare spending

   When they notice a trend of high spending in one paramedical category they start to look    into why (read: bottomline management stuff)

   When there isn't sufficient, scientific data to support the why their assumption is “because people like it” and that is not a good enough reason to fund it. (I like pedicures but sunlife hasn't paid out a single pedicure I have submitted)

   This is the scary part. Now because they don't have a good enough why, they start to introduce negotiations for less coverage upon renewal or hike up premiums to deter said paramedical expense from being kept on plans. Uh oh! Enter some pretty upset therapists
 
 To help build their case, insurers have been taking to smear campaigns, like the recent GreenShield attack on massage therapy, which included guilt trips for those who decided to use massage identifying them as villains taking medicine from babies. Seriously, this actually happened. This is when therapists unite to rise up against this bad press and urge the insured to stand up for the right to preventative care. OORAH!


So insurers bad, therapists good. Right?

#disagree and here's why...

When therapists aren't rallying together because of some outside force threatening their livelihood, some are using garbage “facts” to promote their businesses like, “getting a massage is like sleeping for 8 hours” or “it will flush out toxins” or one of my faves “your muscle isn't aligned properly so this will put it in better alignment.” Eeek! 😳

So do you see the problem here? Not yet? How about these? I have seen massage packaged with tarot card readings, therapists offering up their opinions about vaccination within the context of their clinical practices, and some offering treatment for emotional and physical trauma waaaaaay outside scope. Just the tip of the very unprofessional iceberg, unfortunately. 

What do insurers see? A whole pile of BS that they are having to pay for.


What is the solution?
Not completely sure, but here are some.

1. Stay in your lane. Stop promoting, advertising, publicly discussing things that are not within your scope and just plain don't make sense. This means you may have to do your due diligence and research what you're saying, doing, promoting so as not to misrepresent or step outside of scope. You don't need to be all things. You need to be good at your thing, find others good at their things, and build a referral network.
2. Educate yourself. There is a requirement for most, if not all, healthcare professions that continuing education be central to professional development. Take courses. Talk to colleagues. Find a mentor. Make sure what you invest in is worth your time and offers up a bit more than anecdotal evidence to support its use. Nothing wrong with some fun, just for the heck of it courses, but this should be the exception not the rule. 
3. Position yourself in the trend. This is the one I think we need to look at seriously, as a collective group of professionals. The trend now to look more at the biopsychosocial influences in healthcare offers up the opportunity to have a depth and breadth deeper and wider than what happens in a clinic or on a treatment table alone. We have always been postponed here, but now is the time to draw attention to it, and be explicit with how we fit in and contribute. 

Biopsychosocial Positioning
Manual therapists are strategically placed in a position that can greatly influence peoples lives in so many ways. Well informed, honest, ethical practitioners are able to not only address the obvious physical concerns (biological) but by doing this, and the manner in which they do it, influence the psychological and social concerns of the individual and within a community.

1. The BIOLOGICAL is fairly obvious. This is what foundational education and continued learning facilitate within a healthcare profession. Our interview, assessment, treatment and plan management skills allow us to help treat the sore back, the stiff knees and the soccer injury. While this one should happen pretty easily, there are holes in education, holes that need to be filled by appropriately selected continuing education. Choose correctly and you up your clinical skills and success, and position yourself as a trusted professional.
2. The PSYCHOLOGICAL. Whoa! Pump the brakes. Isn't this outside our lane? Yes, but no. The psychological effects of chronic pain, stress and repeated injury are far-reaching and significant. If we position ourselves to provide evidence informed (not based, there is a difference) care that gets people feeling better, moving well, and co-care with those that can more directly influence psychological stressors then we DO address these factors, and minimize their effects.
3. The SOCIAL. The financial strain of being in pain is crippling (pardon the pun). It also may influence relationships and mean missed work, dance recitals, birthday parties and vacations. If we, as practitioners, can provide care that gets people better sooner, and out of care sooner, this means improved attitude, outlook and better financial health (less psychological stressors). It also means that a person is more able to take part in social interactions that improve mood and happiness. Wait. Less treatment means less money, no? Maybe in the short term, but it also may mean that therapists aren't viewed as money-hungry leachers of healthcare plans. Guess what insurers think of that? They like it. If therapists are off the radar of penny-pinching insurers then their livelihoods feel just a tad more secure, and the short term less money thing doesn't turn into a long term less money thing. #win

In an article written for Massage Therapy Canada, Donald Quinn Dillon RMT says that,

Massage therapy should position hard in the bio-psycho-social model, linking to benefits in mental health, sleep quality and returning injured workers to work. Our profession should look for strategic alliances and pool resources to campaign against the image of profit-focussed, insurance-exploiting practitioners to contributors in public health and economic accountability.


All kinds of yes to that. 🙌🏽


(Link to the Massage Therapy Canada article: https://www.massagetherapycanada.com/insurance/insurers-question-value-of-massage-therapy-–-a-signal-of-changes-to-come-4778)

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