Increased income is just one advantage of adding massage-therapy services to your practice

In today’s competitive marketplace, profits seem all too elusive. Profits get squeezed as the cost of doing business increases and income from reimbursable fee schedules diminish.

All too often, we only look at increasing the income portion of the profit equation. Taking a much closer look at the cost component as well, may prove equally rewarding.

Offering therapeutic massage as an integral part of your practice can contribute significantly to both sides of this equation.

Advantages
One obvious advantage of adding massage-therapy services to your practice is an increase in the number of billable current procedural technology (CPT) codes that will be paid by the patient’s insurance provider.

Another advantage is the addition of a qualified health care professional to your practice. This individual can be trained to perform other adjunct therapies that your office offers.

Patient compliance and an increase in the number of billable patient visits are two more advantages. In effect, this means fewer no-shows. Patients like massage and will keep more of their appointments to receive it. Of course, when they come in for massage, they receive all the other therapies, and with them, added income.

Patients refer family and friends due to positive experiences from massage your clinic provides. This includes patients originally attending for a motor vehicle accident (MVA) or workers’ compensation and being loyal recipients of massage after their cases have been settled.

Improved communication is another advantage. Patients find it easy to talk frankly with massage therapists. Shared concerns and needs can lead to better information shared with the DC. Additional areas of concern discovered by the therapist during therapy sessions and discussed with the DC can assist in patient improvement.

Following are some issues you will need to consider in setting up massage services for your practice.

Contractual Agreements
In writing a contract agreement with a massage therapist, make it detailed and to the point.

The issues to be agreed upon should include, but not be limited to:
1) Compensation: You must determine how much to compensate the massage therapist and determine the form of compensation, such as by the hour, by the massage, or by an insurance fee split, for example.
2) Days and hours required
3) Licenses, applicable occupational taxes, and inspections.
4) Supplies: These include lotions, sanitizer, forms, envelopes, and postage.
5) Insurance
6) The term of the agreement
7) Referrals: These can go in both directions; address them up front.
You may even find some point where an incentive can be introduced to sweeten the deal.

Setting It Up
A multidisciplinary practice that includes massage can be set up basically in one of three formats:
1) A massage therapist is an employee of your practice.
2) Massage is contracted out.
3) Massage is performed by a contract therapist in your office.

In deciding between these formats, consider the following:
Too often, chiropractic practices mistakenly offer massage in too small a space. If this is the case, the massage therapist will not be happy for very long; but more importantly, your patients will not be, either. The right space will result in them returning for more.

Your personal preference or how your office is set up will determine who you want to do the billing for the performed massage services. The standard is to bill in house. If for some reason this does not work for you, the therapist can bill and send you your percentage of the fee.

Do you want to acquire the necessary licenses for offering massage at your office? In Florida, a massage-establishment license—in addition to occupational and professional licenses—is required for all physicians offering massage in the office. Check the requirements in your state.

Chiropractic/Massage Combo
How effective is the combination of chiropractic and massage? I spoke to Paul K. Christian, DC, of Tampa/St Petersburg, Fla, who said his office has seen improved patient compliance and his patients have kept a greater percentage of appointments with massage therapy being offered at the office.

He says he has also noticed improved patient communication. “Patients find massage therapists easy to talk to and are willing to share their needs with regard to their condition and on going treatment,” he says.

Christian also says a competent massage therapist may find additional areas that need attention, which results in Christian being able to make a more complete diagnosis. Other advantages noted by Christian are:
• with massage, patients get more complete and longer-lasting relief, and
• mobilization without muscle work for his MVA patients is not as effective.

The Interview
When interviewing a massage therapist to become a part of your team, here are some factors that will help you make an informed decision.

Ask to see a copy of the therapist’s massage license or certification. Those on top of their game will carry a copy with them.

Review the resume. How long has he or she been a therapist? Experience comes with years worked, but enthusiasm and moldability come with youth and inexperience.

If you have the time to train, a newly licensed therapist may just fit the bill.

Where did they receive their massage training? What continuing-education courses did they take? Continuing-education units obtained in neuromuscular therapy, myofascial release, trigger-point- release therapy, lymphatic drainage, craniosacral therapy, sports massage, active isolated stretching (AIS), and proprioceptive neuromuscular facilitation (PNF) stretching are all very helpful in performing successful clinical massage.

A solid background in Swedish massage is a good foundation on which to build.

Also ask about:
• other degrees or schooling;
• past work history;
• references;
• how flexible are they about days and hours to be worked;
• their willingness to learn and perform additional modalities in your practice; and
• how well they communicate verbally and in writing.

Referrals
Here are a few examples of when referring to a massage therapist is a viable option: Your office does not have sufficient room to offer quality massage; your massage therapist may be ill or on vacation; and specialized massage modalities needed are not available in-house.

The referring licensed massage therapist (LMT) will offer a turnkey operation from billing to progress reports.

In arriving at your decision on which massage therapist to refer to, here are some factors to consider:
1) The experience and training of the therapist.
2) Communication. This is a very important issue, especially since the therapy is being performed off site. Complete and detailed SOAP notes, along with good verbal communication back from the therapist, is critical to an effective working relationship.
3) Does the massage therapist refer patients back to your practice?
4) Are there any references offered that you can verify and feel comfortable with?
5) Are your patients ultimately experiencing good results? Are they getting better and want to continue receiving massage from this therapist?
6) Specialization: Lymphatic drainage, neuromuscular therapy, myofascial release, and trigger-point therapy are some modalities for which you may want to refer out.
7) Availability of the therapist’s office. Is it easy for your patients to get to their scheduled appointments?

In addition, it is important for the DC to define and communicate his/her expectations to the massage therapist.

In referring to an LMT, the DC should include the diagnosis code, CPT code, and comments and instructions.¹

Patients like massage. They feel better after receiving massage, and the positive effects last longer. Patients are therefore more inclined to keep their scheduled appointments. This means less time on the phone for your staff tracking down patients and prodding them to keep their appointments. With increased visits, patient conditions improve, the staff stays off the phone, and more therapy sessions are billed.

Usually, massage therapists are easy to work with. Take care of them, and they will take care of your practice. All this leads to an improved return on your investment. CP

Ron Frers, BS, AAS, LMT, shares an office with a chiropractor and also has a private sports massage practice in Tampa and St Petersburg, Fla. Contact him at frers@verizon.net. 

Reference
1. McGillicuddy M and Solien-Wolfe L., What massage therapy brings to the table. J. Amer Chiropr Assoc. 2005;42(2):10–13.