With job-related stress accounting for an estimated $16 billion in Canada ($300 billion in the United States) and repetitive strain injuries (RSI) estimated to affect one in 10 Canadians, massage therapists have an opportunity to position themselves as allies with industry in keeping claims for workplace injury – and ancillary costs in lost workdays, turnover and employee dissatisfaction – down.
Despite the impact of these workplace-related illnesses, many employee benefit plans are being scaled back. Employers are wanting reliable outcome measures and proof that their invested dollars are yielding healthier, more productive employees. Coupled with an increase in massage therapy insurance fraud, RMTs are at risk for losing a major source of funding for patients.
Report from the Field
I posed the question on Facebook, “Have your workers-with-benefits changed their utilization of massage therapy?” Respondents shared the following:
- EHBP (employee health benefit plan) claim adjudicators are calling to confirm if massage treatments indeed were provided and received. Some are asking for formal treatment plans.
- EHBP brokers merge coverage for several disciplines of what was previously an allowance for each discipline/service provided.
- Insurance coverage per session is capped, causing claimants to examine how to pay for care and forcing RMTs to consider changing their service fees and delivery models.
- Patients/clients are staying within bounds of EHBPs, reporting less discretionary income in a down economy to spend on paramedical care.
- Claimants want practitioners to direct-bill the insurer, instead of paying out of pocket and waiting for reimbursement.
- With the rising cost of claims/benefits used, employers may resort to offering raises or other incentives in lieu of providing benefit plans.
- RMTs are being asked for printed invoices and statements; written receipts are no longer accepted.
- One RMT shared that her name and registration were used fraudulently by another health-care provider. This RMT has had problems ever since with billing a major insurance carrier.
- Claims/online billing for non-commercial (home-based) practices are being denied; apparently insurers suspect home-based practices perpetuate a higher instance of fraud.
A claims adjudicator told an RMT some claimants are committing fraud themselves, submitting bogus receipts with RMTs’ registration info and forging signatures. (Hence the requirement for printed statements.)
Some insurers have antiquated forms – RMTs are challenged to find proper forms.
Some RMTs expressed suspicion that insurance claim processors and policy makers purposely put barriers in place to reimbursement of claims, discouraging practitioners or claimants from submitting claims or seeking reimbursement.
It appears insurance companies are tightening anti-fraud practices and, while certainly necessary, this has clear implications for the small, sole-practitioner practice, especially if working from a home-based office.
Threats to Employee Health Benefit Plans
Recession plus surplus workers-to-jobs
Employee health benefit plans available to post-Second World War baby boomers were used to retain skilled workers at a time of skilled-worker shortage and surplus jobs. Massage therapy practitioners, as well as those working in chiropractic, dental, physiotherapy and other health disciplines, benefit from this generous source of funding. In the current North American recession, there is a surplus of workers and not enough jobs. Employers needn’t offer benefits to retain workers.
Which services should be covered?
Employee benefits have been used to supplement salaries and retain employees, but tangible cost-savings regarding the capability of paramedical services getting injured workers back to work faster are in question. Reporting on employee use of workplace benefits, Danny Peak, senior manager of Private Payers and Strategic Partners, describes results from the Safoni Aventis Healthcare Survey 2011, noting, “Plan members and plan sponsors alike recognize the value of health benefits, yet we appear to be standing on a precipice. On the one hand, we are on solid ground with respect to traditional benefits, such as drug and dental, which seem to deliver an immediate return. The growing availability and utilization of paramedical services suggest an increased understanding of the value of longer-term, more holistic self-care. Perhaps most significant is the emergence of the workplace as a viable, accepted platform for health education, maintenance and promotion.
“On the other hand, ongoing challenges threaten to throw us off balance. The pressure of containing costs makes it difficult to maintain plan designs, let alone explore new approaches to employee well-being. Despite growing evidence of their benefits, workplace wellness programs suffer low participation rates and very few plan sponsors measure ROI (return on investment) in a rigorous way.
“Employers lack systems to track workplace programs and only a handful among the leading organizations are aligning workplace health programs with a broader goal, such as human capital management or workforce productivity. Poor organizational health, particularly stress in the workplace, casts a shadow over employee engagement. Last but not least, baby boomers have just begun their encounters with chronic disease – and too many are unprepared for, or even unaware of, their responsibilities in preventative care and chronic disease management. Similarly, only a minority of employers are seeking out measurement and support tools in chronic disease management.”
It’s evident that, despite billions of dollars spent by employers, there’s been little proof-of-benefit to financing the invoices of numerous practitioners all billing against generous employee health benefit plans.
Practitioners must do their part to show relevance of care through proper outcome measures and must encourage their associations to push for independent research to prove that paramedical interventions make a real difference to industries in cost savings and more productive workers.
Insurance Fraud Sounds a Death Knell
In 2010, CBC went undercover to report on a spa writing legitimate RMT receipts for illegitimate services. With hidden-camera in place, CBC showcased the shady practices apparently epidemic in the spa industry. Insurance fraud does not bode well for a profession already on the ropes for insufficient evidence-based practice and lacking equivalent education (i.e., degree-level program) compared to other health disciplines. With a tightening of dollars in a recessed economy, massage therapy associations must cultivate credibility with the insurance industry.
Brenda Locke and Lori Green – executive directors of the Massage Therapists’ Association of British Columbia and the Massage Therapist Association of Saskatchewan, respectively – have made it their mission to address the insurance industry’s concerns about fraudulent claims for massage therapy care. On behalf of the Canadian Massage Therapist Alliance (CMTA), they have attended the Canadian Life Health Insurance Association (CLHIA) conferences to foster relationships and improve credibility of the massage therapist profession in the eyes of the insurance industry. What began as an adversarial situation has now become an opportunity for consultation and collaboration. Advocating for continued insurance coverage for massage therapy care is just one example of the benefit of a national massage therapist alliance.
There is a Bright Spot!
Benefit plans are seen by employers as an expense, with little accountability by practitioners to prove cost-savings and higher quality of life and productivity for workers. A real threat exists in that massage therapist insurance coverage in employee benefit plans, auto insurance and worker’s compensation claims are at risk.
RMTs and their professional associations need to reframe their services as an investment in improving recovery from workplace accident claims, reducing employee turnover and other negative costs associated with job-related stress and workplace-related musculoskeletal disorders and assist the recovery of the North American economy and its businesses.
Only then can a clear argument be made to keep massage therapy on the list of employee benefits, bypassing traditional health care coverage and proving savings to a business’s bottom line.
|CMTA Advocates Massage Insurance Coverage and Anti-Fraud Initiatives
I recently spoke with Brenda Locke and Lori Green – executive directors of the Massage Therapists’ Association of British Columbia (MTABC) and the Massage Therapist Association of Saskatchewan (MTAS) respectively – on the initiatives by the Canadian Massage Therapist Alliance (CMTA). In particular, we discussed the advocacy for inclusion of massage therapy care in rehabilitation and wellness of workers as funded by their employee health benefit plans.
Locke attended the Canadian Life Health Insurance Association (CLHIA) conference in Whistler, B.C., in 2008 where she outlined the regulatory framework for massage therapy in British Columbia. Green joined on the following year.
As well, MTABC’s director of research Bodhi Haraldsson presented evidence in favour of massage therapy care at the 2008 CLHIA conference.
Representing the CMTA, Locke and Green have attended the CLHIA every year since, anticipating that solid relations with the insurance industry are essential in ensuring claimants can continue to access massage therapy care. Locke and Green acknowledge the insurance industry has many valid concerns: the unregulated status of some provinces, difficulty in identifying registered massage therapists for insurance claims, whether professional standards are ensured, and why all of the provinces are not part of CMTA. Current CMTA members include British Columbia, Saskatchewan, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland/Labrador and the Northwest Territories.
Green goes as far as to say that major providers of health and dental insurance considered removing claim coverage for massage therapy due to escalating fraud and concerns regarding standards and identifying providers. She states MTAS receives calls daily to ensure massage therapy claims are legitimate and providers are registered with their association. Green suspects many insurance adjusters end up rejecting claims because it is very time-intensive to research the credibility of claims and the providers writing the receipts.
Locke adds that insurance companies are agreeable to pay for medically-necessary and legitimate massage therapy services, but they want the help of a national massage therapy body to ensure credibility and to “set the bar.” Locke and Green share that while the CMTA was once on the defensive – particularly after CBC media coverage in 2010 of fraudulent invoicing for massage therapy at a downtown Toronto spa – the organization is now welcomed by the CLHIA and consulted on its perspective. For example, in a best-practices discussion regarding how to improve insurance receipt design issued by providers, the CMTA was acually consulted. CMTA representatives have also attended conferences held by the Canadian Health Care Anti-Fraud Association (CHCAA).
In an informal survey from their trade show booth at the recent CLHIA conference, CMTA representatives discovered insurers want two things: a national registry of RMTs to confirm legitimate practitioners, and a standardized receipt.
Locke and Green agree that continuing to build relationships with the insurance industry and being proactive to maintain credibility and discourage fraud are key CMTA initiatives, and that the CMTA would be stronger with representation from all the provinces and territories in Canada.
In addition to advocating for massage therapist inclusion in employee benefit plans and preventing fraud, the CMTA’s mandate includes supporting research and scientific inquiry, regulation and professional standards. Visit the CMTA’s website at http://www.crmta.ca/?page=10 .
Don Dillon, RMT, is the author of Massage Therapist Practice: Start. Sustain. Succeed. and the self-study workbook Charting Skills for Massage Therapists. Don has lectured in seven Canadian provinces and over 60 of his articles have appeared in massage industry publications in Canada, the United States and Australia. Don is the recipient of several awards from the Ontario Massage Therapist Association, and is one of the founding members of Massage Therapy Radio www.massagetherapyradio.com. His website, www.MassageTherapistPractice.com, provides a variety of resources for massage therapists.