UPDATE: Since my press release (Yes Doctor, Massage IS Medically Necessary, Part I) I have been informed by two organizations that they suspect the reason massage is not offered through home care agencies may be 1) home care services have to be "medically necessary" in order to be covered and massage doesn't fit into that category, 2) they run the risk of massage being considered an illegal gift used to lure patients toward one company vs. another, 3) it would be an "add-on" expense to the patient with no reimbursement option, 4) that Medicare and Medicaid do not cover massage therapy & the majority of home care clients utilize Medicare & Medicaid as their payment method, 5) there's not a "need" for it, and 6) there would likely need to be laws changed in order to get Medicare & Medicaid to cover massage. On all six accounts, once again, massage is misunderstood. Grab a cup of your favorite source of relief and have a seat, this one is a long one!
1-- (Home care services have to be "medically necessary" in order to be covered and massage doesn't fit into that category.) Wrong, massage DOES fit into that category. It falls under "rehabilitation" on a medical bill. Massage is no less medically necessary than an aide going into a client's home and helping them to pay bills, run errands, do housecleaning, cook a simple meal, remind them to take their medication, bathe, get dressed, etc. Insurance pays for those services. What deemed those services medically necessary? Either the client was incapable, it was unsafe, OR it was uncomfortable due to illness or injury. Providing those services offered them either with something they are incapable of doing themselves, a safer environment for them, or RELIEF in having to do it. Massage, over time, can actually help people do things they haven't been able to do in a long time. It can provide a better conditioned body which is safer for the patient who has to move. It can provide a safer environment for the bed-bound patient by reducing the risks of edema and/or limited range of motion or blood clots. It also offers RELIEF -- relief to the frayed, tense, or torn soft tissues of the body that bear down on nerves and cause pain, discomfort, or limited ability to move. It also has the potential to lower blood pressure and high blood glucose levels. Yes, it IS medically necessary and I have the paycheck stubs from insurance bills to prove it.
2 -- (They run the risk of massage being considered an illegal gift used to lure patients toward one company vs. another.) I had to read this one several times to be sure my eyes were not playing tricks on me and if it weren't such a serious issue I'd have found it humorous. Amusing as it is, this statement is wrong. As far as massage services being a gift is concerned, we're not talking about an in-home spa here, we're talking about a health care service that comes with a prescription. Yes, doctors CAN write a prescription for massage! Yes, some massage therapists are recognized as health care providers and yes some of them can bill insurance (but WHICH insurances recognize it varies). A prescription is not a luxury, that's a medical necessity. I've never heard of a home care service being considered a gift either. A gift is something someone receives without paying for it or agreeing for the responsibility of its expense in one way or another. Offering a service is not the same as offering a gift. As far as legalities go, in my experience working in the home care industry I can tell you that the only thing illegal about gifts and home care is when a caregiver takes advantage of a home care client by accepting gifts from them or by giving them gifts in order to manipulate them. There would be nothing of the sort here. For a fee they would be receiving a LEGITIMATE HEALTH CARE SERVICE that follows a doctor's prescription -- either private pay or through their insurance, just like all the other health care services that are available to them. There's no hint of a "gift" in that anywhere. I'm pretty sure that when you pay for something or your insurance pays for something you're not receiving a gift, you're receiving a service. The only thing illegal about offering massage is that if it's illegal it's NOT professional massage! That is something else entirely! Taking into consideration the idea that by offering a service other agencies may not offer an agency may be breaking a law is something I can't even wrap my head around. Here's why: first of all, massage, when offered by a licensed properly trained professional, is a legitimate health care service billable to some insurance companies and recognized by health and medical facilities nationwide. Additionally, some home care agencies don't offer medical services and some do. Does that mean those that offer certain services that others do not are somehow illegally or unethically pursuing patients? No, I don't believe so. Does it make the health care services those agencies offer a "gift" and not a "service"? No, I don't believe so on that one either. Does it make people want to choose one company over the other? Probably, depending on their needs. Is it illegal for people to have those choices available to them? No. Is it illegal for one home care company to offer a legitimate service that another does not? Last time I checked, no. So why, then, would offering legitimate health-based massage as part of rehabilitation or pain management or other health care reasons be an illegal way of pursuing health care clients? No clue where that one came from!
3 -- (It would be an "add-on" expense to the patient with no reimbursement option.) Right AND wrong, it would be a completely optional service and some insurance plans pay for it. So in SOME cases it would be an additional expense IF THEY WANTED IT -- which does not make it an "add-on expense" because they're not being charged for it automatically. It would be OPTIONAL as a service, not an automatic expense, just like under someone's insurance plan they have the OPTION of seeing a DC (chiropractor) or acupuncturist or not to. They could also have the OPTION of seeing an LMT or not to. In some cases yes, it would have to be private pay but in some cases, there is an option to have insurance cover the cost. So yes, sometimes it would be an additional expense but only if the client CHOOSES it and only if their insurance does not cover it and they would go into it knowing whether it's even an option for them and in which way. It's not like it would come as a surprise.
4 -- (That Medicare and Medicaid do not cover massage therapy & the majority of home care clients utilize Medicare & Medicaid as their payment method.) Right and wrong. It's correct that the two do not reimburse massage therapists but it is wrong that they do not cover massage therapy. Also, to the best of my knowledge many home care clients use Medicare as their pay source so it would be reasonable to expect, then, that the profit margin to agencies would be small because it would mean that many of those in home care may not be able to utilize the service in their home if it's offered and have it paid for by their insurance; however, that doesn't mean it shouldn't be offered to all because of some not being able to cover the expense with their insurance or even because most are not able to cover it. It can still be offered and some people will be able to use it like those who are using the services of a home care agency due to an injury at work, for example. Workers' compensation will pay for massage so why isn't it offered when agencies DO accept workers' comp cases? There's nothing unfair about offering massage, just like there's nothing unfair about the fact that some insurances will pay for Patient A to receive help with making a meal but the same insurance will not pay for Patient B to receive the same assistance -- still, assistance with making a meal IS still offered through the agency that both patients utilize. Not all insurances that pay for home care cover the same expenses from one patient to another so why, then, would it matter whether massage would be a covered service from one patient to another as long as it is acceptable in some cases? Of course it would be ideal if each case were more simple but my point is that it's not like that anyway. Each case is already different. Not all plans would cover massage but some would so why deny it? That would be like me saying that because not everyone can pay cash I can't accept cash payments because there aren't enough of them to waste my time on. It makes no sense to me. Also, in some cases Medicare and Medicaid WILL cover the expense of a massage itself albeit there is a trick to it and this is where help from doctors comes in. In order to be covered it has to either be provided by a doctor or under the direct supervision of a doctor. If there's a Medicare or Medicaid expert out there who believes otherwise please correct me but this is what I was told the numerous times I tried to get help for people who wanted it. This is why I say it would really help if more doctors recognized us (massage therapists). If we can't get into the homes of those who have Medicare or Medicaid due to their inability to pay we can see them in the doctor's office when they come for a visit where our work can be supervised and billed to their insurance -- if only we were allowed to. Doctors are, after all, the first ones in line before a care plan is made. Doctors hold the key to our being acknowledged by all these other players -- nurses, PTs, OTs, hospitals, assisted living, home care agencies. In turn, though, home care agencies could hire LMTs on their own as well for those whose doctors DO acknowledge massage as an adjunct to their current plan of care.
5 -- (There's not a "need" for it.) This just made my blood boil. It is wrong, SO SO WRONG! I will be writing a separate blog about "need" (keep an eye out for "This One's For You 'Doc'") but until then I will just say that I have never heard of anyone in pain "not need" to find relief. I've never heard of anyone with stiff muscles and limited range of motion "not need" to be able to move more freely. Human touch is, in itself, a human need. Babies can't thrive without it. The elderly feel lonely without it. We all need it. Massage goes a step further and actually focuses on the problematic tissues to physically make someone feel and function better. But no, there's no need for that! Perhaps this statement is out of ignorance. Perhaps because home care patients know massage is not an option they don't ask for it and that is somehow translated as a lack of demand. Perhaps home care patients who are elderly are afraid to ask for more help. Perhaps, like the people who gave me these reasons for not accepting massage, people don't realize it's a form of health care. That doesn't mean they don't need the help!
6 -- (There would likely need to be laws changed in order to get Medicare & Medicaid to cover massage.) I'm not sure about that, that one may be right, but again as far as I know they do cover it in certain situations but it has to be done by a doctor or under the direct supervision of a doctor. Still, changing the rules of Medicare may be necessary indeed in order to have the service covered in the home by Medicare. But again I will say, not all home care patients are Medicare patients. What I'm asking is for those in positions of power to help out. The need IS there. Let's come together and make this happen for those to whom it is already possible and go from there.