The Thinking Practitioner Podcast

w/ Til LuchauWhitney Lowe

Episode 05: Documentation and Electronic Health Records (guest Diana Thompson)

Jan. 15, 2020 | Transcript | Subscribe | Comments | ⭑⭑⭑⭑⭑

Show Notes:

05: Whitney talks with Diana Thompson about documentation, health records, and including massage therapy in mainstream healthcare practices.

In this episode,

  • Introducing Diana Thompson 
  • History of Hands Heal and SOAP documentation for massage therapy 
  • Washington’s “every category of provider” clause
  • Electronic health records and the future of clinical documentation
  • and more.

Join two of the leading educators in manual therapy, bodywork, and massage therapy, as they delve into the most intriguing issues, questions, research, and client conditions that hands-on practitioners face. Stimulate your thinking with imaginative conversations, tips, and interviews related to the somatic arts and sciences. With Whitney Lowe and Til Luchau.

Resources discussed in this episode:

Sponsor Offers:

Your Hosts:

Til Luchau Advanced-Trainings        whitney lowe
Til Luchau                          Whitney Lowe

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Your Hosts:

Til Luchau Advanced-Trainings        
         Til Luchau                           

whitney lowe
      Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

Full Transcript:

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The Thinking Practitioner Podcast:
Episode 05: Documentation and Electronic Health Records (guest Diana Thompson)

Broadcast date: 01/15/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Whitney Lowe: Welcome to the Thinking Practitioner Podcast.

Til Luchau: A podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today.

Whitney Lowe: I'm Whitney Lowe.

Til Luchau: I'm Til Luchau.

Group: Welcome to the Thinking Practitioner.

Til Luchau: This episode is sponsored by Handspring Publishing. When I was looking for a publisher for my own advanced myofascial techniques book, I was lucky enough to have two offers. One from a giant international media subsidiary and the other from Handspring, a small publisher up in Scotland, run by four lovely people. I'm so glad I went with my gut and chose Handspring, because not only did they help me make the books that I really wanted to share, but their catalog has emerged since that time as one of the leading collections of professional level books written especially for body workers, movement teachers and as they say, all professionals who use movement or touch to help patients achieve wellness. Thanks Handspring.

Whitney Lowe: Yes, Handspring has done a great job of expanding offerings for the movement of manual therapy professions. There are author list reads like a who's who from any of the leading thinkers in our fields. So head on over to their website at handspringpublishing.com and browse this excellent catalog. When you find the gyms that you must have, used the code TTP at checkout for a discount. Thanks Handspring.

Whitney Lowe: Hi everyone. Whitney Lowe here and welcome to the Thinking Practitioner. I'm here today with Diana Thompson. I have a special guest with me while Til is on the road in Europe. So I'm going to have a great conversation with Diana Thompson and we're going to delve into a number of things that I think going to be a great discussions for looking at the role of massage in the healthcare system today. So Diana, welcome and welcome to the Thinking Practitioner and thanks for joining us.

Diana Thompson: Well, thank you for asking me. It's great to be here.

Whitney Lowe: Good. Hey, let's take just a brief moment at the outset here. You and I have known each other for quite a while. I was trying to think the other day of like, when did we first meet? And I don't know, but sometime back in the '90s, I think it was. Relatively early on in the days of the first additions of your book, Hands Heal. But for those people who are not as familiar with your path, tell us a little bit about your background and how you sort of got into what you're doing and where you are today.

Diana Thompson: Great. I'd love to. I have been practicing massage therapy since 1979. I became licensed in Washington state in '84 and immediately started working with acute and traumatic injuries. I was in a couple of car accidents myself and met a chiropractor and my life changed a lot and massage therapy really helped me take care of myself. I learned to work with car accidents right away. So I met an attorney, I met a chiropractor. I started working with physical therapists down the street and from there I just started creating courses on treating injuries. And along with that, with car accidents in particular comes a certain amount of litigation.

Diana Thompson: So I was doing depositions and expert witness testimony and I thought, "People don't know how to do this. Massage therapists aren't keeping records and learning how to testify and defend their use of massage therapy in traumatic injuries." So I wrote Hands Heal. Hands Heal, the first edition came out in 1993 and we might have met at that first teacher's conference.

Whitney Lowe: Yeah.

Diana Thompson: Seattle in '93. I don't know if you were there, but I think that's where we first met.

Whitney Lowe: Yeah. That sounds about right.

Diana Thompson: Yeah. So from there it just turned into consulting on research regarding information gathering for massage therapy, what's appropriate, what kind of measures are important for showing progress. Then I became a board member for the massage therapy research foundation and had four lovely years as president. Then started writing another book on pain. So that book came out, gosh, more recently. Once things started to really change in healthcare, I became very active on panels and working with the insurance commissioner on getting our Every Category Provider Law up. So it was kind of this steamroll effect. Once you get into healthcare, you got exposed to a great deal of other types of healthcare practitioners and policy discussions, legal discussions, those kinds of things. So I've had a very rich and rewarding career as a massage therapist. It's been great.

Whitney Lowe: Yeah. So I want to touch base on a couple of things that you mentioned there. Let me backtrack just a little bit. First off, just recently you mentioned the Every Category of Provider concept in Washington and there probably are quite a number of people around the country who may not be familiar with what that is. And to me this is one of the most progressive policies that we have in the country around the use of massage and is a part of the healthcare system. Can you elaborate a little bit and sort of define that for everyone about what is involved with that?

Diana Thompson: Yeah. The Every Category of Provider Law says that every insurance company has to offer at least one plan that covers every licensed health care provider as long as they're operating within their scope of practice. So if someone is going for rehabilitation and they want to go to a massage therapist or an acupuncturist or a chiropractor or any of the alternative health care or now complimentary healthcare providers, they can. They have that ability to do so if they have chosen the plan that includes a complimentary care.

Whitney Lowe: So to me, this is just really both radical and very innovative and quite astonishing that that happened just because we've had so many difficulties everywhere else. So for someone who's not in Washington state, can you give maybe some background or audience, like how does a state go about getting something like that done? Lots of people have been trying to move massage therapy or soft tissue, manual therapy, whatever your practice is, more into the healthcare system. How did you pull that off in Washington as a group?

Diana Thompson: It was really interesting. It was actually done by our insurance commissioner. She was hearing feedback from the people in Washington that they wanted access.

Whitney Lowe: Was this ?

Diana Thompson: It was. It was Deborah Sean and Lori Balinsky, a massage therapist at the time. She's still a message therapist. This was in 1996 that we started getting together and putting... she put together this committee and we started meeting to create this possibility for in Every Category of Provider Law. But Lori Balinsky was a massage therapist working for Deborah Sean and she in particular was working with women's health and the lack of access to midwifery and naturopathy for pregnancy and other female health conditions. That was the start of it actually was about women's health. From there we, the proverbial we, the group came together and it consisted of everything from massage therapists to podiatrists. They really felt like they were pushed out of the medical field. But it was acupuncturist, naturopaths, midwives, message therapists. Who was that? I think it was just a lovely group.

Whitney Lowe: So you really had a cohesive, sort of coalition that was working on trying to make that happen. It wasn't just the massage therapy group then that was doing that alone.

Diana Thompson: That's correct. That was an important part of it because a lot of those other groups have strong lobbies and can dedicate a great deal of legal clout when it comes to legislative efforts. And there were a lot more needs for people than just massage therapy. I think it's harder to go about it if you're operating alone. So we need to be very friendly with our neighbors in other disciplines.

Whitney Lowe: Yes, for sure. So now with all of the... I mean, we've seen of course, very dramatic changes in the healthcare system in this country over the last several years. It seems like right now it's just a rocking boat with all kinds of tumult in it. And that policy or position with the Every Category of Provider has seems to have weathered the storm a bit. Is it still a part of the regular system there in Washington?

Diana Thompson: Yes. And it's only getting bigger. Also, I don't know if people know this, but the person who helped write the Every Category of Provider Law for us worked on it for the Obamacare. That there's actually a very similar clause in the Affordable Care Act that declares this for the entire country. Now, because there have been 58 lawsuits filed against Obamacare and that it's still being fought over. So many insurance companies aren't abiding by what's in there, but there is in Every Category Provider clause in Obamacare.

Whitney Lowe: So if someday in the somewhat distant future, everything kind of gets settled out with that particular health care law, this is something that then could be enacted or activated throughout the rest of the country. Is that correct?

Diana Thompson: Yes.

Whitney Lowe: And what was that? What is the number of or the policy section. I hear referenced that and people may hear reference to that periodically. What is that part of the section that's in the Affordable Care Act?

Diana Thompson: 2706.

Whitney Lowe: 2706. Remember that number? That's an important number about that policy section in there.

Diana Thompson: Right. There were several of us from Washington state who have gone to meetings and conventions and worn our 2706 buttons and really tried to push the attention in that direction because it's so important for us to know that this exists.

Whitney Lowe: So one of the things that I wanted to just say and part of this is because I've been a watcher of you for many years and know how much you have given of yourself and your time with dedication. I think this is just a really important illustration of why it's important for people to be active and to be aware of things that are going on within our field. Because you and the other people who participated in this process made huge, huge advances for the field that allowed other people to have all kinds of opportunities for making massage more accessible as a healthcare option for people. That's something that I think we have a real struggle with sometimes is trying to get people involved in this process and see that you can actually make a difference.

Diana Thompson: Yes, you can. Absolutely. I'm really big on volunteering. I think the more you can do, even on a little teeny basis, the more you can put yourself out there and just start showing up, the more that can get done. It's really important that we give back to our profession and make it more accessible to everybody.

Whitney Lowe: I want to also call back to something that you were saying in your early description of your initial background and work in this field. You had said that you got involved with doing a lot of acute care things and began working with some insurance companies and realizing that we had very little training or skills and capabilities in dealing with the documentation that was necessary for the insurance industry. I know a lot of that sort of led to your development of the Hands Heal book and your emphasis on soap charting. So I'm curious like how did you learn all of those things? Tell me a little bit more about why you feel like this is so important. Because a lot of massage therapists and other manual therapy practitioners are taught some basics of charting and documentation in school, but it also seems like a lot of people forget those things or don't use them a lot. I think it's really important. I just want to hear a little bit about how you got going with that and why you think it's so important.

Diana Thompson: Well, on a very basic level I believe that massage therapy is health care. Even when we're doing wellness massage, we're improving relaxation and reducing stress, which makes a big difference in the complications that go with life. And that chronically kind of creep up and become issues. If we're healthcare providers, we should be documenting our sessions. That's to me a very basic rule of thumb. Every healthcare provider charts every session that they have. You wouldn't ever go to a doctor for an annual physical and they say, "Hey, you're so healthy. I don't have to chart this session." We do that all the time. It's one of my reasons, raise on debts in life to really make sure that massage therapists are charting their sessions even on a very basic level. And to help make that happen, I felt like it was really important for me to educate people on what's minimally necessary and what do you absolutely need to do if you're going to be billing insurance or working with physician referrals to make sure that you're covering yourself.

Diana Thompson: It's everything from what you did in the session to what you found, what assessments you did and the results of those, but also what you didn't do. Because all of the malpractice suits that I've consulted on have to do with somebody not paying attention to a condition and doing something that was inappropriate in that case.

Whitney Lowe: So that's an interesting thing that a lot of massage therapists and other manual therapy practitioners probably don't think about a lot because it's something that doesn't happen with great frequency. But you had mentioned that you've been involved with some expert witness testimony in some legal facets of these things. What are some of the potential things that may happen or that you have seen happen that are potential dangers or concerns that really people should be aware of, of why the documentation record keeping is so important?

Diana Thompson: Yeah. I've looked at a lot of research on incidences where massage has done harm and for the most part it's an incredibly safe modality to use. And bruising is probably the most common one or burns from hot stones or hot packs or ice packs. The ones that are much more serious are ones that impinge nerves or break fragile bones. Those are things I think we need to be very cautious of when we're working with them. Now that I'm talking about this, I'm not sure that that's really the question you asked.

Whitney Lowe: Well, no, I mean I think that's really getting at it. A lot of these things are things that maybe practitioners don't really think about, that I might be doing something that could potentially be that dangerous or that harmful for people. I think the reality that some people need to recognize is that a lot of times these things actually... Massage is not benign. There are potential problems and adverse events that can occur, even under some relatively normal circumstances. That's why I think it is very important that we document and keep records and pay attention to what we're doing with the both evaluation and treatment processes that we're going through so that we can have good records about this if something were to happen that would be an adverse event.

Diana Thompson: Yes. So to think of some cases where charting save someone's butt, let's say. There were a couple of cases where people said that they got care and they never really even got care, like at a fair, a health fair or a music fair. They didn't sign in, they didn't sign anything at all. They just sat down in the chair and got a massage or said that they did and nobody can remember working on them. But there's no proof either way. Another one where the person did not sign the health intake part. So there was a list of things that were contra-indicated and he saw what he had on there, refuse to sign it, got the massage and sure enough was made worse by the massage and the massage therapist didn't check to make sure that they had signed that didn't go over anything with them. So sometimes even those little oversights.

Diana Thompson: There's another situation where the massage therapist said they got all of the... or the patients that they got all of these symptoms after getting massage but on their intake form, they had said that they had all of these symptoms going into seeing this massage therapist. So the massage therapist was off the hook entirely. So charting can save you and charting can sink you if it's not there.

Whitney Lowe: Right. Yeah. Something else comes to mind here is... Til and I were having a discussion about this in our previous episode when we were talking about some of the big challenges that face the profession. I was talking about the sort of split personality of our profession being part of it that's focused on healthcare and part of it that's focused on the sort of personal care side of the more wellness oriented approaches. But if you take another look at a relatively big sector of occupation now in our field is something like the chains, the massage chains that are around and people who are... I mean they're seeing a lot of clients and doing a lot of massages in that environment.

Whitney Lowe: How do you encourage or anything that you would say to people who work in that chain environment and say, "I don't have time to write notes and take documents on them because they book me back to back to back. I don't have time to take care of this." And they're not necessarily seeing themselves predominantly as healthcare providers. Anything he would say to people in that environment about the importance of the documentation record keeping?

Diana Thompson: Well, I think the first thing I would like to say is it can be super fast and easy. And you could have a checkbox system for charting that's really specific to the chain. So if you've got X, Y, and Z types of services that you offer and the client fills out the intake form before they even come in, there's really something to this electronic health record keeping that's so beneficial. Some of them you can even dictate into, so you could just say a couple of sentences into the device that you've got. You could do it into your phone on a lot of these and get something recorded and that's all you need. I mean, really in a healthy client situation, you just need an intake that gives you enough information to know what your contraindications or precautions might be. And you just need to say what you did, where you did it for how long. That's really the basic type of charting.

Whitney Lowe: So which then really it can be a lot simpler than many people think. It doesn't have to be a long complex process.

Diana Thompson: Right, yeah.

Whitney Lowe: So we're going to take a little break here for just a moment to hear a message from our halftime sponsor. Then when we come back, I want to delve into this same subject a little bit more and have you talk about some of these issues you brought up here with electronic health records. Because I know this is something that's near and dear to your heart here, so we'll be back in a moment and hear some more about that.

Diana Thompson: Okay, great.

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Whitney Lowe: So tell me a little bit about this Hands Heal electronic health record that you're working on now. This sort of seems like it's a natural evolution out of the print version of the book and the sort of the paper record keeping and documentation process that was certainly around in the '90s when you got started on the book, but now everything has evolved to being digital and computer based in so many places. So tell me a little bit about what this project is about that you're working on now.

Diana Thompson: Yeah, it's really, it's been a lot of fun and very exciting for me. As soon as there was the conversation about electronic charting being mandatory for a healthcare providers, any healthcare provider that works with Medicaid or Medicare is how it started.

Whitney Lowe: So let me pause right there because I think a lot of people don't probably have a good understanding of what an electronic health record is. Can you explain a little bit about, you know, this is more than just writing notes on your computers. What is an electronic health record?

Diana Thompson: Yeah. Thanks for asking that. I think when you're in it and you can't see it with fresh eyes. That's a good question. An electronic health record, part of me wants to go way, way back to when computers were huge but I won't.

Whitney Lowe: I love getting into all that stuff. So -

Diana Thompson: I know.

Whitney Lowe: ... talk about that some other time.

Diana Thompson: All right. Okay. It consists of everything that has to do with that person's health and it needs to be portable and accessible to the client. So with HIPAA rules, we haven't talked about HIPAA yet, but HIPAA mandates that every customer, every consumer, client, patient has to have access to their medical health records. And there has to be good communication between providers so that there's less duplication of treatments or tests. We're not spending so much money on healthcare since we have one of the most cost inefficient healthcare systems in the world. So electronic health records became mandatory to help make all of these mandates come to fruition.

Diana Thompson: So you'll find everything from intake forms to test results, to communications between providers, to communications between providers and the patients as well as your treatment records and any bills or communications with insurance companies. A lot of insurance companies are also requiring electronic submissions. So you may have found that you hire someone to do your billing for them and you send them all this paper, while they turn it into a digital format and send that digitally to the insurance companies. So you may think you're not digital, but you might be digital.

Whitney Lowe: down the road.

Diana Thompson: That's right.

Whitney Lowe: Right. So how does your Hands Heal EHR, electronic health record fit into that picture?

Diana Thompson: So having written books about it decades, I wanted to get up to speed and make sure that people have access to an electronic health record system that is not just about scheduling and marketing, but it's really about teaching you how to document things really well and letting people have the flexibility that they need to have based on the different styles of work that they do because not all of us work the same. And to make it educational and the point of having tutorials that really teach people how to chart and teach schools how to teach charting. So having been in the educational realm for most of my career, education is super important that people can't Chart well unless they know what's expected of them. The other thing that I think is extremely, extremely important is having good measures and being in the research fields.

Diana Thompson: Having enough experience there, I know what research measures are typically used in these studies so that we can start looking at data that can show how massage is effective and what kinds of reasons people are going to see their massage therapist. So I wanted an educational system and I wanted a system that can download research and contribute to the knowledge base of the profession and other integrative healthcare professionals so that they can see the effectiveness of massage therapy.

Whitney Lowe: So that sounds like it's a really got huge potential in terms of being both a data repository about information that's in there without necessarily, of course taking somebody's individual personal information. But you will be able to gather a lot of information about what's being done with different types of massage. And really maybe that might be the basis of a good bit of additional research that might come out of that.

Diana Thompson: Absolutely. We could de-identify and collect any of the data in there, but most importantly, the measurement tools are consistent and can be easily collated to use in research. So it would just take a research person to come in with a good IRB, some approval of how they're going to use the data that's acceptable. And they can put together a study of just about anything that's within the system.

Whitney Lowe: Yeah. Then you're also trying to maybe have this be part of what schools are using for health and helping to teach some of their students about documentation. True, is that also correct?

Diana Thompson: Yeah, because this really starts in the schools. If we're not teaching charting and mentoring charting, I think one of the biggest issues that I saw when going across the country to teach charting is that the teachers themselves weren't charting in their own practices. So if they're not doing that, how can they be good role models for charting?

Whitney Lowe: Exactly.

Diana Thompson: So I thought, "Well, the least I could do is teach them how to teach charting."

Whitney Lowe: Exactly. Right.

Diana Thompson: Then maybe they'll see the benefit of it and start doing it themselves. That's my hope.

Whitney Lowe: Yeah. So let me shift gears here a little bit. You also mentioned again in your early description of a lot of the work that you did early on in sort of acute care conditions and dealing with a lot of injuries and pain problems and you recently produced a book on integrative pain management that brought together perspectives of quite a number of different people in there. I was curious, what were some of the key things that you learned on that project because there's been such a lot of both emphasis and controversy in a lot of things going on right now with the topic of pain management and pain science in the soft tissue manual therapy world.

Diana Thompson: Yeah, it's a huge topic and I'm really sorry that it took the opioid epidemic to make sure that on a policy level and an access level that we have to talk about reducing pain meds and integrating complimentary care that can do a great job in a lot of cases with pain. There were 23 authors really fascinating to work at that level. And I learned, in particular, I created a couple of surveys for the authors to do. One was for their patients and one was for the referring caregivers that sent them patients. So two surprising results. 100% of the referrals came to those particular therapists. Most of them were massage therapists because the referring caregiver physician, naturopath, acupuncturist, we had several different varieties, because they hadn't gotten a session themselves. And to me that says a lot about our profession that doesn't make me really happy.

Diana Thompson: It's like people don't say, "Hey, I want you to go see my gastroenterologist because she did a great job for my colon and oh my gosh." You don't behave that way with other health care providers, but you tend to with massage as a physician or other healthcare provider. So that says that we're not getting the word out enough that we're not writing our reports.

Whitney Lowe: So you're saying this is something that the other healthcare professionals aren't enough aware about massage to be referring their patients to massage? Is that what I'm hearing?

Diana Thompson: Yes. And I blame us. It's in part the research because they also said, "Well, there's not enough research or I referred to massage, but I don't get any feedback. But my clients really want it and so I went and got a massage from them and so I decided to keep referring." The other thing that was really interesting was the number of people who did self care. I think that when people are dedicated enough to find their own integrative health care provider, to find a massage therapist, to go to a massage therapist sometimes even when their healthcare provider doesn't send them or give them a prescription for it or highly recommend them, they'll find them themselves. So they end up doing their self care really diligently.

Diana Thompson: So that's something that I want to encourage all of us to make sure that we talk to people about that self care is so important and that the people that come to see us will actually really do it. So that's key. The other thing, we had a research sidebar in the book and it seems like the best research results come from a combination of massage, movement and mindfulness. Those are all three things that we can incorporate into our practices. They're all within our scope. And many of us do movement in a massage session and it's easy to encourage people to walk or do really simple things that will help them get out. People get isolated when they're in pain. That's a problem because the more isolated they become, the less movement they do.

Diana Thompson: It's a vicious downward cycle. It's also really easy to give people tips on how to relax. So in a session we might talk to them about breathing, we might play soft music, we dim the lights, we're really creating a situation where they can relax and be more mindful about what it is that we're doing. Those are all key features in helping people with pain that really came home for me with that book.

Whitney Lowe: Yeah. Well, I really liked the book. I think it was a great compilation of perspectives and individuals that you brought together to do that. So I would encourage people to take a look. And for those that don't know, what's the name of the book, Diana?

Diana Thompson: Integrative Pain Management, Massage, Movement and Mindfulness Based Approaches.

Whitney Lowe: All right. Great. One other thing I wanted to just touch base on because we've talked about this a little bit too here. Til and I mentioned this in one of our previous podcast episodes too about the role of soft tissue manual therapy. Regardless of whether that's a massage therapist or person doing variety different things, integrating this into the healthcare system. Many people see insurance reimbursement as a sort of a ticket in there because that does seem to be some part of the gatekeeping process for massage or these other methods to be accepted as a healthcare profession. I'm just curious, since you've been involved with this for so long, what do you see as some of the key pros and cons of the soft tissue manual therapists pursuing insurance reimbursement for our work?

Diana Thompson: Yeah, that's a great question because there's such a wide divide between the pros and the cons. The pros of course, are access. People deserve to have access to massage. People need massage. And we can learn so much by seeing people who have conditions like pain, whether it's chronic or acute, because what we do has an immediate effect and we could really learn a lot about how to be a better massage therapist. The cons of course are reimbursement rates. It's really insane how our reimbursement rates have continued to go down. We used to get a lot more money from insurance billing. A couple of things happened, some people took advantage of that and started charging a lot more for billing insurance than they did for people who still had injuries that you were working with but paid cash. That can be a problem. I've known people that had to pay back thousands and thousands of dollars for fraud in billing.

Diana Thompson: And two in particular, one was really recent just this year and one was a few years ago and another one was about 15 years ago. So it happens. What's interesting, especially about having the Every Category Provider Law in Washington, it allowed for some really good data to be collected. What they found was that people spent less money on healthcare when they were receiving massage therapy for their conditions.

Whitney Lowe: Oh really? interesting.

Diana Thompson: Yeah. But all the fears that came about as a result of implementing the Every Category of Provider clause never came to fruition. However, it started this spiral of insurance companies being afraid and reducing the reimbursement rates before it even went into effect. The same thing is happening with Obamacare. When the Every Category Provider Clause... They don't call it that in Obamacare, but it's just like that. When into that insurance companies started decreasing in reimbursement rates again. So they're using it as a reactive way to say, "Hey, we know we're going to have to pay out a lot more, so let's just start paying less and maybe people will get out of the network." That's happening. People are leaving the networks right and left in Washington state and some actually are using that to negotiate with insurance companies to get better rates. So there's kind of that catch 22 of how do we get better rates and what does it take to get them? And it takes really shrinking the market so that people are clamoring for their.

Whitney Lowe: It seems in some of the discussions that I've heard too among insurance company, people who are concerned about what was going to happen if massage was included. It's this idea that massage and there are some other types of interventions that are like this, but massage is certainly is one with fits at the top of the list is that there aren't a whole lot of medical procedures that people get that they actually like to get. There's a lot of concern about abuse of that system because people would potentially say, "Oh, hey, I need to get a lot more massage than the prescription may be allotted for," something like that. But it certainly seems like there are some ways around that that could maybe alleviate some of the fears and concerns the insurance companies have, especially if there's some data now that's pointing in the direction of it. This is actually reducing overall healthcare costs.

Diana Thompson: Yes. And one of them is benefit limits. So you could still pay massage therapists a living wage and implement limits. There's another thing going on with some of these home health networks where they pay you more based on results. So they have you keep very specific measures pre and post session and over time. If you can get good results in a shorter amount of time, they pay you more. That's a new one that's come out. So they'll think of creative ways but I'm just really pleased with some of the publications. Pardon me. Yeah, there's some really great articles that have been published that support massage therapy in pain management, like the Health and Human Services Pain Task Force Final Report, mentions the important role of massage therapy. There's another one with the Medicaid, Medicare advantage final call letter that specifically includes massage therapy provided by all a state licensed massage therapist.

Diana Thompson: That was great that they put that in there because some insurance companies say, "Oh, we cover massage, but you just have to be a nurse or a physician to provide it." Then other attorney generals of different States have created pain management plans. Washington is one, West Virginia is another one that has specifically included massage therapy as an alternative to opioids. The department of defense has put massage therapy into their... what do they call it? Their strategic plan and that went in last year I believe. So that's really great.

Whitney Lowe: I think that one is huge because that is... Isn't that I think the country's largest health care system or something like that? It is at least close to that if not, and I think that's very both a significant development and a great opportunity and potential danger zone also for us in this field, if it's not done right, we can really mess it up.

Diana Thompson: Yes. And they've started to hire a massage therapist just in 2019. I'm currently working with a group that helps train the massage therapist to work with that. So I think that's a really critical thing like you say that being really prepared to work with that population is important because it's a population in much need of good care.

Whitney Lowe: Yeah. Absolutely. Well Diana, thank you. I want to thank you so much for your time today and for this delving inside look into the world of massage and other soft tissue interventions in our healthcare system. Because it's certainly, I know you and I both believe this to be a pathway that's got so many tremendous opportunities for all of us. I want to thank you on behalf of everybody in this field for all the work you've done over the years and the things that you continue to do to move us in that direction.

Diana Thompson: No. Thank you so much. Well, you have done a great deal as well, so you're a hero to me.

Whitney Lowe: All right, good. Well, we have a mutual admiration society.

Diana Thompson: That's right.

Whitney Lowe: Okay, good. Well thank you again for being here today and I'd like to also say thank you to our sponsors for helping to sponsor the show. If you'd like to stop by the site for show notes, credits and updates and extras about what we have available there, you can find our show listed over at thethinkingpractitioner.com. And Til site is advanced-trainings.com and you can also find information from me at theacademyofclinicalmassage.com. And questions if you'd like to give us comments, questions, or anything you'd like to give us with information and things you want to hear, just drop us an email line over to info@thethinkingpractitioner.com or you can also find either one of us on social media there. If he would please make sure to stop over if you'd like to and rate us on Apple Podcast or wherever else you happen to be listening. And share it with a friend. We thank you very much for listening and thank you for your time. So Diana, thanks for being here today and we'll talk again here soon.

Diana Thompson: Well, it's great to be with everyone. Thank you.

Whitney Lowe: Okay. All right.


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