AMTA CONVENTIONAUGUST 20 , 2015

AMY CRAWFORD-FAUCHER, MD, FAAFPUNIVERSITY OF PITTSBURGH MEDICAL CENTER

DEPARTMENT OF FAMILY MEDICINE

Working Together:

Collaborating with physicians:Opportunities and Challenges

Our Goals

Discuss opportunities for collaborating with physicians

Strategize how to establish relationships with physicians/health systems

Develop skills needed for collaborationDiscuss case studies of integrated

environments.

But First, Some Stories

Stories

• Diagnosed with seronegative arthritis• Asked her rheumatologist about diet, massage, other

modalities• Told “none of those things really make a difference in this

case.”• Has discovered on her own that paraffin wax treatments on

her hands really helps with morning pain and stiffness

Stories

• Diagnosed with rheumatoid arthritis and mixed connective tissue disorder

• Referred by rheumatologist for massage and went regularly when on Blue Cross

• Now on Medicare which doesn’t cover it• Can occasionally pay out of pocket for massage

(every 2-3 months)

Stories

• Fractured her spine in a sky-diving accident• Has never taken pain medicine beyond ibuprofen outside of

the hospital• 4 years later, her insurance continues to cover

maintenance physical rehab and massage• She lives in Germany

My Story

Family medicine physician I treat patients of all ages, including pregnant women I see patients in the office, home, hospital, psych

hospital Other family doctors and general internists see

patients in nursing homes, assisted living facilities I don’t know very much about massage therapy

What is your story?

Why collaborate with physicians?

Provide more comprehensive patient care You know – and our patients/clients know – the

benefits of massageProvide safer care

Develop a mechanism to communicate progress and concerns

Establish relationships for referring clients who need medical treatment

Potential client source

Why is this a good (or at least better) time?

Small but perceptible advances in insurance coverage for integrative/complementary therapies

Increasing evidence of the lack of long-term effectiveness and addiction risks to chronic opiate use for chronic pain Doctors and patients may become more amenable to

exploring other modalities for chronic pain and dysfunction

Payments are moving to reimbursement for outcomes, not services

Where are the opportunities?

Outpatient settings: Multi-disciplinary pain centers Integrated Medicine Centers Primary care practices Rheumatology Midwifery/OB-GYN Psychiatry Physical therapy centers

Inpatient settings: Nursing homes Inpatient rehab (physical and other) Psychiatric hospitals and units of acute medical hospitals

Opportunities

Practices with patients with Chronic pain Rheumatologic conditions cancer Injury and rehab Pregnancy-related symptoms Stress, depression, anxiety

Physicians and other medical professionals most willing to learn about and explore CAM/therapies

What are the challenges?

We have no idea what you do No training in medical school or residency about massage We don’t know that there are different types of massage

and what the indications are for each type We don’t know the demonstrated medical value of massage We don’t know the contraindications for massage We are not versed in your certification/licensure processes

We don’t know how to find the good ones, AKA YOU We delegate that task to our patients, often without

guidance

What are the challenges?

Insurance coverage is variable, although changing Some private payor coverage

Example: United Healthcare: Does NOT cover massage therapy, “unless it is part of a

multi-modality authorized treatment plan appropriate to the patient's diagnosis plan with a licensed therapist in attendance.”

Some approved use of FSA funds: Example: AETNA:

Will reimburse for massage with a LOMN indicating specific therapy for a specific diagnosis. Not for “general wellness”

Offer member discounts to in-network massage therapists

Cost

Most physicians struggle to recommend services for which the patient pays completely out-of-pocket The healthcare economy is spectacularly messed up

Costs are not obvious or available to patients upfront Patient costs are in form of deductibles, co-pays, co-

insurances… Patients are trained to 1) be confused and stuck with

unexpected bills and 2) to have some coverage for most things

Impressions

Unscientific poll of physicians Included primary care physicians, chronic pain physician,

integrated medicine physicianNot surprisingly, the physicians working in

integrated/multi-modality practices had the most detailed knowledge of massage types and indications

Others generally believe that (any) massage is beneficial Therapeutic touch Value of stress-reduction Would write a prescription/referral for patient if asked

How can we bridge this gap?

Strategies to establish relationshipswith physicians

Establish credibilityConnect with physicians in your communityEducate providers and patientsFacilitate cost discussionsBuild communication tool

Establish Credibility

Achieve and be able to explain certifications Increase physician confidence that you are a trained

expert

Make the Connection

Practices that are massage-friendly… massage curious? Target physicians in your community who market

their own practices as a “holistic approach,” “encourage wellness,” “comprehensive care.”

Have literature/handouts geared to medical providers Explaining types of massage offered Basic list of diagnoses treated with each offered

modality Cost and/or insurance participation Your certifications and credentials

Provide Education

Offer to provide an educational presentation to staff What the modalities do Differences between therapeutic massage and wellness/spa Research data (or references for same) Can answer questions about specific symptoms or diagnoses

most benefitted Can answer additional questions about cost/insurance

coverageOffer to educate patients

Many practices have group visits for prenatal care, diabetes, health and wellness

Find Residency Training programs to connect with*

Facilitate cost discussions

Consider a discount from practices with whom you have collaborated Easier for patients to afford (and conceptualize) Easier for providers to recommend Perhaps a trial period to see if increased referrals

balance the reduced feeEase the insurance process

Clarify with physician practice which insurances you contract with

Provide clear insurance claim/cost process with clients/patients

Build communication tool

Medicine relies on “consult letters” to connect the referring physician to the consultant Formalized process to close the loop between

providers Every time my patient sees another specialist, I get

notified of what transpired Becomes part of the patient’s medical record So important that insurance companies can withhold

payment if this is not done

Build communication tool

Consider developing a massage consult letter With client consent Would definitely do for initial massage consult/therapy

Include diagnoses Client’s medication list Therapeutic plan Modifications planned given client’s diagnoses/meds

Send brief updates regularly

Build communication tool

Benefits Reinforces for client/patient and patient’s physician

the medical benefits of massage therapy Would likely become part of patient’s medical record Keeps your work and progress visible to the medical

team Eases two-way communication when needed Becomes a resource for physicians who may have

questions about wording a referral, writing a Letter of Medical Necessity or the type of massage to recommend.

Massage Therapist Medical Provider

Increased physician knowledge of MT

Better communication for client safety during treatment

Increased client base

Improved client health

Increased knowledge of non-medication modalities

Ability to share medication/conditions concerns

Better affordability

Improved patient health

Comparing our Wish Lists

Make your own caption