Massage Today
October, 2012, Vol. 12, Issue 10

Hospitals Embracing Massage

By Kathryn Feather, Senior Associate Editor

An increasing number of hospitals are throwing their doors open to qualified massage therapists as savvy health care consumers are requesting massage therapy to deal with certain health conditions.

The research showing the validity of massage as a drug-free option for patients to consider has been steadily growing over the last few years and hospitals are finding it a profitable business practice to offer massage and other complementary therapies to their patients.

According to the latest American Massage Therapy Association (AMTA) industry facts, almost 10 percent more people received massage for a medical or health reason. Forty-four percent of adult Americans surveyed who had a massage between July 2010 and July 2011, received it for medical or health reasons as compared to 35 percent the previous year. Of the people surveyed who had a least one massage in the last five years, 40 percent reported that they did so for health conditions such as pain management, injury rehabilitation, chronic pain management or overall wellness. As more people--especially baby boomers--request these services, and have the discretionary income to pay for them, hospitals and other health care providers are taking notice and making changes to the services they offer.

Finding a Career

"Massage in a hospital setting is ideal," said Edie Black, a registered nurse and licensed massage therapist working at Connecticut Children's Medical Center. "As I provide massage therapy to inpatients at our hospital, I see my patients finding a deep sense of relaxation, pain relief and an increase in body awareness."

Black paints a positive relationship between patients and the massage therapists. "Due to the nature of the hospital setting, each patient benefits differently. Our hospital has one floor dedicated to children with cancer and blood disorders and the majority of massage consults are found there. Some [patients] are looking for pain relief as they recover from surgical procedures such as amputation or reconstruction after tumor removal. Some are anxious about the hospital and the painful procedures they have experienced," said Black. "The massage therapist can help by offering that ‘safe' time, not only for the patient but for the family as well."

Elizabeth Schroeder was hired by Children's Mercy Hospital in Kansas City in 2008 as an Occupational Therapist in 2008 and became more interested in complimentary therapies such as massage while she was in school. "I had been researching why the therapeutic use of touch was benefiting the patients I was treating. As I found more evidence-based research in massage, I spoke with my supervisor at the hospital regarding becoming licensed and she was very supportive. Schroeder has been a licensed massage therapist for a little over a year now.

Schroeder says "pain related conditions are the most frequent referrals: idiopathic arthritis, juvenile rheumatoid arthritis, and neck, back or joint pain. I do use massage frequently with ADHD, Autism Spectrum Disorders and Sensory Processing and Modulation Disorder." The survey also found that 59 percent of massage consumers surveyed said they would like to see their insurance cover massage therapy.

Educating Doctors and Consumers

According to the AMTA survey, massage therapists received an increase in referrals from health care professionals, with the number of nurses recommending massage doubling in 2011 and 96 percent of the massage therapists surveyed receiving at least one referral every six months from a hospital or medical office. The survey shows that, on average, massage therapists received about four referrals per month, twice as many as in previous years.

There is also a growing body of research that therapists can point to--and other health care professionals are noticing--that shows the positive benefits and effectiveness of therapeutic massage. Recent studies have examined the effects of massage in dealing with a variety of specific health conditions such as cancer related fatigue and pain, low-back and chronic neck pain, lowering blood pressure, reducing the frequency of headaches, boosting the body's immune system and even easing the symptoms of alcohol withdrawal.

"Our patients and their families have provided positive feedback, including scheduling their planned admissions for treatment around the days the massage therapist is available," said Black. And hospitals are taking notice of the demand. The Mayo Clinic in Minnesota offers a hospital based massage therapy course for therapists who want to join the hospital health care team. The program is divided into three modules and takes two months to complete and requires completion of a 500-hour minimum massage therapy program. The Mayo Clinic states that "through the course, participants will gain an enhanced understanding of the utilization of massage therapy and integrative medicine in the acute care hospital setting. Participants will experience self-care exploration, a team-based approach to integrative health care and scope of practice, navigation and documentation in a medical record, establishing therapeutic relationships and treatment planning." This program is only offered twice a year and is limited to 12 students to ensure that therapists receive close one-on-one instruction and a more comprehensive experience. The Mayo Clinic campus includes extensive facilities including an outpatient complex and research areas, in addition to the well-known hospital. Placement for therapists completing this instruction is very good, according to the Clinic.

True Integration

For those already working in hospitals, they know they are a part of an integrated health care approach to wellness for their patients. At the Children's Mercy Hospital, Schroeder sees this integration first hand. "I am in contact with every patient's doctor regarding plan of care and progress toward goal directed therapies. Specifically for pain-related diagnoses, I am frequently in contact with the patient's psychology support systems. In all of these relationships...I find these providers to be open and willing to see the effects of massage as a modality used in treatment."

Candace Linares has been a massage therapist for 19 years and has worked in the hospital setting for the last seven years. In her experience, the doctors and nurses she works with ask for massage therapists on a regular basis. "I believe there is a reliance and confidence regarding massage services to assist patients' special health concerns," she said. As hospitals and doctors become more aware and accepting of the benefits and effectiveness of massage therapy, and as a greater number of patients continue to request these services, the demand for more massage therapists who are ready and able to become competent and contributing members of the health care team will continue to grow.

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 Women’s Health and Cancer Rights Act

The Federal law

The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breasts rebuilt (reconstructed) after a mastectomy. This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998. The United States Departments of Labor and Health and Human Services oversee this law.

The WHCRA:

·  Applies to group health plans for plan years starting on or after October 1, 1998

·  Applies to group health plans, health insurance companies, and HMOs, as long as the plan covers medical and surgical costs for mastectomy

Under the WHCRA, mastectomy benefits must cover:

·  Reconstruction of the breast that was removed by mastectomy

·  Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy

·  Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction

·  Any physical complications at all stages of mastectomy, including lymphedema

Questions and answers about the WHCRA

Yes. The law also requires that insurance providers notify you of this coverage when you enroll in their plan, and every year after that.

Several states have their own laws requiring health plans that cover mastectomies to provide coverage for reconstructive surgery after a mastectomy. These state laws only apply to those health plans purchased by an employer from a commercial insurance company. If an employer is self-insured, state laws do not apply but federal laws do. Federal laws (like the WHCRA) are enforced by the US Department of Labor.

A self-insured (or self-funded) plan is one in which the employer, rather than a commercial insurance company, pays for the insured person’s health expenses. Some employers that self-insure will hire a commercial insurance company to write the checks and track the paperwork, even though the money for the payments still comes from the employer. So it can be hard to tell whether you are in a self-insured or a commercially insured plan unless you ask.

If you are unsure of your plan’s status, ask your employer’s benefits manager. You can contact your state’s insurance department to find out if your state provides extra protection that will apply to your coverage if you are not in a self-insured plan. The WHCRA applies to self-insured plans that aren’t covered by state law and sets a minimum standard to be sure this service is available for all women in every state. This includes states with weaker or no laws covering breast reconstruction.

Under the Act, group health plans, insurance companies, and HMOs that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to give a more balanced look, breast prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedema (swelling in the arm that sometimes happens after breast cancer treatment).

Yes. Both health plans and health insurance issuers are required to tell you about WHCRA benefits. They must do this when you enroll and every year after that. The annual notice may be sent by itself or it may be included in almost any written communication by the plan or insurer, such as newsletters, annual reports, policy renewal letters, enrollment notices, and others. Enrollment notices may even be a phone number or Web address from which to get more information about coverage.

No. The WHCRA does not keep a plan or health insurance issuer from bargaining about amounts and types of payment with doctors. But the law does forbid insurance plans and issuers from penalizing doctors or providing incentives that would cause a doctor to give care that is not consistent with WHCRA.

No. The WHCRA was not changed by the ACA and there are no provisions or regulations that affect it. Health insurance plans that offer mastectomy must continue to offer breast reconstruction.

No. The law does not apply to Medicare and Medicaid.

Still, Medicare covers breast reconstruction if you had a mastectomy because of breast cancer. Medicaid coverage varies in each state, so you will have to get this information for your state. (See the section called “To learn more” for contact information.)

If you have more questions or concerns, you can contact:

·  The US Department of Labor, which has the WHCRA information on its Web site at www.dol.gov/ebsa/Publications/whcra.html, or you can call their toll-free number at 1-866-487-2365

·  Your health plan administrator (a number should be listed on your insurance card)

·  Your State Insurance Commissioner’s office [The number should be listed in your local phone book in the state government section, or you can find it at the National Association of Insurance Commissioners online at www.naic.org/state_web_map.htm. If you can’t find the number elsewhere, call 1-866-470-NAIC (1-800-470-6242).]

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What exactly are the benefits of receiving massage or bodywork treatments? Useful for all of the conditions listed below and more, massage can:

• Alleviate low-back pain and improve range of motion.
• Assist with shorter, easier labor for expectant mothers and shorten maternity hospital stays.
• Ease medication dependence.
• Enhance immunity by stimulating lymph flow—the body's natural defense system.
• Exercise and stretch weak, tight, or atrophied muscles.
• Help athletes of any level prepare for, and recover from, strenuous workouts.
• Improve the condition of the body's largest organ—the skin.
• Increase joint flexibility.
• Lessen depression and anxiety.
• Promote tissue regeneration, reducing scar tissue and stretch marks.
• Pump oxygen and nutrients into tissues and vital organs, improving circulation.
• Reduce postsurgery adhesions and swelling.
• Reduce spasms and cramping.
• Relax and soften injured, tired, and overused muscles.
• Release endorphins—amino acids that work as the body's natural painkiller.
• Relieve migraine pain.

A Powerful Ally

There's no denying the power of bodywork. Regardless of the adjectives we assign to it (pampering, rejuvenating, therapeutic) or the reasons we seek it out (a luxurious treat, stress relief, pain management), massage therapy can be a powerful ally in your healthcare regimen.

Experts estimate that upwards of ninety percent of disease is stress related. And perhaps nothing ages us faster, internally and externally, than high stress. While eliminating anxiety and pressure altogether in this fast-paced world may be idealistic, massage can, without a doubt, help manage stress. This translates into:

• Decreased anxiety.
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue.

Furthermore, clients often report a sense of perspective and clarity after receiving a massage. The emotional balance bodywork provides can often be just as vital and valuable as the more tangible physical benefits.

Profound Effects

In response to massage, specific physiological and chemical changes cascade throughout the body, with profound effects. Research shows that with massage:

• Arthritis sufferers note fewer aches and less stiffness and pain.
• Asthmatic children show better pulmonary function and increased peak air flow.
• Burn injury patients report reduced pain, itching, and anxiety.
• High blood pressure patients demonstrate lower diastolic blood pressure, anxiety, and stress hormones.
• Premenstrual syndrome sufferers have decreased water retention and cramping.
• Preterm infants have improved weight gain.

Research continues to show the enormous benefits of touch—which range from treating chronic diseases, neurological disorders, and injuries, to alleviating the tensions of modern lifestyles. Consequently, the medical community is actively embracing bodywork, and massage is becoming an integral part of hospice care and neonatal intensive care units. Many hospitals are also incorporating on-site massage practitioners and even spas to treat postsurgery or pain patients as part of the recovery process.

Increase the Benefits with Frequent Visits

Getting a massage can do you a world of good. And getting massage frequently can do even more. This is the beauty of bodywork. Taking part in this form of regularly scheduled self-care can play a huge part in how healthy you'll be and how youthful you'll remain with each passing year. Budgeting time and money for bodywork at consistent intervals is truly an investment in your health. And remember: just because massage feels like a pampering treat doesn't mean it is any less therapeutic. Consider massage appointments a necessary piece of your health and wellness plan, and work with your practitioner to establish a treatment schedule that best meets your needs.

Review the clinical research studies examining the benefits of massage.

Review massage information from the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health.