Massage therapists in the province are upset over recent restrictions implemented by the Workplace Health Safety and Compensation Commission (WHSCC).
Mike Pollard, past president of the Newfoundland and Labrador Massage Therapists’ Association (NLMTA), says although they’re in a legislated, regulated profession and physicians refer patients to them, new regulations that came into effect in June 2010 are essentially denying many injured workers massage therapy to treat soft tissue injuries.
Workers’ compensation now only covers up to six one-half-hour treatments and will only pay $25 per session.
In addition, massage therapy must be “in conjunction with an active treatment program, such as physiotherapy, chiropractic treatment, clinic-based occupational rehabilitation, worksite occupational rehabilitation or a progressive goal attainment program.”
Prior to this policy change, Pollard said massage therapy coverage was determined on a case-by-case basis.
Most therapists, he said, charge $45 for a half-hour session or $85 for one hour. But now under the new policy, where they have to bill for half-hour sessions, the cost for one hour is $90.
In some cases, Pollard said, an injured worker might want to pay the difference between the $25 covered by the WHSCC and the actual fee for their therapy, but WHSCC doesn’t allow the patient to pay the difference or the massage therapists to bill them for that amount.
“If you go to a dentist and your insurance doesn’t pay the full amount, you have to pay the rest,” he said. “So, why can’t Workplace Health and Safety do the same?”
In some cases, Pollard said, massage therapists who work in clinics with physiotherapists, chiropractors and doctors have to pay a percentage of the fees they collect for their services to the business owner.
“It could be 40 per cent that the business owner will take out of the contracting massage therapist,” he said, “so, someone who works for $25 for half-an-hour of treatment is not making very much money.”
Pollard said the massage therapists’ association has been in discussions with the WHSCC since 2009 about the possibility of streamlining its guidelines and procedures.
He believes the recent changes, however, are based on budgetary reasons, not on health-care benefits for the patients.
Pollard said the new guidelines won’t allow massage therapists to effectively treat workers because they’ve narrowed the parameters too much.
In two years down the road, he said, the WHSCC will likely say massage therapy isn’t effective, but the real reason it won’t be effective is because the commission has only allowed six half-hour appointments.
Leslie Galway, chief executive officer of the WHSCC, said costs were a factor in the recent changes.
‘They can’t go beyond our contracted rate’
“We’ve been looking at our costs and the use of massage therapy over a period of five years, 2006 to 2010, and over that period of time the number of therapy sessions have increased by 900 per cent and the costs have increased approximately 1,000 per cent over that five- year period,” she said.
As an example, she said, in 2006 the total annual expenditure for massage therapy was less than $50,000, but by the end of 2009, it had increased to about $450,000 a year.
“We pay attention to our health care costs and our trends and we look for signals that would come out of this analysis that would indicate that we need to do something different, that we can better utilize our injury fund for workers. That fund is available to pay their costs for the duration of an injury, which can be a lifetime for some and a few weeks for others,” Galway said.
In the past, she said, the WHSCC also found inconsistent numbers of massage therapy sessions required for a given therapy and the rates varied largely from $25 to $160.
Before establishing rates and restrictions, Galway said the WHSCC initiated a study across the country of what other jurisdictions were doing. In some, she said, massage therapy isn’t covered by the workers’ compensation programs and the Newfoundland Medical Care Plan also doesn’t cover massage therapy.
“We also noted that in several others, they didn’t accept massage therapy as a stand alone therapy, but if a physiotherapist or chiropractor wanted to do some massage during the session, that would be fine,” Galway said.
In some provinces like Ontario, she said, one-hour sessions are covered to a maximum of $50, so in Newfoundland and Labrador, the WHSCC decided to cover half-hour sessions at $25, “very similar to the rate Ontario is paying.”
“ … We also looked at the number of sessions for many of the injuries that were requiring massage therapy and we capped that at six,” Galway said. Extenuating circumstances, however, will continue to be considered on a case-by-case basis.
In response to the concern that injured workers can’t pay a portion of the fee charged for their therapy, Galway said that’s because of a legislative provision to ensure injured workers are not in a position where they would have to pay an additional fee over and above what the commission has approved to a particular therapy provider.
“We’re basically the contractor for the therapist, so they can’t go beyond our contracted rate,” she said.
With respect to the stipulation that massage therapy has to be in conjunction with another active treatment program, Galway said massage therapy is not seen as a primary, stand-alone treatment.
She said she’s aware of the concerns raised recently and the WHSCC is willing to have further discussions with the massage therapists’ association.
Galway said the WHSCC has asked the association to provide any medical and scientific evidence it has to indicate that massage therapy has a positive influence on an injured workers’ return to work and their functional capacity.
To date, she said, the WHSCC hasn’t received anything to support this, but its doors are open and it would welcome any peer-reviewed research the association can provide.
Pollard said the province’s massage therapists’ association has roughly 196 to 200 members, so financially it can’t afford to pay for a research study.
“But you know what, Workplace Health and Safety can and if they’re committed to the well-being of their injured workers and they want to see if this is an effective modality, then they should do a pilot project,” Pollard said.
The action WHSCC has taken is unfortunate, he said.