Progress for All

July 9, 2019

For decades, AMTA and others have promoted massage therapy as a valuable complement to conventional medicine, starting from the understanding that both increased engagement with governmental agencies and more quality clinical research are crucial for massage therapy to realize full acceptance within the health care environment.

The recognition of massage therapy as an integral part of integrative health care elevates the entire profession and, along with it, all massage therapists. The well-known apho- rism is true: A rising tide lifts all boats. No matter where you work—whether in a hospital or other health care facility, spa, or your own practice—you see clients incorporating regular massage therapy into their health and wellness regimens.

Increased Demand Prompts More Research

Over the last several decades, the increased use of massage and other integrative therapies by consumers for a variety of health issues has driven the demand for research around the value and efficacy of these therapies. Alongside increased consumer demand was the realization that non-pharmacologic approaches to pain management were needed. Both helped foster opportunities where budding relationships among health care organizations, federal and state government agen- cies, and those conducting clinical research on the efficacy of massage therapy could grow.

In 1990, AMTA founded the Massage Therapy Foundation (MTF) with the mission of advancing the knowledge and practice of massage therapy by supporting scientific research, education and community service. Over time, AMTA and the MTF actively promoted the need for more scientific evidence on the efficacy of massage, resulting in research projects that have ranged from massage for peripheral neuropathy related to chemotherapy to postural control in seniors to migraines, cancer and spinal cord injury.

Additionally, prominent medical institutions like the National Institutes of Health (NIH), Mayo Clinic, MD Anderson Cancer Center, Duke Integrative Medicine and the Cleveland Clinic conducted or funded a broader array of clinical research that made its way into peer-reviewed journals. Collectively, these efforts have allowed for a body of research that demonstrates the efficacy and clinical viability of massage therapy, which is summarized in AMTA’s 2018 publication Massage Therapy In Integrative Care & Pain Management.

This publication also contains a second critical piece of the integration conversation centering on economics—mainly that using massage ther- apy in place of opioids when appropriate and for specific types of pain has the potential to save the U.S. between $23 billion and $25 billion each year. This is the first economic study of massage therapy to demonstrate cost savings while simultaneously reinforcing how the use of massage therapy instead of opioids can save lives and decrease long-term health care costs.

Advancing the Profession: Building Important Relationships

In recent years, AMTA has worked to further the research agenda and promote the value and efficacy of massage therapy by expanding collaborations with stakeholders outside of the massage community. This work includes outreach to federal agencies of oversight like the Center for Medicare & Medicaid Innovation (the Innovation Center) and the U.S. Department of Health and Human Services (HHS). These efforts have so far proved to be mutually beneficial, resulting in the HHS Pain Task Force incorporating many of AMTA’s suggestions into the Pain Management Best Practices Inter-Agency Task Force Report.

Research and data have begun changing how the profession is perceived among other health care stakeholders who are starting to seek out industry leaders like AMTA. Recently, AMTA representatives made a presentation to the Academic Consortium for Integrative Medicine and Health on how massage therapy can be effectively integrated into care. The Consortium includes 70+ academic medical centers and affil- iate institutes sharing the mission of advancing integrative health care principles and practices. In addition, articles from AMTA have appeared in several issues of The Pain Practitioner, the publication of the American Academy of Pain Management.

The rise of research quality and quantity has coincided with the increasing profile of massage therapy in the health care community. The increasing body of evidence supporting massage therapy as a viable health care treatment technique is essential. Recognition of the benefits offered by massage therapy, however, is only part of the work that needs to be done. The broader issue alongside evidence that demonstrates the efficacy and economic impact of massage therapy is the idea that massage therapists should be the primary providers of massage.

Advancing the Profession: The Role of Regulation

Massage is generally defined as the application of soft tissue manipulation through various means and methods. This definition is central to the practice of massage therapists, but is not exclusive to them. Physical therapists, occupational therapists, athletic trainers and chiropractors are a few of the health care prac- titioners who also can statutorily incorporate some form of soft tissue manipulation as part of their practice. But, unlike many massage therapists, these practitioners are generally recognized in the health care profession and are frequently reimbursed for their application of soft tissue manipulations (massage) through health, auto and injury insurance programs.

Most states have some form of regulation in place for massage therapists. Today, 46 states, the District of Columbia, Puerto Rico, U.S. Vir- gin Islands and Guam regulate massage therapy, typically through licensure. However, that regulation continues to consist of a patchwork of definitions, standards and requirements that can vary across states. The massage therapy profes- sion needs professional practice acts in every state that provide statutory scope of practice.

No other qualified health care profession lacks a statutory scope of practice in a jurisdiction. Additionally, that scope of practice needs to have relative consistency, most especially in core entry level and practice standards.

AMTA has a long tradition of advocating on behalf of the industry; promoting fair and consistent regulatory requirements has long been a central tenet of the association. After identifying the need for a proactive, national presence in government affairs, AMTA took its commitment to a new level. In 2005, association leaders made a bold move to create a centralized, national government relations program.

This initiative was revolutionary for the massage profession because no national stakeholder had ever made such an in-depth commitment to proactively pursue a favorable regulatory environment across the country. The approach was clear: give massage therapists in each state the direction, support, guidance and resources to promote fair and consistent licensing standards. Key resources include the financial support of lobbyists, resources and materials developed specifically to help massage therapists in their own lobbying efforts, grants and full-time staff support, and a voice at relevant national conferences and conversations.

From 2005 to 2018, AMTA has funded government relations efforts at the state level totaling roughly $8 million. By supporting initiatives, AMTA was able to recruit some of the top lobbying talent in the country. This approach has netted countless wins for the massage profession across state capitals, with 13 states adding new regulation where none previously existed. Additionally, several states either improved upon or defended their regulatory status.

There is a lot of work ahead for massage therapy advocates to create true consistency in core entry level and practice standards. Still, fair and consistent regulation of massage therapy within the health care environment, as well as the acceptance of massage therapists within the broader health care community, are closer to becoming a reality across every state than ever before.

Advancing the Profession: National and Federal Advocacy Efforts

Similar to industry research, advocacy for massage therapy is evolving and growing. In 2016, West Virginia Attorney General Patrick Morrisey sought out many stakeholders in the addiction and pain management community, including AMTA, to assist in drafting policy to address the state’s growing opioid epidemic.

The subsequent development of the Best Practices Toolkit focused on providing new guidelines regarding prescription pain medications to min- imize the risk of addiction and substance abuse, including validating massage therapy as a valu- able, non-pharmacologic therapy in treating pain. Morrisey’s initiative spurred action from the National Association of Attorneys General in 2017, which urged the America’s Health Insurance Plans (AHIP) to take action on the opioid epidemic. In part, they asked insurance companies to incentivize the use of non-opioid pain treat- ments such as massage therapy.

This collaboration, and others like it, represent the evolving advocacy landscape for the massage therapy profession. The profession’s advocacy and research efforts have started to intersect—research about the efficacy of massage therapy has prompted action within the national advocacy and policy arenas. As the nonprofit association representing the profes- sion, policymakers are looking to AMTA to play an important role in addressing common problems.

In addition to state advocacy initiatives, opportunities at the federal level have also expanded, including educating Congress on the value of massage in pain management. Since 2017, AMTA has been working hard to develop a meaningful dialogue with the Senate Finance; Senate Health, Education, Labor and Pensions (HELP); and House Ways and Means Committees. Additionally, interaction with individual mem- bers of Congress through the Integrative Health and Wellness Caucus have been promising.

AMTA has also engaged a variety of federal agencies, ranging from the National Institutes of Health to the Food and Drug Administration (FDA). The heightened profile of massage therapy research, the need for non- pharmacologic approaches to pain management and the efforts of AMTA have led to positive actions from agencies such as the Centers for Medicare & Medicaid Services (CMS).

Over the last two years, CMS has promoted massage therapy provided by a state licensed massage therapist as a supplemental benefit in Medicare Advantage plans. Similarly, the Department of Veterans Affairs (VA) has created a General Schedule (GS) level massage therapist position within the VA. The GS is the principal pay scale for federal employees.

While the strides are significant, the reality is that Medicare Advantage Plans and the VA having a defined position for massage therapy are just the beginning. The engagement from national stakeholders is promising, but there is still work to be done, specifically in conducting meaningful research that reinforces the value of massage therapy.

The industry is at the dawn of a new era in advocacy built on the foundation laid over the past 30 years. A foundation that includes commitments to research, partnerships and public policy that makes the opportunities the massage therapy profession has today possible.