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Wake Forest Baptist System: Analysis of an Expanding Massage Program PDF Print E-mail
Written by John Weeks   

Wake Forest Baptist System: Analysis of an Expanding Massage Program

The cover story on the May 8, 2006 newsletter for the Program for Holistic & Integrative Medicine of the Wake Forest University Baptist Medical Center announces the Center's employment of massage therapists. Data from a recent American Hospital Association/Health Forum survey, published recently in an IBN&R short, suggest that this discipline is making steady inroads into US hospitals. This article looks at the strategy this North Carolina system is taking for moving massage into inpatient and outpatient services.

The Wake Forest University Baptist Medical Center Complex
Suzanne Melcher, MA, LMBT, CTRS, heads up the program as the Center's first employed massage therapist. The system first used her services under her "CTRS" - Certified Therapeutic Recreation Specialist - in the Center's rehab division. (These practitioners are independently licensed in North Carolina.) Melcher shared with IBN&R that the system's second massage therapist employee, starting later this month, will also be doubly-licensed: in this case, with her primary connection to the system as a nurse. Two additional therapists will be brought on by the end of July.

Present plans will have massage offered in two separate, stationary sites in the Center's sprawling campus.
The first location is in the employee fitness center of the comprehensive rehab building. The second, "just acquired," is in the second floor of the
WFUBMC massage therapy coordinator Suzanne Melcher, MA, LMBT, CTRS
J.P. Sticht Center on Aging. This facility includes cardiac rehab, acute

  Positioning Massage: 

 list of some conditions
for which massage
therapy is beneficial

From preventive
to rehabilitative
to restorative care

Improving the function of
circulatory systems
Reducing heart rate
and blood pressure
Decreasing pain, muscle
fatigue, soreness, nausea
Improving sleep and rest
Inducing relaxation
Alleviating depression
and anxiety
Assisting with
autoimmune disorders

Enhancing attentiveness

care for the elderly, adult psychiatric services and acquatics. While the first is "about a mile from the main part of the campus" according to Melcher, the second is "within five minutes of anything." This will be useful: according to the Center's massage plan, massage therapists "can also go to the bedside anywhere" in the Center, on a doctor's approval.

The cover article announcing the WFUBMC program
includes reassurance that massage is the "most  common complementary therapy" offered in hospitals. Then an expansive list of conditions for which massage can be valuable is offered. (See side-bar.) Common use, typically, is to "help patients coping with pain and stress, and as a therapeutic service for cancer and maternity patients." Besides the conditions listed in the table, the article stimulates interest in massage through reference to the following practices and research reports:

  • alleviate cramping and headaches
  • lymph drainage in bedridden patients
  • decrease the amount of pain medication needed
  • help patients eat better
  • aid in recovery
  • enhance wellness
  • improve the quality of life
  • reduce the incidence of complications
  • increased muscle tone
  • decreased scar tissue
  • increased soft-tissue health.

The WFUBMC Business Model for Massage

Melcher is clear in an IBN&R interview that the program in its present form is just beginning and will take time top mature. WFUBMC did not start with the employment model. Melcher began offering massage on a contract basis in 2000. It is just now that she is fulltime in this capacity, with benefits.

WFUBMC holistic and IM director Kathi Kemper, MD
The basic hourly rate for a massage therapist is set at $20/hour. The cost of massage begins at $35 for 30 minutes, and up to $85 for a 90 minute session. A booked massage therapist is viewed as giving roughly 20 treatments a week. No tipping is allowed.

At present, the program is not integrated into any third-party payment. Says Melcher: "Right now it is all fee-for-service." To meet the needs to provide services for patients who cannot afford the cash payment out-of-pocket, Melcher anticipates establishing a "foundation or fund" which can cover these treatments. She also notes that those who have flexible spending accounts can use these "as long as a medical doctor specifically orders the care."

Melcher plans to stimulate outpatient services through outreach to the system's physical therapists and occupational therapists. She noted upcoming talks with groups of each scheduled for mid-June. Physician referral is anticipated to begin more slowly. But Melcher clarifies that the program is approved for inpatient services. Patients can
WFUBMC comprehensive rehab massage room
have pre-operative or post-operative treatments "as long as they have been evaluated for contra-indications." Therapists can go directly to the patient rooms.

The target clientele will come from a broadly-cast net: besides patients, employees
, family members of patients enduring long hospital stays, and employees of community businesses. Melcher anticipates integrating the massage services into the Center's services to nearby corporations. Chair massage may be added to various programs (screenings, education, etc.) in which the Center's personnel go out to these businesses. Says Melcher: "PR and marketing thought it would be a good idea."  She adds: "We have the potential to take tables (to employer workplaces)." While massage is not a covered benefit at WFUBMC, employees, massage is being integrated into Action Health, an employee employee program under which participating employees can receive discounts on treatments.

The massage program is part of a broad Wake Forest University CAM-IM initiative directed by Kathi Kemper, MD, the Caryl J Guth Chair for Holistic and Integrative Medicine.  

Comment: The WFUBMC brochure offers an evocative array of conditions and situations where massage may be useful as mainstream medicine attempts to get its spirit and practice around the practical implementation of "patient-centered care." As noted in a recent IBN&R article, deaths caused by medical errors are elevating "patient-centered care" initiatives in many systems.
Think of how care would shift if affirmative recommendation of massage's healing and pain-reducing services were part of the first nature of medical care. It's an easy bet that hospital deaths would decrease as a positive side-effect of caring about whether patients are helped to healing, and out of pain, through increased human touch.

Want patient-
centered care?

It's an easy bet
that hospital deaths
would decrease as
a positive side-effect
of erring on the side
of promoting the
use of massage's in
a patient's healing,
and pain reduction.

I recall a comment of Ted Kaptchuk, OMD, toward the end of a daylong NIH/AHCPR (now AHRQ) sponsored meeting 10 years ago. The group of 20+ of us were exploring coverage issues in integrating CAM. Kaptchuk sat quietly through most of the day's elaboration of credentialing, utilization, and quality control schemes for managing integration, and ,managing the cross-cultural fears of the representatives of the conventional system as they sought to grok the meaning of these new tribes which were suddenly in their midst. Finally, frustrated by the day's accomplishments, Kaptchuk turned to the whole room and stated (I paraphrase): "We have literally hundreds of thousands of massage therapists out there. All they want to do is create health in their patients. They don't cost much. Why don't we figure out how to use them!" 

Melcher makes clear that WFUBMC's integration of massage into physician and Center practices is just beginning. Hopefully this program will move from a rich concept, to employer benefit, to covered service, to becoming a beacon for showing us toward a new model for respecting the value of massage in a US system which has the patient rather than the medical specialist at its center.

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