Massage therapy. There are many forms of massage therapy. They include the following:

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1 Practice area 177 CLINICAL PRIVILEGE WHITE PAPER Massage therapy Background Massage therapy is described in The Theory and Practice of Therapeutic Massage (Beck, Mark, Melody Publishing Company, 1988) as the systematic manipulation of the body s soft tissues by such movements as rubbing, kneading, pressing, rolling, slapping, and tapping for the purpose of promoting circulation of the blood and lymph, relaxation of muscles, relief of pain, restoration of metabolic balance, and other benefits both physical and mental. There are many forms of massage therapy. They include the following: Swedish massage a technique that incorporates long smooth strokes that create a relaxing experience Shiatsu a Japanese modality that is based on the Oriental concept that the body has a series of energy points; when pressure is properly applied to these points, circulation is improved and nerves are stimulated Sports massage a technique that is used as part of a warm-up or cool-down routine and can significantly reduce the risk of injuries Deep tissue massage a technique that uses deep pressure and is particularly helpful in getting rid of tight, knotted areas A massage therapist may be required to be licensed by a state regulatory board or by a local licensing authority. Positions of societies and academies AMTA The American Massage Therapy Association (AMTA) does not publish credentialing or privileging guidelines for massage therapists. But the association requires that a candidate must meet one of the following three criteria to become an AMTA professional associate: He or she is nationally certified by the National Certification Board for Therapeutic Massage and Bodywork He or she is a graduate of a school that is accredited or approved by the Commission on Massage Training Accreditation/Approval He or she is licensed in a state that has licensing regulations acceptable to the AMTA A supplement to Briefings on Credentialing 781/ Criteria reviewed

2 In regard to the licensing of massage therapists, the following states have massage practice laws: Alabama Arkansas Connecticut Delaware District of Columbia Florida Hawaii Iowa Louisiana Maine Maryland Nebraska New Hampshire New Mexico New York North Dakota Ohio Oregon Rhode Island South Carolina Tennessee Texas Utah Virginia Washington West Virginia Since the licensing requirements may differ from state to state, an AMTA spokesperson suggests that each licensing board be contacted directly for the most current information. In addition, there may be local or county licensing requirements for massage therapists. These entities should also be queried for possible regulations for massage practice. COMTAA The Commission on Massage Training Accreditation/Approval (COMTAA) is an independent affiliate of the AMTA and operates separately under its own mission, policies, and procedures to accredit massage therapy schools. In the past, the COMTAA issued an approved program status to massage therapy schools, but now it issues only accredited status. After March 1999, those schools with an approved program will have to go through accreditation. COMTAA accreditation involves a four-step process. 1. Application This step provides the COMTAA with basic information demonstrating that the school is eligible to proceed with the accreditation process. The eligibility criteria are that the school must teach a 500-hour program must have graduated a minimum of two classes prior to application must have operated the program for a minimum of two years prior to application must meet applicable state laws regulating the operation of post-secondary vocational programs. 2 A supplement to Briefings on Credentialing 781/ Criteria reviewed 2006

3 2. Self-study This step requires the school to initiate a process of self-evaluation concerning its program. The school answers a set of specific questions about all of its parts, ranging from its mission and objectives to fiscal responsibility. 3. On-site visit This step involves a visit to the school by a COMTAA team of educational, administrative, and financial experts. This team verifies the self-study and ensures that COMTAA standards are being met. 4. Evaluation This step involves the final evaluation of the school and the decision of whether to award accreditation. Positions of other interested parties NCBTMB The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) publishes standards for massage therapists and body workers. These standards encompass a core body of knowledge and skills that are necessary to provide quality professional service. According to the NCBTMB standards, a therapeutic massage and body work practitioner must have a working knowledge of the structure and function of the human body, the musculoskeletal system, and all the major organs, as well as an understanding of efficient and safe movement patterns of the body, such as body mechanics, lifting, and walking be able to recognize various conditions, including injuries, joint disorders, respiratory and circulatory conditions, and skeletal dysfunction, as well as recognize the signs and symptoms of disease and other disorders be able to observe and assess clients using massage/body work theory, and use practices affecting soft tissue understand exercise methods and stress management techniques such as breathing, relaxation, yoga, and meditation understand the scope of practice of other disciplines, both within and outside the massage therapy and body work profession, for the purpose of making referrals and accurately assessing a client s needs In addition to publishing standards, the NCBTMB offers certification to massage therapists and body workers who successfully complete the written National Certification Examination. This examination is designed for practitioners to demonstrate mastery of the five basic areas of knowledge common to the profession. The examination is neither designed nor intended A supplement to Briefings on Credentialing 781/ Criteria reviewed

4 to cover any particular massage and/or body work discipline in depth. Rather, it includes the knowledge and skills found to be common among all massage and/or body work disciplines and general knowledge about some of the major disciplines. Candidates can meet the eligibility requirements to sit for the National Certification Examination in one of two ways, as long as they can document the necessary 500 clock hours of training or 50 eligibility points. Each method requires them to have specific amounts of training and/or experience as a massage and/or body work professional. The eligibility methods are as follows: 1. Education/training Candidates must show evidence of receiving a minimum of 500 clock hours in formal training at an established school of massage and/or body work. After May 1, 1997, these hours of formal training must be obtained from a state-licensed training institute or the school must show evidence of exemption from licensing status. One clock hour equals 50 minutes of supervised instruction. Candidates official transcripts must show that their program had at least 100 clock hours in anatomy/physiology; at least 200 clock hours in massage and/or body work theory and practice, including a minimum of two clock hours of ethics; and the remainder of clock hours in related education. Candidates must demonstrate successful completion of their program. For example, if the program is 650 clock hours, candidates must complete the 650 hours prior to applying to prove eligibility. Proof of completion of formal training as outlined above must be in the form of an official transcript and diploma or certificate of completion. 2. Portfolio review process The NCBTMB is supportive of alternative ways to qualify for eligibility and, therefore, has developed the portfolio review process, which allows practitioners to assemble a portfolio of all their training to be reviewed by the eligibility committee. The eligibility committee seeks to ensure that practitioners have a solid foundation on which to build their skills. 4 A supplement to Briefings on Credentialing 781/ Criteria reviewed 2006

5 In order to evaluate each portfolio package fairly, candidates education, experience, and work are assigned eligibility points. Fifty points is the minimum number of points necessary for eligibility. The course work requirements for the portfolio review process are as follows: 20 points can be assigned for 200 hours of formal education and training in massage therapy and/or body work, including at least two hours of ethics 10 points can be assigned for 100 hours of anatomy/ physiology 20 points can be assigned for adjunct/related education and/or professional experience Note: Each year of professional experience earns 7.5 eligibility points. One year of professional experience is defined as at least 400 therapeutic sessions performing massage and/or body work within a full 12-month period. One therapeutic session is equal to one hour in length. Candidates must have completed one full year of professional practice to become eligible to receive points in this category. There is a maximum of 20 eligibility points allowed for professional experience and training must be obtained prior to that professional experience. A total of 50 points are needed for eligibility All eligibility points must be documented with a notarized copy of the appropriate diploma, transcript, or certificate of completion and/or necessary affidavit. Candidates must also provide proof of the number of training hours completed. According to an NCBTMB spokesperson, the following states currently endorse or recognize the National Certification Examination: Alabama Connecticut Delaware District of Columbia Florida Iowa Louisiana Maine (voluntary) Maryland Nebraska New Hampshire New Jersey (pending) New Mexico Oregon Rhode Island South Carolina Tennessee Utah Virginia Washington West Virginia A supplement to Briefings on Credentialing 781/ Criteria reviewed

6 The certification offered by the NCBTMB is valid for four years. Massage therapists can be recertified by retaking the National Certification Examination or by documenting 50 hours of continuing education during the four-year period. In addition to continuing education or retaking the exam, massage therapists have to show that they have performed 200 therapeutic sessions of massage/body work during the fouryear period. JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position concerning the delineation of privileges for massage therapists. But if a hospital includes massage therapy as part of its service, says a JCAHO spokesperson, then the JCAHO human resources standards apply to massage therapists just as they do to anyone else the hospital appoints to its staff. According to the JCAHO spokesperson, the human resources standards require that hospital leaders have to define the qualifications that a massage therapist must possess. Then, the hospital leaders must find individuals who have those specific qualifications and add them to the staff through whatever employment process is used, whether employees are full-time, part-time, or contractual. If a massage therapist comes into a hospital as a volunteer, says the JCAHO spokesperson, there are controls that the hospital is required to have on its volunteer staff. All of that is addressed in the human resource standards. CRC draft criteria When a hospital receives a request from a massage therapist to become a member of the hospital staff or to work within the hospital at the request of a physician, a patient, or a patient s family member, or to perform volunteer work within the hospital, it should not be the first time the hospital considers whether this type of practitioner should be granted privileges. The policy covering massage therapists should be drafted ahead of time by the board, resolving any liability, peer review, and reimbursement issues. In addition, the board should review federal laws, state laws, and state and local licensing requirements. The advice of the medical staff should be considered, as well as the needs of the community and the hospital s mission and strategic plan. 6 A supplement to Briefings on Credentialing 781/ Criteria reviewed 2006

7 Criteria should be in place covering qualifications, scope of practice, and physician supervisory requirements. Minimal formal training: Successful completion of 500 hours of training (100 hours in anatomy/physiology, 200 hours in massage therapy, and 200 hours in related studies) in a state licensed training institute of massage and/or body work. Required previous experience: Applicants must demonstrate that they have performed at least 50 therapeutic sessions of massage/body work in the past 12 months in the massage specialty for which they are requesting privileges. Note: A letter of reference must come from the director of the applicant s massage training institute or from the applicant s supervisor at the hospital where he or she most recently worked. Reappointment Reappointment should be based on unbiased, objective results of care according to the hospital s quality assurance mechanisms. Applicants must demonstrate that they have maintained competence by demonstrating that they have performed at least 50 therapeutic sessions of massage/body work in the past 12 months in the massage specialty for which they are requesting privileges. In addition, continuing education related to massage therapy and/or body work should be required. For more information For more information concerning privileging massage therapists, contact: American Massage Therapy Association 820 Davis Street, Suite 100 Evanston, IL Telephone: 847/ Fax: 847/ Commission on Massage Training Accreditation/Approval 820 Davis Street, Suite 100 Evanston, IL Telephone: 847/ Fax: 847/ A supplement to Briefings on Credentialing 781/ Criteria reviewed

8 Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL Telephone: 630/ Fax: 630/ National Certification Board for Therapeutic Massage and Bodywork 8201 Greensboro Drive, Suite 300 McLean, VA Telephone: 703/ Fax: 703/ A supplement to Briefings on Credentialing 781/ Criteria reviewed 2006

9 Privilege Request Form Massage Therapy In order to be eligible to request clinical privileges for massage therapy, a practitioner must meet the following minimum threshold criteria: Minimal formal training: The applicant must demonstrate successful completion of 500 hours of training (100 hours in anatomy/physiology, 200 hours in massage therapy, and 200 hours in related studies) in a state licensed training institute of massage and/or body work. Required previous experience: Applicants must demonstrate that they have performed at least 50 therapeutic sessions of massage/body work in the past 12 months in the massage specialty for which they are requesting privileges. Reappointment: Reappointment should be based on unbiased, objective results of care according to the hospital s quality assurance mechanisms. Applicants must demonstrate that they have maintained competence by demonstrating that they have performed at least 50 therapeutic sessions of massage/body work in the past 12 months in the massage specialty for which they are requesting privileges. In addition, continuing education related to massage therapy and/or body work should be required. References: A letter of reference must come from the director of the applicant s massage training institute or from the applicant s supervisor at the hospital where he or she most recently worked. I understand that in making this request I am bound by the applicable bylaws or policies of this hospital and hereby stipulate that I meet the minimum threshold criteria for this request. Physician s signature: Typed or printed name: Date: A supplement to Briefings on Credentialing 781/ Criteria reviewed

10 The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Opus Communications retains the copyright to the Clinical Privilege White Papers. 10 A supplement to Briefings on Credentialing 781/ Criteria reviewed 2006