AAMT Bulletin 11 August 2015
An update on developments in the massage therapy sector
Policy and Regulation
Closing the modality migration loopholes
Consultations about ‘Modernising Victoria’s Health Complaints Legislation’ in regard to implementing the recommendations made by the Expert Panel that reviewed the Health Services (Conciliation Review) Act 1987, were recently undertaken on behalf of the Minister for Health, Victoria.
The Minister’s invitation to contribute to the consultations provided a welcome opportunity for AAMT to represent the needs and views of the massage sector about complaints handling in Victoria.
Increasingly the health sector is operating using inter-professional methods or modalities within registered and unregistered scopes of practice. However this poses a challenge because the likelihood and complexity of cross-professional regulatory issues increases.
Rather than a reactive approach, AAMT argued that these circumstances create unreasonable public exposure to risk, driving the need for a monitoring-based approach to complaints handling.
The current regulatory framework is limited in its ability to afford adequate protection against unreasonable risk. This risk arises from unscrupulous individuals and massage therapists who continue to undermine self-regulation and the professional standing of the legitimate massage sector by perpetrating sexual assault and fraud on unsuspecting clients, and participating in other criminal activity such as illegal prostitution and human trafficking.
AAMT believes regulations should attempt to net in all alternative health care fields, including naturopathy, acupuncture, speech therapy, Bowen, myotherapy services, beauty and wellbeing services where any form of massage or soft tissue manipulation is included in the therapy.
Additionally, the disconnect between Registered Health professionals and Unregistered Health practitioners means that complaints about massage therapy from osteopaths and physiotherapists and other registered health services go unreported to professional massage associations.
This creates a significant weakness in self-regulation. Competitors of massage, such as physiotherapy, osteopathy and occupational therapy practice some form of massage, with far less training and qualifications than remedial massage therapists. For example, massage training in other AHPRA-regulated modalities can be as low as 20 hours to around 150 hours of massage and lymphatic drainage training, Remedial massage therapists must undertake over 1,000 hours of clinical practice, to meet the qualification requirements.
The lack of adequate training and registration with a massage association enables the migration of poorly-trained and deregistered Registered Health professionals and Complementary health practitioners into the massage space, unmonitored and without accreditation of a professional massage association.
The successful resolution of complaints and provision of appropriate protection against risk of harm is dependent on gaining access to adequate supporting information and evidence in some form. For this to occur, the information must be submitted, collected, recorded and managed consistently across the health care sector. Legislation can mandate whatever powers of investigation it likes, but if the necessary records and information are not available to use for investigation, little can be done.
The reactive approach to complaints handling and resolution, means that a crime must be committed or alleged to have been committed before reporting requirements come into effect. This is a retrospective process that weakens the effectiveness of the regulatory framework and the complaints resolution process. A proactive preventative/monitoring approach is required if measurable and effective change for the better is to be achieved.
Protecting the provider from vexatious complaints is an important matter and should be built into the system. However, AAMT argued that placing the right to privacy or the need to facilitate fair competition before harm is a significant factor that has enabled migration of delinquent and unscrupulous health practitioners into the massage sector, often leading to sexual assault and misconduct.
To close the loopholes, information-sharing must occur at a secure level to monitor and in some cases prevent misconduct, or at the very least, prevent repeat occurrences of misconduct.
Closing the modality migration loopholes, enabling confidential sharing of complaints and disqualification records, and creating a regulatory environment based on monitoring, rather than reaction, will do much to address the regulatory problems facing the sector.
AAMT has good reason to participate in the Primary Care Better Outcomes review
During 2015 Australia’s Federal Minister for Health established the Primary Health Care Advisory Group (the Advisory Group) to examine how to do things better.
The Advisory Group has developed a discussion paper on possible options to address the issues. A national consultation in regard to people with chronic and complex diseases and surveying potential alternatives to the current system that have been adopted internationally will inform the advisory process.
AAMT welcomes this opportunity because remedial massage is now an integral part of the health care system, being used as a first form of treatment in primary care.
The 2012 Survey of AAMT Registered Massage Therapists found if all massage therapies are counted, 50 per cent of respondents use some form of massage as their first, second or third most frequently used therapy executed solely as massage and not as a combination with other modalities.
As an effective lower cost health service to other soft tissue modalities such as Osteotherapy, remedial massage can make a greater contribution to primary care of chronically ill patients.
This is important because the AAMT survey also found that older patients were seen significantly more often for arthritis, cancer, health and wellness, other chronic disorders marked by reduced musculoskeletal function, and psychological distress including anxiety or depression. Between 5 and 37 per cent of therapists reported that they offer services for cancer treatment issues, e.g., pain, lymphoedema, distress; as well as motor vehicle accident and rehabilitation; diabetes effects management; and addictions rehabilitation support.
Health Funds training requirements are now outside AQF standards
The outsourcing powers of Health Funds are operating outside the Australian Qualifications Framework (AQF), the national policy for regulated qualifications in Australian Education and Training, which is managed by the Department of Education and Training.
While Health Funds have a right and obligation to manage the material business risk of their business activities, the ability to arbitrarily and without consultation alter Provider eligibility training and education requirements, has a direct bearing on the business activities of health providers and the opportunity afforded consumers to access the health services of their choice.
Additionally, students who pay for and undertake costly training to meet AQF and Fund requirements are finding their qualifications to be invalid because they no longer meet new Health Fund Provider status requirements. This level of uncertainty is not best practice.
While the requirements for Outsourcing Standards are designed not to restrict existing or future outsourcing arrangements between insurers and third parties, the uneven playing field and powers of the parties involved in these negotiations demands greater scrutiny and regulation of Health Funds’ practices.
As the independent prudential regulator, the Private Health Insurance Administration Council (PHIAC) seems unable to address this issue. As a result, legitimate remedial massage therapists are feeling the pinch of an uneven playing field that is undermining the commercial viability of legitimate remedial massage clinics and limiting the choice of services for health consumers.
The AAMT is working with Private Health Care Australia to address these issues and ensure a more stable and dependable operating environment for students, educators and qualified massage therapists.
Welcome addition to NHMRC Council
The appointment of Ms Karen Carey to the National Health and Medical Research Council (NHMRC) to represent consumer issues is welcomed by the AAMT.
As one of Australia’s foremost consumer advocates, we hope that Ms Carey will give voice to the rapidly growing demand for complementary health medicine and services.
The IBIS World report, April 2013, reported that Australians spend around $3.5 billion a year on natural health and natural health care and that this trend is expected to grow by around 5.3 per cent to 2018.
Given the demand and change in consumer behaviour, funding for high quality research in this area of health is vital to build a better understanding of how these health services and treatments benefit patients, and how they might help to relieve the stresses on Australia’s health budget.
For example, thousands of studies into the effects of massage indicate that massage offers significant benefit as an intervention by providing relief from the symptoms and discomfort of injury and recovery, chronic illness and muscular skeletal conditions affecting the aged. While such trials and investigations provide highly valuable data, only a small proportion can be included in Cochrane framework analyses of efficacy and conclusive clinical benefit.
Until recently, few clinical trials examined or measured the biological effects of massage, focusing on subjective reporting by the patients in the areas of pain, stress, sleep, anxiety, and general wellbeing.
Higher academic qualifications within the massage sector required to attract funding from the NHMRC or similar bodies is not common, limiting opportunities for robustly conducted trials that would shed greater light on the benefits of massage as an evidence-based modality.
In response, despite limited funding, the AAMT supports a world-first researcher development program—the International Complementary Medicine (CM) Leadership and Capacity Building program with Sydney’s University of Technology. This offers the opportunity to enhance research capabilities in the areas of massage that promise significant benefits for patients and the health sector.
However, unlike other sectors of health such as pharmacy, typified by a small number of large corporations with resources to conduct Cochrane-level clinical trials, the massage sector is characterised by small businesses, and associations funded through membership.
Where clinical efficacy is known, or the body of reasonable evidence suggests worthwhile benefits in order to deliver an effective and affordable health care service, a sensible regulatory framework that encourages integration of contemporary medicine and health care with complementary medicines and health services such as remedial massage seems a likely solution to addressing the growing burden of health care costs in Australia.
For Australia as a developed nation, with a high standard of health care and a leading exporter of education, the opportunity to become a world leader in complementary healthcare is self-evident.
We hope that Ms Carey will pick up this mantle and advocate for programs that channel a greater allocation of research funding to this area of health care in order to overcome the disconnect between conventional and complementary health which currently occurs to the detriment of health professionals’ skill and understanding, and health benefits for consumers.
Overseas industry update
Pakistan’s 2015 Health Bill includes complementary health registration
The draft Federal Health Regulatory Authority Bill under consideration by the Pakistan Cabinet has the potential to provide a regulatory framework that guarantees the provision of quality healthcare services.
Like Australia, Pakistan has a large private health sector. The Federal Healthcare Regulation Act 2015 will establish a Federal Health Regulatory Authority (FHRA). The FHRA will oversee for-profit and non-profit organisations, charities, trusts, semi-government organisations, autonomous healthcare institutions, public-private partnerships, local governments, and corporate sector. This includes complementary, alternative and traditional medical treatment systems.
All healthcare services will be required to be registered with the Registration Board of the FHRA and within each category of healthcare that they offer. All healthcare professionals will be required to have registration under the Medical and Dental Council Ordinance, 1962, Pakistan Nursing Council Act 1973 or the Unani, Ayurvedic and Homoeopathic Practitioners Act 1965.
Given that there are currently no standards for quality assurance in the health sector, the measure is expected to pave the way for improved quality of health services and promotion of patient safety through the implementation of quality standards.
The FHRA will also set standards for registration and licensing, define the scope and extent of services to be provided, monitor compliance and enforce minimum standards of patient and health staff safety in the public and private sectors.
Recent papers and studies
Efficacy of a manual physical therapy to treat female infertility
The 10-year retrospective study on the efficacy of a manual physical therapy to treat female infertility has found positive effects for women diagnosed with infertility from mechanical causes.
Researchers concluded that manual physical therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of the specific etiology.
(Alternative Therapy Health and Medicine 2015, vol.21, no.3, pp.32–40.), ‘Ten-year retrospective study on the efficacy of a manual physical therapy to treat female infertility’, Amanda D. Rice, PhD; Kimberley Patterson, P TA; Leslie B. Wakefield, DPT; Evette D. Reed, PT; Kelseanne P. Breder, BA; Belinda F. Wurn, PT; C. Richard King III, MD ; Lawrence J. Wurn, LMT.
AIHW—Cancer mortality trends and projections: 2013 to 2025
The current downward trend in cancer death rates looks set to continue, according to a report released today by the Australian Institute of Health and Welfare (AIHW).
Cancer death rates have generally decreased over time, with the death rate from all cancers combined decreasing from 199 deaths per 100,000 people in 1968 to 167 per 100,000 in 2012. Between 2013 and 2025 the death rate from all cancers is projected to continue an overall downward trend from an estimated 214 to 183 deaths per 100,000 males, and from 135 to 120 deaths per 100,000 females.