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Advice From The Trenches



                          Advice from

              The Trenches


Washington State's Lori Bielinski offers guidelines, based on her extensive experience dealing with insurance carriers and state legislators. 

By Mirka Knaster


In the less than 10 years since she received her massage license, Lori Bielinski has had a notable impact on the profession. She gave meritorious service, first to AMTA, then to the state of Washington. She traded her massage table in Seattle for a government desk in Tacoma. She went from working privately with individual clients to collaborating publicly with legislators, medical directors, insurance providers, and a variety of health-care practitioners striving for health-care reform. Hands-on therapy turned into hands-on politics.
Since December, 1996, Bielinski has been a staff member of her state's Office of the Insurance Commissioner. She works as a health policy analyst, to provide consumer access to all categories of health-care providers; as a health-care outreach coordinator, which also includes women's issues and reproductive health; tribal health-care coordinator; and a coordinator of the clinician workgroup on the integration of complementary and alternative medicine (CAM). 
In her many roles, she has been able to get an in-depth view of the health-care environment, and the ways in which massage therapy fits into it. Suggestions based on her experiences in the Pacific Northwest offer activist massage therapists an opportunity to rethink what they are doing in their home states. Bielinski's advice speaks directly to massage therapists who want to successfully participate in integrating massage therapy into health care during the next period of change. They also can rethink how they might help facilitate change within themselves and their practices, within their local AMTA chapters, and with health-care power brokers. 
Bielinski's thick, wavy black hair is streaked with gray. Although the day was dreary and wet outside, she brightened the room with her apple-cheeked smile. Her green eyes, fringed with long, dark lashes, sparkled with enthusiasm as she spoke about her commitment to improve the role of massage therapy in the health-care arena, and to fight for greater choices in health care. She was eager to share thoughts and advice, gleaned from her rich background, for furthering the massage therapy profession.
Draw On Your Past
Bielinski took full advantage of her previous life experiences when she became a massage therapist. She put to good use what she had learned from managing a shoe store, working for a criminal lawyer, serving as a telephone operator, and processing bill payments for a major corporation. Being an active union member of Communication Workers of America afforded her training in grass-roots organization, committee structure, lobbying, and operating autonomously, yet reporting to a board. 
All the skills she gained prepared her for future organizational activities, regardless of the subject. Though she never wanted to go into politics, she realized how much she understands it, and decided to apply that knowledge rather than close the door behind her when she became a massage therapist. In 1992, Bielinski became involved with AMTA as a Washington chapter member. Until she left for her government job in 1996, she held various posts: Washington first vice-president and government relations chair; AMTA national government relations chair, and AMTA national board of directors member-at-large. Now she also uses her experience as a massage therapist to be an advocate for access to CAM.
Her advice: Keep all your doors open. Use what you know in marketing, business, finance, etc., to keep developing yourself.
Be A People Person 
Bielinski is a people person. She holds onto business cards and makes it a point to connect with people everywhere she goes. Through her political work in the labor union, she gained many personal contacts (state and national elected officials) and never dropped them. As issues arose in her new profession, she knew whom to call on for help. 
When Deborah Senn offered her the job of health policy analyst, Bielinski was not sure she was qualified for it. But once she was settled and understood her tasks, she realized she did not need to know everything about insurance; she needed to know the right people to whom she could direct questions and with whom she could work.
Her advice: Build relationships wherever you are, whatever you're doing. You never know when you'll need them. 
Share What You Know
"For some reason, I get information that doesn't make sense for me to know or have, but sooner or later, someone will ask me a question and I'll have the answer," says Bielinski. 
She shares information publicly in several ways: testifying before the legislature on bills that come up related to her work; giving presentations to convey the insurance commissioner's message that people have a right to choose their health-care provider, to access the benefits they are paying for, and to keep their health-care issues private; and educating people about what CAM, including massage therapy and acupuncture, do. Part of Bielinski's job is to break down the barriers of understanding between groups. In particular, she tries to dispel the concept that allopathic medicine is the only kind of care that should be paid by health-insurance dollars. "Information is powerful," she says. "Use it appropriately."
Her advice: Dispel myths and misinformation, and win allies by educating your local and state community about the benefits of massage therapy.
Present Professionally
If you get to the right people to present your argument for massage therapy, be sure to dress formally, not in blue jeans, T-shirts, Birkenstocks or Adidas. If you appear in a way that makes insurance carriers and legislators uncomfortable, they are less likely to be swayed in your direction. If you cannot manage or do not want to change how you look, leave the face-to-face contact to others who can dress the part. 
Equally important is the way you communicate. Remember that when you are the underdog, you have to be able to think on your feet. Rather than be defensive and fight with people who are different, learn their vocabulary and teach them yours. Learn Insurance 101: Know how to do billing and read contracts. "They size you up in the first 90 seconds," says Bielinski. "If you talk their language and look like them, they'll listen to you. Remember that their bottom line is, "Can you bring me votes or money?'"
Her advice: Always maintain a highly professional appearance, verbally and nonverbally. 
Build Coalitions
Get a mix of personalities together, and you are bound to run into some internal wrangling unless you are clear on the group's intention. From her extensive participation in committees in and out of AMTA, Bielinski says, "It's not about liking each other, but about listening to what each person has to say, and seeing if it makes sense." She recommends drawing on each other's backgrounds to write out objectives and work with a strategic plan. 
Whether you are working nationally or locally, keep in mind that to accomplish goals, building relationships is far more important than grandstanding your differences. As national AMTA legislative chair from January, 1995, to December, 1996, Bielinski assisted chapters in getting about half a dozen licensing laws passed, including those in Maryland, South Carolina, and Louisiana, because there was a lot of coalition building. Today she is coordinator of approximately 40 people representing health-insurance carriers, primary-provider groups, and CAM-provider representatives from professional associations, and outside facilitation. They work together on issues such as best practices, clinical guidelines, costs related to "add-on" and replacement.
Her advice: Be open-minded to others, and work cooperatively for the good of all. 

Create Options 
Bielinski learned early in her life how to see options, even when she was backed into a corner. When medical doctors told her that because of Guillain-Barr syndrome, she might never walk again, within a year she was running. She is convinced that once you establish your parameters, you can find multiple ways of tackling a problem. But if you give people only a couple of choices, that tactic does not work, she says. 
  Bielinski's creative efforts have paid off for massage therapists. When she took over as government relations chair for the AMTA Washington chapter, she asked for a budget to hold meetings all over the stateÑin clinics, schools, libraries, wherever they could get people to come. That was the singular activity that increased AMTA membership in her state. It also got a personal-service sales tax lifted (with the help of local politicians), and removed massage therapists from the same category as Turkish bathhouses and tattoo operators.

Her advice: When problems arise, do not think small. Maximize and vary your approach to solutions.

Being a "people person" has helped
Bielinski in many ways.

Maintain Balance 
Although it is tempting to sign up for insurance payments, Bielinski believes massage therapists would do well to keep a hold on cash practice to maintain balance. Because the health-care system is in crisis now, CAM providers, in general, can fare better than other health-care providers can if they are not totally dependent on insurance. 
Medical students ask Bielinski why CAM providers want into the system when they are managing on a cash basis. Her response is that it is not so much what massage therapists and other practitioners want, but what consumers are demanding. When clients or patients say they would come more frequently if their insurance paid for it, CAM providers equate more visits with more money, and more opportunities to help people with their problems.
Her advice: Do not rush into a practice that entirely depends on insurance reimbursement.
Know Your Limits
Bielinski reminds massage therapists that it is not in their purview to make a diagnosis or prognosis. Instead, as experts in soft-tissue conditions, they must pay attention to the doctor's prescription for their services. If they do not like being second to such a gatekeeper, they need to consider the reality of educational requirements. Most massage therapy programs run a year or less. That puts them on the outskirts of what other providers consider acceptable. To those health-care professionals who have attended school for six to eight years, it does not make sense that a massage therapist would be a primary caregiver. 
She adds that, as CAM providers, massage therapists have to be careful about saying they can save carriers money when they cannot. As utilization climbs, costs will climb and carriers will more carefully examine such claims. Bielinski warns, "We can't reach further than what is there." 
Her advice: Don't expect to be on a par with doctors when you have a basic massage education.

Challenge Yourself
Bielinski believes massage therapists should challenge themselves to be specialists in their field. She points out that physicians learn basic sciences, then undergo medical training and residency, followed by practice and specialization. If massage therapists want to work on a par with them, they need to go beyond a primary level of massage education. 
Toward that end, she recommends not a general national certification, but certifications in the many aspects of massage therapy and bodywork. Even if a state does not have licensing, such certification would allow massage therapists to specialize in the categories they prefer to practice in, whether medical treatment, spa therapy, pregnancy massage, or sports massage. A national board that offers massage therapists credentials in specialties would result in higher competency, the kind that would create a different acceptance of the profession than now exists. It would enable massage therapists to become assistants, for example, to osteopathic physicians. This specialty excellence also would help consumers make clear choices about whom to work with.
Her advice: Take advantage of opportunities to become a specialist in your field.
The Future
Bielinski foresees a greater level of health-care integration throughout the country in the next five to seven years. However, what happens in the West and East will not be the same. And states with regulation will be different from those without it. For one thing, payment for massage therapy services will be higher in areas where there is regulation because of the competence certification that it confers. 
While it would be a great asset to have a massage therapist fulfill Bielinski's role in every state, Washington is unique in incorporating such a position into its government structure. Still, in their own states and in their own way, all massage therapists can lend hands-on expertise to changing the political face of health care in the United States. 

Mirka Knaster, author of Discovering The Body's Wisdom (Bantam Books), writes from Oakland, California. She can be reached at: Knaster@aol.com.

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