Three national massage organizations are protesting the Federation of State Massage Therapy Boards’ plan to launch its own massage continuing education approval process.
Among the complaints are that a new approval process could:
- Result in fee increases for educators;
- Negatively affect the massage field’s current approver of continuing education, the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB);
- Involve, due to the database used to house continuing education, problematic data sharing.
AFMTE published two open letters to the massage field, back when FSMTB had only announced continuing education approvals through its Regulatory Education and Competence Hub (REACH) program (see section, “Dueling Databases,” below)—one of which stated that “the AFMTE sees FSMTB owning and operating courses that are granted [continuing education] credit as a conflict-of-interest … [and] the AFMTE strongly recommends that FSMTB partner with NCBTMB to utilize their well-established Approved CE Provider Program, which will better serve the needs of FSMTB and their Member Boards.”
Additionally, emails sent by AMTA the week of Oct. 3—one to FSMTB delegates that was read to a reporter by a delegate, and one to members of the Coalition of National Massage Therapy Organizations that was forwarded to MASSAGE Magazine by a non-delegate source who declined to be named—stated AMTA’s opposition to FSMTB creating a continuing education approval process.
The AMTA’s email to coalition members stated, in part, “AMTA feels it would be counter-productive for the FSMTB to continue to pursue directions that are opposed to what the profession and our organizations have said are the best means to advance the profession, and avoid unnecessary redundancy and duplication of function.”
Of AMTA’s and AFMTE’s protestations, FSMTB Executive Director Debra Persinger, Ph.D., said, “The trade associations are separate from regulators. We welcome their input, and it helps us make decisions, but at the end of the day we have to focus on member boards.”
Originally, the FSMTB and NCBTMB were working together to craft a proposal pertaining to continuing education approvals that would allow room for both organizations: The FSMTB would develop standards, and the NCBTMB would continue to approve providers.
But when that collaboration was put on hold due to the NCBTMB rejecting the first draft of the joint proposal, FSMTB then-President Karen Armstrong announced her organization’s plan to member boards’ delegates and other attendees at the FSMTB’s annual meeting in Cleveland, Ohio, Oct. 6–8. (FSMTB’s new president, elected in October, is Ed Bolden.)
“FSMTB is going to enter the open marketplace with an innovative, progressive, affordable [continuing education] program that uses modern technology and meets the needs of licensing boards,” Armstrong said.
Continuing education providers will have to agree to FSMTB-determined terms and conditions, including adherence to standards, to upload into the database. Additionally, students who have completed a course will be asked to fill out a satisfaction survey to help FSMTB assure quality, Armstrong said.
FSMTB began in 2012 to publicly share its plan to administer certain types of massage continuing education, and FSMTB will soon offer public safety classes—on ethics, communicable diseases, human diversity awareness, laws, rules and other courses requested by states—through its REACH program. REACH is now in the final stages of beta testing.
At a meeting of NCBTMB and FSMTB representatives held during FSMTB’s October 2014 annual meeting, in Tucson, Arizona, NCBTMB agreed to discontinue its National Certification Exam for Therapeutic Massage & Bodywork as a licensing exam, in order to focus on developing new specialty certifications and promoting its Board Certification, according to a joint press release issued by FSMTB and NCBTMB.
This left the exam field open to FSMTB’s Massage & Bodywork Licensing Exam (MBLEx), which became the primary exam—and pretty much the only exam—used for licensing. (A few states also offer their own exam.)
On Oct. 3, 2014, FSMTB delegates voted to create a continuing education approval program, based on the recommendation of the FSMTB Continuing Education Task Force. Then, on April 1 of this year, NCBTMB and FSMTB announced a collaboration related to continuing education, but did not offer details about the partnership.
The FSMTB-NCBTMB joint proposal stated FSMTB would create approval standards that would be implemented by NCBTMB, Persinger said.
NCBTMB, in a letter signed by its board of directors and sent to FSMTB’s board of directors on Aug. 24, which was provided to MASSAGE Magazine by NCBTMB, rejected the proposal, stating in part, “Regrettably, it appears clear that FSMTB’s original intent for this collaboration has changed. Therefore, we are not comfortable proceeding with a collaborative program under the current demands and potential implications for the profession.”
The letter stated that NCBTMB had proposed, in December 2015, that all control of continuing education approval by FSMTB be eliminated; that states be surveyed on what they wanted for continuing education instructor requirements and criteria surrounding facilities where massage classes are taught; and that resulting continuing education standards agreed upon by all states would be shared with NCBTMB.
NCBTMB would then update its current continuing education approval program to match state requirements with pre-approved courses and create an evaluation system to measure the effectiveness of courses and instructors, information from which measurements would be reported to the FSMTB and state regulatory boards.
One sticking point seems to be conflicting viewpoints held by FSMTB and NCBTMB regarding the thoroughness of NCBTMB’s approval process.
According to Armstrong, 30,000-some-odd continuing education courses already approved by NCBTMB could not be incorporated into FSMTB’s new database, because those courses have not been vetted by NCBTMB to confirm they delivered the education that their providers claimed they did.
However, according to a statement from NCBTMB, the information about the review of the 30,000 courses is not factual.
“During our collaborative discussions, NCBTMB explained to FSMTB that the last time we totaled our courses, we had around 30,000,” said Vanessa Spasovski, NCBTMB marketing & public relations manager.
“As detailed within our most recent statement on October 13, all new course submissions, as well as previous courses, are thoroughly reviewed to ensure they are within the Massage Therapy Scope of Practice and further educate massage therapists,” she added, “[And] in May 2016, NCBTMB clearly stated to FSMTB that any courses taught for state licensure or that would be added to FSMTB’s list would be carefully reviewed to ensure they were within FSMTB’s guidelines.”
But now, as FSMTB’s plan moves forward, it appears as if continuing education classes will be housed on its new database.
The Massage Therapy Licensing Database (MTLD, pronounced “matilda”) will track massage therapists’ educational, licensing and continuing education data, in an attempt to improve regulators’ ability to make sure therapists are meeting regulation requirements.
It is also intended to support portability while helping combat fraud and human trafficking in the massage field, and is anticipated to begin operating in 2016. The continuing education approval component is anticipated to begin operating in 2017. (Spasovski said NCBTMB is supportive of the database, “as we feel it will greatly benefit the profession.”)
MTLD will be available free of charge to regulators with the FSMTB’s member boards, which comprise 40 states, the District of Columbia and Puerto Rico. The additional six states that regulate massage therapy, but do not belong to FSMTB, would need to pay a fee to access the database.
Additionally, MTLD will allow continuing education course uploads into 12 categories, which Armstrong said would be announced soon. If a course does not fit into one of those categories, it will be reviewed to determine if it fits into massage therapy’s scope of practice.
Also an issue for NCBTMB is the FSMTB proposal to charge NCBTMB for each provider NCBTMB adds to MTLD, a cost that would in turn affect continuing education providers.
In its Aug. 24 letter, the NCBTMB board of directors stated, “As NCBTMB only charges $225 per individual provider every three years, such an excessive fee from FSMTB would result in a more than 100 [percent] increase in cost for NCBTMB Approved Providers.
“This does not include current fees NCBTMB requires to run its program,” the letter continued. “But at its core, [the] email suggests an NCBTMB financial responsibility for development and staffing needs for the portion of the collaboration that is not ours.”
The letter added that this type of business model was not feasible for NCBTMB, “nor is it right for the profession … this approach and other communications from [FSMTB] give us a strong impression that the true intent of FSMTB is to put NCBTMB out of business.”
Persinger said that is not the intent of FSMTB. “[W]e want them to succeed so badly,” she said. “We want to salvage this relationship, but the damage might be done.”
According to Persinger, FSMTB needs to recoup some costs of the database. “[MTLD] has costs us millions of dollars,” she said. “If we have funds, we have to put them into the states, not supplement NCB[TMB]’s financial business needs.” She added that the cost to continuing education providers has not yet been determined.
If NCBTMB is negatively affected by the shift of massage continuing education approval to FSMTB—and, worst-case scenario, goes out of business, it could lead to the massage field losing its status as one of five complementary and integrative health professions that belong to the Academic Collaborative for Integrative Health (ACIH), according to AFMTE Vice President Stan Dawson, D.C., L.M.B.T.
ACIH is an organization that advocates for integrative health care and assists the NIH’s National Center for Complementary and Integrative Medicine “to better understand the distinct challenges and opportunities in research relative to the ACIH disciplines,” as just one of its many actions, according to its website.
“Massage qualifies as a member of [ACIH] because we have licensure in most states, federal accreditation [via the Commission on Massage Therapy Accreditation], a council of schools and educators (AFMTE), and a national certifying body (NCBTMB),” said Dawson. “Without a national certifying body, the massage therapy profession could lose its seat at the table as the future of the national health care system is being discussed.”
To clarify, NCBTMB still offers its Board Certification, as well as specialty certifications in Massage Therapy for Integrative Healthcare, Sports Massage and Military Veteran Massage, and these would not be affected by changes to the continuing education approval process.
The FSMTB’s database, MTLD, will provide a complete snapshot of every regulated massage therapist in states that choose to use the database, and how he or she has represented him- or herself to states and other entities.
MTLD will capture a bounty of data, including each massage therapist’s contact information; state license number, type and expiration date; massage school attended and graduation date; information about any board or disciplinary action taken against the person; and information regarding completion of continuing education as submitted via the continuing education provider system, including day completed, hours earned, name of course, category in the FSMTB approved categories list, who the provider was and how many on-site or distance hours it provided.
The database will also provide information about someone who took the MBLEx and is permanently ineligible to take it again, or who has had a license revoked.
Individuals’ names may be referenced by encrypted Social Security numbers so the regulator can determine if a person has used a different name; has had disciplinary action taken against him or her in a state; or has provided school names that do not match each other—something that “handlers,” or those who use massage therapy as a cloak when trafficking in human beings, often do.
The AMTA’s email to coalition members stated, in part, “[W]e do not support the approach to data sharing proposed by the FSMTB, which we have been advised may be illegal in some states.”
AMTA Communications Senior Manager Ron Precht told MASSAGE Magazine that AMTA has spoken with some state attorneys general, “and they are not at all comfortable that a third party company, FSMTB, would be given data on people’s personal information without their permission,” he said.
“These attorneys general have told us this is not a governmental body, and for pseudo governing bodies like regulatory boards to turn that information over to a third party is something they aren’t comfortable with,” he added.
But Armstrong said, to the meeting’s attendees, that AMTA’s allegation that data-sharing might be illegal is simply not correct, and added that using MTLD to transmit information such as Social Security numbers is legal, as numbers will be encrypted using security software.
At this point, the future picture of massage continuing education approval is still a bit murky.
Both NCBTMB and FSMTB admitted to a reporter that there was never any legally binding, written agreement regarding anything discussed or planned in relation to any continuing education approval program collaboration.
When asked what FSMTB’s response would be if the NCBTMB came to FSMTB tomorrow and said they wanted to work with FSMTB again, Persinger said, “I think FSMTB would be open to hearing this, because that’s what we asked in our letter: ‘Please help us understand so we can salvage this relationship.’”
However, NCBTMB’s Oct. 13 statement noted, “[NCBTMB] will do everything in our power to ensure certification and [continuing education] remain in their rightful place. With [the massage field’s] feedback, we will continue to update our current program to suit your needs, as well as list acceptable courses for licensure renewal—with or without FSMTB’s cooperation.”
Karen Menehan is MASSAGE Magazine’s editor in chief. Her articles for MASSAGE Magazine include “Benny Vaughn: 40 Years of Sports Massage,” “Getting to the Heart of Prejudice in Health Care,” and “Can Massage Help Combat the Opioid Epidemic?”