Thinking about branching out and offering complementary services in your practice?
One type of provider you could hire is a licensed massage therapist (LMT). For patients seeking more than just musculoskeletal treatment, adding an LMT can position your practice as a “one stop shop.” But how do you make this decision?
To get the answers you need, Chiropractic Economics interviewed Uriah J. Low, MHA, CEO and founder of Avethan Healthcare Consulting, who provided crucial tips and thoughts about what to consider when hiring an LMT.
This is part 1 of a three-part series and discusses how to determine if your practice needs an LMT, if employing an LMT will be financially viable and whether to hire an employee, work with an independent contractor or lease space to a service provider.
Does your practice need an LMT?
The first thing to do is decide if you need a massage therapist at all. According to Low, “Chiropractors should evaluate the need for massage therapy among their practice’s patients by examining patient comments, requests and queries regarding massage therapy services.”
To find out what patients think, conduct a survey. Ask current patients if they would be interested in this type of service to enable you to gauge if it’s wanted. If patients seem to want it, realize this service can complement and enhance care, as massage can help with relaxation, pain alleviation and muscle tension release.
Adding an attractive service will also make a chiropractic business more competitive. But Low suggests DCs research the “competitive regional landscape” to determine if other local chiropractic practices are already offering it.
If they are, you may not want to hire someone. If they aren’t, “offering massage care can help distinguish their practice, attracting new patients seeking integrated services and just those patients seeking massage therapy,” explains Low.
“Clinical supervisors and owners must verify prospective candidates’ credentials, qualifications and license status to ensure compliance with legal and professional standards,” says Low.
Massage therapists are specially trained and then licensed by the state in which they work; they typically attend massage therapy school for 500-1,000 instructional hours and pass a state-mandated licensing exam. Most states use the Massage and Bodywork Licensing Examination (MBLEx), but some states have different or additional requirements. Most states also require some combination of background check, fingerprinting and other security measures in order for a license to be issued.
Will employing an LMT be financially viable?
Before you hire someone, it pays to sit down and crunch some numbers. “Chiropractors should conduct an economic analysis to estimate the potential revenue increase from adding massage therapy services. This involves evaluating the demand for massage therapy, determining service prices and forecasting the number of available appointments,” said Low. “Chiropractors can assess the financial impact by comparing the projected revenue with the associated costs, such as salary or contractor fees, administrative expenses and marketing costs.
To do your market research, take into account the number of massage therapy service providers in your area, how much they charge and what services are in high demand by clients. “In understanding the market landscape, practice owners will be better able to determine whether there is sufficient demand to make engaging an LMT financially viable,” Low said.
Another factor to consider is how many massage therapy services your location can reasonably provide. How many patients can one LMT see in a day? A week? How long is a massage session? How many treatment rooms can you dedicate to massage? Who on your staff will schedule and reschedule massage appointments? Be realistic.
“Chiropractic owners should evaluate the ability of their practice to accommodate massage therapy services,” said Low. “Additionally, considering the availability of treatment rooms, the flexibility of scheduling, alterations to the workflow and support resources required are also prudent actions.”
Employee, independent contractor or renter?
“Chiropractors should weigh both advantages and disadvantages when deciding how to engage an LMT ― as an employee, independent contractor or by leasing space,” said Low.
Hiring an LMT as a W2 employee does have several advantages, including greater control over the LMT’s schedule, training and practice integration. “Additionally, this identification [as an employee] aligns the LMT with the aims of the practice as a whole, opening the possibility of cultivating a long-term team member who can contribute to the development and patient satisfaction of the practice,” Low said.
The burden on you as an employer is increased with a W2 employee, of course: payroll taxes, benefits, insurance, etc. You will also have to come up with a way to evaluate the employee’s performance, as you do with your chiropractic assistants.
“In contrast, independent contractors often offer greater availability of scheduling and workload flexibility,” said Low. “Regarding taxes, contractors are responsible for their taxes and benefits, and there is a potential cost saving with reduced payroll and benefits administrative burdens.”
Finally, you can lease space in your practice to an independent-contractor LMT and have them pay you rent while handling all the other service details themselves. The advantages here? You’ll receive rental income without having to do any extra work, and there will be the potential for the LMT to refer clients to you and vice-versa.
“While these may be advantageous, the chiropractic practice does possess less control over the schedule and work processes of the contractor,” said Low. “They also have minimal influence on the training and development of the contractor as well as expanded difficulties in coordinating patient interactions and schedules if they are not integrated with the scheduling team.”
Low suggests practice owners consult IRS Form SS-8 to help guide this decision; it contains 33 questions about how various details will be handled. “A practice owner can submit form SS-8 for an official determination of the nature of the relationship, including whether it is an employer-employee relationship or an independent contractor arrangement,” he said.
“Once the request is received, the IRS considers many factors, such as behavioral control, financial control and relationship control,” he explained. “Regarding assignment control, the IRS examines how the LMT receives tasks and the degree of direction and control exerted over their work.”
Part 2 of this series will illustrate how to go about hiring an LMT if you have never worked with one, what you need to look for in a prospective LMT employee and how to determine the right pay for your new LMT.