Ep 74 – Tackling the Tough Stuff: Charting, Billing, Pain Management, Research with Diana Thompson

Woman filling out forms at her desk

Doing the hard work has always been in Diana Thompson’s blood. From an early age, philanthropy and health-care inequities fueled her passions. Diana talks with us about the importance of charting and record keeping as critical steps in acting “like health-care providers,” the importance of participation in the client-therapist relationship, and resetting goals with clients to inform their long-term, committed therapeutic wellness path.  


“Massage Therapy: The Invisible Profession?” by Diana Thompson, Massage & Bodywork magazine, January/February 2010, page 114, www.massageandbodyworkdigital.com/i/68165-january-february-2010/115.

“Levels of Evidence: How to Learn What We Want to Know,” by Diana Thompson, Massage & Bodywork magazine, March/April 2010, page 116, www.massageandbodyworkdigital.com/i/68173-march-april-2010/117.

“Session Planning: Making Informed Decisions for Older Clients,” by Diana Thompson, Massage & Bodywork magazine, May/June 2010, page 114, www.massageandbodyworkdigital.com/i/68174-may-june-2010/115.

Author Images: 
Diana Thompson, author of Integrative Pain Management
Author Bio: 

Diana Thompson has been a licensed massage therapist for over 35 years and has a private practice in Seattle treating acute and chronic pain disorders and specializing in postoperative care. Currently, Diana dedicates her time to her web-based documentation system Hands Heal Electronic Health Records, available online at www.handshealehr.com. She authored Integrative Pain Management: Massage, Movement, and Mindfulness-Based Practices and Hands Heal: Communication, Documentation and Insurance Billing for Manual Therapists. She’s written many articles for Massage & Bodywork magazine, including our regular research column Somatic Research from 2010–2013. She is a past president of the Massage Therapy Foundation, and a proud recipient of several national awards.


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Full Transcript: 

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0:01:02.1 Darren Buford: Welcome to the ABMP podcast. My name is Darren Buford, I'm the Editor-in-Chief of Massage and Bodywork Magazine and Senior Director of Communications for ABMP.

0:01:10.2 KC: And I'm Kristin Coverly, licensed massage therapist and ABMP's Director of Professional Education.

0:01:15.3 DB: Our goal is to connect with luminaries and experts in and around the massage, body work and wellness profession, in order to talk about the topics, trends and techniques that affect our listeners' practices. Our guest today is Diana Thompson. Diana is a licensed massage therapist for over 35 years, and has a private practice in Seattle treating acute and chronic pain disorders and specializing in post-operative care. Currently, Diana dedicates her time to her web-based documentation system, Hands Heal Electronic Health Records, available online at handshealehr.com. She authored Integrative Pain Management: Massage Movement and Mindfulness Based Practices, and Hands Heal: Communication, Documentation and Insurance Billing for Massage Therapists. She's written many articles for Massage and Bodywork Magazine, including our regular research column, Somatic Research, from 2010 to 2013. She is a past president of the Massage Therapy Foundation and a proud recipient of several national awards. Hello, Diana. And hello, Kristin.

0:02:17.8 Diana Thompson: Hi, how are you?

0:02:19.6 KC: Diana, welcome. We're so happy to have you here and we've got so many fun things to talk about today. Let's jump right in. Please start by sharing what drew you to bodywork and tell us about one of your cherished moments from your career.

0:02:35.4 DT: Well, long, long ago, I wanted to be in the Olympics. And it didn't take long, I was probably in junior high, when I realized that I wasn't gonna make it. And so then I thought, "Okay, sports medicine. I'll get there through sports medicine." And in high school, I started giving massages on the rec room floor. There were these three brothers that lived in one of the apartments, and they would get on the floor and ask me to give them a massage. And then other kids in the apartment complex started coming in and laying on the floor, and there I was almost every day giving massages in high school. And so when I turned 18, I was probably 19 by then, I got my first professional massage. My mom got me one. And then my brother won a 10-session protocol in rolfing, and he gave me one. So I took my first massage course when I was 19 years old, and started doing massage when I went to college. I would do massage on the athletes in between my own sports, and now here we are.

0:03:57.6 KC: And tell us a little bit more about that Olympic connection. Did that ever come back up for you?

0:04:03.2 DT: Oh my gosh, yes, I got to go to the Olympics. It was the highlight of my life. I mean, here I'd been dreaming this since I was a kid, watching the Olympics. And then when it was in Atlanta, there was a call out for a massage therapist, and I applied and I got to be in the track and field tent, which was especially great for me, because my primary sport was track and field. Not the track part, I was never fast. But I did set my college record in the Shot put, but it was about 20 feet shorter than my wife's throw in college, but it was a very small liberal arts school. I should leave that part out and just say I set my college record in Shot put.

0:05:00.0 DB: Absolutely.

0:05:02.3 KC: Absolutely, yeah.


0:05:02.8 DT: But there I was at the Olympics, staring at the shot putters in awe.

0:05:08.1 KC: What a great moment. And who would have ever thought that massage therapy would have been the road that brought you to that great Olympic venue and experience?

0:05:17.6 DT: Yes, and we have Ben Ivan Yvonne to thank for that. He was huge in getting massage in the Olympics in 1996. So thank you, Ben Ivan Yvonne.

0:05:27.8 DB: Diana, we have a connection. So listeners may not know that I have a track and field background too.

0:05:34.0 DT: Really?

0:05:36.0 DB: Pole vaulting.

0:05:36.1 DT: No way.

0:05:37.3 DB: I did. High school, though. High school. That's it. Nothing beyond that. I wasn't good enough to go...

0:05:41.8 DT: But that's cool.

0:05:44.2 DB: It was pretty cool. Diana, your experience is so amazing. Kristin and I actually were at a loss where to begin before, when we spoke before the podcast, but the one path that we saw in common was what we're calling bravery, really. Because you took on a lot of the hard work that other MTs are intimidated by or can be intimidated by, from research to charting, to insurance billing, to pain management. We were talking like our message to MTs was, "Get over it," as a mantra, because there are so many benefits to exploring and getting better at the tough stuff. What drove you to follow those passions?

0:06:21.1 DT: When I was a kid, my father was a minister and it was really important that we as the church's family... I don't even think it was about that actually, but they were all very into volunteering. And so my dad would lead big groups of people in different types of volunteering, and the biggest thing that I learned from being a small child through high school was health disparity, and inequities in healthcare, and opportunities, and food resources. And those racial, cultural and economic disparities are just more and more obvious these days with Covid. I think it's actually a conversation now, and I appreciate that. And having learned that so early on, I think, just really paved the way for, "I have no right to be afraid." If people ask for someone to volunteer, is it despair that I feel? Is it something I really don't want to do? Or is it because I'm afraid? And I volunteered in a home with people who were mentally disabled, and I had a lot of fear with that one, because here I am, 15 years old, and walking a group of people down to the library and being seen.

0:08:04.6 DT: You're trying to be a kid that fits in, and here you are with a group of people that don't look like other people. And it really taught me how important it is to make everybody fit in, that we're all the same on so many levels. And it's just really important as massage therapists, to be able to offer what we do to all types of people, no matter what their disadvantages are, no matter what their equalities are, no matter how they are better than you. When it comes to touching somebody, we all suddenly are on the same level, and we're just human beings needing to be touched. And the only way I could see doing that is with integrative healthcare. That if we could make a place for us, for massage therapy as a profession in healthcare, that we could have more access to people from all different types of life. And people who can't pay for massage can have possibly insurance that pays for it. And if not, we can volunteer to give massage. And doing it with the homeless people is probably the scariest thing. I mean, as a kid, you're scared 'cause you're not fitting in, but as an adult, you're scared because you don't know the reaction of what you're gonna do, of what the other person is gonna do when you touch them.

0:09:43.4 DT: It's, "When was the last time they took a bath?" Just really... I might be being too open about it, but I think really we all have these fears. "Am I gonna catch something?" They're real fears. And what overrides all of that is, "These people need to be touched, and who better to touch them than me, than a massage therapist?" 'Cause we know how to do it in an ethical fashion, in a way that makes people feel good about themselves, and in a way that could improve their health. So I say yes when I'm really afraid. And if I'm dreading it, then I know I could say no to that. But if I'm just plain old scared to death, I should say yes.

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0:11:42.5 KC: And Diana, you referenced finding a place for massage therapy in healthcare. Does that really lead directly into your passions for research and charting? Do those two aspects help us find our place in healthcare?

0:11:54.7 DT: Absolutely. I've had so many doctors say, "If you can't show me six months of charts on every client in your clinic, then I have nothing to say to you." If we're gonna be treated as healthcare providers, we have to act like healthcare providers, that there isn't a healthcare provider out there that wouldn't chart a visit with a patient. Not one. So why should we think we're any different?

0:12:23.1 KC: I think that's a great and very important message for massage therapists listening to hear, because oftentimes, I think people who maybe are in their own private practice, they're not doing insurance billing, they're not right now working with doctors directly, they think, "Well, maybe that's a little less important. That's just for my own information for me to remember and I'll remember anyway." So then they kind of skip that charting piece. What would you say to a therapist who's operating from that point of view?

0:12:51.7 DT: I have done that before, and then something happens. Like they'll say, "Hey, I don't think I ever told you I was in a car accident, but can I have all those notes? My attorney is asking for them." And then they don't get reimbursed for their massages with me if I don't have it. And then I flip the other side where I wouldn't let a guy back in my room until he finished filling out the intake form, and then come to find out he has a learning disability around reading on paper. And you're gonna find it all in life, in massage I think in particular, because people come and they're very vulnerable. So they're not gonna want you to chart or they're not gonna wanna fill out forms, and you're gonna find you're gonna ask too many questions and they don't wanna answer. Whatever it is, you just have to do what you know is right. And there's not that much you have to chart. What you did, where you did it, for how long. Those are the basics. And then when you're ready, throw in why you did it. I think that makes a huge difference in remembering. And then the health history can be really simple too. I know once I start giving you a list, it'll just get longer and longer, but really past history, current health.

0:14:16.1 KC: Done and done.

0:14:16.6 DT: Done and done.

0:14:17.4 KC: Diana, let's talk a little bit about pain management. You literally wrote the book on integrative pain management. What do massage therapists need to know about working with clients in pain, whether it's acute or chronic?

0:14:29.3 DT: Well, I think one of the areas that massage therapists really excel, is what is currently coined as biopsychosocial healthcare. And it's a mouthful, but really it's all the things that we do. So all we have to remember is that everybody is different, and we have to address them with treating their physical ailments and working with their movement and their ability to move with other people. The more you can socialize their movement, the more support they're gonna get around it, 'cause a lot of people isolate in pain. And then third, the mind-body piece, which is easy to do in a session also, because you can talk about visualization. How does this pain feel? Where is it? Let's move through the body and just think about each part as I work on it, and then let it go. And you're already putting them into a trance with rhythmic touch, with the music, with the lighting, so you're bringing them down to a place in their body where they can be very much influenced by what you do and what you say. So make sure your conversation is appropriate, but also make sure you're really talking about their body and how things feel and what a difference they can make.

0:16:00.1 DB: Diana, can you tell us a little bit about one of your newest projects that you've been working on, Hands Heal EHR? And for listeners who may not know, that's Hands Heal Electronic Health Records.

0:16:12.4 DT: It's been a long-time project of mine, I've been wanting to do it, and it's the natural evolution of the books, Hands Heal EHR... I mean Hands Heal. And so to turn it into an EHR is keeping us current, I think. We're one of those professions that is not techy, and it's great having a new generation of massage therapists out there that just want everything on their devices and don't know how to write on paper really, much, so it's time. And if we're gonna keep up in healthcare, we have to. There's just no doubt about it. All healthcare providers that bill Medicaid or Medicare are required to chart electronically. That's been a law for four years. As of last year, just October last year, all office visits, all notes, not just reports or results of tests, have to be accessible to the patient. They have to be able to see all the doctor's notes, all of the PT's notes, all the massage therapist's notes.

0:17:37.3 DT: So, from the beginning, so four years ago when I created Hands Heal EHR, I did it with a patient portal, so that patients could see all of their chart notes from the get-go, because we knew this was coming. So why not be ahead of the game for once? And I think it's scary for some massage therapists. They wanna make notes about clients that they hope they never see or put sticky notes on their files about patients. And it's just really great to kinda know that everything you write is visible, is transparent, is accessible to a client. It puts words to what we do, how we feel, what we think the client needs to know. I just think it's a huge opportunity for the patient-client relationship, and for patient education, and to support homework self-care in our patients. And there's a lot of studies that show patients who participate in their healthcare... So for example, in mine, they go in before a session and fill out where they are on a zero to 10 scale for pain, activity and mood, and can write any notes about that or what they want out of the session before you even go into the room. So just that little bit of interaction that is the patient's responsibility to begin a session, makes them more committed to the outcome.

0:19:16.7 DB: Do you think clients appreciate too that relationship through a portal, knowing that information? I know I do, but do you find that in your practice?

0:19:25.3 DT: I would say half my clients do. Half of my clients don't care, but the half that do, talk about it and get excited about it, and come into the room and tell me what they've been doing for themselves and how they're feeling. So I know that they're aware of the session throughout the week, that those are the people that are gonna keep coming back, even if their insurance stops paying for it. And some of them I've seen now for 20 years, and they just keep participating at that level and they miss it when they can't come in, if they go out of town, for example. But it's those kinds of relationships that build a long-term, full practice.

0:20:18.2 KC: Diana, you write and teach about transitioning clients from being injured clients into long-term wellness clients. What are your tips for how therapists can do that with their own clients?

0:20:29.1 DT: I think the number one thing to do is note progress. If you can talk about the difference in a measurable form, then it's not just that they get up off of the table and they say, "Oh, I feel so much better," and then they get in their car and they're stuck in traffic and they forget all about it, they just go right back to being stressed. But if you can measure their range of motion, look at their posture, touch a spot over and over again and just say, "And how does this feel now? And how does this feel now? And oh, notice this movement, and how different that is." And the other side of that, I think, is equally important, which is acknowledging when it wasn't a success, when there's still something else in there, because that just means you're curious. Oh, you know, that didn't work like I wanted it to. Let's try this. Or how about when you go home, you try this and we'll have more time next time. I'll make a note of it and we'll start there, 'cause maybe it was the psoas and not the external rotator, for example.

0:21:37.7 DT: It helps them find different ways to feel their progress, and think about it and talk about it with other people. Homework is another way, and homework helps them appreciate your skills, really. You're not teaching them to do without you, you're just teaching them to appreciate you more. So don't think of it as you're gonna lose your clients 'cause they can take care of themselves. 'Cause they'll do it, which is great, and then they'll say, "But it's not the same as when you do it. I want you to do it for me." And even if they don't become regulars, they'll think about you, and then when someone else says, "Hey, I need a massage. Who do you know?" they'll think of you, or whatever kind of bodywork you do. I say massage 'cause it's kind of a junk term for me, but really, we're all doing cranial or Feldenkrais or Trager or rolfing or whatever. But they'll think of you. They won't forget you, even if they're not regulars.

0:22:44.6 DB: Diana, if I was going to you as a client and we'd been working together for, say, 10 sessions, and my injury was no longer an injury, what would you do for the next steps to set up, how would you take me from that instead of ending the therapeutic relationship, how would you set up the next set of our relationship together?

0:23:05.4 DT: I would say, "What else should we work on? What's next? And regardless, I should see you once a month to maintain this, because things will keep happening, and what you don't wanna do is wait for the straw that broke the camel's back. So let's maintain where we've got, we can do that once a month. Or if you've got something else you wanna work on, let's create a plan around that."

0:23:31.6 DB: I wanna thank our guest, Diana Thompson, for joining us today. Diana, where can listeners find out more information about you and your special new product?

0:23:41.9 DT: Yeah, so handshealehr.com is available. We have free trials, so you can sign up for a free trial as an individual therapist, as a clinic or as a school, and just really explore the different options. We've got many different intake forms and a Covid screening form, and different types of charting for different types of sessions, wellness or treatment, and really good patient access. So I think it's brilliant.


0:24:22.0 KC: We do too. And also, it includes scheduling, doesn't it?

0:24:26.3 DT: It does. It now includes scheduling, that's a new thing for us. So yes, scheduling is included. So right there on your home page, you can log in, take their money and start a new session note without having to change pages. So it makes it super easy.

0:24:43.1 DB: Excellent, thank you so much, Diana.

0:24:45.0 DT: Yeah, you're welcome. Thanks for having me today. That was fun.

0:24:48.9 KC: Thank you, Dianna, take good care.

0:24:50.7 DT: You too. Bye bye.

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