How to Make Money With Massage (Part 2)

Editor's Note: Part 1 of this article ran in the April issue.

Staffing and Hiring

This is one of the most challenging components to massage because massage therapists tend to be free-spirited, independent thinkers. Having them work in a structured, well-run chiropractic practice can require a change in mindset.

A good idea is to hire two part-time massage therapists. Consider hiring a male and a female therapist, as many patients have a specific preference, so you will be able to accommodate either request.

Most experts say a massage therapist can perform five hours of massage in a day. So, if you're thinking in the context of 60 minutes, five 60-minute sessions in a workday is capacity. Hiring two part-time therapists allows you to have one work in the morning and one in the afternoon. Massage is physical work; this helps to not burn out your therapists. It also is your insurance policy that if one massage therapist is sick or on vacation, your entire massage department won't shut down.

Longevity of employment can be challenging with massage therapists. Having a backup when someone inevitably moves on or goes to work somewhere else keeps you operational. Always have a massage therapist to hire in the wings; someone who can fill in when a therapist is absent or take the position when your therapist moves on.

Whether you have one massage therapist or two, it is essential to have internal policies in place. Have your massage therapist(s) hold a brief massage report of findings with new massage clients. Have the therapist go over the policies for scheduling and rescheduling, including any penalties, so they are aware of your cancellation and rescheduling policies.

Independent Contractors or Employees?

I recommend hiring massage therapists as W-2 employees. The reason for this is you may want to pay a slightly lower base salary and incentivize the therapists based upon the number of massages they deliver. A bonus structure also keeps therapists engaged in the treatment process with patients and encourages them not to act as technicians simply delivering a service. As W-2 employees, you can bonus therapists for converting massage clients to chiropractic patients.

Be aware that if the massage therapists are independent contractors and you are paying them on a 1099 basis, you are prohibited from bonusing based upon the value or volume of services delivered, or for conversion. Profit sharing with a 1099 employee can violate Stark regulations. If you have a 1099 independent contractor, make sure your employment agreement is Stark-compliant.

There are other issues of employment that fall under the guidelines of a W-2 which provide you with more control over therapists as an employer. You can set their hours of operation and treatment style, and require a specific uniform. This may not be possible with 1099 employees.

Guidelines for Paying Massage Therapists

When massage therapists are W-2 employees, most chiropractors pay a base hourly rate plus a bonus based on performance, client conversion to chiropractic and outside new-patient generation. Massage therapists typically earn between $15 and $20 per hour and then an additional $5 per-hour bonus for each full hour of hands-on massage they deliver. The bonus can be broken down into fractional hours, which work out to $1.25 for each 15-minute unit.

Additionally, if the therapist is not hands-on with patients, they should expect to do other work in the practice. These tasks could include backing up the front desk or performing other clerical work, or assisting with passive therapy or rehab exercises, where state law allows. When therapists are on the clock, they're on the clock. There's no surfing the Net or hiding out in the massage room with the door closed if they are not with a patient.

Having a well-thought-out office policy in place when you hire therapists, including a complete job description, can head off many potential challenges before they occur. In a massage franchise, therapists are massaging or they're hanging out at the water cooler. In a chiropractic practice, if they are not hands-on massaging, they should be doing some other value-building work.

How to Market Massage

Having a massage therapist on your practice team provides marketing opportunities a chiropractic practice that doesn't have massage is not able to take advantage of. – You can add massage to your outside marketing events, such as health fairs, or provide chair massages at local businesses.

If the massage therapist has a background in sports massage, you can work with local student athletes. This is a great entry point to care for your local school teams, as you can provide massage as natural performance enhancement, and to increase flexibility and range of motion. Massage therapy is a great marketing tool at 5K runs and other road races where the chiropractic practice has a booth and provides either pre- or post-race massage to the participants.

When marketing chiropractic, we know we are really only reaching the 10 percent who know about chiropractic. When marketing massage and chiropractic together, you access that other 90 percent. Let's face it: Everyone knows they want a massage, but not everyone knows they want an adjustment. This opens the window much wider to potential patients.

Promoting massage with gift certificates is a nice additional source of revenue because people buy gift certificates for massage all the time, especially around the holidays. Have a menu of options that provides easy-to-purchase gifts for Mother's Day, Father's Day, Valentine's Day – and other special occasions.

The Financial Opportunity

How much income can you generate by adding massage to your chiropractic practice? This depends on if you are using massage therapy as a new-patient acquisition tool or as an income-diversification strategy. As a patient acquisition tool, you'll keep your cash fee on the lower side, unlike the income-focused fee of $60-$80 per hour.

I recommend setting your hour-long massage fees at just $50 and pay therapist $20-$25 per hour. This way, you'll be paying your therapists the going rate. This will increase employment longevity and cut down on employee poaching by other massage businesses. It also provides you with a fee for massage that you can aggressively market outside of your practice, not only to your existing patient base.

A $45-$49 massage increases traffic to your practice by people who would never set foot in a chiropractic office before. A therapist who is properly trained in conversion dialogue and comfortable with introducing the concept of a screening exam or consult with the chiropractor, can be expected to convert 20-25 percent of their clients into chiropractic patients, in my experience. When you calculate what a new chiropractic patient is worth to your practice and the increase in patient compliance that accompanies massage, it's a big financial upside!

Massage helps your patient visit average (PVA). Patients love their massages. Set a policy so the only way patients can get their massages is by coming in and getting their chiropractic care, within the confines of medical necessity. After patients receive their massage, they can get their chiropractic adjustment. This encourages patients to remain under care after their insurance stops paying.

You'll find wellness patients will come in more often, as they see a benefit of getting adjusted after a massage. Schedule your massage plan members to come in once a month and schedule their adjustment immediately afterward.

Ancillary product sales can provide an excellent source of income for your practice. There are many massage therapy creams, oils and aromatherapy products that generate natural sales. Lavender-scented eye shades and bolsters make great gifts and have a high profit margin. Cervical pillows are also an easy piggyback sale. You can increase sales by displaying ancillary products both in the massage room and at your front desk.

Where to Find Therapists

Working in a chiropractic practice is an attractive position for massage therapists because it's a professional environment. They do not have to go to people's homes, where it is potentially dangerous and unsecure. It's also very predictable revenue for them. They might make a little bit more if they were doing home massages for $120 an hour, but have to travel back and forth between locations. It takes considerably more for an independent massage therapist to give an hour-long massage when you include the travel time, meeting and greeting, and carting the table and supplies.

When hiring a massage therapist, let your patients know about it, and post an announcement in your reception room. You will find the word-of-mouth of your patients is a great referral source. There are massage schools in most major markets. Post a job notice on the school bulletin board and in the school's newsletter, if it has one.

I've also found great therapists on Indeed.com, a pay-per-click posting service that is similar to Monster.com, but not as broad. You set your own maximum budget and after you reach your cap, the posting is removed.

The right ad establishes that you are a chiropractic practice front and center. You don't want to waste time with people who have a prejudice against chiropractic. Screen them right out. Mention your professional setting and talk about teamwork. Ultimately, that's the attitude you're looking for, trying to balance between what they're doing when they're not with patients and how they interact with the rest of your practice team.

You want to be sure that your therapist can keep up with your volume. "We're a fast-paced office, looking for a friendly, patient-oriented, team player" is perfect wording.

Include wording about your compensation plan so candidates don't feel it's just going to be a J-O-B. If you will pay for all or part of their health and malpractice insurance, be sure to mention it. If you have a 401K or other matching plan, add that as well.

If you'll pay for seminars and training, put that in your advertisement. Bringing your massage therapist to chiropractic seminars so they can be trained in other office procedures helps them become more valuable employees. They get to see the bigger picture of how their role supports the other roles in the practice, which builds loyalty and employment longevity.

When done the right way, the combination of chiropractic and massage can be a win-win-win for the patient, the therapist and the chiropractor!

Dr. Mark Sanna, a 1987 graduate of New York Chiropractic College, is a member of the ACA Governor's Advisory Board and a member of the President's Circle of NYCC and Parker College of Chiropractic. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com).