PT as the patient and a tipping ?

[callmecrazy]

I'm a PT currently under the care of a PT. The facility I'm going to is multi-faceted with physical therapy and personal training sharing a space and a small massage room to the side. Part of my treatment has been with a massage therapist, under the recommendation of and coordination by PT but carried out by the LMT. The sessions are independent of sessions with the PT but are fully covered by insurance.

I know my question is more LMT focused but I'm hoping some PTs have experience in a similar setting. Do patients tip the LMT in this setting? The thought didn't cross my mind until I was already on the table, and then I spent an hour debating in my mind. I initially leaned toward no because you don't tip your PT, but I felt compelled to because it was a far more beneficial massage than I would have received if paying $80+ at a spa or elsewhere. There is a small sign in the massage room listing pay for service prices and a "gratuities appreciated" statement, but they service 'clients' that aren't 'patients' as well. Do LMTs receive the same no-tip treatment as other health professions like PT when functioning in this capacity?

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[jjjDPT]

I don't believe it would be appropriate for a LMT to accept a tip from patient who is covered by a third party, just as it would not be appropriate for any other health professional.

 

[okramango]

I'm in PT school now but in the past have worked as an LMT in similar settings, and have known many other LMTs who did as well. It is commonplace for people to tip LMTs whether or not they are patients with insurance coverage. In general, some patients tip while others don't, and there is no expectation either way. When I was working in this capacity, I had never heard of any type of regulation that prevented LMTs from receiving tips from patients using insurance, and the health provider offices I was exposed to were all fine with the LMTs receiving tips. Perhaps this may differ by state? If you are not sure, you can just ask the LMT directly.

 

[deleted480308]

It depends on how you view them and their level of service, are they more of a health care professional or more like a pizza driver that happens to touch you a lot.

Health care professionals don't get tipped

 

[callmecrazy]

Thanks guys. It's now as clear as it was before, which at least reassures me that there wasn't a simple answer. If I didn't have the insurance coverage I'd be paying out of pocket for a massage and a 15% tip would be a given... even though it would be the same service. It did feel awkward tipping in that gray area though. So I split the difference and left a small tip the first time but not the second. Compromise.

 

[jesspt]

Several questions.

First, would ht PT be "recommending" this service if they didn't have an LMT in their office? This is sometimes a way to increase patient volume while decreasing the cost to provide "service" - a PT can pass a patient off for 30 minutes, bill another 2 units of manual therapy, and keep their boss happy.

Second, what are your insurance company's requirements re: massage? Some require it to be done on the same day as your PT appointment?

Did the LMT agree to this arrangement, knowing they would be an ancillary provider of massage within a setting where tipping has no place? If so, NO TIP.

 

[callmecrazy]

Several questions.

First, would ht PT be "recommending" this service if they didn't have an LMT in their office? This is sometimes a way to increase patient volume while decreasing the cost to provide "service" - a PT can pass a patient off for 30 minutes, bill another 2 units of manual therapy, and keep their boss happy.

Second, what are your insurance company's requirements re: massage? Some require it to be done on the same day as your PT appointment?

Did the LMT agree to this arrangement, knowing they would be an ancillary provider of massage within a setting where tipping has no place? If so, NO TIP.

I can absolutely see this being abused to increase volume or for other side benefits; it's a slippery slope for certain. I specifically chose this clinic largely because of their 1-on-1 treatment with the PT; 2 pts/hr max and no PTAs or aides. If they were trying to just cash in, there's easier ways. Whether she would have recommended it if not in-house, I don't know but it wasn't a pressured sales pitch. I would have sought it out anyway though, and that was even before the ortho and PCP recommended massage as well, so it was a moot point. It is nice to have the PT and LMT communicating between visits though.

My understanding is actually that it can't be on the same day. I will say that my health insurance plan, in general, has more extensive and thorough coverage than is common, with less limiting bureaucracy.

I have no idea what the LMT's arrangement is. As I said initially though, PT is only part of the picture. There is a large non-clinical side for private pay strength and conditioning, and the facility's location and owner seem to attract a sufficient clientele to pay for training and massage services outside the clinical/PT realm.

 

[Mad Jack]

I've left tips in similar scenarios before. I don't view it as a tip so much as a, "You're not getting paid what your service/care/product is worth. Here is the extra compensation that I believe I owe you because of the quality of the service/care/product you have provided me with." I'm kind of weird though, admittedly, as I'm not a haggler and don't try to get things on the cheap. I want quality, and I want to pay a sum that that quality is worth.

 

[jesspt]

I can absolutely see this being abused to increase volume or for other side benefits; it's a slippery slope for certain. I specifically chose this clinic largely because of their 1-on-1 treatment with the PT; 2 pts/hr max and no PTAs or aides. If they were trying to just cash in, there's easier ways. Whether she would have recommended it if not in-house, I don't know but it wasn't a pressured sales pitch. I would have sought it out anyway though, and that was even before the ortho and PCP recommended massage as well, so it was a moot point. It is nice to have the PT and LMT communicating between visits though.

My understanding is actually that it can't be on the same day. I will say that my health insurance plan, in general, has more extensive and thorough coverage than is common, with less limiting bureaucracy.

I have no idea what the LMT's arrangement is. As I said initially though, PT is only part of the picture. There is a large non-clinical side for private pay strength and conditioning, and the facility's location and owner seem to attract a sufficient clientele to pay for training and massage services outside the clinical/PT realm.

This sentence bothers me.

 

[callmecrazy]

This sentence bothers me.

How so? Though now that I reread that, I should clarify that my ortho referred me to my PCP, and the PCP recommended massage. I would have gone directly to PT if direct access was unrestricted here.

 

[jesspt]

It bothers me because you are a recent graduate of a physical therapy school, meaning that you passed the NPTE recently. Meaning that your school theoretically prepared you for that. Meaning that you should have a better understanding of how to manage MSK pain complaints than your PCP. But, you sound as though you are a passive participant in the process that is following the recommendation of a health care professional (in this case your PCP) who likely knows very little about evidence based practice when it comes to MSK pain and treatment. All PCPs are not created equal, of course, and I don't know the specifics of your case, but the fact that this doesn't concern you is problematic to me.

 

[callmecrazy]

It bothers me because you are a recent graduate of a physical therapy school, meaning that you passed the NPTE recently. Meaning that your school theoretically prepared you for that. Meaning that you should have a better understanding of how to manage MSK pain complaints than your PCP. But, you sound as though you are a passive participant in the process that is following the recommendation of a health care professional (in this case your PCP) who likely knows very little about evidence based practice when it comes to MSK pain and treatment. All PCPs are not created equal, of course, and I don't know the specifics of your case, but the fact that this doesn't concern you is problematic to me.

Fair enough based on the information I shared, which was minimal without specifics, as you stated. That wasn't the direction I was going with my question, but since that's where we are at... I sought ortho care when self-treatment wasn't working. The ortho red flagged me back to PCP, claiming the pain was pulmonary. The PCP ruled that out, well within her scope. Then, she and I together discussed which direction to take with the hypothesis that it was msk, as I had suspected. She directly acknowledged that I, as a PT, was most qualified to choose my next step at that point.

I'm struggling to understand if the concern is with following a PCP's recs or with massage in general though? And a bit surprised by your take on passively being a patient. I think part of being a professional is knowing when self-treatment isn't cutting it and when to hand it over. I think it's healthy to the let yourself be the (albeit well-informed) patient and follow your providers lead at some point.