The Association of Schools of Allied Health Professionals defines the allied health sector as “professionals that are involved with the delivery of health or related services pertaining to the identification, evaluation, and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health systems management, among others. Allied health professionals, to name a few, including dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, occupational therapists, physical therapists, radiographers, respiratory therapists, and speech-language pathologists.” Their definition was purposely vague in order to allow others to be labeled as allied health professionals. I would also throw in personal trainers/strength coaches, health coaches, acupuncturists, and massage therapists. Any provider offering health care that is not a physician or nurse. As you can see, it casts quite a large net. Which begs the question, why doesn’t the allied health field play a larger role in the care plan of patients?

Under the traditional health care model, a patient generally goes to a PCP once or twice per year to have an annual physical. Insurance pays for this and puts it under the label of “prevention,” even though it’s not really preventing anything by getting screened or obtaining a physical. I guess you could say it prevents things from getting worse, but it doesn’t actually prevent obesity, tooth decay (if they have dental insurance), heart disease, or arthritis. The same patient may also have chiropractic care covered by their insurance but for only a certain amount of visits per year. That said, because reimbursements are so low for the allied health professions, many chiropractors operate on a cash-only basis where you either pay out of pocket or possibly through an HSA/FSA if that’s an option for you.

Let’s say this same patient severely injures his ankle and requires physical therapy. Similar to the chiropractor, insurance will only pay for a certain amount of sessions, regardless of progress. Again, many physical therapists are going to a cash-only system now for the same reasons as chiropractors.

Now the physician tells the patient they need to lose 25 pounds because his blood glucose measures a little high and he is showing signs of insulin resistance. Unfortunately, this patient doesn’t really know how to exercise, so he wants to get help with the use of a personal trainer. Same story, different provider. The patient will need to pay out of pocket for this service because this is not a covered benefit under insurance, even though there are ICD-10 codes that address physical activity.

Now the patient has lost a few pounds but feels pretty sore due to all of the exercises he’s been doing. Massage therapy sounds fantastic, right? Years of fascial adhesions, trigger points, and muscle soreness could be addressed with just a few session with a masseuse. If you read the previous paragraphs and didn’t just skip ahead, you’ll know what the end game is here. The patient has to pay out of pocket for the service, and similar to personal training, there are ICD-10 codes that would reimburse for this.

Why? Does it make any sense at all that a PCP receives a bulk of the reimbursement, if not all, for setting the wheels in motion for all of these lifestyle changes yet only a couple of them are reimbursable through insurance? The answer is obvious. Additionally, when the patient goes to all of these appointments, there’s no way of passing information from the chiropractor, to the physical therapist, then to the personal trainer, and finally the massage therapist. Unfortunately, all of them are operating in silos. Sometimes there will be a physical therapy clinic operating as part of a physician’s practice, and there’s a possibility they share the same electronic medical record (EMR). But that’s the exception, not the rule. Wouldn’t it make complete sense for everyone to be on the same page and work together and be paid a reasonable amount?

Part of the problem with the allied health field is there is a gaping hole inconsistency regarding accreditation and regulation. Some fields call for full licensure, some only a certification. In terms of certification, some require a college education, some can be obtained from a weekend course. Below are some common allied health professions, along with some common accrediting agencies and what is required to obtain them:

Chiropractor: Council on Chiropractic Education and its Commission on Accreditation are members of the Council on Higher Education Accreditation. Graduation from an accredited chiropractic college is required along with state licensure. Requirements and scope of practice can vary greatly from state to state.

Personal trainer: National Strength and Conditioning Association; American Council on Exercise; American College of Sports Medicine; Certifications vary greatly within each agency with some requiring a college degree (NSCA – CSCS) and some only a home-study program (ACE – CPT). Currently, there is no governing body that requires licensure.

Massage therapy: Individual states may require licensure or certification and the requirements for each is set up through each state’s professional licensing agency.

Dietician: Registered Dietician is a nationally recognized accreditation and obtained with a college degree along with passing an exam through the Academy of Nutrition and Dietetics. State licensure requirements vary. Numerous certifications are available, but only RD or RDN are eligible for licensure.

Health coaching: Wellcoaches; National Society of Health Coaches; Integrative Nutrition; ADAPT Health Coaching through Kresser Institute; Primal Health Coach. All require varying educations, and none are connected to any state licensure. One does not even need to obtain a certification to market themselves as a “health coach.”

While there’s a lot of variance in the accreditation process of those in the allied health field, there’s no question the importance these professions play in the role of the health of an individual and the overall care plan prescribed by the primary care physician.

Rob Arnold is an exercise physiologist.

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