Is managed care dooming osteopathic manipulative treatment?

Source: www.physweekly.com/archive/97/04_14_97/pc.html
Source: Physician Weekly, 1997 article.


Ray Stowers, D.O., FACOFPFP, Medford, Okla.; Consultant, American Osteopathic Association Payer Relations Department; Commissioner, Physician Payment Review Commission

Opinion: NO

Some osteopathic physicians have run up against the obstacle of a single capitation rate for FPs, be they DO or MD. These managed-care firms don’t take into account the additional time and service OMT represents. Some managed-care groups won’t pay for an office visit and OMT on the same day. But osteopathic physicians across the country are winning most of the battles to have OMT-already recognized in CPT and by HCFA as a freestanding and separate procedure-approved by managed care as a covered service. Managed-care groups in general are starting to become aware that OMT and other aspects of osteopathic medicine are not only excellent care, but cost-effective. Over the past year, AOA payer relations has seen a dramatic reduction in physician complaints about managed-care reimbursement or access to managed-care panels.
I am not a fan of managed care. But its basic philosophy is usually in step with osteopathic medicine in paying for services uniquely provided by DOs. Managed care can build OMT and other special osteopathic medical services into the capitation rate. The osteopathic profession only rarely has difficulty resolving problems with managed-care organizations once we bring them up to speed on the cost-effectiveness of osteopathic medicine and OMT.
Mature managed-care plans appreciate this. DOs practicing where there are newer managed-care plans-mainly interested in discounting and restricting services-will face more difficulties. But even though there may be some up-front reimbursement problems, the future of osteopathic medicine and OMT is bright.




Judith O’Connell, D.O., FAAOPrivate Practitioner, Dayton, Ohio; Trustee and Past President, American Academy of Osteopathy

Opinion: YES

Managed-care entities consider me a specialist because my practice is entirely osteopathic manipulative treatment. As long as I have prior authorization, they generally are happy to reimburse for my services. But managed-care organizations are less enthusiastic about OMT as an integrated service in family practice. HMOs like a profession that does only one thing, or a specialist who does only one thing, because it makes it easier for them to restrict services and to predict expenditures. So HMOs look askance at GPs and OMT. As a result, practitioners are inhibited from using these techniques that have served osteopathic medicine well. At best, OMT is being forced into being a back-room procedure, or one for which osteopathic FPs are afraid to bill managed care. At worst, OMT is being abandoned. Insurance carriers are telling DOs that OMT is just an extra procedure done to earn extra money. Sadly, one cannot stay in business by providing a service and not charging for it. FPs are phasing out OMT for their managed-care patients in fear of being singled out as “overutilizers.” HMOs are prejudiced against preventive medicine as well as continuing maintenance care. And, indeed, some practitioners of manual medicine have overused it, which has tainted the procedure. But there is mounting evidence from workers’ compensation that osteopathic care, even when medical and surgical care is factored in, is the most cost-effective manual medicine compared with practices by allopathic physicians, chiropractors, and physical therapists. Managed care is penny-wise and pound-foolish when it comes to OMT.