Advocacy update

Step 2 of the #SaveOMT campaign: Exclude OMT codes from CMS review

OMT has been targeted for review in the 2017 Medicare Proposed Physician Fee Schedule.

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DOs’ expert voices are essential to improving payment policy for osteopathic manipulative treatment. Last week, The DO detailed how 5,024 DOs, osteopathic medical students, and patients used SaveOMT.org to submit comment letters in opposition to a proposed policy that would make it nearly impossible to bill Medicare for an appropriate evaluation and management (E/M) office visit when OMT is performed. DOs and students were visible and vocal advocates for patient access to OMT—now it’s time to find pathways for improved payment policy for OMT.

OMT has been targeted for review in the 2017 Medicare Proposed Physician Fee Schedule. Among the 83 current procedural terminology codes the Centers for Medicare and Medicaid Services (CMS) proposes to revalue are the five OMT codes. At this point in the process, there are only two options: ask CMS to proceed with revaluing the OMT codes, or ask CMS to exclude the OMT codes from the list of 83. Revaluing the OMT codes at this time would be bad policy for physicians and patients—the AOA believes the OMT codes should be excluded from review. Visit SaveOMT.org to tell CMS to exclude the OMT codes from review.

Why not revalue the codes? The short answer—the AOA continues to work with CMS on opening up new pathways for improved payment policy for OMT that will be of greater benefit to physicians and patients. The technical answer—CMS identified the 83 codes for review and possible re-evaluation because they are frequently billed with an E/M. The five OMT codes should be excluded from the review because AMA’s Relative Value Scale Update Committee (RUC) rationale supports that an E/M is typically reported for this service and the RUC accounted for this in its valuation. Revaluing the codes is also inappropriate because they do not meet CMS criteria for review.

Please visit SaveOMT.org and submit your own comment letter to CMS, share the campaign on Facebook, tweet about #SaveOMT, and email your colleagues and ask them to act too.

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8 comments

  1. Joe Freeman OMS3

    So is the goal here to keep it where one can see a patient, bill a visit and also bill a procedure? If so, maybe CMS should review that. Why should a visit with OMT be paid any higher than a visit without? It seems like it makes for an easy way to drive up doctors’ income, but also drive up health care costs. Or have I missed the whole point of this conversation?

    Reply

    1. Joel D. Stein, DO, FAAO, FAOASM, FACOFP

      The reason the patient came in may not be associated with findings on physical exam. For example, if you find hypertension, and the patient came in complaining of headache, you treat the hypertension. They must pay for the treatment you provide or prescribe, for instance, antihypertensives. However, if you do not do anything, you have simply performed an office visit yielding a diagnosis.
      With a procedure, there should be allotment for an evaluation of the patient, especially for OMT as each and every time the patient is seen, the somatic framework changes. Regardless of the complaint, there are also often areas of compensation yielding somatic dysfunction in areas distant to the complaint. Often times, CMS has denied payment for treatment of somatic dysfunction of one area or another because the patient did not complain of that area. However, the current State (Florida) and National determination for OMT states that the medical necessity is based on the finding of Somatic Dysfunction.
      Do you think you can treat your patient for medical problems, diagnose them AND evaluate for somatic dysfunction, and get an inferior pay schedule that does not include the evaluation of the patient? Take my example of hypertension. The patient had headache, with somatic dysfunction of the head, neck, upper ext, thoracic and rib cage areas on exam. You can treat this with OMT. On the return visit, after labs, you find out he has renal involvement, and check for thoracic, lumbar, pelvis somatic dysfunction, and find it, as well. Now he has multiple areas of somatic dysfunction for you to treat as well as renal impairment, and causally related hypertension. So, think about it. It takes time to eval for Somatic Dysfunction and the medical problem, and as an OMS3, who may or may not have the ability to write chart notes on your rotations, in the future you will find out how long it takes to use the EMR to simply chart what I have been talking about. WE Should be paid for our services involving evaluation and management, not just the OMT we performed. And yes, you may have or have not missed the point, because you are not trying to make a living yet, you only need to pass tests to see if you will one day be able to make a living doing osteopathic medicine. With this kind of
      CMS interference in how many of our profession make a living, IT REALLY DOES MATTER.

      Reply

    2. Andrew Teffeau

      You have missed the whole point. Your time is important and you should be paid properly for it. OMT when warranted takes time to do and you as a physician should be paid for it.

      Reply

      1. John E. Kazilionis D.O., ACOFP

        Andrew,
        Included is the cost to the physician of rendering the service. If the physician does not do so, he/she would see another patient and submit a fee. If the physician does not submit a fee, he/she has essentially worked for nothing.

        Another way to look at it is this: Do attorneys charge for the time telephone calls take, or the time to read reports? The answer is of course they do. The time of physicians is no less important or valuable. We should be paid for what we do!

    3. Patrick Soto

      OMT takes additional time to complete. It is an additional service that can benefit the patient. Medicare already pays us pennies to see patients. If you want to provide a free service, then go do volunteer work. I and many others on the other hand remain buried in medical school debt after graduating in 2008. I barely use OMT because it pays poorly for the time it takes. I used to use it a lot. Revalue it. Bundle it and watch OMT go to cash pay. Rising health care costs barely come from the physicians themselves. For examples of the culprits, go visit your local hospital for simple health care and compare it to the cost of seeing your independent physician for the same issue in their office. Ask how much device reps make for sitting around in the OR. There are many times that rep makes more than the surgeon performing the surgery. The list goes on. OMT is the least of the problem. Did I miss your point?

      Reply

    4. John E. Kazilionis D.O., ACOFP

      Joe,
      I believe you have missed the point entirely. The office visit requires time and knowledge to diagnose the problem. Doing the procedure to fix the problem is entirely different.

      For example: if a family physician sees a patient who has recurrent chest pain with activity and diagnosis coronary disease and refers the patient to a cardiac surgeon, should the surgeon not be paid for the by-pass graft?

      In the same way, the diagnosis of a structural problem that can be treated with OMT is one skill set. The treatment of the condition is another. The physician has the option of diagnosing the problem and having the patient come back at a later time for OMT. That would not be fair to the patient who most likely is having pain. The cost for such an approach would also be higher than it needed to be.

      Reply

    5. Dane Shepherd DO

      Yes you did. Omt is not just a for of PT. IT is a for of internal medicine. I that many internal medicine conditions can be treated with OMT, but those that can’t omt will reduce the frequency and dosage of drugs and their sideeffects. Omt can also reduce the frequency of surgery and the extent of surgery. For psychological diseases it can be used to treat shock often at the root of various diseases. So it isn’t a good idea to just limit ones thinking to just mechanics and one needs E/MD office visit time to consider all the variables. The memory stores for all the chronic diseases are in the heavy mass portions of the body; the soma. So Osteopathic Manipulative Medicine offers great promise for our patients

      Reply

  2. Tina Higgins

    I am a patient of OMT and I get great results from continued treatment. I am currently narcotic free with two chronic pain conditions and feel this treatment is a great alternative to narcotics. I have Fibromyalgia and RSD of the right wrist and forearm. My sacrum turns a bit and causes pain from my hips all the way up to my neck. OMT treatment helps with a great deal of pain I experience and make it tolerable as not to have to use narcotics. It is a far better option than narcotics and all the problems that can accompany use of a narcotic. CMS….Save OMT…I do not know where I would be without it !!!!!!!

    Reply

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