A DO provides osteopathic manipulative treatment to a patient.
Q&A

What this DO says the osteopathic profession can do to encourage more DOs to do OMM

“I can’t overemphasize what a powerful tool OMM is in the overall care of patients,” says Roger Beaumont, DO.

When he was young, Roger Beaumont, DO, suffered a significant back injury during a car accident. His family physician, a DO, treated his injury with osteopathic manipulative treatment (OMT).

Years later, when Dr. Beaumont decided to become a physician, he knew his family physician from childhood was the kind of physician he wanted to be.

“I asked my parents about him,” Dr. Beaumont says. “They said, ‘He’s a DO.'”

Thus began Dr. Beaumont’s journey in osteopathic medicine and love affair with osteopathic manipulative medicine (OMM). He has been practicing medicine for 50 years and is AOA board certified in family medicine and osteopathic neuromusculoskeletal medicine (NMM). For the past three years, he has been practicing at Froedtert & the Medical College of Wisconsin in Milwaukee.

In this edited Q&A, Dr. Beaumont discusses his concerns for the future of OMM, what the profession can do to encourage more early-career physicians to embrace OMM, and his advice for aspiring NMM specialists.

You would like to see more DOs providing OMM in their daily practice of medicine. Why?

Osteopathic manipulation is very effective in many different aspects of health care. I’ve personally seen it alleviate not only back pain and joint pain, but also anxiety and depression. It can be used in many different areas of medicine, more than what we usually think of. Also, our society is wanting the DO experience more and more. I have a number of patients who come to me because No. 1, I am a DO, and No. 2, I do manipulation.

Practicing hands-on medicine gives you an opportunity to connect with patients better. It definitely supports a good bedside manner. I can’t overemphasize what a powerful tool OMM is in the overall care of patients.

What has your practice of OMM looked like over the years?

My practice is typically 80% hands-on OMM and 20% family medicine. I’ve been practicing medicine for 50 years now. I’m AOA board certified in family medicine and neuromusculoskeletal medicine (NMM).

I practiced independently for a long time, but three years ago I decided that that was becoming too challenging for me. I now practice family medicine and OMM with a larger specialty group. I’m the only NMM doc in the whole health system. I’d like to create an NMM department and grow it.

The other doctors will refer patients to me for OMM. A lot of the doctors and staff also come to see me themselves for treatment. I really believe in the power of OMM to help patients, and I want to promote it. Because I am concerned about where OMM is heading today.

What are your concerns about the future of OMM?

I’ve noticed at my employer that the number of DOs who practice OMM seems to be declining. A few years ago, my medical director told me that he had bought an OMM table for a new DO who was working in our other clinic, but that he wasn’t using it.

I spoke to another DO who started working with me two years ago. I was offering to mentor him. But he said he didn’t want to do any manipulation. He didn’t feel that he had the necessary skill set to do it, and he was also concerned about how to code for it.

I understand the coding concerns because I was audited by my employer last fall. My employer’s compliance officer said I was an outlier because of my use of modifier 25 as well as the E&M code 99214. He implied that my use of these was excessive.

But they are not comparing me with other osteopathic physicians who do OMM. They don’t have a taxonomy number for NMM specialists, and there really needs to be one so we can be assessed fairly. Editor’s note: A taxonomy code for NMM specialists exists. The AOA worked with the National Uniform Claim Committee to create one in 2017. AOA members who need coding and billing support can contact AOA Physician Services at physicianservices@osteopathic.org.

The number of NMM specialists has actually grown in the last 20 years. But I’m worried that we are heading to a landscape where only NMM specialists practice OMM, and that would be a shame because of the tremendous benefits of OMM.

What do you think needs to be done to encourage more DOs to do OMM?

I’d like to see a bigger focus on OMM in residency programs. In my opinion, most residency programs don’t have the rigor that we need to have our DOs be confident with OMM and integrate it into their regular family medicine or internal medicine work.

That could involve changing the requirements for residency programs. It could be something like a requirement that residents spend six weeks in the field with a DO who does manipulation so they get a significant amount of hands-on experience. I know many residency programs do run OMM clinics, but I don’t think those give you the full picture of what providing OMM looks like outside of a residency program.

What advice would you give to students who are interested in specializing in OMM or getting a good education in OMM while pursuing a different specialty?

If I was applying to residency, I would evaluate program directors and DOs within programs who are in charge of OMM education and get a sense of what their background is. I’d also look at what kind of educational experiences they offer when it comes to OMM. I’d be looking for a program with a robust educational program on OMM.

Medical students who are earlier in their studies can try to spend time with a DO who has a good reputation for practicing OMM.

Identify OMM specialists who are willing to be mentors and pick their brains to find out the best, most efficient ways to practice OMM. There is a lot about OMM that you will learn in the field rather than in medical school.

Medical students and residents should try to attend the American Academy of Osteopathy convocation at least once. It is very inspiring. You will learn things that will help propel you forward and help you succeed in this field.

6 comments

  1. I so relate to this article. I too endured scrutiny from the insurance company because I was an outlier doing OMT but also doing an office visit.
    It was very disheartening to be compared to peers who do not do what we do. Sometimes I feel like I’m the unicorn trying to run with the horses. I don’t fit the mold.
    Thank you so much for sharing this.

  2. Instead of using peer comparisons between physicians, insurance companies should ask patients how the quality of their life has improved with OMT. There are a number of positive economic and well-being results that could be measured to the benefit of all rather than limiting those physicians who do perform OMT because of those who do not.

  3. I encourage the new generation of osteopathic physicians to read this article.
    It is a good description of the OMM of today.
    I use OMM and it is a good tool for helping the patient.
    Keep an open mind and you will see results.
    Thanks for this article

  4. I am NMM/OMM certified. In 2014, I moved to Louisville, KY (population >1,000,000), where I am one of two DOs practicing OMM, only to find that commercial insurance reimbursement was 50% less than what I had been making in MI. Bummer; I make more doing a 5 minute injection. Oh well, it’s not all about the money. Then a CMS audit initiated a clawback because the auditor determined that my use of the 25 modifier was inappropriate. It wasn’t, but my larger organization determined it wasn’t worth the fight since I wasn’t bringing in much from it anyway. Now we collect about $40 for a full OMM treatment, and because I choose to be in network, I cannot collect any more. I no longer train students because the only OMM I do these days is basically for charity. Interest is not the only issue. Valuation is a problem as well.

    1. WOW! I like your thinking. I am still practicing in Michigan, but they are making it more and more difficult. The MOD 25 issue is recurrent. I, as well as the rest of the DO community, have fought it for the past 15 years, and will continue to fight it. Please join, and donate to OPAC and other political organizations that fight for us, something all DO’s need to do. Your skills are invaluable, and your support is necessary for us to continue to do what is best for our patients’ as well as be properly paid for our services and respected for our abilities.

  5. I am a board certified IM DO who is fellowship trained in OMT and has been in practice in Michigan for the past 15 years. Like Dr. Conliffe’s comment, I absolutely agree that the problem is not interest, but the incredible amount of bureaucracy and difficulty in getting paid. I continue to train multiple residents monthly from both Henry Ford and Children’s Hospital. The residents and students show great interest and the patients yearn for proper diagnosis and treatment of their pain complaints.

    The problem, as I have known it, is that there is minimal support for OMT training during residency.

    I often liken this to graduating a surgeon from residency who has never been required to attend a single month of surgery during their residency program, yet certifying they are competent because they had 2 years of training during medical school. It is completely absurd.

    OMT is a procedural skill that requires hands on instruction and hundreds, if not thousands, of actual patient contacts before the practitioner becomes proficient.

    The Osteopathic Profession should be leading the country in defining how to treat chronic pain utilizing OPP coupled with their OMT skills to enhance their patients’ quality of life and reduce dependence on harmful medications.

    This can not happen without increased support from our national organizations, and improved reimbursement for these life altering and non invasive therapeutic modalities.

Leave a comment Please see our comment policy