A DO's PA practicing OMM?

[rpkall]

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This was brought up in the clinical personnel forum, and I was really intrigued by it--though I had no real idea of how valid/functional an idea like this could be. So I thought I would ask the Osteopathic forum on this issue.

If a PA is trained by a DO to do manipulation (and has presumably studied the same texts as DOs and also shadowed/done preceptorship in the office with the DO for some length of time), would that PA be qualified to do OMM on the patients (even if just on "follow-ups" on the same patients who have gotten OMM treatments before)? Is this something that is on a "case-by-case" basis, like all the other "can a PA do ____" questions? Would it even get any reimbursement? Do you need to be "licensed" to get reimbursed for OMM? Can a non-physician provider (under a DO's supervision) get that license?

I've heard of "extension" programs for MDs to get OMM training, but I've never heard this issue of a PA doing it. As an allopathic student, I've thought about going to get trained at some point in my career, or if I wind up in primary care, at least teaming up with a couple of osteopaths so we can, as a group, offer the service to our patients. But I was wondering if a practice could use PAs to expand the OMM service, as long as there was a supervising DO.

Any thoughts?

Thanks for any and all info you folks can provide.

 

[Timbo0984]

Many PA's can register for the same continuing ed programs the MD's register for in order to learn OMM techiniques. This would def give a PA more credibility as an OMM practitioner but i am not sure of any specifics.

 

[raptor5]

I often wondered the same thing. The question is if a PA billa for OMM will it be reimbursed.

 

[Ratch]

i taught my dog cranial; i like it because her paws are softer and she can pick up a sphenobasilar torsion like none other. but she doesn't charge me so i can't help you with the billing thing.

 

[DeLaughterDO]

I don't see a reason why a PA should not be able to perform OMT - the entire time I've been in school, I always wondered why our PA students did not take OMM along with the medical students. It's not like it is brain surgery. If it helps your patients, why not have an extra set of hands in the office. Besides, then if you need some manip as well, you have someone that can help you out... 🙂

Billing, isn't it sad that is really what all this boils down to? Freaking insurance companies.

 

[djquick83]

Billing, isn't it sad that is really what all this boils down to? Freaking insurance companies.

Well it helps pay your $1,000 a month lease for your BMW 745iL. 🙄 😀

 

[Ice-1]

My question would be whether OMM is classified as the practice of medicine that only a licensed physician can do.

 

[DeLaughterDO]

Well it helps pay your $1,000 a month lease for your BMW 745iL. 🙄 😀

My question was a social commentary on how sad it is that we (as a profession) have allowed another class of business (with far less 'noble' goals) to determine our practice behaviors so completely.

I was not remarking on "money makes the world go 'round," more on, "Well, I could do this (which would probably be better for the patient), but the INSURANCE company will not pay me for it, so we'll substitute some other treatment/diagnostic exam instead so I don't get screwed - as badly."

That was the thrust of my question.

Sorry for the confusion (if there was any).

 

[DeLaughterDO]

My question would be whether OMM is classified as the practice of medicine that only a licensed physician can do.

With the current politico-medical climate, I didn't think there was ANYTHING classified as such. Midlevel providers' scope of practice has almost eclipsed that of physicians - the only thing holding them back (in some cases) from making physicians obsolete is legislation. None of the midlevel groups are allowed by law to practice medicine independently - yet. They are working on that already in many states. Ever heard of Ph.D RNs (Dr. RN)? Look it up for an enlightening read.

jd

 

[SOUNDMAN]

However you won't find PA's lobbying to practice w/o a physician. It is the stance of the AAPA, that we are trained to work under a physician.

 

[Jambi]

Here is an extension of the OP:

Would any of you, as DO's or soon to be, teach/train a PA in OMM and allow them to practice it under your supervision?

 

[cremaster2007]

We were told as long as you train your office staff to do some of the techniques like soft tissue, etc you can have them go into the room before you and "prep" the patient then you can come in and do HVLA, or more advanced techniques and we can still bill the patient for the prep work and what we as physicians do to treat them after our staff has worked on them. It has something to do with the fact that we as physicians can be sued by people even if our staff messes up because we receive benefits from the employee or something. I don't know about letting people practice OMM unsupervised, but MD schools are teaching bio-manipulation now and they can bill for it, so I don't see why other schools of philosphy don't just change the name of OMM and bill for it. I am definetly not opposed to teaching people that work for me techniques to use on people whether I get to bill for them or not, but being able to bill for them certainly helps!

 

[rpkall]

However you won't find PA's lobbying to practice w/o a physician. It is the stance of the AAPA, that we are trained to work under a physician.

Absolutely. I spent two semesters in PA school, and can attest to the fact that even on the "inside," most--if not all--PAs and the faculty who taught our program, recognized physician supervision as ESSENTIAL to maintain good quality care when midlevels are seeing patients. One of the PA faculty put it nicely: "If I can't go into an exam room and give to the patient the same quality of care a physician can give, I'm not going into that room." It's not about how many illnesses you are comfortable treating; it's about how many patients you can treat comfortably, providing the same quality of care as physicians. Fortunately, in most primary care settings, this number--for an experienced PA--is relatively high (80+%), for uncomplicated presentations of common ailments.

According to the most basic mission statement of PAs: they are trained to "...practice medicine with the supervision of licensed physicians." No one can ever "practice medicine" without a physician's supervision. The loophole is that advanced practice nurses don't practice medicine; they practice "nursing." 😉

I must say that politically, PAs are afraid, since they do not wish to be independent (like NPs), that they will be more restricted and limited than nurses--even though they recognize that the medical model is the most appropriate one, and that supervision is necessary to ensure quality care! 😉

 

[Buckeye(OH)]

Well it helps pay your $1,000 a month lease for your BMW 745iL. 🙄 😀

A 1000$ won't cover the lease on a 745iL even with a 20k down payment.

 

[corpsmanUP]

As a PA, and 9 months from being a DO physician, I can tell you that manip is not so difficult that you couldn't teach a PA how to do it in about 2 weeks. By law, the PA can do what the physician delegates and the term supervision is about as loose as you can imagine. I have worked for 3 years as a PA for a DO alumn from my school and I have been using manip as long as I can recall there. I started using it right when I was learning it. Billing is not an issue because we bill "incident to" meaning that the insurance company never knows who saw the patient. Its a perfectly legal way to bill depending on the state that you are in. Truth be told, manip is basically a free service dished out by DO's to keep patients feeling closer to them, but it does not pay normally. At least that is what I have seen from my end where most of our patients are cash or HMO. The HMO's never pay for it and the cash patients already pay too much to begin with and will usually not want to tack on extra for a few minutes of hands on therapy. But overall, its an easy service to provide and nothing that should be withheld based on fees in my opinion.