How is it possible? (OMM vs Chiro question...)

[DOwnage]

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How is it possible for a DO to make low to mid six-figures doing OMM only when chiropractors do what the general public would perceive as a similar service and make ~100k or less?

In other words, what makes the OMM Practitioner so special that they make significantly more money than a chiropractor, especially when the general public isn't savvy enough to understand a lot of the differences?

The reason I ask is because you often hear anecdotal stories of OMM docs who accept cash only and can charge several hundreds of dollars per hour. Is it realistic to expect this kind of success, or are there a lot of OMM docs who hover around ~100k or less? Does SDN overstate/understate the opportunities for OMM docs out there in the real world?

thanks!

 

[Bacchus]

Length of education and responsibility.

 

[Nymphicus]

osteopathic manipulation (OMM/OMT) =/= Chiropractic "treatment"

 

[JustPlainBill]

How is it possible for a DO to make low to mid six-figures doing OMM only when chiropractors do what the general public would perceive as a similar service and make ~100k or less?

In other words, what makes the OMM Practitioner so special that they make significantly more money than a chiropractor, especially when the general public isn't savvy enough to understand a lot of the differences?

The reason I ask is because you often hear anecdotal stories of OMM docs who accept cash only and can charge several hundreds of dollars per hour. Is it realistic to expect this kind of success, or are there a lot of OMM docs who hover around ~100k or less? Does SDN overstate/understate the opportunities for OMM docs out there in the real world?

thanks!

Don't know the difference in billing, but I think OMM counts as a 'procedure' just like a knee injection, etc.....Also, you have a review of systems/H&P that can allow you to bill 99213/99214 depending on how many systems you 'treat' etc.....but again, I'm not sure....it's all in how you code the billing....

 

[DOwnage]

osteopathic manipulation (OMM/OMT) =/= Chiropractic "treatment"

I'm aware that the services aren't equal, but my question is really what specifically about osteopathic manipulative therapy relative to chiro makes it so much more lucrative? Is it simply the positive results that people receive from undergoing OMT that make them willing to pay several hundreds of dollars?

Think of it from an uneducated consumer standpoint. For example, let's say you are a blue collar worker who has no idea about how the musculoskeletal system works. You see a chiropractor and a DO separately. They both do manipulations in an attempt to ease whatever pains you may have. From your standpoint, you really have no idea what they did...to you, what they did looked the same. How would someone with that level of knowledge be able to make any differentiation between the two practitioners even though we clearly know there is a difference in training, philosophy, etc.?

Length of education and responsibility.

For training and education to be an "added bonus" that is reflected in the price, wouldn't the buyer would have to actually understand the nature of that bonus before the transaction could be completed? Wouldn't the patient have to appreciate the difference between the two treatment styles in order to be willing to pay a premium for OMM over chiro? Am I severely underestimating typical patients' intellect when I say they probably have no idea about a medical school curriculum and total number of years a DO goes to school vs. a DC?

Don't know the difference in billing, but I think OMM counts as a 'procedure' just like a knee injection, etc.....Also, you have a review of systems/H&P that can allow you to bill 99213/99214 depending on how many systems you 'treat' etc.....but again, I'm not sure....it's all in how you code the billing....

The fact that it's a procedure makes sense when it comes to billing, but I've heard that OMM docs who take insurance actually make a lot less than they do if they charge cash only. It almost sounds like if a doc charges insurance for OMM, he/she has to use OMM as an adjunct to their practice instead of it being the sole focus because insurance reimbursements are poor.

You hear stories of docs doing OMM making 200-300k, sometimes they can make more depending on location, but I've never in my entire life heard of a chiro making anywhere close to that amount. Not to mention that in my area anyways, chiropractic is much better known than OMM to laypeople. ie. If I mentioned OMM to a random joe off the street, he would probably get confused whereas if I said the word chiropractic, he would understand. Does OMM have better name-brand recognition outside of my tiny bubble in which I live, or is there another explanation for why OMM docs can often be much more successful than chiros from a financial standpoint?

 

[JaggerPlate]

Let me preface this response with the fact that I'm an OMM fan, and would love to integrate it somehow/have mad respect for the people who do it cash only, 8 hrs a day, 5 days a week:

1. We always hear these anecdotal stories, but the number of individuals doing 'it' (making bucks with cash only OMM) are pretty slim from what I've encountered. Frankly, the two individuals that I'm aware of doing it in my neck of the woods (who, trust me, are doing WELL) are really into the hollistic, natural, cranial-esque aspects of it, and I think this angle helps them attract a niche market.

2. The billing codes are different, but the guys who are supposedly making nice money doing OMM (200k + a year) aren't doing it with medicare reimbursements.

3. I think the advantages (over something like Chiro, which the average individual would see as a lot cheaper and similar) are:

a. Being able to advertise/network as a physician versus a chiropractor. From what I gather, patients would much rather see a physician, and other docs are much, much more likely to refer to other docs before DCs.

b. Being unique/having that niche market. I was discussing the feasibility of some sort of OMM practice with my roommate before leaving for break, and we started to talk about DC saturation. Essentially, I sat down for 2 minutes and did a run down (just from memory) of the number of DC practices near my house and came up with 5-7ish in a 2-4 mile radius. AKA - it's saturated.

However, my mom recently started having some reoccurring back pain issues and I recommended she look into OMM gurus. To be honest, I really couldn't even find a place to refer her to. My point here is that even if the market for OMM isn't huge, if you're honestly the only guy within 50 miles who does it, every single person who comes across it is going to walk through your door.

c. I hope this doesn't start some flame war ... but in my first-hand experience, the relief (both long and short term) from OMM is much, much better than that experienced from Chiro. I've definitely discussed this with quite a few people, and they seem to agree, which leads me too believe that not only would reoccurring business not be an issue, but that word of mouth (which is the lifeline of nearly anything in business - even in the age of the interweb) would be killer. The guys who go into cash only OMM practices are the ones who can spot a tender point on the transverse process of L3 from watching the patient move from the door to the OTM table; they are the gurus, and love or hate them ... they are good at what they do. This is going to keep the volume coming.

So ... I guess in my novice opinion - I don't think these types of situations are overtly common (though there are many areas of medicine that aren't common, yet individuals still find success - cosmetic practices, concierge medicine, etc), but with the right combination of staking your claim in the market and being good at what you do, it's not impossible to see why/how it would work.

 

[Bacchus]

For training and education to be an "added bonus" that is reflected in the price, wouldn't the buyer would have to actually understand the nature of that bonus before the transaction could be completed? Wouldn't the patient have to appreciate the difference between the two treatment styles in order to be willing to pay a premium for OMM over chiro? Am I severely underestimating typical patients' intellect when I say they probably have no idea about a medical school curriculum and total number of years a DO goes to school vs. a DC?

I haven't used our OMM clinic, but from my understanding in lab, everyone that walks through the door gets an H&P. Right there, a lot is done. I'm sure DC's ask chief complaint and try to figure out what's going on. But, based on that H&P the OMM doc will be able to treat, refer out if necessary, and provide prescriptions for conditions. Granted the patient might not know this, but I'll make the assumption that whomever recommended them to the OMM doc said go see this doctor I know, he'll be able to help you in one way or another.

Patients, I would think, know what they're getting into before they go to the doctor.

 

[facetguy]

I think there are a few reasons why this may be true. I do, however, have to say that I am personally unaware of any such OMM-only practice, but I can believe that they do exist here and there.

The main reason, in my view, would be the "real doctor" vs. "just a chiropractor" issue. As much as a segment of the population loves their chiropractor (and they'd be crazy not to 😉), a significant percentage of the population flat-out would never go see a chiropractor no matter what. A DO, on the other hand, has automatic access to virtually 100% of the population.

Another reason would be that the DO could give them meds or basic injections if needed. And let's face it, people in pain want fast relief and don't always want to hear that it may take some time to get them feeling better. Sure, the patient could go to their PCP for meds, but one-stop shopping helps simplify things.

As Jaggs said, the relative rarity of an OMM-only practice provides a wider patient base, if not an outright mystique. I think this counts for something.

I don't think it has anything to do with a DO being 'better at it' than a DC.

I don't think it has anything to do with billing codes, as these guys/gals are from what I gather cash only.

On the DC saturation issue, I agree to an extent. However, just as in an OMM-only practice, there isn't a standard per se. While there are obvious standards that all DC must adhere to, chiros are more of a heterogeneous group. Chiro A may treat you a bit differently than Chiro B... This is both a plus and a minus for DCs. On the one hand, you could argue that a patient never knows what he is going to get (beyond the minimum standards). On the other hand, if one DC didn't help you, the guy literally across the street might be able to help you because he will treat you in a different fashion. Yes, there's an art to medicine too, but an antibiotic is an antibiotic. The same can't be said for manual medicine treatments, and I would include an OMM-only practice in that as well.

This same notion goes along with what Jaggs said about the duration of relief from DC or DO treatments. I think there is a ton of variability in this, again due to the fact that there is a lot of potential variation in the treatment rendered. In some cases, the 'missing link' to helping that patient can be very subtle, and until that problem gets addressed, the patient's improvements will be incomplete. If the DC is a rack-and-crack-only DC, then a patient with, say, a myofascial problem won't respond well. They then go to the DO who does some myofascial work and voila, better. They could just as well had gone to another DC for that myofascial work with the same good outcome.

You never know how successful a practice will be based on location only. But I'd have to think that a lucrative cash-only OMM-only practice would do best in a wealthier area. Just a hunch.

 

[bubbabott]

You hear stories of docs doing OMM making 200-300k, sometimes they can make more depending on location, but I've never in my entire life heard of a chiro making anywhere close to that amount. Not to mention that in my area anyways, chiropractic is much better known than OMM to laypeople. ie. If I mentioned OMM to a random joe off the street, he would probably get confused whereas if I said the word chiropractic, he would understand. Does OMM have better name-brand recognition outside of my tiny bubble in which I live, or is there another explanation for why OMM docs can often be much more successful than chiros from a financial standpoint?

I think a lot of it depends on marketing and quality of care that you provide. Here in Michigan I have met many Chiropractors making well over 100k per year, so I cant relate to your above comment. Perhaps MI has a larger marker for Chiropractic care, but like it was stated before, the market is saturated, so I think marketing and patient to patient referrals become huge if you want to make money as a chiropractor.

I was pre-chiropractic for a long time, but upon talking to a Chiro he recommended that if I had the grades I should look into becoming a DO. His logic was that you learn a wider variety of manipulations than a Chiro, and can also offer the patient a pain med or muscle relaxer if necessary. I don't know if an OMM only practice is in my future or not, but its definitely an interest of mine.

 

[DOwnage]

So does anyone anticipate DO's and OMM becoming saturated (maybe to the point of chiropractic level) in the coming years since DO's are gaining in number and 1/4 or 1/5 medical students today is a DO?

 

[randomusername]

So does anyone anticipate DO's and OMM becoming saturated (maybe to the point of chiropractic level) in the coming years since DO's are gaining in number and 1/4 or 1/5 medical students today is a DO?

Always possible but it kind of seems doubtful that it would occur anytime soon since so few actually utilize OMM in their practices once they graduate, never mind that even fewer go on to make it the backbone of their practices.

 

[facetguy]

So does anyone anticipate DO's and OMM becoming saturated (maybe to the point of chiropractic level) in the coming years since DO's are gaining in number and 1/4 or 1/5 medical students today is a DO?

Nope.

 

[JaggerPlate]

So does anyone anticipate DO's and OMM becoming saturated (maybe to the point of chiropractic level) in the coming years since DO's are gaining in number and 1/4 or 1/5 medical students today is a DO?

DOs as in DO/MD aka physicians ... in certain fields, maybe. Don't get me wrong though, you'll probably never have a problem with opening a FM practice in a reasonably sized city or something, but saturation is always a possibility.

With regard to people who practice OMM ... absolutely not. I think volume is far more of an issue (especially in the cash only game) than saturation.

 

[DocEspana]

I also think what you might be overlooking is those guys who make the huge bucks at OMM with cash only practices (and i know plenty, but as someone else said, they are all OMM Gurus, not people who are just 'decent' at it) are not bothering with the people who cant tell the difference between Chiro and DO.

I think the big ability to rake in the cash comes from going to an area with a high population and getting the patients who are clearly well educated in the difference and (my experience) superior benefits compared to chiropractic. Cities work best because you have the density, the generally more educated populace, and often enough people who fit the previous descriptor and have enough money to burn to seek out the best person to manage their pain/injury.

My OMM dept has 10 people on staff. Two do hospital work, one does omm heavy family practice and the other seven all do cash-only in major city areas (4 manhattan, one westchester, one queens and one baltimore). Its clear from anecdotal comments from those seven that being in the city helps greatly with the ease of slipping into the cash-only OMM as you build renown and your skills super sharpen.

 

[vanbamm]

chiropractic is far from oversaturated- there are about 50,000 active D.C.'s in the US...certain areas may appear to be be oversaturated, but as a whole, it is far from it.

as far as income goes- it varies according to how liberal the laws are-those in Michigan and Illinois for example will typically make more because the scope of practice is larger than say, NY- where reimbursement is also lower and more restricted.
Other factors to consider: population size, discretionary income, education level, age etc.

OMM over chiropractic is debatable. It varies on an individual basis. No patient responds the same to every treatment- skill of the DO vs DC will also create variables.

 

[JaggerPlate]

I also think what you might be overlooking is those guys who make the huge bucks at OMM with cash only practices (and i know plenty, but as someone else said, they are all OMM Gurus, not people who are just 'decent' at it) are not bothering with the people who cant tell the difference between Chiro and DO.

I think the big ability to rake in the cash comes from going to an area with a high population and getting the patients who are clearly well educated in the difference and (my experience) superior benefits compared to chiropractic. Cities work best because you have the density, the generally more educated populace, and often enough people who fit the previous descriptor and have enough money to burn to seek out the best person to manage their pain/injury.

My OMM dept has 10 people on staff. Two do hospital work, one does omm heavy family practice and the other seven all do cash-only in major city areas (4 manhattan, one westchester, one queens and one baltimore). Its clear from anecdotal comments from those seven that being in the city helps greatly with the ease of slipping into the cash-only OMM as you build renown and your skills super sharpen.

Thanks for the info, and I agree with a lot of the things you're saying. It's also interesting to hear the amount of individuals on staff you know who are doing straight up cash practices. Personally, I think a cash OMM practice would be pretty amazing - getting compensated properly, very, very low overhead, really relieving pain, grateful patients, low stress environment, etc, etc. Like you said though ... guru territory for sure.

chiropractic is far from oversaturated- there are about 50,000 active D.C.'s in the US...certain areas may appear to be be oversaturated, but as a whole, it is far from it.

This is akin to saying something like cosmetic surgery isn't oversaturated. Sure, if you look at the country as a whole, there aren't that many cosmetic surgeons compared to family practitioners, IM guys, OBs, etc, but look at the areas where it is saturated - can't throw a rock in Beverly Hills without hitting a cosmetic office, but probably couldn't find out in rural midwest to save your life.

What's the common denominator? Patient population. No offense, but I have a feeling DCs work on a SLIGHTLY (note slightly) similar scale where you need to be in areas where the patients are at. A few of my uncles farm in rural Idaho, and I know for a fact they would have some interesting MSK issues, but also know for a fact that haven't ever considering seeing a DC. However, go a few hours into a city like Idaho Falls - metro, larger population, etc, etc, and I'm sure you'll find quite a few chiros. I just don't think people see it as a necessary service, so you're going to find saturation in cities and 0 competition in other areas, meaning on average it isn't saturated, but where it matters ... it is.

Like I said in my first example ... I counted 7 or so literally within a few miles of my house, but couldn't find an OMM guy for my mom to see (and I'm a DO student). Again though ... just my observations/assumptions ... could definitely be wrong.

as far as income goes- it varies according to how liberal the laws are-those in Michigan and Illinois for example will typically make more because the scope of practice is larger than say, NY- where reimbursement is also lower and more restricted.
Other factors to consider: population size, discretionary income, education level, age etc.

How do restrictions come into play? It's my understanding that all chiro procedures would bill the same, no matter what state you're in, and I was also under the impression that the DC license didn't allow for prescribing, injecting, or cutting of any kind. How would laws that maybe allow DCs to advertise as 'chiropractic physicians 🙄' result in higher income if it doesn't actually bestow any additional privileges? Again, I'm not trying to be insulting ... just looking for clarification.

 

[DocEspana]

How do restrictions come into play? It's my understanding that all chiro procedures would bill the same, no matter what state you're in, and I was also under the impression that the DC license didn't allow for prescribing, injecting, or cutting of any kind. How would laws that maybe allow DCs to advertise as 'chiropractic physicians 🙄' result in higher income if it doesn't actually bestow any additional privileges? Again, I'm not trying to be insulting ... just looking for clarification.

I can help on this one. I was the bookkeeper and insurance submitter for a DC office before entering med school. I'm not 100% sure what its like in other states, but from my casual research into other states and my substantial experience with treatment filing for NY state i can say that the NY state branches of many health insurances are VERY stingy to chiropractors. And that really comes down to the fact that medicare and medicaid decide what payments will be and all the private insurances base the payment models off of that.

If i remember right, medicare has a decent coverage of DC, but you need to qualify as needing it. Its not something you can elect for without a clear requirement for a DC type treatment. But the catch is that NY medicaid is VERY strict for DC treatment and all the local NY insurances have followed suit. You're only allowed to bill for so many modalities per visit and each one must be seperately documented and frequently all the modalities are rejected as a whole if one portion (remember, they are filed seperately) has any areas that arent 100% backed as to why you suggested such a modality be performed.

This is infuriating from a submitting for payment point of view since you cant charge for everything you do if you go over the maximum allowed modalities per visit or visits per year. and if any 't' isnt crossed or 'i' isn't dotted on any of the claims you send it, they reject the whole patients claim as a whole til you find the small error and either omit that modality from submission or fix the error. they dont put MD/DOs through *that* much crap.

i think this is a NY state thing, they are officious to a major fault with chiropractic modalities

 

[JaggerPlate]

I can help on this one. I was the bookkeeper and insurance submitter for a DC office before entering med school. I'm not 100% sure what its like in other states, but from my casual research into other states and my substantial experience with treatment filing for NY state i can say that the NY state branches of many health insurances are VERY stingy to chiropractors. And that really comes down to the fact that medicare and medicaid decide what payments will be and all the private insurances base the payment models off of that.

If i remember right, medicare has a decent coverage of DC, but you need to qualify as needing it. Its not something you can elect for without a clear requirement for a DC type treatment. But the catch is that NY medicaid is VERY strict for DC treatment and all the local NY insurances have followed suit. You're only allowed to bill for so many modalities per visit and each one must be seperately documented and frequently all the modalities are rejected as a whole if one portion (remember, they are filed seperately) has any areas that arent 100% backed as to why you suggested such a modality be performed.

This is infuriating from a submitting for payment point of view since you cant charge for everything you do if you go over the maximum allowed modalities per visit or visits per year. and if any 't' isnt crossed or 'i' isn't dotted on any of the claims you send it, they reject the whole patients claim as a whole til you find the small error and either omit that modality from submission or fix the error. they dont put MD/DOs through *that* much crap.

i think this is a NY state thing, they are officious to a major fault with chiropractic modalities

Good point and thanks for the clarification ... didn't really think of this, but true.

 

[facetguy]

I can help on this one. I was the bookkeeper and insurance submitter for a DC office before entering med school. I'm not 100% sure what its like in other states, but from my casual research into other states and my substantial experience with treatment filing for NY state i can say that the NY state branches of many health insurances are VERY stingy to chiropractors. And that really comes down to the fact that medicare and medicaid decide what payments will be and all the private insurances base the payment models off of that.

If i remember right, medicare has a decent coverage of DC, but you need to qualify as needing it. Its not something you can elect for without a clear requirement for a DC type treatment. But the catch is that NY medicaid is VERY strict for DC treatment and all the local NY insurances have followed suit. You're only allowed to bill for so many modalities per visit and each one must be seperately documented and frequently all the modalities are rejected as a whole if one portion (remember, they are filed seperately) has any areas that arent 100% backed as to why you suggested such a modality be performed.

This is infuriating from a submitting for payment point of view since you cant charge for everything you do if you go over the maximum allowed modalities per visit or visits per year. and if any 't' isnt crossed or 'i' isn't dotted on any of the claims you send it, they reject the whole patients claim as a whole til you find the small error and either omit that modality from submission or fix the error. they dont put MD/DOs through *that* much crap.

i think this is a NY state thing, they are officious to a major fault with chiropractic modalities

I can vouch for much of this, and it extends beyond just NY. It's one thing for insurance carriers to require good documentation and rationale for care. It's another to put up what are clearly just stumbling blocks to reimbursement for care, which are designed to provide the carriers with any excuse to deny payment. What's more aggravating is that the people reviewing the various forms or SOAP notes or whatever have little clue what they're reading and evaluating. I've spent time on the phone reviewing a case with an insurance company rep, spelling out all the details of the history, exam findings, rationale, etc. (thinking I'm talking to someone who knows what I'm talking about), only to have them at the end ask me "so, how many visits has the patient had?". That's all they go by; very little "medical necessity" involved but simply numbers being looked at by non-medical people. Joy joy.