Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
I'm more curious on what this all means. Like explain it to me like I'm 5. Do they intend to entirely do away with funding for OMT based therapies? What happens if OMT is no longer funded? What does it mean for osteopathic medical training?
 

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
OMT should be saved for non-physicians IMO. Physicians have better uses for their training than working as glorified massage therapists.
 

atomheart

2+ Year Member
May 5, 2016
224
335
Status
Resident [Any Field]
It's Medicare reimbursement. They're always trying to cut programs to save cash, and every year there's a protest.

The people who will be affected are the ones that accept Medicare, ironically, not the ones who practice OMT full time (typically those are cash businesses). Of course osteopathic medicine is here to stay until there's a merger.

Sent from my SM-J320V using Tapatalk
 
  • Like
Reactions: chizledfrmstone
Dec 1, 2014
1,740
1,614
I'd gladly implement OMM in my future practice IF I have the time for it and IF I can charge a solid cash charge for it... and IF I have a solid patient base for it.

But the way things are looking in general... private practice will be dead.

Throw in some pedal pump and thoracic pump and rib raising and charge for multiple visits...?

BAAAAALLLLINNNNNN'!!!
 

FCMike11

7+ Year Member
Aug 24, 2011
1,124
730
Texas
Status
Medical Student
OMT should be saved for non-physicians IMO. Physicians have better uses for their training than working as glorified massage therapists.
In your opinion (pre-med opinion).

Non physicians also have never been trained in OMT.

"Better use" is subjective, I met a guy who works as part of a surgical center and finds it extremely meaningful, and so do his patients.

Sent from my Nexus 6P using SDN mobile
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
In your opinion (pre-med opinion).

Non physicians also have never been trained in OMT.

"Better use" is subjective, I met a guy who works as part of a surgical center and finds it extremely meaningful, and so do his patients.

Sent from my Nexus 6P using SDN mobile
Technically OMT is taught to non-physicians around the world. Only in the US do we have DO physicians.


Sent from my iPad using SDN mobile
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
OMT should be saved for non-physicians IMO. Physicians have better uses for their training than working as glorified massage therapists.
If it something that helps patients I don't see the problem with using it.


However, this thread isn't about OMT it's about the proposed legislation that changes how it is billed. So I would like to stay on topic. Has anyone signed the petition (current doctors or medical students)


If you signed it or didn't sign it what was your reasoning?
 

FCMike11

7+ Year Member
Aug 24, 2011
1,124
730
Texas
Status
Medical Student
Even thought AT Still wasn't thrilled with the direction of the DO profession, the identity is of a physician.

His comment was incredibly short sighted and I would say it is fair to assume United States, in this context.

I concede that they do exist outside of the US, and didn't know that. What's that have to do with saving OMT here/medicare or the AOA?
Technically OMT is taught to non-physicians around the world. Only in the US do we have DO physicians.


Sent from my iPad using SDN mobile

Sent from my Nexus 6P using SDN mobile
 

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
In your opinion (pre-med opinion).

Non physicians also have never been trained in OMT.

"Better use" is subjective, I met a guy who works as part of a surgical center and finds it extremely meaningful, and so do his patients.

Sent from my Nexus 6P using SDN mobile
It's pretty ironic how you're implying I'm ignorant, when you have literally no idea that anywhere outside of the US a DO is not a physician. Outside of the US, they're more akin to chiropractors.

But I guess I'm the ignorant one.

Also, I'm not saying it's not meaningful. OMT is so obscure that to argue that it's not meaningful would be literally impossible because it's proving a negative. I will say, though, that your anecdotal arguments are not very compelling to me.
 

FCMike11

7+ Year Member
Aug 24, 2011
1,124
730
Texas
Status
Medical Student
It's pretty ironic how you're implying I'm ignorant, when you have literally no idea that anywhere outside of the US a DO is not a physician. Outside of the US, they're more akin to chiropractors.

But I guess I'm the ignorant one.

Also, I'm not saying it's not meaningful. OMT is so obscure that to argue that it's not meaningful would be literally impossible because it's proving a negative. I will say, though, that your anecdotal arguments are not very compelling to me.
It's not anecdotal with OMM residencies present in the US with DO students pursuing them - people do find it a "good use" of their time. But yeah, the vast majority of students just want to become a physician...which was my answer to an interview question "Why DO?".

I wasnt implying ignorance, just irritation from such a flippant comment. If people equate them as akin go chiropractors, not much go say to that if they can't be bothered to examine the structure of the degree (US trained DO). If you are talking about internationally trained Osteopaths, what does that have to do with an American DO education? I haven't seen anything to indicate they come here to practice in large numbers.

Sent from my Nexus 6P using SDN mobile
 

ChiTownBHawks

5+ Year Member
Sep 17, 2013
1,685
1,786
Status
Medical Student
It's pretty ironic how you're implying I'm ignorant, when you have literally no idea that anywhere outside of the US a DO is not a physician. Outside of the US, they're more akin to chiropractors.

But I guess I'm the ignorant one.

Also, I'm not saying it's not meaningful. OMT is so obscure that to argue that it's not meaningful would be literally impossible because it's proving a negative. I will say, though, that your anecdotal arguments are not very compelling to me.
? Same letters but different degrees conferred there, kiddo. If I decide to practice in another country (one that recognizes DOs) and I pass everything required then I am a full-fledged physician in said country, kiddo.
 

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
It's not anecdotal with OMM residencies present in the US with DO students pursuing them - people do find it a "good use" of their time. But yeah, the vast majority of students just want to become a physician...which was my answer to an interview question "Why DO?".

I wasnt implying ignorance, just irritation from such a flippant comment. If people equate them as akin go chiropractors, not much go say to that if they can't be bothered to examine the structure of the degree (US trained DO). If you are talking about internationally trained Osteopaths, what does that have to do with an American DO education? I haven't seen anything to indicate they come here to practice in large numbers.

Sent from my Nexus 6P using SDN mobile
The ones who think OMM is a good use of their training probably shouldn't be seeing patients anyway.

I'm not saying that DO's are chiropractors. I'm saying that they're trained as physicians so they shouldn't waste their time massaging people. Let other people do that.

? Same letters but different degrees conferred there, kiddo. If I decide to practice in another country (one that recognizes DOs) and I pass everything required then I am a full-fledged physician in said country, kiddo.
I never claimed anything to the contrary. Guess you're just a little insecure. Consider seeing a psychiatrist.
 

ChiTownBHawks

5+ Year Member
Sep 17, 2013
1,685
1,786
Status
Medical Student
It's pretty ironic how you're implying I'm ignorant, when you have literally no idea that anywhere outside of the US a DO is not a physician. Outside of the US, they're more akin to chiropractors.

But I guess I'm the ignorant one.

Also, I'm not saying it's not meaningful. OMT is so obscure that to argue that it's not meaningful would be literally impossible because it's proving a negative. I will say, though, that your anecdotal arguments are not very compelling to me.
The ones who think OMM is a good use of their training probably shouldn't be seeing patients anyway.

I'm not saying that DO's are chiropractors. I'm saying that they're trained as physicians so they shouldn't waste their time massaging people. Let other people do that.


I never claimed anything to the contrary. Guess you're just a little insecure. Consider seeing a psychiatrist.
:confused:.

Nothing to be insecure about, bro. I'm in med school, you are not. Continue being a tool, though. It seems to fit you.
 
  • Like
Reactions: Dr. Death

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
:confused:.

Nothing to be insecure about, bro. I'm in med school, you are not. Continue being a tool, though. It seems to fit you.
I was talking about DO's who graduated in their own country. Again, consider seeing a psychiatrist for your paranoia.
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
The ones who think OMM is a good use of their training probably shouldn't be seeing patients anyway.

I'm not saying that DO's are chiropractors. I'm saying that they're trained as physicians so they shouldn't waste their time massaging people. Let other people do that.


I never claimed anything to the contrary. Guess you're just a little insecure. Consider seeing a psychiatrist.
Please stop derailing my thread I want a serious discussion about the proposed legislation.
 

ChiTownBHawks

5+ Year Member
Sep 17, 2013
1,685
1,786
Status
Medical Student
I was talking about DO's who graduated in their own country. Again, consider seeing a psychiatrist for your paranoia.
Yes yes, I'm "paranoid" because I responded based off of your syntax, or should I say lack thereof? I'll pull out my ever present pyschic skills next time. My bad, millennial, my bad. Keep toolin' it up.
 

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
Please stop derailing my thread I want a serious discussion about the proposed legislation.
Veto because I don't believe in OMT.

What kind of discussion are you looking for?

I feel like you either believe in OMT or you don't. If you are one of AT Still's true believers, then you want to save OMT. If you believe in evidence based medicine, then you don't.

Yes yes, I'm "paranoid" because I responded based off of your syntax, or should I say lack thereof? I'll pull out my ever present pyschic skills next time. My bad, millennial, my bad. Keep toolin' it up.
Sorry for hurting your feelings ChiTown. Was just trying to have a discussion. Didn't realize you'd be so sensitive. I hope that this doesn't affect our relationship going forward.
 

NimbleNavigator

Membership Revoked
Removed
Account on Hold
Mar 15, 2016
383
277
Do t they reimburse chiropractors? If so, I do t see why they should do away with OMT unless they're getting rid of both.
Good point. I'm not sure. They might just want to incentivize DO's to do actual evidence-based medical work, though.
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
Do t they reimburse chiropractors? If so, I do t see why they should do away with OMT unless they're getting rid of both.
Do t they reimburse chiropractors? If so, I do t see why they should do away with OMT unless they're getting rid of both.
Interesting I'm wondering how this legislation affects them. Does anyone know?
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
Good point. I'm not sure. They might just want to incentivize DO's to do actual evidence-based medical work, though.
Have you ever looked into the evidence supporting OMT? My school constantly gives us studies.
 

Moose A Moose

7+ Year Member
Nov 24, 2009
1,379
1,491
Philadelphia, PA
Status
Resident [Any Field]
Good point. I'm not sure. They might just want to incentivize DO's to do actual evidence-based medical work, though.
True. Just looking for corners to cut, as is custom with anything government run.

It's a shame. There are a handful of good osteopathic modalities that are useful across several specialty spectrums.

Ah, well.
 
  • Like
Reactions: hallowmann and GUH

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
Have you ever looked into the evidence supporting OMT? My school constantly gives us studies.

Not to be dismissive, but I imagine you come from a relatively poor background in research if you are impressed by a significant amount of OMM/OS research. There simply is minimal research and of that minimal research most focuses on very specific issues like back pain, very little is showing that rib lifting or osteopathic care significantly reduces hospital stays or reduces mortalities from Spanish flu without likely having major confounding variables.

Not to say that ME and HVLA aren't helpful or useful. I just believe that a significant part of OS is not well researched and there is no attempt to research it.
 

Mr Roboto

5+ Year Member
Jul 31, 2013
1,009
1,583
A galaxy far, far away...
Status
Medical Student
I'm not planning to sign. If they want to keep billing for it, demonstrate its effectiveness.

In your opinion (pre-med opinion).

Non physicians also have never been trained in OMT.


"Better use" is subjective, I met a guy who works as part of a surgical center and finds it extremely meaningful, and so do his patients.

Sent from my Nexus 6P using SDN mobile
Pre-med A corrects Pre-med B, but demonstrated his own cluelessness. Ouch.
 
  • Like
Reactions: Moose A Moose

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
I'm not planning to sign. If they want to keep billing for it, demonstrate its effectiveness.



Pre-med A corrects Pre-med B, but demonstrated his own cluelessness. Ouch.

I think this may spur some more interest in research on OMT. That or just continue its slow decline.
 
  • Like
Reactions: Mr Roboto
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
Not to be dismissive, but I imagine you come from a relatively poor background in research if you are impressed by a significant amount of OMM/OS research. There simply is minimal research and of that minimal research most focuses on very specific issues like back pain, very little is showing that rib lifting or osteopathic care significantly reduces hospital stays or reduces mortalities from Spanish flu without likely having major confounding variables.

Not to say that ME and HVLA aren't helpful or useful. I just believe that a significant part of OS is not well researched and there is no attempt to research it.
I never said I was impressed with the research.

I was asking if the person that claimed OMM wasn't evidenced based has looked into the evidence for OMM. If you are going to critize it as not being evidence based then I think you should look at the research that has been done.

On an anecdotal note I have seen patients that have reported that OMM has helped them. I also have had it done on me. A lot of the time it doesn't work. However, it has alleviated pain before. I think HVLA works the best. Muscle Energy seems to have similar effects as stretching. If doctors are providing a service that helps alleviate a patients pain without drugs that seems to be a positive thing to me. That also seems very billable to me. Do you have any thoughts on the the billing of osteopathic treatment?
 

jw3600

5+ Year Member
Jan 7, 2013
1,676
2,350
Status
I never said I was impressed with the research.

I was asking if the person that claimed OMM wasn't evidenced based has looked into the evidence for OMM. If you are going to critize it as not being evidence based then I think you should look at the research that has been done.

On an anecdotal note I have seen patients that have reported that OMM has helped them. If doctors are providing a service that helps alleviate a patients pain without drugs that seems to be a positive thing to me. That also seems very billable to me. Do you have any thoughts on the the billing of osteopathic treatment?
He's implying the research is so god damn bad that it's really not even research. So by the fact you are referring him to check out the "research" you're implying that it counts as quality science. It does not.
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
He's implying the research is so god damn bad that it's really not even research. So by the fact you are referring him to check out the "research" you're implying that it counts as quality science. It does not.
A lot of it isn't great, some of it is fine. They are some inherent challenges in doing this type of research.

Things like lower back pain it can be effective: https://om-pc.biomedcentral.com/articles/10.1186/1750-4732-1-7

So there is some evidence for some of OMT, but certainly not a lot of it. However, my point is characterizing OMT as not evidence based isn't fair unless you have looked at the research.

So is establishing the effectiveness dictate the ability to paid? To what degree does that need to be established? Can well regarded techniques be billed for?
 

Mr Roboto

5+ Year Member
Jul 31, 2013
1,009
1,583
A galaxy far, far away...
Status
Medical Student
A lot of it isn't great, some of it is fine. They are some inherent challenges in doing this type of research.

Things like lower back pain it can be effective: https://om-pc.biomedcentral.com/articles/10.1186/1750-4732-1-7

So there is some evidence for some of OMT, but certainly not a lot of it. However, my point is characterizing OMT as not evidence based isn't fair unless you have looked at the research.

So is establishing the effectiveness dictate the ability to paid? To what degree does that need to be established? Can well regarded techniques be billed for?
There's also inherent challenges to demonstrating the effectiveness of surgical techniques, yet surgeons do it.

They're saying they've looked into the crappy research and found it lacking.
 
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
There's also inherent challenges to demonstrating the effectiveness of surgical techniques, yet surgeons do it.

They're saying they've looked into the crappy research and found it lacking.
If you have looked at it that is fair. However, I don't think nimble navigator has. I also think there isn't much controversy of OMT and LBP.
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
If you have looked at it that is fair. However, I don't think nimble navigator has. I also think there isn't much controversy of OMT and LBP.
The problem is that, that's where the decent research actually ends. Even then there's never been an outcomes driven study that compares OMM to other cheaper modalities, i.e meds, therapy, life style changes, etc.

I never said I was impressed with the research.

I was asking if the person that claimed OMM wasn't evidenced based has looked into the evidence for OMM. If you are going to critize it as not being evidence based then I think you should look at the research that has been done.

On an anecdotal note I have seen patients that have reported that OMM has helped them. I also have had it done on me. A lot of the time it doesn't work. However, it has alleviated pain before. I think HVLA works the best. Muscle Energy seems to have similar effects as stretching. If doctors are providing a service that helps alleviate a patients pain without drugs that seems to be a positive thing to me. That also seems very billable to me. Do you have any thoughts on the the billing of osteopathic treatment?

Have you actually looked at some of the OS papers?

And sure, I love getting HVLA and Myofacial release done to me. My back is a hypertrophied giant hard end feel. That does not however tell me about statistical outcomes nor does it tell me whether it should be a prefered tx for lower back pain.
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
In the end I hope that this does draw OS into more research and maybe some of it will be proven to work well for problems. Then everyone can be happy.
 

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,539
5,138
Status
Resident [Any Field]
I didn't want to get involved in this because I imagined it would devolve into what it is now, but there's just a little too much absolutism here.

A lot of medicine is flawed, not proven, purely placebo effect, etc. I do not believe that all of OMT is this way, but unfortunately we don't have a good method nor do we seem to have much interest in devising a good method to study it (its either "throw the whole thing out" or "just believe"). We have some "OK" studies on OMT, but most don't really come from the US, and you can thank the priorities of the AOA for that one. We should be spending time actually studying it so we can eliminate modalities that don't work ever, and determine the applicability of other modalities, because quite frankly we suck at knowing when we should or shouldn't use OMT in the first place, let alone have the ability to study if it works in some situations.

Here's the thing though, OMT is relatively low impact, with relatively few risks (save those associated with HVLA, specifically cervical HVLA, which is in my opinion unnecessary), and can have impressive effects (at least anecdotally) for conditions that we really have little more to offer except for analgesia. When it comes to quite a bit of MSK and neuromusculoskeletal issues (chronic LBP, fibromyalgia, straight up muscular pain, post-traumatic injury pain, heck even TMJ) well targeted and catered OMT can be very impressive, in many cases instantaneous, and a relief for patients that were basically getting by with NSAIDs by the fistful or even considering (and being convinced by their Orthopedic surgeons to have) surgery.

Unfortunately, there's a ton of DOs out there practicing the same asinine methods of OMT on everyone, using "vital forces", "cracking" everyone everywhere, and telling them they'll be sore for the next few days, but come back every 2 wks forever, as if they might as well be seeing a chiropractor. I fortunately witnessed the former before I witnessed the latter.

As far as use and applicability, many PM&R docs are actually all for OMT, and in some cases they already have and use aspects of it day to day. I'd say its a useful enough that we should continue to have it covered by insurance, alongside PM&R evals/recs, PT/OT, and orthopedic or neurosurgical procedures (although at this point, its getting ridiculous the ever expanding studies that show many of the "tried and true" procedures that no one seems to question the way we question OMT on here are actually crap - so maybe we should also talk about not reimbursing arthroscopic knee surgery?).

What we need is better research on it, but that doesn't mean we shouldn't pay for it as a treatment until we have that research. I mean if that was our policy, there's a whole host of other things we use in hospitals everyday based on little more than a hunch, and an expectation that it should help. We still pay for those.

Veto because I don't believe in OMT.

What kind of discussion are you looking for?

I feel like you either believe in OMT or you don't. If you are one of AT Still's true believers, then you want to save OMT. If you believe in evidence based medicine, then you don't.

Sorry for hurting your feelings ChiTown. Was just trying to have a discussion. Didn't realize you'd be so sensitive. I hope that this doesn't affect our relationship going forward.
I'm not sure if you're already a DO student and at least have some experience with OMT, or if you're a pre-med that believes they know all about how medicine works, but that's far too black and white of an attitude to have at basically any stage. I will also say all OMT is not created equal. Some of it is pure garbage and some of it actually makes physiologic sense.

EBM itself isn't black and white. Its not even a fixed definition. Its constantly in flux. What is EBM now, may not be in the not too distant future. There are also flaws inherent to EBM in what it can and can't test (although the goal is to eliminate those flaws), and in all honesty flaws in how we use it and apply it to medical practice. In any case, I agree we should strive for it, and likewise we should strive to study OMT at the same standard that we study similar modalities like PT/OT, Exercise Rx, etc.

What current physicians use is not inherently EBM, and even within the proponents of pure EBM there is always room for clinical judgement based on individual cases. One size fits all isn't how we practice medicine, nor do I honestly believe it should be. If it is, maybe we should all be replaced by AI. The goal of treatment should always be specific to the patient. Without this treatment are they going to be able to get through their job, pay their rent, take care of their aging parents? With surgery are they really going to be able to take the time off from work necessary to reap the full benefits? Are they going to be able to take any recovery or PT time off at all? Will their function improve or will it only produce a fraction of a mm improved ROM? These are real life questions that current evidence and studies don't always address.

And we're even ignoring the inherent bias within research, like the proportion of studies that evaluate conditions that disproportionately affect the wealthy, while there's a dearth of studies on some conditions that affect far more people, but are primarily diseases of the "poor".

Good physicians know how to use EBM and know its (current) limitations. That's the type of physician I'm striving to be, and I'd hope the same is true for everyone.
 
Last edited:

jw3600

5+ Year Member
Jan 7, 2013
1,676
2,350
Status
The only study I have ever seen that was even remotely accepted was showing that NSAIDS or some pharmacological treatment and certain OMT were shown to be clinically equivalent for chronic LBP. That might have been the study posted above. That's really all I've ever seen that wasn't horrendous garbage.
 
  • Like
Reactions: AlteredScale

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
I didn't want to get involved in this because I imagined it would devolve into what it is now, but there's just a little too much absolutism here.

A lot of medicine is flawed, not proven, purely placebo effect, etc. I do not believe that all of OMT is this way, but unfortunately we don't have a good method nor do we seem to have much interest in devising a good method to study it (its either "throw the whole thing out" or "just believe"). We have some "OK" studies on OMT, but most don't really come from the US, and you can thank the priorities of the AOA for that one. We should be spending time actually studying it so we can eliminate modalities that don't work ever, and determine the applicability of other modalities, because quite frankly we suck at knowing when we should or shouldn't use OMT in the first place, let alone have the ability to study if it works in some situations.

Here's the thing though, OMT is relatively low impact, with relatively few risks (save those associated with HVLA, specifically cervical HVLA, which is in my opinion unnecessary), and can have impressive effects (at least anecdotally) for conditions that we really have little more to offer except for analgesia. When it comes to quite a bit of MSK and neuromusculoskeletal issues (chronic LBP, fibromyalgia, straight up muscular pain, post-traumatic injury pain, heck even TMJ) well targeted and catered OMT can be very impressive, in many cases instantaneous, and a relief for patients that were basically getting by with NSAIDs by the fistful or even considering (and being convinced by their Orthopedic surgeons to have) surgery.

Unfortunately, there's a ton of DOs out there practicing the same asinine methods of OMT on everyone, using "vital forces", "cracking" everyone everywhere, and telling them they'll be sore for the next few days, but come back every 2 wks forever, as if they might as well be seeing a chiropractor. I fortunately witnessed the former before I witnessed the latter.

As far as use and applicability, many PM&R docs are actually all for OMT, and in some cases they already have and use aspects of it day to day. I'd say its a useful enough that we should continue to have it covered by insurance, alongside PM&R evals/recs, PT/OT, and orthopedic or neurosurgical procedures (although at this point, its getting ridiculous the ever expanding studies that show many of the "tried and true" procedures that no one seems to question the way we question OMT on here are actually crap - so maybe we should also talk about not reimbursing arthroscopic knee surgery?).

What we need is better research on it, but that doesn't mean we shouldn't pay for it as a treatment until we have that research. I mean if that was our policy, there's a whole host of other things we use in hospitals everyday based on little more than a hunch, and an expectation that it should help. We still pay for those.


.
Idk if OMT has ever been investigated for the Tx or modulation of symptoms of Fibromyalgia. I mean it's a disorder of too many firing adrenergic neurons. Pt presents with fatigue and pain.

But you're right, it's low impact and has low risks. So using it for patients isn't contraindicated and may bring relief to them, albeit in my opinion temporarily. But I suppose this brings up the question of comparing outcomes. How much do we charge the pt for OMM that takes 5 minutes to do at most? How much is a physical therapist charging for an entire hour? What about how much for a recommendation for life style changes and an NSAID?

By all means I agree strongly that OMM research needs to be a top priority of the AOA, up there with reducing the overall esotericness of osteopathic practice. I.e stop with this, I used OMM and saw magic happen stuff or my osteopathic training enabled me to be better than all of the MDs in helping this patient.
 

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,539
5,138
Status
Resident [Any Field]
Idk if OMT has ever been investigated for the Tx or modulation of symptoms of Fibromyalgia. I mean it's a disorder of too many firing adrenergic neurons. Pt presents with fatigue and pain.

But you're right, it's low impact and has low risks. So using it for patients isn't contraindicated and may bring relief to them, albeit in my opinion temporarily. But I suppose this brings up the question of comparing outcomes. How much do we charge the pt for OMM that takes 5 minutes to do at most? How much is a physical therapist charging for an entire hour? What about how much for a recommendation for life style changes and an NSAID?

By all means I agree strongly that OMM research needs to be a top priority of the AOA, up there with reducing the overall esotericness of osteopathic practice. I.e stop with this, I used OMM and saw magic happen stuff or my osteopathic training enabled me to be better than all of the MDs in helping this patient.
Fibromyalgia is also a spectrum though. Its a true neurologic disorder, but there's also this subset of people that clinically fit, but that don't necessarily have detectable issues. I've seen some people with fibromyalgia actually get good results with OMT (again anecdotes). The real question is whether or not those people actually have fibromyalgia or have something else that we just haven't defined yet, or maybe is just an abnormal presentation of something that is defined.

OMT might even be better as a modality used mainly in people with refractory disease, those that can't take certain meds, or as a preliminary course prior to full blown PT, PM&R consult, Ortho consult, etc. Who knows? Unfortunately, like I said, we don't because we don't really study it.

So personally, with more exposure to the different ways OMT is practiced, I don't think we should charge for short term OMT treatment. When a doc spends 30 min to 1 hr in OMT, I think its fair to bill, especially if there's actually a positive result. I've watched a doc, basically one that's amazing at targeted OMT that hits 4-5 body areas based on physical complaints, gait, posture, etc. I've seen a much better response of patients to that than I've seen with any other short single OMT treatment.

A 5 min drop in of ME, MFR, BLT, etc. shouldn't really be billed the same as a real OMT visit. It doesn't make sense. We do a lot of small procedural things in a routine visit that physicians don't end up billing for. Really fast OMT shouldn't be any different. But I think that's a whole other issue with how we bill for anything. Procedures inherently are flawed in how they're valued and billed.
 
  • Like
Reactions: ortnakas
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
The problem is that, that's where the decent research actually ends. Even then there's never been an outcomes driven study that compares OMM to other cheaper modalities, i.e meds, therapy, life style changes, etc.




Have you actually looked at some of the OS papers?

And sure, I love getting HVLA and Myofacial release done to me. My back is a hypertrophied giant hard end feel. That does not however tell me about statistical outcomes nor does it tell me whether it should be a prefered tx for lower back pain.
Not a prefered treatment but an adjunct it's perfectly fine and evidenced based for LBP.

I had an entire lecture on osteopathic research last year. Not the greatest but there was some stuff there that was decent. I had to study it though so I know it pretty well.
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
Fibromyalgia is also a spectrum though. Its a true neurologic disorder, but there's also this subset of people that clinically fit, but that don't necessarily have detectable issues. I've seen some people with fibromyalgia actually get good results with OMT (again anecdotes). The real question is whether or not those people actually have fibromyalgia or have something else that we just haven't defined yet, or maybe is just an abnormal presentation of something that is defined.

OMT might even be better as a modality used mainly in people with refractory disease, those that can't take certain meds, or as a preliminary course prior to full blown PT, PM&R consult, Ortho consult, etc. Who knows? Unfortunately, like I said, we don't because we don't really study it.

So personally, with more exposure to the different ways OMT is practiced, I don't think we should charge for short term OMT treatment. When a doc spends 30 min to 1 hr in OMT, I think its fair to bill, especially if there's actually a positive result. I've watched a doc, basically one that's amazing at targeted OMT that hits 4-5 body areas based on physical complaints, gait, posture, etc. I've seen a much better response of patients to that than I've seen with any other short single OMT treatment.

A 5 min drop in of ME, MFR, BLT, etc. shouldn't really be billed the same as a real OMT visit. It doesn't make sense. We do a lot of small procedural things in a routine visit that physicians don't end up billing for. Really fast OMT shouldn't be any different. But I think that's a whole other issue with how we bill for anything. Procedures inherently are flawed in how they're valued and billed.
I think there in becomes the problem however. If you need to practice OMT for 30 minutes for billing you end up either needing it to be billed at an appropriate rate ( i.e essentially 2 or 3 office visits worth). Which I think again gets back to the original question, i.e when does the outcome become worth it, i.e is OMT at a doctor better than physical therapy?
 

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,539
5,138
Status
Resident [Any Field]
I think there in becomes the problem however. If you need to practice OMT for 30 minutes for billing you end up either needing it to be billed at an appropriate rate ( i.e essentially 2 or 3 office visits worth). Which I think again gets back to the original question, i.e when does the outcome become worth it, i.e is OMT at a doctor better than physical therapy?
The truth is its probably not a one or the other answer for everyone. Also you throw in the actual efficacy of PT based on characteristics and skills of the therapist themselves. Some therapists flat out suck. They don't motivate their patients, they don't adjust their approach, etc. The same can be said of OMT practitioners.

A lot of the people at this OMT clinic have tried physical therapy, with limited results. This is just another thing on their list of attempts to get pain relief. Some people will respond better to different treatments and some will just respond better to different practitioners. I'm not sure which approach is better for which patients. This really is where studies to actually identify who would benefit from OMT vs. other modalities would be really helpful.
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
I suppose this pushes the next question of whether or not that provides evidence for possibly the introduction of OMT into physical therapy schools or for mid level training in OMT.
 
  • Like
Reactions: genericscreenname
OP
Camaxtli

Camaxtli

Medical student
2+ Year Member
Sep 29, 2014
2,935
982
Status
Medical Student
I suppose this pushes the next question of whether or not that provides evidence for possibly the introduction of OMT into physical therapy schools or for mid level training in OMT.
Why hasn't this occurred yet?

I'm curious on your thoughts about the billing? What I'm gathering is that the effectiveness of the treatment has to be proven in order for insurance to cover it? Does this happen with other treatments as well?
 

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,539
5,138
Status
Resident [Any Field]
I suppose this pushes the next question of whether or not that provides evidence for possibly the introduction of OMT into physical therapy schools or for mid level training in OMT.
Maybe. That said, I don't think there is an inherent problem with teaching it (or other skills) to physicians either. Just like I don't believe teaching nutrition to docs is a bad thing, even though we have dietitians.
 

Drrrrrr. Celty

Osteo Dullahan
7+ Year Member
Nov 10, 2009
16,141
5,393
Status
Medical Student
Maybe. That said, I don't think there is an inherent problem with teaching it (or other skills) to physicians either. Just like I don't believe teaching nutrition to docs is a bad thing, even though we have dietitians.
Admittedly, I'd love to be taught more nutrition. But shrugs, I think i'll be telling my patients a lot more of nutrition advice than I will be practicing OMT.
 

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,539
5,138
Status
Resident [Any Field]
Admittedly, I'd love to be taught more nutrition. But shrugs, I think i'll be telling my patients a lot more of nutrition advice than I will be practicing OMT.
And there's nothing wrong with that. We don't force docs to emphasize adjunctive things, but if interest overlaps and docs have info that may benefit a patient's specific problem, why not?

I have a friend in PM&R that spends a good amount of time talking to patients about nutrition. Patients struggling with issues that would instantly benefit from weight loss love it. He has a specific interest in that area, and he relays that to patients.

Nutrition is going to be a part of the curriculum at some point. Even at my school at certain clinical sites they're offering courses during rotations that emphasize it. Not universal, and doesn't fit everyone's schedule, but its just a matter of time.