The AOA is MIA as Insurers Marginalize Osteopathic Medicine

For more than a decade insurers have been implementing discriminatory policies that result in the automatic downcoding of claims filed by osteopathic physicians.

An official journal of the American Osteopathic Association recently published on this topic, but the osteopathic physicians on the front lines are asking the AOA to explain why it has been largely silent to this point and not taken meaningful action to stand up for the best interests of its members.

Here is a letter to the AOA Richard Koss, D.O. shared with IP4PI:

I hope you find the article in the recent DO magazine, dated November, 14, 2018, regarding the major insurers pushing back on the use of the modifier 25 as disturbing and discriminatory as I do.

What is the AAO’s policy, and plan to keep OMM specialists from being marginalized and discriminated out of existence? What is the economics committee doing to prevent this from happening? This has been going on for so long now (about 18 years) that there should be regular updates in all AAO communications about the membership’s ability to earn a living at their chosen profession. Where are these updates?

Yes I know that the AAO is under the AOA, but the AOA has no interest in protecting its members who practice OMM.

If you can’t get paid for your services than you do not exist. As OMM is being wiped off the payment rolls, the upcoming students and residents will have no way to pay back their loans, or make a living. So the existence of the AAO is also at stake here.

The beginnings of this trend started back in the 1950’s when the AOA leadership fought and pushed for full practice rights. That is to prescribe drugs and surgery. To do so they had to put OMM in the closet and denigrate it as a pseudoscience. This began the official death of Dr. Still’s Osteopathy. Now there are no Osteopathic hospitals, and all postgraduate programs are ACGME. Dr. Still is not even mentioned in the Academy Programs.

The AOA has known about the billing problems for 20 plus years and continues to be reactionary bending to the dictates of the AMA, and Federal Government, Insurance company mandates without any fight. This I can speak from personal experience. The modifier 25 issue has been going on for at least 18 years. Most recent in 2010 in Vancouver, Washington and Portland, Oregon. Then came the CMS illegal denial of the modifier 25 in the northeast in the last 2 years. Now this article in the DO……

I asked Mr. Goldman the head of the AOA PAC when he asked of PAC donations: “What is AOA policy and plan to support legislators and programs who support OMM?” His answer: “There is none.” The AOA has no plans or policies to keep OMM in its future business model (especially the “Branding advertisement”). Therefore it is up to the AAO to fight for our right to practice.

Please submit this communication to the board of trustees, governors, and I hope you publish this as an OP ED piece or letter to the editor of the AAO newsletters. To continue to be silent in this matter will condone the AOA’s current path.

Osteopathically,

Richard W. Koss, D.O., C-SPOMM, C-ACOFP

P.S. I hope I am not the only one who finds this disturbing. Is this even addressed in the “Five Year Plans” of the AAO? Because if it is not then we really are in trouble.

P.P.S. Of course the AOA is asleep at the wheel and has not done anything to help their members ability to make a living in their chosen profession. The AAO, our OMM specialty organization, also does not want to get involved. I pointed this out to both organizations on several occasions over the years and never gotten acknowledgement or communication on these issue, only “Crickets”. Thus I expect the same response to this letter.

What’s the AOA doing to combat insurer discrimination against OMM/NMM?

Friend of IP4PI Dr. Domenick Masiello shares correspondence with the AOA:

From: Domenick Masiello
Date: February 26, 2017
To: “Doss, Yolanda” <ydoss@osteopathic.org>
Cc: “Wooster, Laura” <lwooster@osteopathic.org>

Subject: Re: Issues in OMM/NMM

Well, I guess now I have to respond point by point. I am staring at my wall, looking at the 2 AOA board certifications that I have. One is Family Practice and osteopathic manipulative treatment and the other is a separate, different certification called Special proficiency in osteopathic manipulative medicine, C-SPOMM. So, Yolanda, there are actually 3 certificates flying around NOT two. Now we have a residency so there is also Neuromusculoskelatal medicine/OMM. the Special Proficiency is NOT a FP certification. I should know, I didn’t just speak to somebody with 20 years experience, I actually possess these certificates and have been in practice for 30 years! there is no gold standard, just confusion created by the AOA and its various certifying boards. I didn’t say that insurance carriers or hospitals recognized any DO claiming to be a specialist in OMM, I just said that some FPs advertise themselves as such, thereby adding to the confusion for the public.

Yolanda you did offer to help with Aetna over a year ago – it just would have been nice to hear back on the issue. You sort of kept that to yourself until recently about 9-10 months later. Aetna is not the only insurance company that doesn’t recognize our OMM specialty. I have had problems with Connecticare, Empire in NY, Oscar/magnacare in NY in addition to Aetna in NY and CT. In fact none of the exchanges in NY recognize OMM but they do have acupuncture and chiropractic listed in EVERY exchange! Recently I even tried Liberty Health Share, a Christian healthcare cost sharing provider. They would have me contact them for approval first before every visit and then submit treatments plans like a PT because they don’t know what I do.   You haven’t heard about other instances of this insurance problem because many DOs who do manipulation are not members of the AOA. Some doctors who completed their OMM residencies chose not to sit for the exam and many more have cash businesses as I did for the past 29 years. You also don’t have any outreach to folks like me so why would you hear from us. last summer I begged and pleaded for a specialty specific email blast for AOA members to no avail. You assume we will be contacted by our specialty boards but we are not and you assume that we will be contacted by our state societies but many of us are not members of those societies because they don’t serve our needs as traditional osteopaths.  recently, at a meeting of the Bergen County osteopathic Society in NJ, it was suggested that perhaps this less than ideal treatment of physicians board certified in OMM might be because of our minority status within our own profession. Most AOA members are FPs and they have the loudest voice and the rest of us are a minority within a minority profession. Also that the creation of a board certification for manipulation may have been experienced by the FPs as a threat to their insurance reimbursement. Ultimately, the point is not that you are working on it but how does this kind of thing happen in the first place? OMM should be your top priority because that is what makes us different despite our small numbers. Continue reading

OMT – Is there an app for that?

I had a student who wanted to create an app for PAs and NPs with counterstrain positioning, codes, and paymehts electronic records and insurance coding send all rolled into one so non-DOs can use and code for OMT(osteopathic manual treatment).

As his teacher, I was more than a little disappointed. This ‘all you gotta do’ attitude and get rich quick off creating an osteopathic app was shallow and disrespectful of Osteopathic practices and I refused to participate. As a D.O., our students get 1000 extra hours of osteopathic principles, practices and treatment experience than our other physician colleagues.  We are in a period where this type activity will increase and trivialize the value of OMT if THIS is what it comes to mean. By sheer volume this over simplified version of OMT could become what they think it IS. This is dangerous and we should issue policy and position statements carefully as a profession.

I knew this type activity was in the works, so I am not surprised, but I am a little dismayed that THIS is what has come to Osteopathy.

Carlisle Holland, D.O.
Holonomic Institute
Sebastopol, California 95472
Holonomics are the Principles of Integrative Medicine

 

Single accreditation for MDs and DOs by 2020?

Dr. Gina Reghetti comments on Dr. Wax’s letter to AOA (also copied below):

Dr Wax,

I hope he answers back. I wish that we could find an attorney that would file suit due to them restricting our unique trade of Osteopathic Medicine, a national historical healthcare system, that originated in America.

The agenda is definitely against the American way. Osteopathic Medicine, cannot be classified together with Allopathic Medicine. There has to be something that can be filed legally.

Look how far the NPs and PAs have come, yet we are taking another step back to discrimination years ago when DOs weren’t considered doctors. How can this be?

Continue reading