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Utilization and Reimbursement Trends of Osteopathic Manipulative Treatment for Medicare Patients: 2000-2019

Journal: Journal of Osteopathic Medicine Date: 2023/06, 123(6):Pages: 309-315. doi: Subito , type of study: retrospective study

Free full text   (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

economics [30]
OMT [2951]
osteopathic manipulative treatment [2973]
patients [80]
reimbursement [11]
retrospective study [213]
USA [1086]
utilization [6]

Abstract:

Statement of Significance: The application of Osteopathic Manipulative Treatment (OMT) is unique to osteopathic physicians as a noninvasive and beneficial treatment modality (1-3). The proportion of osteopathic physicians of total physicians, both allopathic (MD) and osteopathic (DO), has increased from 6.9% of the total workforce to 9.9% from 2010-2020 (4). With increased representation of osteopathic physicians in the physician workforce, we expect that the number of OMT claims would increase proportionally. Research Methods: OMT utilization data among Medicare patients from the Part B National Summary Data File on Centers for Medicare and Medicaid Services’ website for the years 2000 through 2019 was accessed. The Healthcare Common Procedure Coding System codes 98925-98929 were used to identify OMT procedures. OMT procedures are billed based on the number of body regions treated, ranging from 0-10 regions, with no more than one billed code allowed per day (5). These codes are for 1-2, 3-4, 5-6, 7-8, and 9-10 body regions treated. The data evaluated included “allowed services” or total billing volume in the calendar year, and “allowed charges” which is the payment total disbursed by Medicare in the calendar year. Average reimbursement per-code-billed was determined by dividing the allowed charges by the allowed services. Reimbursement data was adjusted for inflation using the CPI Inflation Calculator using the buying power for December 31 of each respective year relative to January 1, 2022 (6). Service volume data was adjusted for the total number of Medicare enrollees using data from cms.gov and census.gov (7,8) to obtain the ratio of OMT codes billed per 10,000 Medicare beneficiaries. All data was evaluated descriptively based on their frequencies and proportions. Data Analysis/Results: From 2000 to 2019, the total usage of OMT claims had a negative trend. Proportional comparisons of 2000 to 2019 demonstrated a -24.46% change. The only increase in utilization was observed in the 5-year interval from 2000-2004 followed by a decrease in utilization in all other intervals. A constant decrease in utilization of 1-2 (-63.8%), 3-4 (-44.0%), and 5-6 (-11.8%) body regions treated was observed. Utilization of 7-8 (+45.0%) and 9-10 (+88.9%) increased. Reimbursement by Medicare declined for all 5 treatments, with codes representing more body regions showing a smaller decrease compared to codes representing fewer body systems. A decrease in reimbursement was found for treatment of 1-2 (-25.6%), 3-4 (-25.3%), 5-6 (-20.7%), 7-8 (-17.1%), 9-10 (-12.5%) body regions. The adjusted sum reimbursement of all codes showed a decrease of -23.2%, which equates to $11.24 on average. Conclusion: These trends indicate a shift from providing treatment on fewer body regions per visit to providing treatment to a larger number of body regions per session. A potential justification for this trend appears when comparing reimbursements, which revealed a greater decrease for lower numbers of body regions treated. We conjecture that lower remuneration for OMT has disincentivized physicians financially and contributed to the overall decline in OMT utilization among Medicare patients. It is also possible that physicians are increasing the comprehensive usage of OMT treatment of more body regions, thus justifying the use of higher-level codes, and reducing the overall financial impact of OMT reimbursement cuts. Limitations for this study include Medicare being this study’s sole source of volume and reimbursement data. Medicare is the single largest insurance payer in the United States and its beneficiaries represent an older population. Due to the complexity of their care, physicians may prioritize other exams or treatments over OMT thus decreasing its utilization in this specific population. Clinicians may also be limited by financial constraints when accepting or providing care to Medicare beneficiaries. This study’s focus on OMT does not reveal whether similar decreases in compensation from Medicare exist in non-osteopathic treatment modalities in similar primary care settings. Future research should examine these trends and be compared to the steady decline in reimbursement for OMT. The proven efficacy of OMT should prompt advocacy for sustainable and fair reimbursement.


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