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Integration of Osteopathic Principles and Practice OPP Into Your CME Program

Background. Many osteopathic physicians do not routinely utilize OMTMany possible reasons:Lack of modeling by preceptors Reduced frequency of OMT teaching/assessment during clerkships/residencySelection of an allopathic residency . Perceived/Real Challenges to Utilization of OMT. Increased t

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Integration of Osteopathic Principles and Practice OPP Into Your CME Program

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    1. Integration of Osteopathic Principles and Practice (OPP) Into Your CME Program Gautam J. Desai, DO Associate Professor Department of Family Medicine Executive Director, Center for Clinical Competence KCUMB-COM

    2. Background Many osteopathic physicians do not routinely utilize OMT Many possible reasons: Lack of modeling by preceptors Reduced frequency of OMT teaching/assessment during clerkships/residency Selection of an allopathic residency Diminished use of omt and its impct on uniqueness of osteo profession Johnson SM, Kurtz ME Acad Med. 2001 Aug;76(8):821-8. 1998, survey to 3,000 random DOs in US to assess factors affecting use of OMT. Over 50% of the responding DOs used OMT on less than 5% of their patientsDiminished use of omt and its impct on uniqueness of osteo profession Johnson SM, Kurtz ME Acad Med. 2001 Aug;76(8):821-8. 1998, survey to 3,000 random DOs in US to assess factors affecting use of OMT. Over 50% of the responding DOs used OMT on less than 5% of their patients

    3. Perceived/Real Challenges to Utilization of OMT Increased time needed to see pts Loss of familiarity with techniques Uncertainty over appropriate billing Inpatient setting

    4. KCUMB-COM’s AACOM Senior Survey Data % of respondents (n =191) selecting either ‘agree’ or ‘strongly agree’ who had Osteopathic Physician Role Models during: 2004-05 2005-06 First Two Years of Medical School 79.3% 79.2% Required In-Hospital Rotations 48.4% 54.4% Ambulatory Primary Care Rotations 67.9% 69.9% Ambulatory Non-Primary Care Rotations 49.1% 55.3% Selectives/Electives 53.3% 58.9%

    5. KCUMB-COM’s AACOM Senior Survey Data % of respondents (n =191) selecting either ‘agree’ or ‘strongly agree’ who had Opportunity to Practice OMT during: 2004-05 2005-06 First Two-Years of Medical School 91.5% 90.9% Hospital Rotations 36.3% 41.7% Ambulatory Primary Care Rotations 62.1% 66.8% Ambulatory Non-Primary Care Rotations 36.1% 45.7%

    6. Benefits of Incorporating OPP Into Your CME Program Opportunity to highlight our osteopathic heritage Excellent attendance booster Allopathic physicians are curious as well KCUMB COM experience Can target learners who are recertifying boards

    7. Other benefits Increasing modeling of OMT may lead to increased utility Direct patient benefit Efficacy in reducing hospital stay (Noll, et al, Benefits of OMT for Hospitalized Elderly Pts with Pneumonia . JAOA 2000; 100:776-782) Good practice builder Pts > 60 yo omt v lt touch b/l pspinal inhib, rib raising, diaph mfr, condylar decom, st to c spine, mfr to ant thor inlet and t pump, 2 days < abx tx and d/c 2 days earlier Pts > 60 yo omt v lt touch b/l pspinal inhib, rib raising, diaph mfr, condylar decom, st to c spine, mfr to ant thor inlet and t pump, 2 days < abx tx and d/c 2 days earlier

    8. Include Billing and Coding Seminar Will help DO’s who want to do OMT but unsure of billing May assist learners in deciding to perform OMT in their office

    9. Coding and Billing Every pt receiving OMT should have 1 or more dx in the form of 739.X linked to OMT CPT Code for billing, with billing level depending on # of areas tx’d Other medical issues dealt with coded according to dx, and billed according to office visit CPT code approp for level of service provided These 2 bills linked by the –25 modifier, which establishes significant, separately identifiable E&M services by same physician on same day of procedure or other service

    10. ICD Code 739 Non allopathic lesions, not elsewhere classified Includes segmental and somatic dysfunctions ICD Codes Descriptors 739.0      Head Region (occipitocervical region) 739.1      Cervical Region (cervicothoracic region) 739.2      Thoracic Region (thoracolumbar region) 739.3      Lumbar Region (lumbosacral region) 739.4      Sacral Region (sacrococcygeal region) 739.5      Pelvic Region (hip region) 739.6      Lower Extremities 739.7      Upper Extremities (AC & SC joints also) 739.8      Rib Cage (Costochondral/Costovertebral) 739.9 Abdomen and Other (Cranial strain patterns

    11. OMT CPT Codes CPT Codes Number of Regions Treated 98925 1-2 Body Regions Involved 98926 3-4 Body Regions Involved 98927 5-6 Body Regions Involved 98928 7-8 Body Regions Involved 98929 9-10 Body Regions Involved Current Procedural Terminology Current Procedural Terminology

    12. Billing/Reimbursement in MO MO Medicaid : 98925 - $14.90 98926 - $20.64 98927 - $26.60 98928 - $31.52 98929 - $36.22 MO Medicare:     Outpatient      Inpatient     98925                    $25.23              $19.97                            98926                     $38.84              $29.28                         98927                     $49.43              $38.44                           98928                     $53.10              $45.37                           98929                     $60.95              $51.98                           Our charges look like this: 98925              $60.00 98926              $84.00 98927              $106.00 98928              $121.00 98929              $144.00

    13. Consultation Charges 99241 - Prob foc - $107 99242 - Exp pro - $177 99243 - Low Complex - $227 99244 - Mod Complex - $305 99245 - High Complex - $394 The majority of practices use some form of a percentage of Medicare rates.  For instance a practice may utilize 250%-350% of Medicare rates.  Some practices change the percentage based on the CPT codes, other use a straight percentage of Medicare consistent with all CPT codes. The majority of practices use some form of a percentage of Medicare rates.  For instance a practice may utilize 250%-350% of Medicare rates.  Some practices change the percentage based on the CPT codes, other use a straight percentage of Medicare consistent with all CPT codes.

    14. Coding and Billing Provide a written, pocket sized card Demonstrates to students they can be reimbursed for OMT when they are osteopathic physicians

    15. Other benefits (for dually accredited providers) Addresses updated ACCME criteria for reaccreditation Your institution will be rated on ability to ID and correct gaps in practice and/or knowledge in learners

    16. Ways to Incorporate OPP Lecture format Ask speakers to incorporate osteopathic philosophy Reminds learners that even if they are supersubspecialists, they can still think/treat osteopathically Give structural findings when possible for case discussions

    17. Ways to Incorporate OPP Lecture format Take digital photos of: palpatory methods structural exam tenderpoint locations treatment positions Help refresh the learner’s memoryHelp refresh the learner’s memory

    18. Ways to Incorporate OPP Hands on workshops Case presentations may better resemble clinical practice vs straight review of techniques Permits demonstration of adaptability of OMT to all pt types Permits peer discussion/sharing of experience

    19. Ways to Incorporate OPP Combination lecture/hands on workshop Divide time in half for 2 speakers Have speakers collaborate prior to creating talk Combine basic science/clinical info with structural exam findings/treatment

    20. Ways to Incorporate OPP Introduction to OMT session Suited well for CME providers with non-osteopathic attendees Many are curious/unfamiliar with OMT Can demo easy techniques ME for torticollis ME of hip flexors

    21. Ways to Incorporate OPP As complementary modality part of CME program covering Chronic pain Cephalgia Sports medicine topics Procedures Almost anything…

    22. Example: CAD Lecture over current CV guidelines with case presentation, then workshop over common techniques: Rib Raising MFR, ST (esp to decrease sympathetic tone) Still’s Technique Include contraindications: Vigorous techniques Direct tx to region where CPR performed OMT when pt unstable Include precautions: - prevent artifact on telemetry leads

    23. Example: Heart Failure Common Techniques used: Rib Raising MFR Still’s Technique Contraindications Vigorous lymphatic techniques Supine techniques when pt in acute failure OMT when pt unstable

    24. Example: Pneumonia/AECB Common Techniques used: Rib Raising Soft Tissue Still’s Technique Contraindications Vigorous techniques ?Theoretical risk from lymphatic tx < 24 hrs of abx tx OMT when pt unstable

    25. Challenges Consider collaboration to co-sponsor speakers with: Other med schools/COMs Local, regional osteopathic organizations Hospitals Health care organizations

    26. Challenges $$$ Funding Opportunities http://www.aof-foundation.org/index.cfm click on ‘Grants and Awards’

    27. AOA Unity II OPP/OMT Grant Aids orgs in developing OPP/OMT programs focusing on founding principles of osteopathic medicine Possible through the Dale Dodson Educational Fund funded program for last 7 years.

    28. AOA Unity II OPP/OMT Grant Program requirements: Grants limited to osteopathic state/specialty orgs w/ state/specialty populations of 300 or < AOA physician members OR 301 to 750 AOA physician members. For orgs w/ state or specialty populations of 300 or < AOA physician members, funding limited to $2,000 per grant request. For orgs w/ state or specialty populations of 301 to 750 AOA physician members, funding limited to $500 per grant request. Eligible orgs may only receive one OMT Grant per AOA fiscal year (June 1, 2008-May 31, 2009).

    29. AOA Unity II OPP/OMT Grant Recognition of Dale Dodson Educational Fund and the AOA in all event materials or post-event information as program sponsors is required. Admin costs such as copies, postage, AV equipment/room rental or food/beverages not considered for grant funding. Orgs encouraged to expand use of grant beyond just CME programs and consider holding OMT sessions/demos for media/public to help educate others about DOs and osteopathic medicine.

    30. AOA Unity II OPP/OMT Grant For more information and to apply: log in to DO-Online with username and password click on "Advocacy," "Media Advocacy" and "Grants."

    31. Challenges Identifying speakers Ask organizations for speaker list/referrals AAO, AOA Call a COM and speak to someone in OMM Department Poll your attendees

    32. Challenges No/insufficient OMT tables Demonstrate techniques that can be done seated or w/o a table Give discounted registration for bringing OMT table

    33. Challenges Insufficient OMM faculty/table trainers Have student organizations provide table training assistance train them prior to workshop on techniques

    34. Challenges May wish to add verbiage stating that OMT is for instructional purposes only and not for individual participant treatment Or have scheduled OMT with sign up

    35. Challenges Not enough space Limit number of participants Have repeat sessions to permit optimal attendance

    36. Challenges Lack of Speaker Funding and No Grants Found Consider using local physicians to conduct OMT session as per their expertise, and offer: Free conference registration Free membership to your society/organization Free textbook

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