Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.

Background: Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored. Methods: A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality. Results: The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients. Conclusions: The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.

An evaluation of cost and appropriateness of care as recommended by candidates on a national clinical skills examination.

BACKGROUND: The National Board of Osteopathic Medical Examiners administers the COMLEX-USA Level 2-PE, an assessment of clinical skills of osteopathic medical students. This evaluation includes developing a patient care plan. PURPOSE: Based on one simulated case, we investigated the appropriateness and cost of care and quantified their relationship to performance. METHODS: Four hundred sixty-seven postencounter notes were coded for appropriateness using expert physician judgments and for cost of care using Centers for Medicare and Medicaid Services data. Various outcome measures were correlated with physician scores. RESULTS: In this case, candidates recommended an average of 5.6 interventions with an average cost of $227 and appropriateness rating of 2.4 on a 1 (indicated) to 4 (potentially dangerous) scale. Total cost and inappropriateness of actions were negatively correlated with candidate scores (r = -.208, p < .0001 and r = -.318, p < .0001, respectively). CONCLUSIONS: Results from this investigation provide some evidence to support the validity of physician note ratings of patient care plans and demonstrate the need to include these principles in medical education.

Survey of billing and coding for counterstrain tender points.

CONTEXT: The names of certain counterstrain tender points are incongruent with their physical locations because of an assumption that these points are reflective of dysfunction in neighboring body areas. Because the body area that is physically examined does not always match the body region in which somatic dysfunction is diagnosed for these tender points, it is not always clear which evaluation and management service codes should be used for billing physician services. OBJECTIVE: To assess the attitudes of osteopathic physicians toward the billing and coding of incongruent counterstrain tender points. METHODS: Physician members of the American Academy of Osteopathy who use counterstrain in clinical practice were surveyed regarding the body area that they would physically examine when assessing for incongruent tender points and, if tender points were present, the body regions to which they would assign somatic dysfunction for billing and coding purposes. Physician responses were categorized as indicating a structural approach (ie, reflective of anatomic location) or a functional approach (ie, reflective of dysfunction in neighboring body areas) to tender point examination and treatment. Associations between sex, specialty, and years in practice with the approach chosen were also examined. RESULTS: Of 175 physicians who responded to the survey, 156 met the study criteria. Respondents were primarily board-certified in neuromusculoskeletal medicine/osteopathic manipulative medicine (98 [63%]), special proficiency in osteopathic manipulative medicine (30 [19%]), or family practice/family practice and osteopathic manipulative treatment (94 [60%]). Ninety percent of physicians predominantly chose responses indicating a structural approach to the physical examination of tender points and 21% predominantly chose responses indicating a functional approach to somatic dysfunction diagnosis. There were inconsistencies among individual respondents regarding the type of approach chosen for a single tender point. For certain tender points, differences were seen for approach between men and women, specialty, and years in practice. CONCLUSION: Our survey respondents had clear differences in opinion regarding physical examination location and somatic dysfunction diagnosis for incongruent tender points. These results suggest inconsistency among physicians in determining the physical examination component of evaluation and management services and the International Classification of Disease, Ninth Revision, or ICD-9, diagnostic codes in the assessment of these incongruent tender points.

Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.

OBJECTIVE: The primary aim of this study was to determine if there are differences in the cost of low back pain care when a patient is able to choose a course of treatment with a medical doctor (MD) versus a doctor of chiropractic (DC), given that his/her insurance provides equal access to both provider types. METHODS: A retrospective claims analysis was performed on Blue Cross Blue Shield of Tennessee's intermediate and large group fully insured population between October 1, 2004 and September 30, 2006. The insured study population had open access to MDs and DCs through self-referral without any limit to the number of visits or differences in co-pays to these 2 provider types. Our analysis was based on episodes of care for low back pain. An episode was defined as all reimbursed care delivered between the first and the last encounter with a health care provider for low back pain. A 60 day window without an encounter was treated as a new episode. We compared paid claims and risk adjusted costs between episodes of care initiated with an MD with those initiated with a DC. RESULTS: Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient's costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD. CONCLUSIONS: Beneficiaries in our sampling frame had lower overall episode costs for treatment of low back pain if they initiated care with a DC, when compared to those who initiated care with an MD.

Billing and coding for osteopathic manipulative treatment.

Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials.