UPDATE: OMT Payment Issue
Thank you for all your help and participation in the SaveOMT campaign. Due to the extensive feedback and comments provided by the osteopathic community, the National Government Services has released a final version of the LCD OMT, which will ensure that osteopathic physicians get appropriately reimbursed for OMT provided to Medicare beneficiaries. The LCD incorporates a large majority of the language that the AOA and the impacted states have recommended. It will go into effect November 1st, 2016.
You can review the final version of the LCD here.
The next steps are to see physicians and their staff are properly educated on the implementation. There will be 3 webinars that discuss the changes of the LCD, documentation guidelines and requirements that must be followed. The webinars are scheduled for:
|October 28th||10:30 am – Noon|
|November 2nd||7:00 – 8:30 pm|
|November 9th||1:00 – 2:30 pm|
|December 13th||10:30 am (registration not yet available)|
You can register and view information about the webinars at www.ngsmedicare.com. You will need to log in with your credentials or continue as a guest. Then, click on the Education tab at the top of the page and select Webinars, Teleconferences, and Events from the list on the right side of the page. Scroll through the list of webinars until you find the one you want and click the Register button. Related PDF materials will be posted as well. Following implementation, the Medical Review Staff will be collecting data to see that the new LCD is being followed.
Please contact us if you have questions or difficulty registering. If none of these dates work for you and your office staff, NGS will be able to provide additional sessions.
A Message From The President
The National Government Services published a proposed/draft Local Coverage Determination for Osteopathic Manipulative Treatment (DL 33616). This newly proposed/draft LCD will impact Medicare payment for OMT.
According to NGS, the LCD in place prior to the consolidation of jurisdiction J/K was limited. NGS issued the draft LCD following nearly two years of educational meetings between the AOA and Maine Osteopathic Association regarding osteopathic medicine and OMT. During these meetings, the AOA and MOA were assured that revisions to the LCD would be collaborative and would not occur until Fall 2016. Unfortunately, the draft was released with no input from any osteopathic organizations.
Key concerns and limitations to this draft include: narrowly defining OMT, using E/M – work descriptors to refer to osteopathic manipulative treatment services, recommending against employing an E&M service to diagnose the patient, and suggesting that the physician should use a care plan to help document pre-scheduled visits for manipulation.
There will be two Carrier Advisory Committee meetings during which the issue will be discussed. AOA President-Elect Boyd R. Buser, DO, will present our concerns to National Government Services at the June 20 Carrier Advisory Committee meeting. We will also have representation at the June 21 session.
There is an open comment period from June 30 – August 13, 2016, during which we encourage you to provide written comments to NGS. Send your concerns and comments to PartBLCDComments@anthem.com.
This proposal will greatly affect the osteopathic profession as a whole. Your participation and feedback is valuable for I hope that together we can work to address this and maintain our distinctiveness in medicine.
The WHO’s Zika Virus Recommendations
Since the World Health Organization‘s Emergency Committee on Zika virus first met on 1 February, substantial new research has strengthened the association between Zika infection and the occurrence of fetal malformations and neurological disorders. Evidence also suggests that sexual transmission of the virus is more common than previously assumed.
Based on these findings the Emergency Committee made Zika virus – new recommendations that include:
- Scaling-up research and development, surveillance, vector control, clinical care, and community engagement;
- Advice for pregnant women not to travel to areas of ongoing Zika virus outbreaks; and
- Advice for pregnant women, whose sexual partners live in or travel to areas with Zika virus outbreaks, to use safe sexual practices or abstain from sex for the duration of their pregnancy (full information for travellers).
MOS at the 2015 AOA House of Delegates
At the American Osteopathic Association’s 2015 House of Delegates Meeting the Massachusetts Osteopathic Society (MOS) submitted a resolution to the Committee on Educational Affairs opposing efforts by the Massachusetts Board of Registration in Medicine to mandate Maintenance of Certification as a condition for medical licensure, hospital staff privileges, insurance reimbursement or network participation, malpractice insurance coverage or as a requirement for physician employment in the Commonwealth of Massachusetts. The final outcome of this resolution, approved by the House of Delegates, with modifications, is listed below:
REAFFIRMED AS AMENDED: H202-A/10 EQUIVALENCY POLICY FOR OSTEOPATHIC CONTINUOUS CERTIFICATION
The American Osteopathic Association, through its bureaus, councils and committees, will ensure that osteopathic continuous certification (OCC) is comparable to other maintenance of certification programs so that OCC can be recognized by the federal government, state governments and other regulatory agencies and credentialing bodies as an equivalent of other national certifying bodies’ “maintenance” or “continuous” certification program; AND, BE IT FURTHER, RESOLVED, THAT THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA) OPPOSES ANY EFFORTS TO REQUIRE OSTEOPATHIC CONTINUOUS CERTIFICATION (OCC) AS A CONDITION FOR MEDICAL LICENSURE, INSURANCE REIMBURSEMENT OR NETWORK PARTICIPATION, MALPRACTICE INSURANCE COVERAGE OR AS A REQUIREMENT FOR PHYSICIAN EMPLOYMENT; AND, BE IT FURTHER RESOLVED, THAT THE AMERICAN OSTEOPATHIC ASSOCIATION THROUGH THE BUREAU OF OSTEOPATHIC SPECIALISTS (BOS) REVIEW THE OSTEOPATHIC CONTINUOUS CERTIFICATION PROCESS SO AS TO MAKE IT MORE MANAGEABLE AND ECONOMICALLY FEASIBLE.
Residency Merger Recommendations
The ACGME recommendations for the residency merger are posted. This policy will affect all programs seeking osteopathic recognition and then there will be specifics for each specialty. Please review and send comments.
Resources for Ebola Preparedness
The Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) and Office of the Assistant Secretary for Preparedness and Response (ASPR) continues to work with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners in an international response to the current Ebola outbreak in West Africa. The attached document summarizes key messages about the outbreak and the response. It will be updated as new information becomes available and distributed regularly. Please share this document with others as appropriate.
The following are updated guidance documents available:
- Open Letter to All U.S. Healthcare Professionals from Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response, regarding the current Ebola situation. – Oct. 3, 2014
- Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus – Updated Oct. 3, 2014
- HAN 371: Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials – Oct. 2, 2014
- Interim Guidance: EMS Systems & 9-1-1 PSAPs: Management of Patients in the U.S. – Updated Oct. 1, 2014
- Evaluating Returned Travelers for EVD, U.S. – Oct. 1, 2014
- Checklist for Patients Being Evaluated for EVD, U.S. – Oct. 1, 2014
- Ebola Screening Criteria Template for EMS – Updated Oct. 1, 2014
- Detailed Hospital Checklist for Ebola Preparedness
- Checklist for Healthcare Coalitions for Ebola Preparedness
- Detailed Emergency Medical Services (EMS) Checklist for Ebola Preparedness
Webinar Recording Available on Ebola Preparedness for U.S. Health Care System
A recording of a recent webinar hosted by ASPR and CDC on Ebola Preparedness for the U.S. health care system is now available for viewing. The webinar focused on the Detailed Hospital Checklist for Ebola Preparedness, which highlights the activities that all hospitals can take to prepare for the possibility of a patient exposed to Ebola arriving for medical care. This information is especially useful for hospital emergency managers, infection control officers, hospital leadership, and clinical staff. The checklist provides practical and specific suggestions to ensure hospitals can detect possible Ebola cases, protect their employees, and respond appropriately.
CDC and ASPR encourage you to visit the CDC Ebola website for the most updated information on the 2014 Ebola response and to share this information with your colleagues and networks.
Division of Health System Policy
HHS / ASPR / OPP
Thomas P. O’Neill Federal Building
200 C Street SW, Washington, DC 20024
Judge Bars UnitedHealthcare from Dropping Docs
A federal judge in Connecticut has issued a preliminary injunction prohibiting UnitedHealthcare from dropping doctors from its provider networks for Medicare Advantage plans. The ruling by U.S. District Court Judge Stefan Underhill could have national implications as UnitedHealthcare and other insurers move to tighten their Advantage networks.
UnitedHealthcare is Terminating Physicians from its Medicare Advantage Programs
Several AOA members contacted the AOA regarding letters they received as part of UnitedHealthcare’s changes to their network composition. In these letters UHC informed physicians that their UHC Medicare Advantage participation will end, all UHC Medicare Advantage benefit plans will be removed from their contracts, and that patients covered by UHC Medicare Advantage will be instructed to select an alternate UHC Medicare Advantage network for physician services rendered on or after January 1, or February 1, 2014, depending on the state. The physician’s participation in commercial or Medicaid benefit plans will not be terminated through this process.
The AOA is sending a letter to UnitedHealthcare to express our concerns with this initiative and the potential impact on the physician-patient relationship. We strongly encourage physicians who receive letters to immediately appeal UHC’s decision to terminate with specific information on why your services are needed in your geographic area. We also encourage you to alert your patients and have them contact their UHC network representatives.
Yolanda Doss, Director of the AOA’s Division of Compliance and Payment Advocacy, has been in communication with UnitedHealthcare, as well as several physicians impacted by this action. A New Jersey physician has drafted a very good appeal letter and approved the AOA sharing his letter with you. This letter may be used as a guide to assist other physicians with their appeals. Be sure your own personal letters reflect the impact this action will have on your patients, your practice, and possibly the community. (See letter attached above.) If you have questions, you may contact Ms. Doss at (312) 202-8187 or by email at firstname.lastname@example.org.
Watch Dr. John Chang, Lawrence General Hospital Emergency Room physician and Massachusetts Osteopathic Society member, care for patients injured under unusual circumstances.
Rubber Ball —
Swallowed Coin —
MOS Board of Trustee Member Publishes Book
Sixteen: An American Hockey Story was written by a physician who has been in practice for twenty-eight years. He reflects back in the preface on the pursuit of dreams with its ups and downs on the way to a career in medicine. There he describes a young boy and his encounter with one of our great games: hockey. In that sport and others he played, lessons were being presented that would help him get ready for the challenges ahead in the bigger game: life.
Those who contributed to that experience as a youth are recognized as he progresses unknowingly toward an unlikely state championship. It is also a tale of New England hockey of an earlier time and his three coaches in this personal account. It is a parable of experiences in sports that can be applied to life. Lastly, it is an expression of thanks to those who provided this opportunity to be an athlete in America. The historical backdrops and references to Providence reveal it is a story of an American boy growing up in his country with eternal dreams.
End of Life and Palliative Care Motion
The Massachusetts Osteopathic Society so moves to continue to provide and support compassionate end-of-life care to our patients by:
- listening to and empathizing with our patients and their families;
- assessing their needs and treating the medical causes of distress from physical or psychological pain and suffering;
- managing the fear of decline from progressive disease, including loss of function, both physical and cognitive, and creating dependence on others in physical, emotional or financial capacity;
- striving to preserve the dignity and comfort of patients and their families when dealing with end-of-life issues;
- seeking the services of hospice organizations and palliative care programs in our community;
- providing a better understanding of end-of-life issues through Continuing Medical Education, such as the “End of Life National Osteopathic Workshop Modules,” and “End of Life and Palliative Care Education Conferences”;
- incorporating the support of national health organizations to assist with and achieve these goals.