Utilization and reimbursement trends of osteopathic manipulative treatment for Medicare patients: 2000-2019.

CONTEXT: Osteopathic manipulative treatment (OMT) has been established as a beneficial and noninvasive treatment option for multiple conditions. With the total number of osteopathic providers tripling and the subsequent increase in osteopathic physician representation, we would expect the clinical use of OMT to increase accordingly. OBJECTIVES: To that end, we evaluated the utilization and reimbursement of OMT services among Medicare beneficiaries. METHODS: Current procedural terminology (CPT) codes 98925 to 98929 were accessed from the Center for Medicare and Medicaid Services (CMS) from 2000 to 2019. These codes indicate OMT treatment, 98925 (1-2 body regions treated), 98926 (3-4 body regions treated), 98927 (5-6 body regions treated), 98928 (7-8 body regions treated), and 98929 (9-10 body regions treated). Monetary reimbursement from Medicare was adjusted for inflation, and total code volume was scaled to codes per 10,000 beneficiaries to account for the increase in Medicare enrollment. RESULTS: Overall OMT utilization declined between 2000 and 2019 by 24.5%. A significant downward trend in the utilization of CPT codes for OMT involving fewer body regions (98925-98927) was observed, and was contrasted by a slight upward trend in the use of codes for more body regions (98928, 98929). The adjusted sum reimbursement of all codes decreased by 23.2%. Lower value codes showed a higher rate of decline, whereas higher value codes changed less dramatically. CONCLUSIONS: We conjecture that lower remuneration for OMT has disincentivized physicians financially and may have contributed to the overall decline in OMT utilization among Medicare patients, along with a decreased number of residencies offering specific training in OMT, and increased billing complexity. In considering the upward trend of higher-value code usage, it is possible that some physicians are increasing the comprehensiveness of their physical assessment and associated OMT to reduce the overall financial impact of reimbursement cuts.

Circular bioeconomy in African food systems: What is the status quo? Insights from Rwanda, DRC, and Ethiopia.

Increasing global food insecurity amidst a growing population and diminishing production resources renders the currently dominant linear production model insufficient to combat such challenges. Hence, a circular bioeconomy (CBE) model that ensures more conservative use of resources has become essential. Specifically, a CBE model that focuses on recycling and reusing organic waste is essential to close nutrient loops and establish more resilient rural-urban nexus food systems. However, the CBE status quo in many African food systems is not established. Moreover, scientific evidence on CBE in Africa is almost inexistent, thus limiting policy guidance to achieving circular food systems. Using a sample of about 2,100 farmers and consumers from key food value chains (cassava in Rwanda, coffee in DRC, and bananas in Ethiopia), we explored existing CBE practices; awareness, knowledge, and support for CBE practices; consumers' opinions on eating foods grown on processed organic waste (CBE fertilizers), and determinants of such opinions. We analysed data in Stata, first descriptively, and then econometrically using the ordered logistic regression, whose proportional odds assumption was violated, thus resorting to the generalized ordered logistic regression. Results show that communities practice aspects of CBE, mainly composting, and are broadly aware, knowledgeable, supportive of CBE practices, and would broadly accept eating foods grown CBE fertilizers. Households with heads that used mobile phones, or whose heads were older, or married, or had a better education and agricultural incomes were more likely to strongly agree that they were knowledgeable and supportive of CBE practices and would eat CBE foods (foods grown on processed organic waste). However, the reverse was true for households that were severely food insecure or lived farther from towns. Rwandan and Ethiopian households compared to DRC were less likely to eat CB foods. Policies to stimulate CBE investments in all three countries were largely absent, and quality scientific evidence to guide their development and implementation is currently insufficient.

Use of the new preservation solution Custodiol-MP for ex vivo reconditioning of kidney grafts.

Organ shortage and the increasing use of extended criteria donor grafts for transplantation drives efforts for more efficient organ preservation strategies from simple cold storage toward dynamic organ reconditioning. The choice of a suitable preservation solution is of high relevance in different organ preservation or reconditioning situations. Custodiol-MP is a new machine perfusion solution giving the opportunity to add colloids according to organ requirements. The present study aimed to compare new Custodiol-MP with clinically established Belzer MPS solution. Porcine kidneys were ischemically predamaged and cold stored for 20 hours. Ex vivo machine reconditioning was performed either with Custodiol-MP (n = 6) or with Belzer MPS solution (n = 6) for 90 minutes with controlled oxygenated rewarming up to 20°C. Kidney function was evaluated using an established ex vivo reperfusion model. In this experimental setting, differences between both types of perfusion solutions could not be observed. Machine perfusion with Custodiol-MP resulted in higher creatinine clearance (7.4 ± 8.6 mL/min vs. 2.8 ± 2.5 mL/min) and less TNC perfusate levels (0.22 ± 0.25 ng/mL vs. 0.09 ± 0.08 ng/mL), although differences did not reach significance. For short-term kidney perfusion Custodiol-MP is safe and applicable. Particularly, the unique feature of flexible colloid supplementation makes the solution attractive in specific experimental and clinical settings.

Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States.

CONTEXT: Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession. OBJECTIVE: To determine the prevalence of OMT use, barriers to its use, and factors that correlate with increased use. METHODS: The American Osteopathic Association (AOA) distributed its triannual survey on professional practices and preferences of osteopathic physicians, including questions on OMT, to a random sample of 10,000 osteopathic physicians in August 2018 through Survey Monkey (San Mateo, CA). Follow-up efforts included a paper survey mailed to nonrespondents one month after initial distribution and three subsequent email reminders. The survey was available from August 15, 2018 to November 5, 2018. The OMT questions focused on frequency of OMT use, perceived barriers, and basic demographic information of osteopathic physician respondents. Statistical analysis (including a one sample test of proportion, chi-square, and Spearman's rho) was performed to identify significant factors influencing OMT use. RESULTS: Of 10,000 surveyed osteopathic physicians, 1,683 (16.83%) responded. Of those respondents, 1,308 (77.74%) reported using OMT on less than 5% of their patients, while 958 (56.95%) did not use OMT on any of their patients. Impactful barriers to OMT use included lack of time, lack of reimbursement, lack of institutional/practice support, and lack of confidence/proficiency. Factors positively correlated with OMT use included female gender, being full owner of a practice, and practicing in an office-based setting. CONCLUSION: Our data suggest that OMT use among osteopathic physicians in the US continues to decline. Barriers to its use appear to be related to the difficulty that most physicians have with successfully integrating OMT into the country's insurance-based system of healthcare delivery. Follow-up investigations on this subject in subsequent years will be imperative in the ongoing effort to monitor and preserve the distinctiveness of the osteopathic profession.