August 7, 2009
To the Editor:
Thank you for shedding light on the issue of physician "self-referrals," a topic that has gotten little exposure during the health care reform debate but one that could have an enormous impact on overall costs and patient care ("Doctors Reap Benefits By Doing Own Tests," July 31, 2009).
While your article focused on over-utilization of imaging tests, physical therapists are also familiar with the profit motive of self-referral. When physicians refer patients to physical therapists who work for them, the doctors earn money from that therapy treatment. This financial incentive results in inherent conflicts of interest.
Studies, including a May 2006 report by the Department of Health and Human Services of the Inspector General, show this profit motive can lead to over-utilization of physical therapy services, resulting in excessive costs for patients and taxpayers. Congress has approved legislation designed to outlaw the practice. However, loopholes to these laws, such as the "in-office ancillary services exception" mentioned in your article, have been routinely exploited and promoted as a way to boost physician profits.
Articles such as yours are vital in raising patient awareness of the profit incentive that can exist for health care professionals. All patients, including those who need physical therapy services, deserve timely and effective treatment, as well as protections against profit-motivated referrals.
R. Scott Ward, PT, PhD
American Physical Therapy Association