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  • Bill Introduced in House Would End Physician Self-Referral Loophole for Physical Therapy

    Medicare self-referral loopholes—the exception that allows physicians to refer patients for physical therapy and other services to a business that has a financial relationship with the referring provider—is once again in the legislative spotlight on Capitol Hill.

    On April 6, the Promoting Integrity in Medicare Act (PIMA) was reintroduced in the US House of Representatives (HR 2066), in hopes of eliminating the exception to the federal law originally intended to prohibit self-referral. That law, known as the Stark law, does prohibit most self-referral practices, but it also contains language that allows physicians to self-refer for "patient convenience" or same-day treatments—known as in-office ancillary services. Unfortunately those exceptions also include services that are rarely provided on the same day—physical therapy, anatomic pathology, advanced imaging, and radiation oncology.

    PIMA would eliminate this loophole not only as a way to ensure that the exception is used according to its original intent, but also to reduce overutilization and overall health care costs. According to 2016 estimates from the Congressional Budget Office, enacting the changes contained in PIMA would save Medicare an estimated $3.3 billion over 10 years, mostly due to what research points to as overuse of referrals among providers who can direct patients to services with a financial connection. The bill is sponsored by Rep Jackie Speier (D-CA), who introduced a similar bill in 2016.

    APTA is a strong supporter of the legislation, and is a member of the Alliance for Integrity in Medicare (AIM), a coalition of professional groups opposed to the inclusion of the services they represent in the Stark exceptions. AIM isn't alone in the fight: in 2014, the American Association of Retired Persons (AARP) issued a statement in support of PIMA.

    "Physical therapist services should never have been included as an exception to the Stark law," said Michael Hurlbut, APTA senior congressional affairs specialist. "Reasonable exceptions for services such as lab tests and x-rays would still be in place and could be performed during office visits—this legislation would simply correct an obvious problem in the law."

    Find out more about this issue on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact APTA advocacy staff for more information.

    Comments

    • This 3.3 billion is a good offset to the 10 billion to eliminate the Medicare rehab cap

      Posted by Carolyn Bloom on 4/8/2017 12:46 PM

    • Please close this physical therapy loophole. Patients are not always getting the most expert services when physicians are pressured by their parent business to refer to therapy services which are part of that business. We know this personally in our hometown of Wahpeton, ND, where patients are not even made aware by their physicians that they qualify for insurance coverage wherever they choose to go in our town or in Breckenridge, where there is an outstanding physical and orthopedic private provider. Thank you. Sandy Olson, Wahpeton, ND

      Posted by Sandy Olson on 4/8/2017 8:56 PM

    • I am in full support of the motion I feel it is totally unethical for doctors to refer to themselves they take advantage of the patients fear and knowledge about knowing their rights and options and they intimidate the patients the doctors also mistreat their physical therapists nd it is also illegal al therapists by overloading them with patients and not allowing them to be independent in their work and critical thinking This practice is totally unethical in other countries

      Posted by Michelle Zygielbaum on 4/10/2017 7:33 AM

    • does mean mean an end to physican owned PT clinics??

      Posted by michael z on 4/10/2017 11:20 PM

    • Would this also include then large hospital systems that may not be owned by physicians? Physicians in large hospital systems are also pressured to refer to the same hospital for financial gains. Not just physician owned practices that do this even though they get the bad reputation.

      Posted by Adam Halseth on 4/12/2017 4:04 PM

    • Does this new bill limit hospital owned physician practices from referring to the hospital owned PT practices? This is the same conflict of referral for profit.

      Posted by Troy Bage -> =JQ`?G on 4/12/2017 4:35 PM

    • Strong supporter of the bill. Hope senate passes this bill. Physicians should not be allowed to own/run physical therapy practices. Additionally it should be added that only a physical therapist can own/operate a physical therapy clinic as is the case for physicians. No non physician can own a physician practice. Unfortunately there are lot of non technical people own and run physical therapy practices and their focus is not the patient service. That should be discouraged to its extreme.

      Posted by Saadat Iqbal on 4/12/2017 4:46 PM

    • I am in full support of allowing licensed and trained in American Universities Physical Therapists to have a freedom of decision how to best treat the patients. The current programs of Doctor of Physical Therapy is the best acknowledgment they can do what they are train for and provide more efficient treatment than financial motivation they have working in physicians offices. A simple question why physician would like to provide PT services in own office instead to refer and get independent, more efficient treatment without any financial motivation. I propose two years moratorium as a trial to see the medical and financial results by CMS. PTs have what it takes to be integral part of our medical system and can save money and keep patients happy and with what patients want as results. With due respect to all involved. Dr.Peter Kluba PT

      Posted by Dr.Peter Kluba PT on 4/12/2017 4:50 PM

    • God bless you. In 1977, I started the movement against POPTS. It's good to know that the pressure is still on Donald Hiltz, P.T. (retired)

      Posted by Donald L. Hiltz on 4/12/2017 4:53 PM

    • I have worked on both sides of this issue and can honestly say that at least in my case that there was more over utilization of therapy services when I worked for a hospital owned outpatient therapy clinic than with the POPTS. There are some physicians that truly care about getting timely and reasonable care for there patients. Also most patients that I've encountered like the convenience and comprehensiveness of a "one stop shop" where all of their care is coordinated and if there is any question or problem it's as simple as a walk down the hall rather than multiple phone calls and messages that rarely are returned in a timely manner. I think that each situation is unique onto itself and these relationships can often times be a very beneficial for all parties involved.

      Posted by Mike S on 4/12/2017 8:50 PM

    • We have a M.D. group who make numerous calls to patients to report to their group owned Physical therapy out patient clinics. Patients are asked to go to different nearby town PTclinics owned by the group if there is no appointments available in group owned clinics in patients town where they live. Some patients are obligated and some are helpless. This has to stop.

      Posted by Riaz on 4/12/2017 11:18 PM

    • Sounds great...just like the Stark Laws I and II did originally. This would be yet another meaningless victory as they have the means and craftyness to find another way around this. The truth is that until physical therapists as a profession refuse or are banned for working for physician owned practice, these arrangements will be a detriment to our professional.

      Posted by Matthew Riordan on 4/13/2017 7:16 AM

    • This, like direct access is and always will be a money issue. The problem is, PTs almost always will be defeated in this battle. MD and chiro lobbies simply have more money than PT, and we have done this to ourselves. As we claim to continue to fight for our independence as DPTs and primary provider status, our very own are selling themselves as employees to Orthos and Hospitals, thereby not being active in our memberships and supportive of our profession. It is ridiculous that MDs can self refer for profit, and even more ridiculous that PTs are allowing this to happen. The argument of one stop shop is laughable. Shame on you PTs who are giving away our autonomy as the rest of us fight so hard for it!

      Posted by Jason on 4/13/2017 8:35 AM

    • The key question is whether PT's are professionals or technicians. Above all we should be ethical and have the patient's best interest at heart versus our own - a key component of a profession. Abuse can occur in any situation and each must be examined independently. But is it ethical to make patients drive 10 miles further, pay 50% higher charges, and wait 2-3 weeks for an evaluation versus 1-2 days just because their doctor requires them to see the POPTS PT or does not give them an option? PT's- do what is right. Be a professional.

      Posted by Pete Bartel PT on 4/13/2017 4:17 PM

    • As is the case for these issues, there are always 2 perspectives. I work for a POPTS that was started in response to private PT practices in our community that were giving inconsistent care and/ or "alternative" care and were over-treating their patients. Currently in our POPTS, our outcomes are equivalent or better than national averages and we see the majority of patients for 25% fewer visits. Improved communication with our providers, a shared EMR with providers that facilitates communication and utilizing an evidence based approach all contribute to what is clearly a more efficient delivery of healthcare. I recognize that this type of vertical integration may not be the norm, but it certainly can work well, be ethical and provide our community with outstanding care.

      Posted by Mike Baer on 4/15/2017 6:49 PM

    • I urge the APTA and its members to ask their legislators to vote against the Promoting Integrity in Medicare Act (PIMA). Self referral is reason often cited to support this type of legislation, but self referral is greater in hospital affiliated practices. More and more physician practices are becoming owned by or are affiliating with hospitals and this legislation doesn't address that issue. Instead of trying to hurt physician practices and the physical therapists that work for them with this legislation, we instead should be fighting for legislation that allows PTs to partner with or own physician practices.

      Posted by James Barsky -> >MT`<I on 4/17/2017 6:11 AM

    • Like all types of ownership arrangements there can be misuse and overutilization with Physician owned, large corporate owned, hospital owned, and private practice. I have spent my entire career in a physician owned practice and currently serve as Director of Rehab for the company. One area I track is the percentage of pts that use our PT after a TKA and live within 15 miles of any of our offices. Since I began tracking this metric 10 years ago we have averaged seeing less than 50% of those pts who utilize out-pt PT and live within 10 miles. If any practice regardless of ownership is practicing with illegal or unethical practices, discipline of that organization should occur. Also I have seen private practices and corporate owned practices pay Medical Directors significant money...and those physicians feel no obligation to refer???

      Posted by Connie Roberts on 4/18/2017 2:38 PM

    • I've read many arguments for and against POPTs over the years each time one of these bills comes up. I think the real answer to the problem is that we as a profession are weak and squabbling for every nickel and penny we can. Look at the percentages of professionals in their respective organization and you will see that PTs have one of the lowest professional group membership percentages. If we were to unite and strengthen our profession, then we could take it over and take it back. I think the APTA should focus on increasing membership percentage and increasing membership awareness of our legal rights against any entity that would push us toward unethical or fraudulent activity. I have practiced in SNF, IRF, private practice OP, and hospital OP, and acute care over 15 years and been pressured in each setting (except my current one) to extend POCs and increase units/visits. I have been able to stand my ground because I took some time to educate myself on the laws and legal recourse if I felt pressure to do something unethical or fraudulent.

      Posted by Ben "Don't Call Me Doctor" on 6/28/2017 2:07 PM

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