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    FY 2014 Budget Recommends Removing Therapy From In-office Ancillary Services

    APTA is highly encouraged by the proposal within President Obama's fiscal year 2014 budget, released yesterday, to exclude therapy services, including physical therapy, along with radiation therapy and advanced imaging from the in-office ancillary services (IOAS) exception of the Stark self-referral laws.

    The Office of Management and Budget concluded that closing the loophole for these services would provide a savings of $6.1 billion over the standard 10-year budget window, providing further evidence that these self-referral arrangements lead to overutilization of Medicare services and should be addressed by Congress.

    On its own for many years and more recently as part of the Alliance for Integrity in Medicare (AIM) coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups, APTA has long advocated for exclusion of physical therapy from the IOAS exception. APTA agrees with the Administration's proposal on physician self-referral and believes this issue should be addressed as part of any fundamental delivery system reform.

    APTA and its AIM partners continue to be gravely concerned about the ongoing misapplication of the IOAS exception to the physician self-referral law, believing this loophole results in increased spending, unnecessary use of medical services, and potentially compromised patient choice and care. Studies published by the New England Journal of Medicine, Health Affairs, and the Government Accountability Office, among others, have highlighted abuses that result from physician self referral. These ongoing issues serve only to erode the integrity of the Medicare program and undermine patient care.

    APTA and AIM now strongly urge the 113th Congress to follow the recommendations of the Administration budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception.


    Comments

    Great effort on behalf of all of our members. THis continued to reflect poorly on PT care, so it is a move in the right direction.
    Posted by Kay Scanlon on 4/12/2013 2:40 PM
    "I am very concerned about the tremendous need for professional care that is going unrecognized. Physical therapy is and always has been critical to the success and the health of American citizens and our profession continues to impact and provide assistance to a variety of medical professionals all over the world. Countless generations have been provided high quality service and utmost care. Our profession has made leaps and bounds with or without the advancement of technology and will continue to invest in the lives of those we care for each day. Respectfully submitted, Heidi Harris P.T
    Posted by Heidi Harris on 4/12/2013 3:18 PM
    This is excellent news, and long overdue.
    Posted by LeeAnne Carrothers on 4/12/2013 3:20 PM
    Applauding for the APTA to continuing to shepherd the proposal to fiscal 2014 budget to close the loophole of "in-office ancillary services" exception of the Stark self-referral laws.
    Posted by Larry Greenberg, PT, MS, M.Ed. on 4/12/2013 4:26 PM
    Greatly news.looking forward to the final result
    Posted by Xiaobo Wang on 4/12/2013 5:20 PM
    I am very pleased that the APTA has successfully promoted the exclusion of PT from MD offices thus far. I hope the final results in 2014 reflect this exclusion, and doesn't get shot down prematurely. It's an uphill battle here in California with POPs, and a national closure to the loophole of self referral will be long overdue.
    Posted by Allen Ling, PT, OCS on 4/12/2013 11:08 PM
    If this goes through, what would happen to all of the physical therapists currently working for physician practices? While there are abuses of these arrangement, as there can be in any industry, having the opportunity to work so closely with physicians in the same practice can be incredibly valuable for the patient. I think instead of trying to restrict physicians from hiring PTs, we should be fighting for the right to own physician practices.
    Posted by James R. Barsky, PT, MSPT on 4/13/2013 5:49 AM
    I understand that there are abuses and these of course have to be fixed, but I also very much understand the very important nature of physical therapy. I am a physician who happens to have a physical therapist in my office, and our communication is a very crucial part of the practice. There have been times that I had wanted to send a patient in my office to physical therapy, but by discussing the case with the therapist in my office I have learned when it may have been inappropriate to do so, thus avoiding unnecessary care. Also, by working so closely with the physical therapist in my office I have learned how physical therapy can be extraordinarily helpful to my patients, whereas in the past I may not have even considered it and just done medical management. In general, I have learned a great deal by working with a physical therapist, and the idea that I may lose this saddens me. Those physical therapists outside my practice don't always communicate with me except for my original signature that may be requested for continuation of care. I think in many ways this will separate the communication of 2 important areas of healthcare in the outpatient world.
    Posted by Sonya Knight on 4/13/2013 6:47 AM
    I am a PT working in a physician's office and while I understand there are abuses, not everyone is abusing the system. The communication I have with the physician in my office has helped both of us provide better care for our patients. Once I begin my Plan of Treatment with my patients, I have the autonomy to decide what treatment they need and when they are ready to be discharged. THe physician has hired the staff he wants due to our expertise and values our experience. I do not receive any inappropriate referrals from him for PT.
    Posted by Stephanie Ford, PT on 4/13/2013 8:59 AM
    The doctor, therapist relationship has always been maintained as long as the M.D. desires it. I don't know any PT that does not drop what they are doing when a physician or their assistants call for info. Contrary to this is the M.D. not responding to the PT phone call when info is needed. This is particularly troubling when the surgeons don't respond when patient safety is the issue. I have worked side by side with the physicians in a military facility and it works great because it was pure relationship that focused on the patient not the financial health of the practice. The Starke self referral law was a good idea and still is. Physicians are rushing to include PT in the practice for all the wrong reasons. Abuses and patterns of abuse are evident. Referrals from the physician with PT owned practices come in with with less visits authorized on diagnoses that you know will require more. It's just a check in the block for the surgeon so they can say that conservative treatment was tried followed by surgery. Then the patient is channeled back to the PTs in there practice. It a manipulation that is well known to all practice administrators. The only way to lower costs is to stop the self referral and return the autonomy back to the Physical Therapists.
    Posted by Michael Bailey on 4/13/2013 10:03 AM
    I am greatly concerned that the skills attained by physical therapists (such as evaluation, diagnostics, developing and implementing an appropriate plan of care, and re-examination of outcomes to determine need for alterations in that plan of care) that are currently being instructed as a Doctorate level education are being assimilated with the work of the 2-year technical degrees needed for radiation therapists. We, as physical therapists, should not be upset that some physicians view physical therapists as an integral aspect of patient health. Could it be that medical doctors that do not have this type of connection with physical therapists under-utilize us as a profession? Anytime a physician refers a patient to physical therapy it is that physical therapists responsibility to determine if therapy is appropriate or not. It is our responsibility to limit this "over-utilization," if it is really occurring. I hope that our energies can be used elsewhere, perhaps to promote the increase of the currently falling reimbursement rates by displaying and respecting the skills of physical therapists. In case anyone is wondering, I do not work for a physician owned clinic.
    Posted by Elizabeth Bannister, PT, DPT on 4/13/2013 11:48 AM
    There are abuses out there. The biggest abusers are the large hospital systems.
    Posted by Physical Therapist, PT on 4/14/2013 12:10 AM
    Physicians, including orthopedic surgeons who typically employ physical therapists, are selling their practices to hospitals as they prepare for the future "integrated" health system under PPACA (ObamaCare). Since hospitals are not bound to the same degree by the Stark self-referral laws as physician practices I wonder if removing the IOAS exception will really have the anticipated impact on medical spending? The hospitals, further, will show tremendous interest in capturing ALL physician referrals to therapy to better manage costs under arrangements such as Medicare ACOs and Patient Centered Medical Homes. Not sure that changes to Starke at this point will make much difference. Thank you, Tim Richardson, PT
    Posted by Tim Richardson on 4/14/2013 7:03 PM
    This is great! I have an orthopedic group with their own PT in the office and they abuse this constantly even so far as to not give the patients a choice as to rehab. These MDs have been reduced to stealing patients by calling them on their cell phone while in my office. These MD are earning big $$ in the OR. They need to stay out off my business just to earn a few more dollars. Now, I send my patients to another orthopedic group. When they take one of my patients, they cost me hundreds of dollars. When I take one of their patients to another Hospital, they loose tens of thousands of dollars. You think they would be smarter than that. I will not sell out and work for a MD.
    Posted by Mike Stewart on 4/14/2013 9:37 PM
    I have worked for years in POP facilities. The care model of having the referring physician in the same facility is much preferred by all our patients. Having quick access to the referring physician and not waiting for days to get a call back is priceless to our patients. Any referrals from the in house physicians are treated the same as outside referrals. We as PT's determine the length and plan of the treatment like any other practice. I have been unable to back the APTA for years now as they continued to fight to eliminate my job. I find it unfortunate tha APTA appears to only support the private practice physical therapists and not all physical therapists!
    Posted by Tom Bledsoe, MPT on 4/15/2013 10:41 PM
    I am a PT that enjoys having close working relationships with referring physcians. Limitation of physicians from owning a physical therapy practice to prevent self referral and abuse does not exclude developing strong communication with the therapists in which you refer. It also does not limit your ability to have a PT in office. It just does not allow you to profit from their presence. This is a necessary move in the right direction.
    Posted by Dallas Roberts, PT on 4/16/2013 12:19 PM
    I like many of you would love to see this come to pass. And those of you who are in POP situations may find that you can now keep that great relationship and be truly autonomous, by starting your own practice, in close relationship to the physician or physician group. However, I think many of you will find that when the financial incentive is not as great neither will be the quantity of referrals. I've been in private practice as well as the director of a hospital outpatient, and believe me you will soon find out, when you start a private practice, which physicians truly think you and your skills are indispensable and which were only feeding the hospital machine. Please who ever is posting as Physical Therapist, PT. Man up and use your real name or keep quiet, freedom of opinion, even if correct, requires having the courage to own it.
    Posted by Richard Luyster PT on 4/16/2013 5:14 PM
    I ventured out into private practice one year ago. I constantly talk to my referring physicians so the argument of close communication with referring physicians (POPTS argument) is an illusion in this modern age of the telephone. Over the past year, I have been approached by three surgeons to be their in house therapist. You have to ask yourself the question - why would they want in house therapy(could it be the money?). No, it couldn't be about the money. It's all about the close communication and convenience! If you buy that then I've got some oceanfront property in Arizona to sell you. P.S. I'm an Occupational Therapist but I'm in the same boat as the private practice PT's out there trying to make it out here in a POPTS world so I thought I'd give you my 2 cents worth.
    Posted by James Puett MS, OTR, CHT on 5/29/2013 8:07 AM
    Its all smokescreen. California Physical Therapy Association has agreed to pass legislation to legalize Employment for POPTs all in name compromise for Direct Access for private practice. This is a terrible compromise which will destroy small private practices. I have an outpatient clinic and I am hopeful my main referral sources continue to refer based on our expertise, great outcomes and costumer service. This is a sad day for private practice physical therapy in California. Despite over 11,000 letters from patients and private practices opposing this bill The CPTA is continuing to promote AB1000. Shame on the CPTA for selling out private practice.
    Posted by Michael Martines, PT, MPT, OCS on 7/10/2013 1:34 AM
    The PTs' that work in a POPS have an interesting prospective, worrying about their job security. I wonder if these POPS PTs' were as concerned when an autonomous PT in private practice gets driven out of business and files bankruptcy, all because the MD opens a PT clinic to improve his profit margin.
    Posted by John Twomey on 9/27/2013 5:28 PM
    Although there may be some fraud and abuse the real issue should be about quality of care and outcomes. I do not see how removing Stark exclusions is going to change that. There are other areas of fraud and abuse much larger than those that may misuse Stark. Each year CMS puts more (some would say burdensome) reporting requirements on providers to show QOC outcomes. Fair enough. The sad part in all of this is that those providers and therapists who provide quality care for and to their patients suffer at the expense of the few who take advantage of the (already flawed) system.
    Posted by Office Manager on 12/9/2013 8:36 PM
    This may be off the subject a little, but can anyone tell me where to find the latest on if a physican owned PT clinic can accept outside referrals? I am having trouble finding the latest info.
    Posted by b boyd on 5/4/2014 9:38 PM
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