• Friday, March 21, 2014RSS Feed

    APTA Contributes to FTC Discussion on Consumer Access

    A March 20 and 21 meeting of the Federal Trade Commission (FTC) examined activities and trends related to cost, quality, access, and care coordination that may affect competition in the US health care industry. APTA representatives attended the event and provided pre-workshop comments (.pdf) that pressed for greater patient access to physical therapists (PTs), the elimination of physician self-referral, and expanded health care networks under the Affordable Care Act (ACA), among other issues.

    The meeting, "Examining Health Care Competition (.pdf)," was attended by APTA staff and included panel discussions and presentations on the professional regulation of health care providers, measuring the quality of health care, and the interplay between quality and price transparency, among other topics.

    In the pre-workshop comments submitted to the FTC, APTA President Paul A. Rockar Jr, PT, DPT, MS, wrote that even though some form of direct access to PTs is allowed in 48 states, certain state restrictions enacted for political reasons are an obstacle to effective treatment. These restrictions, which include visit caps, time limits, or rules about the number of days a PT can treat before referring a patient to a physician, "are not based on evidence, clinical need, patient safety, or the best interest of the patient," Rockar wrote.

    Rockar also described to the FTC how physician-owned physical therapy services restrict trade and limit “the consumer's right to choose his/her physical therapist," a limitation that the consumer might not even perceive, "as no other option is offered." Other portions of the letter urged the FTC to work toward expansion of health care provider networks to include nonphysician providers, and to carefully review new models of service delivery such as accountable care organizations (ACOs) to ensure that the new systems do not disenfranchise patients by limiting choice.

    The association will also submit follow-up comments after the workshop.

    FTC's meeting follows the release of a policy paper (.pdf) that questions regulatory frameworks that it feels limit consumers' ability to seek treatment from Advance Practice Registered Nurses, particularly by way of restrictions on independent practice. In that paper, agency analysts propose that limited practice scopes and burdensome requirements for physician supervision or approval effectively dampen competition and leave consumers with fewer choices, a situation that "can have serious health and safety consequences."


    Comments

    Thanks for the efforts - right on the money with this one.
    Posted by dano napoli on 3/21/2014 3:40 PM
    I run a Physical Therapy clinic associated with a primary care medical practice. The options to go to another provider are always presented. If they were not, I wouldn't be able to continue my relationship with the clinic. I am fully cognizant of the ethical issues involved in a "POPT" clinic. I am also cognizant of the ethical issues involved in discharge planning for an independent PT. One who has no economic reason to discharge a patient when the opportunity presents itself. But who will increase his income if he sees a patient 1-2 more times... even if it's not "totally necessary". When someone can demonstrate to me that a thief won't be a thief when presented with the opportunity, I'll concede that nobody can be trusted to be ethical. In the meantime, we're all professionals with a fiduciary relationship with our patients and payers and can be trusted to fulfill those responsibilities appropriately.
    Posted by Leon Richard on 3/21/2014 4:13 PM
    I agree this is right on. And not only are insurances and laws lagging behind to the evidence, patient needs, safety, what's best for the patient, etc, but so are policies and procedures of clinics, hospitals, SNF's, etc. Even in those states with legitimate PT practice acts. Think policy and procedure is based on evidence, patient centeredness, cost control? Keep dreaming. It's based on a SNF's bottom line, pressure from referral sources to do what the "doctor" wants despite ignorance of rehab and physical therapy, history, brainwashed and non critical thinking people, nonsensical/baseless/projected/fabricated feelings and beliefs.
    Posted by Burton Ford, PT, DPT, OCS on 3/21/2014 10:40 PM
    Leon, I appreciate your comments. The problem is Medicare is going broke. These ancillary exceptions were put in place only b/c it was determined that the PT visit was and integral part of the MD visit which it is not. I have been in private practice for 15 years and I can only speak for our area. I will tell you that you would be the exception in this area. It's not just PT but a lot of other things as well. Problem now with all the hospitals buying up PCP's the patients will get even less of a choice. I have close friends who are in these arraignments and are required to document why they referred any service to a non-network provider. Happens with insurance companies too.
    Posted by Dano Napoli on 3/24/2014 4:14 PM
    The problem with the POPTS argument is that they don’t impact as much as the hospital systems that do the same thing in regards to self-referral. Hospitals (with help from ACA & ACO models) have been decreasing the number of POPTS anyway by purchasing physician practices, many of which that provide therapy. I have heard many occurrences of patients not given the choice here as well. But I hear mostly about the POPTS. How can there be a level playing field when these hospital systems have no co-pays with the same insurance plans that the PP therapist is in-network with but has to collect $20-$50 from the patient out of pocket every visit? How fair is it that hospitals get inflated rates from private insurers that the PP therapist cannot even get a seat at the table to negotiate? POPTS is blown out of proportion compared to a bigger elephant in my opinion.
    Posted by Jason on 3/25/2014 3:58 PM
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