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  • Obama Budget Would Eliminate Medicare Physician Self-Referral Loophole for Physical Therapy

    President Obama's federal budget proposal would close the loophole that allows physician self-referrals for physical therapy services—a change long supported by APTA that would improve quality of care and lower Medicare costs.

    If adopted by Congress, the FY 2015 budget would eliminate exceptions that now apply to physical therapy, radiation therapy, anatomic pathology, and advanced imaging. The Office of Management and Budget estimates that closing the loophole for these services would provide a savings of just over $6 billion over 10 years.

    APTA has held that in addition to fostering costly overuse, the exceptions compromise patient care and choice. In a press release, APTA President Paul A. Rockar Jr, PT, DPT, MS, said that APTA "fought long and hard" for the elimination of the exceptions. Rockar added that the Obama proposal "would save the country billions in unnecessary Medicare expenses and, more important, protect patients from being used as pawns for profit."

    APTA Private Practice Section President Tom DiAngelis, PT, DPT, was quoted in the same press release saying that self referral has an "abusive financial impact," and that "as health care providers we work and interact with patients every day. When physicians self-refer, patients feel as though they aren’t in the driver’s seat when it comes to their own care.”

    The specific exceptions would be eliminated from the Stark self-referral law, a policy that was intended to prevent physicians from making referrals for certain health services payable by Medicare to an entity with which he or she, or an immediate family member, has a financial relationship. The exceptions to the law were carved out for in-office ancillary services (IOAS) that could be quickly administered for patient convenience, such as routine lab tests or x-rays. The problem, according to APTA and other groups, is that the exceptions have been broadly applied and now include self-referral for physical therapy services well beyond original intent.

    APTA has advocated for the elimination of physical therapy from the exceptions for years and is a founding member of the Alliance for Integrity in Medicare (AIM), a consortium of organizations focused on eliminating the IOAS loophole. In addition to APTA, the consortium includes laboratory, radiation oncology, and medical imaging groups.

    APTA strongly urges Congress to follow the recommendations laid out in the Administration's budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception. Find out more about this issue at APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.


    • Hopefully we can get some leverage so the MD lobby doesn't get this aspect dropped off of the budget.

      Posted by dano napoli on 3/4/2014 5:28 PM

    • As an OT looking in from the outside, this is a huge victory for not just PT (and OT/SLP as well), but especially the patient. Patients should be able to establish a long-term and sustained relationship with the PT of their choosing, much like how the very same patients do so with their MDs. Its comforting to know that this change could foster these relationships in the future.

      Posted by Dan Martin OTR/L, NMT on 3/5/2014 12:04 PM

    • These are slanderous and incorrect assumptions. As a practicing orthopedic surgeon and hand surgeon for 20 plus years I am involved with both therapists that are independent and therapists that are employed by me. Our patients choose where they want PT or OT and their choice is respected. We find having therapist in our office that work side by side the MD is very efficient and benefits the patient. Immediate splinting, and immediate teaching of exercise protocols are available. Interaction and collaboration on patient care is more conducive when therapists and physicians are together. Independent physical therapist do a great job as well but the communication and timing is more difficult. Cost abuse is not just seen in a minority of physician owned therapy practices. Beware you may be biting the hand that feeds you. I would suggest you team up with physicians as providers of health care and together make changes in Obama care that truely help patients and are not for self interest. Respectively, Henry Backe,MD

      Posted by H Backe MD on 3/5/2014 11:11 PM

    • There are a large number of "incident to" rehab services being done in MD offices with licensed PT staff. This would mean a large loss of jobs and opportunities to work side by side with MDs. I find that the team multidisciplinary approach works better in my practice. In my opinion and from many rehab articles I have reviewed PT services are very UNDER utilized, which makes sense since MDs do not have physical therapy courses or training (unless in DO school). From my experience most physicians/mid levels do not screen for rehab needs. I have first hand experience with this doing chart review in MD offices and working side by side with MDs. For the most part I find it difficult to get MDs to refer PT even when the need is strong. I have met and worked with hundreds of physicians and I do not know any trying to drive excessive and unnecessary rehab for profit. It seems that one bad apple spoils the whole country to this as being something common, when it is not.

      Posted by James Lee -> =IX^>M on 3/6/2014 10:07 AM

    • This is excellent potential news; however, it is kind of like closing the barn door after the horse gets out. Currently the trend is less POPTS and more hospital ACO's where the hospital buys the physician practice then requires the physicians to refer to the hospital ancillary services. Just as severe of a problem for private practice PT as well as for patient choice and quality.

      Posted by Chris Goodwin on 3/6/2014 10:25 AM

    • As a PT who has worked with a physician group for years, I find it interesting that self-referral is such a target when it stands to reason that if the IOASE goes away, you're going to see more ancillary services shifted to hospital settings where costs have shown to be higher. If ancillary services are no longer options for MDs, you'll see more physician practices selling out to hospitals or large networks. Good luck getting a referral out of a hospital or network system. You think POPTS is bad, just wait until you start fighting HOPTS. Our group gladly refers patients to outside PTs if patients request to follow-up with a PT outside of our practice. One other thing: at our location, we spend time focusing on patient care and patient outcomes. We haven't had to spend time on marketing efforts. If the IOASE is removed and we set up a private practice, I can guarantee we will not only continue to be supported by our former employer (the MD group), but we will also be aggressively establishing relationships with the other MDs in our area who we have heretofore not been able to market. A change to the status quo will have a ripple effect that I don't know if many have really considered.

      Posted by Robert on 3/7/2014 4:23 PM

    • In response to the comments posted by James Lee and H Backe, I would be curious to know how many of the PT working in MD offices are really "incident to"? Many PTs working for physicians are individually enrolled with payers as PTs, billing under their NPI # and assigning payment to the physician or physician group. If this does finalize these PTs and those that do actually work "incident to" can continue to work collaboratively with physicians as private practitioners. I don't see this as a job killer.

      Posted by Sandra McCuen on 3/7/2014 6:03 PM

    • As much as I see this as a win-win for both the therapist (based on a more level playing field) and patients (fewer visits based on the MedPac analysis from previous years), I believe that until unrestricted direct access occurs, we will still be treated as technicians instead of professionals. Regarding POPTS, I have many complaints regarding inequality, with the first being that the therapist employed in that specific setting does not have to be licensed in order to treat Medicare patients. Although the hand surgeon reports that his patients are free to attend therapy in a clinic of their choosing, this statement is not true for all physicians which own PT services. A former IPTA president once said that PT's are not allowed to own physician practices, but physicians are allowed to own PT practices. This again returns to the point that are profession, at this time, is still considered a paraprofession. Although the abolishment of POPTS is a step in the right direction, more has to be done to legitimize PT.

      Posted by Vince Gutierrez on 3/7/2014 6:20 PM

    • Why can't a patient choose to go to a therapist associated with a physician? So long as the services are provided by a licensed PT, as a licensed PT I have no problem with it. I work in a medical practice. It is a primary/urgent care center with a strong walk-in population. I spend much of my time consulting with the other providers during their appointments. At times it results in a warm handoff to me. Other times it results in them being advised that they should seek out a physical therapy provider, and they are given a written referral to bring with them. At no time is anyone pressured to utilize me or my services. If I saw that happening, I would have to leave the practice. Patients' right to self-determination is very important to me and I am unable to participate in any situation I view as unethical.

      Posted by Leon Richard -> AJSa@O on 3/7/2014 6:31 PM

    • Stop with the self serving nonsense? What do you MDs and PTs (working for MDs)who come on here think YOU are doing? MDs? Sorry. Your gravy train of self referall for profit is coming to an end. Threaten to bite the hand that feeds? Really? I suppose we'll find decreased referrals for PT services once you are cut out of it, but a good many of them were probably bogus, uneccessary referrals to your own service anyway. You know how many honest involved MDs there are in an MD/PT "incident to" setting? Near zero. I've heard this argument for 30+ years. "It's convenient", "we get to work in conjunction with the MD", yada, yada, yada. I know MDs who have had their own PT places for 10+ years with a connecting door, and have never ONCE set foot in them, let alone worked "side by side" with their PT in delivering care. And you PTs, fear not. You won't be out of jobs long. The decent private practices and other patient sites in your town will be hiring. You won't be out of work long, but you will probably take a cut in pay from your inflated trumped up salaries earned off the backs of patients and the Medicare program. The monopoly needs to end. The strict control over patients and the PT marketplace needs to end. These incidents are true and factual. I have personally had patints tell me that if they didn't go to their Mds PT department, they would have to find a new doctor!!!! I've seen MDs write out charge slips with $295.00 on them for a consult, they order PT then the patient says they have their own PT, the MD takes the charge slip back out of the patient's hand, crosses out $295 and writes in $395!!!! If that doesn't spell out the greed and nonsense that is going on, I don't know what does. Since when does an MD with his thriving PT practice need to order a double set of hand carved exotic rare wood doors for his home at a cost of $60,000? Answer: Anytime he wants, because he can. He has a thriving PT pracice with loads of MTs, OTs, PTs lavishing all kinds of uneccessary care on his patients. It's about as wasteful as wasteful can be. The true heroes here are the PTs who have successfully competed against this unethical and often times criminal behavior for years. Do you lazy PTs who work for MDs have any idea just how GOOD you have to be to survive and thrive as a PT in business under these circumstances? No, you wouldn't. You'd better start boning up though. And put a resume together, you're gonna need it.

      Posted by Mark1PT on 3/7/2014 6:45 PM

    • I understand the concerns that drive APTA to pay attention to physician self referrals, but as a therapist employed by an orthopedic surgical group, my experience is that the autonomy in our practice is absolutely respected, patients are in no way disuaded from seeing any therapist they choose, and no unnecessary referrals have come to us. The quality of care patients receive and responsiveness of our referring providers to patient concerns are superior to any independently owned clinics I have worked in. Having a close working relationship with these providers improves outcomes and has improved the phsician's understanding of physical therapists' value and expertise, an added benefit to the profession

      Posted by Marla Crago on 3/7/2014 7:28 PM

    • Physical therapists working for physicians or having offices in physician buildings etc. would not be a problem if patients had unrestricted direct access to physical therapy services. Take away the 3rd party payer's requirement for MD oversight of therapy plans of care and this would allow for fair business competition regardless of who employees the therapist or where the therapy practice is located.

      Posted by Ryan on 3/7/2014 8:31 PM

    • I think it is great that some feel working for physician groups fosters a close working relationship with physician referrors. I would prefer a professional and collegial relationship with physicians and improve the communities' understanding of our knowledge and expertise. Be prepared to stand as a profession with your profession

      Posted by Bryan O'Halloran on 3/7/2014 10:23 PM

    • To H Backe, MD Really?!! Slanderous?!! I compete against over 150 orthopedist physician owned physical therapists on a daily basis. They are spread between the three dominant Ortho surgeon groups in my area. On top of that I have to compete against the hand surgeon office, the neurologists, and the OB/GYN groups that all own, and like the Ortho surgeons, exclusively refer to their own PTs. Presenting your patients "a choice" of where they will go is a farce. As they will almost always choose to go where their doctor tells them that "they can keep an eye on the rehab". Now that the GPs are joining the hospital umbrellas to secure better reimbursement, they are contractually required to utilize only the services in their hospital groups. No referrals to be had from these folks either. I have watched my referrals from physicians decrease, as those same physicians derive profit from referring to PTs they employ. It no longer matters what the outcome is for the patient, rather only that the doctor's practice not suffer any "leakage" of lost revenue from referrals made to outside their organization. This budget proposal from President Obama will change nothing. His last was defeated 99-0 in the senate. This one will likely suffer a similar fate. The future of independently owned PTs is to make the case to the patients who fail our of the POPTS facilities. Thankfully, there are many. Direct your marketing to the public and away from the physicians. They stopped caring long ago about your patient results. Faced with decreasing reimbursements of their own, they decided to capitalize by earning profit on the backs if their employed PTs. Build a practice on capitalizing on their vast limitations. Jack Keller, MS, PT

      Posted by Jack Keller, MS, PT on 3/7/2014 10:26 PM

    • As a physical therapist, I understand the challenges faced by those who work both in a private practice MD owned facility and those who work in the "real world", as Mark1PT boldly states "it isn't easy in the real world" and with the healthcare standards changing every year and mounting budget cuts I agree...it is important to make things more efficient. However, having worked in all of these different settings, I will say the unjust over billing issues are every where, to say that PT practices aren't based on monetary gain is ridiculous. I currently work at a MD owned private practice and feel it is a superior level of care and the communication is greatly enhanced. Our patients always have a say in the care they receive and may go elsewhere if they wish. That is part of providing accommodations and services to the community that is professional and respectable. The MD's in our clinic, as well as the MD's who refer to us are very reasonable and leave it up to the LICENSED physical therapist to determine the appropriate plan of care for each patient given the results of the initial evaluation. In my opinion I would agree that many MD's usually under refer in our practice, more so than I have seen elsewhere.

      Posted by Joshua on 3/8/2014 1:35 AM

    • I take great offense at the comments made by Mark1PT. I have been a PT for 20 years. I have worked with a physician owned practice for the past 7 years. I am a Fellow in the American Academy of Orthopedic Physical Therapists, I have taught in graduate and post graduate courses, I take over 200 hours of con-ed annually. Many of my patients pay cash and wait 4 - 6 weeks to see me--by choice! There may be physicians and PT's who abuse the physician owned practice setting, no more I suspect, than PT owned practices who have aides teaching exercise, who add ultrasound and e-stim to pad bills, who see 3 or 4 patients per hour, etc. I am well paid, I am treated with respect, I practice autonomously regarding who I see, how I treat and for how long. Please save the insults. You're welcome to spend a day with me and observe how I practice.

      Posted by bob baumgarten on 3/8/2014 1:43 AM

    • That's nice Marla but why do you have to be employed by the ortho group? Why can't the same set up work equally as well if you owned the therapy practice down the hall vs being an employee? Why can't PTs and MDs work together without one profession owning the other?

      Posted by Dean B on 3/8/2014 2:07 AM

    • These individual positive experiences with referral for profit are not the norm. Repeated research has shown referral for profit is costly and not in the patients best interest. Use some logic & think about it..do you want your physician referring you for any reason other than you needing the care? Thank you APTA! Keep it up and let us all know what we can do to help

      Posted by Eric on 3/8/2014 7:37 AM

    • To Bob B, If you have such a following, why settle to have a secure referral source? Take the risk like I have for 20 years and see what type of following you have. These are all excuses to get easy money. Maybe the reason they wait for weeks to see you is because you and the MD are telling them that they have to- by the way, those pts are paying cash to the MD, not you!

      Posted by Scott W on 3/8/2014 8:33 AM

    • People, people, people. Please listen to yourselves. Anecdotal evidence is fine, but it is still anecdotal. I am SURE the are POPTS that are fine. But, the evidence is that it is NOT fine--in more cases than not, the referral process is corrupted and that is why insurance industry and OIG research demonstrates that these relationships increase the cost of care. I am seeing a patient on Monday who when to a POPTS--he questioned my office administrator for 10 minutes about what would happen when he was seen in our office because his experience was so bad. When he told the referring physician that he was told, "in that case, you should go to this clinic because they do a much better job." The patients complaint is "why didn't he send me to the 'better' clinic in the first place." Anecdotal, I know. As for communication--I get texts and phone calls from doctors that want to talk to me. In the 1990s before POPTS invaded Atlanta, it was 2-3 times/week. Today it is 2-3 times PER YEAR. I send notes regularly--never get read. I have closed 4 clinics because of POPTS. I have always been told our clinics offered superior value. So, why would I have to close clinics. Anecdotal, I know. In truth, I would love to work in conjunction with physicians in an Accountable Care Organization where the incentive would be a superior outcome, not increased revenue. I am waiting for that to happen as I believe I am the most cost effective provider in musculoskeletal care and in that environment I would thrive.

      Posted by herb Silver on 3/8/2014 12:17 PM

    • First I do not believe that the President’s Budget will pass and all of this is an exercise in futility. I would like to share with you just few of the many incidents that I have experienced with a POPTS in my Private Practice. First one of my patients was told when she requested to see me that she had to see that groups PT practice. The patient then reluctantly went for her first treatment and was very unhappy deciding not to continue. On her follow up with her MD the next week she had her husband with her, who in the end had to step in to stop the MD from attempting to force her to go and continue with his PT. That MD then reluctantly gave her an Rx to take to us for treatment (Extra cost to Medicare for a second Evaluation). After her course of PT she was seen for a follow up by this MD who then asked the patient how I was doing prior to questioning her about her own condition and status. In another case we were referred a work comp. patient through a Therapy provider network. The patient was seen for an Evaluation and when the MD received the POC refused to sign it and raised a fuss with the referral network causing us to lose that patient to his own PT practice. If this is what I have experienced with my small practice I could only imagine to what scale this is actually going on.

      Posted by John on 3/8/2014 1:34 PM

    • selfreferral just lubricates the physicians pockets since the restrictions in reimbursement continue to bemore and more restrictive-the bull that it enhances care due to proximity to the doctor does not exist-all it is is a well oiled money making machine to fund the pockets of the physicians -altruism does not enter into it.why would the doctors put up such a battle if it were for communicating with the therapist for better care.Also it leaves the therapist little prerogative to treat without charge if the patient needs the care and independent therapists do, NOT have quotas that they have to meet.

      Posted by harry m.brafmann,p.t. on 3/8/2014 1:36 PM

    • To reply to Scott W...again I'd ask why go straight to insults. It does nothing to bolster your argument. My patients are not "told" anything, they are explicitly given a choice of PT's both by myself and my MD's , an entire page filled with options. Many are returning patients, many are patients who've failed rehab at other clinics, most remark on the amount of time I spend with them (45 minutes one on one) and the fact I don't have an inexperienced aide working with them (as I was forced to do in both private practice and in the hospital outpatient clinic. I don't find my money to be any "easier" now than when I worked either in private practice or in hospital based setting. I work hard for my patients and hard for my money. Perhaps you could refrain from slander when you present your side. I choose not to open a practice of my own out of desire to focus on patient care not on running a business

      Posted by bob baumgarten on 3/8/2014 8:51 PM

    • I have worked in both the Private PT setting and the POPTs settings and the truth is there is a great potential for abuse in both settings. In the POPTs practice I worked for we chose not to see Medicare patients to avoid undue scrutiny. Medicare patients often begged us to come to our clinic because the poor care they perceived they experienced at privately owned clinics. The truth is I often was forced to see 4-6 patients at a time in private practice during prime times. Was that ethical? Was that good patient care? How many of those practices over utilize just the same as some POPTs. Why is the issue of POPTs so important to the APTA? Because the APTA has always been run and largely influenced by private practice ideology. Why is private practice pushing this so hard? Because at the end of the day its all profit driven. Don't think for second it's about the patients best interest. Those bonuses and incentive pay are directly tied to profit. The APTA has a double standard and if this was not the case why not go after HOPTs (who by the way are often owned by Physician Groups through investment or other means and directly benefit from those referrals) with the same passion as POPTs? You ask, why do you have work for a POPTs, and I will ask why can't I work for a POPTs when it was run more autonomously and ethical than the private practice I worked for? Stop being so self righteous and let patients decide where the best care is in their local area!!! It may surprise you!

      Posted by Jason on 3/8/2014 10:53 PM

    • I am a PT. This is another bad decision by the APTA. Another bad decision by Obama. It won't save money, and will hurt more PT's, rehab professionals, and patients than they realize. Please stop pushing agendas and vote smarter people into all offices of government and professional governing bodies. Then maybe we can start fixing some problems.

      Posted by Tony C on 3/10/2014 3:04 PM

    • Having previously worked for a POPTS facility, I can only use the example set forth during this course of employment. If the MDs tell their patients that they must see their owned PTs, then I have a problem with that. If PT is offered in a MD facility with no mention that they must perform these services in house, then by all means, carry on. In my experience where patients were told "go make your appointment right here" or "we want you to go here" and don't OFFER other alternatives, that is just plain WRONG. Reverse the situation ...If I hired a MD in my facility and told patients that they could only see my team of physicians, how would the rest of the independent MDs in the community react? I can guarantee they would be as unhappy as the PTs are now who deal with this on a daily basis. Can't quite understand why this is so debatable.

      Posted by Tracy Urvater on 3/10/2014 11:22 PM

    • I have no respect for the APTA. Their only focus is pushing legislation for the benefit of private practice. There are just as many ethical issues related to providing physical therapy for profit (PT owned settings) as there are to referring physical therapy for profit. So, the only answer is regulation to the point that all PT services are controlled by ACO's. Our profession should focus more on ethical practices. Very skilled, ethical PTs work for large hospital organizations, physican owned practices and private practices. I'm also quite certain that PT is abused in private practices, hospital organizations and physican owned settings. I believe that the APTA should be fighting for the ability of every PT to be able to continue to choose the setting they prefer rather than lobbying for limited choices. Everyone for this policy should see that once for-profit referrals are limited, the next step would be for-profit services, right? Is more legistation, regulation and restriction really what you want?

      Posted by Kari on 3/11/2014 10:47 AM

    • I have worked in an area with 2 large physician-owned practices for 6 years. If I had a dime for every patient who told my colleagues that they were told by their physician that they had to go to their therapists, I would be a very rich person. I have seen established patients in the middle of a course of care come in and say that their physician told them they would not continue to see them unless they started receiving care at the physician's practice. I have had family members and friends see a physician and during the visit they are strong-armed into scheduling a therapy appointment at the physician's own practice. Whenever I have inquired of the offices whether the patients are given a choice, I am told that the physician would never restrict patient choice, that it must be some rogue person in their front office. Nonetheless, it happens -- again, and again, and again. I have seen physicians who historically did not order therapy for their post-operative hip patients because they claimed it was not necessary, then suddenly begin referring the patients to their own practice once they employed therapists. I have also witnessed inpatient discharge notes written by physicians that specify that a patient must receive therapy at their practice. Meanwhile, case managers at the local hospital are required to present all community providers equally to patients when assisting them with discharge therapy planning. Many regulatory eyes are on hospitals and their affiliated practices. How many regul

      Posted by Jen on 3/12/2014 9:35 AM

    • In more cases than not referral for profit is not good for patients, certainly not cost effective and reduces the professional status of Physical Therapists most of whom now have doctorate degrees. What is the point of long and very costly education, a DPT after your name and finally a law permitting direct access to our services. Doctors do not own drug stores and ownership in a physical therapy practice is no different. In my view Physical Therapy is a noble and independent Health care profession and should not be "owned" by any other profession. And to respond to Kari-we often need legilation to force us to do the right thing-example discrimination.

      Posted by Judith Hurley on 3/12/2014 4:16 PM

    • In more cases than not referral for profit is not good for patients, Not cost effective and reduces the professional status of physical therapists most of whom now have doctorate degrees. What is the point of long and costly professional education resulting in a doctorate degree and why do we finally have a law permitting direct access to physical therapy if we are going to work in a POPTS? Doctors have never owned drug stores and they should not be able to self refer for physical therapy services. To answer Kari's post there are time when legislation is the only way to get us to do the right thing. Example "DISCRIMINATION".

      Posted by Judith on 3/12/2014 4:57 PM

    • The only way to really fix this is to put everyone on a reasonable salary. PTs, MDs, hospital administrators, insurance execs, EVERYONE. The problem is fee for service, much more than the setting in which we work. Call me a socialist if you want, but sooner or later we need to take the "business" out of healthcare.

      Posted by Real fix on 3/14/2014 1:05 AM

    • To Mark1PT, I must say you are painting with a very broad brush. Your comments are very narrow-minded. I will say this, though. It is therapists like you who we will target if and when our situation changes. Presently, we can't market other physicians in the community. Furthermore, our MDs give our patients a choice, although most prefer to come to us because, in our market, we have better outcomes than the private practice and hospital clinics. However, if for some reason the IOASE goes away, I can promise you our MDs will not be near as likely to refer to these other therapists and we WILL be marketing our services to the other referral sources in our market who, to this point, we have not even touched. You better be careful what you wish for or you just might be sending me YOUR resume.

      Posted by Robert on 3/14/2014 4:06 PM

    • For 30 years I have heard and experienced all sides of this argument. To be clear there is good and bad care in all settings. The worst abuse I have seen however is from the private practice setting. The private practice setting has more motivation to see the patient longer and bill the patient more and at time for services that have not even been delivered. What the APTA should be doing is working with the AMA to have to Physicians and PTs work as colleagues and yes in the same offices. If you are an employed PT someone else is always going to be making or at times loosing money on your labor. That includes Physicians, other PTs ie owners of the private practice, hospitals, SNF, HH etc. PTs as a group sometime act like a bunch of entitled brats.

      Posted by Harry on 3/19/2014 1:05 AM

    • I have worked in every setting possible and currently am in private practice. I left a physician owned group for the mere reason I was asked to see patients that did not require PT services. When I refused to do so, my salary was cut. I realize there are stories everywhere but I can assure you in the area I work ALL of the physician owned groups are excellent physicians but the therapy is lacking at best. If the laws do not allow for partnership, then there should be no employer-ship-period. There was a reason Stark laws were passed. The employer relationship does not change what used to be the partnership. Physicians need to keep being physicians, chiropractors being chiropractors and physical therapists being therapists. And according to the OIG the worst abuse on more than 1 occasion has been found in the physician ownership setting. This can not be disputed.

      Posted by Jeff on 3/31/2014 3:42 PM

    • This is a truly stimulating debate. What amazes me is to see medical doctors responding on a PT article web page. This in addition to the numerous PT's who are employed by them and feel threatened by the potential change. The profession of PT is evolving into an autonomous practice based on the level of education and growth in our curriculum model. Consider it as the child who is now growing to a healthy responsible adult. We have established our own identity and should be allowed to pursue full independence without requiring oversight by a medical physician who often has no idea what physical therapists are capable of. If a medical doctor believes in the value of having a physical therapist onsite to improve communications and quality of care then why not establish a professional relationship and allow PT's to lease space or time in your office, and be independent practitioners who fully control the billing of their patients. This can be done without any financial gains from PT sessions going directly to the physician. It would merely be a professional referral . In a fantasy world this could be possible but the reality is physicians want full control of that pie and this is why they fight to maintain the billing power for providing these services in their office. To be continued...

      Posted by Matthew St.Aimee, PT, DPT on 4/7/2014 3:13 PM

    • For those of you that enjoy being used as slaves , and like to be considered third class citizens in the hierarchy of healthcare delivery, enjoy this moment because it will end soon!! We will surgically remove the loophole that is keeping us from prospering. To Dr. Rockar and Dr. Diangelis thank you for pushing hard. Now let's focus on changing the verbiage of our practice act. Ultimately this is how Chiropractors won the battle against the AMA. Let's not re-invent the wheel let's learn from others that won this battle a while back. You never see a Physician owned Chiropractic practice due to the fact that they are recognized as Physicians. This is where our issue is! We raised the bar for the DPT level but didn't change the practice act to match the level of education. Let's push harder then ever before!! We have the numbers, drive and intelligence to beat this!!! The battle has just started!!

      Posted by Blair on 4/7/2014 9:02 PM

    • I have been a physical therapist for 21 years and a private practice owner for 10. Some of the physicians owning therapy clinics in our area are to the point of rabid to keep "their" referrals. A nurse I know who worked for a large Neurology group told me if they didn't refer to their therapy clinic or dissuade patients from going to other clinics they would be fired. There is rampant abuse in our area by greedy physicians/groups. It is so bad one orthopods out right tells patients they will go to XYZ physical therapy owned by him. My practice is doing well. I built it on quality service and outcomes. Patients want results and happily tell others who get referrals for our services. But when physicians out right obstruct patients from going where they want it is time for the system to change.

      Posted by Charles on 5/29/2014 4:58 AM

    • I have owned a private therapy clinic in Austin for 7 years and am an OT specializing in hands. I think that the stark laws were passed for a reason and I do think that we are not very well respected. Often the physicians see us as some sort of tech or replaceable office person (I have worked for a POPTS and when I questioned a very strange patient bill I was immediately let go by ironically one of the biggest opposers in the state of Texas to direct access to therapy). I do wonder why physicians don't worry about participating in businesses that are based on an abuse of a loop hole in a law that was simply meant to prevent the POPTs from even existing. Doesn't that put the therapists employed by the POPTS and the physician at risk? It's a house of cards and one law suit or mistake and everyone in that situation could LOSE THEIR LICENSES. I say this as someone who has talked to an OIG agent. Those POPTs are usually under investigation for something. PTs working for physicians really aren't very safe nor are the physicians that own their asses. Does no one even care about the stark laws? Incident two billing turns out to cost 1.5 times more than the bill for a stand alone clinic by the way. POPTs are very very expensive. The POPTs needs to end to protect all of us and the future of our professions. We need respect, we need to know our future is not one of abject poverty, and we need our licenses to be protected.

      Posted by Emily on 8/13/2014 4:32 PM

    • Bob Baumgarten, I am impressed that PT's working at your POPTS clinic see patients for 45 minutes sessions with one-on-one. That's impressive and I am happy to see that, but just know that is definitely NOT the norm for POPTS. I have worked at some, interviewed at some, and talked with people who have worked at POPTS, and contrary to your situation, they are PT mills. I got the sense on my interview that they wanted a warm body that new how to make charges. When observed their clinic, patients were literally sitting around waiting to get there few minutes of 'hands on' time with the therapist. I'm sure there are some good PT's working at these clinics, but how good can you be when you have to see 30-40 patients a day. In one that I worked at, I couldn't remember who certain patients were at the end of the day in trying to finish documentation because I had seen so many; they spent most of the time with the tech while I was juggling and bouncing from patient to patient. I overheard patients asking the tech questions about their condition that should have been directed to me; I tried my best, but impossible with all the patients that I saw. I find it insulting that POPTS think that that is what PT is about. We are capable of so much more but it is impossible to give good therapy that way. I do not want to run myself into the ground just to make physicians more money. You don't even have time to use your manual skills that you have spent time and money to obtain. Billing for POPTS and hospital corporations is WAY more expensive than a private owned clinic. They get reimbursed significantly better than private clinics. Why do insurance companies do that? If they want to make some budge cuts, they might want to do away with some of that. I am excited to see those therapists who have made the leap and gone into cash-based practices. Massage therapists do it, personal trainers do it. Why can't we? To quote something I read that I felt makes a good point, "Historically, PTs have not aggressively entered the cash pay arena, preferring to maintain their long-established dependence on insurance reimbursement and MD referrals. As a profession, are we allowing other fitness and healthcare professionals to define us by marketing directly to the public with similar messaging to our own? Can we afford to stay in the cycle of referral-reimbursement, and now, what are our options?" Being a cash clinic that does not take insurance can be a solution, though it is not for everybody. But it can be answer for those who are sick of bouncing from patient to patient; there are therapists who are doing this successfully in states that do not have direct access as well. Patients pay more per hour for ~1 hour of quality one on one time and no time with a tech. As a result, patients are getting better quicker.

      Posted by Debbie on 10/21/2014 9:50 AM


      Posted by JOANNA on 7/25/2016 5:18 PM

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