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  • APTA Applauds New Legislation Seeking to Curb Physician Referral-for-Profit

    Mounting evidence that physician self-referral encourages unnecessarily higher use of certain services more than justifies the introduction of the Promoting Integrity in Medicare Act today in Congress.

    Rep Jackie Speier (D-CA) introduced the bill, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral.

    APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception. The exception—originally intended for same-day services, such as x-rays or blood draws, that are integral to the physician's services and convenient for the patient—has instead encouraged misapplication for financial self-interest. The result is overuse and hundreds of millions of Medicare dollars in unneeded treatments.

    A series of reports from the Government Accountability Office (GAO) is but one source of evidence that supports this claim. Two published reports have concluded that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO so far has investigated self-referral in advanced imaging services and anatomic pathology. GAO is expected to release a third report, on radiation oncology, any day now, and APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.

    "APTA strongly supports all efforts to eliminate self-referral situations and relationships that compromise patient access and quality or add cost," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "APTA has worked hard to reach a solution to close this loophole, and we are pleased to see this important legislation introduced."

    View APTA's Self-Referral webpage for more information and background.


    • This is a great effort by you guys.we in Nigeria delight to collaborate to strengthen our first line contact practice also.thanks

      Posted by ilesanmi oluwafemi on 8/2/2013 12:20 AM

    • When they force hospitals to decentralize and disallow them from forming monopolies I will go along with the idea. Right now, the Health Care Exchange process is producing a system where people in Maine will not be able to utilize independent physical therapists or even go to any kind of provider or hospital near to them. If they purchase their insurance through the health care exchange in Maine they will have to drive to a MaineCare facility in southern Maine. Referral for profit? I work in a small medical practice, and do so ethically. I am as ethical as any free standing PT, because I evaluate and assess every physical therapy patient. I develop the treatment plan and determine when and how often they will be seen. I collaborate with the other providers in the office as a peer. In fact, I am often called in during office consults as the "resident expert" because of my skill and knowledge set. We've seen dozens of people, briefly and at no cost to them, in three years and made minor recommendations that resolved their condition with no formal PT evaluation and no cost or inconvenience to the patient. This resulted in a significant savings to the patient and other payers. What about the private practice PT who sees every patient 3x/wk x 4-8 weeks? We all know it's possible to justify seeing a patient "one or two more times" to progress their home program and therapeutic exercises... even when maybe they don't need it. But we're encouraging private practice PT, despite the potential for unethical behavior? Because by and large we expect that people are going to be ethical. Some of the issue is also the specialists becoming involved, orthopedists and others, investing in PT providers and staffing with ATCs and even "aides" with a PT or two to "run things". Then seeing people 3x/wk x 12 weeks ad infinitum and billing for 60 to 80 service units of care in an 8 hour day. "The impossible day"... never happens in my practice and never will.

      Posted by Leon Richard on 8/2/2013 4:08 PM

    • Does this go far enough to for physicians from owning their own outpatient PT clinics? Many orthopedists have their own PT offices to which all patients are sent. Also does it have in it safeguards to force the large healthcare organizations to allow PT to go outside their entities. This too is inappropriate.

      Posted by Dallen on 8/2/2013 5:48 PM

    • Once again, the ATPA strikes out against POPTS with no data, no information, only assertations. If you want real data - see the following study http://link.springer.com/article/10.1007/s10926-012-9412-y/fulltext.html - which was published in January 2013 in the Journal of Occupational Rehabilitation, and studied over 70,000 worker's compensation patients and one of the findings was: "Patients receiving care in corporate physical therapy clinics and private physical therapy practices consistently had more visits and overall units of treatment during their episode of care than did the other practice settings addressed in this study." Further, review the MedPAC study from 2005: "The 2005 MedPAC Report found that (a) for all conditions, Medicare spending per PT patient averaged $653 in private PT practices, and only $405 in physician groups (for a 38 percent savings in physician groups), and (b) for PT patients with knee and lower leg musculoskeletal conditions, the average PT cost per Medicare patient was $874 in private PT practices and only $639 in physician groups (for a 27 percent savings in physician groups)." See full text of the article at Advance for Physicial Therapy and Rehab Medicine: http://physical-therapy.advanceweb.com/features/articles/another-popts-view.aspx?cp=3 The ATPA should stop spreading misinformation and untruths, and use current data and facts as evidenced by these studies. But then agin, that would not support the self-serving interested of the leaders of ATPA.

      Posted by Jake on 8/2/2013 5:52 PM

    • Thanks for keeping us up to date and the great work you do.

      Posted by Dan Walsh on 8/2/2013 7:50 PM

    • Alleluia! I hope this passes. It is long overdue. Pam Chaney,PT

      Posted by Pam Chaney on 8/2/2013 10:16 PM

    • I understand statistics in relation to medicare spending in POPST as outlined in the earlier comment, but spending results without being tied to outcome results are meaningless. Many patient will not complete their therapy if not satisfied and will look for other options after 3-4 visits of substandard care. Hence the early DC notices. Many patients will come to our office looking for solutions after exhausting a good part of their medicare cap allowance in a POPST. Very frustrating situation.

      Posted by Rudi Ide on 8/3/2013 9:50 AM

    • Too bad the California Chapter doesn't feel this way.

      Posted by Debbie on 8/3/2013 10:27 AM

    • Good answer! I see the same in my office. I hear often "they did nothing for me." Probably an overstatement but dissatisfied nonetheless. Our challenge is to continually educate our consumers that they have choices, that their responsibility is to be good healthcare consumers and to deliver outcomes timely so you become "their physical therapist" for all future needs.

      Posted by Gina on 8/3/2013 9:49 PM

    • I have a sincere question - as a new graduate, should I stay away from seeking employment in orthopedic physician-owned PT outpatient clinics if they are located in the same physical building? What about practices which are PT-owned but reside in the same building as an orthopedist practice and get 50-75% of their referrals from these physicians? If this legislation passes, how will it be implemented in the outpatient community? Could an APTA supporter of this bill please answer these questions - I am job hunting and trying to make the best choices for my future. Thanks!

      Posted by Elle Gannon on 8/4/2013 12:02 AM

    • hi Jake ( 08-02-2013) Your numbers are correct.In Physician owned and oprated physical therapy care is done by techs, quality and results are poor.No wonder charges per patient PT care is less. When independent physical therapist work for one hour 874 charges are justifiable because results are good patient does not come back for same conditions. In physician office patient get physical therapy for same condition under different diagnosis. In fact medicare pays more for one condition in physician office ( under different diagnosis).

      Posted by Deepak on 8/5/2013 9:32 AM

    • I work in a medical clinic that is owned by the in-house physician. He is a sports fellow and offers ATC and physical therapy services in the office. The physician also has good relationships with other physical therapy clinics in the area and always offers the patient the choice of where to pursue rehabilitation services. We are an ethical practice, and a very good one at that. If you want to find unethical practices, all you have to do is look to large, corporate, physical therapist-owned offices who bill the max number of units for every patient seen, regardless of need. The patient's from our physician's clinic have the ability to see whichever physical therapy group they want. They choose, key word-choose, ours because of the communication, cooperation, and collegiality that our office provides above the others. Our patient's receive the best care because all of the providers are working together on their case. I am a member of the APTA and appreciate the leadership and support they provide, but this is an issue where I disagree. The APTA and the majority of schools are closed-minded to POPTS. The opportunity to practice unethically is available to both POPTS and physical therapist-owned clinics. Ask good questions and research the clinics when interviewing, then make the best decision for yourself. There are good POPTS in our medical system that provide excellent rehab to their patients, it's time to stop the witch hunt.

      Posted by Detlef Maltas, DPT on 8/5/2013 9:59 AM

    • About time! Thank you!

      Posted by Alex Ivashenko on 8/5/2013 11:21 AM

    • Great Insite Detlef and Jake. I also work in a POPTS and we provide specialized and specific PT, working in collaboration with the physicians. Being called unethical because of the location where I practice is out of line. Our physicians always give their patients a choice depending upon where they live, but ~50% choose to come to me. I consider myself an ethical PT and have worked in non-POPTS where questionable practices were encouraged. I have a choice to leave those situations and provide ethical practice elsewhere. BCBS gives my a report every quarter comparing me to other OP PT in my state, and am continually demonstrating an A rating in cost effectiveness. In addition, I track pt satisfaction surveys and outcome scores to further demonstrate my quality of care. So, the proof is in the pervervial pudding. What flavor are you?

      Posted by Renee Hill on 8/6/2013 2:20 PM

    • Whether you are a PT; MSPT or DPT this will benefit all of us. Lets face it the reality stands that the Orthopedic surgeons have added ancillary services to their clinics once the reimbursements for their scope of practice services dropped a while back. In addition, while initially they only dealt with the easy high paying Medicare billing PT cases in direct violation of the Stark Law, and left out the lower paying HMO's and Workers Compensation,now they are after everything leaving nothing for some of us who dreamed of opening and succeeding in having a private practice as we rightfully and legally earned the right to do so by attending accredited programs. Considering that Workers Compensation was the only fair source of referrals based on quality of service and compliance for us to stay in business, since all the rest was absorbed in house by POP's and OP hospital clinics where these surgeons were affiliated to, now even this is eliminated since the Physicians have found a loophole to coerce the workers compensation cases to stay in house even though they are out of network. This is costing the state 3 times more then sending it to us. So when you mention that we are over charging and over utilizing think again. Now, there are good and bad in every profession but at least the consumer should have a choice to go where they choose to do so based on on line ratings, word of mouth and actual visits at our clinics, rather then being coerced. It is true, they do refer once in a while but only the left overs. Only the cases that the in house clinics cant handle due to the fact that these cases need too much attention which will limit their profitability since they cant squeeze 3-5 patients in one hour. By eliminating the POP's we all would have a fair chance and the entrepeneurship in this country as we rightfully are entitled to do so if we choose to pursue this path as US citizens.In addition we don't have to humiliate ourselves anymore by taking lunches to their offices which are consumed like vultures without even saying a simple thank you. In the end despite the fact that we present our credentials, flyers and business cards NO referrals are ever sent. Somehow it appears to be an epidemic since they always state "we are out of cards, we keep sending you all our cases". Its sickening. To the comment posted by Posted by Jake on 8/2/2013 5:52 PM Last week Align Networks "A large workers compensation group" dispatched a patient to our clinic since we are in network with them and through hard work and dedication we achieved a preferred provider status. When we tried to contact this patient which had a meniscus repair, he stated that the surgeon told him to stay at his clinic.We contacted the referral coordinator from Align Network which stated that this particular Physician was out of network for the Physical Therapy service. The claims adjuster was given no choice but to approve the out of network charges by this Physician. This is a shame because until this point we had a steady stream of referrals from this workers company group and now that this Ortho group started in house therapy services, our census dropped by 75% with a risk to close down and affecting all of our employees and their families as well as all the small local businesses that we dealt with for operating supplies. So if you want facts here are the facts. Blerim Dibra PT, DPT Private practice owner in Homestead FL

      Posted by Blerim Dibra PT, DPT on 4/6/2014 4:53 PM

    • There are some studies are for and others are against so the data is a wash. Ultimately it is the choice of the patient to choose who they see, it is as you say we all have rights. Anyone can start any kind of business they want in our country, that is part of what makes it great, but success in entrepreneurship is not a right it is something you earn.

      Posted by Hi my name is on 7/20/2014 8:53 PM

    • I am a PT who owns a small outpatient clinic for 26 years and I would like to comment on the topic of POPTS and referral for profit clinics. I have read two studies, one done in 1990-91 and one in 2005 who state that POPTS actually save money in costs per patient by approximately 38% over privately owned clinics. My comment to this issue would be this. If I were a PT in a POPTS clinic I have only so much space and resources to treat patients. Now, my referral source is 5 - 20 Orthos each doing 10 surgeries a week and with each doctor seeing another 25 patients 2-3 times per day in the office. Potentially I could have 15 - 20 new referrals per day to my clinic. I cannot envision a situation where I could see all of these patients in a timely manner and my bosses would not like me telling a new referral we can schedule you in 4-6 weeks from now, so, I could see the situation whereby patients number of treatments would be limited resulting in less cost per patient. I would like to see studies where the quality of treatments were studied. Were goals met? What do patient surveys reveal? If you want to do numbers how about examining how many treatments in a day are performed in a POPTS versus a Therapist owned clinic. My bet is that POPTS volume (number of treatments) is considerably more than 38% than my volume in a day!

      Posted by Eric on 12/12/2014 12:59 PM

    • I work for a POPTS, where 85% of my caseload comes from the Physician who owns the practice. The patient has a choice where they go, and I see anywhere from 8-11 patients a day (1 hour evals, and regular visits arriving each 1/2 hour. Our focus is on preventing surgery (MD's surgery schedule has cut down 50% in the last 2 years) post injury, and on optimal rehab post surgically (often with complicated and intensive surgeries). We send patients out to a therapy specialist when we cannot get the problem solved expeditiously and with excellence. We discharge as soon as the patient is appropriate to go to HEP, and without compromising ethics in any way. With reimbursements for therapy dropping every year, the MD who owns the clinic is satisfied if he just breaks even, so that he can get the best outcomes for his patients by having "in house" therapy. And I do believe that In house therapy is superior because he personally explains to me his surgery techniques/considerations, I have developed a full online library of best protocols for reference, I can pull up his diagnostic testing, his patient follow up notes, and ALL patient details needed. Besides that, the POPTS supports advanced certifications, degrees, and pays a good salary. Best job I ever had, and patients love coming here. The issue should be to cut down on clinics that over-use services, and defy ethics, not necessarily on the classification of where the services are coming from.

      Posted by Melanie Broome, PT, DPT, OCS, OMPT, CEEAA, Myofasc on 5/9/2015 10:12 AM

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