|
|
Physician owned P.T/O.T services
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Physician owned P.T/O.T services - March 24, 2004 9:28:00 AM
|
|
|
PTPLUS
Posts: 50
Joined: February 12, 2004
Status: offline
|
I have not seen a discussion of this topic on this site yet. What do you think good, bad, need to be outlawed, best job any rehab guru could want, whatever? Also include any thoughts on multi-disciplinary clinics that could be interesting.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 11:55:00 AM
|
|
|
Ron
Posts: 105
Joined: January 8, 2001
Status: offline
|
Not really enough info. Is the Doc an investor, passive owner, working owner. Same building, seperate buildings.
full owner?
Therapists employed, contracted?
Lots of red flags with this type arrangement especially from the standpoint of Stark /State laws.
Present a scenario and I am sure you will spark a discussion.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 12:39:00 PM
|
|
|
mato_tom
Posts: 89
Joined: June 20, 2003
Status: offline
|
the stark and the state anti kickback laws are a joke.......stark was so watered down the end rule has no effect on physician ownership.......the antikickback laws are good to have and enforceable but are dependent on whistle blowers to weed out the crooks, + anyone with a decent attorney can find ways to make a "mutually beneficial" relationship legal........
I think POPTs and multidisciplinary clinics in the current legislative environment, are the future of our profession......if we ever get true direct access this will change
As much as i wish that PT would own the profession and become truly autonomous, i think it is a good idea AT THIS TIME for PTs to be "hooked up" with physicians, whether employed, leased, or renting space.
unfortunately we are not in a power position in these scenarios, and while some PTs will be able to carve out an ownership or partnership role, the majority wont. Simply because the physician, or more than likely, the physicians accountant/legal team know the laws and know how to set up a business structure that increases the physicians bottom line. With reimbursement for physician services declining the revenue can be made upo elsewhere. Ancillary services that are now common place in doc offices, like lab, diagnostics, PT are revenue producers and convenient for the patients, a "full service" one stop shop.
I dont think most PTs will wake up and notice the spread of POPT's until it gathers momentum outside of orthopedic surgery and physiatry. How many of your local orthos have gone in house PT in the last 3-5 years?
look around and count how many family practice, neurology, pain management, and podiatry offices offer in house PT...very, very few.........count again next year.
again, i dont think POPT is evil so long as they use licensed PTs, which not all do because they dont have to, which sucks.
and i do believe there are many fine PTs out there who are doing great in this environment and will continue to do just fine even as POPT spreads.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 1:10:00 PM
|
|
|
PTPLUS
Posts: 50
Joined: February 12, 2004
Status: offline
|
Ok here is a scenario: most of the orthopedist, neurosurgeons, etc. and many other related M.D.’s in a Metropolitan area are forming “groups”. I am sure this is/or has happened everywhere in the country. As a part of these groups a rehab center is operated that is owned 100% by the physician group and investors. These rehab centers are staffed largely by newer graduate PT’s OT’s and ATC’s who make bottom pay since these clinics handle most of the sports medicine/orthopedics over a large area and this is a desirable area for many rehab professionals to work. Actual quality of patient care varies clinic to clinic but all are based on high production “cookie cutter” type therapy that at least in theory should make the clinics hugely profitable for the investors. The practice act of this state actually states it is illegal for any therapist or therapy clinic EXCEPT those owned by a physician, hospital or nursing home to pay a physician for referrals.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 2:39:00 PM
|
|
|
mato_tom
Posts: 89
Joined: June 20, 2003
Status: offline
|
im assuming in your scenario that the doc office and rehab are all under the same roof....if not, then there will be a big legal problem if they are seeing medicare patients...
if the doctors own the PT why would the PT pay the docs for referrals....perhaps you mean he is profiting from the referrals, which is just fine and is standard business practice with just a few hoops to jump through for medicare compliance and antikickback compliance......i believe new york state is the only state that has laws that are particularly friendly to independent PTs....if there is anyone in NY here, is this correct?
as far as the cookie cutter, use ATC's, PTAs and new grads modus operandi ...this is no different than the healthsouth, corporate owned PT approach....
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 4:47:00 PM
|
|
|
j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
|
Mato_Tom, I'm a bit confused about your comment:
"As much as i wish that PT would own the profession and become truly autonomous, i think it is a good idea AT THIS TIME for PTs to be "hooked up" with physicians, whether employed, leased, or renting space."
It seems most PT's are not currently employed, leasing or renting space from MD's. Am I right that you are suggesting we should be? If so that would seem to stand in contrast to your position on direct access and your comments in a thread regarding DPT...
"basically in pushing forward on direct access we are potentially biting the hand that feeds us....we have been and still are getting fat off the referral system controlled by the docs and they obviously have opposition to us getting direct access.....the rise of POPT and the games played with reimbursement on the federal level(caps and such), certainly make me wonder about the future supply of patients and i think if i had direct access i could compete very well against those that now "control" my access to patients"
Wouldn't encouraging people to be in POPTs and virtual POPT's make progress toward direct access more difficult?
Since my writing skills are limited (and grammar even more) my tone may not be conveyed. These are honest questions, not accusations disguised as questions.
Thanks, jon
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 24, 2004 7:05:00 PM
|
|
|
mato_tom
Posts: 89
Joined: June 20, 2003
Status: offline
|
Jon...im not really suggesting anything, the thread asked for opinions on POPT....but you made excellent points and you are exactly right.........i am saying 2 different things and perhaps it could only make sense to a fellow schitzo....but here it is.........one point of view is based on MY perception of reality, which is the expansion of POPT and the power of the referral process, and the other is based on what i would like to see happen, what i think PT is ready for, and that is true direct access(eval and treat without referral and get paid thru insurance), which i feel would allow us to greatly expand our business possibilities.... I'm not saying its a done deal and everyone is going to POPT and PT owned OP or even corporate OP is doomed...there are many, many fine practices that are thriving in the current environment, and will continue to do so......my take is on the future and in the immediate future, pre - true direct access there will be opportunities with physicians whether thru employment, leasing space, contracting, or best scenario, partnering...because physicians are getting into the PT game by the boatload, and who can blame them,,,compared to lab and diagnostics , etc the overhead is low.
for the record i do not think we need to be a DPT to be able to provide true direct access....we are ready now.....the DPT is a bargaining tool to get there, a hoop to jump through(my opinion only)...also for the record, just to confuse you more, even though i think its a fine idea for PTs to participate in POPT as they see fit, i would support any legislation to ban them.
you ask..... would increased partnering and working for a physician delay/stall true direct access....i dont think so.... what do you think?
does that make sense??
basically on one hand im saying take advantage of the opportunities that present themselves now........but fight for and expect even more opportunities in the future....
[This message has been edited by mato_tom (edited March 24, 2004).]
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 25, 2004 10:16:00 AM
|
|
|
Ron
Posts: 105
Joined: January 8, 2001
Status: offline
|
So what happens with POPT practices when we get direct access, ( I am optimistic) don't think I would like to be in a POPT arrangement. I would think collectively and as a profession, looking forward, that we would discourage POPT
I also stand by the fact that the POTENTIAL for ethical issues arises in these practices
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 25, 2004 4:39:00 PM
|
|
|
j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
|
It seems that most professionals would like some sort of stability. If someone went out and purposely employed themselves in a POPT they may hesitate to actively participate in legislation against it.
While it may be (economically) pragmatic to be in a POPT it seems philisophically flimsy to lobby against them while employed in one. Imagine a white civil rights activist that takes full advantage of the prejudices of the time while marching for equal rights. It's absurd. One should figure out which side of the issue they are on, especially if they are advocating to others how to act. I think mato_tom was simply musing that it is economically advantageous to be in a POPT. Ultimately POPT's would be minimally controversial (I think) in an enviornment of fiscally recognized direct access. That is, direct access recognized by insurance as we would no longer have financial need to team up with MD's.
Rather, the MD/PT relationship would be based more on functional communication. And at that point a POPT would facilitate that.
Sorry about this next digression, I don't mean to get too far off topic but it seems relevant. Perhaps direct access would be more politically acceptable if PT/MD communication was provided for when the patient comes to the PT via MD referral. I say this because when an MD specifically refers to PT, we are part of the MD's plan of care and the MD should be kept in the loop (similar to us delegating to PTA). When a patient comes to PT out of the blue, then we are not part of the MD's plan of care. This would release the MD from liability I would imagine. This would seem to be a win/win. The MD is assured of communication when sending patients to PT and isn't burdened with paper work or liability when the patient goes on their own.
jon
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 25, 2004 5:46:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
I have no idea how popular or dispopular this makes me, but I have full intention of being part owner of a PT clinic with my best buddy (a PT) in the near future.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 25, 2004 6:05:00 PM
|
|
|
mato_tom
Posts: 89
Joined: June 20, 2003
Status: offline
|
[QUOTE]It seems that most professionals would like some sort of stability. If someone went out and purposely employed themselves in a POPT they may hesitate to actively participate in legislation against it.[/QUOTE]
i see your point....but its the same internal argument we have now whether POPT or otherwise...we are dependent on the referral relationship we have now while at the same time some of us are actively fighting the need for it..... i accept and appreciate referrals, because it pays my bills, but i still the think the sytem is stupid and i hope it changes. I personally have not and will not hesitate to support legislative change , but you wont see me telling my referral sources that i dont need or want their referrals. When i do start getting direct access patinets that may need meds or diagnostics, i will send them to the folks that reciprocate. Basically i dont see much difference b/w working for a PT or working for a POPT, or working for yourself in private practice, like i am, we are all dependent on a doc referral for income, its all the same to me.
[QUOTE] One should figure out which side of the issue they are on, especially if they are advocating to others how to act.[/QUOTE]
I know what side of the issue im on, both [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG], and i am much too selfish and concerned with myself to give a rats ass how others act...and , im not advocating anything, im expressing an opinion, food for thought, sparking conversation.
[QUOTE]While it may be (economically) pragmatic to be in a POPT it seems philisophically flimsy to lobby against them while employed in one. Imagine a white civil rights activist that takes full advantage of the prejudices of the time while marching for equal rights. It's absurd.[/QUOTE]
imagine being someone who loves animals, but indirectly supports their pain and suffering by eating them......imagine being someone who is a fiscal conservative who hates big govenment and is sickened by the death spiral into socialism that is gripping their country, while at the same time gets 95% of their income from medicare.....i could think of a hundred other examples of "hypocrisy" and absurdities that describe me and if you are honest you could do the same for yourself...the fact is, on the continuum between realism and idealism, i am very much a realist, almost to a fault. I could see where someone who is mostly an idealist would struggle with the thought of using a POPT for their gain while rallying against it. Oh well, Not my problem.
[QUOTE]I think mato_tom was simply musing that it is economically advantageous to be in a POPT.[/QUOTE]
it COULD be economically advantageous, and you may have some level of security knowing that this doc is NOT going to stop referring to his own clinic. Im saying its an option.
[QUOTE]Sorry about this next digression, I don't mean to get too far off topic but it seems relevant. Perhaps direct access would be more politically acceptable if PT/MD communication was provided for when the patient comes to the PT via MD referral. I say this because when an MD specifically refers to PT, we are part of the MD's plan of care and the MD should be kept in the loop (similar to us delegating to PTA). When a patient comes to PT out of the blue, then we are not part of the MD's plan of care. This would release the MD from liability I would imagine. This would seem to be a win/win. The MD is assured of communication when sending patients to PT and isn't burdened with paper work or liability when the patient goes on their own.[/QUOTE]
communication is a given particularly when you get a referred patient. when you get a direct patient, it sure the hell isnt going to hurt you to rip off a short blurb to the patients primary care doc or whoever they see, to keep them in the loop......and if the patient is not progressing after 3 -4 -6 visits,, whatever, send them off to the doc and make sure the doc knows that you sent them....we dont need to be a solo island, we need to be in the chain of islands like we already are, we just need to be the first island sometimes.
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 25, 2004 11:55:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Hi all. I just received this today in my clinic. A family member was back visiting the states, was seen by an orthopaedic group for her back pain, she then returns to my clinic and hands me this.
[IMG]http://img28.photobucket.com/albums/v85/brennerak/PTsheet.jpg[/IMG]
My only experience in a civilian clinic was when I was a student in San Antonio, TX. If you are a PT working at a POPT, is this what to expect? Can you believe this, it says 12-15 sessions of ultrasound. Is this the typical POPT? If so, this would be hurting our profession. Shame on the therapists who accept to work and treat like this.
Army
[This message has been edited by ArmyPT (edited March 26, 2004).]
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 26, 2004 12:31:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
[QUOTE]Originally posted by mato_tom:
I think POPTs and multidisciplinary clinics in the current legislative environment, are the future of our profession......
i think it is a good idea AT THIS TIME for PTs to be "hooked up" with physicians, whether employed, leased, or renting space.
again, i dont think POPT is evil so long as they use licensed PTs, [/QUOTE]
Tom,
A POPT like this is NOT the future of our profession. This is like taking a step back to the 1980's and 1990's when most therapist would just treat exactly how the physician sees fit, even if it has been shown not to be efficacious. Look at this script. 12-15 sessions of ultrasound for a questionable diagnosis??? I could accept an evaluate and treat, but these little PT prescription pads are a joke. This is obviously a money making tool.
[IMG]http://img28.photobucket.com/albums/v85/brennerak/PTsheet.jpg[/IMG]
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 26, 2004 2:28:00 AM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Unless I've missed something, isn't US and TFL stretching the evidence-based standard of care for greater trochanteric bursitis?
Granted, 12 to 15 visits is excessive, but what MD really knows that? My guess it that it's an authorization maximum.
FYI, I grew up in Owings Mills and know these guys --- be careful what you post.
Drew
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 26, 2004 2:52:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 26, 2004 2:57:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Good point Drew. I don't want to upset any POPTs. Why not let the PT evaluate and decide the best treatment. I evaluated this patient this morning, no signs even close to trochanteric bursitis, but if I worked at this POPT I would probably be ironing her hip even as we speak, and for the next couple of months. Fun.
Army
|
|
|
|
|
Re: Physician owned P.T/O.T services - March 26, 2004 4:00:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
I think Drew is on the money here...The Doc is writing for the authorization max, does not necessarily expect all visits to be used, but offers them.
If the patient does NOT appear to have trochanteric bursitis upon your visit remember, perhaps the presentation to the physicians office is completely different. I can guarantee you that when patients leave the PT clinic and present to the Dr.'s offics, their stories change as well...just like their subjective pain information.
Communicate with your referral source, I would appreciate a call from the PT.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Physician owned P.T/O.T services 
