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Re: Physician owned P.T/O.T services
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Re: Physician owned P.T/O.T services - March 26, 2004 4:21:00 AM
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Alex Brenner PT MPT OCS
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Joined: February 29, 2004
From: Kentucky
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SJBird,
Thanks for you insight. I have learned a lot about civilian PT since coming to this site. As far as this civilian consult, I have received them in the past but usually do not pay too much attention to them unless they are specific instructions for a post op. I thought as a civilian you were bound to treat as they say. Why do they have them in the first place? Who would want to conduct physical therapy like that?
Army
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Re: Physician owned P.T/O.T services - March 26, 2004 4:28:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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Drew,
You saw the script before I deleted it. Would you accept this or is this acceptable in your eyes? Even if they choose an appropriate treatment in addition to the amount if visits wouldnt you want to do a good unbiased physical exam and decided how to treat this patient?
Now help me out here becuase I am not sure about civilian practice, but could you do anything else with the patient besides the US and soft tissue work without consulting the physician? What if you felt that the hip pain was from her L-spine. Could you treat the L-spine how you see fit and ignore the ordered US treatments?
I am not civilian, but I am willing to learn. Will they send me some place special? (Quote from the 1980's movie Stripes)
Army
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Re: Physician owned P.T/O.T services - March 28, 2004 9:30:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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The new Stark laws just came out. APTA's email came which suggested the new revised laws. I
have'nt had time to read thru, however, if someone on this thread has read them..then I would appreciate any info.
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Re: Physician owned P.T/O.T services - March 29, 2004 6:35:00 AM
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mato_tom
Posts: 89
Joined: June 20, 2003
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it does not appear that much/anything has changed with respect to DHS and the ancillary services exception......the language and rulings make things easier to understand/follow(believe it or not).....as far as PT is concerned,it is now even more evident that the stark laws have done nothing to stop/limit POPT and referral for profit..there are enough loopholes and exceptions to drive a 5000 sq ft physican owned clinic thru.......not that this is the end of the world for independent PT, there is significant opportunity for us in this environment......it would be interesting to keep a running tab on the # of physicians and specialty types that begin to offer PT services in the next 6 -12 months
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Re: Physician owned P.T/O.T services - March 29, 2004 10:08:00 AM
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Ron
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From the CMS website
The new regulations will protect Medicare and Medicaid beneficiaries from potentially abusive referrals, while accommodating legitimate business and financial arrangements, including those that enhance the emerging national health information infrastructure," said CMS Acting Administrator Dennis Smith. "Overall, there shouldn't be any additional burden on physicians trying to structure their business arrangements to comply with the law, and the regulations will not prevent doctors from continuing to provide high quality health care services to their patients."
The physician self-referral law prohibits a physician from referring Medicare and Medicaid patients for certain designated health services to entities with which the physician (or a member of they physician's immediate family) has a financial relationship, unless an exception applies. The law also prohibits an entity from billing for services provided as a result of a prohibited referral. There are eleven designated health services to which the prohibition applies, including clinical laboratory services, physical therapy services, including speech-language pathology services; occupational therapy services; radiology and certain other imaging services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. A financial relationship can be either a compensation arrangement or an ownership or investment interest, and it can be either direct or indirect.The statutory exceptions addressed in this second phase include those for physician investment interests in publicly traded securities and mutual funds and physician ownership of rural providers and hospitals. The new regulation revises the hospital ownership exception to reflect the new 18-month moratorium on physician ownership of specialty hospitals, which was recently enacted in section 507 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003).
The new regulations also interpret a number of statutory exceptions for compensation arrangements involving physicians, including the exceptions for space and equipment rentals, employment relationships, personal services arrangements, and physician recruitment.
Regarding the employment exception
CMS eliminated a proposed restriction on productivity bonuses, making it clear that physician employees may be paid bonuses based on their personal productivity (but not referrals for ancillary services). The new regulations contains a new provision that deems certain hourly payments to physicians to be consistent with fair market value, a key requirement for most compensation arrangement exceptions. CMS also expanded the recruitment exception to apply to physician recruitment conducted by federally qualified health centers (FQHCs).
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Re: Physician owned P.T/O.T services - March 29, 2004 6:17:00 PM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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One big problem with PTs is that we seem to feel bad about standing up for our own interests. I think every PT should be against POPs. In my experience they take lots of business from PTs who want to own their own practices and they are not known (at least in my area) for offering good PT services!
I work in a PT owned clinic that prides itself on individual hands on care and has a great reputation in the area. The clinic was very busy (been around for 20 some yrs) however, many local MDs have opened their own PT clinics. There are also 2 major ortho groups in town (about 95% of the surgeons) and they have there own clinics. Now our clinic struggles and we only get close friends and family members of these MDs (because they know we are better)
If we do not stand up for our profession who will?
More cost of education + less money and independence= intelligent people stay away from PT
This weakens the whole profession. We need to attract smart ambitious young people and if there is little or no opportunity to own a clinic it will be very difficult to attract higher quality people into the profession!
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Re: Physician owned P.T/O.T services - March 31, 2004 7:15:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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Afetr seeing all the POPTS in my area, I thought, why not PTs hire MDs i.e. change the structure around. I wonder how this would work legally. If it is legally possible then as mato
suggets we as PTs still have a future in the POPTS world. I have hunch that PTs cannot hire MDs as MDs have always put themselves up on a pedestal as legally in my state MDs can hire anybody and can legally do anything allopathic or alternative medical they can make money on.
Any comments?
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Re: Physician owned P.T/O.T services - April 1, 2004 4:45:00 AM
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Dr.Wagner
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Joined: January 24, 2003
From: Indianapolis
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Since when did I become the "bad guy...the man...scum" simply because I am a physician? I see such strong words with little to back it up. No proof. If I opened a POPT, I do it purely to maintain quality and to have the therapists I know and trust working with the same goals in mind...the more many of you speak, the more I realize how abrasive many PT's can be...purely to prove a point. While many of you stand on a tree stump and preach the'evils' of POPT, GIGANTIC corporations run multiple clinics than span states!!! Sorry, but isn't that a bigger evil??
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Re: Physician owned P.T/O.T services - April 1, 2004 5:54:00 AM
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mato_tom
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very well put, bird. POPTs are not inherently evil and i agree with doc that corporate owned PT is much much worse. Unethical, illegal behavior is not profession specific, it is people specific, and in big companies it can be part of the culture, but still the individuals are responsible.
working for a POPT as a PT, like i said before, is a good move, for many reasons. All the recent rulings coming down fom CMS/HHS with respect to PT are, whether purposely or not, designed to expand the choices of BOTH PTs and Docs.
Their are many ways to make a POPT mutually beneficial to both, PT as employee, PT as leasor of employees, PT as manager, PT as partner, etc...the last 3 may take a PT that does not want to be stuck in strict "employee" mode, which is an issue in our profession that is changing slowly. Dont get me wrong, there is nothing wrong with being an employee and avoiding all the hassles of being a small business owner.
and yes, A PT can employee a doc and accept referral from them so long as the docs compensation is of "free market value"
The rest of the issue is of course pure money and politics, and this is where is gets cloudy.
PTs including me, want to own the profession. When someone gets PT, I want the provider to be licensed in PT. For all there knowledge, a doc, PA, NP, CNS, do not have this, but under CMS they are able to both provide PT and they are able to supervise the provision of PT as provided by any living breathing person with a pulse they deem fit. This is the wrong that must be corrected first IMO.
PTs like I said before are getting more and more into private practice, and we want more and more opportunity to make money. Who could possibly argue against the fact that if POPT were banned their would be more opportunity for private practice PT. And there would be less money available for the doc to make.
So lets not kid ourselves, the major factor in the battles b/w all health care professions is about money. Our organizations can spit out words like pt safety, and patient access, and blah blah blah,, but i pay my dues so APTA can go to DC and find a way for me to make more money, directly or indirectly, period. Anyone who says any different about their organization is lying, or canadian(ha ha just kidding [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG])
doc, you should'nt feel attacked personally, one of my best friends is a physiatrist. I pay APTA to go to DC to get me direct access, he pays the AMA to go to DC to prevent me from getting direct access.
its nothing personal, its life...he just has to be careful when i serve the beer [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
[This message has been edited by mato_tom (edited April 01, 2004).]
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Re: Physician owned P.T/O.T services - April 1, 2004 7:10:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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SJ:
I did make generalizations and not all POPs give bad care. But, in my area, they are not known for quality care. My info comes from patients, PTs who used to work there and from the fact that the MDs tell there friends and family to go other places. I am not saying that PT owned practice don’t have some of the same problems but, it is much easier to market against bad PT’s.
What am I supposed to do, go up to the MD and say we give better care than your clinic so stop sending pts there and send them my way. There is no way they are going to do that.
My problem with POPs is more a finacial issue not a treatment issue.
I look at it as a monopoly. They control referrals so they can easily crush any competition. Moving sounds very easy but in our area I would have to move more like 1-2 hours away not 15 min. We did take steps and we now have a clinic in a medical building. The MDs do not own us we rent space from them. Why can’t this solve the problem of convenience for pts and easy communication with MDs. It works very well in our situation.
I wish all MDs were as ethical and responsible as Dr. Wags. You are right that corporate owned PT practices are a big problem. It is very similar to POPs and as a profession we are against and fighting to stop both!
Patient care aside, I think that PTs should stand up for each other. If a POP is running a colleague out of business, I should fight for them and be on their side. Because this can easily happen to any of us. The problem is that many of the PTs who don’t own their own practices just don’t care.
If we get true direct access (including insurance coverage) we will at least be able to compete with the POPs some!
[This message has been edited by arufa (edited April 01, 2004).]
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Re: Physician owned P.T/O.T services - April 1, 2004 7:17:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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Mato
Very good points.
It is not personal. I don't get mad at my wife because the med society is trying to keep me from getting direct access and she is a member.
Professions stand up for there own interests, even when it is just for a financial reasons. There is nothing wrong with the APTA doing the same!
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Re: Physician owned P.T/O.T services - April 1, 2004 5:07:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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I suppose I feel a certain way because I am both a PT and a Doc. I have seen many sides of the same story. What I AM FOR is the small business man/woman. Regardless of a Dr. or a PT it is SMALL business and NOT corporate business that sees the patient as more than a number. Even Tx:Team (one of the sponsors) is big business. It is a savvy way to get their name out, but they care no more for your professional development than does PhyAmerica or HealthSouth.
Whether a PT is direct access doesn't affect me anymore than if a Massage Therapist has direct access...it really, in the long run is virtually pointless and is little more than an APTA agenda. They have falsely made it important. It is no more than "keeping up with the Jones's"...not a bold move. A bold move would be stating across the board CORPORATE MEDICINE AND THERAPY IS BAD.
Do they do this?
Who are the board members?
Who are the past presidents?
Where is their allegence?
They are pulling the wool over decent intelligent therapists eyes. Don't buy what they are selling.
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Re: Physician owned P.T/O.T services - April 2, 2004 8:20:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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No the world is not fair, but I expect the APTA to fight so I can have more autonomy and not have to worry about MDs running me out of business. On the other hand, I expect MDs to fight for their right to have POPs just as hard. That’s the game and because the MDs have more money they will always (most of the time) win. That’s why I broke down and married one (if you can't beat them, join them)
Like I stated before, there is great communication between the PTs at my clinic and the MDs who own the building and supply us with 90 plus percent of our patients. A ban on POP would make arrangements like ours more prevalent. It benefits the MDs because they get rent and us because we get to own our business.
With that said, I do understand the draw of more money, less headaches and more financial security that a POP can provide.
Dr. Wag, I am pretty sure that the APTA has come out and said corporate owned PT practices are bad!
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Re: Physician owned P.T/O.T services - April 2, 2004 10:41:00 AM
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moneyinthebag
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Joined: April 1, 2004
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why don't you study medicine and get an MD. then you can have your own variety of services. in that way you don't have to whine about lesser profit. not all popt's give poor quality services. if you know of one, take action, correct it, or report it. you don't need your association to fight for you, you can do it yourself.
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Re: Physician owned P.T/O.T services - April 2, 2004 4:16:00 PM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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I am not "whining about my lesser profits" And I am not saying that all POPs give bad care! And I do expect the APTA to stand up for the best interests of Physical Therapy and Physical Therapists! That is why I pay my dues every year and that is their primary role.
If I wanted to be an MD I would be. I want to make a living as a PT!
And please give me some advice on how I should go about correcting poor pt care in other clinics (whether they are POP, PT owned practices or corporate owned)
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Re: Physician owned P.T/O.T services - April 2, 2004 6:22:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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POPTS limit or discourage PTs from being their own business owners. If every PT starts thinking about how can I improve my financial independance then every PT will want to have their own practice.PTs in general are a very complascent lot. They are happy with a 9-5 job, see x number of patients, feel good for the good deed they did for the day and go home. This feeling PTs have is the greatest limiting factor in achieving financial freedom. Only 10 patients per day multiplied by approximate $70.00 per visit is equal to $700 per day..that comes to approx.$200,000.00 per year with a few better paying insurances. So my PT friends, the "quality conscience" MD who is wooing you to join his POPT is going to squeeze $200,000.00 out of you. And all the equipment he has bought to entice you is all a tax write-off and his CPA is very happy as he has taken his tax-advantage advise. The middleman in every business makes the most money, here the MD is the middleman. So every positive argument I have heard for POPTS is wrong. They stiffle competition and that is why Microsoft is in an anti-trist hot soup with Sun micro. When a privtae PT practice hires a PT to work in their clinic, it is a different situation..the new hire is working with their own lot for the improvement of their own kind. I am a private practice owner and I have a PT with me who I am going to give profit sharing. I think every PT should be rewarded in accordance with their efforts in improving the business. Most POPTS are owned by ortho and neurosurgeons..these guys make hefty sums in doing their surgeries...PT is just the icing on the cake.. to afford a luxury yacht or vacation homes in exotic places. Ethically and morally it is insanely wrong when a good PT has to either close down or move just because the MD can afford to make his alimony payments as is ex-wife is used to a rich lifestyle, or have a house in Hawaii (real instances in the lifestyles of the rich and famous POPT's personal life. So SJ..my blood just boils when PTs want to go work for POPTS..just as my blood boils when I hear PTs fighting to get HMO contracts which pays one time of $150.00 per capitated rate.
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