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Re: Physician owned P.T/O.T services
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Re: Physician owned P.T/O.T services - April 2, 2004 6:41:00 PM
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roger_depena
Posts: 1
Joined: April 1, 2004
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I have an idea, Why don't you ask APTA how to safeguard PT quality practices. In that way you can have full use of your dues.
In relation to the PT - MD issue, it doesn't really matter because all of us will be out of work in the next 10 years when Medicare goes down.
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Re: Physician owned P.T/O.T services - April 5, 2004 11:28:00 PM
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E-rehab
Posts: 2
Joined: April 5, 2004
From: San Diego, CA
Status: offline
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Having been in the profession for 15 years, seen the corruption of the MD's and POPTS practices, taking pride in rehabilitating patients for as few visits as possible, and hearing from our soon to be former referring doctors that they are opening a POPTS for the money, it is clear that the resurgence of POPTS clinics will do nothing but harm patients and PT professionals that have dedicated their lives to helping others.
It is always about the money.
Here are some references:
Mitchell, J., Scott, E., “Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
Swedlow, A., Johnson, G., et al, “Increased Costs and Rates of Use in the California Workers’ Compensation System as a Result of Self-Referral by Physicians,” New England Journal of Medicine, 1992.
“Joint Ventures Among Health Care Providers in Florida,” State of Florida Health Care Cost Containment Board, 1991.
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Re: Physician owned P.T/O.T services - April 6, 2004 7:14:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
Status: offline
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E-Rehab, I fully agree with you, however, the POPTS and other negative forces can only harm PTs if the PTs want to be harmed. PTs are a passive bunch and they do not want to move towrads to direct access as that is road to freedom. Yes, freedom comes with great costs and fear of the unknown namely lawsuits due to misdiagnosis or treatment. Also with the prior input by decent chiros that cash base business is a difficult one, however, direct access with cash base is ideal and I am ready for it. Now how do we instill this feeling in PTs?
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Re: Physician owned P.T/O.T services - April 6, 2004 10:02:00 PM
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E-rehab
Posts: 2
Joined: April 5, 2004
From: San Diego, CA
Status: offline
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Here are my opinions:
1. We have to view ourselves as being on a level playing field with MD's.
2. We have to work harder; therefore, meet the standards set before us that will allow us to be on a level playing field-the DPT. Key word being doctor!
3. Realize that MD's are no better diagnosticians than we are. I recall a conversation with a fellow PT who had his charts audited. Most of the diagnoses he received were "neck pain, back pain, shoulder pain, knee pain" with orders to "evaluate and treat". If that is not a concession to us PT professionals, I don't know what is. He said this was published as well. If anyone has a reference, I would appreciate it. We need to be able to recognize "red flags" and refer appropriately. Bill Boissonnault has an excellent presentation and text out on this subject.
4. Educate our own. The conversation previously is a prime example. Would you work hard day in and out, go to con-ed courses, take OCS exams, only to have an MD collect the rewards. Show me an MD that knows how to evaluate and rehabilitate a shoulder patient (they don't exist). Do PT's know that?
5. Stay focused. Evidence-based practice is the key. Without standards, we are left to our own discretion which leads to chaos (E-myth good quote). T Flynn has published some wonderful research on manipulation. We are just scratching the surface in many areas.
6. PT's need to continue to position themselves for success. As much as we may hate the dues, very few, including myself (but I am growing), understand what the APTA at the national and state chapters are trying to do for us. Only through knowledge and financial support can we move ahead. I support the APTA and so should all PT professionals.
7. Get board certified. Would you go to an MD that wasn't? Why are only 5% of PT's board certified?
8. The quality practitioners will survive. Isn't that who you want treating your family or friends.
9. Get involved. We have to educate the public about what we do. I challenge you to ask a random person on the street "what a PT does." Most have no idea. If they do know, it's through experience, but they only have seen one of the multifaceted skill sets that we bring to those with movement dysfunction.
10. Remain optimistic. We are going to lose 1/2 of our business to POPTS this year at our practice. My challenge is keeping all of the great staff I have the good fortune of working with. These challenges will spark innovation. We will be even better.
11. Network and support each other. There is strength in numbers. As a team we can share the workload and meet all the challenges that come before us.
That's what I am going to do.
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Re: Physician owned P.T/O.T services - April 7, 2004 11:06:00 AM
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PTPLUS
Posts: 50
Joined: February 12, 2004
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It has been really interesting keeping up with this tread since starting it…I think many good points and broad range of opinions have been given representing those of many therapist…from those who want to work for a POPT, to those who want them outlawed, to those who think Medicare will put us all out of work.
MONEY? Heck yea it is all about money. There is no shame in saying that. If you go out and ethically build a successful private clinic that makes you a good living then good for you. This profession is how we make our living so we can support our families, buy a house, etc. The more money we make the stronger the profession becomes. Why? We will have more disposable income for cont. Ed, professional organizations, and support of pro-PT issues. Heck, we can even afford to give some therapy away to deserving folks and do even more good in the world (you know like accept Medicare under part B). PT’s incomes have been on a steady decline since the mid-90’s. POPT’s keep the most profitable patients within the system, therefore reducing the earning potential of ALL PT’s.
I think whom you work for does say much about you. I have in the past worked for a large healthcare organization as an OP clinic manager, but would prefer not to work for a POPT. Some would say there is no difference, but I would disagree. Any organization that employees PT’s in such a way must put out a quality product to compete in a free market. They need highly trained, friendly, professional PT’s and will pay to hire and train said individuals. Where is this motivation for a POPT clinic? The referrals come no matter what, who, or how patients are treated.
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Re: Physician owned P.T/O.T services - April 7, 2004 1:03:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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E-rehab...dude, are you bitter? It sounds like someone p!ssed on your birthday cake (a physician) and now you are gonna get'em.
I fully understand your fire, but remember, not all Docs are bad. In a world where big business rules the day, shouldn't you be fighting for the little guy, regardless of title? It really isn't the APTA vs the world. Don't see yourself as the victim.
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Re: Physician owned P.T/O.T services - April 7, 2004 11:24:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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PTPLUS, you surely took the words out of my mouth! I was going to post that-working in a POPT you truly have no incentive to excel yourself as you are going to have a steady, good insurance (well paying) patients no matter what you do!!!. I recently had patient who came from a POPT clinic extermely upset and threatened to file a malpractice law suit where a PT aide (CMT) who did a forceful manual traction. This CMT is European trained. The MD had known that she has beginnings of osteoporosis. Now she has all the symptoms of severe C5-C6 disc with weakness and pain down her arm.
The MD owner settled with the patient with an unknown amount of money. The patient is contemplating surgery. This incidence in my clinic would be devastating as I am not owned by an MD and no gaurantee of repeat business no matter what kind of service I am providing.
Most POPTS I have seen are very well equipped as they are geared to see zillion patients . So most of these patients when they come to me after 1 year of not getting better say that the other (POPT) clinc is a great place for a workout but my neck pain is still not better. This is because the poor PT in the POPT never got time to work hands-on with the zillion minus one patient--who eventually landed at my clinic.
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Re: Physician owned P.T/O.T services - April 8, 2004 4:56:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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"Fight the fight to have appropriate personnel performing physical therapy services."
In an MD office anyone can perform so called physical therapy services as long as it is physician supervised. If a therapist really wants to work in this kind of situation (IMO) they should contract and not be employed by said physician. At that point you are your own boss and not influenced the powers that be. Any thought on contracting services?
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Re: Physician owned P.T/O.T services - April 8, 2004 8:46:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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May I ask what region everyone works.
It seems many of these businesses have regional variation.
Where I am from, there are virtually no Physician Owned Practices but a plethora of big coroporation PT practies
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Re: Physician owned P.T/O.T services - April 8, 2004 9:12:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
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Currently I'm in Dallas Texas where 3 ortho MD offices close to us have recently decided to go inhouse. TPTA is currently starting a taskforce to examine this situation and see what can be done to protect the independent therapist. Those opposed to POPTS need to get involved with their local associations.I know other states are starting to look at this as well.
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Re: Physician owned P.T/O.T services - April 8, 2004 12:27:00 PM
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PTPLUS
Posts: 50
Joined: February 12, 2004
Status: offline
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sjbird5>> I've actually held a position with a non-profit hospital group who ran a large number of PT clinics. All of the supervisors were PT's and expanding one's skills, showing proper cost-effective outcomes, and patient satisfaction were all part of the job. I know this type of job is rare, but they are out there.
TLB>>Contracting with docs could be a good way to go. Leasing space from a doctor could be a way to have a mutually beneficial situation between PT and MD. A good business deal is one were all parties involved improve income. That is why POPT is so bad for PT; one side improves income while the PT's generally work for less just to get to see some sports medicine, have a stable job, etc.
Dr Wag>>Work in a southern state. POPT's and hospital-based clinics dominate metro markets with competition from private practices of various sizes, usually providing more manual therapy than the others. Smaller towns and rural areas are usually served by hospital and private clinics. Large corporations such as HEALTHSOUTH are not big players anymore and seem to be losing market share.
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Re: Physician owned P.T/O.T services - April 10, 2004 3:53:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
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SJ,
Please think long and hard before accepting a position with a POPTS clinic. People who work in this kind of situation are taking a step backwards when the profession as a whole is trying to move forwards. Here's the APTA's position.
Strategic Plan to Address Physician Owned Physical Therapy Services (POPTS)
(BOD 11-03-06-15)
Goal I: Identify possible statutory changes to prevent physician ownership of physical therapy services
Objective 1: Coordinate with APTA Chapters in a focused review of state practice acts and
corporation acts.
Objective 2: Develop federal legislation to increase requirements that apply to physician owned
physical therapy services.
Objective 3: Develop model state practice act language options to prevent physician ownership of
physical therapy services.
Objective 4: Develop a “Take Action Packet” for APTA Chapters.
Goal II: Develop evidence of the harmful effects of POPTS arrangements
Objective 1: Cooperate with APTA Private Practice Section (PPS) on its survey on the experience of
its membership.
Objective 2: Evaluate the results of the PPS survey and the appropriateness of conducting a follow-up
survey of the general APTA membership on POPTS related experiences.
Objective 3: Improve intelligence gathering with state Chapters regarding POPTS related
experiences.
Objective 4: Attempt to identify situations where POPTS practices take unfair advantage of physician
control of referrals in order to limit competition.
Goal III: Identify opportunities for joint activities with other health care providers
Objective 1: Initiate outreach to and discussion with other health care providers who are experiencing
encroachment by physician owned services (hospitals, radiologists, clinical laboratories, home health providers).
Objective 2: Coordinate with state Chapters on local outreach activities with other health care
providers.
Goal IV: Educate the public and key opinion shapers on the value of physical therapy and concerns about how it is provided
Objective 1: Initiate focused activities to inform the public, the press, and other key opinion shapers about the value of physical therapy provided by qualified physical therapists who are not employed by physicians.
Goal V: Educate and increase the awareness of physical therapists regarding the importance of professional control of physical therapist services
Objective 1: Develop and distribute educational material to physical therapists to promote the value of
professional autonomy and of physical therapist ownership of practices.
Objective 2: Develop activities and projects that convey the message of the importance of
professional autonomy and control and integrate into APTA strategic plans and communications the principles of autonomous ownership and practice.
Objective 3: Educate physical therapists regarding the value and importance of state professional
corporation laws and state practice acts and how to understand and utilize those statutes
to promote autonomous ownership and practice.
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Re: Physician owned P.T/O.T services - April 10, 2004 7:26:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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I once worked for a practice owned by someone who was not only a non-PT, but a non-clinician.
BAD NEWS!
New grads, take some advice here:
NEVER work for a non-PT
NEVER sign an employment agreement, or contract. In fact, get ANYTHING that needs to be signed viewed by a lawyer first.
Be VERY wary of non-compete agreements.
Be VERY wary of clinics who have a few old-timers and no one else whose been there for more than a few months.
In my recent experience, non-PT owned clinics do NOT have the best interests of the patient, nor the professional employee at the forefront of their minds. Questionable practice is RAMPANT in this type of environment, and by the time you realize it, you're knee deep in crap.
DO NOT be so nieve as to think that we can all just "get along." That's EXACTLY how those in the helping professions, with excellent morals, ethics, and intent, get taken advantage of by professional vultures.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited April 10, 2004).]
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Re: Physician owned P.T/O.T services - April 10, 2004 2:30:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
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Do the POPTs typically pay their therapist well or do they tend to pay the local average? Is there a disparity between what a POPTs staff PT makes and lets say privately owned PT clinic staff therapist?
Army
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Re: Physician owned P.T/O.T services - April 28, 2004 9:57:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
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As any small clinic/group would emphasize, pay should be market driven with incentives for longevity and certainly partnership opportunity. It simply is not a get rich opportunity, so having quality therapists with incentives for part ownership only makes sense...a Physician gives the capital up front, with a buy-out agreement (for part ownership, not to end contract) as the clinic prospers.
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