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Re: "Medical" diagnosis? Isn't PT diagnosis good enough?
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 2:40:00 AM
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SJBird55
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Currently there isn't proof that we are cost effective. Yes, insurance companies have data and there has been a supposed increase in utilization of PT services - but that isn't necessarily the case because chiropractors and physicians can use the same codes that physical therapists use (and with some payers speech therapy is lumped in with physical therapy - don't ask me how). The other aspect to consider isn't just cost effectiveness but also the outcome of the service. Insurance companies do not track the change in function (nor do most providers of care utilize those types of tools).
Not all employers have non-compete clauses. I worked for the other large hospital system in our area - I did not have a non-compete clause. The clinic I am opening in 1/2 mile down the road from where I had been employed.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 6:13:00 AM
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Diane
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Jon wrote: [QUOTE]in reality, except for those who claim to literally be fixing some connective tissue in the body sans scapel or pharmacology, aren't we essentially symptom managing while providing educational expertise/guidance on how to make things better? If we accept this as our role, which I think it largely is, then the whole making a diagnosis and practicing "medicine" argument becomes much weaker in my opinion. Although then we have to accept what one of our major roles really is which may be tough on the profession's ego. [/QUOTE]I agree with the definition of the role, and don't see why this role should be tough on anyone's ego. Don't know why such a role would be suppressed legislatively unless all of the system has a vested interest in keeping people unwell rather than actually helping them to feel/get better, and therefore have to suppress us in the process. Don't know why the system would want to do that.
[QUOTE]Chiro's can refer to us but as insurance will have it, the patient first has to see their MD before seeing us if they want insurance to pay for it. So it's chiro, then MD then us. On the other hand, since insurance pays for chiro treatment without MD referral, if we send a patient to a chiro they can go directly. Of course the patient doesn't need us to send them, they can just go and still be reimbursed by insurance.
Just follow the dollar signs and you'll start to understand referral patterns. Chiros are the cat that slipped out of the bag and as I've said before, not too many people are interested in letting that happen again.[/QUOTE]I'd be very interested in learning exactly how they managed to accomplish the slipping out of the bag thing. I heard ( [URL=http://www.chirotalk.com]www.chirotalk.com[/URL] ) that chiro utilization rates are down. I guess that doesn't have any consequence for this conversation however. Just an interesting tidbit.
Sebastian, love the irony you pointed up. Likewise in BC, there is no non-compete anything, there are no such clauses to be found. Here, there would be a loud outburst of "That's patently unfair!!!"..and a l-o-n-g media boil, a long process and much money spent no doubt in court or else in a human rights case outside of court. Any such nonsense would be nipped in the bud that way.
Here's a little article I found this morning, [URL=http://www.newswise.com/articles/view/510956/?sc=dwhn]Alt care[/URL], which shows us a sampling of who goes to alt practitioners and why. If PT were out there and unshackled, fairly able to compete, these people would have better more direct access to our set of skills.
SJ, if you were to set up a cash practice with direct access, you could keep your own stats and see how cost effective you really are..
:) ,
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 6:19:00 AM
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tr6454
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Non-comptes:
So, I should hire a PT, pay a salary, provide state of the art equipment, introduce them to MD's, help them develop their practice and referral network, all the while absorbing costs of their overhead until they are productive. Once they have developed relationships with the referral sources that I made available to them they should be able to open a practice down the block?
Think about this from the practice owners perspective. Why should I risk my capital (and my kids college fund), for a PT to come, learn how a private practice operates, and then compete against me?
Non-comptes are standard in the business world.
I wish PT schools provided a little more instruction in business so new graduates would have a better understanding, and less fear, of the whole process.
_____________________________
Terry
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 6:35:00 AM
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Diane
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Hi Terry,
[QUOTE]So, I should hire a PT,[/QUOTE]..if you want.
[QUOTE] pay a salary,[/QUOTE]don't worry, s/he'll bring in more than s/he earns as salary; if you are interested in hiring someone in the first place it will be to profit from his/her presence
[QUOTE] provide state of the art equipment,[/QUOTE]..all deductible of course as overhead
[QUOTE]introduce them to MD's,[/QUOTE]bottleneck them, make them go through you to get anywhere in life
[QUOTE] help them develop their practice[/QUOTE]excuse me, their practice?
[QUOTE] and referral network,[/QUOTE]if they are good practitioners, you shouldn't stand in their way. How professional is that, how loyal to the growth of our profession?
[QUOTE] all the while absorbing costs of their overhead [/QUOTE]and writing off such costs
[QUOTE]until they are productive.[/QUOTE].. ahem. Probably more like starting them off on day one with a full slate of 4 people per hour and rubbing your hands behind your office door.
[QUOTE] Once they have developed relationships with the referral sources that I made available to them they should be able to open a practice down the block?[/QUOTE]If you are so great, such a good therapist, and were there first, why would you care?
[QUOTE]Think about this from the practice owners perspective.[/QUOTE]I am.
[QUOTE] Why should I risk my capital (and my kids college fund), for a PT to come, learn how a private practice operates, and then compete against me?[/QUOTE]Because it's more honorable than forcing people to choose between a job and no future freedom.
Really Terry, cry me a river.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 6:56:00 AM
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SJBird55
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Our profession definitely isn't managed like the "business" world. Has any staff physical therapist ever received a huge bonus based on the financial gain or increased referrals? Has any staff physical therapist ever been been provided an all-expense paid cruise based on productivity? If a new service is offered within the department and becomes successful, does the staff employee(s) every receive any financial gain? If a staff therapist dreams up some cost-effective way of doing something that saves the department some cash, does that therapist receive a percent of that savings? There are quite a few things standard in the business world that don't translate into our little medical world.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 7:12:00 AM
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Diane
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SJ, I agree. Your PT world sounds like a world of Big PT sewing up life so that Little PT never gets rid of the ball and chain. I can see how the profession stagnates given these conditions, why there is apathy, why there is a macJob attitude. It's because of this inequity. This wool that is being pulled over PT eyes.
The PT associations and colleges should outlaw this whole non-compete clause thing ASAP. It is unconscionable. If it's already a law (anti-monopoly, anti-protectionist or whatever) at citizen levels of governance, it should be extended tout suite into the domain of PT comings and goings, to come into compliance with the rest of US humanity. Emphasis on the word "humanity." Nothing to do with corporate sociopathy.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 8:41:00 AM
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Sebastian Asselbergs
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Terry, I am a clinic owner (12 years now), and have been in private practice for 20 years. And, physiotherapists in Ontario CAN open up a practice anywhere they want. Period. It happened twice in my (short) ownership career. My clinic adjusted.
If the clinic owner does not like paying a salary to another PT for fear that they will venture out on their own, they are in the wrong business. Lawyers, doctors, dentists, phamacists, speechpathologists all have similar arrangements: you want to break up the business partnership/association to go private on your own? Go ahead.
I have yet to see a good practitioner in any of those settings fall by the wayside after associates split off.
"So, I should hire a PT, pay a salary, provide state of the art equipment, introduce them to MD's, help them develop their practice and referral network, all the while absorbing costs of their overhead until they are productive."
Terry, I offer a percentage of revenues produced by the associate PT. That eliminates the whole issue of payroll deductions and links them to the income they can generate; they will do more to market themselves. It offers them (and ME!)some tax advantages too.
"Why should I risk my capital (and my kids college fund), for a PT to come, learn how a private practice operates, and then compete against me? "
terry, you do not HAVE to hire someone - then all you worry about is your own caseload and income. IF you hire someone to enhance your clinic's income, you hire a potential competitor. That is the potential "other" side of the coin.
Most PTs who practiced in my clinic ended up going to other towns or to different fields of PT. Gee, maybe I was so good, they did not even dare to go in competition with me.... Yeah, that's it! (That concludes my self inflicted pat-on-the-back for today)
Seriously, Terry. Check with other professions, since those are more comparable with PT than business is. Just like SJ indicated.
_____________________________
Mundi vult decipi
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:03:00 AM
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tr6454
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Diane,
Wow, quite a response to a standard business concept. I'm not crying, just thought some would be open to another veiw point. Geeze, sounds like you've had some bad experiences with managment, sorry for that but not all employers qualify to be condemned.
I do want to hire a PT - because I offer a great opportunity for the right person.
At some time they will bring in more than their salary, but not in the first few months. There are costs associated with hiring.
Yes, - help them develop their practice. So that one day they can buy into my practice, being a partner, sharing in profits, sharing in risk, and helping to continue growth. This is the model that is generally accepted in many professional groups, Attorneys, MD's, CPA's etc., and the one that I am adopting for the future of my clinic. I think hiring PTs and increasing the number of PTs in ownership of private practice is very professional, thank you very much.
SJ- I agree our profession isn't managed like the business world, - to our detriment.
Start a new program in my clinic that results in more revenue for my practice, take out the overhead and split the profits. We both gain.
Shave costs that lowers overhead- great, take your cut from the savings. Win Win. The more my staff makes the more the company makes. Many staff PTs are not compensated for productivety and innovation. On the other hand many staff PTs would starve if paid strictly on productivety. Sharing in profits must be tied to sharing the risk. I agree that some of the big corporate groups may not have the best interest of the individual PT at heart, so I wouldn't work there. But again, from my perspective as a small but growing, single clinic owner, there is a better way. But Diane, as long as snap judgements are made, unscrupulous business behavior is assumed, will I be able to change the status quo?
_____________________________
Terry
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:12:00 AM
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SJBird55
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I've always wondered why there were non-compete clauses. It's kind of a negative thing. Who likes to be told something that they can't do right in the beginning of a relationship? I've never had a non-compete clause - in fact, with one company I scratched it out and initialed my line through the clause.
In an employee/employer relationship, if an employer maintains satisfaction of the employee(s), how often would an employee have the desire and energy to pursue competing? I think most employees terminate an employee/employer relationship secondary to dissatisfaction. It isn't always money that drives that decision - sometimes I believe it is as simple as lack of appreciation, lack of support, poor communication and poor management style.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:21:00 AM
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tr6454
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SJ
I gaurantee you that once a PT ( who was initially against noncompetes) buys in to my practice, has ownership, shares in risk and profits, has their sweat equity invested into the long term future of the company, they will require the next PT to go through the same process. I agree noncompetes can't restrict one from making a living. If they are too restrictive they will not stand up to challenge. I have an outpatient clinic. I can't reasonably limit someones ability to work in a hospital, nursing home, school system, home health etc.
_____________________________
Terry
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:23:00 AM
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SJBird55
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Terry (since our posts crossed),
I understand your view on the non-compete clause.
If you were offering what you just described, I'd be interested. If it all worked out to a win-win situation, why would I ever leave? But... if the relationship didn't go well, I really wouldn't want a non-compete clause over my head determining where I might be able to practice if I left your clinic. Granted, though, for what you are seeking, you'd be looking very long-term and will be very selective in who you choose. If you chose well, I would doubt that the person would go out and compete with you in a close proximity. Why? For the simple reason that there would be mutual respect. Or, if the person did go and compete with you in a close proximity, I would hope the person would have a strong focus on a new program that you don't offer.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:38:00 AM
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tr6454
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SJ
I applaud your faith in your fellow man and the idea that humans would behave with mutual respect. But this is business. I would trust my current partner to raise my children, but we still have a contract governing the assets of the company and what would happen if ....
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Terry
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 9:54:00 AM
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chiroortho
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Terry, you are right. Business can come between the best of friends, and an employment contract can spell out the considerations ahead of time so that there is no misunderstanding should things go wrong.
Prospective employees are free to reject the contract.
I think it is ill-advised to hire employees having the same professional license without some protection of the employer's goodwill and reputation in the community. Unfortunately, to do otherwise is to invite unscrupulous or malcontent employees to capitalize on our willingness to help them by stealing patients and referral sources. It's naive to imply that this does not occur on a regular basis.
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Greg Priest, DC, DABCO
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 10:39:00 AM
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OAK
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I used to believe in contracts but now am having doubts. If you are dealing with an honest person a contract is not needed and if you are dealing with a dishonest person no contract will ever be able to protect you.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 11:43:00 AM
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Jon Newman
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Hi Greg,
I don't think anyone owns patients or referral sources. If a patient follows a therapist to a different venue because they like that therapist then it was never that business' patient. Instead the business employs the therapist and made money from that therapist’s interaction with the patient.
Terry,
A non-compete clause is to insure that the therapist is indentured to the clinic owner, at least in that geographic area. It is not so that your kids can go to college. It is a power move. You expect others to trust you but you don't have to do the same in return? Of course you don't. And you don't. Of course everyone knows business operates in a vacuum from society. Our business decisions don’t convey anything to anyone; they are simply utilitarian devoid of any greater meaning. It's nothing personal, it's just business right?
As SJ points out, insurance aren't really interested in outcomes unless of course it earns them a denial of payment. Mostly they see PT as a profit center for someone other than them. Therefore, why allow patients the convenience of direct access? It's nothing personal to insurance companies, just business.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 12:03:00 PM
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Diane
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Jon, good points.
No one "owns" anyone, in a modern non-slave state. One develops "customer" loyalty by being a good fit with them, which is natural, logical and ethical.
Anything contractual between equal professionals that spells out servitude such as these noncompete things, are inherently objectionable, unfair, inequitable. They should be abolished.
PTs, don't sign them. Cross them out the way SJ suggests, and sign your crossout line. Don't let yourself be bullied by a sociopathic business practice that has been around long enough to "seem" normal, and has been touted as normal by anyone who stands to gain unfair advantage from it. Just cuz it's normal operating practice or business as usual, doesn't make it right. Get rid of that thing.
PT business owners, grow a conscience and stop doing this to prospective employees. (Don't copy the chiros if that's where this odious practice originated..).
If you're good at what you do, your base will remain loyal, so why worry? If you're a crappy therapist and never help anyone get better or get off treatment, you deserve to lose business to competitors in a fair playing field. That would be free market, and ethical, not protectionist.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 1:48:00 PM
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dosrinc
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As a PT/Owner of an outpt. clinic I could not ask the therapists who eventually joined my staff to sign non-compete clauses because I knew I would not sign one if in their shoes. I hope that I have establlished a working environment/ professional relationship with each of them that they will never want to leave. I want them to feel a sense of ownership, in fact to take ownership of their practice and to be responsible for its growth and development. In return I offer a great salary and incentives based on productivity. The more they work the more they make, just as it is when you own a practice. I also make a point to include them as we review profit and loss, they each know how much they bring in and how much it costs to keep the business afloat. There is no sense that they are making me tons of money while I roam the country playing golf because the books are open and the costs are clearly spelled out and I am right beside them working just as hard if not harder than they are. All things that I asked for when working for someone else but never recieved.
Rick
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 2:48:00 PM
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Wisecracker
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As an aside, non-compete clauses can and do hold water, if they're constructed correctly. I know of 2 that were enforced and became quite costly to the losers. The key is not complete removal of competition, but a mile radius (say 5 in an urban setting, 25 in very rural) over a restricted period of time (say 2-3 years) with defined consequences ($10,000 per mile within the restricted area). To sign one with the thought that violating it later will be of little consequence could prove to be quite costly.
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 11, 2005 4:49:00 PM
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Jon Newman
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Not that the no-compete clause topic is boring or that people shouldn't be encouraged to stay away from businesses that have them, but I'd like to try to address something I've stated in a prior post and Diane has asked about in f/u.
I did some searching and found what I remembered hazily from PT school. I'm not sure what life was like for chiros prior to this lawsuit. Maybe the suit didn't change much at all. Here's the link to [URL=http://www.chirobase.org/08Legal/AT/at00.html]Wilks vs. AMA[/URL]
There is a lot to read at the posted link but some shorter summaries are available if you Google. This seemed like a very thorough account of the suit however.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "Medical" diagnosis? Isn't PT diagnosis g... - April 12, 2005 4:19:00 AM
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Diane
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I'm glad to see that there are some corporate (?) practice owners like Rick who are choosing to not imprison their associates but instead are investing in them as equals, helping them to finish growing, and thereby helping the profession improve, since the profession is the sum of its component parts (both matured and newbie).
Back to the gist of the thread; the issue of diagnosis doesn't seem to me to be any real sort of obstacle, rather it is a perception shaped by the insurance culture. So it looks to me like it's possible for PTs to practice freely outside of insurance, legally/ retaining full lisence. If anyone knows any different, feel free to speak up.
My next question is, are insurance companies being challenged by professional PT organizations to change their policies on requiring medical diagnoses, presuming hypothetically that solo practitioners would still want to work for insurance?
Seems to me they need a bug put in their ear along the lines of what Jon referred to earlier, that in an outpatient setting we assess and treat mostly functional or pain problems of otherwise intact individuals, referring to the medical camp anything red flaggy and out of our purview. Has anyone ever pointed out to them that it would be cheaper to not have to have every sprained thumb go through a medical referral first?
Jon, quick question, I'm wondering why you brought that chiro case here. Maybe it could be in a new thread?
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