Worse than POPTS? (Full Version)

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JLS_PT_OCS -> Worse than POPTS? (April 29, 2005 7:15:00 AM)

Here is a company (www.veridianhealth.com) that employs PTs to work in Chiro offices.

The PT is "supervised" by the Chiro, and the company pays the PT, to get around addressing the Chiro or PT spending cap, and to get around the referral-for-profit issue.

Any thoughts on this procedure, and how damaging it is to professional autonomy and to private practice Physical Therapy?

I think that Chiros should be Chiros and PTs should be PTs, that we neither work for each other nor supervise each other.
Thoughts?
J



dosrinc -> Re: Worse than POPTS? (April 29, 2005 7:45:00 AM)

If the Chiro still benenfits financially from the referral to the PT, despite someone else paying the PT's salary, then this would not get around the referral for profit issue. If the Chiro has no financial gain issues involved in the referral process then I don't see much wrong with it. Does the PT or the paying company lease space from the Chiro? Is the lease fair market value and not tied to a # of referrals? Who does the billing and who recieves the payment, the PT, the Chiro or veridian health? All questions that I would want answered.
Now any PT's out there who would agree to be "supervised" by a Chiro please raise your hand. "Here, let me supervise you performing a thoracic manipulation so that I can then sue you for practicing chiropractic", sure better hope you don't do anything that causes a pop or you could be in big trouble.
Rick



jma -> Re: Worse than POPTS? (April 29, 2005 8:14:00 AM)

No PT should be supervised by a someone from another profession. Those working for them set a bad example for the rest of us.



SJBird55 -> Re: Worse than POPTS? (April 29, 2005 8:38:00 AM)

jma, I'm not sure if I understand exactly what you are saying... but frequently in the hierarchy of things in the rehab world and in hospitals and sometimes long term facilities, a professional different than a PT is supervising a PT.... sometimes a PT may have a nurse, or an OT, or a speech therapist or a PTA or an MD or DO supervising a PT.



JLS_PT_OCS -> Re: Worse than POPTS? (April 29, 2005 10:32:00 AM)

Rick-
Even if the Chiro doesn't get money back, the lease is fair market value, and Veridian does the billing and payment, it still is a very very bad thing.
You have essentially a PT working under the clinical supervision of a chiro. The patient only has access to PT if the chiro 'refers' the patient, and for obviously limited services. How is that a good idea?
I think your comment about practice act issues and such is very true, I hadn't even thought of Arkansas implications. Nice call.

All-
As far as PTs willing to do this, evidently there are many, as someone was inquiring in a chiro forum if any DCs were "interested".

This is why the DCs win so many times in legislative and marketing battles. They are trained to be independent practitioners and to keep their autonomy sacred. They keep the profits from their work, not another profession they work "for", and that money gets reinvested in the practice and in the profession. We have such a broader skill set and education, why are we not doing that?
Too many PTs are just programmed to be "employees" of a health system (which I have no problem with) and not individual providers or private pracitioners, required to be only 'supervised' by another PT. So they end up working 'for' another professional.

Other professions such as law and accounting/CPAs have strict rules on autonomy and ownership of services, from an ethics standpoint. Why is this not pushed harder for us???

When are all of us going to wake up and stop selling out and whoring out our profession??

Practice acts need to be rewritten, and this is one thing that needs to be updated!!

J



TLB -> Re: Worse than POPTS? (April 29, 2005 11:45:00 AM)

I don't see one bit of difference whether it's a chiro or an MD/DO, both are bad situations and not one worse than the other. A self referral is a self referral no matter who it is doing it. How many of us have contacted our state chapters concerning the new ruling in South Carolina and asked how can I help bring this to my state? How many of us even belong to the APTA? I for one can answer yes to both question.



JLS_PT_OCS -> Re: Worse than POPTS? (April 29, 2005 1:08:00 PM)

Well said, Todd. Agreed.



dosrinc -> Re: Worse than POPTS? (April 29, 2005 1:25:00 PM)

Jason, Please let me clarify:
When I said "I don't see much wrong with it" I meant strictly from a legal, non-kickback standpoint. On the other hand:
Is it worse for the chiro to hire a PT to bill for and perform PT services than it is for him to either do these things himself or have a tech or massage therapist do it? If the Chiro doesn't benefit financially from the referral how is this different than a private practice PT accepting a referral from a Chiro? In this aspect the only "supervisory" role the Chiro would play would be to sign the treatment plans, which, unfortunately is still required in most states for 3rd party payment.
Rick



jma -> Re: Worse than POPTS? (April 29, 2005 3:06:00 PM)

SJBird55,
Sorry for the generalization. Our practice act in NY does not include Chiropractors supervising PTs



JLS_PT_OCS -> Re: Worse than POPTS? (May 3, 2005 4:00:00 AM)

Rick-
I do see your point. But I still think keeping us in some sort of secondary tech-type role is a bad thing.
We can just as easily have their family physician sign the plans, and that way there is a separate referral, etc.
I think we are better off letting the chiros do their thing, and we do our thing, and ne'er the twain shall meet. So to speak.

I think consumers should see and feel a clear delineation between chiros and PTs and between physicians and PTs. It's the only way to change the role and respect of our profession. In this setup, what does the patient think?
"I go to Dr. Smith (DC) who also has me doin' physical therapy."
Sound like a good idea to you?

It should be "I go to Dr. Smith(DC) but also he sent me to Dr./Mr./Mrs. Jones, who's the physical therapist working with me."
We will never, ever have this if we work in a tech role "supervised" by another profession. Period.
J



dosrinc -> Re: Worse than POPTS? (May 4, 2005 1:49:00 PM)

Jason, I like your idea better
Rick



ron2368 -> Re: Worse than POPTS? (May 4, 2005 4:36:00 PM)

Here is why I think its good for patients.Lots of other issues can make it a bad situation overall.

The trend in most chiro offices is to add rehab services for patients , not just passive therapy. Unfortunately most guys go out and buy a big rubber ball and a few therabands = rehab suite. (Not putting it down, I just had a month of OT/PT and all I ever saw was a dumbell and theraband .)Plus if they are seeing patients there is no time to spend watching patient exercise so probably an office assistant does it. Thats more profitable but not great for the patient. Having a professional handle the rehab is much more effective way to go.

There are many other angles on this to consider but for a dc to have great rehab its a smart move.



JLS_PT_OCS -> Re: Worse than POPTS? (May 5, 2005 3:12:00 AM)

Ron,
For a DC to have great rehab all they need to do is consult/refer to a PT.
:)

Think of the shoe on the other foot. I have a rehab and fitness clinic, and I want to add spinal manipulation services. Never mind, PTs already do that. How about, I want to hire a DC so I can say I offer chiropractic services. Let's say I hire a DC to do that for me. When I order it. On people that I choose. His patients must come through me.
It seems to me that that would interfere with the autonomy and privilege of the DC, them being an independent practitioner.
Seems unfair to the DC to me, in my hypothetical case.

I have met lots of DCs who would say, well if you want your patient to have quality chiropractic care, you need to refer to a chiropractor and not just hire one to do what you say when you say it.
I would think that is a fair assessment.

What do you think about this?
Thanks for your interest and contribution.
Jason.



Dr.Wagner -> Re: Worse than POPTS? (May 5, 2005 7:31:00 AM)

Quick question...

If there were 4 clinics in town.

Who would you rather work for.

1.The MEGA corporate PT clinic (100 regional clinics) 2.a solo DC practice with rehab 3a Orthopedic surgery group with rehab 4.The private PT clinic that has PTA's only and needs a PT to do evals at the 1 clinic and 2 nursing home contracts.

To me, this is the overwhelming majority of situations that I have seen and I am curious...which is the greater EVIL.



hmgross -> Re: Worse than POPTS? (May 5, 2005 7:58:00 AM)

If I had to choose from the 4, I would prefer to work at #3 vs. the others.
Now, as far as "which is the greater Evil" I haven't decided yet, I may need to mull it over.
Glad I made a "real life" choice to work on my own independently.



SJBird55 -> Re: Worse than POPTS? (May 5, 2005 11:17:00 AM)

I'd definitely do 3 in a heartbeat. That being said... I see no evil if the rules and regs are being followed in that situation. If the rules and regs are not being followed, then I believe that I'd need to exercise my "autonomy" and educate those involved (and reap whatever consequences).



TLB -> Re: Worse than POPTS? (May 5, 2005 12:34:00 PM)

I would rather work for #1 then #4 (due to the nursing home contract) nix the Nursing home then I would switch 1 and 4. 2 and 3 are a wash.

Work for #4, refine your skills and set out on your own, independently.



goodlooks58 -> Re: Worse than POPTS? (May 5, 2005 10:13:00 PM)

All 4 of them are EVIL...As a PT and believer in my own skills: I would start my own clinic give one-on-one excellent care, keep my overhead low and make a good profit. A few of the PTs who have worked for me in the past have decided to start their own clincs and have failed because they still have employee mentality and had the time off/vacation/waste time as being paid hourly..old habits remained with them even when they owned their practise..this led to the failure. Doc Wagner: My opinion--PTs in general need to think in the terms of owning their own clinic and not too much in terms of jobs.This autonomous thinking will empower the new grads in terms of better earning capacity and being the best in the NMS rehab education we have received.



Alex Brenner PT MPT OCS -> Re: Worse than POPTS? (May 5, 2005 10:53:00 PM)

I would join the Army. Oh, wait...



Diane -> Re: Worse than POPTS? (May 6, 2005 6:10:00 AM)

Jason, I totally see your point, and think that the outfit that is trying to sell PTs to chiros so that chiros can bill for rehab is a pernicious sellout. PTs, let's grow a collective political spine and stop being other peoples' slaves.



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