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Re: drawing the line!!
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Re: drawing the line!! - January 22, 2007 2:11:00 AM
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ptdan23
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From: Orlando, FL
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I couldn't agree more with savela. As long as PT's are willing to work in MD offices then the curse of the POPTS will continue. But promises of big money working for a POPTS practice is usually what is the draw in the first place. I think all states should follow South Carolina and make it against the practice act for a PT to work for an MD. The loop holes need to be plugged for laws such as these as well.
ONstudentPT555 - I have never known of a POPTS that was owned by an internal med or general practice doc. Most of the time they are owned by orthopedic/sports med docs as well as physiatrist.
Dan C., PT MTC
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Re: drawing the line!! - January 22, 2007 10:56:00 AM
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savela
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From: toronto
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On Student,
The clinics that I know of are owned by GP's or sport med docs, but I heard that a cardioloigst opened up shop in Northern Ontario.
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Re: drawing the line!! - January 22, 2007 4:33:00 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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A local GP group around me opened up their own, and it cost me a huge amount of business, which I had to go make up elsewhere. As someone indicted...PT's work at these places, and are just as guilty for the professional problem as the payors, lawmakers, and these physicians. And let's not all fool ourselves into thinking that PT ownership is some pure church like state. There are plenty of sleazy PT's who are milking the system, and give nothing back to our profession.....PT money whores are all around us.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: drawing the line!! - January 23, 2007 2:13:00 AM
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KIDPT23
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From: Illinois
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I have chatted with 2 different docs who have told me that they have attended seminars that focus on setting up their own P.T. The seminar tells them how to get around the loopholes, discusses each states policies on doing this, how to market it, what to say to patients, and that if they are not doing this they are missing out on making easy money....they are specifically told that this will not be a primary money maker for them but it will offset costs, IE malpractice insurance....I do know a local doc here that has set up his practice so that he is in the office once a week and the P.T. is there 5 days a week....the doc is friends with attorneys and he sees 100% auto/attorney cases....he tells me that most of the money he makes is from the P.T. because of the type of patient he sees...his main practice is 100 miles away where he is there treating the other 4 days a week....
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Re: drawing the line!! - January 23, 2007 3:58:00 AM
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Dr.Wagner
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From: Indianapolis
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You know guys...what if...just what if...the PTs at these places are good...the rehab is good...the follow up care is good...what if all of this posturing is really due to political differences and not actually the care of the patient.
You know, I read these posts and sense an overall negative tone and one that is NOT patient focused but soaked in rhetoric and political overtones (ie the George Bush "if you aren't with us, you are against us".)
I understand survival and I understand your passion. But to be honest, if the rehab is good...then the rehab is good. Bad rehab is bad for the patient regardless of who performs it. I understand the passion many of you have, but I wonder if it is misplaced. There are "money whores" everywhere...they may wear a blue suit or perhaps a golf shirt. But to claim or to support the idea that all physician owned practices are bad...is irresponsible. It is a political agenda and not one that is patient focused. Abuse is abuse, regardless of who practices it. As a PT, I have seen many PT owned abuses.
Ethical practice is NOT monopolized by the degree earned, but by the business you practice.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: drawing the line!! - January 23, 2007 4:26:00 AM
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mcap56
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From: New York, NY
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Dr. Wagner:
You raise some good points. And, I agree with you and Duffy that there are unethical people and substandard care everywhere and in many different forms.
But I don't think we should assume that quality of care dictates where people will get services. When an MD refers within clinic, that is where the bulk of the patients will go. And regardless of the actual quality of care, it does create a higher potential for abuse than would be the case for a PT owned clinic. That doesn't mean abuse is automatic, but why have the potential built into the system.
I don't have access but I was told there was a section on the AMA website on how to generate "passive" income that included the use of in house rehabilitation. I know plenty of good PT owned practices in my area that are getting squeezed by MD owned practices. One of them asked my friend to consult. The instructions were "just tell me how to maximize my revenue."
Again, I am not implying that all PT owned practices are good and MD practices are bad. I know cases where it's the opposite and there are advantages to having all under one roof. But with the higher potential for abuse, I would support legislation against it.
Marc
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Re: drawing the line!! - January 23, 2007 4:31:00 AM
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dfjpt
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I support the political side of the argument. I think that Wagner is right; the issue of patient quality of care doesn't belong in the discussion. If it's about "abuse", it's about abuse of one whole profession by another whole profession, i.e. institutionalized PT serfdom, and PT collusion in this, whether knowingly or unwittingly.
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Re: drawing the line!! - January 23, 2007 5:59:00 AM
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ptdan23
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From: Orlando, FL
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While politics may come into play in some way (in what arena don't politics have an influence?) like mcap said the potential for abuse is there. There should rules and laws in place to minimize any potential for abuse which may in some cases not be the best for the patient. What keeps the doc from not referring someone to his own clinic PT that is not experienced in a certain area but if he does not he will miss out on that revenue. While the patient may not get hurt by going to a less experience PT within that docs clinic his outcome may not be as good and it may require more visits than if that patient was sent to a more experienced PT down the road. I am hoping that in the future when we have direct access and get paid for it that it will level the playing field and PT-owned offices can compete w/ the physician-owned practices.
Dan C., PT MTC
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Re: drawing the line!! - January 23, 2007 9:54:00 AM
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yarringtonpt
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From: Waynesville, NC
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I agree that the quality issue does not come into play. I worked for a POPT clinic that had and still has very good PT's.
I agree that the potential for abuse is certainly a major arguement. These docs generally are not giving their patient's options ot 5 PT clinics to choose from and patients generally "go where the doctor told them" to go.
The political side of things remains confusing to me. Stark Law prohibits referring to "ancillary services" (by the way it send chills up my spine when PT is referred to as ancillary - especially when patients constantly rave about the quality of the physical exam and treatment they receive from us vs. other providers)that docs have ownership in. But... You can do theose same services, and profit form them, when they are in house. Logic?
The main arguement I have is that PT has evolved beyond "ancillary". The skill with which we practice places us in a cooperative position with physicians, not dependent upon handholding for strict guidance.
Maybe my arguement is more philosophical:I just don't see why POPTS should exist. There is no real arguement that can be made excpet for one of "passive income" as many have stated thus far.
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: drawing the line!! - January 23, 2007 4:06:00 PM
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jlharris
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From: Nebraska
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I'd like to bring up another potential "abuse" of POPT clinics...the type of pt referred to that clinic. I did a large part of my clinical work in a Orthopeadic POPT and 95% of the pt's were post op. I had 2 LBP pt's the whole time I was there. Compare that to 16+ in my next OP ortho clinic owned by a PT. Which group will have better "outcomes"? The group that is seeing pt's that, in general, elected to have ortopeadic surgery, or the group of PT's seeing the LBP pt that was hurt at work, or has been in pain for over a year, etc. Hopefully you get my point.
There is a Ortho group in town that owns their own clinic and generally refers in house. So, it can almost be assured that if we get a pt from them it's because they are likely to have poor outcomes d/t pending lawsuits, workman's comp that did not get sx, chronic LBP, or maybe had sx when it was questionable if it was appropriate.
These same groups will then boast about their outcomes because they can "watch over the PT" when in fact their client base is statistically different than any other PT offices.
Oh well, surgeons are God (I should know I'm married to one) and don't do well with having their decisions questioned.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: drawing the line!! - January 23, 2007 6:37:00 PM
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TLB
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From: Arizona
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[QUOTE] I think the only way to stop MD owned clinics, is for PT's to stop working for them. [/QUOTE]The only way to put a halt to this is for the state practice act to push though legislation like the one in SC. How many are involved in their state issues is the big question, I'll bet it's a small portion of people posting on this site.
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Todd
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Re: drawing the line!! - January 23, 2007 9:08:00 PM
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goodlooks58
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From: CA
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Being a Private practice owner for 21 years I have come to a conclusion that MDs will always look at PTs as Pharm reps. Unfortunately we are in the business of DEPENDENCE on MDs for referrals and DEPENDENCE on Ins. cos for putting food on our tables. The road to Direct Access/independence is lonely, we have to fight for our independence alone with a cohesive force. And I will state this again and again...10 unethical private PT practices are still better than 1 "ethically" run POPT. This is because every unethical private practice owner knows that it is not how but in a matter of time when their practice is going to be closed down due to improper practices. They know that they are walking on the grey line and their own state chapter or an ins. co. or another PT down the street or a patient/consumer is going to complain and that will be the end. However, on the other end an "ethically" run POPT is just plain wrong because PTs do not have other skills to earn their income unlike MDs/Orthos-they can make mucho bucks in surgeries. A new POPT in my neighborhood drops my business literally by 10%-20% within 1-2 weeks. Unfortunately there are 2 large Ortho groups in my town and now both have opened up their POPTs, so you know how much it has reduced my business. My own cousin who is an Internist in New York makes a sizable chunk of money by working a few hours here and there for SNFs on top of his own private practice. Under an MD license they can wear many hats and can do many other jobs. A very mediocre Physiatrist in my town has become a PT!! I just saw a patient who had been seen by this Physiatrist and I asked the patient about any PT treatment he received. The patient said yes and that treatment was not from an MA or a massage therapist but the MD himself was doing some massage and teaching the patient a home exercise program. We as PTs went to school to become good PTs and that is all we know. But the business side of PT is another world which we need to fight with all our collective might to keep it alive. Dr. Wagner: Let me give you examples of the abuse MDs do when they open up POPT: This Neurosurgeon in town, when he is done with his intial exam, takes the pt for a walk to the other side of his clinic where his PT clinic is, and tells the pt.: "This is where I want you to come for your rehab, I can definitley keep an eye on you" This same pt. has just gone to this MD for a consult and is being referred by myself for just a consult. Inshort this MD literally stole my pt. right under my nose!!!Do you know how many pts I as a PT can refer to a good ortho/MD?...a lot! Guess what, this MD is never getting any referrals from my clinic. We have to get to the grass root level and do what S. Carolina has done and ban POPT!!!
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Re: drawing the line!! - January 24, 2007 12:35:00 PM
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ptdan23
Posts: 224
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From: Orlando, FL
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I think that what happened in SC should be made into a federal law. Not sure if something like that would ever happen but would sure make POPTS go away. The Stark Laws also need to be changed to take out the loopholes that allow those to abuse the law.
Dan C., PT MTC
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Re: drawing the line!! - January 25, 2007 5:29:00 AM
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myr11
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I am just a student looking into both physical therapy and certain areas of medicine. It is not ethical if all patients are being "monopolized" by physicians who provide the referals. But if we take the view of the patient, isn't it more convienient for the patient to go to these Physician owned practices? Also isn't the communication between the PT and the physician greatly enhanced? How do most of those POPT practices work...Are the therapists mere employees or more like independent contractors? I am just beginning to research these issues. Is the problem that physicians are billing the insurance companies and not compensating the therapists fairly? I don't understand why they don't make the physical therapy curriculum equal to that of a podiatrist, or dentist. If the problem is the ability to be independent and earn as much as they deserve, how come the education doesn't requre just one year where students can learn even more diagnostic skills. Students wouldn't have to learn how to stick needles in patients or even administer drugs but they learn how to fully diagnose the patient. This way they can be fully independent and direct access. Even though that one more year might add to the already expensive education wouldn't it benefit in the long run, if direct access is holding back so many practices? I guess this would just put a lot of physicians out of business? Politics prevent this from happening?
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Re: drawing the line!! - January 25, 2007 5:38:00 AM
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myr11
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I hope I don't come off as saying that physical therapists are not well educated. But as someone who would love to go into physical therapy or medicine, I don't know why therapists aren't "rehabilitation physicians", since they are already so educated. If physicians and insurance companies do not look at the profession the way many should, then what could be done other then improve the already great education they get?
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Re: drawing the line!! - January 25, 2007 8:42:00 AM
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KIDPT23
Posts: 222
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From: Illinois
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myr11- I can only answer some of your questions based on my experiences only but as far as convenience for the patients....answer is not really becasue most patients have a doctor that they visit who may have an office near the hospital but they may live on the other side of town and do not want to travel 20 minutes or longer to go to therapy....Is the communication better? Not really because the physician's who I know who have P.T. in their office are usually way too busy to be bothered with what is going on in P.T....The bottom line is that most physicians are doing this for extra cash, bottom line and not for the best interest of their patients...
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Re: drawing the line!! - January 25, 2007 10:53:00 AM
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myr11
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Interesting, I appreciate the advice.
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Re: drawing the line!! - January 25, 2007 2:26:00 PM
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xltherapy
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I didn't read all the posts but do you guys think if writing some sort of articles in local news paper might help getting people more aware of our profession/expertise. Columns could include simple things like "what to do when-xx"; How to pick a PT etc. Somehow letting people know that we listen, we care and do what is best for them.
I opened my office few mths ago and POPTs are one of the biggest challanges for getting work-comps, PIs and PPOs. All they try to send out way is HMOs.
DP
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Re: drawing the line!! - January 25, 2007 7:05:00 PM
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savela
Posts: 63
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From: toronto
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I have been reading all the posts above.
Dr. Wagner, is correct........ some of the MD owned clinics, may be admin. great treatment.
Thing is ..... are they telling their pts. that they own the clinic they are referring too? and they will profit from the pt.?????
In Canada, they are required to do so. Most don't.
The pt. will follow the MD's advice, and trust that their MD is leading to "the best quality of care"?
I would like to trust that the PT that works with these MD's keeps up with evidence based practice....and is an ongoing learner.
I would like to think most are.........but I still feel that, by working for MD's , we are setting our progession back ( esp. when we are trying to get Advanced practice status).
I am not sure if many Part A's/B's reply to this forum?
Or if any Canadian PT is interested in the advanced practice leg. that would allow Pt's in Canada to prescribe MRI's, some med's, jt.aspriation etc??
When this advance status becomes the norm. in ON PT's may not have to ask MD's for their advice.
I keep going back to my original statement.... Can we grow as a profession? .... if PT's let other health professions own and profit from our work (which many do)are we a dying breed?
Dentists do not do it, Pharm. do not do it, etc.
For those who work for MD owned clinics......stop.
If you have peers who do so.... network and stop it.
I understand we all have to make a living, but if we believe in our profession, we should not need an MD's help.
Do not get me wrong, if you have an MD working in your clinic (not an owner)it is a great help.
I am against referral for profit.
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Re: drawing the line!! - January 25, 2007 7:19:00 PM
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ONstudentPT555
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<<<<<<<<When this advance status becomes the norm. in ON PT's may not have to ask MD's for their advice.<<<<<<<<<
Savela,
What is this advance status all about.. when and how will this happen...can you give some more info on this?
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