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Working with a chiro...
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Working with a chiro... - August 1, 2007 11:22:27 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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I have been approached with a great opportunity to work with a local chiropractor....The situation is this....The chiro owns his own practice and wants to start doing physical therapy treatments...He would contract me out on a 1099 basis...I would be there 2 times a week to perform IE's/Re-Evals and to update programs for current patients...there will be a P.T.A. that will be performing the tx's on the patients on a daily basis...I will be interviewing and training the P.T.A...All billing will be thru the chiropractic clinic using the chiro tax ID...I will be paid per patient i see...The reason he is persuing this is because he is performing M.U.A.'s and will need to follow these manipulations with P.T. tx's...One more thing...there will be no Medicare patients....I have some questions...1) Is there any legality/restrictions/limitations/ethical issues in this?? 2) Is there any billing issues when billing the P.T. codes thru the chiro tax ID?? 3) Can a P.T.A. perform tx's in the chiro setting without direct supervision of a P.T.??? 4) Is there anything else I may need to look into or something I may be missing???
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RE: Working with a chiro... - August 1, 2007 11:40:32 AM
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OAK
Posts: 184
Joined: September 1, 2003
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There are always loopholes when billing PT/chiro so most likely you won't get into trouble, but what do you think? Do you think it's ethical for this chiro to be doing PT treatment without you being present. Are you being hired only because you have a PT degree and not because of the skills you can offer? Do you like this set up or are you doing it primarily for the money? The whole thing sounds like a terrible idea to me.
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RE: Working with a chiro... - August 1, 2007 1:29:40 PM
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proud
Posts: 944
Joined: March 22, 2006
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I have never fully understood the reason why PT's think this concept makes good clinical sense.
Personally, I see no reason why PT's and Chiro's cannot work together for the best interest of patients. But my question is...what is the chiropractor offering that you yourself cannot offer?
Why not be up to date with the literature and provide your patients with an evidence-based/best practice approach that includes "non-specific" manipulation as part of your PT management approach? And if you feel the patient requires a service outside of your scope of practice( nutritional counselling, psychological counselling, surgical consult etc), then source the experts in that field through the patients MD. Simple.
If it's about an opportunity to line pockets...then you have your answer about the ethical objections one may have....
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RE: Working with a chiro... - August 1, 2007 2:43:50 PM
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jesspt
Posts: 85
Joined: April 3, 2007
From: Illinois
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Wait a minute. It looks as though you're practicing in Illinois. Do you know what the chiros are tyring to do to the Illinois Physical Therapy Practice Act? They want to restrict PT's practice to include only grade 1 to grade IV mobilization, with only chiros, MDs and DOs able to perform a grade V mobilization. Why any PT who provides evidenced-based care would chose to work FOR a chiro is beyond my ability to comprehend.
Sounds like he'd be hiring you becuase the initials after your name will allow him to earn some extra $$$.
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RE: Working with a chiro... - August 1, 2007 3:24:20 PM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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This chiropractor is a good friend of mine and will be getting a P.T. to do this no matter what....He approached me because he knows how successful our clinic has been and wanted a good Therapist to oversee this... I would be doing this to make a situation that I feel could easily be done incorrectly and try to make the best of it....I can't help that health regulations allow this type of set up to occur...Is money an aspect of this...absolutely....I will be getting paid $100 per each IE and $75 per each Re-eval I perform....plus $75 dollars/hour for updating charts...For me to spend 3-4 hours a day 2 days a week and make an extra $1200-$2000 dollars a week is not a bad gig....I just want to make sure that I have all my bases covered before I commit....
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RE: Working with a chiro... - August 1, 2007 3:28:30 PM
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PainFreeMan
Posts: 42
Joined: October 26, 2006
From: Texas
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KIDPT23
Several things you should consider:
Is the facility registered with the state as a PT clinic? If not, NO physical therapy can be performed there.
You said the Chiro is billing out under his tax ID #, but as far as I know a Chiro can NOT bill out 97001, 97002 codes; these codes can be billed out under MD’s, DO’s license as an “incident to” service regardless the type of insurance the pt has.
If the PTA is there full time seeing patients for you, you have to be “on call” and be able to make to the clinic within 20 min. or you'll have to be in the same facility to supervise the PTA.
Doug
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RE: Working with a chiro... - August 1, 2007 3:57:04 PM
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OAK
Posts: 184
Joined: September 1, 2003
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Wow, I guess we know what's motivating you. Helping a chiro perform Physical Therapy treatments is not something that will promote our profession, a duty that all PTs have. You won't find much support from your colleges with what you are doing.
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RE: Working with a chiro... - August 1, 2007 4:45:31 PM
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orthotherapist
Posts: 218
Joined: February 6, 2007
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Look yourself in the mirror and ask yourself if you are providing those patients value-added services that are worth $520,000 a year (Full time salary based on your projections above of $2000/8 hours). If you can still ook yourself in the mirror and honestly feel your services are worth over half a million a year I say all the power to you.
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RE: Working with a chiro... - August 1, 2007 4:55:09 PM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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Listen....if the only thing you people want to do is complain and judge me, then I feel bad for you...Why don't you complain about the thousands of P.T.'s that work in physician owned clinics taking away a lot of our patients...I am needing advice here on what to look for if I do this or not....I haven't committed to it yet, but it is a way to pump some money back into our business that we are losing with POPTS and with terrible insurance reimbursements....
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RE: Working with a chiro... - August 1, 2007 7:39:37 PM
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proud
Posts: 944
Joined: March 22, 2006
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KidPT23,
I do complain about PT's that work for physician owned clinics. And I will complain about what appears to be your motivation. You say that you are losing money due to insurance reibursements. Guess what. Too many PT's make bad choices like the one you are about to make and as a result we have a watered down profession. No need for a profession with excellent ongoing research to be mixed in with NMSK providers with a much lower profile within the medical community. You have all the tools required to provide excellent service as a PT. Going into this business venture may provide you with short-term gains, but I suspect your choice will haunt you in the long run. Look at this as judgement if you like. Or look at it as sound advice.
PT's that choose this option make it harder for those of us who choose to put our patients first and provide evidence based, cost effective services. I have stated all along that eventually one conservative NMSK provider will be chosen as the "expert" provider of choice and then all these reimbursment issues will dissolve. Be a part of the solution...not a part of the problem.
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RE: Working with a chiro... - August 1, 2007 8:55:19 PM
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Kaden
Posts: 334
Joined: June 17, 2007
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My personal view is I have a huge problem with chiros that are allowed to hire a PTA and say they offer physical therapy. A chiro is not a PT and a PTA is not a PT and if your not going to be there to oversee daily operation and follow the rx of these patients then I think this is a probem - primarily an ethical one. As a PT you owe it to our profession to make sure physical therapy services you are associated with are peformed to the highest quality possible and in this case you are not doing so.
As far as the money issue...If the chiro is able to pay this much then I question how ethical things are. IF everything is on the up and up then I think this is an issue for the APTA to investigate how reimbursement for "therapy services" is a "questionable" therapy setting can mean better reimbursement.
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RE: Working with a chiro... - August 1, 2007 10:30:14 PM
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plhunter
Posts: 42
Joined: March 5, 2006
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I believe that only a PT may supervise a PTA. If your patients at this chiropracters office are Medicare then you have to be "on site"; if they are not then I am not sure if your State Practice Act allows for general supervision of a PTA? Arizona (where I live) has just recently allowed general supervision, so you may want to look into that aspect of your dilemma. The other issues I am not familiar with but good luck.
Peggy
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RE: Working with a chiro... - August 2, 2007 12:36:13 AM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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KidPT, I would rather dip my bum in hot tar and cover it with turkey feathers and run through the mall than allow my professional standing to be so compromised.. If you can't see this as the thin edge of a very dodgy wedge you need your licence turned into confetti and thrown from the highest tower.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Working with a chiro... - August 2, 2007 12:44:10 AM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
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Oh er, if you turn it down , I can be in illinois in a few days , $2000 a week for a few hours eh?
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Working with a chiro... - August 2, 2007 12:59:25 AM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
Status: offline
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Kid,
At first I thought you must be kidding. Then I realized you were serious. You mean to tell us you have nothing better to do with your license. You had better give yourself a good shake and then reconsider.
Tim
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RE: Working with a chiro... - August 2, 2007 12:08:50 PM
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Lehmkuhler
Posts: 69
Joined: December 14, 2005
Status: offline
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The legality questions should be directed first towards your state association, and then towards an attorney who has advanced knowledge of these partnerships/situations. They will be able to tell you how to do it and what you can/can't do under your state's laws. The PTA situation is what I would be most careful with. As for billing, just make sure you will retain the power to make sure your billing is done properly as it is ultimately your license on the line if done incorrectly. That's probably the biggest "trust" issue.
As far as if you "should" do it, you have a pretty strong concensus from the replies so far. I have a completely different view as I'm a D.C. I don't operate from the assumption that you would be exploited visciously by the predatory D.C. in an illegal and unethical manner... But that's just me. I'd say you should evaluate this on an individual basis. I don't see why you can't provide excellent care in this environment. Unethical/illegal activity occurrs in all types of settings as does excellent patient care.
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RE: Working with a chiro... - August 2, 2007 12:43:23 PM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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All I can say is your avatar fits perfectly. j/k
< Message edited by TLB -- August 2, 2007 12:47:34 PM >
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RE: Working with a chiro... - August 2, 2007 1:24:49 PM
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proud
Posts: 944
Joined: March 22, 2006
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It is not about exploitation here. It's about poor choices. The fact is that there is no excuse for a PT to turn to this sort of partnership. PTs have the evidence base that demonstrates we can provide efficient, effective care. We need PT's willing to practice in this manner and provide the results that further validate this fact. Partnerships like this one only serve to dilute an otherwise well respected profession. I also know PT's who have been "employed" by massage therapists. It's unnessecary and unprofessional behavior that shoulld be discouraged by our professional associations and licensing boards. Period. Massage has no evidence to support it and spinal manipulation has very limited evidence. So why the need to align with occcupations associated with this?
My question to kidpt would be....are you losing money due to your own incompetance with manual therapy skills? The only reason I see for getting invloved here is to pony up with a chiro who manipulates the majority of his/her clients, generates revenue based on phony claims of joints requiring adjustments etc, and then asking you to provide "PT" services( whatever that means). I think we are going to see more of this type of appraoch as spinal manipulation becomes more and more exposed as a very limited tool in the management of NMSK conditions. It willl always be useful, but not for an entire practice to be based upon, thus the need for PT partnership.
Why not apply simple spinal manipulation to those few who may benefit along with other excellent evidence based PT skills? Get involved in informing the insurance companies about the value of evidence based PT( start with a recent Wall Street Journal article about the cost savings to insurance companies).
I see this partnership as downgrading your skills. First question you should ask is what are you contributing to the fact that you are losing money...not how can I avert the problem and bandage things up with such a touchy partnership.
< Message edited by proud -- August 2, 2007 2:00:55 PM >
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RE: Working with a chiro... - August 2, 2007 5:36:04 PM
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aph401
Posts: 82
Joined: April 16, 2007
Status: offline
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I'm sure I'm going to get totally flamed for this, but sh*t, no patients have a gun to their head forcing them to go to you. If they don't like what you're offering and don't think they're getting better, they can go anywhere they would like. The amount of money you're talking about would be, in my opinion, worth giving it a try and see how it works out. You are your own person and you don't have to treat the patients in an unethical manner, you can be just as good of a clinician as you were in your own clinic. As for not being there to supervise the PTA, well, the PTA who does daily treatments in the home health arena doesn't have anyone standing over their shoulder, either. Look into this and find out more info, discuss things thoroughly with your friend and see where you both stand on the issues. If you don't think the situation is working out for you, you can always get out of it. Talk to him about this, too. After all, it's only 8 hours a week max. It's not a fulltime job. Well, just my two cents. I'm not going to automatically dismiss you as an unethical, money hungry, sh*tty PT. You're only as good or bad as the services you provide. :) And yes, money is important for anyone.
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RE: Working with a chiro... - August 2, 2007 6:13:47 PM
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proud
Posts: 944
Joined: March 22, 2006
Status: offline
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aph401,
The main point of my suggestion was that as PT's we should not have to turn to that sort of partnership. Comments on that?
And on the comment about being forced to go to a certain provider. This is true, however it insinuates a connection between patient satisfaction and clinical outcomes.
To wit: Tons of individuals with low back pain come out of a physicians office "satisfied" with the treatment provided...they got an MRI, they got some prescribed NSAID, they were told what the problem was( they have DDD). None of this is solid clinical practice when it comes to LBP...yet the patient is satisfied.
As another example...tons of people are satisfied once they discover that their years of suffering at the hands of LBB was caused by an anteriorly rotated innonimate and the clinicians magic hands can cure it. Power of suggestion over-rides some pain patheways temporarily....patient "satisfied".
Neither of the above were going to assist this patient with overcoming chronic LBP episodes. The evidence is pretty strong in favour of that.
NMSK is a complex topic. Even experts are struggling with all the peices to the puzzle. At the end of the day, cost containment will be paramount and to expect joe public to appropriatly select sound, clinically relevant treatments amongst all the snale oil....is a scary thought. And one our health care systems cannot continue to entertain.
So as far as kidpt is concerned, I stick with my suggestion. He/she should recognize the upper hand he/she has with all the good research coming out of PT's streams and learn to apply spinal manipulation when indicated in accordance with EBM and do his/her own PT work.
< Message edited by proud -- August 2, 2007 6:30:49 PM >
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