Podiatrist offers "in house physical therapy"

[Fiveoboy11]

I suggest every single PT or PT student on this website submit a formal complaint against these "doctors" as I have.

Cumberland Foot and Ankle centers of Kentucky
http://www.somersetfootdocs.com/services.html

Kentucky state law:
327.020 License required -- Exceptions -- Use of designation or name
[FONT=Arial,Arial][FONT=Arial,Arial]
(1) No person shall practice or hold himself out as being able to practice physical therapy in any manner whatsoever unless he meets the educational requirements of this chapter, is licensed in accordance with the provisions of this chapter, he is in good standing with the board and his license is not suspended or revoked.
..

Complaint Form:
http://pt.ky.gov/NR/rdonlyres/4FAC0970-E6DF-45A9-8564-3CD2B50C4423/0/COmplaintForm.pdf

---

Members don't see this ad.

 

[facetguy]

I suggest every single PT or PT student on this website submit a formal complaint against these "doctors" as I have.

Cumberland Foot and Ankle centers of Kentucky
http://www.somersetfootdocs.com/services.html

Kentucky state law:
327.020 License required -- Exceptions -- Use of designation or name
[FONT=Arial,Arial].
[FONT=Arial,Arial][FONT=Arial,Arial](1) No person shall practice or hold himself out as being able to practice physical therapy in any manner whatsoever unless he meets the educational requirements of this chapter, is licensed in accordance with the provisions of this chapter, he is in good standing with the board and his license is not suspended or revoked. .


.

Complaint Form:
http://pt.ky.gov/NR/rdonlyres/4FAC0970-E6DF-45A9-8564-3CD2B50C4423/0/COmplaintForm.pdf

Do they have a PT working there?

 

[jesspt]

Five,

Do a little digging on their web site prior to going off. When you click on the physical therapy link it takes you to a site of an indpendent PT clinic that appears to be located within the office building the podiatry clinic is in.

I don't think your complaint is going to garner much traction. Perhaps you want to call the owner of this PT clinic and ask him about the relationship?

As is often the case, we are our own worst enemy, with many PTs willing to work in POPTs. We have just as great a need to clean up our own house as we do to rail against the prevalence of POPTs and the legislation that allows it.

I suggest every single PT or PT student on this website submit a formal complaint against these "doctors" as I have.

Cumberland Foot and Ankle centers of Kentucky
http://www.somersetfootdocs.com/services.html

Kentucky state law:
327.020 License required -- Exceptions -- Use of designation or name

[FONT=Arial,Arial][FONT=Arial,Arial](1) No person shall practice or hold himself out as being able to practice physical therapy in any manner whatsoever unless he meets the educational requirements of this chapter, is licensed in accordance with the provisions of this chapter, he is in good standing with the board and his license is not suspended or revoked. .
.

Complaint Form:
http://pt.ky.gov/NR/rdonlyres/4FAC0970-E6DF-45A9-8564-3CD2B50C4423/0/COmplaintForm.pdf

 

[facetguy]

Five,

Do a little digging on their web site prior to going off. When you click on the physical therapy link it takes you to a site of an indpendent PT clinic that appears to be located within the office building the podiatry clinic is in.

I don't think your complaint is going to garner much traction. Perhaps you want to call the owner of this PT clinic and ask him about the relationship?

As is often the case, we are are own worst enemy, with many PTs willing to work in POPTs. We have just as great a need to clean up our own house as we do to rail against the prevalence of POPTs and the legislation that allows it.

Five, if this is true, will you withdraw your complaint? Do you feel as though you jumped the gun?

 

[greco13]

from what I've seen from their postings on here, five's a hothead. I called them. The PTs they refer to are in a building adjacent to one of the DPM locations. Chill out, dude.

 

[Fiveoboy11]

Yep I do jump the gun, trying to hold people accountable in relation to our pofession as nobody else seems to care very much.

My stance doesn't change even if they have a separate POPTS clinic "on site." Physical therapy as a provided service should not be listed on a podiatry website regardless, if there is a POPTS clinic adjacent to it or not. Lets say a PT owned a medical practice. Should the PT website state that medical services (i.e. medication prescription) is provided onsite? No. By the way, one of the podiatrists on staff at these clinics wrote an article in 2007 detailing how a podiatrist can provide and bill for physical therapy in a podiatry clinic. I don't comprehend why there are all these youtube videos with chiropractors, physicians, etc yapping on about physical therapy as if they offer it or are experts in it. This is no different. See two articles below, the author is one of the podiatrists at the clinic in question.


http://www.podiatrytoday.com/article/6695
http://www.podiatrytoday.com/article/6946

 

[GTT4DPT]

http://www.podiatrytoday.com/article/6695
http://www.podiatrytoday.com/article/6946

I just read a little bit of the article (first link), and then the exchange between the APTA task force chair and the article's author (second link). This is an issue that I haven't really been aware of, and that second link in particular was illuminating.

I'd gotten the impression from the first post that this was about DPMs practicing physical therapy (which seemed to be the point of referencing that section of Kentucky State Law). But then I guess it becomes more about the "referral for profit" aspect of these in-house PTs.

The APTA rep (Fran Welk) mentions that POPTs are getting "serious concern from government entities". Does that mean anything? It sounds like a lot of bluster, but are there any arrangements that are expressly forbidden and some that just walk the line?

Interesting stuff. Thanks.

gtt

 

[Textbookversion]

Yep I do jump the gun, trying to hold people accountable in relation to our pofession as nobody else seems to care very much.

My stance doesn't change even if they have a separate POPTS clinic "on site." Physical therapy as a provided service should not be listed on a podiatry website regardless, if there is a POPTS clinic adjacent to it or not. Lets say a PT owned a medical practice. Should the PT website state that medical services (i.e. medication prescription) is provided onsite? No. By the way, one of the podiatrists on staff at these clinics wrote an article in 2007 detailing how a podiatrist can provide and bill for physical therapy in a podiatry clinic. I don't comprehend why there are all these youtube videos with chiropractors, physicians, etc yapping on about physical therapy as if they offer it or are experts in it. This is no different. See two articles below, the author is one of the podiatrists at the clinic in question.


http://www.podiatrytoday.com/article/6695
http://www.podiatrytoday.com/article/6946

Unrestricted medical license is unrestricted medical license?

 

[jblil]

Five, Do a little digging on their web site prior to going off.

Does SDN have an "Ignore" function? I looked but did not find one. I think the time has finally come to invoke it.

 

[Fiveoboy11]

Unrestricted medical license is unrestricted medical license?

Physical therapy is NOT within the scope of medicine, thus an unrestricted medical license is irrelevant. Have a great day!

 

[jesspt]

Yep I do jump the gun, trying to hold people accountable in relation to our pofession as nobody else seems to care very much.

My stance doesn't change even if they have a separate POPTS clinic "on site." Physical therapy as a provided service should not be listed on a podiatry website regardless, if there is a POPTS clinic adjacent to it or not. Lets say a PT owned a medical practice. Should the PT website state that medical services (i.e. medication prescription) is provided onsite? No. By the way, one of the podiatrists on staff at these clinics wrote an article in 2007 detailing how a podiatrist can provide and bill for physical therapy in a podiatry clinic. I don't comprehend why there are all these youtube videos with chiropractors, physicians, etc yapping on about physical therapy as if they offer it or are experts in it. This is no different. See two articles below, the author is one of the podiatrists at the clinic in question.


http://www.podiatrytoday.com/article/6695
http://www.podiatrytoday.com/article/6946

This is your problem. I think you could likely be a great advocate for the profession, but no one will ever listen to the logical and rational aspects of your stance, because your initial salvo into any argument is one of an irrational zealot. In fact, I cringe when I see you interacting on this board with other medial professionals on this board because I worry they will associate your attitudes with our profession and not with just you.

 

[Textbookversion]

Physical therapy is NOT within the scope of medicine, thus an unrestricted medical license is irrelevant. Have a great day!

Really? So you don't consider yourself a medical professional?

I'm pretty sure physical therapy is a medical modality.

 

[Fiveoboy11]

This is your problem. I think you could likely be a great advocate for the profession, but no one will ever listen to the logical and rational aspects of your stance, because your initial salvo into any argument is one of an irrational zealot. In fact, I cringe when I see you interacting on this board with other medial professionals on this board because I worry they will associate your attitudes with our profession and not with just you.

Fair enough but keep in mind that I'm just trying to say what I think and do what is right. Being professional in someone else's mind is a distant second if you ask me. Further, our profession has been too professional for its and patient's own good.

I personally enjoy reading your posts but find it pathetic that I seem to be the only one calling things out on here.

 

[Fiveoboy11]

Really? So you don't consider yourself a medical professional?

I'm pretty sure physical therapy is a medical modality.

Ugh, is anyone on here really surprised at the way I post when I read things like this?

Medical students and medical residents have zero training in physical therapy. Zero. Classifying physical therapy as a medical specialty does not magically mean it is within a physician's scope of practice. So annoying.

 

[Textbookversion]

Ugh, is anyone on here really surprised at the way I post when I read things like this?

Medical students and medical residents have zero training in physical therapy. Zero. Classifying physical therapy as a medical specialty does not magically mean it is within a physician's scope of practice. So annoying.

You speak with a lot of authority about physician education for someone who hasn't attended medical school.

I'm at a DO school so there are a lot of opportunities to attend seminars and take electives in PT related stuff, plus training we get in manual medicine during OMM class.

I imagine PM&R residents must have a healthy chunk of domain specific knowledge as well given their role as gatekeepers to PT.

 

[Fiveoboy11]

You speak with a lot of authority about physician education for someone who hasn't attended medical school.

I'm at a DO school so there are a lot of opportunities to attend seminars and take electives in PT related stuff, plus training we get in manual medicine during OMM class.

I imagine PM&R residents must have a healthy chunk of domain specific knowledge as well given their role as gatekeepers to PT.

I speak wtih authority with regard to physical therapy education. I would think it'd be common sense that you'd have to go to PT school to practice PT...

Manual medicine, being a gatekeeper to PT, DO school are all fine, it doesn't make you qualified to practice PT. Electives in PT? PT's take over 100 credits in PT (my alma matter is 170 credits in PT in a graduate school), taught by PT's and with information based on physical therapy research. Do you think a few electives in PT is nearly the same thing? Reminds me of some DC curriculums who float on the PT profession with their "Physical therapy" classes.

 

[MaxillofacialMN]

My stance doesn't change even if they have a separate POPTS clinic "on site." Physical therapy as a provided service should not be listed on a podiatry website regardless, if there is a POPTS clinic adjacent to it or not. Lets say a PT owned a medical practice. Should the PT website state that medical services (i.e. medication prescription) is provided onsite? No.

Why are you starting a meaningless turf war?? The only people doing PT work are PTs at this clinic. At your contrived PT/Medical clinic the only people writing scrips are physicians... Who cares how it is advertised? You're not losing business, the patients get treated, why are you upset??

 

[jesspt]

Fair enough but keep in mind that I'm just trying to say what I think and do what is right. Being professional in someone else's mind is a distant second if you ask me. Further, our profession has been too professional for its and patient's own good.

I personally enjoy reading your posts but find it pathetic that I seem to be the only one calling things out on here.

I would say that our profesison has been too passive for its own good. And, there are ways to be professionally aggressive in advancing the profession's agenda. Flying off of the handle is not one of them. And, it is usually met with significant resistance from anyone you are attempting to intreract with.

You seem to be awful angry at the podiatrists who list PT as a service on their web site. We're not even certain if they own the PT clinic or if it is owned by a PT. And if they do own it, I'm just as upset, if not more so, by the PT who chooses to work there, than I am at the podiatrists who do not appear to be doing anything illegal at the moment.

 

[MaxillofacialMN]

You seem to be awful angry at the podiatrists who list PT as a service on their web site. We're not even certain if they own the PT clinic or if it is owned by a PT. And if they do own it, I'm just as upset, if not more so, by the PT who chooses to work there, than I am at the podiatrists who do not appear to be doing anything illegal at the moment.

Why are you mad that a PT works for a pod? Why does that matter? If I found a successful PT that wanted a pod in his/her office to do foot care, I would not mind working for that individual, and I wouldn't mind if the PT clinic's website advertised "full foot care available on site!" I'm really not sure why that would matter.

 

[jesspt]

Why are you mad that a PT works for a pod? Why does that matter? If I found a successful PT that wanted a pod in his/her office to do foot care, I would not mind working for that individual, and I wouldn't mind if the PT clinic's website advertised "full foot care available on site!" I'm really not sure why that would matter.

I think that a physician owned PT practice is an example of a referral for profit situation, which, when not ethically run, can lead to overutilization.

 

[atstudent]

I think that a physician owned PT practice is an example of a referral for profit situation, which, when not ethically run, can lead to overutilization.

Would you also be upset with a PT who works for a hospital?

 

[jesspt]

Would you also be upset with a PT who works for a hospital?

Nope. You?

 

[Fiveoboy11]

Would you also be upset with a PT who works for a hospital?

Would you agree that hospitals are necessary and POPTS are not? A PT employed in a hospital, let's say owned by a physician or physician group, is an entirely different thing than a PT working in a POPTS outpatient ortho clinic.

Why:
1) hospitals are necessary
2) POPTS are not necessary
3) POPTS are relatively easy to set up (in comparison) for a physician for the obvious incentives
4) physician(s) or anyone else owning a hospital that employs PT's would never do so with PT as a primary driving force to make them more money, thus lessening abuse and conflict of interest. Case in point, outpatient ortho hospital clinics are well known for alloting greater time per patient with the PT, and are never a major revenue generator in comparison to all the other services.
5) Hospitals are one of the cornerstones of patient healthcare, POPTS clinics are a cornerstone of referral for profit agendas.

 

[facetguy]

I think you guys might be going a little too tough on POPTs. Sure the potential for abuse and unethical behavior is there, but those things are available everywhere. If a physician wants to practice in an unethical fashion, there are other ways to do so. But I see it a little differently. When you are in private PT practice, you will market yourself to docs as being a worthy PT to refer to. In other words, you'll want to put yourself out there as the best around.

But what if the physician already knows a PT that s/he feels is top notch? Why not remove uncertainty and include that person in the practice? There are some bad PTs out there (no more than any other profession, but they're out there), and nobody wants to refer a good patient to a slacker. And I would think that a PT who is an integral part of a medical practice would have better overall communication with the doc, which should benefit the patient.

It may be unfair to automatically judge any POPT as unethical without going case by case. But perhaps such an arrangement should require some higher level of scrutiny to avoid bad behavior?

 

[Fiveoboy11]

I think you guys might be going a little too tough on POPTs. Sure the potential for abuse and unethical behavior is there, but those things are available everywhere. If a physician wants to practice in an unethical fashion, there are other ways to do so. But I see it a little differently. When you are in private PT practice, you will market yourself to docs as being a worthy PT to refer to. In other words, you'll want to put yourself out there as the best around.

But what if the physician already knows a PT that s/he feels is top notch? Why not remove uncertainty and include that person in the practice? There are some bad PTs out there (no more than any other profession, but they're out there), and nobody wants to refer a good patient to a slacker. And I would think that a PT who is an integral part of a medical practice would have better overall communication with the doc, which should benefit the patient.

It may be unfair to automatically judge any POPT as unethical without going case by case. But perhaps such an arrangement should require some higher level of scrutiny to avoid bad behavior?

There is a significant subgroup of PT's who flat out will refuse to work in a POPTS clinic, and I highly doubt you could find PT's who refuse to work in PT owned outpatient ortho clinics. Therefore there is already less PT's in the pro POPTS pool to chose from. So, on average, a PT who works in a POPTS clinic will not be as good as a non POPTS PT.

Further, to me it goes far beyond the ethical aspect of it. It isn't fair that a PT has to work infinately harder to set up a private PT practice (and advertise as you say) to stay afloat, while a physician can do it way easier and just hire a pro POPTS PT and refer everyone there. If PT's had direct access with reimbursement from insurance it wouldn't be an issue because there would be no PT's for these physician's to hire and the PT's that you say aren't very good could focus on patient care and outcomes versus their business ala MBA style. BUT, in the current system POPTS should not be legal, because it's too easy for a physician to abuse their referral and money making power, and to continue owning/controlling something that they have no business doing.

 

[MaxillofacialMN]

There is a significant subgroup of PT's who flat out will refuse to work in a POPTS clinic, and I highly doubt you could find PT's who refuse to work in PT owned outpatient ortho clinics. Therefore there is already less PT's in the pro POPTS pool to chose from. So, on average, a PT who works in a POPTS clinic will not be as good as a non POPTS PT.

Further, to me it goes far beyond the ethical aspect of it. It isn't fair that a PT has to work infinately harder to set up a private PT practice (and advertise as you say) to stay afloat, while a physician can do it way easier and just hire a pro POPTS PT and refer everyone there. If PT's had direct access with reimbursement from insurance it wouldn't be an issue because there would be no PT's for these physician's to hire and the PT's that you say aren't very good could focus on patient care and outcomes versus their business ala MBA style. BUT, in the current system POPTS should not be legal, because it's too easy for a physician to abuse their referral and money making power, and to continue owning/controlling something that they have no business doing.

I read this post 3x to make sure I wasn't mistaken in what you wrote.

Firstly, your argument about "fairness" is invalid, mostly because we don't live in a socialist society where everything is equal and we all get the same piece of the pie. It's also invalid because you chose to be a PT and now you're upset you can't open shop as easily as an MD can... Turns out podiatrists can't open shop and work on teeth! Not fair!

Next, you can complain that POPTS should be illegal because it's too easy to abuse the same system. Believe it or not, a lot of crimes are really easy to commit. I could put the keys in my car, and slam my car into the hospital across the street if I wanted to. That would be really easy to do! But guess what? Everyone can still drive cars, even though it is incredibly easy to break the law in them! Same is true with POPTS. Innocent until proven guilty, and because of that, you don't outlaw practices because of the possibility of criminal behavior, but instead you punish the criminal behavior if it happens.

Also, would you still be upset if the POPTS offered you double your salary? I doubt it.

POPTSs is an easy/convenient way for a patient to get care. If you think only bad PTs will work there (also, logical inaccuracy, but w/e), then quit training bad PTs and get higher standards for your profession, if this is truly how you feel. Personally, I'll let the free market decide if I want to go to Dr X's office knowing his PT staff is poor...

 

[Fiveoboy11]

I read this post 3x to make sure I wasn't mistaken in what you wrote.

You might want to read it again

Firstly, your argument about "fairness" is invalid, mostly because we don't live in a socialist society where everything is equal and we all get the same piece of the pie. It's also invalid because you chose to be a PT and now you're upset you can't open shop as easily as an MD can... Turns out podiatrists can't open shop and work on teeth! Not fair!

Socialist society ay? So... what do you think of the police force, firefighters, USPS, parks, libraries, etc?? Those are all "socialized" things, just so you know. "Podiatrists can't open shop and work on teeth." This makes no sense. PT's should be able to open up shop to pratice PT just as easy as an MD can open up shop to practice medicine, and as easy as a podiatrist to practice podiatry. We can't, that's the point.

Next, you can complain that POPTS should be illegal because it's too easy to abuse the same system. Believe it or not, a lot of crimes are really easy to commit. I could put the keys in my car, and slam my car into the hospital across the street if I wanted to. That would be really easy to do! But guess what? Everyone can still drive cars, even though it is incredibly easy to break the law in them! Same is true with POPTS. Innocent until proven guilty, and because of that, you don't outlaw practices because of the possibility of criminal behavior, but instead you punish the criminal behavior if it happens.

Yeah, that is pathetic. You can go buy a gun easy as pie, but you have to wait 3 months to see a physical therapist for LBP.

Also, would you still be upset if the POPTS offered you double your salary? I doubt it.

I am just fine with my salary. Would you be upset if another profession took half your salary away without legitimate basis?

POPTSs is an easy/convenient way for a patient to get care. If you think only bad PTs will work there (also, logical inaccuracy, but w/e), then quit training bad PTs and get higher standards for your profession, if this is truly how you feel. Personally, I'll let the free market decide if I want to go to Dr X's office knowing his PT staff is poor...

FYI, the vast majority of PT's are graduating with a doctorate, and from reputable schools (i.e. columbia, USC, emory) so stop the "doctor's office" BS. I really have had enough of that. Just focus on treating hangnails and bunions and stop trying to float on a profession that is at a doctorate level of it's own.

 

[MaxillofacialMN]

FYI, the vast majority of PT's are graduating with a doctorate, and from reputable schools (i.e. columbia, USC, emory) so stop the "doctor's office" BS. I really have had enough of that. Just focus on treating hangnails and bunions and stop trying to float on a profession that is at a doctorate level of it's own.

Firstly, I'd like to make it clear I never attacked you or PT, nor did I ever say anything about PTs not being doctors or "doctor's office BS" as you put it.

Just because your profession has a doctorate, does not mean things should be as equally easy to do. If its harder for you to open an office and stay afloat it's because the free market has decided that your services are not as valued by society as an MD/DO's. This might be because there are too many PTs, or you don't get compensated financially enough to run a private PT office, but the fact or the matter is, a DPT is different than a DPM which is different to than an MD which is different than a DDS which is different than a PhD which is different than a AuD, etc etc. just because you are a doctor doesn't not mean you are equal and nor should it! Each field is valued differently by society. If the "I am a doctor argument" was valid, PCPs would make as much as plastics - which is obviously not the case (and not should it be!).

The argument about socialist agencies in our gov is irrelevant not only because I think public libraries and firefighters are a waste of taxpayer dollars, but because even though we have these institutions it does not mean our entire economic system is based off these ideas. We have libraries does not = DPTs make the same as MDs. That's the leap that argument was making, and hopefully now you see it's a bit frivolous.

As an interesting side not, I'm going to be a DPM, and I'd be very excited if I get hired by an ortho group to be the F/A guy. As a DPT in an ortho group you are guaranteed a salary (you dodged my doubling salary hypothetical, btw), guaranteed patients, guaranteed care for your patients and making them better. If you think orthopods steal more of your money than they should, don't work for them! If you can't sustain your own business outside of a POPTS, then obviously working for a POPTS would be more beneficial for you (guaranteed money), and perhaps the POPTS salary is all you are capable of getting. If you want more, you should have done integrated plastics...

 

[Fiveoboy11]

Firstly, I'd like to make it clear I never attacked you or PT, nor did I ever say anything about PTs not being doctors or "doctor's office BS" as you put it.

Just because your profession has a doctorate, does not mean things should be as equally easy to do. If its harder for you to open an office and stay afloat it's because the free market has decided that your services are not as valued by society as an MD/DO's. Not true, society is ignorant of PT's value even more so than they are of the value of podiatrists. MD/DO's are overvalued with regard to NMSK conditions that are amenable to conservative care (i.e. physical therapy). It is hard for a PT to open an office and stay afloat because of politics and lack of direct access reimbursement for PT services. This might be because there are too many PTs, or you don't get compensated financially enough to run a private PT office, but the fact or the matter is, a DPT is different than a DPM which is different to than an MD which is different than a DDS which is different than a PhD which is different than a AuD, etc etc. just because you are a doctor doesn't not mean you are equal and nor should it! Each field is valued differently by society. If the "I am a doctor argument" was valid, PCPs would make as much as plastics - which is obviously not the case (and not should it be!). Makes no sense. I do not think a PT should make as much as a neurosurgeon. As I've stated many times I have no problem with my pay. I have a big problem with podiatrists making money off my and my colleagues hard work.

The argument about socialist agencies in our gov is irrelevant not only because I think public libraries and firefighters are a waste of taxpayer dollars, but because even though we have these institutions it does not mean our entire economic system is based off these ideas. We have libraries does not = DPTs make the same as MDs. That's the leap that argument was making, and hopefully now you see it's a bit frivolous.

Yikes! I for one am happy we all have these services. Socialized healthcare does not mean DPT=MD in pay. It means everyone has access to care, including direct access to physical therapy (you know what they have in Australia, new zealand, finland, sweden, UK, canada, singapore, norway).

As an interesting side not, I'm going to be a DPM, and I'd be very excited if I get hired by an ortho group to be the F/A guy. As a DPT in an ortho group you are guaranteed a salary (you dodged my doubling salary hypothetical, btw), guaranteed patients, guaranteed care for your patients and making them better. If you think orthopods steal more of your money than they should, don't work for them! If you can't sustain your own business outside of a POPTS, then obviously working for a POPTS would be more beneficial for you (guaranteed money), and perhaps the POPTS salary is all you are capable of getting. If you want more, you should have done integrated plastics...

Good for you, have fun with that.

 

[jesspt]

There is a significant subgroup of PT's who flat out will refuse to work in a POPTS clinic, and I highly doubt you could find PT's who refuse to work in PT owned outpatient ortho clinics. Therefore there is already less PT's in the pro POPTS pool to chose from. So, on average, a PT who works in a POPTS clinic will not be as good as a non POPTS PT.

This doesn't make logical sense.

Further, to me it goes far beyond the ethical aspect of it. It isn't fair that a PT has to work infinately harder to set up a private PT practice (and advertise as you say) to stay afloat, while a physician can do it way easier and just hire a pro POPTS PT and refer everyone there. If PT's had direct access with reimbursement from insurance it wouldn't be an issue because there would be no PT's for these physician's to hire and the PT's that you say aren't very good could focus on patient care and outcomes versus their business ala MBA style. BUT, in the current system POPTS should not be legal, because it's too easy for a physician to abuse their referral and money making power, and to continue owning/controlling something that they have no business doing.

As far as I can tell, there are no laws that make it any harder for a PT to open a PT owned practice than for an MD to open a PT clinic.

My responses in bold above.

 

[Fiveoboy11]

There is a significant subgroup of PT's who flat out will refuse to work in a POPTS clinic, and I highly doubt you could find PT's who refuse to work in PT owned outpatient ortho clinics. Therefore there is already less PT's in the pro POPTS pool to chose from. So, on average, a PT who works in a POPTS clinic will not be as good as a non POPTS PT.

This doesn't make logical sense.
You're saying the PT's who work in POPTS are on average the same or higher quality as PT's who work in other outpatient ortho clinics? I don't follow how this makes logical sense since as I've said there is a subgroup of PT's who refuse to work in POPTS, thus there is less to chose from. Would you agree that the more informed a PT is the more likely he/she is to refuse to work in POPTS clinic? And if a PT is more informed about that, they would be more likely to be informed of evidence based practice and interventions for certain problems. Thus yielding a better PT. To clarify, you would refuse to work in a POPTS would you not? Can you cite me a single PT you know that is on par with you, or any of the well known PT's in our profession who are pro POPTS?


Further, to me it goes far beyond the ethical aspect of it. It isn't fair that a PT has to work infinately harder to set up a private PT practice (and advertise as you say) to stay afloat, while a physician can do it way easier and just hire a pro POPTS PT and refer everyone there. If PT's had direct access with reimbursement from insurance it wouldn't be an issue because there would be no PT's for these physician's to hire and the PT's that you say aren't very good could focus on patient care and outcomes versus their business ala MBA style. BUT, in the current system POPTS should not be legal, because it's too easy for a physician to abuse their referral and money making power, and to continue owning/controlling something that they have no business doing.

As far as I can tell, there are no laws that make it any harder for a PT to open a PT owned practice than for an MD to open a PT clinic.

Laws are not the only issue, by the way there ARE laws that restrict a PT's ability to open and make business as a PT (lack of direct access in some states). And imagine how fast Target would go out of business if they needed a referral from Walmart for "customers." But there's no "laws" preventing Target from going into business.

Regulations and policies make it far more difficult for a PT to open up a clinic vs an MD. If I could open up a PT clinic with direct access reimbursable by all insurance I would have a small rinky dink clinic already.

 

[jesspt]

I think you guys might be going a little too tough on POPTs. Sure the potential for abuse and unethical behavior is there, but those things are available everywhere. If a physician wants to practice in an unethical fashion, there are other ways to do so. But I see it a little differently. When you are in private PT practice, you will market yourself to docs as being a worthy PT to refer to. In other words, you'll want to put yourself out there as the best around.

But what if the physician already knows a PT that s/he feels is top notch? Why not remove uncertainty and include that person in the practice? There are some bad PTs out there (no more than any other profession, but they're out there), and nobody wants to refer a good patient to a slacker. And I would think that a PT who is an integral part of a medical practice would have better overall communication with the doc, which should benefit the patient.

It may be unfair to automatically judge any POPT as unethical without going case by case. But perhaps such an arrangement should require some higher level of scrutiny to avoid bad behavior?

facet -

How does bringing this PT into the physician' practice help the patient? If he/she are already referring to this PT becuase they know that the Pt is "top notch" how does changing the physical location of the PT benefit the patient?

In regards to the communication comment, I can say from experience that it doesn't tend to happen. Certainly there are some POPTs where regular and beneficial communication happens, but I think this happens far less than you might think. In fact, if you ask many PTs in the Chciago area who work for large POPTs, they can go weeks without speaking to any of the physicians in their practice.

Let me state again, I am not saying that all POPTs are unethical, or that all POPTs provide sub-standard care. I am syaing that POPTs is a referral for profit situation, and those situations can lend themselve to the temptation of overutilization of services.

 

[jesspt]

You're saying the PT's who work in POPTS are on average the same or higher quality as PT's who work in other outpatient ortho clinics? I don't follow how this makes logical sense since as I've said there is a subgroup of PT's who refuse to work in POPTS, thus there is less to chose from. Would you agree that the more informed a PT is the more likely he/she is to refuse to work in POPTS clinic? And if a PT is more informed about that, they would be more likely to be informed of evidence based practice and interventions for certain problems. Thus yielding a better PT. To clarify, you would refuse to work in a POPTS would you not? Can you cite me a single PT you know that is on par with you, or any of the well known PT's in our profession who are pro POPTS?



Laws are not the only issue, by the way there ARE laws that restrict a PT's ability to open and make business as a PT (lack of direct access in some states). And imagine how fast Target would go out of business if they needed a referral from Walmart for "customers." But there's no "laws" preventing Target from going into business.

Regulations and policies make it far more difficult for a PT to open up a clinic vs an MD. If I could open up a PT clinic with direct access reimbursable by all insurance I would have a small rinky dink clinic already.

You can't amek the statements you make in the first stanza. You talk about a subset of PTs who won't work in the POPTs setting (I'm one of them, for the record), so there are fewer PTs for MDs to choose from? Ho much fewer? The sample size is still very large, so you would expect a typical bell curve distribution, mostly "average" in clinical acumen, a small percentage of "exceptional" clinicians and a small percentage of "bad" clinicians.

A "more informed" PT is less likely to work in a POPTs if they place a significant amount of importance on avoiding working in a referral for profit scenario. If it's low on their priority list (and I think it's pretty low on many PTs radar) they'll work wherever they can that caters to their personal priorities (small commute, large salary, flexible hours, 8-5 schedule, etc.)

And, I don't think we can extrapolate that being polictically informed or engaged correlates with being more engaged with evidence-informed practice.

I don't know of any prominent PTs who are pro-POPTs, and in fact, many are vocal oponents of POPTs.

I agree with you that some legislation makes it more difficult to remain competitive in the current landscape when running a PT owned practice, but starting the practice is no more daunting for a PT compared to an MD starting a POPTs.

 

[jesspt]

Soem references which support my stance on POPTs and the conflict of interest they can represent:

• http://ptjournal.apta.org/content/77/1/10.full.pdf
• http://www.ncbi.nlm.nih.gov/pubmed/1404742?dopt=Abstract
• https://oig.hhs.gov/oei/reports/oei-09-02-00200.pdf
• https://oig.hhs.gov/oei/reports/oei-02-90-00590.pdf

Some of the numbers that suggest overutilization in the POPTs setting are staggering, certainly lending credence to my contention that POPTs can represent a conflict of interest for a referring provider.

 

[jesspt]

Jeez. Just read back through some of my posts. Sorry about all of the typos.

 

[Myosin]

Some explain this to a future pt student.

Why exactly is podiatry so bad? I thought they were the supposed to diagnosis and treat lower extremity injuries.

I understand how it would be bad for one to be treating cervical, lumbosacral, or shoulder injuries, but it doesn't seem like that the case with what the op linked.

What is with the war between physical therapists and podiatrists?

 

[VIllaHJF]

Some explain this to a future pt student.

Why exactly is podiatry so bad? I thought they were the supposed to diagnosis and treat lower extremity injuries.

I understand how it would be bad for one to be treating cervical, lumbosacral, or shoulder injuries, but it doesn't seem like that the case with what the op linked.

What is with the war between physical therapists and podiatrists?

There is no problem between the two and podiatry is not bad. The concern was that the podiatrist had a physical therapist working for their clinic. In such a situation, the podiatrist could pay the PT say 80k per year despite the revenue that the PT generates. This presents an opportunity where the podiatrist could refer more and more patients to PT so that revenue is increasing while still paying the PT the same 80k. This is referred to as referral for profit.

 

[fozzy40]

Very interesting discussion!

I hear two points:
1) For profit businesses
2) Business ethics.

I'm speaking to the 2nd point and playing devil's advocate...
The PTs that are working for POPTs...are they obligated to overutilize resources? My point is any health care provider (or working individual for that matter) can find themselves in a workplace situation where they don't agree with the way business is being implemented. Is not the ethical responsibility to speak to either take action for change or walk away if that practice does not agree with you?

 

[Myosin]

Very interesting discussion!

I hear two points:
1) For profit businesses
2) Business ethics.

I'm speaking to the 2nd point and playing devil's advocate...
The PTs that are working for POPTs...are they obligated to overutilize resources? My point is any health care provider (or working individual for that matter) can find themselves in a workplace situation where they don't agree with the way business is being implemented. Is not the ethical responsibility to speak to either take action for change or walk away if that practice does not agree with you?

As stated above, I have zero knowledge on this issue, as I am just a soon to be pt student.

I can give my insight about the ethics part with an example.

I have shadowed a very intelligent and caring physical therapist. He works for a company that was bought out by a much larger investor company. He has told me that over the last ten years they have turned the clinic into what can best be described as a physical therapy factory where patients go down the assembly line.

The new protocols have all patients do the exact same premade flow sheets for each region, regardless of injury. Patients come in, do exercises, get e-stim/heat, and come back in two days.

He has told me that he hates it. Even though it's not a bad clinic, it is far from optimal, with profit being the driving factor. Patients do get good and adequate care, but it is very mechanical and mundane for the patients and the therapists, and could be so much better in every facet. He has been promoted to administrative positions in the clinic to where he could not leave this job and get anywhere near a comparable salary. His position is just high enough to where he can't change things and he can't leave for another job without making a major change in lifestyle

With 3 kids, a mortgage, two car payments, cost of living, and two sets of student loans (his and wife, who is now a stay at home mother), getting on the bad side of corporate is not in his personal best interest, both as a therapist and personally.

That's just how life is sometimes and you can't really fault someone over it. I'm not excusing it by any means, but just pointing out that the ideal and real life do not always over lap.

 

[MaxillofacialMN]

There is no problem between the two and podiatry is not bad. The concern was that the podiatrist had a physical therapist working for their clinic. In such a situation, the podiatrist could pay the PT say 80k per year despite the revenue that the PT generates. This presents an opportunity where the podiatrist could refer more and more patients to PT so that revenue is increasing while still paying the PT the same 80k. This is referred to as referral for profit.

This is how all businesses work and I don't see a problem... A chef at a restaurant makes thousands of dollars of billable food a night, but maybe only makes a hundred bucks if he's lucky. That's how business works. The employee MUST generate more money than he is paid of be I'd not a valuable asset to the company and it would be wise to fire that employee. If the relationship between the pod and the pt wasn't mutualistic, it wouldn't exist. The pod would fire the pt or the pt would find employment in other places.

If you're trying to say that pods abuse the system by over referring to their pt employees to generate more money, this is a hazard in literally every profession and you deal with it if it happens. Any doctor can perform needless operations. PTs can do this by telling their patient they need to come in twice as often as usual. Abuse of the system! Under the logic presented, we should disallow PTs to own practices because they might lie to the patients and tell them they need more pt than they do!

 

[Myosin]

Abuse of the system! Under the logic presented, we should disallow PTs to own practices because they might lie to the patients and tell them they need more pt than they do!

That's actually a good point.

Any worker who works at and owns his own business presents the greatest conflict of interest possible

 

[Fiveoboy11]

This is how all businesses work and I don't see a problem... A chef at a restaurant makes thousands of dollars of billable food a night, but maybe only makes a hundred bucks if he's lucky. That's how business works. The employee MUST generate more money than he is paid of be I'd not a valuable asset to the company and it would be wise to fire that employee. If the relationship between the pod and the pt wasn't mutualistic, it wouldn't exist. The pod would fire the pt or the pt would find employment in other places.

Do not put physical therapy and food service in the same category. A restaurant is a business with customers by nature. A physical therapy office is a clinic with patient's by nature. Respect the difference. Anyone who lets money have any impact on their decisions with regard to patient healthcare should be thrown in jail and have their license permanently revoked.

If you're trying to say that pods abuse the system by over referring to their pt employees to generate more money, this is a hazard in literally every profession and you deal with it if it happens. Any doctor can perform needless operations. PTs can do this by telling their patient they need to come in twice as often as usual. Abuse of the system! Under the logic presented, we should disallow PTs to own practices because they might lie to the patients and tell them they need more pt than they do!

How about each professional sticks to their own profession, with their agenda being providing the best care within their scope. Forget about business agenda and let the patient make informed decisions vs making them more and more passive a la walmartized businesscare.

 

[Azimuthal]

This is how all businesses work and I don't see a problem... A chef at a restaurant makes thousands of dollars of billable food a night, but maybe only makes a hundred bucks if he's lucky. That's how business works. The employee MUST generate more money than he is paid of be I'd not a valuable asset to the company and it would be wise to fire that employee. If the relationship between the pod and the pt wasn't mutualistic, it wouldn't exist. The pod would fire the pt or the pt would find employment in other places.

If you're trying to say that pods abuse the system by over referring to their pt employees to generate more money, this is a hazard in literally every profession and you deal with it if it happens. Any doctor can perform needless operations. PTs can do this by telling their patient they need to come in twice as often as usual. Abuse of the system! Under the logic presented, we should disallow PTs to own practices because they might lie to the patients and tell them they need more pt than they do!

I believe the point is to alleviate as much possible preconceived notion of referral for profit. The key phrase is "referral for profit". Your argument does not address the issue of 'increased' unethical behavior (that may or may not exist). You only addressed an issue of separate entities (which can happen in any profession and I agree can be an issue) and not their relationship (a more preventable behavior), so although I know where you want to go, you have not provided a valid argument. Plus many people negate how a company culture can change people over time.

If we go back 25-30 years and observe how many orthopedic surgeons provided 'ancillary' PT services over time, we may see why or why haven't these numbers increased. It may answer many questions. Though, after seeing the stances of some of these posters, no one is changing sides. lol. Forget the presidential debates, I'm reading SDN!

 

[jesspt]

Very interesting discussion!

I hear two points:
1) For profit businesses
2) Business ethics.

I'm speaking to the 2nd point and playing devil's advocate...
The PTs that are working for POPTs...are they obligated to overutilize resources? My point is any health care provider (or working individual for that matter) can find themselves in a workplace situation where they don't agree with the way business is being implemented. Is not the ethical responsibility to speak to either take action for change or walk away if that practice does not agree with you?

Of course those PTs should be held to the same ethical standard that other health care providers are.

The issue boils down fairly simply, to this:

1. POPTs are a referral for profit situatiation
2. These situations can lead physicians to make patient care decisions based on factors other than what may be best for the patient, and in fact, we have a decent amount of utilization data which suggests that this occurs far more often than most health care providers think
3. If we removed the referral for profit situation, patients would still have access to quality physical therapy, and referring providers would be removed from a situation where their judgement might be influenced by financial considerations

fozzy40 - appreciate you playing devil's advocate here, and your participation in the forum.

 

[fozzy40]

Some other questions that popped up in my head:

Do you know what percentage of physical therapists (in the US) are employed by physician owned clinics?
How is hospital employed PTs different?
With respect to the utilization data, might this be representation of the fact that physicians don't understand what physical therapy is which translates into overprescription?

 

[jesspt]

Some other questions that popped up in my head:

Do you know what percentage of physical therapists (in the US) are employed by physician owned clinics?

I do'nt know the answer to this, and I don't know of any organization that would have an accurate number.

How is hospital employed PTs different?

Different than what? A PT who works for a physician, or a PT in private practice?

With respect to the utilization data, might this be representation of the fact that physicians don't understand what physical therapy is which translates into overprescription?

I suppose that is possible, but I think it is unlikely. Look at some of the data regarding utilizaton of MRI once the physician/physician group purchases an MRI machine. Do you think the average physician doesn't understand an MRI?

My responses in bold above

 

[Fiveoboy11]

Some other questions that popped up in my head:

Do you know what percentage of physical therapists (in the US) are employed by physician owned clinics?
How is hospital employed PTs different?

I tried to answer this in one of my above posts

With respect to the utilization data, might this be representation of the fact that physicians don't understand what physical thera.py is which translates into overprescription?

.

 

[fozzy40]

.

I saw your response. If a hospital physician sends a patient for inpatient (or outpatient) therapy services which is owned by the same system, it's the same thing in my mind. Physician owned versus hospital owned is the same structure in my mind. I'm sure that we will agree to disagree on this point.

 

[fozzy40]

I suppose that is possible, but I think it is unlikely. Look at some of the data regarding utilizaton of MRI once the physician/physician group purchases an MRI machine. Do you think the average physician doesn't understand an MRI?

I think that the average physician knows how to look for certain things but may not have a great explanation for everything that is seen when it comes to MRI. In addition, defensive medicine is a practice that we are often forced to practice which does not help with utilization...that's beside the point.

I'll contact the APTA about that number of PTs employed by POPTs. It would be interesting to know.

In my own experience, I personally like having PTs in house out of convenience of communication and patient care. Having worked at a PT clinic throughout college, I used to hate the disconnect between providers. It drove me (and likely you guys as well) crazy!

 

[Azimuthal]

That's actually a good point.

Any worker who works at and owns his own business presents the greatest conflict of interest possible

Please elaborate. Need to apply some CT here.