"The Truth Behind APTA’S Campaign Against POPTS" courtesy of the AAOS

[DesertPT]

http://www.aaos.org/news/aaosnow/nov12/managing3.asp

Thoughts?

When I shadowed at a clinic where the PT is in a POPTS format, the PT's loved it and wouldn't have it any other way. Besides being somewhat subservient to the doctors, they liked that it was easy to communicate with the docs/surgeons about each patient readily, and that ability alone seemed to be what made the job for them.

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[Bluecase]

Well it was written by a lawyer (presumably paid by the aaos) and not a physician. And the fact that he wrote ""doctors" of physical therapy" pretty much sums up his general attitude towards PT as a profession. Anyone can spin any articles or make question an authors motives/use of scientific method for their own agenda. If this was written by a physician it would have different meaning than by an outside consultant (and probably lobbyist).

 

[PTMattI]

my anecdotal experience with a POPTS clinic was when I was a tech prior to starting PT school...the therapists there were tremendously overworked (up to 3 patients per hour), I pretty much never saw any manual PT done, the pt techs took the patients through their exercise program and there was (in my opinion) an over reliance / utilization of modalities.

it certainly did not provide the best patient care...is it indicative of all or a majority of POPT clinics? i dont know.

 

[AlanWattsBlues]

Seems like the author has some heavy critiques of the studies that the APTA leans on (and on my first reading they strike me as valid critiques, honestly). This was published in November 2012. Has there been some kind of open reply from a representative of the APTA?

In general, direct access is something that I can get passionate about. All of the POPT stuff...I just find myself not feeling that worked up about it.

 

[DesertPT]

Well it was written by a lawyer (presumably paid by the aaos) and not a physician. And the fact that he wrote ""doctors" of physical therapy" pretty much sums up his general attitude towards PT as a profession. Anyone can spin any articles or make question an authors motives/use of scientific method for their own agenda. If this was written by a physician it would have different meaning than by an outside consultant (and probably lobbyist).

I definitely think you are right about all of this. Definitely not an unbiased opinion.

my anecdotal experience with a POPTS clinic was when I was a tech prior to starting PT school...the therapists there were tremendously overworked (up to 3 patients per hour), I pretty much never saw any manual PT done, the pt techs took the patients through their exercise program and there was (in my opinion) an over reliance / utilization of modalities.

it certainly did not provide the best patient care...is it indicative of all or a majority of POPT clinics? i dont know.

This was largely the case in the POPTS clinic where I observed. There was some manual therapy but at least 50% of each patient care was provided by 18 y.o. minimum wage techs. 4 patients an hour was the standard. They wanted PT patients in and out the door in 30 minutes, but the PTs always had them stay longer than that. This happens in non physician-owned clinics to though. The store-front chain PT clinics seem to be fast become the standard, and they are often "patient mills" too.

 

[DesertPT]

Seems like the author has some heavy critiques of the studies that the APTA leans on (and on my first reading they strike me as valid critiques, honestly). This was published in November 2012. Has there been some kind of open reply from a representative of the APTA?

In general, direct access is something that I can get passionate about. All of the POPT stuff...I just find myself not feeling that worked up about it.

I agree with you here, and I do think the APTA's vehement arguments and constant battling against POPTS could be energy better spent somewhere else. APTA's goal does sometimes seem to be to make PTs equal with orthopedists, which strikes me as a little misguided but I am certainly not an expert on the subject.

 

[Azimuthal]

Have you guys read this? Thoughts?

MEDICARE PHYSICAL THERAPY
Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary

http://www.gao.gov/assets/670/662860.pdf

 

[NewTestament]

I agree with you here, and I do think the APTA's vehement arguments and constant battling against POPTS could be energy better spent somewhere else. APTA's goal does sometimes seem to be to make PTs equal with orthopedists, which strikes me as a little misguided but I am certainly not an expert on the subject.

But POPTS are ultimately bad for our profession, and entrench the the idea that physical therapists are subservient to physicians. I don't think surgeons and physicians (led by the AMA) want inter-disciplinary health care. The AMA still wants to maintain this 19th-century model in which the physician is at the center and everyone else is at the periphery ("allied health") and simple takes orders from the god-physician. I wish PT's would stop undermining their own profession and stop working at these clinics. Only physicians can hire other physicians. Physical therapists should be the only clinicians to be able to hire physical therapists.

 

[southernswimmer]

Only physicians can hire other physicians. Physical therapists should be the only clinicians to be able to hire physical thearapists.

This is a huge question going through the SC courts right now. SC banned POPTS back in 2006: http://www.judicial.state.sc.us/opinions/displayOpinion.cfm?caseNo=26209. 2 MDs and a PT filed a suit last year, arguing that an MD should be able to refer treatment to a PT in the same way a PT refers treatment to a PTA within the same practice. The opinion was issued in April and upheld the ban on POPTS: http://www.apta.org/uploadedFiles/A...rral_for_Profit/SCTrialCourtDecision_2014.pdf

Take a gander at that. I do believe the plaintiffs filed an appeal, taking the case to the state supreme court, so stay tuned.

 

[jesspt]

Well it was written by a lawyer (presumably paid by the aaos) and not a physician. And the fact that he wrote ""doctors" of physical therapy" pretty much sums up his general attitude towards PT as a profession. Anyone can spin any articles or make question an authors motives/use of scientific method for their own agenda. If this was written by a physician it would have different meaning than by an outside consultant (and probably lobbyist).

"Cary B. Edgar is an attorney and one of the principals of Ancillary Care Solutions, LLC, an Arizona-based company that helps hospitals and health systems, physician groups, and therapists manage outpatient physical, occupational, and speech therapy programs."

He is a principal of a company that helps physicians' run their POPTs clinic. Not exactly an unbiased opinion.

 

[jesspt]

http://www.apta.org/LegislativeIssues/SelfReferral/

Some more info - click on the above link and go to hte General Information section. Click on

• GAO Report Identifies Incentive to Self-Refer Among Physicians Who Transition to Self-Referral Model (.pdf) - 6/2/14

 

[DesertPT]

But POPTS are ultimately bad for our profession, and entrench the the idea that physical therapists are subservient to physicians. I don't think surgeons and physicians (led by the AMA) want inter-disciplinary health care. The AMA still wants to maintain this 19th-century model in which the physician is at the center and everyone else is at the periphery ("allied health") and simple takes orders from the god-physician. I wish PT's would stop undermining their own profession and stop working at these clinics. Only physicians can hire other physicians. Physical therapists should be the only clinicians to be able to hire physical therapists.

You raise some excellent points. For the most part what you have described is the general impression I have gotten during my forays through the healthcare world.

He is a principal of a company that helps physicians' run their POPTs clinic. Not exactly an unbiased opinion.

No doubt about that!

 

[DesertPT]

I was talking to my dad about orthopedic surgeons trying to limit the dominion of PTs and he was like well ya if a PT fixes someones problem non-surgically their goes the surgeon's paycheck!

 

[NewDPT31]

I was talking to my dad about orthopedic surgeons trying to limit the dominion of PTs and he was like well ya if a PT fixes someones problem non-surgically their goes the surgeon's paycheck!

This might be anecdotal, but from my experience and from the experience of several other PT friends at other clinics, Spinal surgeons tend to be the worst with this. Refer the minimum amount of PT sessions necessary to justify surgery via the insurance. "Patient A didnt reduce his pain from 9/10 to 0/10 with 6 -30 min sessions? Lets do a $100k surgery!"

 

[fozzy40]

I think it's fair to say that everyone is biased...APTA, AAOS, etc. Is the statement he made non-factual?

 

[jesspt]

I think it's fair to say that everyone is biased...APTA, AAOS, etc. Is the statement he made non-factual?

Sure, there is truth in what he says. But, he has cherry-picked the research that the APTA uses to defend their position. There is other research that supports the ATPAs stance. Here is one example:

http://www.apta.org/uploadedFiles/A...Direct_Access/MitchellStudyonDirectAccess.pdf

And the abstract from another:

http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01324.x/abstract , and an APTA press release where they discuss this article: http://www.apta.org/Media/Releases/Consumer/2011/10/13/

To me, the crux of the matter is this: the potential for referral-for-profit exists in POPTs clinics, the inclusion of physical therapy in the Stark legislation fall outside the original intent of the bill (which was to reduce the potential of referral for profit), and I don't see how the patient benefits from a potential referral for profit scenario.

 

[fozzy40]

A couple comments/questions:
1) Let's be honest. Both factions are political parties. It's almost impossible to receive a unbiased opinion.
2) I realize that direct access and POPTs are two separate issues but the overlying theme is increase autonomy. I'm all for direct access personally. There was a great podcast with Julie Fritz (Archives of PM&R, I believe) where she discussed recent medicare data and comparing PT versus other treatment. She did bring up the point that PT is generally cheaper but she could not conclude that it was better compared to other treatments. This I think is the bigger problem versus POPTs and Direct access. Our outcome data is just now starting to become more function and quality of life vs. pain score based.
3) Are PT owned clinics non-profit? My point is everyone is for profit to keep the lights on. Hospital systems hire clinical staff to use their own resources. Not sure how this is different.
4) My issue with the APTA POPT argument is that it's based on the idea that physician owned practices have a higher likelihood of being unethical compared to others. Everyone has the potential to be unethical. A good example is the patient I saw yesterday who had 24 sessions of modality heavy treatment with no improvement. The only reason they stopped was because the insurance company had questioned it and PCP referred patient to me. Another referral I received had "Direct Access" listed as the referring provider and asked me to sign off on a script for a MSK issue that I had never seen. Direct access is one issue. Asking me to commit fraud is another.
5) Anytime dollars are exchanged there is always the potential for unethical practice. If you have a problem with the system that's one thing. Slandering and throwing business owners under the bus to achieve the goal of autonomy is another.
6) Do we know how many PTs are employed by physician owned practices? I called the APTA and never received an answer.

 

[AlanWattsBlues]

6) Do we know how many PTs are employed by physician owned practices? I called the APTA and never received an answer.

Looks like 5%: http://www.bls.gov/ooh/healthcare/physical-therapists.htm#tab-3

 

[fozzy40]

Thank you, AlanWattsBlues!

Knowing that 5% are in PO practices, is direct access the bigger fish to fry from the APTA's standpoint?

 

[jesspt]

@fozzy40

1) Let's be honest. Both factions are political parties. It's almost impossible to receive a unbiased opinion.

• Agreed.

2) I realize that direct access and POPTs are two separate issues but the overlying theme is increase autonomy. I'm all for direct access personally. There was a great podcast with Julie Fritz (Archives of PM&R, I believe) where she discussed recent medicare data and comparing PT versus other treatment. She did bring up the point that PT is generally cheaper but she could not conclude that it was better compared to other treatments. This I think is the bigger problem versus POPTs and Direct access. Our outcome data is just now starting to become more function and quality of life vs. pain score based.

• Funcitonal outcome measurement has been a hallmark of rehabilitation reserach for over two decades, with many well validated options at our disposal.

3) Are PT owned clinics non-profit? My point is everyone is for profit to keep the lights on. Hospital systems hire clinical staff to use their own resources. Not sure how this is different.

• Nope. PT-owned clinics are certainly for-profit entities. The difference between them is in one scenario there exists another layer of potentially unethical behavior (referral for profit) compared to the other.

4) My issue with the APTA POPT argument is that it's based on the idea that physician owned practices have a higher likelihood of being unethical compared to others. Everyone has the potential to be unethical. A good example is the patient I saw yesterday who had 24 sessions of modality heavy treatment with no improvement. The only reason they stopped was because the insurance company had questioned it and PCP referred patient to me. Another referral I received had "Direct Access" listed as the referring provider and asked me to sign off on a script for a MSK issue that I had never seen. Direct access is one issue. Asking me to commit fraud is another.

• In a POPTs clinic there is yet another avenue that one could leverage for unethical behavior. I don't think we have any data that suggests that POPTs are "more likely" to be unethical, but we do have some that supporst the notion that they seem to charge more and see patients for more visits per episode of care (see my references above). The APTA puts their spin on this. I wish they would ask the AMA for data on how POPTs actaually benefit the patient. My guess is they don't have any.
• 1 visit of modality heavy PT is too many. Remember that therapist's name. Never send someone there.

5) Anytime dollars are exchanged there is always the potential for unethical practice. If you have a problem with the system that's one thing. Slandering and throwing business owners under the bus to achieve the goal of autonomy is another.

• I think the APTA is trying to protect a portion of their membership whose business's are threatened by POPTs. They are not doing this in pursuit of autonomy, although they certainly are also pursuing advancement of direct access (rightly so, in my opinion). And, I think if the AMA thought the APTA had produced anything libelous they would likely have pursued some legal action.

Knowing that 5% are in PO practices, is direct access the bigger fish to fry from the APTA's standpoint?

• I can't speak for the APTA, but Direct Access is certainly more important to me as a practitioner compared to POPTs.

 

[fozzy40]

@fozzy40

1) Let's be honest. Both factions are political parties. It's almost impossible to receive a unbiased opinion.

• Agreed.

2) I realize that direct access and POPTs are two separate issues but the overlying theme is increase autonomy. I'm all for direct access personally. There was a great podcast with Julie Fritz (Archives of PM&R, I believe) where she discussed recent medicare data and comparing PT versus other treatment. She did bring up the point that PT is generally cheaper but she could not conclude that it was better compared to other treatments. This I think is the bigger problem versus POPTs and Direct access. Our outcome data is just now starting to become more function and quality of life vs. pain score based.

• Funcitonal outcome measurement has been a hallmark of rehabilitation reserach for over two decades, with many well validated options at our disposal.

3) Are PT owned clinics non-profit? My point is everyone is for profit to keep the lights on. Hospital systems hire clinical staff to use their own resources. Not sure how this is different.

• Nope. PT-owned clinics are certainly for-profit entities. The difference between them is in one scenario there exists another layer of potentially unethical behavior (referral for profit) compared to the other.

4) My issue with the APTA POPT argument is that it's based on the idea that physician owned practices have a higher likelihood of being unethical compared to others. Everyone has the potential to be unethical. A good example is the patient I saw yesterday who had 24 sessions of modality heavy treatment with no improvement. The only reason they stopped was because the insurance company had questioned it and PCP referred patient to me. Another referral I received had "Direct Access" listed as the referring provider and asked me to sign off on a script for a MSK issue that I had never seen. Direct access is one issue. Asking me to commit fraud is another.

• In a POPTs clinic there is yet another avenue that one could leverage for unethical behavior. I don't think we have any data that suggests that POPTs are "more likely" to be unethical, but we do have some that supporst the notion that they seem to charge more and see patients for more visits per episode of care (see my references above). The APTA puts their spin on this. I wish they would ask the AMA for data on how POPTs actaually benefit the patient. My guess is they don't have any.
• 1 visit of modality heavy PT is too many. Remember that therapist's name. Never send someone there.

5) Anytime dollars are exchanged there is always the potential for unethical practice. If you have a problem with the system that's one thing. Slandering and throwing business owners under the bus to achieve the goal of autonomy is another.

• I think the APTA is trying to protect a portion of their membership whose business's are threatened by POPTs. They are not doing this in pursuit of autonomy, although they certainly are also pursuing advancement of direct access (rightly so, in my opinion). And, I think if the AMA thought the APTA had produced anything libelous they would likely have pursued some legal action.

Knowing that 5% are in PO practices, is direct access the bigger fish to fry from the APTA's standpoint?

• I can't speak for the APTA, but Direct Access is certainly more important to me as a practitioner compared to POPTs.

With respect to my #2, I did not elaborate. I'm well aware of the validated measures. However, the application of validated measures and uniformity is not well reported across the board in the US. Every clinic seems to use different measures if they do at all which makes the interpretation of their outcomes nebulous

We can agree to disagree at the end of the day. However, the assumption that physicians have more potential to be unethical compared to anyone else is ridiculous. I'm part of a POPTs multispecialty group and I routinely refer outside of my clinic. I realize the skill level of my therapists and send my patients where they will receive the best care. My group has significantly lower average visit, low modality use, with better outcomes which we monitor. I ask the PT groups for similar information and they have no answer.

At 5% of the practicing PTs, are POPTs really a threat? Perhaps the battle should be with the insurance companies directly since that seems to be the limiting factor with direct access. Has the APTA addressed them specifically?

 

[Fiveoboy11]

A couple comments/questions:
1) Let's be honest. Both factions are political parties. It's almost impossible to receive a unbiased opinion.
2) I realize that direct access and POPTs are two separate issues but the overlying theme is increase autonomy. I'm all for direct access personally. There was a great podcast with Julie Fritz (Archives of PM&R, I believe) where she discussed recent medicare data and comparing PT versus other treatment. She did bring up the point that PT is generally cheaper but she could not conclude that it was better compared to other treatments. This I think is the bigger problem versus POPTs and Direct access. Our outcome data is just now starting to become more function and quality of life vs. pain score based.
3) Are PT owned clinics non-profit? My point is everyone is for profit to keep the lights on. Hospital systems hire clinical staff to use their own resources. Not sure how this is different.
4) My issue with the APTA POPT argument is that it's based on the idea that physician owned practices have a higher likelihood of being unethical compared to others. Everyone has the potential to be unethical. A good example is the patient I saw yesterday who had 24 sessions of modality heavy treatment with no improvement. The only reason they stopped was because the insurance company had questioned it and PCP referred patient to me. Another referral I received had "Direct Access" listed as the referring provider and asked me to sign off on a script for a MSK issue that I had never seen. Direct access is one issue. Asking me to commit fraud is another.
5) Anytime dollars are exchanged there is always the potential for unethical practice. If you have a problem with the system that's one thing. Slandering and throwing business owners under the bus to achieve the goal of autonomy is another.
6) Do we know how many PTs are employed by physician owned practices? I called the APTA and never received an answer.

1) Read the evidence regarding POPTS that the APTA bases its statements on, then read the "evidence" proponents to POPTS have to justify or outweigh the negative aspects of self referral.

2) traditional businesses in the U.S. are often anti autonomy and pro management and control, POPTS are no different plus the added physician power above baseline (i.e. Termination of employment). Direct access is not likely in a POPTS clinic regardless of law or insurance as many would have policy/procedure to discourage it. Autonomy is profoundly important in people as it is a key component in motivation, imagine the impact in physical therapy and patient care.

3) There is unethical behavior more on average in POPTS. Interestingly enough, unethical behavior increases with "extrinsic motivation" (i.e. Orders, non self determination).

4) It's been proven over and over that the average POPT's more unethical versus non POPTs. Anecdotes prove nothing.

5) POPT's are fundamentally flawed, the elimination of them to me would have far reaching effects for the better.

 

[Fiveoboy11]

With respect to my #2, I did not elaborate. I'm well aware of the validated measures. However, the application of validated measures and uniformity is not well reported across the board in the US. Every clinic seems to use different measures if they do at all which makes the interpretation of their outcomes nebulous

We can agree to disagree at the end of the day. However, the assumption that physicians have more potential to be unethical compared to anyone else is ridiculous. I'm part of a POPTs multispecialty group and I routinely refer outside of my clinic. I realize the skill level of my therapists and send my patients where they will receive the best care. My group has significantly lower average visit, low modality use, with better outcomes which we monitor. I ask the PT groups for similar information and they have no answer.

At 5% of the practicing PTs, are POPTs really a threat? Perhaps the battle should be with the insurance companies directly since that seems to be the limiting factor with direct access. Has the APTA addressed them specifically?

How in the world do you figure a physician with financial incentive is no more likely to be unethical versus a physician without incentive or a non PT clinic owner or partner? What incentive does the average PT have to prolong care or provide services that are not indicated? None.

Physician control doesn't enhance patient care in physical therapy in my opinion, especially in the long term both for PT's and for patients. Where's the motivation for a PT to master their craft in this scenario? interdependence is often paramount. But, dictating and controlling care by physicians is harmful. How many non POPTs clinics have you set foot in? How many hours have you spent observing a PT regarding quality of care or outcome measure use or ethics? Talk about bias.

 

[DesertPT]

Good debate so far everyone! Thank you all for your insights and opinions!

 

[fozzy40]

What is the incentive of a privately owned PT clinic...Uh...how about money? I can name at least 5 clinics in my area that practice that way. Discharge Plan: When patient stops coming or when PIP has run out. No matter who owns the clinic, if money is being exchanged there is always a question of ethical business and clinical practice.

I do not think it's anyones goal to control physical therapy. In my clinic, we do not "control" anybody. We work with our therapists and support their professional goals. They are well compensated and have excellent schedules. No guns to there head. They are free to leave anytime they want. Especially at 5% of the practicing PTs, I do not think it's on the AMA or AOA's agenda to take over physical therapy practice.

 

[fozzy40]

http://www.nytimes.com/2014/04/28/b...-4-million-in-2012-medicare-billing.html?_r=0

There are plenty of similar articles about questionable practice involving physicians, DCs, PAs, NPs, accountants, attorneys, etc...everybody has potential...everybody

 

[jesspt]

With respect to my #2, I did not elaborate. I'm well aware of the validated measures. However, the application of validated measures and uniformity is not well reported across the board in the US. Every clinic seems to use different measures if they do at all which makes the interpretation of their outcomes nebulous

We can agree to disagree at the end of the day. However, the assumption that physicians have more potential to be unethical compared to anyone else is ridiculous. I'm part of a POPTs multispecialty group and I routinely refer outside of my clinic. I realize the skill level of my therapists and send my patients where they will receive the best care. My group has significantly lower average visit, low modality use, with better outcomes which we monitor. I ask the PT groups for similar information and they have no answer.

At 5% of the practicing PTs, are POPTs really a threat? Perhaps the battle should be with the insurance companies directly since that seems to be the limiting factor with direct access. Has the APTA addressed them specifically?

Fozzy40,

I know that you're aware of the validated measures and I agree with you that few clinics use them.

I respect the fact that you are an obvious and active advocate for physical therapy,and I am not implying that physicians are more likely to be unethical compared to other health care providers. Read my previous posts - I have never directly stated or even hinted at this. I have only ever said that physicians in a POPTS environment have more ways they can profit off of unethical behavior than other health care providers. A physician who owns a PT clinic can refer his/her patient to that clinic (and may then receive profit from this) and as the therapists are the employee, that unethical physician can exert some pressure over how that PT practices. Again, I am not saying that physicians are more likley to be unethical, only that they have more opportunity to be profitable off of a referral for profit situation. Given the fact that POPTs do not seem to offer obvious benefit for the patient, and present a potential (although possibly unlikely) conflict of interest for the physician, I would agree with the APTA's stance against POPTs. From my perspective, I have yet to hear a compelling argument that refutes those. But, as you state, we can agree to disagree.

 

[fozzy40]

JessPT,

Thank you for the article "A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy." I enjoyed reading it!
According to the authors, "on average, the physician-referred PT episodes had one more PT visit than self-referred episodes (7.0 versus 5.9)." So one visit more with physician referred (not necessarily POPTs) vs. self referred. They did find that self-referral was slightly cheaper $20-40. Supports Fritz's findings which I agree is a good way to go.

Not sure if you had access to the journal article or if it's public access. Just highlighting the findings for the other viewers of the board.

 

[ptisfun2]

A recent 'article' (i.e., popular literature and not peer-reviewed) on self-referral that some may find interesting: http://www.azcentral.com/story/mone...phoenix-radiation-referral-medicare/14192375/.

 

[fozzy40]

What are the pros and cons of working for a POPT clinic? I've heard the communication pro. Lack of practice autonomy as a negative. What are some of the others?

 

[Fiveoboy11]

What are the pros and cons of working for a POPT clinic? I've heard the communication pro. Lack of practice autonomy as a negative. What are some of the others?

Pro: more interesting and challenging cases are possible, potential for more professional collaboration with the right kind of physician, better access to reports, less worry about staying busy/booked, more money.

Con: support of the status quo, make money for another profession, limit patient choice (physicians think its up to them to decide where the patient will go when its actually up to the patient), be more subservient to the physicians, less motivation to improve and provide best quality care due to lack of autonomy, purpose of job is diminished (follow "dr" orders vs critical thought and thoroughly based POC to serve the patient), less chance for mastery of skillsets, reinforce myth that physicians should and are qualified to supervise and direct "the PT." I could go on all day.

 

[fozzy40]

"make money for another profession"...there it is Lots of generalizations as usual but I appreciate your thoughts!

 

[NewTestament]

Imagine the uproar from the AMA if anybody except physicians could hire and employ physicians and profit from their work. It's condescending that physicians can hire physical therapists and direct them, but not the other way around.

 

[fozzy40]

@NewTestament I do not think that the AMA actually has a stance on POPTs. However, your point I think is addressing a separate issue of who your is your employer. A large percentage of physicians are employed by non-physicians so I do not see a problem there. I'm not sure what you mean by condescending because it's not like PTs are forced to be employed by a physician. It's not in the AMA or AOA's mission to own or control any profession. As far as working the other way around, give me work space, job security, health benefits, 401K, and fair pay...I would be glad to work for them no matter what initials are behind their name.

 

[Fiveoboy11]

"make money for another profession"...there it is Lots of generalizations as usual but I appreciate your thoughts!

There it is? Would you view physicians making money off PT's work as anything other than a con from the perspective of a PT? Do you really think it is fair and ethical? Why don't you list the pros and cons of PT's working for you? Let's see how many cons you can think of. How about the pros and cons of you working for a PT (obviously hypothetical). How about your perception of the pros and cons of a PT working for a physician?

 

[Fiveoboy11]

@NewTestament I do not think that the AMA actually has a stance on POPTs. However, your point I think is addressing a separate issue of who your is your employer. A large percentage of physicians are employed by non-physicians so I do not see a problem there. I'm not sure what you mean by condescending because it's not like PTs are forced to be employed by a physician. It's not in the AMA or AOA's mission to own or control any profession. As far as working the other way around, give me work space, job security, health benefits, 401K, and fair pay...I would be glad to work for them no matter what initials are behind their name.

The AMA is a piece of trash association. Has done immense harm to the profession of physical therapy, therefore physical therapist and patients who need physical therapy. And you must be crazy if you think the AMA is against referral for profit, let alone POPTs. Who cares what the AMA's mission is? They have been controlling healthcare in the US in many respects for decades, look at the lobbying money spent by the AMA alone per year. You don't think a lot of that is to push their agenda, inhibit others, and therefore control.

I'd like to see your thoughts on working for a non physician with the history that PT/medicine has. The tables turn real quick when someone takes your money, tries to control a profession that isn't theirs, inhibits societal and professional recognition, implies professional superiority, claims danger of autonomous physical therapist practice.

 

[IlDestriero]

The AMA is an ineffective organization that doesn't seem to help anyone and certainly doesn't represent physicians. I doubt they did anything to hurt your profession.
And their PAC is far from a powerhouse dictating policy. The only thing they have going for them is their name and access to newsmen looking for a sound bite.

 

[fozzy40]

There it is? Would you view physicians making money off PT's work as anything other than a con from the perspective of a PT? Do you really think it is fair and ethical? Why don't you list the pros and cons of PT's working for you? Let's see how many cons you can think of. How about the pros and cons of you working for a PT (obviously hypothetical). How about your perception of the pros and cons of a PT working for a physician?

PT's working for a POPT (or any clinic) are employees with associated costs. So there are always costs before revenue. The main advantage of having an employer I think are the benefits (health care, potential PTO, retirement funding), minimal to no overhead, job security, and potential dependable income. The main potential con I think would be autonomy (schedule and practice) but I think that this is a employee wide issue and nonspecific to POPTs.

I personally do not have a problem working for somebody (PT, DC, MD, DO, DPM) as long as the practice fit my style of practice.

 

[atstudent]

The AMA is a piece of trash association. Has done immense harm to the profession of physical therapy, therefore physical therapist and patients who need physical therapy. And you must be crazy if you think the AMA is against referral for profit, let alone POPTs. Who cares what the AMA's mission is? They have been controlling healthcare in the US in many respects for decades, look at the lobbying money spent by the AMA alone per year. You don't think a lot of that is to push their agenda, inhibit others, and therefore control.

I'd like to see your thoughts on working for a non physician with the history that PT/medicine has. The tables turn real quick when someone takes your money, tries to control a profession that isn't theirs, inhibits societal and professional recognition, implies professional superiority, claims danger of autonomous physical therapist practice.

It's always interesting to me how PTs are so against the idea of working for someone else. But then they turn around and hire other professionals so they can direct them. And if you really believe that there isn't unethical behavior in a PT-owned clinic, I've got some ocean-front property for sale...

 

[NewDPT31]

It's always interesting to me how PTs are so against the idea of working for someone else. But then they turn around and hire other professionals so they can direct them. And if you really believe that there isn't unethical behavior in a PT-owned clinic, I've got some ocean-front property for sale...

Yeah I tend to agree. I've been a PT for 3.5 years now, worked in PT owned SNF, PT owned outpatient, non profit snf, non profit OP. PT owned outpatient is where I felt the least comfortable with ethics, as we had to make up for not having a Referral feeder. I tend not to care who is in charge of me as long as I get a fair shake and some autonomy. I see POPTS as no different than non profit hospital in the respect that our Physicians and Ortho surgeon give the referral on our hospital script which shows the location of our clinic and then they walk down the hall to leave with the script past the PT clinic and stop in. No different. They are told they can go anywhere they want, but every hospital does this.

 

[jesspt]

There it is? Would you view physicians making money off PT's work as anything other than a con from the perspective of a PT? Do you really think it is fair and ethical? Why don't you list the pros and cons of PT's working for you? Let's see how many cons you can think of. How about the pros and cons of you working for a PT (obviously hypothetical). How about your perception of the pros and cons of a PT working for a physician?

Five,
If that's your position, then a PT shouldn't work anywhere other than a physical therapist-owned practice. Is that really what you're saying?

 

[jesspt]

It's always interesting to me how PTs are so against the idea of working for someone else. But then they turn around and hire other professionals so they can direct them. And if you really believe that there isn't unethical behavior in a PT-owned clinic, I've got some ocean-front property for sale...

This is a pretty big generalization. I think most PTs work for someone else. I do, and always have.

 

[jesspt]

Imagine the uproar from the AMA if anybody except physicians could hire and employ physicians and profit from their work. It's condescending that physicians can hire physical therapists and direct them, but not the other way around.

If I had my own PT practice, could I not hire a physician to provide medical care services? I dont know the answer. Does a physician have to be the owner of a private medical practice?

 

[fozzy40]

If I had my own PT practice, could I not hire a physician to provide medical care services? I dont know the answer. Does a physician have to be the owner of a private medical practice?

I do not believe so. Honestly, I do not think that would be a major issue. As far as I know, Stark Law really applies to physicians not really the other way around.

 

[Fiveoboy11]

Five,
If that's your position, then a PT shouldn't work anywhere other than a physical therapist-owned practice. Is that really what you're saying?

It would be nice to see outpatient PT across the board be partnered by PT's. Exceptions are hospitals, SNF's, LTACH's, HH, etc. These only can be partners or self employed.

And:
Take money off the table (pay to make happy, no incentive to be unethical).
Purpose is to serve the patient
Full autonomy with no exceptions
Encourage mastery of all aspects of PT.

 

[Fiveoboy11]

If I had my own PT practice, could I not hire a physician to provide medical care services? I dont know the answer. Does a physician have to be the owner of a private medical practice?

Not the same because:
You would not be their gatekeeper
You could not control their care

And you would create a sort of physical therapist owned physician referral service and less autonomy for your PT's in light of the referring physician in house.

 

[fozzy40]

Are physicians really the gatekeeper or is it the payors and state laws that limit/dictate autonomy?

 

[jesspt]

Are physicians really the gatekeeper or is it the payors and state laws that limit/dictate autonomy?

For all intents and purposes here in Illinois, the state practice acts is what restrics my patient's access to me directly. Now in Washington DC, direct access to PT was unfettered, and BCBS PPO did not require a referral to cover PT, so a PT could see quite a few folks without them having to go to a physician prior to initiating care.

 

[Fiveoboy11]

Are physicians really the gatekeeper or is it the payors and state laws that limit/dictate autonomy?

In POPTS physicians are always the gatekeeper regardless of law and insurance. State law in AZ (where I work) has unrestricted direct access, and there are insurances who allow direct access. Do you think I have not seen physician referrals ordering a specific frequency and duration and interventions with those insurances? Do your practice patterns with regard to PT vary by insurance? If you transplanted to AZ would your organizational policy and procedure magically morph with the law with regard to PT? Many insurances do require physician referral to cover services but how does that necessitate a physician directing "the PT"? I.e. Why do physicians think they are in charge of the PT POC even when insurance requires a referral? How is it different than an HMO requiring referral to a specialist? Is it just the cliqueishness?

To me it has to do with history, organizational policy and procedure, and physicians having way too much power.

 

[DesertPT]

Are physicians really the gatekeeper or is it the payors and state laws that limit/dictate autonomy?

You are right that it is the payors and laws for the most part. Even in states with unrestricted direct access a large number of payors (ie private insurance, medicare/medicaid, workman's comp insurance) will require a script from a doc before they will pay for PT. Even for patients whose insurance does not require a script for PT, sometimes clinics will still want one to cover their own butt. I'm all for direct access, and yes superfluous doctor visits definitely increase cost, but really its not that difficult to have one 15 min. appt. with an orthopedist for a H&P/exam and to get the script before you go to PT. You never really have to see the doc again in a lot of cases (though some such as workman's comp often requires a new script from the doc every 30 days or something along those lines).