Evidence Based Rehab

A subject that is, again, seeing some light in PT world is Physician Owned PT clinics or POPTS as they are often referred to (acronyms are cool). This subject is also being discussed over at Evidence In Motion and Rehabedge (a rehabilitation forum).

Why are these a problem or concern to those outside the PT profession? This is an excellent question, because this situation does affect the general public as well as my profession.

I'll forgoing making any claims of the ethical nature of a physician owned clinic or those PT's that work for them. Suffice to say, it IS bad policy. While the mantra of these setups is that it is an attempt to provide convenient care with better oversight, in the end it is more about improving the revenue stream than patient care. An MD wanting to make money is not a bad thing. But, POPTS do present specific problems:

1. Inherent conflict of interest. The MD stands to profit from referring a patient to the clinic THEY OWN.
2. Doing so restricts a patient's CHOICE in regards to PT consultation.
3. When a patient can be used as an additional revenue source, the trust between that patient and the doctor is seriously compromised.
   
4. POPTS directly impact the autonomy of an individually licensed, regulated, and recognized profession. Doing so can affect the quality of care a patient seeking consultation with a physical therapist receives.
   

Additionally, a well known study done by Jean M. Mitchell, PhD, published in the Journal of the American Medical Association (JAMA) found the folowing in regards to POPTS:

• “Visits per patient were 39% to 45% higher in joint venture facilities.
• “Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians.
• “Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities.
• “Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities.
• “Joint ventures also generate more of their revenues from patients with well-paying insurance.”

For those being referred to a physical therapist, ask you MD if they have financial interest in where they are sending you (seems as though they should tell you upfront, doesn't it?). If you are not comfortable with this situation, request that they refer you to a more convienient or non-physician owned PT clinic. You can also go HERE to do a search for local physical therapists and how to contact them directly.

Jason L. Harris

Labels: AMA, APTA, Direct access, education, kickbacks, physical therapist, physical therapy, physicians, POPTS, referral-for-profit

Found a brief PR article on lumbar stabilization by Physical Therapists. It is from ADVANCE magazine and the article can be found here. It appears directed at nurse practitioners, which is an important audience for us as more and more of family practice is being handled by "second tier" providers.

Maybe something that could be added to you "packet" of general information one could provide to your referral base.

Labels: Direct access, education, Low back pain, physical therapy, physicians

A Reuters report on MSNBC relates that there has been a 20% increase in hospital and doctor visits since 2002. The article claims

The reason is clear — Americans are getting older. “When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors,” Burt said.

Now, predictably, the Centers for Medicare & Medicaid Services (CMS) has announced a 10% reduction in the fee schedule for Doctors and other health care providers. That's right...to artificially control the cost of providing social insurance to our aging baby boomers, CMS wants to just cut how much they pay. Forget that they are already to lowest reimbursers (well, UHC is getting close to that honor in Physical Therapy) and now they want to pay even less. Anecdotally, many physicians report the costs of providing routine care (salaries, paperwork, compliance measures, etc) are just covered by what Medicare reimburses (read - MD's maybe break break even). Drop that 10% and more MD's will surely exercise their ability to opt out of treating Medicare patients. I'll let you all ponder the consequence of that.

Labels: CMS, legislation, Medicare, physicians

Can Physician-Industry Relationships Can Be Ethically Established?

Theres been some recent push in the media pointing out shady deals (and here, here, and here)between MD's and companies that manufacture the components and drugs they use. The link at the very top, a blog entry from Evidence in Motion brings up the issue of full physician disclosure to their patients. While it gets harder and harder for us to sell a patient a $10 brace, the AAOS, AMA, on the federal government seem to have been looking the other way while a few MD's were making significant income from "kickbacks" and use of unproven treatments that they control and recommend to their patients.

Now the point shouldn't be to just bash these MD's but to learn from this situation and encourage change from our physicians and the federal government. We need to police our own health care industry if we are going to regain control over health care costs and immoral practice.

Labels: AAOS, AMA, kickbacks, physicians