Referral for Profit (POPTS) Issue

Professional Issues Forum

Re: Referral for Profit (POPTS) Issue

Postby ryanthept » Mon Jun 15, 2009 2:52 pm

Just curious, why is it ok (ethically) for a physician to self refer a surgery but not a physical therapy visit? Seems to me the financial gain for the surgery is far greater, but there is no issue there?
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Re: Referral for Profit (POPTS) Issue

Postby eeerrrrd2 » Sun May 09, 2010 10:13 pm

Hi...
I know this is a hot topic and everyone will be angry when they read this.
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Re: Referral for Profit (POPTS) Issue

Postby JeffHathaway » Tue May 25, 2010 7:17 am

In SC where it was determined that PT's cannot be employed by MD's, the ortho's are attempting to change that from a legislative standpoint. Here is their website http://www.physicaltherapychoice.com/ What is your response to their claims?

Jeff
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Re: Referral for Profit (POPTS) Issue

Postby jftruax » Tue Nov 02, 2010 3:58 pm

My suggestion is to acquire the June 2009 study conducted by CMS and reconsider some of the distorted logic that has burdened many of you with an inflammatory judgmental position regarding POPTS. It serves to defray some of the overgeneralized assumptions that POPTS are all money mongers and that PT Private Practices are always a better option for the patient. In all reality, private practices, hospital clinics, POPTS, and other arrangements are all valuable and are also needed to address the public's need for rehab services. There are plenty of slices in this pie for all of business models that support we do as a profession. Like all professions, there are relationships and organizations that abuse the system, but before making blanket assumptions about all POPTS, entertain the possibility that it can serve as a patient focused model where physician's are the owners and collaborate and team with the PTs. One could argue fairly that MDs hire PTs to best manage the rehab side of orthopedics and are seeking the continuum of care for the patients that benefit from having all services in one place. I have a strong opinion that by removing choices of where to practice we are actually painting ourselves in to a narrow and lonely corner as a profession. In this country, we should be free to work within the law under various circumstances or arrangements that promote the best of our profession for our patients, not just our own pocket books. I most certainly respect anyone that has decided to hang their own shingle for a business, but like the previous posts, I think that the niche and approach will bring referals. Excellent clinics employ therapists that are excellent at providing medically necessary physical therapy. This excellent PT can be provided regardless of ownership.

Medical care costs more and more money. Each year this seems to be spinning out of control. If we were shown that POPTs clinics actually saved money, would we believe it? Would it be a dissapointment to see that PPPTs actually bill a great deal more for the same services rendered?

Like posts placed earlier in this message thread, I feel that we cannot make blanket assumptions that POPTs or PPPTs are unethical. There will always be examples of greed where there is money to be made. It seems a real disapointment to me that we are even wasting time on this when we have so many more important issues to be putting time and resources toward. Please look for this study and recognize that there is data that serves in direct contrast to the traditional logic. We need more studies, but this is a good start to address the outdated and misplaced criticisms that were originally based on research done in worker's compensation practices where PT extenders were used in the 1980s. I’m curious to learn if any of you have seen this study from CMS yet? Working to bring Center of Excellence models to our community, we are seeing how these relationships can foster keeping costs down not up, visits down, not up, outcomes improved, not prolonged..... Respectfully,
JFT
June 2009 Developing Outpatient Therapy Payment Alternatives (DOPTA): 2007 Utilization Report
Prepared for David M. Bott
Centers for MC and MC Services
Physician employed PTs average reimbursement is $521/ per patient; Private Practice is $870
Patients can expect to pay $349 more for the same therapy treatment when in private practice than at a POPTS; Total MC expenditures on PT increased by 6.6% to $4.5 billion from 2006 to 2007; Private Practice Physical Therapists accounted for 28.4% of the total MC expenditures for 2007 while POPTs accounted for 5.8%; POPTS clinics decreased by 21.2% while Private Practice PT clinics increased by 31%
Last edited by jftruax on Fri Jan 14, 2011 3:57 pm, edited 6 times in total.
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Re: Referral for Profit (POPTS) Issue

Postby lee9786 » Fri Dec 03, 2010 11:46 pm

jftruax wrote:I'd like all of us to acquire a June 2009 study conducted by CMS and consider some of the logic that has been burdening you with a narrow minded judgment about POPTS. Private Practices, hospital clinics, POPTS, and other arrangements are all valuable and needed to address the public's need for rehab services. There are plenty of slices in this pie for all of us. I can see that, and I wish more could too. Like all professions, there are relationships and organizations that abuse the system, but before making blanket assumptions aboiut all POPTS, entertain both sides of how a patient focused model where physician's are the owner's and collaborate with the PTs they hire shows that MDs trust us manage the rehab side of orthopedics. I think in this country, we should be free to work within the law and under various circumstances that promote the best of our profession to our patients, not just our own pocket books. I do respect anyone that has decided to hang their own shingle for a business, but like the previous posts, I think that your niche and your approach will bring you referals because you are good at what you do, not because you are not in a relationship with a physician. Recently, PTPPs are very concerned about losing the ability to use aid/tech extenders because it devalues the patient care and can cause a possble ethical problem with billing. POPTS primarily use licensed professionals thus elevating the quality of the care, and in turn improving the outcomes of care. Please look this study up and see there are data out that serves in direct contrast to the traditional logic that POPTS PTs are children of the devil. It does serve to address the outdated and misplaced criticisms that were originally based on research done in worker's compensation practices where PT extenders were used (in the 1980s.... Abuse anyone?1980s? It was everywhere). I’m curious to learn if any of you have seen this study from CMS yet? Working to bring Center of Excellence models to our community, we are seeing how these relationships can foster keeping costs down not up, visits down, not up, outcomes improved, not prolonged..... Respectfully,
JFT
June 2009 Developing Outpatient Therapy Payment Alternatives (DOPTA): 2007 Utilization Report
Prepared for David M. Bott
Centers for MC and MC Services
Physician employed PTs average reimbursement is $521/ per patient; Private Practice is $870
Patients can expect to pay $349 more for the same therapy treatment when in private practice than at a POPTS; Total MC expenditures on PT increased by 6.6% to $4.5 billion from 2006 to 2997; Private Practice Physical Therapists accounted for 28.4% of the total MC expenditures for 2007 while POPTs accounted for 5.8%; POPTS clinics decreased by 21.2% while Private Practice PT clinics increased by 31


Would you say it's bad for the PT profession as a whole when a private-PT owner has to shut down their clinic because their primary referral source decided to initiate their own POPTS? Isn't the lack of ability to control one's own fate a huge problem for any profession? PTs should be able to compete directly with Chiropractors and Physicians. One is competing against a garbage philosophy and the other is competing against unnecessary surgery and medication. It's a necessary checks and balances. To take it away would be bad. I see the stats above as areas to work on, not an excuse to hinder progress in the profession. Look up the costs for spinal fusion, pain injections, etc. I'm sure you know it as a PT. These are the areas PT need to be focusing on.

To work for a POPTS is a stand against the profession. It hinders any progress from third-party payers. It hinders any progress toward controlling one's fate. It's making a statement that religious-based alternative musculoskeletal treatment and unnecessary injections/surgeries/medications are okay. The professions is in a position to take the difficult step in moving forward as professionals and entrepreneurs or stepping back, working for the POPTS, devolving to technician status, and watch third-party reimbursement disappear. It could go both ways. PTs hold their own fate. I see the biggest threat as within.
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Re: Referral for Profit (POPTS) Issue

Postby jftruax » Mon Jan 10, 2011 1:41 am

I think you make good points about controlling our own fate and that the enemy to that fate is within. I’d like to respectfully explain my point of view recognizing you and I have very different opinions on this matter. In my experience, working for a physician’s group has proven entirely fair, collaborative, ethical, and has lead to better care all the way around for the patient. I am not asked to have aids run my therapy visits. I’m not asked to use ultrasound and estim on every patient because it is a guarantee for reimbursement. I’m seeing patients for one on one care that lasts 45 minutes to an hour or more for each visit. I’m not working 55 hours per week with equipment that is not up to date or use cumbersome paper charts. I am paid more fairly by criterion that reflects the excellence of physical therapy care. I cannot overgeneralize that PPPTs all run in this way, as I would ask you not to overgeneralize that all POPTs are exploiting PTs either.
PTs tend to see medical providers as a food chain versus a weave of helpful practices that best serve a patient. The term "medical home" is being used a lot in Med Schools right now. What this entails is a vast array of services all in under one roof for the patient so they can be directed quickly to the trained health care provider than can help most effectively. This cuts costs and takes care of the long delays that often lead to poor timing of the appropriate care. What I am most interested is that it is a cooperation model, not a competition model.
My observation is that PTs don't cooperate well even with each other.... they compete. We compete with ATCs, MDs, DCs.... but what we want is to have our slice of the pie uncontested. It’s like saying we want to be the star player, but don’t see we need the entire team to actually make something good happen. If we had not been so competitive against each other and our allies in other professions in years past, we might have a unified vision of what you speak. BUT comments like what you made just reinforce that we haven't gotten there yet. Try to imagine that we can collaborate, take care of patients who benefit from that collaboration, and work in practices that we may not always own outright. This “ownership” argument never seems to be a philosophical or ethical dilemma for PTs that work with doctors that self refer in hospital systems , pain clinics, spinal cord trauma centers... but in outpatient orthopedics we just get nasty toward each other and to all others that are part of the patient's big picture. Is it entirely possible that the referral sources that PTs work so hard to acquire are the same people that PPPTs condemn with comments like "One is competing against a garbage philosophy and the other is competing against unnecessary surgery and medication?" and "It's making a statement that religious-based alternative musculoskeletal treatment and unnecessary injections/surgeries/medications are okay." Why are these comments necessary and aren’t they seemingly self righteous? Can you entertain the idea that in all professions, there are those that are excellent at what they do and those that are not?
Do PTs feel this strongly against osteopaths, acupuncturists, massage therapists, PAs and/or occupational therapists? Are we really the only ones that know what we are doing? Are we really the only Profession providing exactly what a patient needs? Can we back up all that we are promising the patient when we still will need MDs and DOs for diagnostics, surgery, and other important facets of medicine we cannot provide for the patient? I would like to just say that working closely with physicians has provided an amazing opportunity to showcase and elevate the credibility of what P Ts know and this serves to elevate respect for PT even higher. Many surgeries are prevented because we all see that prevention programs are what is really needed. Recovery after surgery is expedited, and patients are shown all of the options because we are all on the same team. There may be a day when a PT group owns such a business and employs physicians too. Would that be unethical or would it simply be that they have the capital to do so? Would it surprise you that PAs own such practices in this country? I am trying to say that there are many models of care and the public will inevitably have to choose between several good choices to determine how they want to be treated. This choice comes down to the reputation of excellence of providers that do it best regardless of ownership. What should drive this decision is the quality of the care and the totality of the experience. Every patient must be reminded they CAN and should choose where they would like to be cared for. Truly, if a POPT group was abusing the system, treating patients poorly while owned by a physician’s group, patients would look elsewhere for what they need, and insurance payers would not allow it either.
If we are to solve this debate and move into the future to survive we should recognize the potential for several viable cooperative models. Some PTs can own practices, some won't. The reality is that we can’t see everyone, the demand is too high. We need to do it better. We need to think differently than we have. We should collaborate more, not less. Doctors, all other experts, and PTs should be on the same page, complementing each others skills and educational background. The outcome to this is simply that the patient will get the best of all worlds when they are the star player and we ALL play the respective supporting positions.
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Re: Referral for Profit (POPTS) Issue

Postby jftruax » Fri Jan 14, 2011 2:16 pm

Would you say it's bad for the PT profession as a whole when a private-PT owner has to shut down their clinic because their primary referral source decided to initiate their own POPTS? Isn't the lack of ability to control one's own fate a huge problem for any profession? PTs should be able to compete directly with Chiropractors and Physicians. One is competing against a garbage philosophy and the other is competing against unnecessary surgery and medication. It's a necessary checks and balances. To take it away would be bad. I see the stats above as areas to work on, not an excuse to hinder progress in the profession. Look up the costs for spinal fusion, pain injections, etc. I'm sure you know it as a PT. These are the areas PT need to be focusing on.

To work for a POPTS is a stand against the profession. It hinders any progress from third-party payers. It hinders any progress toward controlling one's fate. It's making a statement that religious-based alternative musculoskeletal treatment and unnecessary injections/surgeries/medications are okay. The professions is in a position to take the difficult step in moving forward as professionals and entrepreneurs or stepping back, working for the POPTS, devolving to technician status, and watch third-party reimbursement disappear. It could go both ways. PTs hold their own fate. I see the biggest threat as within.[/quote]
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Re: Referral for Profit (POPTS) Issue

Postby jftruax » Fri Jan 14, 2011 2:18 pm

My suggestion is to acquire the June 2009 study conducted by CMS and reconsider some of the distorted logic that has burdened many of you with an inflammatory judgmental position regarding POPTS. It serves to defray some of the overgeneralized assumptions that POPTS are all money mongers and that PT Private Practices are always a better option for the patient. In all reality, private practices, hospital clinics, POPTS, and other arrangements are all valuable and are also needed to address the public's need for rehab services. There are plenty of slices in this pie for all of business models that support we do as a profession. Like all professions, there are relationships and organizations that abuse the system, but before making blanket assumptions about all POPTS, entertain the possibility that it can serve as a patient focused model where physician's are the owners and collaborate and team with the PTs. One could argue fairly that MDs hire PTs to best manage the rehab side of orthopedics and are seeking the continuum of care for the patients that benefit from having all services in one place. I have a strong opinion that by removing choices of where to practice we are actually painting ourselves in to a narrow and lonely corner as a profession. In this country, we should be free to work within the law under various circumstances or arrangements that promote the best of our profession for our patients, not just our own pocket books. I most certainly respect anyone that has decided to hang their own shingle for a business, but like the previous posts, I think that the niche and approach will bring referals. Excellent clinics employ therapists that are excellent at providing medically necessary physical therapy. This excellent PT can be provided regardless of ownership.

Medical care costs more and more money. Each year this seems to be spinning out of control. If we were shown that POPTs clinics actually saved money, would we believe it? Would it be a dissapointment to see that PPPTs actually charge more for the same services rendered?

Like posts placed earlier in this message thread, I feel that we cannot make blanket assumptions that POPTs or PPPTs are unethical. There will always be examples of greed where there is money to be made. It seems a real disapointment to me that we are even wasting time on this when we have so many more important issues to be putting time and resources toward. Please look for this study and recognize that there is data that serves in direct contrast to the traditional logic. We need more studies, but this is a good start to address the outdated and misplaced criticisms that were originally based on research done in worker's compensation practices where PT extenders were used in the 1980s. I’m curious to learn if any of you have seen this study from CMS yet? Working to bring Center of Excellence models to our community, we are seeing how these relationships can foster keeping costs down not up, visits down, not up, outcomes improved, not prolonged..... Respectfully,
JFT
June 2009 Developing Outpatient Therapy Payment Alternatives (DOPTA): 2007 Utilization Report
Prepared for David M. Bott
Centers for MC and MC Services
Physician employed PTs average reimbursement is $521/ per patient; Private Practice is $870
Patients can expect to pay $349 more for the same therapy treatment when in private practice than at a POPTS; Total MC expenditures on PT increased by 6.6% to $4.5 billion from 2006 to 2007; Private Practice Physical Therapists accounted for 28.4% of the total MC expenditures for 2007 while POPTs accounted for 5.8%; POPTS clinics decreased by 21.2% while Private Practice PT clinics increased by 31%
Last edited by jftruax on Fri Jan 14, 2011 10:44 pm, edited 4 times in total. jftruax
Last edited by jftruax on Fri Jan 14, 2011 3:57 pm, edited 1 time in total.
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Re: Referral for Profit (POPTS) Issue

Postby Ronin9 » Tue Nov 08, 2011 9:04 am

I'm curious about others opinions and insight into this topic. I have an initial idea for myself about free enterprise business in American and government intervention. Any ideas?

Positive: Working in a POPTs provides the professional with collegial relationships and the patients with collaborative benefits that are positive for the profession.

Negative: Tolerance of POPTs is detrimental to the future of the profession and confusing to the patient
texas Hold Em Tex
Last edited by Ronin9 on Fri Jun 21, 2013 1:09 am, edited 1 time in total.
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Re: Referral for Profit (POPTS) Issue

Postby Alteregnom » Fri Nov 18, 2011 2:25 pm

If POPTS provides collegial relationship then I'm not sure that it's harmful for the development of the profession
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