Re: Therapists at physician's clinics

[Guest guest]

Physicians can employ therapists as employees of their practice and provide

therapy services under their roof. The insurance is billed under the MD's

provider number, therefore the therapist is providing care " incident to " the

physician and is legal. It does not violate any Stark law.

Sherman,MA.PT,OCS

Coconut Creek,FL

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[Guest guest]

>Physicians can employ therapists as employees of their practice and provide

>therapy services under their roof. The insurance is billed under the MD's

>provider number, therefore the therapist is providing care " incident to " the

>physician and is legal. It does not violate any Stark law.

>

> Sherman,MA.PT,OCS

>Coconut Creek,FL

>

I believe there are also a few states ( Delaware, I think is one) where

employment of PT's by MD's is illegal under state law, rather than federal

law. The NY referral for profit bill died in committee this year.

Perhaps someone else is more familiar with this?

Laurie Walsh

Daemen College

Amherst, NY

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[Guest guest]

You may want to reference the STARK II laws. They are available for

download in Acrobat format (PDF) at <www.PTManager.com/news.htm> then click

on OIG Reports about halfway down the page.

Hope that helps.

At 01:05 PM 7/15/99 , you wrote:

>Physicians can employ therapists as employees of their practice and provide

>therapy services under their roof. The insurance is billed under the MD's

>provider number, therefore the therapist is providing care " incident to " the

>physician and is legal. It does not violate any Stark law.

>

> Sherman,MA.PT,OCS

>Coconut Creek,FL

>

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>

>

R. Kovacek, MSA, PT

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313 884-8920

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[Guest guest]

I am a physical therapist that works in a physician group. I must tell you

that I have never before been treated more professionally than at this group.

When I worked for 2 private practice therapy clinics I was treated poorly.

The hospital was somewhat better, but I have more autonomy, etc., at this

clinic than I did anywhere else.

Perhaps therapists would not be so apt to work for such arrangements if

private practice therapy practices followed the partnership model and not the

one owner every other therapist an employee model.

Linnea Comstock PT

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[Guest guest]

LCPTMPA@... wrote:

>

> I am a physical therapist that works in a physician group. I must tell you

> that I have never before been treated more professionally than at this group.

> When I worked for 2 private practice therapy clinics I was treated poorly.

> The hospital was somewhat better, but I have more autonomy, etc., at this

> clinic than I did anywhere else.

>

> Perhaps therapists would not be so apt to work for such arrangements if

> private practice therapy practices followed the partnership model and not the

> one owner every other therapist an employee model.

>

> Linnea Comstock PT

>

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Linnea:

Does your physician group follow a partnership model? Are you a

partner or will you be eligible to become one? When? I'd certainly

like more details! By the way, I do agree with the partnership

concept, even though I am in private practice. When employees

act(perform) like owners then they deserve(?) to be owners. Hope

to hear from you!

Elmer Platz, PT

platzpt@...

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[Guest guest]

Laure's right. It's illegal in Delaware for a MD to employ a PT.

I'm not sure if that's good or not when there are: clerks doing ultrasound, trainers doing "sportsmedicine" and "massage therapists" doing soft tissue work while licensed PTs are out of work.

In the case we've just read, the PT would prefer that there be no competition, and that all 4 docs send their patients to this clinic.

To the physician: PT done in the office by a PT will now represent a source of revenue, which could increase the take-home pay of the Doc.

Or, to the Managed Care MD, using in-house PT will reduce his/her outside specialist expense, spend less of the reserved 20% of fees, and therefore... increase the take-home pay of the Doc!

To the profession and the community, there's some work which would have otherwise been done by a clerk in a white jacket which is now at least performed by a professional PT...

Perhaps the guys with the new PT clinic across the street should approach the Docs In Question (D.I.Q.) about providing that PT service under contract? After all, they're just across the street, and they probably have some excess unused capacity... Perhaps the docs should buy their practice and hire them to run it. Hmmm... Consolidate billing offices... Let someone else figure out the quarterly form 941s...

Just my Friday Afternoon musings after a rugged week with ! -- The one who who wrote those laws!

Dick Hillyer, PT

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[Guest guest]

At 08:00 AM 7/18/99 -0700, you wrote:

>But why would it be illegal? Sure, in Delaware it is illegal, but the

>federal laws do take precedence, so, then, is it really illegal in

>Delaware? ...

,

Yes, it really is illegal. Federal laws do take precedence - but

only in the area covered. I assume by federal law you mean the Medicare

laws and regs, which will tell you what you must do to be reimbursed under

the Medicare program. They don't override the state practice act in terms

of what is legal practice.

Laurie Walsh

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[Guest guest]

Dear the PT:

I congratulate you on practicing in what you consider to be a highly

ethical manner--some would argue that Robin Hood practiced " monetary

reallocation " in a highly ethical manner. The question in this

relationship is not how YOU practice, but how such relationships may

POTENTIALLY lead to something less than an ideal, ethical situation.

You bring up several good points. You said that when YOU referred a

patient to an OT in the same practice, I have to ask, did you personally

benefit from that referral--were you a partner in the practice or an owner.

Also, didn't you, in fact, make a suggestion to the referring MD to refer

the patient to the OT or ST. The difference is that there ideally was some

outside, unbiased oversight. Now, I would agree that there are other

issues involved where this oversight by the MD is not the case. But the

idea is that an outside (meaning someone who will not profit financially)

makes the decision.

As far as the opinion of the APTA, it just so happens that the AMA code of

ethics prohibits referral for profit as well at the APTA.

As far a quality of care, I am sure you are correct when you say that what

you are delivering care that supercedes what you were delivering in the

hospital and private PT setting. I think this speaks more to the poor

quality in the hospital and private OP clinic than the superior quality in

your present setting. I work in a private OP clinic and we have

established superior relationships with some physicians which results in a

similar type of situation as what you describe in your POPT situation. On

the other hand, we get referrals from MDs who do not communicate well with

the PT or the patient. This situation speaks more to the quality of care

the MD provides and the efforts made by the PTs to facilitate communication

in any environment.

One final point. When you move to a capitated situation, you comments will

be correct. The model in a capitated system is that when a patient enters

into " the system " with a problem, only so much money is allocated to the

treatment of that problem. If PT is the best solution, the money will be

allocated to PT (as the PT will provide the care). If in fact, PT is the

most efficient provider for that patient, the MD will benenfit by not

" using up " funds that would be better spent in PT. This is not the case in

the fee for service model. Those that you describe as " suits " (me being an

MBA as well as a PT would qualify me to be a suit I think), would agree

with you that a POPTs is the most efficient system only up to a point. In

a fee for service POPTS, as has been mentioned in a previous post, studies

in Florida and California have show that statistically, these relationships

result in higher costs (thus are more ineffecient) than PTs who practice in

states with INDEPENDENT PRACTICE--a much higher level of efficiency exists

in states where PTs treat independent of MDs for musculoskeletal problems.

Besides just looking at POPTs, more recent studies have looked at PTs

practicing in states that allow independent practice and have noted

savings. That is why in some states Blue Cross/Blue Shield have considered

reimbursing PTs without requiring a referral from the MD.

So, in summary. Those of us who are really interested in the most ethical

and efficient system should lobby for independent practice legislation. It

will then be incumbent on the PT to practice ethically. I wonder what the

MDs in s clinic feel about PTs practicing without referral and if in

fact that were the law, would still be working in an MDs office.

Herb Silver, PT MBA

At 08:00 AM 7/18/99 -0700, you wrote:

>This thread has been very interesting for me, to say the least.

>Currently, I am 'Physician Owned,' and we operate completely within the

>law as it stands. This topic hits hard, as my clinic has repeatedly

>been accused of ilegality...

>

>Is it a self-referral? Maybe... BUT, when I ask a patient to return

>after an evaluation, is that not a self-referral? When I worked for a

>large rehab agency, and a patient was slated only for PT, but I

>referred that patient to OT, ST, Psych, etc, did I not make a

>self-referral? If I had a PT clinic which had an orthotist or EMG guy

>show up once every three weeks and I referred my patients to that

>aspect of my clinic, is that not a self-referral? It isn't because of

>how the law is read. Thus, MD's can own PT's, without it being illegal.

>

>Looking back on my career in hospital based PT and a few years in a

>large rehab agency, there is absolutely no comparison in terms of

>quality of care, This arrangement, on site PT in conjunction with the

>Physician is so much cheaper and more effective than any other health

>care delivery model, it is shocking. Patient satisfaction is through

>the roof.

>

>But why would it be illegal? Sure, in Delaware it is illegal, but the

>federal laws do take precedence, so, then, is it really illegal in

>Delaware? ... sure, the APTA frowns on it... not to down grade the

>efforst of the APTA, but their edicts are merely recommendations, and

>it is not time for me to get into what the APTA needs to make

>recommendations on...

>

>Now, the other question in this: is it wrong, somehow, morally,

>ethically, etc? That depends on who you ask. If I, as a Physical

>Therapist, can provide a service with higher quality and beter

>cost-effectiveness, then I am doing a great job, and I feel that the

>arrangement is not wrong. If a Physician (Orthopedic Suregeon) can

>provide a higher quality service under his own roof, get better

>outcomes, get more time with his patients, get extra visits that are

>not billed to his patients, watch the progress of his patients, and see

>any problems with their rehab on the spot and under his own roof, why

>would it be wrong? It sounds to me like a very resourceful decision,

>from the business side of things. Highly satisfied clients, cheaper

>product... that's what the 'suits' tell us is good business. But it is

>not up to the suits, the therapists, or the doctors... it _should_ be

>up to the patients.

>

>Well, I have witnessed an exhaustive list of satisfaction by the

>patients we have treated in this arrangement, and guess what? The law

>is not broken, and the patient is happy! Is that not what it is all

>about? That's what I think it is about, and I encourage my competitors

>not to care about patient satisfaction (it would save a lot of money

>and time spent marketing)

>

>My advice to all those detractors is this: either do a better job with

>your own delivery model, quality of care, and marketing so that your

>service is comparable or even better in quality, cost-effectiveness,

>and patient satisfaction... or go ahead and try and change the laws so

>that you can compete on more 'even' terms. Expect more 'one stop shop'

>places to continue to open in the future.

>

>Peace,

> the PT

>

>

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>

>

>

>

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[Guest guest]

In a message dated 7/18/1999 4:36:56 PM Pacific Daylight Time,

hlsilver@... writes:

<< You said that when YOU referred a

patient to an OT in the same practice, I have to ask, did you personally

benefit from that referral-- >>

I worked in 2 hospitals with bi-ann. bonuses. Referrals to other therapies

increased bonus dollars. Lynn

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[Guest guest]

:

I would ask you to answer one question for yourself. If you were to open an office next door to these Physicians, with " higher quality and better effectiveness " , and they had no financial interest whatsoever, would they continue to refer to you? If you answer yes, I would suggest that, with all due respect, you are kidding yourself. If their motivation was solely better care and patient convenience, then they would jump at the opportunity to provide this at no cost to their practice. I hope that I am wrong about your particular colleagues, but I doubt it.

With respect to your point about self-referral after evaluation, this is simply a question of seeking reimbursement for services rendered, rather than for services referred. This is a critical distinction in understanding this argument about referral for profit. I assure you that if you were to prescribe a plan of care that was not clinically supported by your evaluation, you would be condemned as severely, or more than, the referring MD.

With regard to your contention that " this arrangement...is so much cheaper and more effective than any other health care delivery model " , I would suggest that you consult the studies conducted by the feds. Their conclusion differs from your own and frankly these are the " suits " that I would be most concerned about in this particular environment.

I understand what you are saying about your current situation exceeding the quality of care in your previous settings. I think, however, that you are engaging in some serious rationalizing when you credit this model for what you have experienced. And by the way, how are you assessing the quality and effectiveness of this model in comparison to others? I think we would all love to see your data on this and you should publish it as well.

This issue is another where the limitations of e-mail communication can be somewhat limiting. I would welcome the opportunity for some serious debate on this and other issues if we had the format to do so in real time. Unfortunately chat rooms don't fit this definition in my mind. So, what do you say guys, who wants to sponsor a debate? My living room is too small.

Ken Mailly, PTPresident

Mailly Consulting Inc.

Director of Government Affairs

aptanj.

khmailly@...

Re: Therapists at physician's clinics

This thread has been very interesting for me, to say the least.

Currently, I am 'Physician Owned,' and we operate completely within the

law as it stands. This topic hits hard, as my clinic has repeatedly

been accused of ilegality... Is it a self-referral? Maybe... BUT, when I ask a patient to return

after an evaluation, is that not a self-referral? When I worked for a

large rehab agency, and a patient was slated only for PT, but I

referred that patient to OT, ST, Psych, etc, did I not make a

self-referral? If I had a PT clinic which had an orthotist or EMG guy

show up once every three weeks and I referred my patients to that

aspect of my clinic, is that not a self-referral? It isn't because of

how the law is read. Thus, MD's can own PT's, without it being illegal.

Looking back on my career in hospital based PT and a few years in a

large rehab agency, there is absolutely no comparison in terms of

quality of care, This arrangement, on site PT in conjunction with the

Physician is so much cheaper and more effective than any other health

care delivery model, it is shocking. Patient satisfaction is through

the roof.

But why would it be illegal? Sure, in Delaware it is illegal, but the

federal laws do take precedence, so, then, is it really illegal in

Delaware? ... sure, the APTA frowns on it... not to down grade the

efforst of the APTA, but their edicts are merely recommendations, and

it is not time for me to get into what the APTA needs to make

recommendations on... Now, the other question in this: is it wrong, somehow, morally,

ethically, etc? That depends on who you ask. If I, as a Physical

Therapist, can provide a service with higher quality and beter

cost-effectiveness, then I am doing a great job, and I feel that the

arrangement is not wrong. If a Physician (Orthopedic Suregeon) can

provide a higher quality service under his own roof, get better

outcomes, get more time with his patients, get extra visits that are

not billed to his patients, watch the progress of his patients, and see

any problems with their rehab on the spot and under his own roof, why

would it be wrong? It sounds to me like a very resourceful decision,

from the business side of things. Highly satisfied clients, cheaper

product... that's what the 'suits' tell us is good business. But it is

not up to the suits, the therapists, or the doctors... it _should_ be

up to the patients.

Well, I have witnessed an exhaustive list of satisfaction by the

patients we have treated in this arrangement, and guess what? The law

is not broken, and the patient is happy! Is that not what it is all

about? That's what I think it is about, and I encourage my competitors

not to care about patient satisfaction (it would save a lot of money

and time spent marketing)

My advice to all those detractors is this: either do a better job with

your own delivery model, quality of care, and marketing so that your

service is comparable or even better in quality, cost-effectiveness,

and patient satisfaction... or go ahead and try and change the laws so

that you can compete on more 'even' terms. Expect more 'one stop shop'

places to continue to open in the future.

Peace,

the PT

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[Guest guest]

Likely not legal in this day an age at least for Medicare.

GiorsalID@... wrote:

> In a message dated 7/18/1999 4:36:56 PM Pacific Daylight Time,

> hlsilver@... writes:

>

> << You said that when YOU referred a

> patient to an OT in the same practice, I have to ask, did you personally

> benefit from that referral-- >>

>

> I worked in 2 hospitals with bi-ann. bonuses. Referrals to other therapies

> increased bonus dollars. Lynn

>

> ------------------------------------------------------------------------

>

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[Guest guest]

I worked for several years at a large university hospital, Univ. of Michigan.

U of M has it's own HMO/PPO called MCare. ALL referrals made to ANY

specialists including PT's were made within the MCare network. The U of M

" owns " MCare. I personally know physicians who wanted and still want for

whatever reason to send a particular patient out of network for treatment but

cannot due to the specificity of the HMO. I am not sure whether the

physicians themselves receive financial gains from " in-house " referrals (they

might), but certainly the hospital has enormous vested interest. And all of

the employees of UofM and UofM Hospitals, as well as the students, have MCare

insurance. So what, really, is the difference, except scale?

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Likely not legal in this day an age at least for Medicare.

GiorsalID@... wrote:

> In a message dated 7/18/1999 4:36:56 PM Pacific Daylight Time,

> hlsilver@... writes:

>

> << You said that when YOU referred a

> patient to an OT in the same practice, I have to ask, did you personally

> benefit from that referral-- >>

>

> I worked in 2 hospitals with bi-ann. bonuses. Referrals to other therapies

> increased bonus dollars. Lynn

>

> ------------------------------------------------------------------------

>

> eGroups.com home: /group/ptmanager

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[Guest guest]

This is similar to a large hospital in NJ who now owns several Physical

Therapy clinics, private physician offices and other health and medical

entities. The patients don't realize that when then are sent to neighboring

specialty offices with different facades that it is all the same entity. It

has gotten out of control!

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[Guest guest]

Dear JKMILLIS:

I don't have enough information of this particular situation(s) to reply

specifically. However, the general principle is, if there are $ incentives to

refer, or not to refer in a capitated environment, then there is a high

potential

for abuse. While the U of M has an incentive not to spend it's resources

hopefully the decisions about spending the university's resources are made by

people who do not have incentives not to spend the $.

JKMills@... wrote:

> I worked for several years at a large university hospital, Univ. of Michigan.

> U of M has it's own HMO/PPO called MCare. ALL referrals made to ANY

> specialists including PT's were made within the MCare network. The U of M

> " owns " MCare. I personally know physicians who wanted and still want for

> whatever reason to send a particular patient out of network for treatment but

> cannot due to the specificity of the HMO. I am not sure whether the

> physicians themselves receive financial gains from " in-house " referrals (they

> might), but certainly the hospital has enormous vested interest. And all of

> the employees of UofM and UofM Hospitals, as well as the students, have MCare

> insurance. So what, really, is the difference, except scale?

>

> ------------------------------------------------------------------------

>

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[Guest guest]

In reference to the difference between benefit by referring " in house " vs.

out in a HMO environment:

The difference is not subtle at all. In a fee for service environment, the

more things a practitioner does, the more income whether the intervention

was appropriate or not. When referring within a managed care environment,

the care is already paid for--the more treatment that is done, the LESS the

practitioners profit. So, there is an built in incentive to only perform

interventions that will benefit the patient. UNFORTUNATELY, the problem is

that in some (actually many) HMO environments, even appropriate

interventions are not performed. The problem in an HMO as many of us have

noted is not overtreatment but undertreatment. So there is a 'vested

interest " in referring in house. To balance this out, we should be vocally

supporting legislation that REQUIRES HMOs to allow " out of network "

referrals should the efforts of " in house " treatment not succeed.

Referring out of network costs the insurer more money and this

counterincentive should lead to better inhouse interventions. Therefore,

it is particularly important to allow for these physicians to refer out of

network--unless they are getting something illegally for these referrals,

they are referring out of network in the best interest of the patients and

not for capital gain. In the long run, this out of network referral, if it

provides better care actually saves the HMO money, even if they pay more

for the out of network treatment, since these patients should require less

future care.

It is difficult to explain, but in an HMO, the incentives are exactly

opposite than in a fee for service situation. If an HMO has out of network

benefits, it is actually a much more ethical system than the fee for

service model (and it makes POPTs an non issue--even if a PT worked in the

MDs office, there is no economic advantaged in an HMO). I am sure this is

an inadequate explaination, but it really helps to think about these

differences and how we can all work to make a more ethical health environment.

Herb Silver, PT

At 08:37 PM 7/19/99 EDT, you wrote:

>I worked for several years at a large university hospital, Univ. of

Michigan.

> U of M has it's own HMO/PPO called MCare. ALL referrals made to ANY

>specialists including PT's were made within the MCare network. The U of M

> " owns " MCare. I personally know physicians who wanted and still want for

>whatever reason to send a particular patient out of network for treatment

but

>cannot due to the specificity of the HMO. I am not sure whether the

>physicians themselves receive financial gains from " in-house " referrals

(they

>might), but certainly the hospital has enormous vested interest. And all of

>the employees of UofM and UofM Hospitals, as well as the students, have

MCare

>insurance. So what, really, is the difference, except scale?

>

>

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>Likely not legal in this day an age at least for Medicare.

>

>GiorsalID@... wrote:

>

>> In a message dated 7/18/1999 4:36:56 PM Pacific Daylight Time,

>> hlsilver@... writes:

>>

>> << You said that when YOU referred a

>> patient to an OT in the same practice, I have to ask, did you personally

>> benefit from that referral-- >>

>>

>> I worked in 2 hospitals with bi-ann. bonuses. Referrals to other therapies

>> increased bonus dollars. Lynn

>>

>> ------------------------------------------------------------------------

>>

>> eGroups.com home: /group/ptmanager

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>

>

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[Guest guest]

Interestingly, as a former administrator of a multisite, multi-specialty

group practice, one of my responsibilities was that of marketing as well. My

target for this large primary group was largely occupational and family

medical services. My contracts were with casino hotels, industry as well as

governmental agencies such as individual municipalities, the county

government and state agencies. During the eighties and early nineties most

large employer groups preferred to have all services provided under one roof

in one setting. Therefore, I arranged for the in-house dispensing of

medications because the clients preferred it. I also retained an in-house

physical therapist and billed for his services under the professional

corporation of the multi-specialty group. The physical therapist was

comfortable and was reimbursed very adequately for his services, the

companies were satisfied and the patients were able to conveniently be

treated under one roof. They already provided radiology services and thus my

efforts were extremely successful.

The state of New Jersey then removed the ability to dispense in-house due to

lobbying by the Pharmacists. This was understandable though as a

convenience, the employers were disappointed.

The early nineties brought forth large corporate physical therapy and rehab

centers and the workers comp insurance companies decided, in an effort to

discourage self referral, to remove that choice. One particular company

insuring much of this areas business, issued a directive to refer all

injuries requiring Physical Therapy to one particular large, multisite,

corporate provider. This no longer was a marketing advantage and was

extremely disappointing to the therapist. I must say that during those

years, the quality of care contained continuity and control, which was

necessary for large medical centers.

Presently, as a consultant to one particular physical therapist in private

practice, with two locations, it's difficult when an individual medical

office offers that service because though we've said it's always the

patients' choice, whether it's x-ray, lab tests or physical therapy, they

listen to where the doctor or his front desk staff, tells them to go. We're

currently going through an experience of one primary source of referral

deciding to retire. All of his patients are being referred to another

physician who provides physical therapy in-house. I'm not even certain that

he's got a licensed therapist there and may call it " physical medicine. "

With all of the effort I could muster up, I called and requested that those

patients already receiving therapy in our office, be " allowed " to continue

and was successful with my request. Forget any new patients forwarded from

the office of that retiree.

I'm wearing a different hat these days and have learned that all of the

advertising, marketing, health fairs and whatever else cannot compete with

the referral source. My target once again is employer groups and workers

comp insurance companies because they do have the authority to direct in this

state and can also direct the primary care providers as well.

It does make for creating excellent public and community relations Does

anyone disagree with my philosophy?

Pat Vitkow

Administrative & Marketing Consultant

Bayside Physical Therapy

Pleasantville, NJ

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[Guest guest]

OK, I see your point about HMOs disincenive to refer, and fee-for-service's

incentive to refer. However, when the hospital itself owns the HMO (MCare),

and the incentive is to save money / limit referals -- does this not in

essence provide the hospital with greater net revenue and the CEO's with

heftier bonuses? Ultimately, someone will make money from in-house referals.

It's not as direct or readily obvious as in a fee for service set-up, but

believe me it is there.

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[Guest guest]

Ken,

Concur with you, it continues to amaze me that we still have folks who don't

see the downside of promoting these MD/PT relationships. Kinda like that

other relationship that continues to haunt us as we sell out of souls.

On a personal note, send me your mailing address, I have a picture for you

and . PATowne@.... Thanks

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[Guest guest]

In general, my demeanor and tone of my prior post was a lot more mean

than it should have been, for this I apologize.

And I did generalize my situation... when part of the problem of

MD-owned entities are when specific abusive situations are generalized.

I just wanted to mention that abuse is ocurring at all levels, and my

particular entity is proud (almost boastfullly) to not be a part of

that. And I believe it is the boastfullness that comes out in the prior

message I sent.

One question was curiously posed: That if the MD that owned 'me' had a

PT site across the hall, where would he refer to? Well, a good doctor

will refer to the place where the patient is most likely to get better,

should he not? In other words, a good doc will have 'hired' or 'signed

up' a good PT that is a good fit into his practice, thusly his patients

are better served by being referred there. But, a patient does have the

right to go elsewhere, although they are not often told to do so...

giving the MD-owned entity 'first chance'.

Another thing I wish to mention is this: hMo's often make the decision

process a moot point. If you 'aint network' it doesn't matter. I have

often said that the end buyer of health care is NOT the educated

consumer, and have also asserted that quality doesn't matter if you

have a contract. Of course, both of those assertions were heavily

criticized. (Man, it seems my ideas are quite unpopular these days)

About entities that are potentially abusive: I do not have the research

to judge exactly how comparably I stand up to other facilities... but I

have done enough comparison with competitors to judge (will not bore

you with the details of my methods for this makeshift study)

In the private company I worked for, we were not given incentive to

self-refer (to OT/ ST/ Psy/ etc), but we were threatened to be fired if

we did not refer a certain number to other disciplines, and employees

were written up for not referring anough...

But, then again, I get caught up in generalizing... transferring my

experiences into the largest scheme of things... like my grandfather

always taught me that they are like the 'pimple on the elephant's a & $'

Peace,

the PT

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[Guest guest]

Dear ,

In the 20 years I've been in private practice, the " good

doctor " you refer to has proven to be an incredibly rare bird. I

feel that the most difficult thing to deal with effectively is the

astounding indifference common among those referring patients for PT.

Since most do not have a financial incentive, they opt for the

convenience of a list of local PTs to hand out, as if we were as alike as

pharmacists.

If a financial incentive crops up, most will drop old relationships quite

easily. If you don't think that this would happen to you, I guess you're

living in an environment quite different than NE Ohio. I would like it to

be otherwise. It isn't.

Barrett L. Dorko P.T.

" The Clinician's Manual "

<http://qin.com/dorko>

At 09:50 AM 7/20/99 , you wrote:

>In general, my demeanor and tone of my prior post was a lot more

mean

>than it should have been, for this I apologize.

>

>And I did generalize my situation... when part of the problem of

>MD-owned entities are when specific abusive situations are

generalized.

>

>I just wanted to mention that abuse is ocurring at all levels, and

my

>particular entity is proud (almost boastfullly) to not be a part

of

>that. And I believe it is the boastfullness that comes out in the

prior

>message I sent.

>

>One question was curiously posed: That if the MD that owned 'me' had

a

>PT site across the hall, where would he refer to? Well, a good

doctor

>will refer to the place where the patient is most likely to get

better,

>should he not? In other words, a good doc will have 'hired' or

'signed

>up' a good PT that is a good fit into his practice, thusly his

patients

>are better served by being referred there. But, a patient does have

the

>right to go elsewhere, although they are not often told to do

so...

>giving the MD-owned entity 'first chance'.

>

>Another thing I wish to mention is this: hMo's often make the

decision

>process a moot point. If you 'aint network' it doesn't matter. I

have

>often said that the end buyer of health care is NOT the educated

>consumer, and have also asserted that quality doesn't matter if

you

>have a contract. Of course, both of those assertions were

heavily

>criticized. (Man, it seems my ideas are quite unpopular these

days)

>

>About entities that are potentially abusive: I do not have the

research

>to judge exactly how comparably I stand up to other facilities... but

I

>have done enough comparison with competitors to judge (will not

bore

>you with the details of my methods for this makeshift study)

>

>In the private company I worked for, we were not given incentive

to

>self-refer (to OT/ ST/ Psy/ etc), but we were threatened to be fired

if

>we did not refer a certain number to other disciplines, and

employees

>were written up for not referring anough...

>

>But, then again, I get caught up in generalizing... transferring

my

>experiences into the largest scheme of things... like my

grandfather

>always taught me that they are like the 'pimple on the elephant's

a & $'

>

>

>Peace,

> the PT

>

>

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>

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/group/ptmanager

>

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>

>

>

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[Guest guest]

To All:

Perhaps it is time that we got use to a different concept: " Patient manipulation for profit " .

As we have discovered in our musings about referral/non-referral for profit, this is a multi-headed serpent we are battling. What it comes down to, in my humble opinion, is that there are many out there who have absolutely no interest in the patient other than a financial one. As licensed professionals, we must accept that we have been entrusted with our patients' collective well-being. If some of us (MDs, PTs, OTs SLPs, et al.) wish to shirk this responsibility in the name of " convenience " I, for one, feel that there should a serious penalty for violating that trust.

As we have all witnessed, " Florence Nightingale and Marcus Welby " have become " Bonnie and Clyde " in many peoples' eyes. The painful truth is that we deserve much of the scorn with which we are now viewed. If we are to restore our previous status, we have a lot of fence-mending to do. I dare say that we don't help our cause when we spend more time talking about how we can maximize reimbursement rather than maximize our patients access to our services. Our misplaced emphasis only serves to bolster our negative perception.

If our clinical decision-making is constantly colored with financial decisions, we are alienating the very people we are trying to sway. Now, for those of you who will say that I am ignoring the economic realities of the current Healthcare environment, I would argue that, on the contrary, I am embracing these realities. As I have said in previous posts, " The longest journey begins with but a single step " , but first you must know where you are and how you got there. If we don know, we run the risk of making the same missteps again.

Ken Mailly, PT

President

Mailly Consulting Inc.

Director of Government Affairs

aptanj

knmailly@...

Re: Therapists at physician's clinics

OK, I see your point about HMOs disincenive to refer, and fee-for-service's incentive to refer. However, when the hospital itself owns the HMO (MCare), and the incentive is to save money / limit referals -- does this not in essence provide the hospital with greater net revenue and the CEO's with heftier bonuses? Ultimately, someone will make money from in-house referals. It's not as direct or readily obvious as in a fee for service set-up, but believe me it is there.

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[Guest guest]

I am a PT Director for a large multispecialty physician group, and have

some questions about billing for other PTs employed by physicians:

1) do you bill Medicare under your own provider number or do you use the

physician's provider number? I have always billed under my own number

and

followed Medicare part B guidelines for outpatient PT. Recently, my

employer

instructed me to bill under the physician's number; however, this again

is being

reverted back to using my Medicare provider number

2) If you do bill under the physicians provider number to Medicare, are

you still

under the $1500 cap?? I currently am still following this guideline,

but this

question has been raised to me

3) Also, Medicare requires they patient to see the referring doctor

every 30 days.

I require this from my physicians, but this question has been brought

to me..

would not just a signed HCFA 701 and a written prescription be enough,

without

patient being physically seen for a physician office visit?

Thanks for comments regarding these topics.

Craig Longhofer PT

Hutchinson Clinic, PA

[Guest guest]

A solution to your problem: don't work for physicians, work with them, e.g.

in partnership. Physician owned practices are unethical, unacceptable,

unhealthy for our profession, and most of all, detrimental to our patients.

How's that for being self-righteous?

JP Viel, PT, OCS

[Guest guest]

Several years ago I practiced in Nevada; about the time we were relocating

to California (90-91); the NV state Board put forth a proposal whereby they

would not consider your PT license for renewal if you were employed by a

physician. I have no idea if this came to pass, and if it did, how they

planned to police it......but I think it's something for every state to

consider.

Trager, PT

Re: Therapists at physician's clinics

A solution to your problem: don't work for physicians, work with them, e.g.

in partnership. Physician owned practices are unethical, unacceptable,

unhealthy for our profession, and most of all, detrimental to our patients.

How's that for being self-righteous?

JP Viel, PT, OCS

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