RE: Stark Laws and Incident-To

March 10, 2005

This is the scariest letter I have seen yet. Mr. McClain seems to justify

working for a physician owned practice by favorably comparing yourself to

people in unethical private practice. I especially like the part that you

don't want to be bothered by billing or units. You want to practice, yet

you don't want to assume any real responsibility. One has to be concerned

with billing and units even if they don't personally collect 100 percent of

it.

There will always be people who practice unethically in any environment.

The idea is to practice ethical physical therapy in an autonomous

environment so you can truly give the patient the treatment that they need

in an ethical way. There are certain situations that prohibit people from

being able to start a private practice, but the discussion is all about the

ideal practice situation. The person who initially wrote for input and

clarification certainly got that and more.

I know that their are some physicians that work long hours and have high

overhead. Why would that make me want to work for them and hand them some

of my hard earned money? All of us can find some doctor or business man to

go contract with who can offer us great pay and offer to take care of all

the details of the billing for us. I am sure many of these business people

are waiting in the wings for one of us right now. Thank God most of us have

self- respect.

Carla Kazimir PT

Stark Laws and Incident-To

> >

> >Dear Group,

> >I have been approached by a group orthopedic surgeons to set-up and run a

> >physical therapy clinic in their office building. The therapy staff and

I

> >would

> >be employed by the physician group and would bill as " incident to " the

> >physician

> >services. Admittedly, I think this would be a nice challenge and a good

> >opportunity, but I would like to know from you what considerations there

> >are in

> >this type of arrangement.

> >Specifically, I would like to hear comments related to whether there is

any

> >problem with Stark Laws and this type of arrangement. I also would like

to

> >know

> >how this arrangement differs from a physician-owned private practice (it

> >seems

> >the same to me) and whether the $1500 therapy cap is in effect in this

> >arrangement.

> >Any advice would help!

> >Mark Fellwock, PT

> >

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March 11, 2005

I have waited awhile to enter this discussion that is a major one in the PT

profession, much less this list serv. I hope I can give a perspective that

gives my colleagues a different way to look at things.

Quality of service:

Many have equated the POPTS issue with the quality provided the patient.

The issue of quality good and bad, is the same regardless of the business

relationship. the same monetary factors that adversely affect care in POPTS can

also arise in other business relationships, PT owned and non PT owned.

Philosophically we should not have our business relationships determiend by

another

licensed professional.

Marketplace:

The number of physical therapists, if you count those in facility based

practice (acute care, acute/sub acute Rehab, LTC etc) could very well outnumber

those who are practicing, though not owning, their own practice, in an office

based environment. They certainly outnumber those PTs who own their own

practice. What does it say that we hire our own yet we " poo poo " others who do

the

same? Do we minimize the value and clinical excellence of our colleagues who

are in facility based practice simply because they are employed? Does the

profession jettison their responsibility to these patients simply because the

reimbursement system is set up to pay the facilitity rather than individual

therapists? Should these faciltiy based reimbursement structures be a focus of

equal

importance for our profession as well as the physician fee schedule?

Not including those in POPTS, if we achieve our professional goal that

many have discussed on this list serv that all PTs achieve " autonomy " thru

ownership, will the marketplace support the influx of all these PTs currently in

facility based practice?

And if we achieve this " autonomy " by " abandoning " employed environments for

financial reasons, how are we meeting, as a profession, our commitment to the

rehabilitation of patients throughout the continuum of care?

So, how do we as a profession achieve " autonomy " as a profession?

Well, we have to achieve autonomy in clinical practice, wherever it is

practiced, first.

Having said that, I am 200% behind efforts to achieve financial control of

what we do in all settings. It can be done if we as a profession have the

resolve to achieve it. That financial control maybe contractual, private

ownership

or other business relationships consistent with our need for clinical autonomy,

as long as we do not give other professions the right to bill for services

using our license.

Autonomy is earned thru clincal practice...which is a privilege, and

hopefully in time it will include a private financial relationship with our

patients

in all settings.

How have each of us earned that privilege of service to society today?

Your thoughts

Jim Dunleavy PT MS

Adminstrative Director of Rehab Services

Trinitas Hospital

, NJ 07207

March 11, 2005

I have waited awhile to enter this discussion that is a major one in the PT

profession, much less this list serv. I hope I can give a perspective that

gives my colleagues a different way to look at things.

Quality of service:

Many have equated the POPTS issue with the quality provided the patient.

The issue of quality good and bad, is the same regardless of the business

relationship. the same monetary factors that adversely affect care in POPTS can

also arise in other business relationships, PT owned and non PT owned.

Philosophically we should not have our business relationships determiend by

another

licensed professional.

Marketplace:

The number of physical therapists, if you count those in facility based

practice (acute care, acute/sub acute Rehab, LTC etc) could very well outnumber

those who are practicing, though not owning, their own practice, in an office

based environment. They certainly outnumber those PTs who own their own

practice. What does it say that we hire our own yet we " poo poo " others who do

the

same? Do we minimize the value and clinical excellence of our colleagues who

are in facility based practice simply because they are employed? Does the

profession jettison their responsibility to these patients simply because the

reimbursement system is set up to pay the facilitity rather than individual

therapists? Should these faciltiy based reimbursement structures be a focus of

equal

importance for our profession as well as the physician fee schedule?

Not including those in POPTS, if we achieve our professional goal that

many have discussed on this list serv that all PTs achieve " autonomy " thru

ownership, will the marketplace support the influx of all these PTs currently in

facility based practice?

And if we achieve this " autonomy " by " abandoning " employed environments for

financial reasons, how are we meeting, as a profession, our commitment to the

rehabilitation of patients throughout the continuum of care?

So, how do we as a profession achieve " autonomy " as a profession?

Well, we have to achieve autonomy in clinical practice, wherever it is

practiced, first.

Having said that, I am 200% behind efforts to achieve financial control of

what we do in all settings. It can be done if we as a profession have the

resolve to achieve it. That financial control maybe contractual, private

ownership

or other business relationships consistent with our need for clinical autonomy,

as long as we do not give other professions the right to bill for services

using our license.

Autonomy is earned thru clincal practice...which is a privilege, and

hopefully in time it will include a private financial relationship with our

patients

in all settings.

How have each of us earned that privilege of service to society today?

Your thoughts

Jim Dunleavy PT MS

Adminstrative Director of Rehab Services

Trinitas Hospital

, NJ 07207

March 12, 2005

I really think that the bottom line to this question is whether Physical

Therapy is a profession practiced only by PTs, or a commodity that can be

owned by anyone. Some PTs, including " Private Practice owners " , seem to

view themselves as a commodity, regardless of their practice setting or

employment status. I would argue that our own professional documents, and

many state laws, contradict this view. If we don't have a consensus that PT

is a profession, then all efforts to advance the profession will be in vain.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Stark Laws and Incident-To

I have waited awhile to enter this discussion that is a major one in the PT

profession, much less this list serv. I hope I can give a perspective that

gives my colleagues a different way to look at things.

Quality of service:

Many have equated the POPTS issue with the quality provided the patient.

The issue of quality good and bad, is the same regardless of the business

relationship. the same monetary factors that adversely affect care in POPTS

can

also arise in other business relationships, PT owned and non PT owned.

Philosophically we should not have our business relationships determiend by

another

licensed professional.

Marketplace:

The number of physical therapists, if you count those in facility based

practice (acute care, acute/sub acute Rehab, LTC etc) could very well

outnumber

those who are practicing, though not owning, their own practice, in an

office

based environment. They certainly outnumber those PTs who own their own

practice. What does it say that we hire our own yet we " poo poo " others who

do the

same? Do we minimize the value and clinical excellence of our colleagues who

are in facility based practice simply because they are employed? Does the

profession jettison their responsibility to these patients simply because

the

reimbursement system is set up to pay the facilitity rather than individual

therapists? Should these faciltiy based reimbursement structures be a focus

of equal

importance for our profession as well as the physician fee schedule?

Not including those in POPTS, if we achieve our professional goal that

many have discussed on this list serv that all PTs achieve " autonomy " thru

ownership, will the marketplace support the influx of all these PTs

currently in

facility based practice?

And if we achieve this " autonomy " by " abandoning " employed environments for

financial reasons, how are we meeting, as a profession, our commitment to

the

rehabilitation of patients throughout the continuum of care?

So, how do we as a profession achieve " autonomy " as a profession?

Well, we have to achieve autonomy in clinical practice, wherever it is

practiced, first.

Having said that, I am 200% behind efforts to achieve financial control of

what we do in all settings. It can be done if we as a profession have the

resolve to achieve it. That financial control maybe contractual, private

ownership

or other business relationships consistent with our need for clinical

autonomy,

as long as we do not give other professions the right to bill for services

using our license.

Autonomy is earned thru clincal practice...which is a privilege, and

hopefully in time it will include a private financial relationship with our

patients

in all settings.

How have each of us earned that privilege of service to society today?

Your thoughts

Jim Dunleavy PT MS

Adminstrative Director of Rehab Services

Trinitas Hospital

, NJ 07207

March 13, 2005

Mr. Zerr makes some good points. However, is there an effort by our

professional association and members to prevent Hospital systems from owning

their PT practices...outpatient or otherwise? This is the biggest example

of " non-participating administration " that I can think of. Many of our

fellow PT's that work in the hospital systems of the nation are paid much

less than those in private practice.

Let me get extremely off topic as many of us do and suggest we get limit the

practice of architects, who don't build anything but fill out some paperwork

and reap the benefits of someone elses hard work. Sure, the architect uses

their intellectual knowledge to design a plan, but do you think many of them

can actually do the construction....no, they leave that responsibility to

the construction crews because that's their speciality. No one should

question a physicians knowledge of the body and it's functions. Are they

experts in PT aspects...probably not, but should they know when to refer to

PT...absolutely.

As we continue this discussion, let's not demean each other with the term

" subservient " when discussing those that work for others.

Mike McClain

>

>Reply-To: PTManager

>To: <PTManager >

>Subject: Stark Laws and Incident-To

>Date: Sat, 12 Mar 2005 11:12:42 -0500

>

>Hello group.

>

>To me practicing autonomously doesn't mean that PT needs to be PT owned.

>We all get Eval and Treat orders (occassionally with precautions)and we

>choose how we want to treat.

>

>The issue at stake with Physician Owned PT Practices is definitely that of

>referral. As a business owner it is a very difficult and competitive

>market to be in when we are the lowest on the food chain. If a PCP thinks

>the patient needs an ortho consult, where is that ortho going to send the

>patient for a) conservative treatment prior to surgery, or

>post-surgically? There own POPT!

>

>If they had to " earn " there PT referrals like everyone else it would be

>different.

>

>The other problem I have with the POPT is the financial gain made by the

>owner. The physician / owner is allowed to profit for simply writing a rx

>and sending the patient his way " incident to " and benefits tremendously for

>next to nothing for effort. He doesn't have to worry about overhead

>because he can automatically cover those expenses. When a business is run

>through " non-participating administration " the amount of to be earned by

>the essential workers is much less!

>

>One other problem I have with the POPT's is the guise in which the billing

>is allowed as an " ancillary service " . The definition of ancillary is: Of

>secondary importance, auxillary, of secondary importance,or servant.

>

>We are a profession giving professional services that we are the experts on

>for this given body of knowledge. The definition of a profession is: an

>occupation, law, medicine, or engineering, that requires considerable

>training and specialized study. The body of qualified persons in an

>occupation or field. A skilled practitioner; an expert.

>

>I ask you then, how can a physician bill for PT services rendered by

>himself that are proclaimed to be ancillary services which are performed by

>a group of professionals? To me this smacks of incredible unethical

>activity.

>

>I do not fault anyone for working as an employee, but why would you want to

>work for an administratively run company and automatically get less income

>than you are worth?

>

>If PT services were not covered by insurance would Dr's still offer these

>services? What would the public's response be?

>

>The value of PT services is being undermined by our " subservient " attitude.

> We agree that it's okay to be a professional OWNED by another profession.

> We agree to accept the fees for our services. We work extremely hard for

>companies that get into bidding wars to have get insurance contracts at the

>lowest possible rate so another group of providers won't be able to treat

>them.

>

>By being owned, by not being unified, by not fighting for a better and more

>fair reimbursement rate we all pay the price of less autonomy, less

>respect, and less income.

>

>Where would our patients, our community, our nation be if we didn't have a

>licensed physical rehabilitation professional? I for one believe that the

>improved quality of life of the patients I treat is a result of

>professional knowledge and skills to improve their physical activity by

>enhancing flexibility, strength, endurance, coordination for meaningful

>functional activity.

>

>We deserve and should demand more!

>

> Zerr, PT

>Summit PT

>Tempe, AZ

>

> Zerr,PT

>Summit Physical Therapy

>www.summitpt.com

>

>Looking to start your own Practice?

>Visit www.InHomeRehab.com.

>Bring PTManager to your organization or State Association with a

>professional workshop or course - call us at 313 884-8920 to arrange

>PTManager encourages participation in your professional association. Join

>and participate now!

>

March 14, 2005

And I think that the bottom line is that some are confusing the practice of

Physical Therapy Art (i.e. the actual delivery of care to patients) with

ownership of a business (running the day to day aspects of a business

environment). I am not advocating that what is deemed proper Physical Therapy

technique and care of patients be given up to others outside the profession.

But we need to recognize in a free market economy such as ours, there are going

to be all kinds of interesting ownership arrangements. Regulations should be in

place to protect consumers from fraud and harm but these regulations should not

limit ownership of any type of business to certain individuals only. Doing so

only fosters abuse, inefficiency, and complacency

Furthermore I suggest that we be careful in assigning the blame of inadequate

and unethical care to others outside the profession. Remember that in the POPTS

practices that are deemed to be unethical there is not only an MD making

inappropriate and unnecessary referrals but also a PT accepting those referral

and rendering care that is inappropriate and unnecessary.

The problem isn't simply that there was/are physicians that are doing

unethical/illegal also, the problem is that there was/are physical therapists

partaking in illegal/unethical activities also. This may be the true bottom

line that isn't being addressed.

Ford, PT

Manager of Rehabilitation Services

CareGroup Home Care

44 Trapelo Rd

Belmont, MA 02478

rford@...

Re: Stark Laws and Incident-To

I have waited awhile to enter this discussion that is a major one in the PT

profession, much less this list serv. I hope I can give a perspective that

gives my colleagues a different way to look at things.

Quality of service:

Many have equated the POPTS issue with the quality provided the patient.

The issue of quality good and bad, is the same regardless of the business

relationship. the same monetary factors that adversely affect care in POPTS

can

also arise in other business relationships, PT owned and non PT owned.

Philosophically we should not have our business relationships determiend by

another

licensed professional.

Marketplace:

The number of physical therapists, if you count those in facility based

practice (acute care, acute/sub acute Rehab, LTC etc) could very well

outnumber

those who are practicing, though not owning, their own practice, in an

office

based environment. They certainly outnumber those PTs who own their own

practice. What does it say that we hire our own yet we " poo poo " others who

do the

same? Do we minimize the value and clinical excellence of our colleagues who

are in facility based practice simply because they are employed? Does the

profession jettison their responsibility to these patients simply because

the

reimbursement system is set up to pay the facilitity rather than individual

therapists? Should these faciltiy based reimbursement structures be a focus

of equal

importance for our profession as well as the physician fee schedule?

Not including those in POPTS, if we achieve our professional goal that

many have discussed on this list serv that all PTs achieve " autonomy " thru

ownership, will the marketplace support the influx of all these PTs

currently in

facility based practice?

And if we achieve this " autonomy " by " abandoning " employed environments for

financial reasons, how are we meeting, as a profession, our commitment to

the

rehabilitation of patients throughout the continuum of care?

So, how do we as a profession achieve " autonomy " as a profession?

Well, we have to achieve autonomy in clinical practice, wherever it is

practiced, first.

Having said that, I am 200% behind efforts to achieve financial control of

what we do in all settings. It can be done if we as a profession have the

resolve to achieve it. That financial control maybe contractual, private

ownership

or other business relationships consistent with our need for clinical

autonomy,

as long as we do not give other professions the right to bill for services

using our license.

Autonomy is earned thru clincal practice...which is a privilege, and

hopefully in time it will include a private financial relationship with our

patients

in all settings.

How have each of us earned that privilege of service to society today?

Your thoughts

Jim Dunleavy PT MS

Adminstrative Director of Rehab Services

Trinitas Hospital

, NJ 07207

March 14, 2005