RE: Stark Laws and Incident-To

March 9, 2005

mark,

first of all, I believe your decision or anyone's decision to enter into such

a relationship is incestuous at best. We all know the reason doctors are

moving this way is to capture their market referrals and to make a profit off

the

skin of physical therapists. This stymies free enterprise and free choice.

Lastly, as an emerging doctoring profession, we are moving into an autonomous

position to work along side our referring physicians as colleagues, not as

indentured servants.

Its a shame that these physicians would compromise their ethical position to

the almighty dollar. They probably have told you that they can't find any

superior services to which they refer, which is baloney.

Keep to the straight path. Don't compromise. You don't know where that will

ultimately lead you.

Good luck

March 9, 2005

mark,

first of all, I believe your decision or anyone's decision to enter into such

a relationship is incestuous at best. We all know the reason doctors are

moving this way is to capture their market referrals and to make a profit off

the

skin of physical therapists. This stymies free enterprise and free choice.

Lastly, as an emerging doctoring profession, we are moving into an autonomous

position to work along side our referring physicians as colleagues, not as

indentured servants.

Its a shame that these physicians would compromise their ethical position to

the almighty dollar. They probably have told you that they can't find any

superior services to which they refer, which is baloney.

Keep to the straight path. Don't compromise. You don't know where that will

ultimately lead you.

Good luck

March 9, 2005

Mark,

Not to rain on your parade but why would you want to work FOR a group of

arthropods? Why not establish your own private practice and serve a wider

group

of physicians and patients in your community?

Are you a member of APTA, PPS? Are you aware that our major opposition to

our Direst Access effort under Medicare is coming from the arthropods?

At a time when we, as a profession, is striving for greater independence and

clarity of our role it is difficult to understand why we have PT's willing

to enslave themselves in physician owned arrangements.

A. Towne, PT

Past President, PPS

March 9, 2005

I agree with on this issue. I am in private practice and the PT's who

provide this arrangement hinder my progress and the progress of PT's who want

to be in private practise. If no one did it there would be no one for those

guys to employ and they would have to send them out to independent therapist.

Onuwa Terry, PT

( Doctor of physical therapy Candidate)

Terry Physical Therapy, PC

1918 E. Parkway

Mission Texas 98752

www.terrypt.com

) Office

Fax

March 9, 2005

Some of this may have been answered in my previous post. But, I paid $7.95 for

wireless connection at the airport... might as well make the best of it!!

There is the " In-Office Ancillary Services Exception " under Stark. The elements

of the exception are:

-Direct Supervision

-Building Requirements

-Billing Requirements

Then there's “Incident-To” billing. Under " incident-to " , the supervision

requirements are stricter than under the in-office supervision requirements.

Basically, supervision was defined under " incident-to " to require the physician

be in the office and available to perform services. It does NOT mean that the

physician has to be in the same room or within line of sight.

CMS (HCFA at the time) wanted to use the same definition under the " In-Office "

exception but this was dropped.

Here are a couple articles that you may find helpful.

http://www.physiciansnews.com/law/401jonesdv.html

http://www.physiciansnews.com/law/402jones.html

And, as I said in my earlier post, if you're going to enter into any type of

arrangement with a physician that has anything to do with referrals or referral

arrangements, have your attorney take a look at it. It's better to be safe than

sorry!!

Tessa

Tessa L. Chenaille, CHC, CHP

President & CEO

Chenaille Compliance Consulting, LLC

5 Ross Street

Medford, MA 02155

P:

F: 781.874-0590

W: www.chenailleconsulting.com

>

> Date: 2005/03/09 Wed AM 06:42:22 EST

> To: ptmanager

> Subject: 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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and/or privileged and may contain confidential health information. This email is

intended to be reviewed only by the individual or organization named as

addressee. If you have received this email in error please notify St.

Hospital immediately - by return message to the sender or to

infosec@... - and destroy all copies of this message and any

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Hospital or St. Health. Confidential health information is protected by

state and federal law, including, but not limited to, the Health Insurance

Portability and Accountability Act (HIPAA) of 1996 and related regulations.

> ==============================================================================

>

March 9, 2005

" Incident to " bypasses the cap as far as I know. The patients you see must

be a patient of the doctor (or group) and one of them must be present to use

" incident to " billing.

You are essentially performing a task much like an ordered lab. The MD is

the responsible party.

The reality of " incident to " billing is that anyone employed by the MD

group can use the CPT codes commonly referred to as PT codes.

In your case they can actually call it Physical Therapy because therapists

are providing the care.

This is a hot topic here in KY. Contact me if you would like to discuss.

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

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be aware that any disclosure, copying, distribution, or use of the

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PROHIBITED. If you received this transmission in error, please immediately

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without retaining a copy in any form. Thank you. "

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

------------------------------------------------------------

The St. email system added the following official information to this

message.

------------------------------------------------------------

NOTICE OF CONFIDENTIALITY [sTV-NOTIFY-021604]

----------------------------------------------------

The information in this email, including attachments, may be confidential

and/or privileged and may contain confidential health information. This

email is intended to be reviewed only by the individual or organization

named as addressee. If you have received this email in error please notify

St. Hospital immediately - by return message to the sender or to

infosec@... - and destroy all copies of this message and any

attachments. Please note that any views or opinions presented in this email

are solely those of the author and do not necessarily represent those of

St. Hospital or St. Health. Confidential health information is

protected by state and federal law, including, but not limited to, the

Health Insurance Portability and Accountability Act (HIPAA) of 1996 and

related regulations.

============================================================================

==

March 9, 2005

Russ,

Me thinkeths thou protesteth too much.

I would propose that POPTS directly interfere with the progress and

direction of the profession. A profession that is trying to achieve autonomous

and

professional practice.

Regarding corporate employment, there are numerous problems with the

corporate world, but this is a far more ethical way to practice than a POPT.

For

many people they prefer to be small fishes in a big pond, and the corporate

environment works well for them.

I do not recall the last time a person who was in a professional position

purposely placed him/herself in a subserviant relationship. I feel sorry for

you if your self esteem is too low to to believe that your skills are good

enough to make it on your own. Furthermore, of you do not see the conflict of

interest that exists in the POPT setting, there is a further erosion of

professionalism. Finally, there is a strong possibility that POPT arrangements

will

be ruled as fee splitting, and this could result in forfeiture of your

liscense.

I know of some high quality physical therapists in POPT situations, however,

If the physicians you report are truly concerned with quality, offer them

equal status. Offer to rent your space at market value, hire your own staff

and do your own billing. you can still have face to face contact with the

referring MD's and together create programs that you both think are of highest

quality.

My business is helping Physical Therapists go into autonomous, professional,

private practice. These Therapists are my hero's. They have decided to

risk their homes, their cars, and almost everything they own to achieve this

dream. They struggle, work long hours, get stressed out, and become very

tired.

They do this not only for themselves, but for the profession. They

understand that for us as Physical Therapists to achieve our goals as

professionals

we need to risk failure. There are easier ways, but none are more rewarding.

As a third generation, private practitioner, I hope that we never forget the

importance of people like Towne, these pioneers started a ripple in

the water that will lead us to direct access and true autonomous professional

practice.

Russ as far as the new changes to the incident to rule, I would suggest that

you log onto the PPS website and see the new rules.

What's legal and what's right often differ. I prefer to associate with my

hero's. The ones who do the right thing.

Chad Novasic P.T.

President P.T. Plus

5605 Washington Ave

Racine, WI 53406

Phone:

e-mail: Chadnov@...

Web: PTPLUS.com

March 9, 2005

Mark, would it not be an even greater experience for you to open a practice and

have the orthopedic surgeon group refer to your practice! Unfortunately the

other manner smacks of a POPTS format. The American Physical Therapy Association

endorses collaborative, collegial practice relationships between physical

therapists and other providers.

When we have removed all barriers to autonomous practice, such as POPTS, we can

partner with those who would have been our referrer.

Slocum PT

GHHA, Pennsylvania

March 9, 2005

Group,

Can someone help me in identifying what physician

owned is and why the stigma on " Physician Owned " .

Is it because the MD is profiting from a piece of the

pie?

If that is the case than I think we may want to

broaden the net to include hospital out-patient

departments.

Physicians that work in hospitals are in not so many

words encouraged to refer to the hospitals out-patient

department. I know not all Hospitals, however I know

of many that do surgeries at a hospital and refer to

that clinic. As they can because some of the PT's that

have seen them in In-patient can see them for

out-patient and know specific protocols and it is a

great continuum of care for patients. (Who is

profiting from this?) Not the PT who is working for

someone else. Should they not have their own clinic?

How about our big corporations? The H word. Health

South who owned and operated not only rehab, but

management companies that manged orthopedic physicians

groups. Is it OK to work for a corporation? Guess not.

What about our SNF's? Are all of the SNF's PT owned?

Home Health? I don't think so.

I am a little mystified and defensive because I direct

a POPT and it is the best care I have ever directed.

Guess why this GP practice opened their clinic?

Because of over utilization of PT by some local

vendors.

I have direct and I mean direct contact with all

referring MD's, I have direct e-mail with all

referring MD's. If a patient has a problem or I feel

they need something they do not have to wait I pick up

the phone and it's taken care of.

Now how is that hurting patient care? I would be more

than happy to share statistics on the average number

of visits per patient evaluation. Why because SOME MD

are not out to screw PT they are looking for better

deliveries of care.

To all who are doing their own thing. God bless, you

are awesome and we should all be like you to venture

out and try are hand at BUSINESS and patient care. To

all who chime in and complain but are working for

someone else....

SHAME ON YOU......

This should get some interesting feedback.

As always I love PT and the opportunities it affords

me to affect other people lives with healing....

Russ Case PT

--- PATowne@... wrote:

>

> Mark,

>

> Not to rain on your parade but why would you want to

> work FOR a group of

> arthropods? Why not establish your own private

> practice and serve a wider group

> of physicians and patients in your community?

>

> Are you a member of APTA, PPS? Are you aware that

> our major opposition to

> our Direst Access effort under Medicare is coming

> from the arthropods?

>

> At a time when we, as a profession, is striving for

> greater independence and

> clarity of our role it is difficult to understand

> why we have PT's willing

> to enslave themselves in physician owned

> arrangements.

>

> A. Towne, PT

> Past President, PPS

>

> [Non-text portions of this message have been

> removed]

>

> 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 9, 2005

Russ;

For the sake of discussion, how would you view a " Therapist-owned " physician

practice?

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

Group,

Can someone help me in identifying what physician

owned is and why the stigma on " Physician Owned " .

Is it because the MD is profiting from a piece of the

pie?

If that is the case than I think we may want to

broaden the net to include hospital out-patient

departments.

Physicians that work in hospitals are in not so many

words encouraged to refer to the hospitals out-patient

department. I know not all Hospitals, however I know

of many that do surgeries at a hospital and refer to

that clinic. As they can because some of the PT's that

have seen them in In-patient can see them for

out-patient and know specific protocols and it is a

great continuum of care for patients. (Who is

profiting from this?) Not the PT who is working for

someone else. Should they not have their own clinic?

How about our big corporations? The H word. Health

South who owned and operated not only rehab, but

management companies that manged orthopedic physicians

groups. Is it OK to work for a corporation? Guess not.

What about our SNF's? Are all of the SNF's PT owned?

Home Health? I don't think so.

I am a little mystified and defensive because I direct

a POPT and it is the best care I have ever directed.

Guess why this GP practice opened their clinic?

Because of over utilization of PT by some local

vendors.

I have direct and I mean direct contact with all

referring MD's, I have direct e-mail with all

referring MD's. If a patient has a problem or I feel

they need something they do not have to wait I pick up

the phone and it's taken care of.

Now how is that hurting patient care? I would be more

than happy to share statistics on the average number

of visits per patient evaluation. Why because SOME MD

are not out to screw PT they are looking for better

deliveries of care.

To all who are doing their own thing. God bless, you

are awesome and we should all be like you to venture

out and try are hand at BUSINESS and patient care. To

all who chime in and complain but are working for

someone else....

SHAME ON YOU......

This should get some interesting feedback.

As always I love PT and the opportunities it affords

me to affect other people lives with healing....

Russ Case PT

--- PATowne@... wrote:

>

> Mark,

>

> Not to rain on your parade but why would you want to

> work FOR a group of

> arthropods? Why not establish your own private

> practice and serve a wider group

> of physicians and patients in your community?

>

> Are you a member of APTA, PPS? Are you aware that

> our major opposition to

> our Direst Access effort under Medicare is coming

> from the arthropods?

>

> At a time when we, as a profession, is striving for

> greater independence and

> clarity of our role it is difficult to understand

> why we have PT's willing

> to enslave themselves in physician owned

> arrangements.

>

> A. Towne, PT

> Past President, PPS

>

> [Non-text portions of this message have been

> removed]

>

> 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 9, 2005

Russ;

For the sake of discussion, how would you view a " Therapist-owned " physician

practice?

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

Group,

Can someone help me in identifying what physician

owned is and why the stigma on " Physician Owned " .

Is it because the MD is profiting from a piece of the

pie?

If that is the case than I think we may want to

broaden the net to include hospital out-patient

departments.

Physicians that work in hospitals are in not so many

words encouraged to refer to the hospitals out-patient

department. I know not all Hospitals, however I know

of many that do surgeries at a hospital and refer to

that clinic. As they can because some of the PT's that

have seen them in In-patient can see them for

out-patient and know specific protocols and it is a

great continuum of care for patients. (Who is

profiting from this?) Not the PT who is working for

someone else. Should they not have their own clinic?

How about our big corporations? The H word. Health

South who owned and operated not only rehab, but

management companies that manged orthopedic physicians

groups. Is it OK to work for a corporation? Guess not.

What about our SNF's? Are all of the SNF's PT owned?

Home Health? I don't think so.

I am a little mystified and defensive because I direct

a POPT and it is the best care I have ever directed.

Guess why this GP practice opened their clinic?

Because of over utilization of PT by some local

vendors.

I have direct and I mean direct contact with all

referring MD's, I have direct e-mail with all

referring MD's. If a patient has a problem or I feel

they need something they do not have to wait I pick up

the phone and it's taken care of.

Now how is that hurting patient care? I would be more

than happy to share statistics on the average number

of visits per patient evaluation. Why because SOME MD

are not out to screw PT they are looking for better

deliveries of care.

To all who are doing their own thing. God bless, you

are awesome and we should all be like you to venture

out and try are hand at BUSINESS and patient care. To

all who chime in and complain but are working for

someone else....

SHAME ON YOU......

This should get some interesting feedback.

As always I love PT and the opportunities it affords

me to affect other people lives with healing....

Russ Case PT

--- PATowne@... wrote:

>

> Mark,

>

> Not to rain on your parade but why would you want to

> work FOR a group of

> arthropods? Why not establish your own private

> practice and serve a wider group

> of physicians and patients in your community?

>

> Are you a member of APTA, PPS? Are you aware that

> our major opposition to

> our Direst Access effort under Medicare is coming

> from the arthropods?

>

> At a time when we, as a profession, is striving for

> greater independence and

> clarity of our role it is difficult to understand

> why we have PT's willing

> to enslave themselves in physician owned

> arrangements.

>

> A. Towne, PT

> Past President, PPS

>

> [Non-text portions of this message have been

> removed]

>

> 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 9, 2005

Russ;

For the sake of discussion, how would you view a " Therapist-owned " physician

practice?

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

Group,

Can someone help me in identifying what physician

owned is and why the stigma on " Physician Owned " .

Is it because the MD is profiting from a piece of the

pie?

If that is the case than I think we may want to

broaden the net to include hospital out-patient

departments.

Physicians that work in hospitals are in not so many

words encouraged to refer to the hospitals out-patient

department. I know not all Hospitals, however I know

of many that do surgeries at a hospital and refer to

that clinic. As they can because some of the PT's that

have seen them in In-patient can see them for

out-patient and know specific protocols and it is a

great continuum of care for patients. (Who is

profiting from this?) Not the PT who is working for

someone else. Should they not have their own clinic?

How about our big corporations? The H word. Health

South who owned and operated not only rehab, but

management companies that manged orthopedic physicians

groups. Is it OK to work for a corporation? Guess not.

What about our SNF's? Are all of the SNF's PT owned?

Home Health? I don't think so.

I am a little mystified and defensive because I direct

a POPT and it is the best care I have ever directed.

Guess why this GP practice opened their clinic?

Because of over utilization of PT by some local

vendors.

I have direct and I mean direct contact with all

referring MD's, I have direct e-mail with all

referring MD's. If a patient has a problem or I feel

they need something they do not have to wait I pick up

the phone and it's taken care of.

Now how is that hurting patient care? I would be more

than happy to share statistics on the average number

of visits per patient evaluation. Why because SOME MD

are not out to screw PT they are looking for better

deliveries of care.

To all who are doing their own thing. God bless, you

are awesome and we should all be like you to venture

out and try are hand at BUSINESS and patient care. To

all who chime in and complain but are working for

someone else....

SHAME ON YOU......

This should get some interesting feedback.

As always I love PT and the opportunities it affords

me to affect other people lives with healing....

Russ Case PT

--- PATowne@... wrote:

>

> Mark,

>

> Not to rain on your parade but why would you want to

> work FOR a group of

> arthropods? Why not establish your own private

> practice and serve a wider group

> of physicians and patients in your community?

>

> Are you a member of APTA, PPS? Are you aware that

> our major opposition to

> our Direst Access effort under Medicare is coming

> from the arthropods?

>

> At a time when we, as a profession, is striving for

> greater independence and

> clarity of our role it is difficult to understand

> why we have PT's willing

> to enslave themselves in physician owned

> arrangements.

>

> A. Towne, PT

> Past President, PPS

>

> [Non-text portions of this message have been

> removed]

>

> 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 9, 2005

I doubt that the physicians who choose to be employed by a hospital

or some other corporate structure get derided by their colegues in

the same manner that PT's are when they say that they want to

practice in a way that is comfortable for them.

I take exception to a couple points that have been raised: the

respect that comes with the move to a doctoring profession will NOT

come because PT's are in their own private practices (e.g.

chiropractors are privately employed and many actually serve to drag

down the respect of the entire profession). The respect we attain

WILL come from the professional behaviors and attitudes of ALL PT's

in ALL settings (read some of Warren May's research on professional

behaviors . . . there is nothing in there about self-employment).

Those of us who mix-up the issues of autonomus practice, quality

care, and doctoring profession with the issue of how you choose to

be employed are simply wrong.

A person's risk tolerence for self employment is in NO WAY related

to the professionalism, autonomy and authoritative power he/she can

command in the work place. If you think that you are more

professional or " doctoring " because you are self employed you need

to re-think your position. Consider the professors in your PT

program, how many of them are self-employed? They seem to have

instilled knowledge and confidence, fostering ethical and

professional behaviors in their students.

I thank some of you who have offered both advice and resources that

I can use to make an informed decision. To the rest, who simply

think that all PT's must be self employed and use every chance to

belittle their collegues, I am hope your vindictive attitudes will

not drag-down the respect for the PT profession in the medical

community.

March 9, 2005

I doubt that the physicians who choose to be employed by a hospital

or some other corporate structure get derided by their colegues in

the same manner that PT's are when they say that they want to

practice in a way that is comfortable for them.

I take exception to a couple points that have been raised: the

respect that comes with the move to a doctoring profession will NOT

come because PT's are in their own private practices (e.g.

chiropractors are privately employed and many actually serve to drag

down the respect of the entire profession). The respect we attain

WILL come from the professional behaviors and attitudes of ALL PT's

in ALL settings (read some of Warren May's research on professional

behaviors . . . there is nothing in there about self-employment).

Those of us who mix-up the issues of autonomus practice, quality

care, and doctoring profession with the issue of how you choose to

be employed are simply wrong.

A person's risk tolerence for self employment is in NO WAY related

to the professionalism, autonomy and authoritative power he/she can

command in the work place. If you think that you are more

professional or " doctoring " because you are self employed you need

to re-think your position. Consider the professors in your PT

program, how many of them are self-employed? They seem to have

instilled knowledge and confidence, fostering ethical and

professional behaviors in their students.

I thank some of you who have offered both advice and resources that

I can use to make an informed decision. To the rest, who simply

think that all PT's must be self employed and use every chance to

belittle their collegues, I am hope your vindictive attitudes will

not drag-down the respect for the PT profession in the medical

community.

March 9, 2005

I doubt that the physicians who choose to be employed by a hospital

or some other corporate structure get derided by their colegues in

the same manner that PT's are when they say that they want to

practice in a way that is comfortable for them.

I take exception to a couple points that have been raised: the

respect that comes with the move to a doctoring profession will NOT

come because PT's are in their own private practices (e.g.

chiropractors are privately employed and many actually serve to drag

down the respect of the entire profession). The respect we attain

WILL come from the professional behaviors and attitudes of ALL PT's

in ALL settings (read some of Warren May's research on professional

behaviors . . . there is nothing in there about self-employment).

Those of us who mix-up the issues of autonomus practice, quality

care, and doctoring profession with the issue of how you choose to

be employed are simply wrong.

A person's risk tolerence for self employment is in NO WAY related

to the professionalism, autonomy and authoritative power he/she can

command in the work place. If you think that you are more

professional or " doctoring " because you are self employed you need

to re-think your position. Consider the professors in your PT

program, how many of them are self-employed? They seem to have

instilled knowledge and confidence, fostering ethical and

professional behaviors in their students.

I thank some of you who have offered both advice and resources that

I can use to make an informed decision. To the rest, who simply

think that all PT's must be self employed and use every chance to

belittle their collegues, I am hope your vindictive attitudes will

not drag-down the respect for the PT profession in the medical

community.

March 10, 2005

Interesting discussion for one who is not in Outpt PT to watch from the

sidelines but Chad I do have a few points of observation.

1) You suggest to Russ that he and others of his ilk (PT's in POPTS) are placing

themselves in a " subservient relationship " but are not those you purport to help

placing them in a subservient relationship to you in a sense ( " My business is

helping Physical Therapists go into autonomous, professional, private

practice " ). I realize that there are subtleties but you sound as if you are

profiting from the professional growth of PTs just as an MD might be profiting

from a POPTS.

2) There may be many good reasons as to why a PT would practice in a POPTS and

I'm sure one could do so in an ethical manner. Conversely, there is not

guarantee that independent practice is synonymous with ethical practice.

Medicare requires that us Home Health Rehab Clinicians practice our art under a

signed plan of care from a physician so I suppose that I am subservient also,

therefore I may not understand the true heroic act of blazing a trail as our

colleagues in independent outpatient practice do. All hail the independent

practitioners for we are lost without them.

Ford, PT

Manager of Rehabilitation Services

CareGroup Home Care

44 Trapelo Rd

Belmont, MA 02478

rford@...

Re: Stark Laws and Incident-To

Russ,

Me thinkeths thou protesteth too much.

I would propose that POPTS directly interfere with the progress and

direction of the profession. A profession that is trying to achieve autonomous

and

professional practice.

Regarding corporate employment, there are numerous problems with the

corporate world, but this is a far more ethical way to practice than a POPT.

For

many people they prefer to be small fishes in a big pond, and the corporate

environment works well for them.

I do not recall the last time a person who was in a professional position

purposely placed him/herself in a subserviant relationship. I feel sorry for

you if your self esteem is too low to to believe that your skills are good

enough to make it on your own. Furthermore, of you do not see the conflict of

interest that exists in the POPT setting, there is a further erosion of

professionalism. Finally, there is a strong possibility that POPT arrangements

will

be ruled as fee splitting, and this could result in forfeiture of your

liscense.

I know of some high quality physical therapists in POPT situations, however,

If the physicians you report are truly concerned with quality, offer them

equal status. Offer to rent your space at market value, hire your own staff

and do your own billing. you can still have face to face contact with the

referring MD's and together create programs that you both think are of highest

quality.

My business is helping Physical Therapists go into autonomous, professional,

private practice. These Therapists are my hero's. They have decided to

risk their homes, their cars, and almost everything they own to achieve this

dream. They struggle, work long hours, get stressed out, and become very

tired.

They do this not only for themselves, but for the profession. They

understand that for us as Physical Therapists to achieve our goals as

professionals

we need to risk failure. There are easier ways, but none are more rewarding.

As a third generation, private practitioner, I hope that we never forget the

importance of people like Towne, these pioneers started a ripple in

the water that will lead us to direct access and true autonomous professional

practice.

Russ as far as the new changes to the incident to rule, I would suggest that

you log onto the PPS website and see the new rules.

What's legal and what's right often differ. I prefer to associate with my

hero's. The ones who do the right thing.

Chad Novasic P.T.

President P.T. Plus

5605 Washington Ave

Racine, WI 53406

Phone:

e-mail: Chadnov@...

Web: PTPLUS.com

March 10, 2005

While we expound on the evils of POPTS, and our professional association's

policies that denounce this arrangement, let's ask a few other explorative

questions:

Would these physicians refer to you if you already had a practice next door? If

not, why not?

Where have they been sending their patients for PT up to now? Why are they

looking to change?

Will their patients have the freedom to select their own PT if they wanted to go

to someone other than the clinic the physicians normally refer to? If not, why

not?

Will the physicians referral pattern of who gets seen for PT change under this

new arrangement? If so, why?

Will the physicians under this new arrangement be involved in determining

utilization of service via # visits or # of procedures/interventions? If so,

why?

The answer to these or similar questions will lead to you the motive behind the

physicians? Is it quality patient care, or cash flow? If they value quality

patient care, then they should be willing to explore with you a variety of

collaborative practice arrangements other than " incident to " .

Let us also keep in focus that while APTA's policy stance has shifted to

anti-POPTS, the original intent and that of STARK was anti-referral for profit.

No entity should receive compensation for the mere fact of referral without

providing service.

For any of us in the profession, regardless of whether in independent practice

or employed by someone (physician, hospital, home care agency, etc), is our

focus kept on the patient and what they truly need? Abusive relationships can

and do occur in all settings, whether independent practice or employed

arrangements. It is not the employment relationship that ultimately determines

the ethical nature of the practice. It is the values and core beliefs and ethics

of the professionals providing the care to each patient. And whether we will

stand behind those values if pressed by others.

I have never been, nor ever will be, employed in a POPTS arrangement. That's a

basic value I have adopted. But I will also not condemn those who are without

exploring with them the whys and hows of their arrangement. Let's attempt to

guide our colleagues into a practice arrangement that is ethically sound and

morally right, regardless of whether they are independent entrepreneurs or

employees of someone else (physician or otherwise). And always assure we keep

the focus where it should be, and that is the appropriate care for our patients

in a non-exploitative relationship.

W. , PT, MS

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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