RE: Physician Ownership New Perspective

May 14, 2005

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" This is about macro economics and the lack of inherent consumer / producer

equity... "

Thanks for the insight. Macro addreses the global, international, and

perhaps national levels -- where the interests of the nation and society as

a whole are at stake. The nation does not want docs writing prescriptions

and then selling the drugs, so docs may not own drugstores. The same is the

case with them controlling demand for other goods and services over which

they also control supply. It doesn't respond to market forces, and the

beneficiary patient doesn't either, since they are in effect spending

**someone else's money**. Where markets cannot control, strong central

forces must, or else chaos ensues.

The **someone else** would be... we the people, their fellow citizens who.

with our tax money are paying today for services received by the Medicare

population in hopes that years or decades in the future someone else will be

paying for the goods and services which we will receive. Or, in the

non-Medicare arena, we the people are the premium payors for insurance

benefits demanded (economic term!) and supplied (another!) to others in our

insurance plan.

At the industry, region, State, and local level -- right down to the small

practice, it's a microeconomic issue. The doc who used you for years can

suddenly become fickle and make alliances (shades of Reality TV!) with the

newer, more " kiss-up " therapist in town who brings them fancy cake every

other Friday. This moves economic power to the doc. Our national policy

makers don't like anticompetitive practices, such as a doc may exert over

those to whom they refer. (Consider the Bureau of Competition at the

Federal Trade Commission).

I agree with . It's no longer about neurons, myofibrils, and correct

hand positioning. It's about economics and about whether the profession is

willing to return to the master-slave relationships of previous decades, or

is determined to finally cast off the shackles of physician dominance.

Actually, I think that the profession has actually taken a stance on these

issues... Has everyone read them?

As a former teacher of graduate economics, I'm preparing a set of CEU

presentations for our own PT/OT/ SLP staff on the Economics of Rehab

Practice, for the upcoming fall. What are other rehab managers doing to

innoculate their staffs?

Dick Hillyer, PT, MBA, MSM

System Director

Rehabilitation Sevices

Lee Memorial Health system

Ft. Myers, FL

Physician Ownership New Perspective

Group

I have enjoyed reading all the posts regarding the physician owned practice

scenario. If we judge the " ethics " of this business model solely on the

individual PT's or MD's ethics and clinical skills it will lead to nothing

more than unending disagreement among PT's, depending upon which environment

you work. Why? Because there is no shortage of fine PT's working for MD's

and no shortage of fine MD's involved with incident to PT services for their

profit. Further, I am sure there also is no shortage of profit hungry MD's

and minimally competent PT's working in a physician owned practice.

To me, the main point of it all is quite simple. There is an uneven playing

field when the MD holds both the entry ticket to the clinic AND owns the

clinic as well. Why is this not grossly obvious to all of us as PT's? This

is not about individuals and their dedication to their patients. This is

not about individuals and their valued close clinical relationship with the

in office MD. This is not about individuals and whether they are good or

bad clinicians, ethical practitioners or not.

This is about macro economics and the lack of inherent consumer / producer

equity. Basically, there exist two groups of producers of PT service.

1) PT's in a Physician owned practice, and 2) PT's in a private practice or

independent hospital or other independent entities. These two groups offer

the exact same service (quality, ethical clinicians in the MD office as well

as in the private entities office), but independent PT's do not have the

same inherent access to the consumers of that service as the MD groups have.

It is not about who is better; it's about having equal access.

How is this inequity fixed? To me, that is simple too. Do not allow MD's

to refer patients to a facility in which they hold financial interest.

Wasn't that the original intent of Stark with reference to PT, MRI, and

labs. Physicians now cannot refer a patient to a PT office that they or a

family member have a financial interest. Why then is it ok for the

physician to refer a patient to a PT office that they have a financial

interest as long as it is located under the same roof, and not across the

street? What is different in those two scenarios to make one, but not the

other totally unethical? Is this not blatantly absurd to all of us PT's?

If we see ourselves as professionals with our field of expertise, I think we

should all be a little outraged with this inequity. If you want to work

closely with an MD, develop a relationship with an MD who shares the same

interest . . . open an office right next door . . . location, location,

location . . . if you have a practice specialty in the area of vestibular

dysfunction, open an office near ENT's and neurologists. That is just good

business sense. I certainly do not believe that the PT's that work in

physician owned practices are inherently bad . . . shame of any of us for

thinking that way. But until the laws change . . . PT's must continue to

develop relationships with MD's (even those that have their own PT) in order

to make a living doing the great things for their patients.

Thanks for your time :-)

Witt, PT

Delray Beach, FL

Private Practice

May 14, 2005

Dick

Thank you for the schooling on economics. Also, thank you for understanding

the intent of my message and not running me over because of my incorrect use

of the term macro vs. micro. Have a great weekend