RE: Physician Ownership New Perspective

[Guest guest]

No problems with frankness, I enjoy the discourse and I learn alot

from all sides on this issue.

" If you have an opinion, come to meetings,

call the APTA, change our minds " .

As mentioned numerous times, I am an APTA member, I am involved in the

processes at the state level. I do let the leaders know how feel, but

you and I both know it's laughable to think I will change Ben Massey's

mind about POPTS, direct access or anything else on that grand scale.

" And to say that the APTA doesn't speak for non-members is

misinformed " . I think you are misinterpreting what I said. I know

APTA advocates for PTs in general, member and nonmembers. What I said

to another person was that APTA could not speak for all therapists on

a particular issue. Many PTs disagree with them, so they cannot speak

for them on that issue. I think of it like the Democratic Party.

Their party is platform is pro-choice. But at the same time, they

aren't speaking for all the pro-life Democrats on that issue, they are

just spouting the party's platform. that's the fundamental difference

i keep trying to point out here. The APTA is giving their platform,

but they are not speaking for all PTs.

> ,

>

> Please forgive my frankness, but this has to be said:

>

> The APTA would speak for a more licensed PT's if they joined. That is a

> point that we make over and over. If you have an opinion, come to meetings,

> call the APTA, change our minds. If you are not doing that then you have

> little right to complain about the course that the APTA sets.

>

> And to say that the APTA doesn't speak for non-members is misinformed. Call

> the APTA research department and ask them about all the surveys that have

> been taken by them, by components of the APTA and that they have compiled

> from other sources and ask them how many of them involve non-members. They

> have plenty of " evidence " to support the issues and vision that they have

> chosen to pursue, including plenty of survey evidence of strong support

> against POPTS

>

> Also check the volumes of minutes of the House of Delegates over the years

> to see how passionate, intense and in depth the discussions are on these

> issues. There is plenty of dissention but at the end of the session there

> is professional agreement based on the input of hundreds of state delegates

> who themselves have listened to the opinions of both members and non-members

> of their state.

>

> As far as the APTA denying membership to those that work in POPTS. You know

> as well as I that if they wanted to make that a criteria for membership,

> they could. In fact, it might be a good thing to propose to the next House

> of Delegates. But I bet it would be defeated easily because it would not be

> the " right " thing to do. I agree that it wouldn't be the right thing to do.

> The right thing to do is to continue to try to change the hearts and minds

> of those who don't believe that the APTA really does represent all

> therapists, and to get you to trust that at the end of the day thousands of

> committed APTA members and staff are working as hard as they can to make our

> profession, your profession, the best it can be.

>

> Tom Howell, P.T., M.P.T.

> Howell Physical Therapy

> Eagle, ID

> ptclinic@...

>

> 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

> > > > >

> > > > >

[Guest guest]

No problems with frankness, I enjoy the discourse and I learn alot

from all sides on this issue.

" If you have an opinion, come to meetings,

call the APTA, change our minds " .

As mentioned numerous times, I am an APTA member, I am involved in the

processes at the state level. I do let the leaders know how feel, but

you and I both know it's laughable to think I will change Ben Massey's

mind about POPTS, direct access or anything else on that grand scale.

" And to say that the APTA doesn't speak for non-members is

misinformed " . I think you are misinterpreting what I said. I know

APTA advocates for PTs in general, member and nonmembers. What I said

to another person was that APTA could not speak for all therapists on

a particular issue. Many PTs disagree with them, so they cannot speak

for them on that issue. I think of it like the Democratic Party.

Their party is platform is pro-choice. But at the same time, they

aren't speaking for all the pro-life Democrats on that issue, they are

just spouting the party's platform. that's the fundamental difference

i keep trying to point out here. The APTA is giving their platform,

but they are not speaking for all PTs.

> ,

>

> Please forgive my frankness, but this has to be said:

>

> The APTA would speak for a more licensed PT's if they joined. That is a

> point that we make over and over. If you have an opinion, come to meetings,

> call the APTA, change our minds. If you are not doing that then you have

> little right to complain about the course that the APTA sets.

>

> And to say that the APTA doesn't speak for non-members is misinformed. Call

> the APTA research department and ask them about all the surveys that have

> been taken by them, by components of the APTA and that they have compiled

> from other sources and ask them how many of them involve non-members. They

> have plenty of " evidence " to support the issues and vision that they have

> chosen to pursue, including plenty of survey evidence of strong support

> against POPTS

>

> Also check the volumes of minutes of the House of Delegates over the years

> to see how passionate, intense and in depth the discussions are on these

> issues. There is plenty of dissention but at the end of the session there

> is professional agreement based on the input of hundreds of state delegates

> who themselves have listened to the opinions of both members and non-members

> of their state.

>

> As far as the APTA denying membership to those that work in POPTS. You know

> as well as I that if they wanted to make that a criteria for membership,

> they could. In fact, it might be a good thing to propose to the next House

> of Delegates. But I bet it would be defeated easily because it would not be

> the " right " thing to do. I agree that it wouldn't be the right thing to do.

> The right thing to do is to continue to try to change the hearts and minds

> of those who don't believe that the APTA really does represent all

> therapists, and to get you to trust that at the end of the day thousands of

> committed APTA members and staff are working as hard as they can to make our

> profession, your profession, the best it can be.

>

> Tom Howell, P.T., M.P.T.

> Howell Physical Therapy

> Eagle, ID

> ptclinic@...

>

> 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

> > > > >

> > > > >

[Guest guest]

,

While you are correct that the APTA is an advocacy group, if that were its only

purpose then it would only exist to lobby legislators, CMS, insurers, etc. I'm

sure you know that APTA does MUCH more than that. The lobbyist that we use here

in Kansas, as good as he is, does not financially support and disseminate PT

research, does not sponsor continuing education, does not put together clinical

specialist board exams, does not plan the future of our profession, does not

organize PT's and PTA's into component and section groups, etc. Definitely ONE

of the functions of the APTA is to serve as an advocacy group, however, it is

but one of the many functions of APTA.

Mark Dwyer, PT, MHA

Olathe, Kansas

markdwyer87@...

--------- 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

> > > > >

> > > > >

[Guest guest]

Hi ,

Sorry for the delay in responding.

I have to disagree again with your responses. Very few groups (or

governments for that matter) can speak for everyone. What they try to do is

gather information from as many in the group and come up with a mission and

a vision based on the responses of the majority. You know that but I needed

to point it out again to emphasize that the position on POPTS is based on

survey upon survey and meeting upon meeting where it has been cited as a

major problem facing the PT profession. Based on that feedback, the APTA

has also made it a priority.

If enough members and non-members come back with survey evidence and

research evidence to show that the current majority position on POPTS is

misguided, the APTA including Ben Massey would change their position.

Currently, members like yourself are in the minority and have not mounted

any coordinated effort to change the opinion and vision of the APTA. Nor

has there been any hard evidence to show that there is any benefit to the

profession or even to patients by the POPTS setting.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

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

> > > > >

> > > > >

[Guest guest]

Hi ,

Sorry for the delay in responding.

I have to disagree again with your responses. Very few groups (or

governments for that matter) can speak for everyone. What they try to do is

gather information from as many in the group and come up with a mission and

a vision based on the responses of the majority. You know that but I needed

to point it out again to emphasize that the position on POPTS is based on

survey upon survey and meeting upon meeting where it has been cited as a

major problem facing the PT profession. Based on that feedback, the APTA

has also made it a priority.

If enough members and non-members come back with survey evidence and

research evidence to show that the current majority position on POPTS is

misguided, the APTA including Ben Massey would change their position.

Currently, members like yourself are in the minority and have not mounted

any coordinated effort to change the opinion and vision of the APTA. Nor

has there been any hard evidence to show that there is any benefit to the

profession or even to patients by the POPTS setting.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

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

> > > > >

> > > > >

[Guest guest]

Hi ,

Sorry for the delay in responding.

I have to disagree again with your responses. Very few groups (or

governments for that matter) can speak for everyone. What they try to do is

gather information from as many in the group and come up with a mission and

a vision based on the responses of the majority. You know that but I needed

to point it out again to emphasize that the position on POPTS is based on

survey upon survey and meeting upon meeting where it has been cited as a

major problem facing the PT profession. Based on that feedback, the APTA

has also made it a priority.

If enough members and non-members come back with survey evidence and

research evidence to show that the current majority position on POPTS is

misguided, the APTA including Ben Massey would change their position.

Currently, members like yourself are in the minority and have not mounted

any coordinated effort to change the opinion and vision of the APTA. Nor

has there been any hard evidence to show that there is any benefit to the

profession or even to patients by the POPTS setting.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

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

> > > > >

> > > > >

[Guest guest]

,

I have to share my experience with you. I know it may differ state to state

but after having been a member of APTA for years I decided to become active

in the state. Within 5 years I had held the job of Chief Delegate and am now

President of our Chapter. Within my first year of being active, I was

fortunate to meet Ben Massey and some of the board members and have been able

to

share my thoughts and opinions with them. I also have gotten to know the

staff at APTA and have been given insight on how to promote change within the

organization.

My point, if a person is motivated enough, it may take a few years but one

dedicated, motivated person who is willing to reach out to colleagues

especially those involved in APTA can truly make a difference. It is corny but

true,

APTA is a member driven organization.

Marc Lacroix, PT

President

NHAPTA

[Guest guest]

,

I have to share my experience with you. I know it may differ state to state

but after having been a member of APTA for years I decided to become active

in the state. Within 5 years I had held the job of Chief Delegate and am now

President of our Chapter. Within my first year of being active, I was

fortunate to meet Ben Massey and some of the board members and have been able

to

share my thoughts and opinions with them. I also have gotten to know the

staff at APTA and have been given insight on how to promote change within the

organization.

My point, if a person is motivated enough, it may take a few years but one

dedicated, motivated person who is willing to reach out to colleagues

especially those involved in APTA can truly make a difference. It is corny but

true,

APTA is a member driven organization.

Marc Lacroix, PT

President

NHAPTA

[Guest guest]

,

I have to share my experience with you. I know it may differ state to state

but after having been a member of APTA for years I decided to become active

in the state. Within 5 years I had held the job of Chief Delegate and am now

President of our Chapter. Within my first year of being active, I was

fortunate to meet Ben Massey and some of the board members and have been able

to

share my thoughts and opinions with them. I also have gotten to know the

staff at APTA and have been given insight on how to promote change within the

organization.

My point, if a person is motivated enough, it may take a few years but one

dedicated, motivated person who is willing to reach out to colleagues

especially those involved in APTA can truly make a difference. It is corny but

true,

APTA is a member driven organization.

Marc Lacroix, PT

President

NHAPTA

[Guest guest]

: The APTA has a governance structure that allows PTs and PTAs

to have a voice and that is the House of Delegates. Each state has

a voice in the house. Each state delegation is supposed to

represent the voice of the members in that state. The Sections also

have non-voting representation so the Section voice can be heard.

Each component has a mechanism for their members to voice their

concerns and vote on the priorities of that component that the

members want represented in the House of Delegate.

There are varying opinions in the House as those who have been

delegates can attest. It can get very passionate on both sides of

an issue.

The Board of Directors is elected by the HOD and acts for the

organization to carry out directives and poliies set by the house.

They are not out there fre willing it.

There are numerous Committees, Task Forces, and othe groups that

meet to advice the board.

So if you do not like what APTA says, provides or advocates there

are numerous ways for you to get involved and be heard. It is Not

an " old boys " network and you don't have to be an insider to have an

effect.

I have a great friend who is a PT in a POPTS (it is fair in

operation, ethical and he is considered partner in the practice)but

he knows that he is very lucky in his setting. He is in support of

our state and national efforts regarding POPTS. He is actually a

good influence with some of the MDs in his area because of this

relationship and can rationally explain APTAs position on POPTs in

such a way that the MDs will listen and understand.

Pat Jobes, PT

President Acute Care Section

and District Chair of Memphis District of the Tennessee Physical

Therapy Association

> > > > > > -

> > > > > >

> > > > > > " 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

> > > > > >

> > > > > >

[Guest guest]

: The APTA has a governance structure that allows PTs and PTAs

to have a voice and that is the House of Delegates. Each state has

a voice in the house. Each state delegation is supposed to

represent the voice of the members in that state. The Sections also

have non-voting representation so the Section voice can be heard.

Each component has a mechanism for their members to voice their

concerns and vote on the priorities of that component that the

members want represented in the House of Delegate.

There are varying opinions in the House as those who have been

delegates can attest. It can get very passionate on both sides of

an issue.

The Board of Directors is elected by the HOD and acts for the

organization to carry out directives and poliies set by the house.

They are not out there fre willing it.

There are numerous Committees, Task Forces, and othe groups that

meet to advice the board.

So if you do not like what APTA says, provides or advocates there

are numerous ways for you to get involved and be heard. It is Not

an " old boys " network and you don't have to be an insider to have an

effect.

I have a great friend who is a PT in a POPTS (it is fair in

operation, ethical and he is considered partner in the practice)but

he knows that he is very lucky in his setting. He is in support of

our state and national efforts regarding POPTS. He is actually a

good influence with some of the MDs in his area because of this

relationship and can rationally explain APTAs position on POPTs in

such a way that the MDs will listen and understand.

Pat Jobes, PT

President Acute Care Section

and District Chair of Memphis District of the Tennessee Physical

Therapy Association

> > > > > > -

> > > > > >

> > > > > > " 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

> > > > > >

> > > > > >

[Guest guest]

: The APTA has a governance structure that allows PTs and PTAs

to have a voice and that is the House of Delegates. Each state has

a voice in the house. Each state delegation is supposed to

represent the voice of the members in that state. The Sections also

have non-voting representation so the Section voice can be heard.

Each component has a mechanism for their members to voice their

concerns and vote on the priorities of that component that the

members want represented in the House of Delegate.

There are varying opinions in the House as those who have been

delegates can attest. It can get very passionate on both sides of

an issue.

The Board of Directors is elected by the HOD and acts for the

organization to carry out directives and poliies set by the house.

They are not out there fre willing it.

There are numerous Committees, Task Forces, and othe groups that

meet to advice the board.

So if you do not like what APTA says, provides or advocates there

are numerous ways for you to get involved and be heard. It is Not

an " old boys " network and you don't have to be an insider to have an

effect.

I have a great friend who is a PT in a POPTS (it is fair in

operation, ethical and he is considered partner in the practice)but

he knows that he is very lucky in his setting. He is in support of

our state and national efforts regarding POPTS. He is actually a

good influence with some of the MDs in his area because of this

relationship and can rationally explain APTAs position on POPTs in

such a way that the MDs will listen and understand.

Pat Jobes, PT

President Acute Care Section

and District Chair of Memphis District of the Tennessee Physical

Therapy Association

> > > > > > -

> > > > > >

> > > > > > " 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

> > > > > >

> > > > > >

[Guest guest]

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to state

> but after having been a member of APTA for years I decided to become active

> in the state. Within 5 years I had held the job of Chief Delegate and am now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been able

to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is corny

but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>

[Guest guest]

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to state

> but after having been a member of APTA for years I decided to become active

> in the state. Within 5 years I had held the job of Chief Delegate and am now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been able

to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is corny

but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>

[Guest guest]

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to state

> but after having been a member of APTA for years I decided to become active

> in the state. Within 5 years I had held the job of Chief Delegate and am now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been able

to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is corny

but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>

[Guest guest]

;

Perhaps some of the confusion or misinterpretation regarding your messages

might be related to your use of terminology. IMHO, members of APTA should

really use the terms " us " or " we " when discussing the association, and

non-members should use the terms " them " or " they " . This is probably a more

accurate way of thinking of the role of the association.

Obviously, this does not mean that all members agree with all Association

positions, but clearly the Association speaks for all members, whether we

like it or not. If we don't like what is being spoken, we need to speak out

ourselves, while not shooting ourselves in the foot.

Most importantly, these discussions need to occur within the Association,

rather than on public listserves. Relating our concerns outside of APTA

venues is not only unwise, it is ultimately ineffective. I can only assume

that those with concerns would want their concerns heard.

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: Re: Physician Ownership New Perspective

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to

state

> but after having been a member of APTA for years I decided to become

active

> in the state. Within 5 years I had held the job of Chief Delegate and am

now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been

able to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within

the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is

corny but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>

[Guest guest]

;

Perhaps some of the confusion or misinterpretation regarding your messages

might be related to your use of terminology. IMHO, members of APTA should

really use the terms " us " or " we " when discussing the association, and

non-members should use the terms " them " or " they " . This is probably a more

accurate way of thinking of the role of the association.

Obviously, this does not mean that all members agree with all Association

positions, but clearly the Association speaks for all members, whether we

like it or not. If we don't like what is being spoken, we need to speak out

ourselves, while not shooting ourselves in the foot.

Most importantly, these discussions need to occur within the Association,

rather than on public listserves. Relating our concerns outside of APTA

venues is not only unwise, it is ultimately ineffective. I can only assume

that those with concerns would want their concerns heard.

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: Re: Physician Ownership New Perspective

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to

state

> but after having been a member of APTA for years I decided to become

active

> in the state. Within 5 years I had held the job of Chief Delegate and am

now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been

able to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within

the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is

corny but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>

[Guest guest]

;

Perhaps some of the confusion or misinterpretation regarding your messages

might be related to your use of terminology. IMHO, members of APTA should

really use the terms " us " or " we " when discussing the association, and

non-members should use the terms " them " or " they " . This is probably a more

accurate way of thinking of the role of the association.

Obviously, this does not mean that all members agree with all Association

positions, but clearly the Association speaks for all members, whether we

like it or not. If we don't like what is being spoken, we need to speak out

ourselves, while not shooting ourselves in the foot.

Most importantly, these discussions need to occur within the Association,

rather than on public listserves. Relating our concerns outside of APTA

venues is not only unwise, it is ultimately ineffective. I can only assume

that those with concerns would want their concerns heard.

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: Re: Physician Ownership New Perspective

Tom, Pat, Mark, et al

Thanks for the replies. I haven't paid much attention to the listserv

this week and right now I just don't have time to reply to everything

you have added. Thanks for your insights and opinions.

One thing I will say from all the responses I got that " defended " APTA

is that nothing I wrote was intended to malign them in the first

place. I just don't seem to be expressing myself well in that regard,

because I'm a long term member of APTA and I appreciate what they do

and I do agree with many of their policies.

When things get back to normal here, I look forward to continuing

discussion on this and other professional matters with all of you.

Regards,

> ,

>

> I have to share my experience with you. I know it may differ state to

state

> but after having been a member of APTA for years I decided to become

active

> in the state. Within 5 years I had held the job of Chief Delegate and am

now

> President of our Chapter. Within my first year of being active, I was

> fortunate to meet Ben Massey and some of the board members and have been

able to

> share my thoughts and opinions with them. I also have gotten to know the

> staff at APTA and have been given insight on how to promote change within

the

> organization.

>

> My point, if a person is motivated enough, it may take a few years but one

> dedicated, motivated person who is willing to reach out to colleagues

> especially those involved in APTA can truly make a difference. It is

corny but true,

> APTA is a member driven organization.

>

> Marc Lacroix, PT

> President

> NHAPTA

>

>

>