RE: FW: physician ownership

May 10, 2005

Only if the point of the friendship is to get referrals.....or if there is

some kind of payback

If you can prove either of the above, I would report it to your state board

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

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

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

information contained herein (including any reliance thereon) is STRICTLY

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

advise me, by reply e-mail, and delete this message and any attachments

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

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an

increase in utilization of high-cost procedures. Looking at more than

250,000 workers' compensation claims, found the incidence of

complex spinal fusion surgeries and other highly paid procedures in

Oklahoma

City and Tulsa rose following the emergence of physician-owned

facilities,

even though the number of worker injuries declined. AHA executives noted

that the findings raise " serious concerns about conflict of interest,

implications for patient care and unnecessary increases in health care

spending, " and urged Congress to make permanent the ban on physician

referral to new limited-service hospitals they own. "

For those that are still defending physician owned practices of any

type,

here is yet another study that is showing physician ownership =

unnecessary

increased in health care spending. Please think about it. As the

evidence

mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to

be a wake up call to all of us to do better.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

May 10, 2005

Only if the point of the friendship is to get referrals.....or if there is

some kind of payback

If you can prove either of the above, I would report it to your state board

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

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

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

information contained herein (including any reliance thereon) is STRICTLY

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

advise me, by reply e-mail, and delete this message and any attachments

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

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an

increase in utilization of high-cost procedures. Looking at more than

250,000 workers' compensation claims, found the incidence of

complex spinal fusion surgeries and other highly paid procedures in

Oklahoma

City and Tulsa rose following the emergence of physician-owned

facilities,

even though the number of worker injuries declined. AHA executives noted

that the findings raise " serious concerns about conflict of interest,

implications for patient care and unnecessary increases in health care

spending, " and urged Congress to make permanent the ban on physician

referral to new limited-service hospitals they own. "

For those that are still defending physician owned practices of any

type,

here is yet another study that is showing physician ownership =

unnecessary

increased in health care spending. Please think about it. As the

evidence

mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to

be a wake up call to all of us to do better.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

May 10, 2005

Only if the point of the friendship is to get referrals.....or if there is

some kind of payback

If you can prove either of the above, I would report it to your state board

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

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

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

information contained herein (including any reliance thereon) is STRICTLY

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

advise me, by reply e-mail, and delete this message and any attachments

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

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an

increase in utilization of high-cost procedures. Looking at more than

250,000 workers' compensation claims, found the incidence of

complex spinal fusion surgeries and other highly paid procedures in

Oklahoma

City and Tulsa rose following the emergence of physician-owned

facilities,

even though the number of worker injuries declined. AHA executives noted

that the findings raise " serious concerns about conflict of interest,

implications for patient care and unnecessary increases in health care

spending, " and urged Congress to make permanent the ban on physician

referral to new limited-service hospitals they own. "

For those that are still defending physician owned practices of any

type,

here is yet another study that is showing physician ownership =

unnecessary

increased in health care spending. Please think about it. As the

evidence

mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to

be a wake up call to all of us to do better.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

May 10, 2005

,

I would guess some managing company will come in and

fill the loop hole that will be made.

So instead of the PT's having their direct supervisor

being the Medical Director who is a MD and provides

patient care. They will get a bean counter who has no

concept of patient care!

Great for the patients and the PT profession eh!!

Russ

--- Brown wrote:

> While we are on the POPTS discussion, what does

> everyone expect the

> ramifications to be in South Carolina now that

> things look good for

> SCAPTA's victory?

>

> Will they doctors have to sell the ancillary

> services or can they just

> continue to provide them using massage therapists,

> ATCs or unlicensed

> personnel instead of PTs and bill it as incident to?

> If MDs can do

> this, they will continue to provide the ancillary

> service in-house

> with cheaper personnel, which will increase their

> profits and give

> other professions a bigger chunk of our market as

> PTs.

>

> On 5/10/05, Ken Mailly

> wrote:

> > " No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession... "

> >

> > Brett;

> >

> > I recall a comment on this issue that I once heard

> from a therapist who at

> > the time was working part-time for a physician.

> She stated, " I hope that

> > POPTS are made illegal, because then I will have

> to quit. " Is this your

> > hope as well? I ask because your comment above

> seems to indicate to me that

> > you wish these situations did not exist, but in

> the mean time you are

> > comfortable with being in one yourself. Can you

> see how this could strike

> > some as simply being a rationalization?

> >

> > 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: FW: physician ownership

> >

> > A study by the AHA, the organization with the most

> need and incentive to

> > demonstrate these exact findings, can hardly be

> seen as completely

> > credible. Hospitals are the ultimate in conflict

> of interest; they have

> > been profiting wildly from PT and other Ancillary

> services for decades.

> > Try being a regular staff hospital Physician and

> refer a PT patient

> > outside your hospital and see how far you get.

> What of the trend towards

> > Hospitals owning their own Physician groups? Guess

> where all those PT

> > referrals go - it usually isn't the little mom and

> pop shop down the

> > street.

> >

> > Does increased utilization and higher costs

> absolutely mean lapse in

> > ethics, inappropriate? The US trends toward

> underutilization of many

> > services, especially PT, reference BBA of 1997.

> Compare our utilization

> > rates in the US with those in countries with

> universal healthcare? Our

> > healthcare system is set up through the third

> party payers and designed

> > to decrease utilization. United Health Providers

> made $800 million in

> > the first quarter this year.

> >

> > In addition, you're making a fairly abstract

> comparison - the procedures

> > you mentioned are performed by the physician. It's

> totally their

> > decision to provide or not provide care. With PT -

> you are supposedly

> > dealing with highly educated professionals who are

> seeking direct

> > access, primary care privileges and full

> professional autonomy. Yet

> > everyone and their brother just insist that we

> cannot trust any Physical

> > Therapist to decide who they work for, let alone

> decide which patients

> > are appropriate to be under their care. Which is

> it? Are we capable of

> > making these decisions, or are we subservient

> morons incapable of

> > resisting the least pressure to do something

> unethical? And, this is the

> > same profession that not 15 years ago was falling

> all over itself to

> > sell out small practices to the highest corporate

> bidder. Not many were

> > standing back from the trough then.

> >

> > In addition, there is growing data within the MGMA

> (admittedly, an

> > interested party, but you cited the AHA) to

> suggest that medical group

> > practices with ancillary services are increasingly

> both what consumers

> > are demanding, and where superior clinical

> outcomes are being found. The

> > clinical model of Multi-specialty Group practices

> with ancillary

> > services works, both clinically and yes,

> economically - that fact cannot

> > be disputed. Shall we prevent a PCP from referring

> to a Cardiologist

> > within his group? Both profit from the referral.

> >

> > No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession,

> > but I am getting really frustrated by the way we

> are trying to achieve

> > it. There are a lot of good people out there whose

> only aim is to make a

> > fair wage for a fair days work. The rhetoric

> generally (I'm not

> > suggesting your note here Tom) is in many cases

> getting beyond that of a

> > civil discourse. But there's a lot of money at

> stake here. This is an

> > economic argument, not a moral one. Punitive

> legislative recourse (as in

> > SC; good luck trying to get Physician support on

> any bill there for the

> > next 20 years) simply will not work in the great

> majority of cases. We

> > simply lose political capital that we've spent

> decades trying to build.

> >

> > The only viable option for us is to get federal

> direct access, so that

> > we can take our case directly to the consumer and

> compete on the same

> > level as everyone else. We also need to improve

> our ability to convince

> > patients to part with cash for our services. We

> haven't traditionally

> > been able to do that well, though we are slowly

> getting better. Remove

> > the incentive through normalizing market forces.

> Until patients know

> > they don't need to see a doctor, and don't have to

> see a doctor to get

> > to PT, this problem is not going away. No law can

> be written that can't

> > be gotten around by dedicated special interests.

> Then we can look at the

> > State corporation acts and try to better protect,

> develop our ownership

> > rights.

> >

> > Finally, where is the patient in all of this?

> Isn't it about time that

> > we expected more of them? It is ultimately the

> responsibility of the

> > patient to ensure that they are being cared for in

> a manner consistent

> > with their beliefs and practices. It shouldn't

> take clinical knowledge

> > to know that if you go to PT, you should actually

> occasionally see a PT,

> > or that when you're better, you don't need to come

> anymore.

> >

> > Brett Windsor, PT, OCS, COMT, FAAOMPT

>

=== message truncated ===

Discover Yahoo!

Find restaurants, movies, travel and more fun for the weekend. Check it out!

http://discover.yahoo.com/weekend.html

May 10, 2005

,

I would guess some managing company will come in and

fill the loop hole that will be made.

So instead of the PT's having their direct supervisor

being the Medical Director who is a MD and provides

patient care. They will get a bean counter who has no

concept of patient care!

Great for the patients and the PT profession eh!!

Russ

--- Brown wrote:

> While we are on the POPTS discussion, what does

> everyone expect the

> ramifications to be in South Carolina now that

> things look good for

> SCAPTA's victory?

>

> Will they doctors have to sell the ancillary

> services or can they just

> continue to provide them using massage therapists,

> ATCs or unlicensed

> personnel instead of PTs and bill it as incident to?

> If MDs can do

> this, they will continue to provide the ancillary

> service in-house

> with cheaper personnel, which will increase their

> profits and give

> other professions a bigger chunk of our market as

> PTs.

>

> On 5/10/05, Ken Mailly

> wrote:

> > " No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession... "

> >

> > Brett;

> >

> > I recall a comment on this issue that I once heard

> from a therapist who at

> > the time was working part-time for a physician.

> She stated, " I hope that

> > POPTS are made illegal, because then I will have

> to quit. " Is this your

> > hope as well? I ask because your comment above

> seems to indicate to me that

> > you wish these situations did not exist, but in

> the mean time you are

> > comfortable with being in one yourself. Can you

> see how this could strike

> > some as simply being a rationalization?

> >

> > 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: FW: physician ownership

> >

> > A study by the AHA, the organization with the most

> need and incentive to

> > demonstrate these exact findings, can hardly be

> seen as completely

> > credible. Hospitals are the ultimate in conflict

> of interest; they have

> > been profiting wildly from PT and other Ancillary

> services for decades.

> > Try being a regular staff hospital Physician and

> refer a PT patient

> > outside your hospital and see how far you get.

> What of the trend towards

> > Hospitals owning their own Physician groups? Guess

> where all those PT

> > referrals go - it usually isn't the little mom and

> pop shop down the

> > street.

> >

> > Does increased utilization and higher costs

> absolutely mean lapse in

> > ethics, inappropriate? The US trends toward

> underutilization of many

> > services, especially PT, reference BBA of 1997.

> Compare our utilization

> > rates in the US with those in countries with

> universal healthcare? Our

> > healthcare system is set up through the third

> party payers and designed

> > to decrease utilization. United Health Providers

> made $800 million in

> > the first quarter this year.

> >

> > In addition, you're making a fairly abstract

> comparison - the procedures

> > you mentioned are performed by the physician. It's

> totally their

> > decision to provide or not provide care. With PT -

> you are supposedly

> > dealing with highly educated professionals who are

> seeking direct

> > access, primary care privileges and full

> professional autonomy. Yet

> > everyone and their brother just insist that we

> cannot trust any Physical

> > Therapist to decide who they work for, let alone

> decide which patients

> > are appropriate to be under their care. Which is

> it? Are we capable of

> > making these decisions, or are we subservient

> morons incapable of

> > resisting the least pressure to do something

> unethical? And, this is the

> > same profession that not 15 years ago was falling

> all over itself to

> > sell out small practices to the highest corporate

> bidder. Not many were

> > standing back from the trough then.

> >

> > In addition, there is growing data within the MGMA

> (admittedly, an

> > interested party, but you cited the AHA) to

> suggest that medical group

> > practices with ancillary services are increasingly

> both what consumers

> > are demanding, and where superior clinical

> outcomes are being found. The

> > clinical model of Multi-specialty Group practices

> with ancillary

> > services works, both clinically and yes,

> economically - that fact cannot

> > be disputed. Shall we prevent a PCP from referring

> to a Cardiologist

> > within his group? Both profit from the referral.

> >

> > No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession,

> > but I am getting really frustrated by the way we

> are trying to achieve

> > it. There are a lot of good people out there whose

> only aim is to make a

> > fair wage for a fair days work. The rhetoric

> generally (I'm not

> > suggesting your note here Tom) is in many cases

> getting beyond that of a

> > civil discourse. But there's a lot of money at

> stake here. This is an

> > economic argument, not a moral one. Punitive

> legislative recourse (as in

> > SC; good luck trying to get Physician support on

> any bill there for the

> > next 20 years) simply will not work in the great

> majority of cases. We

> > simply lose political capital that we've spent

> decades trying to build.

> >

> > The only viable option for us is to get federal

> direct access, so that

> > we can take our case directly to the consumer and

> compete on the same

> > level as everyone else. We also need to improve

> our ability to convince

> > patients to part with cash for our services. We

> haven't traditionally

> > been able to do that well, though we are slowly

> getting better. Remove

> > the incentive through normalizing market forces.

> Until patients know

> > they don't need to see a doctor, and don't have to

> see a doctor to get

> > to PT, this problem is not going away. No law can

> be written that can't

> > be gotten around by dedicated special interests.

> Then we can look at the

> > State corporation acts and try to better protect,

> develop our ownership

> > rights.

> >

> > Finally, where is the patient in all of this?

> Isn't it about time that

> > we expected more of them? It is ultimately the

> responsibility of the

> > patient to ensure that they are being cared for in

> a manner consistent

> > with their beliefs and practices. It shouldn't

> take clinical knowledge

> > to know that if you go to PT, you should actually

> occasionally see a PT,

> > or that when you're better, you don't need to come

> anymore.

> >

> > Brett Windsor, PT, OCS, COMT, FAAOMPT

>

=== message truncated ===

Discover Yahoo!

Find restaurants, movies, travel and more fun for the weekend. Check it out!

http://discover.yahoo.com/weekend.html

May 10, 2005

,

I would guess some managing company will come in and

fill the loop hole that will be made.

So instead of the PT's having their direct supervisor

being the Medical Director who is a MD and provides

patient care. They will get a bean counter who has no

concept of patient care!

Great for the patients and the PT profession eh!!

Russ

--- Brown wrote:

> While we are on the POPTS discussion, what does

> everyone expect the

> ramifications to be in South Carolina now that

> things look good for

> SCAPTA's victory?

>

> Will they doctors have to sell the ancillary

> services or can they just

> continue to provide them using massage therapists,

> ATCs or unlicensed

> personnel instead of PTs and bill it as incident to?

> If MDs can do

> this, they will continue to provide the ancillary

> service in-house

> with cheaper personnel, which will increase their

> profits and give

> other professions a bigger chunk of our market as

> PTs.

>

> On 5/10/05, Ken Mailly

> wrote:

> > " No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession... "

> >

> > Brett;

> >

> > I recall a comment on this issue that I once heard

> from a therapist who at

> > the time was working part-time for a physician.

> She stated, " I hope that

> > POPTS are made illegal, because then I will have

> to quit. " Is this your

> > hope as well? I ask because your comment above

> seems to indicate to me that

> > you wish these situations did not exist, but in

> the mean time you are

> > comfortable with being in one yourself. Can you

> see how this could strike

> > some as simply being a rationalization?

> >

> > 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: FW: physician ownership

> >

> > A study by the AHA, the organization with the most

> need and incentive to

> > demonstrate these exact findings, can hardly be

> seen as completely

> > credible. Hospitals are the ultimate in conflict

> of interest; they have

> > been profiting wildly from PT and other Ancillary

> services for decades.

> > Try being a regular staff hospital Physician and

> refer a PT patient

> > outside your hospital and see how far you get.

> What of the trend towards

> > Hospitals owning their own Physician groups? Guess

> where all those PT

> > referrals go - it usually isn't the little mom and

> pop shop down the

> > street.

> >

> > Does increased utilization and higher costs

> absolutely mean lapse in

> > ethics, inappropriate? The US trends toward

> underutilization of many

> > services, especially PT, reference BBA of 1997.

> Compare our utilization

> > rates in the US with those in countries with

> universal healthcare? Our

> > healthcare system is set up through the third

> party payers and designed

> > to decrease utilization. United Health Providers

> made $800 million in

> > the first quarter this year.

> >

> > In addition, you're making a fairly abstract

> comparison - the procedures

> > you mentioned are performed by the physician. It's

> totally their

> > decision to provide or not provide care. With PT -

> you are supposedly

> > dealing with highly educated professionals who are

> seeking direct

> > access, primary care privileges and full

> professional autonomy. Yet

> > everyone and their brother just insist that we

> cannot trust any Physical

> > Therapist to decide who they work for, let alone

> decide which patients

> > are appropriate to be under their care. Which is

> it? Are we capable of

> > making these decisions, or are we subservient

> morons incapable of

> > resisting the least pressure to do something

> unethical? And, this is the

> > same profession that not 15 years ago was falling

> all over itself to

> > sell out small practices to the highest corporate

> bidder. Not many were

> > standing back from the trough then.

> >

> > In addition, there is growing data within the MGMA

> (admittedly, an

> > interested party, but you cited the AHA) to

> suggest that medical group

> > practices with ancillary services are increasingly

> both what consumers

> > are demanding, and where superior clinical

> outcomes are being found. The

> > clinical model of Multi-specialty Group practices

> with ancillary

> > services works, both clinically and yes,

> economically - that fact cannot

> > be disputed. Shall we prevent a PCP from referring

> to a Cardiologist

> > within his group? Both profit from the referral.

> >

> > No reasonable Physical Therapist would disagree

> that exclusive PT

> > ownership of PT services has to be the ultimate

> goal of our profession,

> > but I am getting really frustrated by the way we

> are trying to achieve

> > it. There are a lot of good people out there whose

> only aim is to make a

> > fair wage for a fair days work. The rhetoric

> generally (I'm not

> > suggesting your note here Tom) is in many cases

> getting beyond that of a

> > civil discourse. But there's a lot of money at

> stake here. This is an

> > economic argument, not a moral one. Punitive

> legislative recourse (as in

> > SC; good luck trying to get Physician support on

> any bill there for the

> > next 20 years) simply will not work in the great

> majority of cases. We

> > simply lose political capital that we've spent

> decades trying to build.

> >

> > The only viable option for us is to get federal

> direct access, so that

> > we can take our case directly to the consumer and

> compete on the same

> > level as everyone else. We also need to improve

> our ability to convince

> > patients to part with cash for our services. We

> haven't traditionally

> > been able to do that well, though we are slowly

> getting better. Remove

> > the incentive through normalizing market forces.

> Until patients know

> > they don't need to see a doctor, and don't have to

> see a doctor to get

> > to PT, this problem is not going away. No law can

> be written that can't

> > be gotten around by dedicated special interests.

> Then we can look at the

> > State corporation acts and try to better protect,

> develop our ownership

> > rights.

> >

> > Finally, where is the patient in all of this?

> Isn't it about time that

> > we expected more of them? It is ultimately the

> responsibility of the

> > patient to ensure that they are being cared for in

> a manner consistent

> > with their beliefs and practices. It shouldn't

> take clinical knowledge

> > to know that if you go to PT, you should actually

> occasionally see a PT,

> > or that when you're better, you don't need to come

> anymore.

> >

> > Brett Windsor, PT, OCS, COMT, FAAOMPT

>

=== message truncated ===

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May 10, 2005

Hi everyone,

I think that a point needs to be remade here. No one is legislating away

what setting a PT can work in.

There is a major distinction between working with physicians and being a

peer versus being employed by a physician.

There is evidence, however you want to spin it, that shows problems with the

POPTS arrangement. If there weren't problems, there wouldn't be such a

strong push to end this type arrangement.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an

increase in utilization of high-cost procedures. Looking at more than

250,000 workers' compensation claims, found the incidence of

complex spinal fusion surgeries and other highly paid procedures in

Oklahoma

City and Tulsa rose following the emergence of physician-owned

facilities,

even though the number of worker injuries declined. AHA executives noted

that the findings raise " serious concerns about conflict of interest,

implications for patient care and unnecessary increases in health care

spending, " and urged Congress to make permanent the ban on physician

referral to new limited-service hospitals they own. "

For those that are still defending physician owned practices of any

type,

here is yet another study that is showing physician ownership =

unnecessary

increased in health care spending. Please think about it. As the

evidence

mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to

be a wake up call to all of us to do better.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

May 10, 2005

Tom

What do you mean we're not legislating away where a PT can work? It just

happened in South Carolina. It's been done in Delaware and at least 5

other states are considering that exact strategy.

You're exactly right about there being a distinction between

arrangements and it's up to PT's to determine whether the relationship

is in their best interests. No-one else should have that right.

Good point about the evidence. You can make numbers say whatever you

want. But you have to take into account the source - that's a basic

scientific rule.

Brett

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an increase in utilization of high-cost procedures. Looking at more

than 250,000 workers' compensation claims, found the incidence

of complex spinal fusion surgeries and other highly paid procedures in

Oklahoma City and Tulsa rose following the emergence of physician-owned

facilities, even though the number of worker injuries declined. AHA

executives noted that the findings raise " serious concerns about

conflict of interest, implications for patient care and unnecessary

increases in health care spending, " and urged Congress to make permanent

the ban on physician referral to new limited-service hospitals they

own. "

For those that are still defending physician owned practices of any

type, here is yet another study that is showing physician ownership =

unnecessary increased in health care spending. Please think about it.

As the evidence mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to be a wake up call to all of us to do better.

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

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its attachments, please be advised that you have received this email in

error and that any use, dissemination, distribution, forwarding,

printing or copying of this email or any attached files is strictly

prohibited. If you have received this email in error, please

immediately purge it and all attachments and notify the sender by reply

email.

May 11, 2005

Tom,

I really appreciate the insight on the POPTS, again

can you please site some research that supports your

findings.

" There is evidence, however you want to spin it, that

shows problems with the POPTS arrangement " .

Specifically in the PT setting?

Thanks,

Russ

--- Tom Howell wrote:

> Hi everyone,

>

> I think that a point needs to be remade here. No

> one is legislating away

> what setting a PT can work in.

>

> There is a major distinction between working with

> physicians and being a

> peer versus being employed by a physician.

>

> There is evidence, however you want to spin it, that

> shows problems with the

> POPTS arrangement. If there weren't problems, there

> wouldn't be such a

> strong push to end this type arrangement.

>

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

> Howell Physical Therapy

> Eagle, ID

> ptclinic@...

>

> RE: FW: physician ownership

>

> A study by the AHA, the organization with the most

> need and incentive to

> demonstrate these exact findings, can hardly be seen

> as completely

> credible. Hospitals are the ultimate in conflict of

> interest; they have

> been profiting wildly from PT and other Ancillary

> services for decades.

> Try being a regular staff hospital Physician and

> refer a PT patient

> outside your hospital and see how far you get. What

> of the trend towards

> Hospitals owning their own Physician groups? Guess

> where all those PT

> referrals go - it usually isn't the little mom and

> pop shop down the

> street.

>

> Does increased utilization and higher costs

> absolutely mean lapse in

> ethics, inappropriate? The US trends toward

> underutilization of many

> services, especially PT, reference BBA of 1997.

> Compare our utilization

> rates in the US with those in countries with

> universal healthcare? Our

> healthcare system is set up through the third party

> payers and designed

> to decrease utilization. United Health Providers

> made $800 million in

> the first quarter this year.

>

> In addition, you're making a fairly abstract

> comparison - the procedures

> you mentioned are performed by the physician. It's

> totally their

> decision to provide or not provide care. With PT -

> you are supposedly

> dealing with highly educated professionals who are

> seeking direct

> access, primary care privileges and full

> professional autonomy. Yet

> everyone and their brother just insist that we

> cannot trust any Physical

> Therapist to decide who they work for, let alone

> decide which patients

> are appropriate to be under their care. Which is it?

> Are we capable of

> making these decisions, or are we subservient morons

> incapable of

> resisting the least pressure to do something

> unethical? And, this is the

> same profession that not 15 years ago was falling

> all over itself to

> sell out small practices to the highest corporate

> bidder. Not many were

> standing back from the trough then.

>

> In addition, there is growing data within the MGMA

> (admittedly, an

> interested party, but you cited the AHA) to suggest

> that medical group

> practices with ancillary services are increasingly

> both what consumers

> are demanding, and where superior clinical outcomes

> are being found. The

> clinical model of Multi-specialty Group practices

> with ancillary

> services works, both clinically and yes,

> economically - that fact cannot

> be disputed. Shall we prevent a PCP from referring

> to a Cardiologist

> within his group? Both profit from the referral.

>

> No reasonable Physical Therapist would disagree that

> exclusive PT

> ownership of PT services has to be the ultimate goal

> of our profession,

> but I am getting really frustrated by the way we are

> trying to achieve

> it. There are a lot of good people out there whose

> only aim is to make a

> fair wage for a fair days work. The rhetoric

> generally (I'm not

>

=== message truncated ===

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May 11, 2005

Tom,

I really appreciate the insight on the POPTS, again

can you please site some research that supports your

findings.

" There is evidence, however you want to spin it, that

shows problems with the POPTS arrangement " .

Specifically in the PT setting?

Thanks,

Russ

--- Tom Howell wrote:

> Hi everyone,

>

> I think that a point needs to be remade here. No

> one is legislating away

> what setting a PT can work in.

>

> There is a major distinction between working with

> physicians and being a

> peer versus being employed by a physician.

>

> There is evidence, however you want to spin it, that

> shows problems with the

> POPTS arrangement. If there weren't problems, there

> wouldn't be such a

> strong push to end this type arrangement.

>

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

> Howell Physical Therapy

> Eagle, ID

> ptclinic@...

>

> RE: FW: physician ownership

>

> A study by the AHA, the organization with the most

> need and incentive to

> demonstrate these exact findings, can hardly be seen

> as completely

> credible. Hospitals are the ultimate in conflict of

> interest; they have

> been profiting wildly from PT and other Ancillary

> services for decades.

> Try being a regular staff hospital Physician and

> refer a PT patient

> outside your hospital and see how far you get. What

> of the trend towards

> Hospitals owning their own Physician groups? Guess

> where all those PT

> referrals go - it usually isn't the little mom and

> pop shop down the

> street.

>

> Does increased utilization and higher costs

> absolutely mean lapse in

> ethics, inappropriate? The US trends toward

> underutilization of many

> services, especially PT, reference BBA of 1997.

> Compare our utilization

> rates in the US with those in countries with

> universal healthcare? Our

> healthcare system is set up through the third party

> payers and designed

> to decrease utilization. United Health Providers

> made $800 million in

> the first quarter this year.

>

> In addition, you're making a fairly abstract

> comparison - the procedures

> you mentioned are performed by the physician. It's

> totally their

> decision to provide or not provide care. With PT -

> you are supposedly

> dealing with highly educated professionals who are

> seeking direct

> access, primary care privileges and full

> professional autonomy. Yet

> everyone and their brother just insist that we

> cannot trust any Physical

> Therapist to decide who they work for, let alone

> decide which patients

> are appropriate to be under their care. Which is it?

> Are we capable of

> making these decisions, or are we subservient morons

> incapable of

> resisting the least pressure to do something

> unethical? And, this is the

> same profession that not 15 years ago was falling

> all over itself to

> sell out small practices to the highest corporate

> bidder. Not many were

> standing back from the trough then.

>

> In addition, there is growing data within the MGMA

> (admittedly, an

> interested party, but you cited the AHA) to suggest

> that medical group

> practices with ancillary services are increasingly

> both what consumers

> are demanding, and where superior clinical outcomes

> are being found. The

> clinical model of Multi-specialty Group practices

> with ancillary

> services works, both clinically and yes,

> economically - that fact cannot

> be disputed. Shall we prevent a PCP from referring

> to a Cardiologist

> within his group? Both profit from the referral.

>

> No reasonable Physical Therapist would disagree that

> exclusive PT

> ownership of PT services has to be the ultimate goal

> of our profession,

> but I am getting really frustrated by the way we are

> trying to achieve

> it. There are a lot of good people out there whose

> only aim is to make a

> fair wage for a fair days work. The rhetoric

> generally (I'm not

>

=== message truncated ===

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May 11, 2005

So the physicians in South Carolina could decide to just cherry pick

the best paying insurances and keep them in their ancillary ATCs or

unlicensed personnel and bill it as incident to. They could just farm

out tthe Medicare and Medicaid patients to outside PT clinics.

That doesn't sound too good either. The ATCs gain more of our market

share and do rehab on the younger patients with good insurances while

the PTs get all the lower paying older patients and have to deal with

the most overregulating payer in the business.

> Per the new Medicare " incident to " regs (which apply only to Medicare

> patients, of course), in order for physicians to bill PT, OT, or SLP as

> incident to they have to use a graduate of a PT, OT, or SLP education

> program (don't have to be licensed in that state) or a NPP, PA, or Clinical

> Nurse Specialist if that state has therapy services in their practice acts.

> Since Medicare defines many of the 97xxx CPT codes as " therapy only " (and

> therefore must be performed by a PT, OT, or SLP), this effectively prohibits

> physicians from billing " incident to " when provided by non-PT/PTA's,

> OT/OTA's, and SLP's. Of course, this is true only for Medicare patients -

> for non-Medicare patients physicians can continue to bill " incident to " for

> PT, OT, and SLP when provided by non-therapists or by the physician

> him/herself.

>

> This reg was supposed to go into effect on March 1, 2005, but as of early

> April CMS had still not published Medicare manual instructions for this, so

> they are not enforcing it. If you want to see the actual CMS document on

> this, here is the link -->

> http://www.cms.hhs.gov/regulations/pfs/2005/1429fc/master_background_1429-fc

> .pdf. The pages you want to look at are 553 through 582.

>

> As for your comment about " fair " money for the physicians, that is a very

> subjective term. In most other parts of our market economy, the customer

> determines what is fair by deciding whether to purchase the good or service.

> However, we do not have a market economy in healthcare with a true

> buyer-seller relationship since we have the insurers and government

> functioning as third parties. To further divorce healthcare from a true

> market, those third parties often set the prices (especially Medicare since

> we cannot negotiate with them) whereas in a market the seller sets the

> prices. Getting the government out of healthcare will not really solve

> anything as it is but one of the third parties. The only thing that will

> bring a true market to healthcare is to eliminate all third parties from

> healthcare. Only then will the patient be able to determine what is " fair " ,

> but then the question is how will they pay for these very expensive services

> without insurance? And will physicians, or any of us, think that what the

> patients can pay is fair?

>

> Mark Dwyer, PT, MHA

> markdwyer87@...

>

> FW: physician ownership

> >

> > Hi everyone,

> >

> > Many of you have read the following synopsis from PT Bulletin:

> >

> > " A study

> >

> <http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

> > sp.p

> > df> by town University economist M , PhD, released

> > last

> > week by the American Hospital Association (AHA), concludes that the

> > emergence of physician-owned limited-service hospitals in Oklahoma led

> > to an

> > increase in utilization of high-cost procedures. Looking at more than

> > 250,000 workers' compensation claims, found the incidence of

> > complex spinal fusion surgeries and other highly paid procedures in

> > Oklahoma

> > City and Tulsa rose following the emergence of physician-owned

> > facilities,

> > even though the number of worker injuries declined. AHA executives

> noted

> > that the findings raise " serious concerns about conflict of interest,

> > implications for patient care and unnecessary increases in health care

> > spending, " and urged Congress to make permanent the ban on physician

> > referral to new limited-service hospitals they own. "

> >

> > For those that are still defending physician owned practices of any

> > type,

> > here is yet another study that is showing physician ownership =

> > unnecessary

> > increased in health care spending. Please think about it. As the

> > evidence

> > mounts, can we as a profession continue to support it??

> >

> > One caveat, I do understand that PT owned rehab practices may be just

> as

> > guilty of over utilization and overcharging. Let these studies

> continue

> > to

> > be a wake up call to all of us to do better.

> >

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

> >

> > Howell Physical Therapy

> >

> > Eagle, ID

> >

> > ptclinic@...

> >

> > This email and any files transmitted with it may contain PRIVILEGED or

> > CONFIDENTIAL information and may be read or used only by the intended

> > recipient. If you are not the intended recipient of the email or any

> of

> > its

> > attachments, please be advised that you have received this email in

> > error

> > and that any use, dissemination, distribution, forwarding, printing or

> > copying of this email or any attached files is strictly prohibited.

> If

> > you

> > have received this email in error, please immediately purge it and all

> > attachments and notify the sender by reply email.

> >

May 11, 2005