RE: Marketing new clinic

[Guest guest]

Mark,

I agree with you whole heartedly that the push for PT's to move to autonomous

practice is more critical now than it ever has been. I spoke with a PT in a

hospital setting the other day that said autonomous practice didn't pertain to

her and asked how things were going with POPT's. She then went on to add that

she felt like the nurses, who are critically overworked, felt that PT stood

for " potty trainers " and their sole purpose in life was to get patients up to go

to the bathroom. I quickly pointed out to her that if she had embraced

autonomous practice as an issue that was important to her, she could be fighting

to

be seen as a specialist consultant as opposed to another employee to help with

bathroom duty.

My business partner and I (both PT's) left other practices because of the

" corporate " climate. And that corporate climate can be a hospital, other large

corporations, and even PT owned private practices in which other PT's are

employees rather than owners. But don't get me wrong, I don't believe that

working

in any setting is necessarily wrong as long as PT's are practicing ethically.

I argue that we as PT's, in existing private practices, are no better than

any other " corporate entity " if we hire PT's as employees instead of making them

partners in the practice. Have you ever heard of a physician hiring another

physician as an employee? Maybe someone has, but I would venture to guess that

almost all get added to the practice at the partner level! Some may be senior

partner status but the junior partners are still partners. Why are we not

doing the same?

Thanks for your insight!

PS- After saying all that in case anyone was wondering why the name of the

company I co-own has the Inc. after it, it is because NC in all of its wisdom

doesn't allow PT's to form Professional Corporations (yet). Hopefully that will

change soon!

J. Boyle PT, MS, CSCS

Physical Therapist/ Co-owner

Gaston Rehab Associates, Inc.

1361-B East Garrison Blvd.

Gastonia, NC 28054

Phone:

Fax:

www.gastonrehabassociates.com

In a message dated 02/01/06 11:39:39 PM Eastern Standard Time,

mschwall@... writes:

Steve,

I understand what you are saying but I must respectfully disagree with your

assertion that there is a continued need for therapists in " traditional

employment settings " . These are legacy arrangements that harkens back to

the day when therapists were not autonomous practitioners but were solely

reliant on " orders " from physicians.

Corporate entities have very little exposure to accountability issues that

" licensed " professionals have. They have no state boards to which they are

held accountable as would be evidenced by the recent scandals at one such

large corporation. If an individual practitioner had been guilty of the

same infractions I would be fairly certain that they would have had some

action taken against their license and their privileges for billing

Medicare.

Your assertion that " ...corporate/facility ownership of therapy has

advantages too. " is true. But I would venture to say that the primary

advantages are for the shareholders and not the clinicians.

I agree that the administrative demands can be cumbersome. However these

are positions that could be filled within a MSO/IPA by personnel

appropriately trained and possessing the knowledge and skills to perform

these duties without infringing on the autonomy of the professional. I

would also argue that every practicing professional needs to have

proficiency in fully understanding the regulatory, compliance and

administrative issues involved in their practice. In my experience too many

of my colleagues lack this understanding especially regarding coding,

billing and regulatory compliance issues because in far too many instances

they are insulated from them because " somebody else " takes care of them.

Most of these issues are far from rocket science and should be required

competencies for anyone who bills for professional services. In fact if we

reviewed most of our practice acts I think many would be surprised to find

out that they are expected to understand these issues by statute and are

fully accountable for such. I doubt any CPA would say he doesn't need to

fully understand the tax laws because one of the clerks in a back office

takes care of those things.

I admit that what I am proposing is a sea change and would require dramatic

reorganization but that doesn't mean it shouldn't be done. I feel that the

time has come for Physical Therapists to fully embrace their professional

status and in fact is long overdue. Physicians and other professional

groups have long recognized that a central tenet of being a professional is

OWNERSHIP. That is why they have long protected themselves by statute

including professional regulation and professional corporation statutes

which prohibit nonprofessional ownership or nonprofessional shareholders.

Do I think there should be exceptions? Perhaps there should be exceptions

made with regard to critical nonprofit institutions or state facilities.

But with regard to most other settings I would ask " Why not? " In fact I

think many institutions or other organizations such as HHA's would embrace

it if they fully understood it. It would certainly relieve them of many

problems if all they had to do was provide management services for a

contracted fee. Who knows it might be more profitable for them in the end

since the practitioner would now be FULLY responsible for their practice.

I think that is my 4 cents worth for this evening.

I look forward to any comments.

Mark F. Schwall, PT

RE: Marketing new clinic

We may be seeing a shift toward more practice ownership; but, that does not

diminish the continued need of therapists in traditional employment settings

(hospitals, home health, nursing homes). It's also fine to push toward

practice ownership in every situation, but corporate / facility ownership of

therapy has advantages too. A lone therapist trying to staff and manage a

nursing home practice could become consumed in regulation, facility fickle

demands, denial appeal payback, payroll demands, etc.

I believe we have a place and equal value for both type practices for the

patient - company - therapist gain.

Steve Passmore PT

Healthy Recruiting Tools

spass@...

[Guest guest]

,

Actually in many physician practices there are physicians who are

employees. For example orthopedic practices that have physiatrist or

podiatrist on staff employ them, as the partnership requirements have

surgical attachments. They receive salaries based on their business,

but do not share in the profit of the practice as a whole and don't have

voting power in the decisions of the practice. Many people are happy to

be able to come to work and treat patients without having the day to day

responsibilities of owning/running a practice. Often times the business

and management end have little or no appeal to a large majority of

therapist. I completely agree with you that where you practice isn't as

important as how you practice. Part of the autonomy that we talk about

is allowing people to decide for themselves what is best for them and

not having that dictated to them by someone else. I feel part of our

failure as a profession has been to allow the stripping of areas that we

physical therapy and are now performed by others. Our current

educational models do not accurately prepare us to run businesses and

manage people. If a move to autonomous practice is to be a reality we

need to look at how we are preparing future therapist and make sure that

they are not only given the skills to perform in the clinic but in the

business world as well. Physician's often have a practice administrator

to handle the business aspect for them both because of time and

knowledge limitations. Just some of my rambling thoughts on the topic.

Adam Paris P.T.

Director of Rehabilitation Services

The Orthopaedic and Sports Medicine Center

polis, MD

Bowie, MD

sville, MD

RE: Marketing new clinic

We may be seeing a shift toward more practice ownership; but, that does

not diminish the continued need of therapists in traditional employment

settings (hospitals, home health, nursing homes). It's also fine to

push toward practice ownership in every situation, but corporate /

facility ownership of therapy has advantages too. A lone therapist

trying to staff and manage a nursing home practice could become consumed

in regulation, facility fickle demands, denial appeal payback, payroll

demands, etc.

I believe we have a place and equal value for both type practices for

the patient - company - therapist gain.

Steve Passmore PT

Healthy Recruiting Tools

spass@...