Re: from the Orthopedic surgeons journal...

February 27, 2008

This is pure rubbish. If one looks at the studies done by the GAO it is

evident that POPTS do not comply to Medicare standards and fail miserably by

78%

and 91% respectfully with the 1994 and 2005 studies. Who is behind the

legislative efforts to allow ATC's and personal trainers to treat and charge as

physical therapists but the Ortho's. No, it is pure GREED and we should not

be lulled into believing that they are SO concerned about their patients that

they need to CONTROL the use and amount of PT their patients require.

Having practiced 50 years, I would say that the referrals received were

basically worthless regarding anything more than a simple Dx scans any real

direction.

I would love to see a real study of the charges, utilization patterns and

comparison of outcomes by all providers using the 97000 CPT codes. Let's get

the real facts on the table.

A. Towne, PT

**************Ideas to please picky eaters. Watch video on AOL Living.

(http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/

2050827?NCID=aolcmp00300000002598)

February 28, 2008

,

You are absolutely correct. Unfortunately, you are preaching to the choir.

The problem is that the AMA and AAOS are powerful lobbying groups and

present themselves in Washington as being the shepherds of the " unfortunate

patients who need someone to protect their interests. " We all know the

truth is that these MDs are concerned about one thing only...their bottom

line. The problem I am seeing is that they are able to control referrals to

make their own outcomes look better. Recently, our Association met with the

Board of Directors of Blue Cross Blue Shield of Arkansas. Keep in mind, the

Boards of most large insurance carriers is composed of physicians and bean

counters. We were trying to make the argument that BCBS should consider

refusing to pay for any PT services provided in a physician's office due to

the data you provided. We argued that abuse in POPTS (Referral for

Profit)should be a serious concern. Unfortunately, the data collected by

BCBS does not suggest abuse (on the surface anyway). Their data suggested

that PT provided in a physician's office was less costly and consisted, on

average, of less visits to the PT. A survey of patient satisfaction and

functional outcomes seemed to support the assertion that patients were

better off being seen in the RFP arrangement. At first, we were shocked.

But upon later examination, that made perfect sense. The physicians

controlled the referrals, so they were able to " cherry pick " the patients

who had the best insurance, the best potential outcomes, and the shortest

anticipated durations of care. All of the most complicated, troublesome

patients are referred out to private providers or hospitals. The RFPs

operate on pure volume and tend to select the cases who can be seen three

times per week for 30 minutes at a time and discharged in less than 3 weeks.

Modalities and hands-on treatment are seldom utilized and exercise is the

preferred means of treatment. RFPs tend to avoid Medicare patients since

the regulations are cost-prohibitive and the potential for scrutiny is high.

It is my belief that we are at a defining point in our profession's

evolution. Physician ownership of PT and suppression by insurance companies

and Medicare are pushing us backward. Surprisingly, though, many PTs show

very little concern for what is happening. APTA is a very effective

lobbying organization, yet only a fraction of PTs are members of the

Association. Still fewer contribute to our PAC, whos sole function is to

protect the interests of PT in Washington, D.C. Many PTs have no idea who

their Senators or Congressmen are and even fewer know who their state

legislative representatives are. We are facing a nationwide shortage of PT

talent and it is not uncommon for a PT to float from one job to another,

simply trying to make a few more bucks. Yet, when they do make more money,

they still can't seem to afford APTA dues. How rational is that?

RFPs are unethical and the therapists who work in them are practicing

unethically. We need to face that fact. If we, as a profession, don't

stand up and shine a light on this unethical situation, and call it what it

is, we will all be working for doctors one day. Our profession has been

suppressed by physicians for so long that we seem to have lost our will to

fight. Currently, 45 states have some form of direct access, yet most PTs

do not promote direct accessibility to their patients. We must adopt a

mindset that allows us to " market " our services directly to the public. And

we must develop a means of providing services to patients on a cash basis so

that we no longer continue the subservient relationship with physicians,

Medicare and insurance companies.

Rob Jordan, PT, MPT, GCS, OCS

President, ArPTA

_____

From: PTManager [mailto:PTManager ] On Behalf

Of PATowne@...

Sent: Wednesday, February 27, 2008 11:16 PM

To: PTManager

Subject: Re: from the Orthopedic surgeons journal...

This is pure rubbish. If one looks at the studies done by the GAO it is

evident that POPTS do not comply to Medicare standards and fail miserably by

78%

and 91% respectfully with the 1994 and 2005 studies. Who is behind the

legislative efforts to allow ATC's and personal trainers to treat and charge

as

physical therapists but the Ortho's. No, it is pure GREED and we should not

be lulled into believing that they are SO concerned about their patients

that

they need to CONTROL the use and amount of PT their patients require.

Having practiced 50 years, I would say that the referrals received were

basically worthless regarding anything more than a simple Dx scans any real

direction.

I would love to see a real study of the charges, utilization patterns and

comparison of outcomes by all providers using the 97000 CPT codes. Let's get

the real facts on the table.

A. Towne, PT

************-**Ideas to please picky eaters. Watch video on AOL Living.

(HYPERLINK

" http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-du

ffy/ " http://living.-aol.com/video/-how-to-please--your-picky--eater/rachel--

campos-duffy/

2050827?NCID=-aolcmp0030000000-2598)

February 28, 2008

:

I am not sure your reply is to my original copy and paste from from the Ortho's

journal, but it sounds like it is.

I just wanted to tell you, in case it was not obvious, that I am, obviously,

with you on this one!

As a matter of fact, unless you work for a POPT, you all should be thinking like

that, pretty much.

The main point, however, to me, in their text, was the sense of " defeat " in

their words when they say the APTA is putting most of its resources behind

fighting it, while them (orthos and AMA presumably) have to worry about other

equally important issues, therefore passing the idea that, perhaps, eventually,

we (PTs) will get this corrected (to our terms).

This message and any of its attachments is private and confidential and intended

solely for the recipient(s) named above.

It may contain Protected Health Information (PHI), which is protected by State

and Federal Law. If you received this message in error,

please contact the sender immediately for remedial measures. If you accept

this message you agree to store it in a safe, protected and confidential

manner, according to HIPAA standards.

Armin Loges, P.T.

Tampa, FL

armin@...

www.restoretherapies.com

Re: from the Orthopedic surgeons journal...

This is pure rubbish. If one looks at the studies done by the GAO it is

evident that POPTS do not comply to Medicare standards and fail miserably by

78%

and 91% respectfully with the 1994 and 2005 studies. Who is behind the

legislative efforts to allow ATC's and personal trainers to treat and charge

as

physical therapists but the Ortho's. No, it is pure GREED and we should not

be lulled into believing that they are SO concerned about their patients that

they need to CONTROL the use and amount of PT their patients require.

Having practiced 50 years, I would say that the referrals received were

basically worthless regarding anything more than a simple Dx scans any real

direction.

I would love to see a real study of the charges, utilization patterns and

comparison of outcomes by all providers using the 97000 CPT codes. Let's get

the real facts on the table.

A. Towne, PT

**************Ideas to please picky eaters. Watch video on AOL Living.

(http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/

2050827?NCID=aolcmp00300000002598)

February 29, 2008

Rob, you are 100% right on the POPTS issue, but I must jump in here to

correct something that is often repeated incorrectly in many POPTS

discussions:

You stated:

" RFPs are unethical and the therapists who work in them are practicing

unethically. We need to face that fact. If we, as a profession, don't

stand up and shine a light on this unethical situation, and call it

what it

is, we will all be working for doctors one day. "

POPTS or RFP is definitely wrong on many fronts (access, patient choice,

conflict of interest, financial harm/uneven playing field, etc.), but we

as a profession, should stop stating or inferring that PT's who work in

such a setting are practicing unethically. That is simply not true and

only serves to foster misunderstanding.

Look at all the APTA published documents on this issue, and you will be

hard-pressed to find such a statement. At worst, we can state, along

with the AMA, that the potential for unethical behavior exists to a

greater degree because of the avoidable conflict of interest.

We need a unified message in order to eliminate POPTS - and we don't

have it yet- even amongst the elite in our field.

As a group, lets continue to focus on killing this 30+ year malady

callled POPTS by unifying our message based on these other reasons

listed above from APTA documents(2005 white paper), and not broad-based

misdirected attacks on ethics.

Walsh, MS, PT, OCS

Georgia delegate

> ,

>

> You are absolutely correct. Unfortunately, you are preaching to the

choir.

> The problem is that the AMA and AAOS are powerful lobbying groups and

> present themselves in Washington as being the shepherds of the

" unfortunate

> patients who need someone to protect their interests. " We all know

the

> truth is that these MDs are concerned about one thing only...their

bottom

> line. The problem I am seeing is that they are able to control

referrals to

> make their own outcomes look better. Recently, our Association met

with the

> Board of Directors of Blue Cross Blue Shield of Arkansas. Keep in

mind, the

> Boards of most large insurance carriers is composed of physicians and

bean

> counters. We were trying to make the argument that BCBS should

consider

> refusing to pay for any PT services provided in a physician's office

due to

> the data you provided. We argued that abuse in POPTS (Referral for

> Profit)should be a serious concern. Unfortunately, the data collected

by

> BCBS does not suggest abuse (on the surface anyway). Their data

suggested

> that PT provided in a physician's office was less costly and

consisted, on

> average, of less visits to the PT. A survey of patient satisfaction

and

> functional outcomes seemed to support the assertion that patients were

> better off being seen in the RFP arrangement. At first, we were

shocked.

> But upon later examination, that made perfect sense. The physicians

> controlled the referrals, so they were able to " cherry pick " the

patients

> who had the best insurance, the best potential outcomes, and the

shortest

> anticipated durations of care. All of the most complicated,

troublesome

> patients are referred out to private providers or hospitals. The RFPs

> operate on pure volume and tend to select the cases who can be seen

three

> times per week for 30 minutes at a time and discharged in less than 3

weeks.

> Modalities and hands-on treatment are seldom utilized and exercise is

the

> preferred means of treatment. RFPs tend to avoid Medicare patients

since

> the regulations are cost-prohibitive and the potential for scrutiny is

high.

>

> It is my belief that we are at a defining point in our profession's

> evolution. Physician ownership of PT and suppression by insurance

companies

> and Medicare are pushing us backward. Surprisingly, though, many PTs

show

> very little concern for what is happening. APTA is a very effective

> lobbying organization, yet only a fraction of PTs are members of the

> Association. Still fewer contribute to our PAC, whos sole function is

to

> protect the interests of PT in Washington, D.C. Many PTs have no idea

who

> their Senators or Congressmen are and even fewer know who their state

> legislative representatives are. We are facing a nationwide shortage

of PT

> talent and it is not uncommon for a PT to float from one job to

another,

> simply trying to make a few more bucks. Yet, when they do make more

money,

> they still can't seem to afford APTA dues. How rational is that?

>

> RFPs are unethical and the therapists who work in them are practicing

> unethically. We need to face that fact. If we, as a profession,

don't

> stand up and shine a light on this unethical situation, and call it

what it

> is, we will all be working for doctors one day. Our profession has

been

> suppressed by physicians for so long that we seem to have lost our

will to

> fight. Currently, 45 states have some form of direct access, yet most

PTs

> do not promote direct accessibility to their patients. We must adopt

a

> mindset that allows us to " market " our services directly to the

public. And

> we must develop a means of providing services to patients on a cash

basis so

> that we no longer continue the subservient relationship with

physicians,

> Medicare and insurance companies.

>

> Rob Jordan, PT, MPT, GCS, OCS

> President, ArPTA

>

> _____

>

> From: PTManager [mailto:PTManager ] On

Behalf

> Of PATowne@...

> Sent: Wednesday, February 27, 2008 11:16 PM

> To: PTManager

> Subject: Re: from the Orthopedic surgeons journal...

>

> This is pure rubbish. If one looks at the studies done by the GAO it

is

> evident that POPTS do not comply to Medicare standards and fail

miserably by

> 78%

> and 91% respectfully with the 1994 and 2005 studies. Who is behind the

> legislative efforts to allow ATC's and personal trainers to treat and

charge

> as

> physical therapists but the Ortho's. No, it is pure GREED and we

should not

> be lulled into believing that they are SO concerned about their

patients

> that

> they need to CONTROL the use and amount of PT their patients require.

>

> Having practiced 50 years, I would say that the referrals received

were

> basically worthless regarding anything more than a simple Dx scans any

real

> direction.

>

> I would love to see a real study of the charges, utilization patterns

and

> comparison of outcomes by all providers using the 97000 CPT codes.

Let's get

>

> the real facts on the table.

>

> A. Towne, PT

>

March 2, 2008

,

Point taken, but I respectfully disagree. While we could spend days

debating the " ethics " of POPTS (referral for profit) and the therapists who

work in them, the fact is this: the therapists who work in these situations

went to school to become therapists. They sat for a national exam to become

therapists. They became state licensed to practice as physical therapists.

In doing so they voluntarily joined the profession of physical therapy.

Referral for profit is inherently wrong. That is why it is illegal for a

physician to own a pharmacy or a durable medical equipment company. It is

wrong. Referral for profit is the single biggest threat to our profession

since the Balanced Budget Act of 1997. The therapists who choose to work in

these settings are willing participants in activities that stand to

jeopardize the future of our entire profession. They have chosen to ally

themselves with the enemy. Currently, there are 10,000 vacant jobs for PTs

in the United States. Why, then, would a therapist need to " sleep with the

enemy? " It is a choice. APTA has refrained from branding these therapists

as unethical because APTA is a membership organization. It cannot

selectively make such an assertion. You are absolutely correct in your

statements that we need a unified message. We have had a unified message

now, for several years. That message has been that " Referral for profit

offers the 'potential' for unethical behavior. " Our message has been that

the therapists who work in them cannot be held responsible for that. They

have simply found themselves in a position of absolute subservience and

suppression by the physicians they work for. Perhaps we could say they are

actually helping our profession by putting therapists out of work by forcing

closure of those annoying private practices, thereby freeing more PTs up to

get honorable jobs in hospitals and nursing homes. I must ask, " how is this

message resonating so far? " The fact is, this message is not working at

all.

The unified message should be that RFP and the therapists who work in them

are unethical and RFP should be illegal in all areas involving referral

relationships where the MD stands to gain financially from making a

referral. If I indicate that a therapist is practicing unethically, does

that necessarily mean that they are performing the actions of a licensed

physical therapist unethically? No, not at all. If you define ethics as

simply relating to the involvement a therapist has with a patient in the

clinic, then you are establishing an ethics " blind spot. " What about if you

look at the bigger picture? These individuals are a part of our profession

and they are participating in a system that is harming the profession to

which they belong. That, to me, is unethical and should be identified as

such. Your argument is that doing so is misdirected because it might hurt

someone's feelings. Well, most of us would agree that selling babies into

slavery is pretty high on the list of unethical things. Your argument is

akin to saying that the fellow who dresses the babies up so they will look

nice on the auction block should not be called unethical because he is doing

a fine job in dressing up those babies. It is only the system that is bad,

not the baby dresser. We should develop a " unified message " against the

system, but for heaven's sake, don't hurt the baby dresser's feelings.

Rob Jordan, PT, MPT, GCS, OCS

_____

From: PTManager [mailto:PTManager ] On Behalf

Of dwcycle

Sent: Friday, February 29, 2008 8:02 PM

To: PTManager

Subject: Re: from the Orthopedic surgeons journal...

Rob, you are 100% right on the POPTS issue, but I must jump in here to

correct something that is often repeated incorrectly in many POPTS

discussions:

You stated:

" RFPs are unethical and the therapists who work in them are practicing

unethically. We need to face that fact. If we, as a profession, don't

stand up and shine a light on this unethical situation, and call it

what it

is, we will all be working for doctors one day. "

POPTS or RFP is definitely wrong on many fronts (access, patient choice,

conflict of interest, financial harm/uneven playing field, etc.), but we

as a profession, should stop stating or inferring that PT's who work in

such a setting are practicing unethically. That is simply not true and

only serves to foster misunderstanding.

Look at all the APTA published documents on this issue, and you will be

hard-pressed to find such a statement. At worst, we can state, along

with the AMA, that the potential for unethical behavior exists to a

greater degree because of the avoidable conflict of interest.

We need a unified message in order to eliminate POPTS - and we don't

have it yet- even amongst the elite in our field.

As a group, lets continue to focus on killing this 30+ year malady

callled POPTS by unifying our message based on these other reasons

listed above from APTA documents(2005 white paper), and not broad-based

misdirected attacks on ethics.

Walsh, MS, PT, OCS

Georgia delegate

> ,

>

> You are absolutely correct. Unfortunately, you are preaching to the

choir.

> The problem is that the AMA and AAOS are powerful lobbying groups and

> present themselves in Washington as being the shepherds of the

" unfortunate

> patients who need someone to protect their interests. " We all know

the

> truth is that these MDs are concerned about one thing only...their

bottom

> line. The problem I am seeing is that they are able to control

referrals to

> make their own outcomes look better. Recently, our Association met

with the

> Board of Directors of Blue Cross Blue Shield of Arkansas. Keep in

mind, the

> Boards of most large insurance carriers is composed of physicians and

bean

> counters. We were trying to make the argument that BCBS should

consider

> refusing to pay for any PT services provided in a physician's office

due to

> the data you provided. We argued that abuse in POPTS (Referral for

> Profit)should be a serious concern. Unfortunately, the data collected

by

> BCBS does not suggest abuse (on the surface anyway). Their data

suggested

> that PT provided in a physician's office was less costly and

consisted, on

> average, of less visits to the PT. A survey of patient satisfaction

and

> functional outcomes seemed to support the assertion that patients were

> better off being seen in the RFP arrangement. At first, we were

shocked.

> But upon later examination, that made perfect sense. The physicians

> controlled the referrals, so they were able to " cherry pick " the

patients

> who had the best insurance, the best potential outcomes, and the

shortest

> anticipated durations of care. All of the most complicated,

troublesome

> patients are referred out to private providers or hospitals. The RFPs

> operate on pure volume and tend to select the cases who can be seen

three

> times per week for 30 minutes at a time and discharged in less than 3

weeks.

> Modalities and hands-on treatment are seldom utilized and exercise is

the

> preferred means of treatment. RFPs tend to avoid Medicare patients

since

> the regulations are cost-prohibitive and the potential for scrutiny is

high.

>

> It is my belief that we are at a defining point in our profession's

> evolution. Physician ownership of PT and suppression by insurance

companies

> and Medicare are pushing us backward. Surprisingly, though, many PTs

show

> very little concern for what is happening. APTA is a very effective

> lobbying organization, yet only a fraction of PTs are members of the

> Association. Still fewer contribute to our PAC, whos sole function is

to

> protect the interests of PT in Washington, D.C. Many PTs have no idea

who

> their Senators or Congressmen are and even fewer know who their state

> legislative representatives are. We are facing a nationwide shortage

of PT

> talent and it is not uncommon for a PT to float from one job to

another,

> simply trying to make a few more bucks. Yet, when they do make more

money,

> they still can't seem to afford APTA dues. How rational is that?

>

> RFPs are unethical and the therapists who work in them are practicing

> unethically. We need to face that fact. If we, as a profession,

don't

> stand up and shine a light on this unethical situation, and call it

what it

> is, we will all be working for doctors one day. Our profession has

been

> suppressed by physicians for so long that we seem to have lost our

will to

> fight. Currently, 45 states have some form of direct access, yet most

PTs

> do not promote direct accessibility to their patients. We must adopt

a

> mindset that allows us to " market " our services directly to the

public. And

> we must develop a means of providing services to patients on a cash

basis so

> that we no longer continue the subservient relationship with

physicians,

> Medicare and insurance companies.

>

> Rob Jordan, PT, MPT, GCS, OCS

> President, ArPTA

>

> _____

>

> From: HYPERLINK

" mailto:PTManager%40yahoogroups.com " PTManager@...

[mailto:HYPERLINK

" mailto:PTManager%40yahoogroups.com " PTManager@...] On

Behalf

> Of PATowne@...

> Sent: Wednesday, February 27, 2008 11:16 PM

> To: HYPERLINK

" mailto:PTManager%40yahoogroups.com " PTManager@...

> Subject: Re: from the Orthopedic surgeons journal...

>

> This is pure rubbish. If one looks at the studies done by the GAO it

is

> evident that POPTS do not comply to Medicare standards and fail

miserably by

> 78%

> and 91% respectfully with the 1994 and 2005 studies. Who is behind the

> legislative efforts to allow ATC's and personal trainers to treat and

charge

> as

> physical therapists but the Ortho's. No, it is pure GREED and we

should not

> be lulled into believing that they are SO concerned about their

patients

> that

> they need to CONTROL the use and amount of PT their patients require.

>

> Having practiced 50 years, I would say that the referrals received

were

> basically worthless regarding anything more than a simple Dx scans any

real

> direction.

>

> I would love to see a real study of the charges, utilization patterns

and

> comparison of outcomes by all providers using the 97000 CPT codes.

Let's get

>

> the real facts on the table.

>

> A. Towne, PT

>

March 2, 2008

You wrote:

Perhaps we could say they are

actually helping our profession by putting therapists out of work by forcing

closure of those annoying private practices, thereby freeing more PTs up to

get honorable jobs in hospitals and nursing homes. I must ask, " how is this

message resonating so far? " The fact is, this message is not working at

all.

As a facility based practitioner I do not know any practice environment that is

more or less " honorable " than any other, in fact one could say that the honor

brought to a practice environment is the honor brought by the therapist themself

and not the building they work in. I resent your hopefully tongue in cheek

accusation about those colleagues who choose to provide care in facilities. they

provide a vital services to persons in need at that stage of their illness or

post injury recovery.

If we do not stop this type of dialogue and raise it to a level of

professionalism that we all can participate in, POPTS will be the least of our

problems.

Some facts:

1. A POPTS is not considered unethical because by its mere exitance does not

insure that the patient is in any way harmed. If you know where they are harmed,

just like any setting, you should report them. Education is clear integral part

of this issue. But if you have a therapist that doesn't see themselves as a

member of the professional society of physical therapists, then why wold you

think that they would understand what they are doing to the profession? I do not

like POPTS either, but when colleagues who have first hand knowledge of abuse do

not report or encourage their patients to do so because they are afraid of the

loss of a referral source or sources, well your argument becomes a bit hollow.

2. Studies have shown that while POPTS and Corp owned practices are issues in

the market place, so to is the increase in PT owned practices. It is a function

of the marketplace and what it will support in terms of the number of

practitioners in any one area. thats not healthcare, its economics. So what do

we do, stop opening up our own practices? Of course not, but lets realize all

the factors affecting us.

I again ask my colleagues on this and any other list serv to raise the level of

discourse. Dumpng on eachother only shows our lack of understanding of the

bigger picture.

Jim Dunleavy PT, MS

Director, Rehabilitation Services

Trinitas Hospital

, NJ 07207

Re: from the Orthopedic surgeons journal...

>

> This is pure rubbish. If one looks at the studies done by the GAO it

is

> evident that POPTS do not comply to Medicare standards and fail

miserably by

> 78%

> and 91% respectfully with the 1994 and 2005 studies. Who is behind the

> legislative efforts to allow ATC's and personal trainers to treat and

charge

> as

> physical therapists but the Ortho's. No, it is pure GREED and we

should not

> be lulled into believing that they are SO concerned about their

patients

> that

> they need to CONTROL the use and amount of PT their patients require.

>

> Having practiced 50 years, I would say that the referrals received

were

> basically worthless regarding anything more than a simple Dx scans any

real

> direction.

>

> I would love to see a real study of the charges, utilization patterns

and

> comparison of outcomes by all providers using the 97000 CPT codes.

Let's get

>

> the real facts on the table.

>

> A. Towne, PT

>

March 3, 2008

I have to agree with my esteemed colleague Mr. Dunleavy on the issue of

attempting to characterize the professionalism of any of my colleagues based

solely on choice of practice setting. The characterization that those who

work in institutional settings are somehow less is an absurd argument.

Different practice environments present their own challenges. I've known

many colleagues who are as equally dedicated to their practice within their

respective institution as I am to my private practice and this demands

respect.

I do however take issue with regard to the ethics of practicing in a

referral for profit arrangement. While it can be argued that participating

in this arrangement does not necessarily violate the APTA Code of Ethics it

can be argued that this is not an all encompassing document with regard to

ethics. The Merriam-Webster Dictionary defines Ethics as follows: " the

discipline dealing with what is good and bad and with moral duty and

obligation " . Based on this broader definition I would argue that the

inherent and well documented potential for abuse posed by referral for

profit and its economic impact on consumers, the lack of incentive of those

profiting from these arrangements as " additional revenue centers " to

re-invest in our profession as argued by McMenamin, PT present serious

challenges to the inherent " obligation " of a professional to act in the best

interest of their patient, their profession and society as whole. With that

in mind I don't see it as a stretch to call into question the ethical

implications of practicing in a referral for profit arrangement.

I am also not completely clear on the Mr. Dunleavy's statement regarding

" harm " . If he is referring to the potential for physical harm, I agree that

there is probably no increased likelihood of physical harm in the referral

for profit environment than any other. However I do see the tremendous and

again well documented potential for economic harm to the patient and society

as a whole and therefore have to disagree with his position on this

particular point.

Thanks Jim for trying to raise the level of discourse. We need to examine

and discuss these issue objectively and based on the facts not just

unsubstantiated assertions and innuendo.

Mark F. Schwall, PT

Future Physical Therapy, PC

1594 Route 9

Unit 2

Toms River, NJ 08755

Fax

Skype mfschwall

President

New Jersey Society of Independent Physical Therapists

2123 Route 35

Sea Girt, NJ 08750

From: PTManager [mailto:PTManager ] On Behalf

Of JIMDPT@...

Sent: Sunday, March 02, 2008 11:39 AM

To: PTManager

Subject: Re: Re: from the Orthopedic surgeons journal...

You wrote:

Perhaps we could say they are

actually helping our profession by putting therapists out of work by forcing

closure of those annoying private practices, thereby freeing more PTs up to

get honorable jobs in hospitals and nursing homes. I must ask, " how is this

message resonating so far? " The fact is, this message is not working at

all.

As a facility based practitioner I do not know any practice environment that

is more or less " honorable " than any other, in fact one could say that the

honor brought to a practice environment is the honor brought by the

therapist themself and not the building they work in. I resent your

hopefully tongue in cheek accusation about those colleagues who choose to

provide care in facilities. they provide a vital services to persons in need

at that stage of their illness or post injury recovery.

If we do not stop this type of dialogue and raise it to a level of

professionalism that we all can participate in, POPTS will be the least of

our problems.

Some facts:

1. A POPTS is not considered unethical because by its mere exitance does not

insure that the patient is in any way harmed. If you know where they are

harmed, just like any setting, you should report them. Education is clear

integral part of this issue. But if you have a therapist that doesn't see

themselves as a member of the professional society of physical therapists,

then why wold you think that they would understand what they are doing to

the profession? I do not like POPTS either, but when colleagues who have

first hand knowledge of abuse do not report or encourage their patients to

do so because they are afraid of the loss of a referral source or sources,

well your argument becomes a bit hollow.

2. Studies have shown that while POPTS and Corp owned practices are issues

in the market place, so to is the increase in PT owned practices. It is a

function of the marketplace and what it will support in terms of the number

of practitioners in any one area. thats not healthcare, its economics. So

what do we do, stop opening up our own practices? Of course not, but lets

realize all the factors affecting us.

I again ask my colleagues on this and any other list serv to raise the level

of discourse. Dumpng on eachother only shows our lack of understanding of

the bigger picture.

Jim Dunleavy PT, MS

Director, Rehabilitation Services

Trinitas Hospital

, NJ 07207

Re: from the Orthopedic surgeons journal...

>

> This is pure rubbish. If one looks at the studies done by the GAO it

is

> evident that POPTS do not comply to Medicare standards and fail

miserably by

> 78%

> and 91% respectfully with the 1994 and 2005 studies. Who is behind the

> legislative efforts to allow ATC's and personal trainers to treat and

charge

> as

> physical therapists but the Ortho's. No, it is pure GREED and we

should not

> be lulled into believing that they are SO concerned about their

patients

> that

> they need to CONTROL the use and amount of PT their patients require.

>

> Having practiced 50 years, I would say that the referrals received

were

> basically worthless regarding anything more than a simple Dx scans any

real

> direction.

>

> I would love to see a real study of the charges, utilization patterns

and

> comparison of outcomes by all providers using the 97000 CPT codes.

Let's get

>

> the real facts on the table.

>

> A. Towne, PT

>

March 3, 2008

On this same line of referral for profit,

should we also not be condemning the HealthSouths, Novacare/Select

Medical, Physiotherapy Associates, etc who are the big profit, push

the numbers, who cares about care, but it's all about the bottom line

companies.

I have worked for a group of orthopedic surgeons in the past. Rehab

was about the money, but it also was about patient care. The 4 of us

who worked for these doc's and out PTA's had complete autonomy of

patient care. Our doc's didn't do patient picking to get the " best

outcomes " ; in fact, in a lot of cases, we got the hard cases because

we were expected to help get these folks better therefore improving

patient satisfaction.

I will never again work as a lackey for anyone, POPT,RFP,big

corporate profitteers, or PTIP who are inappropriately billing.

Lindberg, PT

Louisville, CO

>

> ,

>

> Point taken, but I respectfully disagree. While we could spend days

> debating the " ethics " of POPTS (referral for profit) and the

therapists who

> work in them, the fact is this: the therapists who work in these

situations

> went to school to become therapists. They sat for a national exam

to become

> therapists. They became state licensed to practice as physical

therapists.

> In doing so they voluntarily joined the profession of physical

therapy.

> Referral for profit is inherently wrong. That is why it is illegal

for a

> physician to own a pharmacy or a durable medical equipment

company. It is

> wrong. Referral for profit is the single biggest threat to our

profession

> since the Balanced Budget Act of 1997. The therapists who choose

to work in

> these settings are willing participants in activities that stand to

> jeopardize the future of our entire profession. They have chosen

to ally

> themselves with the enemy. Currently, there are 10,000 vacant jobs

for PTs

> in the United States. Why, then, would a therapist need to " sleep

with the

> enemy? " It is a choice. APTA has refrained from branding these

therapists

> as unethical because APTA is a membership organization. It cannot

> selectively make such an assertion. You are absolutely correct in

your

> statements that we need a unified message. We have had a unified

message

> now, for several years. That message has been that " Referral for

profit

> offers the 'potential' for unethical behavior. " Our message has

been that

> the therapists who work in them cannot be held responsible for

that. They

> have simply found themselves in a position of absolute subservience

and

> suppression by the physicians they work for. Perhaps we could say

they are

> actually helping our profession by putting therapists out of work

by forcing

> closure of those annoying private practices, thereby freeing more

PTs up to

> get honorable jobs in hospitals and nursing homes. I must

ask, " how is this

> message resonating so far? " The fact is, this message is not

working at

> all.

>

> The unified message should be that RFP and the therapists who work

in them

> are unethical and RFP should be illegal in all areas involving

referral

> relationships where the MD stands to gain financially from making a

> referral. If I indicate that a therapist is practicing

unethically, does

> that necessarily mean that they are performing the actions of a

licensed

> physical therapist unethically? No, not at all. If you define

ethics as

> simply relating to the involvement a therapist has with a patient

in the

> clinic, then you are establishing an ethics " blind spot. " What

about if you

> look at the bigger picture? These individuals are a part of our

profession

> and they are participating in a system that is harming the

profession to

> which they belong. That, to me, is unethical and should be

identified as

> such. Your argument is that doing so is misdirected because it

might hurt

> someone's feelings. Well, most of us would agree that selling

babies into

> slavery is pretty high on the list of unethical things. Your

argument is

> akin to saying that the fellow who dresses the babies up so they

will look

> nice on the auction block should not be called unethical because he

is doing

> a fine job in dressing up those babies. It is only the system that

is bad,

> not the baby dresser. We should develop a " unified message "

against the

> system, but for heaven's sake, don't hurt the baby dresser's

feelings.

>

> Rob Jordan, PT, MPT, GCS, OCS

>

> _____

>

March 4, 2008

Rob,

I am a PT working in a hospital based practice and have been a PT for near 19

years, therefore, I feel I can speak the following. I know several PTs working

in physician owned practices who practice ethically and practically. I say this

only for the fact that not all PTs are practicing unethically, as you state, and

not all of these practices are " cherry picking " . I say this to emphasize the

fact that our association would harm these PTs and their livlihood as well as

those you describe. I want to stick up for these PTs who are hard working and

ethical in their practices. Mark my word...there are many hospital based PT

departments as well as privately owned practices out there who are practicing as

you described. There are hospital based departments who are part of a hospital

organization who own their own insurance company and limit who their clients can

see for therapy. I suffer from this. I also have issue with physician offices

having ATCs seeing patients and billing these as PT services. This is more

alarming to me. PTs using aides and billing for PT services as well as billing

for two patients seen at the same time is also more alarming to me. These are

issues we need to address along with our association. In my experience, the

abuse of utilizing and billing for aides and ATCs time with the patients has

done more for the prediciment our profession is in since the BBA of 98.

Insurances and patients want a PT working with them not aides and ATCs. This

needs to be our first concern. My two cents.

Matt Dvorak, PT

Yankton, SD

________________________________

From: PTManager on behalf of Jordan

Sent: Thu 2/28/2008 12:03 PM

To: PTManager

Subject: RE: from the Orthopedic surgeons journal...