Re: from the Orthopedic surgeons journal...

March 8, 2008

Vinod:

Your comment, " Unfortunately, there was a max of 50 PT's (from the country)

participating (1 month before) the Medicare

cap was to hit in Dec of 07. This was a crying shame " ?seems a little off base.

Unfortunately, not everyone can afford to drop everything, pay for airfare, take

3 days off of work and attend these events, however, I would suspect that the

number of people ( many on this listserve) who phoned their legislators in DC

was tremendous.? Thanks to those of you who have the means to travel to DC at

the drop of a hat and lobby on our behalf, but also thanks to the many who take

the time to call their DC Senators/Reps and lobby on our behalf as well--the

phone calls and letters are equally important.

?

Ric A. Baird, MS, PT, ATC

Interactive Physical Therapy & Fitness Center

4745 NW Hunters Ridge Circle

Suite D

Topeka, KS 66618

(785)246-2300 (P)

(785)246-2301 (F)

Interactive Physical Therapy

2018 SE 28th Street

Topeka, KS 66605

(P)

(F)

www.interactiveptandfitness.com

RE: from the Orthopedic

> surgeons journal...

>

> ,

>

> 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

>

=== message truncated ===

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March 8, 2008

Ric,

In all due respect, we are talking about our professional autonomy here and more

PT's need to take this direct action.? I also realize that we have made

considerable strides in increasing the work?in this area of our profession.???

I do realize every (call, letter)?action helps and?I drove 4 hours the night

before getting to DC?at 2 am?and returned that same day?to NY- getting back to

patient care the following day.? There were other practice owners that basically

took that one day off (and hadn't taken a vacation in over a year-and this is a

fact) to attend and support.? From my experience, the direct contact with

legislators had a big impact.? I have emails from a couple of senators and HR

stating that they signed the bills?on the following day.? If?you went to DC and

saw the representation from other healthcare?clinicians, I'm sure that you'd?see

the urgency of this direct contact action-its scary the numbers of the AMA,

chiro.? It is a political kind of world and we have to show up in numbers (not

my rules).? We're obviously working on a similar goal and my message is here to

get an increase in this action-because I saw that it works.? I'm sure that if an

additional?20% of this listserve made a move towards direct contact we'd may

create a better scenario going forward.? ??

Respectfully,?

Vinod ??????

???

RE: from the Orthopedic

> surgeons journal...

>

> ,

>

> 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

>

=== message truncated ===

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March 8, 2008

Jon,

Medicare does not allow techs to " perform treatments " in the Part A

setting, in fact they are very clear that while it may be appropriate

for unliscensed personell to assist the PT in the performance of

skilled activity, the PT must always be present and primary in the

task being performed.

E. s, PT, DPT, OCS, FAAOMPT

www.douglasspt.com

> > >

> > > Matt:

> > >

> > > Nice to read the various opinions that come across this server.

> > > It is really great, so we all learn to disagree.

> > > And off course we all hear about the wonderful POPTs that are

out

> > there, and just how they are truly motivated solely by the

betterment

> of

> > their patients and the entire healthcare.

> > > As a matter a fact, I just got approached by a physician like

that 2

> > days ago. True story! Now. Keep in mind that he practices on the

space

> > next to mine. Sends me 2 patients per year, but now offers me a

full

> > case load if I open practice inside of his new building.

> > > Have you considered why is illegal for physicians to own MRIs,

Labs

> > etc?

> > > Now, consider this: why wouldn't they open a dental office

there as

> > well? Wouldn't that make a wonderful, one-stop-shop, place for the

> > betterment of their patients?

> > > The reason for that is because, UNLIKE THE PHYSICAL THERAPISTS,

> > dentists stood up for themselves, united, and nowadays only

dentists

> are

> > legal practice owners of dental practices.

> > > Unfortunately, at least in this country, history has not served

us

> > well. Only 200 years after the creation of the profession, we

decide

> to

> > take a vision of our own (Vision 2020) and decide to become

> independent.

> > > Just to find out that a good bunch of " us " still consider

the " need "

> > to remain a technician - named physical therapist.

> > > 200 years later, we are still trying to find out if we can bill

for

> > Iontophoresis if the milliseconds don't add up right, we are still

> > having to fight to bill evaluations (like in BCBS of NJ).

> > > And most of all, some colleagues like you are outraged of some

of us

> > that treat two patients simultaneously. Without getting into the

> minutia

> > of this last statement, which could take all gigabytes of this

server

> > for sure, have you considered the fact that statements like yours

> " ...as

> > well as billing for two patients seen at the same time is also

more

> > alarming to me " are not guided by clinical decision but by some

> > centenary rule, which is not universal by the way, but Medicare

> imposed.

> > > When you see your dentist, is he billing one of the 4 clients

he has

> > in different stages of his care, only because you are all present

at

> the

> > same time in his office?

> > > Or perhaps, the surgeon moving back and forth between surgeries

(2)

> is

> > not getting paid by one of them? Or the anesthesiologist as well?

> > > I just miss to see the ethical misconduct to perform manual PT

in

> one

> > patient while I have another one in HP and E-stim, and I find it

even

> > more ludicrous to not be able to bill it. I am not saying for us

to

> > break medicare rules, but I am certainly criticizing such

arguments as

> > being the holy ground of ethical behavior. Because, to drag my

feet to

> > add extra seconds of Ionto treatment sure sounds like unethical

if you

> > ask me.

> > > I have been practicing for 16 years in this country. Before

that, I

> > practiced for one year in mine. And I am afraid I am yet to see

one

> > physical therapy carrying a stop watch, adding minutes. I have

worked

> in

> > large and small hospitals, large and small SNFs, large hospital

based

> > rehabs, Home Health, PT owned private practices, Corporate

outpatient

> PT

> > clinics, " amateur " owned PT Clinics, I staffed a POPT once long

ago

> > (shame on me!), I rented space inside a Chiro's office, which

kind of

> > resembles a COPT if you think about it - this one deserves

> explanation:

> > in my country at the time we did not have chiros, therefore I had

no

> > clue what they were. Needless to say, less than 4 weeks into it,

we

> > almost had a fist fight...(just thought this would be

entertaining for

> > some of you...)

> > > All in all, realize the monopoly the AMA wants to have in

> healthcare.

> > You may think its ok. But the proof is in the fact that if orthos'

> > cannot have their POPTs, they are just as happy to back up NATA

and

> have

> > the ATCs or the PTAs or whomever, just as long as they can bill

like

> PT.

> > > Another shocking fact! I just realized this now that I am in

private

> > practice: The MD owned PT clinic gets paid much better rates (MUCH

> > BETTER!) than I get as a private practice owner. Explain that one!

> > (retorical).

> > > Why are we billing our services based on the antiquated AMA

model?

> > > These should be the questions asked.

> > > Why should I decide, per se, Ionto is clinically necessary to my

> > patient, use a set of electrodes that cost me 7.00 and not be

able to

> > bill for it?

> > > These should be the questions asked.

> > > Why physicians/chiros/etc etc can bill PT if I am the PT and not

> them?

> > > These should be the questions asked.

> > > Why is it a problem to treat two patients simultaneously? Are

you

> > incapable of such multitasking? And if so, didn't you provided the

> > service just like the dentist did? Is the dentist going to let

you go

> > for free?

> > > We don't need to break medicare rules, but we need to change

them!

> > > Dentists have dental fee schedules. Not AMA fee schedules.

> > > When are we going to rebel against this system of subservience

and

> > free ourselves to do what's best for our patients and be

compensated

> > with dignity without everyone and their cousin encroaching on our

> > profession?

> > > When not one more PT think and act like a tech!

> > > These are my 99 cents!

> > > Chew me back, I can take it. But take no offense. Lets rebel

> together!

> > >

> > > Armin Loges, P.T.

> > > Tampa, FL

> > >

> > > From: Matt Dvorak

> > > Sent: Tuesday, March 04, 2008 5:53 PM

> > > To: PTManager

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

> > >

> > > 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...

> > >

> > > ,

> > >

> > > 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%

40yahoogroups.com>

> > [mailto:PTManager <mailto:PTManager%

40yahoogroups.com>

> ]

> > On Behalf

> > > Of PATowne@ <mailto:PATowne%40aol.com>

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

> > > To: PTManager <mailto:PTManager%

40yahoogroups.com>

> > > 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-

campo\

> \

> > s-du

> >

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

campo\

> \

> > s-du>

> > >

> >

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

eater/rach\

> \

> > el--

> >

> <http://living.-aol.com/video/-how-to-please--your-picky--

eater/rachel--\

> \

> > >

> > > campos-duffy/

> > > 2050827?NCID=-aolcmp0030000000-2598)

> > >

March 9, 2008

,

I should have been more specific. I was referring to Part A as it

relates to hospital based acute care services. The following is a quote

from ine M. o, MCSP, PT, and Danna D. Mullins, MHS, PT from

Advance Magazines Medicare Advisor.

" Medicare's guidelines for therapy services provided under the Part A

benefit (Hospital Insurance) do not address the use of aides in any

hospital (Acute, CAH or LTAC) or inpatient rehab facility setting; they

are, however, very specific on SNF. "

SNU facilities requrie " line of sight " treatments by techs. This " rule "

does not apply to the acute care setting.

Where there are no specific rules as it applies to Medicare, we have to

default to our State Practice Act (in this case Texas). The Texas

practice act is clear in stating that a PT should initiate all

treatments. However, it does not prohibit the PT from turning the

treatment over to a tech if the PT feels it is appropriate (Professional

Judgement).

If you have information (from Medicare) to the contrary as it relates to

the acute care hospital setting, please direct me.

Thanks,

Jon Mark Pleasant, PT

> > > >

> > > > Matt:

> > > >

> > > > Nice to read the various opinions that come across this server.

> > > > It is really great, so we all learn to disagree.

> > > > And off course we all hear about the wonderful POPTs that are

> out

> > > there, and just how they are truly motivated solely by the

> betterment

> > of

> > > their patients and the entire healthcare.

> > > > As a matter a fact, I just got approached by a physician like

> that 2

> > > days ago. True story! Now. Keep in mind that he practices on the

> space

> > > next to mine. Sends me 2 patients per year, but now offers me a

> full

> > > case load if I open practice inside of his new building.

> > > > Have you considered why is illegal for physicians to own MRIs,

> Labs

> > > etc?

> > > > Now, consider this: why wouldn't they open a dental office

> there as

> > > well? Wouldn't that make a wonderful, one-stop-shop, place for the

> > > betterment of their patients?

> > > > The reason for that is because, UNLIKE THE PHYSICAL THERAPISTS,

> > > dentists stood up for themselves, united, and nowadays only

> dentists

> > are

> > > legal practice owners of dental practices.

> > > > Unfortunately, at least in this country, history has not served

> us

> > > well. Only 200 years after the creation of the profession, we

> decide

> > to

> > > take a vision of our own (Vision 2020) and decide to become

> > independent.

> > > > Just to find out that a good bunch of " us " still consider

> the " need "

> > > to remain a technician - named physical therapist.

> > > > 200 years later, we are still trying to find out if we can bill

> for

> > > Iontophoresis if the milliseconds don't add up right, we are still

> > > having to fight to bill evaluations (like in BCBS of NJ).

> > > > And most of all, some colleagues like you are outraged of some

> of us

> > > that treat two patients simultaneously. Without getting into the

> > minutia

> > > of this last statement, which could take all gigabytes of this

> server

> > > for sure, have you considered the fact that statements like yours

> > " ...as

> > > well as billing for two patients seen at the same time is also

> more

> > > alarming to me " are not guided by clinical decision but by some

> > > centenary rule, which is not universal by the way, but Medicare

> > imposed.

> > > > When you see your dentist, is he billing one of the 4 clients

> he has

> > > in different stages of his care, only because you are all present

> at

> > the

> > > same time in his office?

> > > > Or perhaps, the surgeon moving back and forth between surgeries

> (2)

> > is

> > > not getting paid by one of them? Or the anesthesiologist as well?

> > > > I just miss to see the ethical misconduct to perform manual PT

> in

> > one

> > > patient while I have another one in HP and E-stim, and I find it

> even

> > > more ludicrous to not be able to bill it. I am not saying for us

> to

> > > break medicare rules, but I am certainly criticizing such

> arguments as

> > > being the holy ground of ethical behavior. Because, to drag my

> feet to

> > > add extra seconds of Ionto treatment sure sounds like unethical

> if you

> > > ask me.

> > > > I have been practicing for 16 years in this country. Before

> that, I

> > > practiced for one year in mine. And I am afraid I am yet to see

> one

> > > physical therapy carrying a stop watch, adding minutes. I have

> worked

> > in

> > > large and small hospitals, large and small SNFs, large hospital

> based

> > > rehabs, Home Health, PT owned private practices, Corporate

> outpatient

> > PT

> > > clinics, " amateur " owned PT Clinics, I staffed a POPT once long

> ago

> > > (shame on me!), I rented space inside a Chiro's office, which

> kind of

> > > resembles a COPT if you think about it - this one deserves

> > explanation:

> > > in my country at the time we did not have chiros, therefore I had

> no

> > > clue what they were. Needless to say, less than 4 weeks into it,

> we

> > > almost had a fist fight...(just thought this would be

> entertaining for

> > > some of you...)

> > > > All in all, realize the monopoly the AMA wants to have in

> > healthcare.

> > > You may think its ok. But the proof is in the fact that if orthos'

> > > cannot have their POPTs, they are just as happy to back up NATA

> and

> > have

> > > the ATCs or the PTAs or whomever, just as long as they can bill

> like

> > PT.

> > > > Another shocking fact! I just realized this now that I am in

> private

> > > practice: The MD owned PT clinic gets paid much better rates (MUCH

> > > BETTER!) than I get as a private practice owner. Explain that one!

> > > (retorical).

> > > > Why are we billing our services based on the antiquated AMA

> model?

> > > > These should be the questions asked.

> > > > Why should I decide, per se, Ionto is clinically necessary to my

> > > patient, use a set of electrodes that cost me 7.00 and not be

> able to

> > > bill for it?

> > > > These should be the questions asked.

> > > > Why physicians/chiros/etc etc can bill PT if I am the PT and not

> > them?

> > > > These should be the questions asked.

> > > > Why is it a problem to treat two patients simultaneously? Are

> you

> > > incapable of such multitasking? And if so, didn't you provided the

> > > service just like the dentist did? Is the dentist going to let

> you go

> > > for free?

> > > > We don't need to break medicare rules, but we need to change

> them!

> > > > Dentists have dental fee schedules. Not AMA fee schedules.

> > > > When are we going to rebel against this system of subservience

> and

> > > free ourselves to do what's best for our patients and be

> compensated

> > > with dignity without everyone and their cousin encroaching on our

> > > profession?

> > > > When not one more PT think and act like a tech!

> > > > These are my 99 cents!

> > > > Chew me back, I can take it. But take no offense. Lets rebel

> > together!

> > > >

> > > > Armin Loges, P.T.

> > > > Tampa, FL

> > > >

> > > > From: Matt Dvorak

> > > > Sent: Tuesday, March 04, 2008 5:53 PM

> > > > To: PTManager

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

> > > >

> > > > 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...

> > > >

> > > > ,

> > > >

> > > > 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%

> 40yahoogroups.com>

> > > [mailto:PTManager <mailto:PTManager%

> 40yahoogroups.com>

> > ]

> > > On Behalf

> > > > Of PATowne@ <mailto:PATowne%40aol.com>

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

> > > > To: PTManager <mailto:PTManager%

> 40yahoogroups.com>

> > > > 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-

> campo\

> > \

> > > s-du

> > >

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

> campo\

> > \

> > > s-du>

> > > >

> > >

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

> eater/rach\

> > \

> > > el--

> > >

> > <http://living.-aol.com/video/-how-to-please--your-picky--

> eater/rachel--\

> > \

> > > >

> > > > campos-duffy/

> > > > 2050827?NCID=-aolcmp0030000000-2598)

> > > >

March 10, 2008

To Tyler, who asked a simple question about the politics of healthcare, and to

all those who support increased market influences in healthcare, and even to

those who don't (that should cover it!):

Even today, when centralized systems and their concentrated powers are

everywhere the rule, it's difficult to find a more egregious example of

power-mongering and special-interest control than in healthcare. Mega-business,

government, government-business hybrids (which includes Medicare and its private

intermediaries), and quasi-private special interest groups (of which the biggest

and most powerful is the AMA, but the APTA is certainly another) control all

aspects of healthcare, from financing right down to defining what healthcare is.

Individuals meanwhile have virtually NOTHING to say about it. On this forum and

everywhere, for example, we hear of providers and third-party payers battling

over money. But no matter who wins the skirmish du jour, one outcome is always

certain: more decision-making power will be stolen from the consumer. (To my

great dismay, the vast majority of our own conversations on these matters make

not even a passing reference to the rights of consumers, unless it's to say that

all those unfortunate, under-served patients should have the right to see us

more often, and at higher rates, at the expense of their neighbors!)

Because of the immense momentum of our control ethos, and the vast amounts of

money at stake, it is, IMHO, unreasonable to expect the current power

brokers(meaning democrats, republicans, CEOs, providers, and third-party payers)

to fix the mess. (To do so they would have to give up their power. Now THAT'S

likely, isn't it?)

So where do we turn? Typically in America our best hope for improvement has

always been with the grass roots, and often there from single, determined

individuals, like Parks, or Clarence Earl Gideon, or Esther McQuigg. But

healthcare is an unusual case, for the people--the grass roots themselves--have

been bought off. Far too many believe that government or their employer can

" give " them (there's a word that needs to be looked up in the dictionary)

medical insurance. They don't see the long-term consequences of such pandering,

like medical costs that have risen way faster than inflation (been doing so for

decades) while our physical health has simultaneously become progressively

worse! Those facts may be uncomfortable, but they are also, apparently, very

ignorable.

The solution, I'm afraid, will come only when this current system's spindly legs

finally succumb, and the whole mess collapses into the dust. It's not

unthinkable, given the financial trends. We've ratcheted up to unthinkable

levels of spending. In 2007 total healthcare spending was $2.3 TRILLION--16

percent of the gross domestic product ($7,600 per person). The current trend

will take those expenditures to $4.2 trillion in less than ten years. That,

folks, will be equivalent to 20 percent of GDP--a number that is, in just about

everybody's considered opinion, not sustainable. We should keep that in mind

when we conjure new reasons for better remuneration.

I suppose that we can only hope that if we do go down, what arises from the

rubble will be a more sane, more humane, and very much more freedom-sensitive

system.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

RE: from the Orthopedic

> > surgeons journal...

> >

> > ,

> >

> > 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

> >

> === message truncated ===

>

> __________________________________________________________

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ<

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ<http://mobile.yah\

oo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>>

>

March 10, 2008

To quote Margaret Mead, " never underestimate the power of one " .

Our collective voice is APTA. Unfortunately, only about 28% of us belong. Some

of the most financially successful therapists and assitants in my community do

not belong. I do not see another way to protect our profession and have any

influence on our implding healthcare system.

Kathleen e,PT

HSA, Stanislaus County

--------- RE: from the Orthopedic

> > surgeons journal...

> >

> > ,

> >

> > 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

> >

> === message truncated ===

>

> __________________________________________________________

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ<

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ<http://mobile.yah\

oo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>>

>

March 11, 2008

This reply is the Dave and Kathleen

Dave, I sort of understood what you where saying, but got from it a bit of a

viewpoint that we are a small blip in the whole big picture. I can't say

that this is untrue as what is happening in the economy and society is real and

unjust (consider the billions the pharm companies make giving meds to

everyone for everything). But the viewpoint of change always starts small,

like in

a Parks, and has a lot more power behind it because it is that

viewpoint that is correct. What the PT profession is doing is correct, helpful

and

certainly one of the best (non-drug/surgery) means of health promotion. I

mean, who could argue with the fact that exercise, wellness, movement, decrease

pain etc. is a benefit to a humans life span. There is no argument (unlike

the drugs and surgery etc.) Again, many persons giving meds & surgery do it

with good means and that is fine, but we aren't really concerned about them.

We have enough to work on and need to step up to take action and get the

ball firmly moving (with all those who are trying) in the right direction. Let

me give you another example, last year there was I believe ~ 25 PT's

nationwide that donated ~$1500 to the PTPAC (I could be off a bit since I saw

the

board visually at the PPS conference). I think this is a far cry from what

needs to be done and believe there are plenty of PT's making over 100K annually

and can't put out money to help our group. The point is that what is being

done isn't enough from the total of the group. I'll be honest, if a PT hasn't

given a least $25 to the PTPAC (after your APTA membership/annually- a

dinner at Applebee's) then you should really think about what side you are

really

on. I know if sounds a bit rough, but I is the truth. I would say....take

action and get it done no matter what the circumstance may be in the future.

Kathleen you are dead on.

Vinod

In a message dated 3/10/2008 5:28:58 P.M. Eastern Daylight Time,

kathyclarke@... writes:

To quote Margaret Mead, " never underestimate the power of one " .

Our collective voice is APTA. Unfortunately, only about 28% of us belong.

Some of the most financially successful therapists and assitants in my

community do not belong. I do not see another way to protect our profession and

have

any influence on our implding healthcare system.

Kathleen e,PT

HSA, Stanislaus County

--------- RE: from the Orthopedic

> > surgeons journal...

> >

> > ,

> >

> > 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

> >

> === message truncated ===

>

____________ & shy; & shy;_________ & shy; & shy;_________ & shy; & shy;_________ & shy; & shy;_\

________ & shy; & shy;_________ & shy; & shy;_

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

http://mobile. & shy;yahoo.com/ & shy;;_ & shy;ylt=Ahu06i62sR & shy; & shy;8HDtDypao8Wcj

9tA & shy; & shy;cJ< http://mobile. & shy;yahoo.com/ & shy;;_ylt=Ahu06i62sR & shy;

8HDtDypao8Wcj9tA & shy;cJ<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tA\

cJ>

>

March 17, 2008

I love to see passion for our profession like this. Perhaps one day

PTs will rise up and decide that they are tired of being the effect of

all of these outside forces. Perhaps we will decide to be the " cause "

of positive changes. Last year pharmaceutical companies spent $4.8

billion advertising directly to the public and another $7.2 billion on

direct marketing to physicians. It is untold how many billions they

spent to influence Congress. Yet, here we are with less than 70,000

PTs belonging to our only national organization out of nearly 300,000

practicing PTs. We beg and plead for $25 from each one to support the

cause. Actually, very few of us donate at all and still fewer

participate in the legislative process. What else can be said but "

you get what you pay for. "

Rob Jordan,PT, GCS, OCS

Pres, ArPTA

Sent from iPhone

> This reply is the Dave and Kathleen

>

> Dave, I sort of understood what you where saying, but got from it a

> bit of a

> viewpoint that we are a small blip in the whole big picture. I can't

> say

> that this is untrue as what is happening in the economy and society

> is real and

> unjust (consider the billions the pharm companies make giving meds to

> everyone for everything). But the viewpoint of change always starts

> small, like in

> a Parks, and has a lot more power behind it because it is that

> viewpoint that is correct. What the PT profession is doing is

> correct, helpful and

> certainly one of the best (non-drug/surgery) means of health

> promotion. I

> mean, who could argue with the fact that exercise, wellness,

> movement, decrease

> pain etc. is a benefit to a humans life span. There is no argument

> (unlike

> the drugs and surgery etc.) Again, many persons giving meds &

> surgery do it

> with good means and that is fine, but we aren't really concerned

> about them.

> We have enough to work on and need to step up to take action and get

> the

> ball firmly moving (with all those who are trying) in the right

> direction. Let

> me give you another example, last year there was I believe ~ 25 PT's

> nationwide that donated ~$1500 to the PTPAC (I could be off a bit

> since I saw the

> board visually at the PPS conference). I think this is a far cry

> from what

> needs to be done and believe there are plenty of PT's making over

> 100K annually

> and can't put out money to help our group. The point is that what is

> being

> done isn't enough from the total of the group. I'll be honest, if a

> PT hasn't

> given a least $25 to the PTPAC (after your APTA membership/annually- a

> dinner at Applebee's) then you should really think about what side

> you are really

> on. I know if sounds a bit rough, but I is the truth. I would

> say....take

> action and get it done no matter what the circumstance may be in the

> future.

>

> Kathleen you are dead on.

> Vinod

>

> In a message dated 3/10/2008 5:28:58 P.M. Eastern Daylight Time,

> kathyclarke@... writes:

>

> To quote Margaret Mead, " never underestimate the power of one " .

> Our collective voice is APTA. Unfortunately, only about 28% of us

> belong.

> Some of the most financially successful therapists and assitants in my

> community do not belong. I do not see another way to protect our

> profession and have

> any influence on our implding healthcare system.

> Kathleen e,PT

> HSA, Stanislaus County

> --------- RE: from the Orthopedic

> > > surgeons journal...

> > >

> > > ,

> > >

> > > 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

> > >

> > === message truncated ===

> >

> ____________ &

> shy;

> & shy;

> _________ &

> shy;

> & shy;

> _________ &

> shy; & shy;_________ & shy; & shy;_________ & shy; & shy;_________ & shy; & shy;_

> > Be a better friend, newshound, and

> > know-it-all with Yahoo! Mobile. Try it now.

> http://mobile. & shy;yahoo.com/ & shy;;_ & shy;ylt=Ahu06i62sR & shy; & shy;

> 8HDtDypao8Wcj

> 9tA & shy; & shy;cJ< http://mobile. & shy;yahoo.com/

> & shy;;_ylt=Ahu06i62sR & shy;

>

8HDtDypao8Wcj9tA & shy;cJ<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tA\

cJ

> >

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