Physician Owned Physical Therapy Services (POPTS) - Call for Action

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Category: Blog

Published on Saturday, 18 June 2011 10:26

Written by Devdeep Ahuja

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Physician Owned Physical Therapy Services (POPTS): CALL FOR ACTION for physical therapists in CALIFORNIA, USA

California Assembly Bill 783 has been granted reconsideration and is scheduled to be heard by the Senate Standing Committee on Business, Professions, and Economic Development on June 20, 2011. This bill would add licensed physical therapists and licensed occupational therapists to the list of healing arts practitioners who may be shareholders, officers, directors, or professional employees of those corporations. James Syms, president of the California Physical Therapy Association, said the bill would’ve made it legal for medical corporations to employ physical therapists and allowed physicians to refer physical therapy services to their own employees. That creates a profit motive and an inherent conflict, he said.

At PhysioGuru, today we will try to explore the issues surrounding this bill, the effect it will have on physical therapists and patients and also analyse the stance of various medical and physical therapy organizations towards this Bill.

Physical therapy referral for profit describes a financial relationship in which a physician, podiatrist, or dentist refers a patient for physical therapy treatment and gains financially from the referral. A physician can achieve financial gains from referral by (a) having total or partial ownership of a physical therapy practice, (b) directly employing physical therapists, or (c) contracting with physical therapists. The most common form of referral for profit relationship  in physical therapy is the physician-owned physical therapy service, known by the acronym “POPTS.”

In recent years, facing pressures of decreasing revenues and increased costs of malpractice  insurance premiums, and aided by weakening of federal antitrust legislation, physicians have  accelerated the addition of POPTS to their practice. APTA’s push to achieve autonomous practice and direct access are in conflict with the medical profession’s renewed push to subsume physical therapy as an ancillary service for financial gain.

APTA in its white paper on POPTS has discussed the effects of POPTS on consumers to include –

1. Conflict of Interest - Having a financial interest in other services to which a physician refers a client may cloud the physician’s judgment as to the need for the referral, as well as the length of treatment required. Similarly, the physical therapist employed by a physician may face pressure to evaluate and treat all patients referred by the physician, without regard to the patient’s needs.

2. Loss of Consumer Choice. In addition to inherent conflicts of interest that exist within  POPTS, physician referral to services within his/her office, or to those with whom he/she may  have a financial interest, limits the consumer’s right to choose his/her physical therapist.

3. Economic and Financial Harm - Studies have demonstrated that POPTS arrangements have a significant adverse economic impact on consumers, third-party payers, and physical therapists. In a study examining costs and rates of use in the California Workers’ Compensation system, Swedlow et al reported that physical therapy was initiated 2.3 times  more often by the physicians in self-referral relationships than by those referring to  independent practices. Mitchell and Scott in another study revealed greater utilization of physical therapy services by the joint venture clinics, rendering on average about 50 percent more visits per year than their counterparts. It also concluded that visits per physical therapy patient were 39 percent higher in joint venture clinics.

On17th June, 2011, KNBC Los Angeles's Frank Snepp, investigative reporter exposed POPTS clinics in his story. Some of the comments from his report include –

• Nationwide data from six months in 2002 showed that 91 percent of physical therapy billed by physicians and allowed by Medicare resulted in 136 million in improper payments, according to the US Department of Health and Human Services.
• In many cases, the department found there was insufficient proof that licensed physical therapists had performed the treatment or that there was a “plan of care” to document the need for treatment.
• According to California statutes, physical therapists cannot work for medical corporations owned by doctors any more than pharmacists can.
• The purpose behind the laws, according to legal experts, is to ward off conflicts of interest, since a doctor who employs such providers might send patients to them simply for personal profit, not for health reasons.

In the White Paper, APTA concludes that recognizing the incongruity of POPTS and APTA’s Vision 2020 that embraces the autonomous practice of doctorally prepared professionals, the inherent conflicts of interest  existing within POPTS, the loss of the patient/client’s right to choice of provider, and the  increased cost to society identified resulting from POPTS, the American Physical Therapy  Association reaffirms its decades-long position of opposition to physician-owned physical  therapy services.

Assembly Bill 783, sponsored by Assembly Member Mary Hayashi and strongly supported by the California Medical Association, was introduced on February 17. The legislation would amend the California Business and Professions Code and the California Corporations Code to specifically add licensed PTs to the list of "healing arts practitioners" who may be employees of medical or podiatric medical corporations. The legislation is in response to an opinion issued by the State of California Legislative Counsel in 2010 that stated that based on existing law it is illegal for PTs to be employed by any professional other than naturopaths. In its opinion, the Legislative Counsel confirmed that, because the existing California Corporations Code does not specifically include PTs on the list of those who may be employed by a medical corporation, a PT is prohibited from providing physical therapy services as an employee of a medical corporation, podiatric corporation, or chiropractic corporation. This ruling means that PTs in these employment situations may be subject to discipline by the Physical Therapy Board of California.

Despite massive opposition from the California Chapter concerning such arrangements, and recent high-profile media coverage, the Assembly passed AB 783 May 12 by a vote of 66-0 (with 12 abstentions). The bill did not pass the Senate voting on 13^th June 2011 but has been put up for reconsideration and will be voted again on 20^th June 2011.

California Private Physical Therapists Group, a subsidiary of CAPT have called upon their members to fax, call and be present on 20^th June 2011 at the Capitol.

WHAT YOU CAN DO –

Download the Documents from -  http://www.cppsig.com/noonAB783.doc,

On the documents:

1. Enter your name in the FROM field at the top.

2. Delete Yellow Highlights (Word doc only) and Sign the bottom and fill in your name, credentials and address (address is important too).

3. If you want to format it for your letterhead that will get more attention from the Senators.

4. Fax them

5. Call them

For Phone Calls

Here are the names and phone numbers.  If they ask questions, simple state the information that is contained on the fax.   

Senator Mark Wyland
Phone: (916) 651-4038
Fax: (916) 446-7382

Senator Ellen Corbett
Phone:(916) 651-4010
Fax: (916) 327-2433

Senator Ed Hernandez
Phone: (916) 651-4024
Fax: (916) 445-0485

Senator Lou Correa
Phone: (916) 651-4034
Fax: None available

Senator Juan Vargas
Phone: (916) 651-4040
Fax: (916) 327-3522

Senator Mimi Walters
Phone: (916) 651-4033
Fax: (916) 445-9754

Senator Curren Price
Chairman,
Phone: (916) 651-4026
Fax: (916) 445-8899

Senator Bill Emmerson
Vice Chair,
Phone: (916) 651-4037
Fax: (916) 327-2187

Senator Gloria Negrete-McLeod
Phone: (916) 651-4032
Fax: (916) 445-0128

Remember only 5 YES votes are needed for the bill to be passed and the CMA lobbyists (more than 8 of them) have been working overtime to convince the senators to vote for their bill.

If you are not in California, but have friends there who are training as or practicing as physical therapists in California, ask them to send the faxes first thing on Monday... 

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