APTA and POPTS-II

Let me start by stating that this is my opinion. Nothing more; nothing less. I hold some positions in our professional associations that might serve to discourage me from expressing my opinion freely, but then I am reminded by several good friends in the profession that I actually have an obligation to express those opinions.

There are apparently several of you out there that want to hear them.

If you don't want my opinion, you should stop right now. Maybe morbid curiosity will compel you to keep reading but be forewarned: you might have your own ideas tweaked a bit. And you might hear some truths that you aren't ready to acknowledge.

So, here goes.

Last week was a bad week for me (not that it should concern you). I had a huge fight with a dear friend over my stance on the POPTS issue and then a patient told me a long story about her physician (the owner of a POPTS) that insisted that she see "his" physical therapist (non-caps intentional).

I was frustrated, angry, disturbed, and defeated. I was ready to quit.

So I wrote a long blog about all that and sent out a note that there was a new blog on my site. After mowing my yard Friday evening, an event that always gives me time to think things through, I decided to pull that blog. Some of you read it before I held it out for further editing this morning. That's OK. Some of you wondered out loud what happened.

In any case, let me make a couple of things really clear.

I am against POPTS situations. I realize that certain of you feel compelled to stay in those work situations because of finances and/or practice opportunities. Let's face it: if you want to see orthopedic patients, your only choice in some areas seems to be to work in a POPTS.

I also acknowledge and will shout from the mountaintops that we are all Physical Therapy professionals. Period.

I will state for the record that I want every Physical Therapy professional in the country to be an involved member of APTA. Every single one of us.

Membership should not be predicated by a work situation that I find favorable, not that you were asking anyway.

But, as an association, it is my personal opinion as a dues-paying member of APTA that we should, as an association, pursue an agenda that eliminates POPTS from the list of practice opportunities.

And that is nothing new, for, as you will see, APTA agrees.

To wit:

APTA's official position:

Opposition to Physician Ownership of Physical Therapy Services

Whereas, The American Physical Therapy Association Vision for Physical Therapy 2020 supports autonomy of physical therapist practice and judgment;

Whereas, Financial relationships and incentives between a patient’s/client’s physician and physical therapist represent an avoidable conflict of interest, reduce consumer choice, and diminish professional autonomy;

Whereas, There is evidence that such avoidable conflicts of interest affect delivery of care, utilization of services, and aggregate cost of treatment, and that patients/clients and payers would benefit from the elimination of such conflicts;

Whereas, In recent years, ownership of physical therapy services has been marketed to physicians as a means to recover revenues lost as a result of managed care, which has led to an accelerating trend of physician ownership of physical therapy services and referral of patients/clients to these services;

Whereas, The American Physical Therapy Association (APTA) opposes physical therapy services provided in practice settings in which the physician profits as a results of the referral;
Whereas, Numerous professions have successfully regulated ownership of their professional services through state legislative provisions; and

Whereas, The APTA, through its Goals and Objectives and other documents, has identified and implemented comprehensive legislative strategies to ensure the public’s right to direct access to physical therapy;

Resolved, That the American Physical Therapy Association supports the development of strategies to secure enactment of federal and state laws and regulations that prohibit physician ownership of physical therapy services. [RC 30-03, RC 31-03]

Seems pretty clear to me.

And from the "APTA Guide for Professional Conduct" section on "Interpreting Ethical Principles:"

PRINCIPLE 9
A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
D. A physical therapist may not participate in any arrangements in which patients are exploited due to the referring sources’ enhancing their personal incomes as a result of referring for, prescribing, or recommending physical therapy. See Sections 2.1.B, 4, and 7.

Again, pretty darn clear.

Fran Welk, PT, DPT, MEd reported on an APTA "White Paper" position statement on POPTS:

"APTA opposed the ownership of physical therapy services by physicians and supported federal and state laws and regulations that prohibit physician ownership of physical therapy services. That was unanimously passed by the House of Delegates, made up of more than 400 people. A unanimous passage of any resolution in a body that size is pretty remarkable."

Dave Mason, APTA Vice President of Government Affairs says that, in a nutshell, APTA believes that POPTS are just wrong.

"There was a law passed that was supposed to prevent [POPTS]. To the extent that it is not preventing the situation, folks are just plain getting it wrong," says Mason. [See "The Stark Laws."] "Combined with the Medicare mandatory referral requirement, this is an unbalanced playing field-even for physician offices that are set up for appropriate purposes and have legitimate concerns about patient access.

"It is impossible for there to be another solution. The [medical] doctor controls the referral, and the doctor has a financial interest in where that patient goes. So it is inherently anti-competitive," Mason says.

APTA's policy on POPTS Job listing:

APTA is opposed, as a matter of health care policy, to arrangements under which sources of referral (including physicians) stand to profit from referring patients for physical therapy. The policy, adopted by the House of Delegates, states: "The American Physical Therapy Association opposes ... participation in services that is in any way linked to the financial gain of the referral source." Financial Considerations in Practice (HOD 06-99-13-17).

Because of this policy, PT Bulletin Online does not accept job listings for positions in a practice if any physician has a financial interest in the practice and refers patients to an employed physical therapist or to a physical therapist who supervises an employed physical therapist assistant.

Draw your own conclusions, but APTA's position seems crystal clear to this member.

If the future of the profession is important to you, then eliminating POPTS situations should be on your agenda too.

And for that position, I can't apologize.

Joe B