The advantages and disadvantages of Physician providing therapy services in their facilities have been hotly debated over the years.  The debate was recently renewed when President Obama included a measure in his FY 2015 budget to end the exception in the Stark Law that permits physicians to offer rehabilitation services in the same facility where they perform surgeries.   Although Obama’s FY 2015 budget did not pass, the debate over the value of POPT continues to rage. Physical Therapists are caught in the middle of these arguments when deciding whether or not to accept employment with these facilities, commonly referred to as POPT or physician-owned physical therapy clinics.

What you need to know

Before you decide whether or not to accept employment in a POPT, you need to consider the complex issues surrounding POPTs. We’d like to help by outlining the following arguments for and against these clinics.

Advantages of working as a physical therapist in a POPT Clinic.

The American Academy of Orthopaedic Surgeons maintains that patients have freedom to choose where they want to have therapy and should not be criticized for choosing the convenience of receiving treatment in the same facility where they had their surgery.  They tout the benefits of such practices in streamlining communication between the physician, therapist, and patient. Therapists who work in POPT appreciate the following:

  • Ease of referrals. Working directly for a physician can help ensure a strong referral system for physical therapists. This way, therapists can spend more time doing what they love—treating patients—and less time trying to find new customers. Also, when therapy services are in-house they’re more convenient for patients, helping to reduce cancellations and no-shows.
  • A team environment. Patient care can become fragmented when patients must travel in between facilities for care. In-house therapists can meet regularly with doctors to discuss patient treatment plans, reinforcing their place in a patient’s continuum of care.
  • Competitive Compensation. In general, Physical Therapists who work for physician owned practices receive good compensation packages. The shortage of physical therapists forces POPT clinics to offer competitive salaries and other incentives to attract talent to their facilities.

Drawbacks of employment as a POPT therapist.

Therapists who choose to work for POPT will have to live with the following controversies that surround these practices:

  • Legal Issues: Physicians who provide rehabilitation services do so by using an “in-office ancillary services exception” (also referred to as the ioas exception) in the Physician Self Referral Law. This regulation, commonly known as The Stark Law, is a part of the Centers for Medicare and Medicaid Reimbursement Regulation. In summary, this law prohibits a doctor from referring patients to a clinic for services that will result in his or her own financial gain. The ioas exception has come under attack because it was originally granted for patient convenience for lab work or x-rays. Opponents argue that the current use of this extension for therapy services goes well beyond the original intent of the law.
  • Future Job Insecurity: As proposed in Obama’s FY 2015 Budget, the day may come when the ioas exception is eliminated.  Elimination of this exception will force physical therapists that are currently employed by POPT to start clinics of their own, or find a new employer.
  • Potential Conflicts of interest. An unethical physician owned practice could require extensive, unnecessary care to add to their financial gain. Therapists who work in POPT clinics may find themselves stuck in unethical situations where they feel pressured to over-utilize therapy services to promote profits, rather than patient wellbeing. All healthcare settings have a potential for abuse, the self-referral aspect of a POPT makes this concern especially relevant.
  • Autonomy of the physical therapy profession. Just as patients can shop around and request second opinions when deciding on a physician, patients have the same freedom when it comes to choosing where to receive physical therapy. The American Physical Therapy Association (APTA) opposes POPTs because they feel these practices limit a patient’s freedom to choose the physical therapy provider of their choice. The APTA wants to support private physical therapy practitioners and enable them to compete fairly for referrals against other therapy providers.  This issue is related to direct referral for physical therapy services. Physical therapists have autonomy in 49 states to see patients with out a physician’s referral.  Working directly for a physician gives the message that physical therapists are dependent upon a doctor’s referral to provide treatment.
READ  Technology and Innovation in Physical Therapy: Robotic Device Use in Ankle-Foot Rehab

In addition, the following articles further explore these advantages and disadvantages: PTPN: Referral For Profit AAOS: The Truth Behind APTA’S Campaign Against POPTS

Ultimately, whether or not to work in a POPT is a matter of circumstance and preference.

Both private practice and POPT can be great places or difficult places to practice PT, depending on the integrity of the management.  Rather than ruling out an employment opportunity based on a stereotype of the facility, take time to interview the company that you will be working for and determine for yourself if it is the right decision. As a therapy professional, you must consider the possible outcomes of your employment choice and the opinions of professional organizations, as well as the law.

What’s your experience?

Have you worked for a Physician-Owned Physical Therapy Clinic?

Would you recommend taking a job with one? Why or why not? Please share your comments below. Thanks!

Investigating your employment options?

If you’re a therapist who is evaluating your employment options, myPTsolutions can help you find your next assignment. We place physical, occupational and speech therapists in both permanent and contract assignments. Our recruiters will work with you for placement best matched to your skills and experience. To learn more, contact myPTsolutions today.

Working in a Physician-Owned Physical Therapy Clinic: Arguments For and Against was last modified: by

Comments

comments

  1. Avatar
    September 25, 2019

    Thank you for the above. Can an MD work as an employee or contractor in a PT- owned PT office? I am an MD and considering an association with a local PT.

  2. Avatar
    August 29, 2019

    Thanks for this helpful information on what it’s like to work in a POPT clinic. This is definitely a unique situation compared to working in solely an outpatient PT clinic, and it’s great to know the differences. Your efforts are much appreciated!

    • myptsolutions
      August 29, 2019

      Adrienne, Thank you for your comment. We strive to provide value-added information. Glad you found it helpful.

  3. Avatar
    June 3, 2018

    can a physical therapist hire a physician

    • myptsolutions
      June 5, 2018

      Hi there – we are not sure on the laws of conflict of interest and recommend consulting with the APTA. http://www.apta.org 800/999-2782
      Thanks for reaching out to us!
      myPTsolutions

  4. Avatar
    February 8, 2018

    In a Physician owned practice, does a PTA still require Direct Supervision from a PT or is the MD whose office it is enough for supervision?

    • Avatar
      April 19, 2019

      A PTA always requires supervision from a PT in any work environment.
      “Supervision of the Physical Therapist Assistant: The Physical Therapist Assistant shall perform specific physical therapy duties under the supervision of a Physical Therapist who is properly CREDENTIALED IN THE JURISDICTION in which the PTA practices.”

  5. Avatar
    September 5, 2017

    Kyle, you are correct in regard to the DC and incorrect in relation to the Dermatologist. DCs, DPTs, DPMs, and ODs are all non-medical/allied health clinical doctorates. A dermatologist is a physician specialist, and in fact is one of the most competitive out of all of the physician specialties. Hope this clears things up.

  6. Avatar
    February 15, 2017

    I love working in physician owned clinic. I have great relationship with the physicians. If i think they need xrays or medication i go and talk to the doctor. No waiting on the phone for 45′. If a patients condition deteriotes i have direct acess to the doctor. I actually have more freedom. My experience may be unusual.

    • Avatar
      March 2, 2017

      Thanks for sharing your experience Adrian. It’s great to hear both sides of the story.

  7. Avatar
    June 11, 2016

    Working for a POPTS was an eye-opener for me. I had patients that were having difficulty financially getting to therapy and had clinics close to their home. Their physician, who was a POPTS owner told them that they could only go to their physical therapy clinic. Their clinic was located 35 miles away from the patients home.

    In addition, I have received patients from their referring physicians that wanted therapy but their condition would not be reimbursable or for not very long, so they send them to our private practice to protect their image by not refusing a referral, without regard to another non POPTS facility having little or no financial gain from their working with the client.

    The POPTS claim that they want to keep a “close eye” on the patient by having them in their clinic. I never had a physician contact me about any of my patients, much less return my phone calls. It is purely an ancillary service to line their pockets and diversify their income sources under a more difficult insurance payor system.

    I would recommend not taking a position with a POPTS because physical therpists are not respected for their input on the best treatment for their clients, at least not where I was. In addition, making physical therapists subservient to physicians is not a proper place for a Doctor of Physical Therapy, in other words, a Doctor of the musculoskeletal system to be relegated to. We are no different than any other Dr. in healthcare, such as a Dr. of Chiropractic, Dr. of dermatology, etc.

    In addition, the hospital groups force their referring physicians to refer to their in house physical therapy departments. This is not a open market system to allow the patient to choose where to go for therapy. Without a free market system there is not an incentive to improve your quality of care because your patients will come regardless, out of either lack of knowledge about their options, or due to the physicians being forced to refer in-house. This is simply large corporation control of a market and not in the best interest of a free market system for healthcare.

    Please do not take this information as being negative. I am stating the facts.

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