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.
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.