Podiatrists Jump onto the POPTS train

I just came across this article, from Podiatry Today, February 2007 (http://www.podiatrytoday.com/article/6695) outlining how to develop and bill for physical therapy services in a podiatric practice. Nice review of the Stark legislation and the corruption of same. The author is a Texas grown podiatrist now living in Kentucky. Rob & Larry, what's up?

PT will be coming to your local foot clinic soon.
Britt

Comments

[Eric Robertson]

First, thank you for scouring the web and finding some good stuff, Britt. Now, while I find it chilling that there are articles which so carefully dissect the complexities of becoming a POPTS group, it's not necessarily unexpected. That said, there were some assumptions in this article that bothered me:

1. Reasons 1-4 for Why PT should be added to your practice talk about the reasons physician oversight is important. The absurdity of this is well discussed in our circles, so there is no need hammering on it. But, how can we communicate our views on this to physicians. It seems any anti-POPTS piece I've seen written by a physician discusses the same, unsubstantiated points. We, as a profession, are not getting our point across.

2. "Giving patients the option to choose the site of their care is vital and when patients get a choice, most will choose the site with the best outcomes and the most convenient site for them." Oh really? Where, exactly, is the choice given the patient in this situation?

3. "one would need to add a $12 to $15 per hour physical therapy assistant who will be the primary face of your physical therapy program." Wow! While true in some places, this doesn't speak well to our preservation as a profession. Perhaps the next step would be legislation by a medical group to allow PT Assistants to work under direct supervision of a physician. Perhaps not, but this assumption seems ominous to me.

4. "room as small as 300 square feet will do" Sad.

5. "Your profit potential will depend mostly on the number of referrals you put into your physical therapy program" At least we don't have to spell out where the conflict of interest lies!

6. "Assume those five patients attend all 12 visits within a given month (three visits per week for four weeks)." I am probably assuming too much here, but I really feel like manual-based, progressive minded PT's do not actually see patient simply to fill out a prescription. I would like to get them better in far fewer visits (despite the economic penalties involved, its best for the profession to do so), but my problem with this lies in how we have failed to educate our referral sources and the general pubic of our ability to determine the appropriate treatment needed. Again, we are not getting our point across.

My summary: This article makes it seem really easy to earn another 60% on the bottom line for a podiatry clinic. It makes me feel like a used commodity rather than a professional. Our profession needs to really improve our collective marketing efforts in the form of massive campaigns that can reach millions of people repeatedly. Have you heard the new radio spots for the Orthopaedic Surgeons? They are great, air on ESPN Radio, and probably cost a ton. I have no idea of the economics of such a campaign, but we should examine it.

[britt smith]

Eric,
I agree with you comments, and last, but certainly, not least, WE NEED TO DEVELOP A NATIONAL ADVERTISING/PROMOTIONAL CAMPAIGN.
The AAOMPT is providing leadership on developing press releases and campaign tactics. APTA is attempting to guide and inform legislators about this mounting threat to quality patient care. We can no longer retreat into our comfortable clinical settings.
Thanks,
Britt

[Larry Benz]

Thanks Britt for some hilarious Super Bowl weekend reading. My favorite gems:
-the complete revisionist history of the physical therapy profession
-list of PT necessities-Ultra lotion 5 liters $9.00
-how the author got started. He found the best PT in the area who had "nothing to lose and everything to gain" (most PT's are clamoring to look at feet all day-especially those in Somerset, KY)
-"services under this plan of care must be provided by someone formally trained in physical or occupational therapy"
-"it reduces errors and over utilization"

Britt: you have had some funny material in this blog but this surpasses anything that you could make up.

Larry

[britt smith]

Larry,
I thought you might find this article amusing. I can't wait to be approached by local podiatrists. Britt

[rick shutes]

Our podiatrist friends are looking to their orthopaedist brethern for economic guidance. In fact, they've simply lifted the language directly from the AAOS position paper on POPTS -
http://www.aaos.org/about/papers/position/1166.asp
It's a conundrum for sure.
But, remember the "Golden Rule" -
The insurance companies and employers have the gold. We've got good data, but we need more press.
The squandering of precious healthcare resources needs to become our mantra.

[Herb Silver, PT, ECS, OCS]

I have watched this trend in Georgia pretty much come and go in several podiatry clinics. The podiatrists didn't pretend they were doing it for patient benefit but simply because they "needed to improve [their] bottom line". These same podiatrists went from referring a few patients out to PT to filling up a clinic with over 20 patient visits a day. They hired a management company out of New York to do the billing, hiring, etc. Fortunately, even though they billed over $100 a visit, they were not reimbursed very well. The management company made money, the podiatrists did not--it was only a headache for them. It ended up with them asking me if I could come in once a week to evaluate patients so that a PTA could treat all of these folks when I wasn't there (somehow I never found the time). It was very difficult for them to get out of the contract but they finally did. Of 10 podiatrists that entered in to these deals, 2 are still going. Podiatrists are also trying to get into doing electrodiagnostic testing. It is true that many electromyographers don't do a very good job on feet so there are some appropriate patients--it was useful in one clinic where they had data to help determine when a release of the tarsal tunnel was appropriate vs. conservative therapy (exactly like screening for carpal tunnel). But once they discovered they could make a lot of money just ordering EMGs, they over utililzed the service.

[Sean]

So is it just my experience, or are Podiatrists one step above Chiros when it comes to the % who actually have ethics? I have no idea about their training, but I have had an experience.
I was working in a small town, in a new state and needed some orthotics. I knew a Podiatrist and made an appointment to get casted. So I'm laying on my face with her secretary performing quite an awful job of paper macheting my feet, when it hits me what a huge waste of $ this will be.
This brings me to an even bigger question: why the heck can a "doctor" train any schmo off the street to do something under his supervision and its completely legal to charge for it. However if I have a tech lead a Medicare patient thorough exercises (and charge for it 97110), its fraud???

[Triston]

I have recently opened a private PT practice, and being the thorough "marketeer" that I am, I wanted to stop be a local podiatrists office. This was two days after the article mentioned in this blog came across my desk, which I had read. Wouldn't you know that the podiatrists that I sat down with actually presented the article to me, which I promptly stated that I had already read. I also explained the inaccurate details of the article and difficulties in starting a "POPTS" in New Jersey. He was impressed that I was familiar with the article, and who knows, maybe he'll reconsider. I also came across another issue in my public relation travels that I would like to discuss. I was asked to present at a Rotary club meeting, yet was later informed that the rotary club had a "conflict of interest" due to the fact that a local personal trainer was going to speak the week before me on, "The prevention AND TREATMENT of low back injuries". This heated me to no end, so I professionally and promptly explained that this should not be a conflict of interest due to the scope of our and their practices. I sent them the link to the NSCA and CSCS website to provide them with a clear statement regarding the limitations of a personal trainer. Bottom line, like others have stated in this blog, the PT profession has to clearly define to the public our professional boundaries and the limitations of others for our profession to be successful, and to protect the Health and Wellness of the general public.

[britt smith]

Triston,
Your experiences point up a growing need to 'get the word out' about what PT is all about (and what it IS NOT ALL about, e.g. POPTS). The podiatrist received some one-on-one time getting educated by a PT with a message. The personal trainer needs to be scrutinized if they are putting them selves out as 'other PTs'. We've had cases in Colorado of personal trainers using the PT (for personal trainer), which is illegal. Push the message with the Rotary Club. Present on a related topic (low back pain & athletes, or dance or work) and show them the QUALITATIVE difference. Thanks,
Britt