Foot Owned Physical Therapy Services

All referral for profit (RFP) situations restrain trade, limit consumer choice, etc. However, some arrangements just seem worse than others at face value. Some of you may have already seen this, but the February edition of Podiatry Today published a 'how to' article on FOPTS ('foot' owned physical therapy services). I would put this right up there with COPTS (chiropractic owned physical therapy services)...I just can't imagine any physical therapist subjecting themselves to these environments. PT post bunionectomy anyone?

Fran Welk, Chair of the APTA Task Force on Referral for Profit, did a nice job responding to this article in a letter to the editor. The response of course from the podiatrist was the typical smokescreen verbiage you always hear in defense of RFP arrangements. Note the reference the podiatrist makes to himself as a 'physician' in his response. Sorry, you're still a FOPTS in my book.

RFP is a multifaceted issue to be sure. However, it would be interesting to know if the rates of employment in RFP settings immediately following graduation are higher in some educational programs compared to others. It just seems to me that the fact that there is a supply of PTs willing to rub feet all day and be exercise lackeys for chiros is at least partially a function of our inability to persuade them early in their professional careers that RFP arrangements are not consistent with a professional’s behavior. Do we even condone them in some programs as a way to help pay of school debt? What about educational programs that affiliate with RFP settings for their clinical education? In many ways, the onus of solving the RFP dilemma remains with us. Where there is no supply, there is no RFP.

John

Comments

[Selena Horner]

The rebuttle to Moore are the questions: During the provision of physical therapy services, how are patients classified, how are outcomes measured, how frequently are outcomes measured, what data for comparison is utilized to ensure better outcomes are being obtained?

A polite reminder that no literature exists to support the thought that frequent one-on-one communication between a physical therapist and a referring physician improves the quality of care. Physical therapists generally function quite independent of physicians. Based on a qualitative study analyzing qualities of "expert" therapist by Resnik, "expert" therapists do not rely heavily on referrals for information, but instead are very patient-oriented in their approach.

Welk has a perfect opportunity with information provided directly by a source that owns a referral for profit to learn how much better the services provided by that source really are. Are the referral for profit service outcomes truly better?

[Jon Newman]

Hello all,

I tried to find out whether a particular place in WI was a POP and I couldn't tell from the information available on their website.

I'll update my comment from the POPs thread. Is there a publicly available resource that lists RFP facilities (of all flavors)?

I think such a list would help people seeking jobs to narrow down the facilities to which they wish to apply.

It would also make it easier to track changes in the number of these places.

Thanks

[John Ware]

Did anyone else happen to go back and read Moore's original article describing how to get around Stark? He actually refers to the states that have outlawed POPTS as "circumventing" Stark. Unbelievable. Did anyone tell him that the Supreme Court in SC ruled in favor of the State PT Board there? Also, his response to Fran Welk about who makes the PT decisions implies that the PT is autonomous in these FOPTS, but in the original article he states that the "doctor" can decide when another modality is indicated. This guy's talking out both sides of his mouth.
John

[Jason Silvernail]

John-

Right on, as usual here. These arrangements are typically described as being advantageous because of communication. What they really mean is that the referral source (Ortho, Pod, whatever) feels that they need to be making decisions about the patient's care, so they need to be close by.

I guess APTA's idea is that the patient and therapist should decide together about the therapy, regardless of what the referral source thinks. This is the ownership of professional services issue, again rearing it's head.

Middlemen are never good for the consumer, and this is no exception.
Jason.

[Dan Pinto]

I would find this action on the part of physicians or podiatrists a little less repugnant if they didn't try to cloak their greed with the notion that they will better supervise rehabilitation. Do you think a clinician who doesn't have enough time to spend more than 5 minutes with a patient is going to somehow find the spare time to discuss patients and "supervise" physical therapy. Wouldn't it be refreshing if these referral for profit places were honest for once, "we want PT in house because we would like to make more money and we find this to be a reasonable way to do it." Ahh, doesn't that feel better? I think John brings up a great point, professionals don't act that way. We should be dealing with the problem in our own profession. By the way, I bet they are also bringing pharmacy in house so they can better supervise pharmacists.

[Samuel Homola]

Fellow Health care Professionals

During the past year Dr. Gary Gorniak, Physical Therapy Program Director, and I as President of the University, have taken a long, hard look at enabling chiropractors who wish to become physical therapists to do so. We were considering chiropractors who had graduate education in the musculoskeletal area as prime candidates to receive transfer credit and testing by examination for a fair percentage of the program. The process has been exhaustive and has involved numerous meetings with chiropractic leaders and with individual chiropractors. There is no lack of interest on the part of many chiropractors.

However, what also had to be considered was the community of physical therapists and its leadership. Many serious concerns were expressed. Foremost amongst them were: Do chiropractors just wish to add PT so they can bill for it?; How do we know that a DC will transition to being a PT and start thinking like a PT?; What will this do to the reputation of the University - how will we be viewed?; Even if a DC has more imaging hours than a PT, those hours were completed with a different philosophy often far removed from our movement science emphasis.

While it is the stated interest of the University to help enable a change in careers, or the addition of a second professional license to a health care professional, it appears that the physical therapy community is not yet ready to extend such an opportunity to those who have (for want of a better phrase) "been educated outside of the traditional health science community." Therefore, we have reluctantly come to the conclusion that we cannot at this time allow any other form of credit reduction for chiropractic education.

Presently, we have admitted three chiropractors into our on-line and weekend DPT "Flex" program based out of Boca Raton, FL. Those candidates completed the regular application process, participated in the standard interview process, and were admitted into this 12-semester on-line coursework with weekend lab sessions program. Of course, where their education parallels that of our other students they will no doubt fly through that portion of their education - but they are taking all the courses required to earn the DPT degree.

To all those who took part in these meetings, I extend my heartfelt thanks and best wishes. I know the decision contained in this letter will be a disappointment to many but I hope also to have your understanding. We tried.

Sincerely,

Stanley V. Paris, PT, PhD, FAPTA
President, University of St. Augustine
1 University Boulevard
St. Augustine, FL 32086
USA
www.usa.edu