Unintended Consequences

When the name of the person who created the laws admits that it created more opportunities than it sought to halt, you know you have problems.

Forbes magazine recently interviewed Pete Stark about impact of the self-referral laws that are in place-Stark I, Stark II, and now for those anxiously awating this stark (pardon the pun) sequel-Stark III.  Mr. Stark (who by the way has actually been nationally recognized for his “support” of physical therapist as a “friend of PT”) admits that this probably created more loopholes, niche industries, and opportunities to commit more self-referral than it ever prevented.  He appropriately likens it to the tax law whereby people will always find a way around it.  This is a must read and a clear lesson for how not to fight POPTS unless you are unequivacably banning all aspects of it (like pharmacy, Missouri, and S. Carolina).

This blog a few years ago pointed out something that we did as a profession and industry that has had the same impact.  Several physical therapy association and lobbyists fought and successfully obtained the right for physicians to get a medicare provider number for the physical therapists who work under an employed or arrangement in a physician office-the same Physical Therapy Private Practice (PTPP) number that PT’s in independent practices obtain.  The theory being that CMS can then “track” utilization.  Guess what?  It has been embraced by physician practices and gives them more flexibility in terms of supervising than the “incident to” practices that were the only prior mechanism for billing PT in an MD’s office.  As to the tracking of data of POPTS?  It has gotten harder not easier. Now the PTPP billing in an MD office and a PT in independent practice are in the same category and cannot be differentiated under data analysis.  To make matters worse, CMS has seen the explosive growth of PT and continues to regulatory crush us with Caps (except a hospital of course), exceptions processes, superimposed rules (e.g. 8 minute, group therapy), and overall reduction in reimbursement (can you say 10% starting Jan 1). 

Many believe the explosive growth is due to POPTS and increased usage of PTPP billing in MD offices.  Unfortunately, this cannot be determined by data analysis under the present system and remains conjecture.

Let’s please don’t honor Mr. Stark anymore for his “support” or being a “friend of PT” unless it is coming from health care lawyers associations or the AMA.

Thoughts?

 

Larry@physicaltherapist.com

Comments

[sean]

Well it sounds like a perfect example of the road to Hell being paved with good intentions.
However, based on your statements above, I feel you have contradicted yourself with your comments on Mr. Stark. As we discussed in another thread regarding outcomes measurements, you strongly support measuring without full knowledge of what new pitfalls that may bring.
You can't have it both ways - implement something and hope it benefits patients and PTs (your argument for outcomes measurement), because it's better than nothing. Or criticize the fallibility of the current system and do nothing. If we draw the parallel between Stark and outcomes measurement tools, which you strongly support using, your points seem to be on opposite sides of the arguments. (My position as stated in that thread is that the outcomes tools available today are flawed and easily subverted. In addition, since some clinics market their own, I feel there is a conflict of interest which allows for the skewing of their clinics to being measured as better than average).
In hindsight, it’s easy to see the Stark laws were more harmful than beneficial to PTs in private practice. I don’t know if you were in practice at the time they were implemented, but I would venture to guess that if you and I were, we would have seen that few PTs, at the time, objected to the seemingly favorable legislation. Is any PT on the record with objections to the Stark Laws at or near the time of their inception? If so did they predict how the Stark laws could have been subverted?
Is this not then “a clear lesson for how not to fight (against poor insurance reimbursement) unless you are unequivocally banning all aspects of it?”
I don’t believe that is your opinion based on your other posts, but I am interested in your current thoughts in light of what you posted here.
I apologize for the argumentative tone of my post. But I believe we are going down the same road we did with Stark when pushing for the use of outcomes measurement tools. Only at first glance, the outcomes tools seem much more flawed. Maybe this post would best be moved to the outcomes measurement thread.