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
