RE: working for popts

September 24, 2000

What then do you think about the large corporate PT providers out there (ie

Novacare, HealthSouth, etc) who all started out the same way ... Working

with and associating themselves with physicians, clinics, hospitals, etc??

Where do you think we all should work??

Lindberg, PT

Message: 5

Date: Sat, 23 Sep 2000 23:04:26 -0400

Subject: Re: Digest Number 180

I assume since you have this great repore with your employer, and since you

are working so hard, that he has provided you with incentives such as a

percentage of profits--and not just a salary-- or are all of the net

profits going directly into his pockets.

I am totally against the concept of popts because it has the proven

potential for massive abuse. Look at the latest advertising campaign put

forth by uspt--ads aimed directly at physicians stating that they can

increase the net worth by setting up rehab centers with physicians and

creating a parnership with the MD's. It's all about money!!!

psmythe, P.T.

September 24, 2000

Herb,

I've been on your side of the fence, working for a privately owned private

practice. Actually, that is where I as a therapist, was abused the most.

The practice provided no CE, did not care about outcomes, and ONLY cared

about how much we billed.

I know how hard you all in private practice work. I know how the

marketplace works. Yes, clinics like the one I work for have made

competition VERY difficult. What do you think about the large corporate

providers (HealthSouth, etc) ? I think they've done more to decrease

competition in our occupation than a small orthopedic groups practice. How

hard would it be for YOU to turn down hundreds of thousands to millions of

dollars to sell your clinic??

Lastly, I was hired by the clinic I am with because of my clinical skills.

I had worked for another practice here and saw patients of the group I am

working for now. They appreciated the outcomes their patients achieved.

Yes, our clinic has begun looking at outcomes. There is a larger POPTS and

ortho group in my area that loves to flaunt their " padded " outcomes (they

are very selective as to which patients they keep in house and which they

send out to other places), so based on their outcomes, our clinic is very

competitive without being selective.

I'm sorry you resent my choice of employer. I actually envy your choice. I

would much rather be in private practice than working for someone else, but

in my market, that is just not financially feasible.

Lindberg, PT

Message: 7

Date: Sat, 23 Sep 2000 23:32:59 -0400

Subject: Re: Digest Number 180

Unfortunately it appears you TOTALLY miss the point. It is not that

it is impossible to practice ethically in a POPTS nor is private practice

inherently ethical. The point is that POPTS lead to overtreating patients

and more expensive medical intervention. That is based on independent

research by the insurance industry, not my opinion, or how I feel. Anyone

with any understanding of business would also see that this has the

tendency to reduce competition. Despite what we would all like to believe,

a lack of competition is what brings about all the complaints in Socialize

medicine. Also, the manner in which preferred provider groups are selected

tends to reduce competition as well. You may not realize the degree these

relationships negatively impact the profession unless you are outside of

these situations. OH HOW EASY IT WOULD BE!!! I use to have a doctor tell

his patients I didn't even send him a card at Christmas--he referred for

one reason and one reason only, because of the quality of the therapy

provided. There was simply no other incentive. Whenever there is another

incentive, (even if it were something like we went to the same church, or

our kids went to the same school, or whatever), whenever there are any

other incentives besides the quality of the therapy provided, quality will

eventually suffer. There is another doctor I know that refers about 90% of

his patients to our clinics. He will routinely refer to other PT practices

to determine if there is something someone else is doing better than our

clinics. He will even refer patients within our practice to specific

therapists. He is a great source of information as he can tell where we

need improvement--and if we didn't meet his expectations and other

practices did, we would lose his referrals--the sad reality of competition

in a free market.

Out of curiosity do the surgeons you work for, or for that matter,

do you know therapist who provide services better than what you

provide. Has anyone made an effort to find out? The doctors who refer to

my practice only refer because they have " comparison shopped " . I am

concerned that no matter how you " feel " about the quality you provide, you

are not really competing and hence really do not know--since there is no

" gold standard " for quality in PT, the one thing that might help gauge

quality--the knowledgeable MD that has tried different PTs, is simply

excluded in your environment. I wish you the best, but PTs that make the

choice you have made make it very difficult for those of us choosing the

hard road of competition--it is NOT a level playing field and I guess I

must admit, as a PT working in an independent practice, I simply resent the

choice you have made. And, just so long as you understand my incentive, I

make less money and work far longer hours than if I had taken a recent

opportunity to work for an orthopedic practice--now what does that make

sense?

Here is hoping you can understand the other side of this issue.

Herb Silver, PT, MBA

September 24, 2000

Dear Chris:

Ah, now that is an interesting question. If you can't work for a POPTs

where can you work. Could it be that because these relationships are

allowed to exist (POPTs) that other forms of practices can not exist? That

is EXACTLY my point. And I don't expect you NOT to work. You need to work

and I am happy that you have good employment and are able to provide a

service in the environment where you work. It is amazing how well you

stated the whole problem as I see it--I believe you are so correct that

Novacare and Healthsouth and other practices developed their businesses by

working out relationships with doctors. And I believe that was the

beginnning of what turned out to be very detrimental for our profession. I

think both Novacare and Healthsouth had dynamic business plans--from an MBA

prospective. As a matter of fact, Healthsouth would probably be a good

investment right now. But, I just don't agree with the impact Healthsouth

will have on physical therapy. Now before I upset anyone (which I am sure

I already have), there are many good PTs that work for Healthsouth that

need work. And, because their business model is so pervasive, it has

driven other providers out of business. In fact, Heathsouth seems to have

as many stores as Mcs in Atlanta! But, is this a good model for

providing good care? Again, the model does not prevent good care, but by

being a national corporation, Healthsouth is able to negotiate national

contracts with insurance companies to provide care at all of their

locations--this is independent of the quality of care provided at those

clinics (who may provide good care--my point is that the business model

does not require good care; and as Jules points out so well, making a

claim that they or anyone else provides " better " care is impossible to

prove or disprove at our level of science). You know what folks, if we had

an information system on the level that Walmart had in 1985, we could

produce more data in the next 6 months, very inexpensively, than we will

ever produce do controlled, double blind studies (if double blind is even

possible in most cases of musculoskeletal injury). So that is my goal, to

support companies that will help develop a data base that will give us

answers that will point us toward quality outcomes.

Herb Silver, PT MBA

At 11:00 AM 9/24/00 -0400, you wrote:

>What then do you think about the large corporate PT providers out there (ie

>Novacare, HealthSouth, etc) who all started out the same way ... Working

>with and associating themselves with physicians, clinics, hospitals, etc??

>

>Where do you think we all should work??

>

>Lindberg, PT

>

>Message: 5

> Date: Sat, 23 Sep 2000 23:04:26 -0400

>

>Subject: Re: Digest Number 180

>

>I assume since you have this great repore with your employer, and since you

>are working so hard, that he has provided you with incentives such as a

>percentage of profits--and not just a salary-- or are all of the net

>profits going directly into his pockets.

>

>I am totally against the concept of popts because it has the proven

>potential for massive abuse. Look at the latest advertising campaign put

>forth by uspt--ads aimed directly at physicians stating that they can

>increase the net worth by setting up rehab centers with physicians and

>creating a parnership with the MD's. It's all about money!!!

>

>psmythe, P.T.

>

>Visit our EStore at www.RehabBusiness.com

>

>Rehab Pro - The software solution to controlling your rehab business! Call

>to arrange a demo -.

>

>Rehab Management Solutions can can improve your bottom line -

September 24, 2000

Chris:

Maybe I should have said " I resent the choice you were forced to make " . I

recently was offered a very similar opportunity--I think it will be

possible for me to demonstrate there is a far better model. It will take

an incredible amount of hard work and money, but that is what I am going to

do. If that fails, I am going to move to the mountains, do home health for

Medicare, make more than I make now, and have less expenses. So

fortunately, I have a fall back plan.

Herb

At 11:16 AM 9/24/00 -0400, you wrote:

>Herb,

>

>I've been on your side of the fence, working for a privately owned private

>practice. Actually, that is where I as a therapist, was abused the most.

>The practice provided no CE, did not care about outcomes, and ONLY cared

>about how much we billed.

>

>I know how hard you all in private practice work. I know how the

>marketplace works. Yes, clinics like the one I work for have made

>competition VERY difficult. What do you think about the large corporate

>providers (HealthSouth, etc) ? I think they've done more to decrease

>competition in our occupation than a small orthopedic groups practice. How

>hard would it be for YOU to turn down hundreds of thousands to millions of

>dollars to sell your clinic??

>

>Lastly, I was hired by the clinic I am with because of my clinical skills.

>I had worked for another practice here and saw patients of the group I am

>working for now. They appreciated the outcomes their patients achieved.

>Yes, our clinic has begun looking at outcomes. There is a larger POPTS and

>ortho group in my area that loves to flaunt their " padded " outcomes (they

>are very selective as to which patients they keep in house and which they

>send out to other places), so based on their outcomes, our clinic is very

>competitive without being selective.

>

>I'm sorry you resent my choice of employer. I actually envy your choice. I

>would much rather be in private practice than working for someone else, but

>in my market, that is just not financially feasible.

>

>Lindberg, PT

>

>Message: 7

> Date: Sat, 23 Sep 2000 23:32:59 -0400

>

>Subject: Re: Digest Number 180

>

>Unfortunately it appears you TOTALLY miss the point. It is not that

>it is impossible to practice ethically in a POPTS nor is private practice

>inherently ethical. The point is that POPTS lead to overtreating patients

>and more expensive medical intervention. That is based on independent

>research by the insurance industry, not my opinion, or how I feel. Anyone

>with any understanding of business would also see that this has the

>tendency to reduce competition. Despite what we would all like to believe,

>a lack of competition is what brings about all the complaints in Socialize

>medicine. Also, the manner in which preferred provider groups are selected

>tends to reduce competition as well. You may not realize the degree these

>relationships negatively impact the profession unless you are outside of

>these situations. OH HOW EASY IT WOULD BE!!! I use to have a doctor tell

>his patients I didn't even send him a card at Christmas--he referred for

>one reason and one reason only, because of the quality of the therapy

>provided. There was simply no other incentive. Whenever there is another

>incentive, (even if it were something like we went to the same church, or

>our kids went to the same school, or whatever), whenever there are any

>other incentives besides the quality of the therapy provided, quality will

>eventually suffer. There is another doctor I know that refers about 90% of

>his patients to our clinics. He will routinely refer to other PT practices

>to determine if there is something someone else is doing better than our

>clinics. He will even refer patients within our practice to specific

>therapists. He is a great source of information as he can tell where we

>need improvement--and if we didn't meet his expectations and other

>practices did, we would lose his referrals--the sad reality of competition

>in a free market.

>

> Out of curiosity do the surgeons you work for, or for that matter,

>do you know therapist who provide services better than what you

>provide. Has anyone made an effort to find out? The doctors who refer to

>my practice only refer because they have " comparison shopped " . I am

>concerned that no matter how you " feel " about the quality you provide, you

>are not really competing and hence really do not know--since there is no

> " gold standard " for quality in PT, the one thing that might help gauge

>quality--the knowledgeable MD that has tried different PTs, is simply

>excluded in your environment. I wish you the best, but PTs that make the

>choice you have made make it very difficult for those of us choosing the

>hard road of competition--it is NOT a level playing field and I guess I

>must admit, as a PT working in an independent practice, I simply resent the

>choice you have made. And, just so long as you understand my incentive, I

>make less money and work far longer hours than if I had taken a recent

>opportunity to work for an orthopedic practice--now what does that make

>sense?

>

>Here is hoping you can understand the other side of this issue.

>

>Herb Silver, PT, MBA

>

>Visit our EStore at www.RehabBusiness.com

>

>Rehab Pro - The software solution to controlling your rehab business! Call

>to arrange a demo -.

>

>Rehab Management Solutions can can improve your bottom line -

September 25, 2000

Great arguments! It's about time PT's acknowledge our worth. In Wisconsin,

the laws have changed, (and I'm curious if it is the same in other states),

PT's can now be part of a service corporation. In other words, we can own

MD's, instead of the other way around which has only belittled our

profession to be considered " supporting staff. " This, of course, also

presents the opportunity to " partner up " with MD's which leads to other

exciting arguments, I'm sure. What is the general PT perception on the S.C.

development? My opinion is that this is an excellent opportunity to

eliminate the descriptor of " supporting staff. " PT's are routinely the most

profitable departments in hospitals. It's high time we reassess our worth

and become players in the world of ownership. For any of you questioning

how this can change our future, let me ask you this. Who has the most impact

on any decision in the work environment? The owner or an employee?

Re: Digest Number 180