RE: FW: physician ownership

May 9, 2005

A study by the AHA, the organization with the most need and incentive to

demonstrate these exact findings, can hardly be seen as completely

credible. Hospitals are the ultimate in conflict of interest; they have

been profiting wildly from PT and other Ancillary services for decades.

Try being a regular staff hospital Physician and refer a PT patient

outside your hospital and see how far you get. What of the trend towards

Hospitals owning their own Physician groups? Guess where all those PT

referrals go - it usually isn't the little mom and pop shop down the

street.

Does increased utilization and higher costs absolutely mean lapse in

ethics, inappropriate? The US trends toward underutilization of many

services, especially PT, reference BBA of 1997. Compare our utilization

rates in the US with those in countries with universal healthcare? Our

healthcare system is set up through the third party payers and designed

to decrease utilization. United Health Providers made $800 million in

the first quarter this year.

In addition, you're making a fairly abstract comparison - the procedures

you mentioned are performed by the physician. It's totally their

decision to provide or not provide care. With PT - you are supposedly

dealing with highly educated professionals who are seeking direct

access, primary care privileges and full professional autonomy. Yet

everyone and their brother just insist that we cannot trust any Physical

Therapist to decide who they work for, let alone decide which patients

are appropriate to be under their care. Which is it? Are we capable of

making these decisions, or are we subservient morons incapable of

resisting the least pressure to do something unethical? And, this is the

same profession that not 15 years ago was falling all over itself to

sell out small practices to the highest corporate bidder. Not many were

standing back from the trough then.

In addition, there is growing data within the MGMA (admittedly, an

interested party, but you cited the AHA) to suggest that medical group

practices with ancillary services are increasingly both what consumers

are demanding, and where superior clinical outcomes are being found. The

clinical model of Multi-specialty Group practices with ancillary

services works, both clinically and yes, economically - that fact cannot

be disputed. Shall we prevent a PCP from referring to a Cardiologist

within his group? Both profit from the referral.

No reasonable Physical Therapist would disagree that exclusive PT

ownership of PT services has to be the ultimate goal of our profession,

but I am getting really frustrated by the way we are trying to achieve

it. There are a lot of good people out there whose only aim is to make a

fair wage for a fair days work. The rhetoric generally (I'm not

suggesting your note here Tom) is in many cases getting beyond that of a

civil discourse. But there's a lot of money at stake here. This is an

economic argument, not a moral one. Punitive legislative recourse (as in

SC; good luck trying to get Physician support on any bill there for the

next 20 years) simply will not work in the great majority of cases. We

simply lose political capital that we've spent decades trying to build.

The only viable option for us is to get federal direct access, so that

we can take our case directly to the consumer and compete on the same

level as everyone else. We also need to improve our ability to convince

patients to part with cash for our services. We haven't traditionally

been able to do that well, though we are slowly getting better. Remove

the incentive through normalizing market forces. Until patients know

they don't need to see a doctor, and don't have to see a doctor to get

to PT, this problem is not going away. No law can be written that can't

be gotten around by dedicated special interests. Then we can look at the

State corporation acts and try to better protect, develop our ownership

rights.

Finally, where is the patient in all of this? Isn't it about time that

we expected more of them? It is ultimately the responsibility of the

patient to ensure that they are being cared for in a manner consistent

with their beliefs and practices. It shouldn't take clinical knowledge

to know that if you go to PT, you should actually occasionally see a PT,

or that when you're better, you don't need to come anymore.

Brett Windsor, PT, OCS, COMT, FAAOMPT

Director of Ancillary Services

The Vancouver Clinic

(office)

FW: physician ownership

Hi everyone,

Many of you have read the following synopsis from PT Bulletin:

" A study

<http://www.aha.org/aha/key_issues/niche/content/effectslimitedserviceho

sp.p

df> by town University economist M , PhD, released

last

week by the American Hospital Association (AHA), concludes that the

emergence of physician-owned limited-service hospitals in Oklahoma led

to an

increase in utilization of high-cost procedures. Looking at more than

250,000 workers' compensation claims, found the incidence of

complex spinal fusion surgeries and other highly paid procedures in

Oklahoma

City and Tulsa rose following the emergence of physician-owned

facilities,

even though the number of worker injuries declined. AHA executives noted

that the findings raise " serious concerns about conflict of interest,

implications for patient care and unnecessary increases in health care

spending, " and urged Congress to make permanent the ban on physician

referral to new limited-service hospitals they own. "

For those that are still defending physician owned practices of any

type,

here is yet another study that is showing physician ownership =

unnecessary

increased in health care spending. Please think about it. As the

evidence

mounts, can we as a profession continue to support it??

One caveat, I do understand that PT owned rehab practices may be just as

guilty of over utilization and overcharging. Let these studies continue

to

be a wake up call to all of us to do better.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of

its

attachments, please be advised that you have received this email in

error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If

you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

May 9, 2005