RE: FW: physician ownership

[Guest guest]

,

Your comments:

" The physicians may refer patients wherever they want

and of course, we would prefer that they refer to our

clinics " .

Are interesting, The integrated hospitals in are area

give patients a prescription for physical therapy with

all of their locations and availability. So if a

physician is writing a referral and says you need

therapy, where do you think the patient will go?

Does your hospital give blank scripts? If so that is

fair.

Let's say the patient decides to go to another

therapist, the patients " Insurance/Hospital " says sure

you can go to another Therapy Clinic but you will be

paying out of network. So add $50.00 co-pay and 50%

coverage. Joe therapist can't compete because the

" Insurance/Hospital " is not accepting any other

clinics, except their own for in-network contracts.

This is fair?

Your Comments:

" The difference between this and a physician owned

practice is that there is no financial

incentive/reward for the physicians if they refer to

our clinics and no punitive action against them if

they refer outside of the system " .

Physicians are pressured daily to refer to hospitals

where they have privileges, this is a known fact. I

have spoken to Md's that have had concerns with

hospital staff and wanted their patients to go to a

certain specialty. Now don't get me wrong, my wife

works as a PT for a hospital and I would consider her

a better therapist than I. What I am stating is that

there is a direct correlation to benefits and it is

called privileges and MD need to be in good standing

in order to maintain those privileges. Someone in

private practice has a much harder time networking to

Md's who are linked directly with hospitals.

It seems the hospitals are taking advantage of a

direct relationships with Md's weather employed or not

employed by the hospitals, just as POPTS and any

private practice would do.

Russ

--- " Zarosinski, "

wrote:

> Matt, I work for an integrated health care system.

> We do have physician groups as a part of the system

> and the system does have an insurance company. The

> physicians may refer patients wherever they want and

> of course, we would prefer that they refer to our

> clinics. The difference between this and a

> physician owned practice is that there is no

> financial incentive/reward for the physicians if

> they refer to our clinics and no punitive action

> against them if they refer outside of the system. I

> see this as a huge difference. Physicians owning PT

> clinics is an avoidable conflict of interest. I

> find it interesting that the only patients sent to

> us by physicians who own PT clinics are patients

> that have insurance that do not allow them to go to

> that physician's office, patients who have no

> insurance or patients who have Medicaid and the

> Medicaid does not pay for PT. We have had patients

> tell us that their physician will not write them an

> order for PT unless the have the PT in the

> physician's office.

>

> Zarosinski, PT, MS

> Providence Health System

> Portland, OR

>

> Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read

> more on the topic thru

> your professional association and fully understand

> the negative impact POPTS

> have on the image of the profession, the lack of

> support it gives to your

> colleagues work in trying to gain a clear,

> unquestioned position in the health care

> service community, and frankly, that many of these

> types and for profit

> types of practice environments are the antithesis of

> where this profession is

> heading.

>

> Naive, I can assure you I am not. Take long look at

> what you have wrote and

> ask yourself where your decisions have benefitted

> the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State

> Association with a professional workshop or course -

> call us at 313 884-8920 to arrange

> PTManager encourages participation in your

> professional association. Join and participate now!

>

[Guest guest]

,

Your comments:

" The physicians may refer patients wherever they want

and of course, we would prefer that they refer to our

clinics " .

Are interesting, The integrated hospitals in are area

give patients a prescription for physical therapy with

all of their locations and availability. So if a

physician is writing a referral and says you need

therapy, where do you think the patient will go?

Does your hospital give blank scripts? If so that is

fair.

Let's say the patient decides to go to another

therapist, the patients " Insurance/Hospital " says sure

you can go to another Therapy Clinic but you will be

paying out of network. So add $50.00 co-pay and 50%

coverage. Joe therapist can't compete because the

" Insurance/Hospital " is not accepting any other

clinics, except their own for in-network contracts.

This is fair?

Your Comments:

" The difference between this and a physician owned

practice is that there is no financial

incentive/reward for the physicians if they refer to

our clinics and no punitive action against them if

they refer outside of the system " .

Physicians are pressured daily to refer to hospitals

where they have privileges, this is a known fact. I

have spoken to Md's that have had concerns with

hospital staff and wanted their patients to go to a

certain specialty. Now don't get me wrong, my wife

works as a PT for a hospital and I would consider her

a better therapist than I. What I am stating is that

there is a direct correlation to benefits and it is

called privileges and MD need to be in good standing

in order to maintain those privileges. Someone in

private practice has a much harder time networking to

Md's who are linked directly with hospitals.

It seems the hospitals are taking advantage of a

direct relationships with Md's weather employed or not

employed by the hospitals, just as POPTS and any

private practice would do.

Russ

--- " Zarosinski, "

wrote:

> Matt, I work for an integrated health care system.

> We do have physician groups as a part of the system

> and the system does have an insurance company. The

> physicians may refer patients wherever they want and

> of course, we would prefer that they refer to our

> clinics. The difference between this and a

> physician owned practice is that there is no

> financial incentive/reward for the physicians if

> they refer to our clinics and no punitive action

> against them if they refer outside of the system. I

> see this as a huge difference. Physicians owning PT

> clinics is an avoidable conflict of interest. I

> find it interesting that the only patients sent to

> us by physicians who own PT clinics are patients

> that have insurance that do not allow them to go to

> that physician's office, patients who have no

> insurance or patients who have Medicaid and the

> Medicaid does not pay for PT. We have had patients

> tell us that their physician will not write them an

> order for PT unless the have the PT in the

> physician's office.

>

> Zarosinski, PT, MS

> Providence Health System

> Portland, OR

>

> Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read

> more on the topic thru

> your professional association and fully understand

> the negative impact POPTS

> have on the image of the profession, the lack of

> support it gives to your

> colleagues work in trying to gain a clear,

> unquestioned position in the health care

> service community, and frankly, that many of these

> types and for profit

> types of practice environments are the antithesis of

> where this profession is

> heading.

>

> Naive, I can assure you I am not. Take long look at

> what you have wrote and

> ask yourself where your decisions have benefitted

> the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State

> Association with a professional workshop or course -

> call us at 313 884-8920 to arrange

> PTManager encourages participation in your

> professional association. Join and participate now!

>

[Guest guest]

,

Your comments:

" The physicians may refer patients wherever they want

and of course, we would prefer that they refer to our

clinics " .

Are interesting, The integrated hospitals in are area

give patients a prescription for physical therapy with

all of their locations and availability. So if a

physician is writing a referral and says you need

therapy, where do you think the patient will go?

Does your hospital give blank scripts? If so that is

fair.

Let's say the patient decides to go to another

therapist, the patients " Insurance/Hospital " says sure

you can go to another Therapy Clinic but you will be

paying out of network. So add $50.00 co-pay and 50%

coverage. Joe therapist can't compete because the

" Insurance/Hospital " is not accepting any other

clinics, except their own for in-network contracts.

This is fair?

Your Comments:

" The difference between this and a physician owned

practice is that there is no financial

incentive/reward for the physicians if they refer to

our clinics and no punitive action against them if

they refer outside of the system " .

Physicians are pressured daily to refer to hospitals

where they have privileges, this is a known fact. I

have spoken to Md's that have had concerns with

hospital staff and wanted their patients to go to a

certain specialty. Now don't get me wrong, my wife

works as a PT for a hospital and I would consider her

a better therapist than I. What I am stating is that

there is a direct correlation to benefits and it is

called privileges and MD need to be in good standing

in order to maintain those privileges. Someone in

private practice has a much harder time networking to

Md's who are linked directly with hospitals.

It seems the hospitals are taking advantage of a

direct relationships with Md's weather employed or not

employed by the hospitals, just as POPTS and any

private practice would do.

Russ

--- " Zarosinski, "

wrote:

> Matt, I work for an integrated health care system.

> We do have physician groups as a part of the system

> and the system does have an insurance company. The

> physicians may refer patients wherever they want and

> of course, we would prefer that they refer to our

> clinics. The difference between this and a

> physician owned practice is that there is no

> financial incentive/reward for the physicians if

> they refer to our clinics and no punitive action

> against them if they refer outside of the system. I

> see this as a huge difference. Physicians owning PT

> clinics is an avoidable conflict of interest. I

> find it interesting that the only patients sent to

> us by physicians who own PT clinics are patients

> that have insurance that do not allow them to go to

> that physician's office, patients who have no

> insurance or patients who have Medicaid and the

> Medicaid does not pay for PT. We have had patients

> tell us that their physician will not write them an

> order for PT unless the have the PT in the

> physician's office.

>

> Zarosinski, PT, MS

> Providence Health System

> Portland, OR

>

> Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read

> more on the topic thru

> your professional association and fully understand

> the negative impact POPTS

> have on the image of the profession, the lack of

> support it gives to your

> colleagues work in trying to gain a clear,

> unquestioned position in the health care

> service community, and frankly, that many of these

> types and for profit

> types of practice environments are the antithesis of

> where this profession is

> heading.

>

> Naive, I can assure you I am not. Take long look at

> what you have wrote and

> ask yourself where your decisions have benefitted

> the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State

> Association with a professional workshop or course -

> call us at 313 884-8920 to arrange

> PTManager encourages participation in your

> professional association. Join and participate now!

>

[Guest guest]

Matt, our system is in competition with two other large health systems who have

insurance companies, one has an insurance administration company and a panel

that excludes our system from participating. There are hundreds of thousands of

lives in this area that we cannot serve because we are excluded from their

panel. They have nearly every private practice in the area on their Worker's

Comp panel which covers about 60% of the insured employees in this area. The

other system is Kaiser. There is a lot of competition which I think is good and

a lot of private practices that are thriving. I believe that competition keeps

us all on our toes and requires that we must be sure that we are offering

quality services, that we keep abreast of current practices and that we do not

over utilize our services or take advantage of insurance companies. No one

system or practice dominates all areas of practice. I guess that we just

disagree that hospitals contribute to a conflict of interest.

Re: FW: physician ownership

Russ it comes to values. I would urge you to read more on the topic thru

your professional association and fully understand the negative impact POPTS

have on the image of the profession, the lack of support it gives to your

colleagues work in trying to gain a clear, unquestioned position in the health

care

service community, and frankly, that many of these types and for profit

types of practice environments are the antithesis of where this profession is

heading.

Naive, I can assure you I am not. Take long look at what you have wrote and

ask yourself where your decisions have benefitted the goals of your

profession

Jim Dunleavy Pt, MS

[Guest guest]

Matt, our system is in competition with two other large health systems who have

insurance companies, one has an insurance administration company and a panel

that excludes our system from participating. There are hundreds of thousands of

lives in this area that we cannot serve because we are excluded from their

panel. They have nearly every private practice in the area on their Worker's

Comp panel which covers about 60% of the insured employees in this area. The

other system is Kaiser. There is a lot of competition which I think is good and

a lot of private practices that are thriving. I believe that competition keeps

us all on our toes and requires that we must be sure that we are offering

quality services, that we keep abreast of current practices and that we do not

over utilize our services or take advantage of insurance companies. No one

system or practice dominates all areas of practice. I guess that we just

disagree that hospitals contribute to a conflict of interest.

Re: FW: physician ownership

Russ it comes to values. I would urge you to read more on the topic thru

your professional association and fully understand the negative impact POPTS

have on the image of the profession, the lack of support it gives to your

colleagues work in trying to gain a clear, unquestioned position in the health

care

service community, and frankly, that many of these types and for profit

types of practice environments are the antithesis of where this profession is

heading.

Naive, I can assure you I am not. Take long look at what you have wrote and

ask yourself where your decisions have benefitted the goals of your

profession

Jim Dunleavy Pt, MS

[Guest guest]

Matt, our system is in competition with two other large health systems who have

insurance companies, one has an insurance administration company and a panel

that excludes our system from participating. There are hundreds of thousands of

lives in this area that we cannot serve because we are excluded from their

panel. They have nearly every private practice in the area on their Worker's

Comp panel which covers about 60% of the insured employees in this area. The

other system is Kaiser. There is a lot of competition which I think is good and

a lot of private practices that are thriving. I believe that competition keeps

us all on our toes and requires that we must be sure that we are offering

quality services, that we keep abreast of current practices and that we do not

over utilize our services or take advantage of insurance companies. No one

system or practice dominates all areas of practice. I guess that we just

disagree that hospitals contribute to a conflict of interest.

Re: FW: physician ownership

Russ it comes to values. I would urge you to read more on the topic thru

your professional association and fully understand the negative impact POPTS

have on the image of the profession, the lack of support it gives to your

colleagues work in trying to gain a clear, unquestioned position in the health

care

service community, and frankly, that many of these types and for profit

types of practice environments are the antithesis of where this profession is

heading.

Naive, I can assure you I am not. Take long look at what you have wrote and

ask yourself where your decisions have benefitted the goals of your

profession

Jim Dunleavy Pt, MS

[Guest guest]

I've been sitting quietly on this discussion, but would like to point

out at least one difference with the hospital examples that have been

cited.

Some may certainly profit from forcing patients to stay in the system

for therapy, but...at least in our situation, 50% of the hospital

patients are Medicaid, and I take a loss with each and every Medicaid

patient that comes through our door. We do not " force " the other

patients to come to us, but we certainly encourage it, as it is the only

way for us to meet our costs.

Although I am sure they exist, how many private practices (or physician

owned practices) are willing to have a 35% caseload of Medicaid?

Mickey Bonk, PT, MBA

Director, Rehab Services

Children's Memorial Hospital

Fax:

email: embonk@...

Re: FW: physician ownership

Do the physicians get paid by the health system? If so, then I believe

there is a conflict. What would happen if a physician referred 100% of

his

patients out of the system? I don't think they would be part of the

system

for long. Why else would the system employ them? If the system pays

the

physicians, they are looking for a return on that investment. I'm sure

the

administration tracks the income generated from employing the

physicians.

The incentive here is financial in that if the physician wants to

continue

to be employed that had better improve their referral profiles. I see

no

difference in this scenario then the one Matt describes. I see this

issue

as a violation of antitrust laws. The APTA should be fighting to close

the

loop-holes in the Stark legislation. Do they have the clout and power

is

the main question!

Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read more on the topic

thru

> your professional association and fully understand the negative impact

POPTS

> have on the image of the profession, the lack of support it gives to

your

> colleagues work in trying to gain a clear, unquestioned position in

the

health care

> service community, and frankly, that many of these types and for

profit

> types of practice environments are the antithesis of where this

profession

is

> heading.

>

> Naive, I can assure you I am not. Take long look at what you have

wrote

and

> ask yourself where your decisions have benefitted the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

>

[Guest guest]

I've been sitting quietly on this discussion, but would like to point

out at least one difference with the hospital examples that have been

cited.

Some may certainly profit from forcing patients to stay in the system

for therapy, but...at least in our situation, 50% of the hospital

patients are Medicaid, and I take a loss with each and every Medicaid

patient that comes through our door. We do not " force " the other

patients to come to us, but we certainly encourage it, as it is the only

way for us to meet our costs.

Although I am sure they exist, how many private practices (or physician

owned practices) are willing to have a 35% caseload of Medicaid?

Mickey Bonk, PT, MBA

Director, Rehab Services

Children's Memorial Hospital

Fax:

email: embonk@...

Re: FW: physician ownership

Do the physicians get paid by the health system? If so, then I believe

there is a conflict. What would happen if a physician referred 100% of

his

patients out of the system? I don't think they would be part of the

system

for long. Why else would the system employ them? If the system pays

the

physicians, they are looking for a return on that investment. I'm sure

the

administration tracks the income generated from employing the

physicians.

The incentive here is financial in that if the physician wants to

continue

to be employed that had better improve their referral profiles. I see

no

difference in this scenario then the one Matt describes. I see this

issue

as a violation of antitrust laws. The APTA should be fighting to close

the

loop-holes in the Stark legislation. Do they have the clout and power

is

the main question!

Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read more on the topic

thru

> your professional association and fully understand the negative impact

POPTS

> have on the image of the profession, the lack of support it gives to

your

> colleagues work in trying to gain a clear, unquestioned position in

the

health care

> service community, and frankly, that many of these types and for

profit

> types of practice environments are the antithesis of where this

profession

is

> heading.

>

> Naive, I can assure you I am not. Take long look at what you have

wrote

and

> ask yourself where your decisions have benefitted the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

>

[Guest guest]

I've been sitting quietly on this discussion, but would like to point

out at least one difference with the hospital examples that have been

cited.

Some may certainly profit from forcing patients to stay in the system

for therapy, but...at least in our situation, 50% of the hospital

patients are Medicaid, and I take a loss with each and every Medicaid

patient that comes through our door. We do not " force " the other

patients to come to us, but we certainly encourage it, as it is the only

way for us to meet our costs.

Although I am sure they exist, how many private practices (or physician

owned practices) are willing to have a 35% caseload of Medicaid?

Mickey Bonk, PT, MBA

Director, Rehab Services

Children's Memorial Hospital

Fax:

email: embonk@...

Re: FW: physician ownership

Do the physicians get paid by the health system? If so, then I believe

there is a conflict. What would happen if a physician referred 100% of

his

patients out of the system? I don't think they would be part of the

system

for long. Why else would the system employ them? If the system pays

the

physicians, they are looking for a return on that investment. I'm sure

the

administration tracks the income generated from employing the

physicians.

The incentive here is financial in that if the physician wants to

continue

to be employed that had better improve their referral profiles. I see

no

difference in this scenario then the one Matt describes. I see this

issue

as a violation of antitrust laws. The APTA should be fighting to close

the

loop-holes in the Stark legislation. Do they have the clout and power

is

the main question!

Re: FW: physician ownership

>

>

>

> Russ it comes to values. I would urge you to read more on the topic

thru

> your professional association and fully understand the negative impact

POPTS

> have on the image of the profession, the lack of support it gives to

your

> colleagues work in trying to gain a clear, unquestioned position in

the

health care

> service community, and frankly, that many of these types and for

profit

> types of practice environments are the antithesis of where this

profession

is

> heading.

>

> Naive, I can assure you I am not. Take long look at what you have

wrote

and

> ask yourself where your decisions have benefitted the goals of your

> profession

> Jim Dunleavy Pt, MS

>

>

>

>

[Guest guest]

In response to the statements by Zarosinski....she had asked why

a hospital would continue to employ physicians that consistently refer

patients out of the system. I can assure you, it happens all the

time, at least it does for the orthopedic surgeons. Lets face it,

surgery makes the hospital more money than many other services

combined. If the orthopods want to refer patients to their own clinic

for outpatient therapy, the hospital will not stand in their way. The

hospital is often willing to sacrifice where the follow-up therapy is

received in exchange for keeping the orthopods happy, keeping them on

campus, and ensuring that the revenue from surgery continues. That is

especially the case in a hospital where there is only one orthopedic

group. If that group left, the hospital would be up a creek without a

paddle. Fortunately in our case, our patient volume has supported

both our outpatient clinic as well as the physician-owned therapy

clinic on our hospital campus.

-Curtis

[Guest guest]

In response to the statements by Zarosinski....she had asked why

a hospital would continue to employ physicians that consistently refer

patients out of the system. I can assure you, it happens all the

time, at least it does for the orthopedic surgeons. Lets face it,

surgery makes the hospital more money than many other services

combined. If the orthopods want to refer patients to their own clinic

for outpatient therapy, the hospital will not stand in their way. The

hospital is often willing to sacrifice where the follow-up therapy is

received in exchange for keeping the orthopods happy, keeping them on

campus, and ensuring that the revenue from surgery continues. That is

especially the case in a hospital where there is only one orthopedic

group. If that group left, the hospital would be up a creek without a

paddle. Fortunately in our case, our patient volume has supported

both our outpatient clinic as well as the physician-owned therapy

clinic on our hospital campus.

-Curtis

[Guest guest]

In response to the statements by Zarosinski....she had asked why

a hospital would continue to employ physicians that consistently refer

patients out of the system. I can assure you, it happens all the

time, at least it does for the orthopedic surgeons. Lets face it,

surgery makes the hospital more money than many other services

combined. If the orthopods want to refer patients to their own clinic

for outpatient therapy, the hospital will not stand in their way. The

hospital is often willing to sacrifice where the follow-up therapy is

received in exchange for keeping the orthopods happy, keeping them on

campus, and ensuring that the revenue from surgery continues. That is

especially the case in a hospital where there is only one orthopedic

group. If that group left, the hospital would be up a creek without a

paddle. Fortunately in our case, our patient volume has supported

both our outpatient clinic as well as the physician-owned therapy

clinic on our hospital campus.

-Curtis