Guest guest Posted January 7, 2012 Report Share Posted January 7, 2012 I, too, have had a few of these interactions, mostly from POPTS. It always ends up with the phone call, which I make sure it is not a pleasant one. Unfortunately, I am afraid reporting it would go nowhere. In my previous experiences, never did. We have reported blatant physician Medicare fraud and fraudulent billing, which is a heavier issue, just to find out it continues the same, even with insider scoop. In my opinion, a public campaign for public awareness, in mass, would fix this and many other like issues, simply by having consumers better informed and by shaming guys like these. Reputation is everything. That's where we can hurt, when is appropriate. Armin Loges, PT Tampa, FL Armin Loges, PT This message and any of its attachments is private, confidential & privileged information intended solely for the named addressee(s). It may contain Private Health Information (PHI) protected under HIPAA law and must be handled as such. If you received this message in error, delete it and all it's attachments and inform this sender for remedial measures. Thank you. > Great thread and some really good thoughts and opinions though I see that you still haven't had your question answered so, because I would like to know the answer as well, I will re-ask it: > > The patient is wanting to pursue reporting this illegal action, how does he go about it? > > I have run across similar actions and I have called the physician directly and asked them to explain to me why they would deny a patient their right to see me, I ask if there is something I or my company has ever done to or with one of their patient's in the past that has concerned them, when the answer is no I then again ask why they would deny their patients rights. I explain my relationship with the patient, why they have chosen to see me, etc. I have never had a refusal beyond that point though I have had a few who refuse to ever come to the phone, for those we find another physician or I ask the patient to go to a local walk in clinic for a referral, the shame of that is the increased cost not only to the patient but to the entire system, something we and the APTA should be shouting from the mountain tops. > > Sincerely, > E. s, PT, DPT > Orthopedic Clinical Specialist > Fellow American Academy of Orthopedic Manual Physical Therapists > www.douglasspt.com > > > > > > Hi group, > > > > I had an issue come up today that I need some advice on. I had a patient call me stating they were working with a DME company on getting a wheelchair. The DME company requested that a PT perform a wheelchair evaluation. I do these on a regular basis, and the patient called me to request that I get a prescription from the MD to perform this. > > > > I send the request to the physician. They called me today and stated they will not refer out their own hospital system. I called the patient and asked him to call the doctor and discuss free choice of providers and that he really wanted me to do the eval. He called the physician, but the physician is adamant that she will not refer outside her own hospital system for PT, and that she will be glad to give him a prescription for PT within the system. > > > > The patient is wanting to pursue reporting this illegal behavior. How does he go about doing this. Anything I should be doing about this. I have always known about physicians doing this, just never heard of anybody doing this when the patient is requesting a specific PT and never heard a doctors office just coming out and blatantly stating that they are doing this. > > > > Thank you for your advice. > > > > Odilia Egbers, PT > > Rehab Enterprises > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2012 Report Share Posted January 7, 2012 PT private practitioners, should all keep in mind that, with the possibility ACOs looming in the horizon, MDs and hospitals will work on collaborating with each other to keep most dollars with themselves. Many physicians in my area have their advertising, their offices and even some of their staff paid for by the hospital even at times when they are not employed by the hospital. They will always only refer back to the hospital. And if not for ACOs, for POPTs all of it apply as well, obviously. If we don't wedge ourselves between physicians and patients, we may as well order the private practice tombstone. " Physical therapists " are never in the picture. But read me right. " physical therapy " is always in the picture. " It " is a nice source of revenue. Physical therapists are a necessity (so far), an expense and for any body but us, only ancillary. Commodity. Buy/sell/lease/lend/negotiable. It is only up to us (private practice) to change that. Physical therapists is who " physical therapy " [should] belong to. The commoditized physical therapist does not have a direct need for it (yet), but the public does. Armin Loges, PT Tampa, FL This message and any of its attachments is private, confidential & privileged information intended solely for the named addressee(s). It may contain Private Health Information (PHI) protected under HIPAA law and must be handled as such. If you received this message in error, delete it and all it's attachments and inform this sender for remedial measures. Thank you. > This is a great discussion > > Here are my 2 cents > > Traditionally, it was always that we were trained and we pushed hard to have the physician be the decision maker and try to get favored status with key physicians who would then send patients to us. We were somehow - less. > > Traditionally, it was considered heresy to put your self as a therapist between the patient and the physician. > > I suggest that now is that now only NOT heresy, it is needed. > > There are many times when we need to put ourselves between a patient and a physician. At times, we need to be a wedge to separate the patient from their " less than desirable " physician. It is not only not heresy, it is expected and desirable- for both the patient and our practice. > > The first few times, it can be very uncomfortable. Our training is to be passive, step in line and comply. That is no longer the case. > > As Tom Howell points out - there is nothing to lose with the physician - you've already lost them. So they get mad and don't like you - they don't like you now. Big deal. > > We, as PTs, should have the skills and abilities to make decisions, to advise patients, and sometimes that includes helping them find a new medical resource or physician. > > For our practice, for the past several years, in over 70% of our patients, the patient comes to us directly and just happens to bring his or her physician along. We are not in a direct consumer access state - it does not matter. The patient can still have a choice - we just have to help them know that. > > We have had to learn methods to forge new relationships. > > Key targets for relationship-building have expanded to include adult children of aging parents, owners and operators of senior housing facilities, home health agencies, community-based senior advocates including elder law professionals and private duty personal care companies. > > These are all in addition to, not instead of, the traditional physician relationships that we have always tried to develop. > In addition to communicating how we can help physicians help their patients as we always have, we concurrently communicate to the non-physician community that they should consider us to be the Physical Therapists for their family - much like families have dentists and plumbers and physicians. > > This has allowed us to encourage referrals from our current patients of their friends, neighbors and families when they have issues that could benefit from our services or counsel. > > Repeat business and patient referrals are now driving our business - sometimes in spite of efforts by physicians and hospital system employees to direct patients away from us. > > It has not been quick, but it has been successful. Otherwise, we would still be somehow - less. > > Kovacek, PT, DPT, MSA > Harper Woods, MI > > > > > > > > Hi group, > > > > > > I had an issue come up today that I need some advice on. I had a patient call me stating they were working with a DME company on getting a wheelchair. The DME company requested that a PT perform a wheelchair evaluation. I do these on a regular basis, and the patient called me to request that I get a prescription from the MD to perform this. > > > > > > I send the request to the physician. They called me today and stated they will not refer out their own hospital system. I called the patient and asked him to call the doctor and discuss free choice of providers and that he really wanted me to do the eval. He called the physician, but the physician is adamant that she will not refer outside her own hospital system for PT, and that she will be glad to give him a prescription for PT within the system. > > > > > > The patient is wanting to pursue reporting this illegal behavior. How does he go about doing this. Anything I should be doing about this. I have always known about physicians doing this, just never heard of anybody doing this when the patient is requesting a specific PT and never heard a doctors office just coming out and blatantly stating that they are doing this. > > > > > > Thank you for your advice. > > > > > > Odilia Egbers, PT > > > Rehab Enterprises > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2012 Report Share Posted January 7, 2012 Hi everyone, Absolutely well said and inspiring ! Thanks! I have not forgotten the question of whether this is legal or not and the answer is that unless there is a specific law in your state forcing physicians to allow a patient to choose their health care providers, there is generally not much that can be done. You can check with your state insurance commission for advice or to lodge an ethics complaint (the patient should do this as well)but if there are no clear laws to stop this, your complaint will be politely registered and not much else. You could do the same if the patient is a Medicare beneficiary (file a fraud complaint) but there is no clear cut evidence of fraud here either so I doubt, unless there is a long history of problems and other fraud with this physician, then not much will be done. Some states, luckily, have been able to pass laws requiring physicians to leave the choice up to the patient and does not allow them to direct care to a specific facility. There are certainly regulations in insurance contracts that specify that the person has the choice of providers and I certainly agree that in this case, if there is that language, then the patient should take that to the physician and remind him or her that the patient has the choice. In this case, I would bet that the physician would then simply say " don't come back " . So, in reality, the best thing to do is to advocate for this patient. Have them find out from their insurance and the state insurance commission what they can do and if there is anything in writing or in state law that provides documentation of choice (most times there isn't or isn't much) then they can try and reason with this physician. In the mean time, try to direct them to one of your better referral sources and someone who will give them better services. I would even call the new physician's office and see if in exchange for referring a new patient to them, if they would get the person in right away. This the what " autonomy " looks like and in reality we must get to the point of being absolutely comfortable with it. This is also another instance where everyone needs to understand why direct access is so important to our profession. For those in states that do not yet have it, keep up the fight! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... 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. From: PTManager [mailto:PTManager ] On Behalf Of Sent: Saturday, January 07, 2012 12:28 PM To: PTManager Subject: Re: referral issue This is a great discussion Here are my 2 cents Traditionally, it was always that we were trained and we pushed hard to have the physician be the decision maker and try to get favored status with key physicians who would then send patients to us. We were somehow - less. Traditionally, it was considered heresy to put your self as a therapist between the patient and the physician. I suggest that now is that now only NOT heresy, it is needed. There are many times when we need to put ourselves between a patient and a physician. At times, we need to be a wedge to separate the patient from their " less than desirable " physician. It is not only not heresy, it is expected and desirable- for both the patient and our practice. The first few times, it can be very uncomfortable. Our training is to be passive, step in line and comply. That is no longer the case. As Tom Howell points out - there is nothing to lose with the physician - you've already lost them. So they get mad and don't like you - they don't like you now. Big deal. We, as PTs, should have the skills and abilities to make decisions, to advise patients, and sometimes that includes helping them find a new medical resource or physician. For our practice, for the past several years, in over 70% of our patients, the patient comes to us directly and just happens to bring his or her physician along. We are not in a direct consumer access state - it does not matter. The patient can still have a choice - we just have to help them know that. We have had to learn methods to forge new relationships. Key targets for relationship-building have expanded to include adult children of aging parents, owners and operators of senior housing facilities, home health agencies, community-based senior advocates including elder law professionals and private duty personal care companies. These are all in addition to, not instead of, the traditional physician relationships that we have always tried to develop. In addition to communicating how we can help physicians help their patients as we always have, we concurrently communicate to the non-physician community that they should consider us to be the Physical Therapists for their family - much like families have dentists and plumbers and physicians. This has allowed us to encourage referrals from our current patients of their friends, neighbors and families when they have issues that could benefit from our services or counsel. Repeat business and patient referrals are now driving our business - sometimes in spite of efforts by physicians and hospital system employees to direct patients away from us. It has not been quick, but it has been successful. Otherwise, we would still be somehow - less. Kovacek, PT, DPT, MSA Harper Woods, MI > > > > Hi group, > > > > I had an issue come up today that I need some advice on. I had a patient call me stating they were working with a DME company on getting a wheelchair. The DME company requested that a PT perform a wheelchair evaluation. I do these on a regular basis, and the patient called me to request that I get a prescription from the MD to perform this. > > > > I send the request to the physician. They called me today and stated they will not refer out their own hospital system. I called the patient and asked him to call the doctor and discuss free choice of providers and that he really wanted me to do the eval. He called the physician, but the physician is adamant that she will not refer outside her own hospital system for PT, and that she will be glad to give him a prescription for PT within the system. > > > > The patient is wanting to pursue reporting this illegal behavior. How does he go about doing this. Anything I should be doing about this. I have always known about physicians doing this, just never heard of anybody doing this when the patient is requesting a specific PT and never heard a doctors office just coming out and blatantly stating that they are doing this. > > > > Thank you for your advice. > > > > Odilia Egbers, PT > > Rehab Enterprises > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2012 Report Share Posted January 7, 2012 Hi everyone, Absolutely well said and inspiring ! Thanks! I have not forgotten the question of whether this is legal or not and the answer is that unless there is a specific law in your state forcing physicians to allow a patient to choose their health care providers, there is generally not much that can be done. You can check with your state insurance commission for advice or to lodge an ethics complaint (the patient should do this as well)but if there are no clear laws to stop this, your complaint will be politely registered and not much else. You could do the same if the patient is a Medicare beneficiary (file a fraud complaint) but there is no clear cut evidence of fraud here either so I doubt, unless there is a long history of problems and other fraud with this physician, then not much will be done. Some states, luckily, have been able to pass laws requiring physicians to leave the choice up to the patient and does not allow them to direct care to a specific facility. There are certainly regulations in insurance contracts that specify that the person has the choice of providers and I certainly agree that in this case, if there is that language, then the patient should take that to the physician and remind him or her that the patient has the choice. In this case, I would bet that the physician would then simply say " don't come back " . So, in reality, the best thing to do is to advocate for this patient. Have them find out from their insurance and the state insurance commission what they can do and if there is anything in writing or in state law that provides documentation of choice (most times there isn't or isn't much) then they can try and reason with this physician. In the mean time, try to direct them to one of your better referral sources and someone who will give them better services. I would even call the new physician's office and see if in exchange for referring a new patient to them, if they would get the person in right away. This the what " autonomy " looks like and in reality we must get to the point of being absolutely comfortable with it. This is also another instance where everyone needs to understand why direct access is so important to our profession. For those in states that do not yet have it, keep up the fight! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... 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. From: PTManager [mailto:PTManager ] On Behalf Of Sent: Saturday, January 07, 2012 12:28 PM To: PTManager Subject: Re: referral issue This is a great discussion Here are my 2 cents Traditionally, it was always that we were trained and we pushed hard to have the physician be the decision maker and try to get favored status with key physicians who would then send patients to us. We were somehow - less. Traditionally, it was considered heresy to put your self as a therapist between the patient and the physician. I suggest that now is that now only NOT heresy, it is needed. There are many times when we need to put ourselves between a patient and a physician. At times, we need to be a wedge to separate the patient from their " less than desirable " physician. It is not only not heresy, it is expected and desirable- for both the patient and our practice. The first few times, it can be very uncomfortable. Our training is to be passive, step in line and comply. That is no longer the case. As Tom Howell points out - there is nothing to lose with the physician - you've already lost them. So they get mad and don't like you - they don't like you now. Big deal. We, as PTs, should have the skills and abilities to make decisions, to advise patients, and sometimes that includes helping them find a new medical resource or physician. For our practice, for the past several years, in over 70% of our patients, the patient comes to us directly and just happens to bring his or her physician along. We are not in a direct consumer access state - it does not matter. The patient can still have a choice - we just have to help them know that. We have had to learn methods to forge new relationships. Key targets for relationship-building have expanded to include adult children of aging parents, owners and operators of senior housing facilities, home health agencies, community-based senior advocates including elder law professionals and private duty personal care companies. These are all in addition to, not instead of, the traditional physician relationships that we have always tried to develop. In addition to communicating how we can help physicians help their patients as we always have, we concurrently communicate to the non-physician community that they should consider us to be the Physical Therapists for their family - much like families have dentists and plumbers and physicians. This has allowed us to encourage referrals from our current patients of their friends, neighbors and families when they have issues that could benefit from our services or counsel. Repeat business and patient referrals are now driving our business - sometimes in spite of efforts by physicians and hospital system employees to direct patients away from us. It has not been quick, but it has been successful. Otherwise, we would still be somehow - less. Kovacek, PT, DPT, MSA Harper Woods, MI > > > > Hi group, > > > > I had an issue come up today that I need some advice on. I had a patient call me stating they were working with a DME company on getting a wheelchair. The DME company requested that a PT perform a wheelchair evaluation. I do these on a regular basis, and the patient called me to request that I get a prescription from the MD to perform this. > > > > I send the request to the physician. They called me today and stated they will not refer out their own hospital system. I called the patient and asked him to call the doctor and discuss free choice of providers and that he really wanted me to do the eval. He called the physician, but the physician is adamant that she will not refer outside her own hospital system for PT, and that she will be glad to give him a prescription for PT within the system. > > > > The patient is wanting to pursue reporting this illegal behavior. How does he go about doing this. Anything I should be doing about this. I have always known about physicians doing this, just never heard of anybody doing this when the patient is requesting a specific PT and never heard a doctors office just coming out and blatantly stating that they are doing this. > > > > Thank you for your advice. > > > > Odilia Egbers, PT > > Rehab Enterprises > > > Quote Link to comment Share on other sites More sharing options...
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