Stop POPTS-Facts and Updates about Physician Owned Physical Therapy Services and Referral for Profit

In an effort to protect the Medicare Trust Fund and ensure proper payments, the Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program. CERT measures the accuracy of Medicare fee-for-service (FFS) payments. CERT contractors generate a number of measurements and statistics that reflect how effectively providers submit their claims and how Medicare contractors review and pay those claims.

First Coast Service Options Inc. (FCSO) analysis of CERT errors identified a trend of increased claim payment errors in the November 2011 CERT report when therapy services are billed by a physician in the state of Florida. Services billed by physician specialties represented 70 percent of the dollars incorrectly paid for therapy services with a 19.05 percent claim payment error rate (based on dollars). Additionally, past medical review experience has identified high claim error rates when therapy services are billed by physicians.

“The most common reasons for an error to be assigned are insufficient documentation, including failure to meet Medicare’s documentation requirements specific to therapy services and failure to meet medical necessity.”

Data analysis indicates that therapy services billed by general practice specialty represent over 12 percent of all of the therapy services billed in Florida. Therefore, based on high error rates validated through CERT findings and FCSO’s data analysis, a prepayment medical review edit will be implemented on March 19, 2012. This prepayment edit will require submission of medical records to support physical therapy services billed by general practitioners.

Read the whole report by clicking here.

STOP the MADNESS!

Physical Owned Physical Therapy Services are an avoidable REFERRAL FOR PROFIT conflict of interest.

The problems are clear to everyone now:

1.  It’s clear now what they are trying to maintain their kickbacks.

2. CA can’t afford this.

3. The cat is out of the bag – physical therapy care delivered at a POPTS is substandard care.

4. The public knows now that POPTS kill more PT jobs than create them.

5. POPTS are a monopoly – pure and simple.

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The word is that the CA Orthopedic Association’s Tim Shannon is in support of SB 1273. The bill, if passed, would allow athletic trainers to immediately diagnose and treat sick patients without any training whatsoever in patient care.  Here’s a summary of what we expect Tim would say to a reporter “off the record”.

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We’ve stated previously that referral for profit is not just a problem with physical therapy but also MRI and laboratory ownership.

Here’s yet another study that corroborates the large number of studies that conclude referral for profit is a major problem.

 Conclusion

“This suggests that financial incentives prompt self-referring urologists to perform prostate biopsies on men who are unlikely to have prostate cancer. These results support closing the loophole that permits self-referral to “in-office” pathology laboratories.”

Click here to read the entire abstract.

We are supposed to trust medical doctors.  Medical ethics demands putting patients’ best interests before the doctors’.  Clearly that old-school concept is repeatedly being challenged!

The take-home lesson we wish to provide anyone that is prescribed physical therapy by a doctor is:

Ask the doctor if he owns the physical therapy practice, does the billing for these services or has any financial interest in the practice physical therapy practice at all.  If that referring physician does, avoid it like the plague and find an independently owned physical therapist in your area.

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Last year one of the most popular posts published on Stoppopts revealed incriminating content and advice for doctors who were opening physical therapy clinics with the objectives of increasing revenue and putting local physical therapy private practices out of business.

We published this article last year – it was a full recording of a doctor telling his physician audience how to do this.

The link to it was here – Reference: Click here to watch the entire presentation. SCROLL TO 8 MINUTES AND 17 SECONDS

THEN THEY REMOVED IT TO CONCEAL THE EVIDENCE! – YOU GET A 404 PAGE NOT FOUND ERROR.

Well – we did our homework and found the recording.  You can listen to it here:

In his presentation this doctor states:

There is some good news…having athletic trainers do PT and charging CPT codes for their services.

[regarding this Kentucky case] The appellate court ruled against it and the Supreme Court ruled in his favor.

This is another avenue and this supreme court victory may set the stage for this occurring in other states where you can just hire athletic trainers

One physician, after I gave a talk on this last year, had hired a chiropractor and had athletic trainers doing the PT and it shut down 60 percent of the business in South Carolina for the local physical therapy groups which I thought was kind of exciting [then he chuckles]…

Now the athletic trainers have a new bill, SB 1273, which is a clone of last year’s Hayashi bill, AB 374, which would have allowed athletic trainers to be licensed, bill insurance for services, and replace physical therapists and physicians’ assistants within POPTS and in general.  The bill is an UNRESTRICTED DIRECT ACCESS BILL for ATHLETIC TRAINERS, who earn Bachelors degrees and are educated to treat athletes on the field and in the training room.

You’d think the CMA would be opposed to unlimited direct access for ATC’s, wouldn’t you???  Their lack of opposition while opposing limited direct access for PTs  is a double standard and shows their true intent.  They want yet another passive income stream to kill more physical therapists’  jobs.  These are not Stoppopts words, they are the words in the Orthopaedic Surgeons’ SMOKING GUN presentation.

Unfortunately, they shot themselves in the foot with this SMOKING GUN!

Stop the Madness! California is broke. We cannot afford to legalize POPTS or allow non-PTs to perform physical therapy services.

It’s bad business, providing substandard care, and costs California Billions of dollars!

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As reported by USA Today:

“A Dallas-area physician has been arrested and indicted for allegedly bilking Medicare of more than $350 million for bogus health care services.”

Click here to read the full story.

This is the same greedy behavior you see with physician ownership of physical therapy, MRI, laboratory equipment, and the list goes on.

STOP THE MADNESS!

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View more videos at: http://nbclosangeles.com.

Read all of the stories behind the abuse here:

Physical Therapy Group Audited by State

Physical Therapy Bill Defeated

Physical Therapy Clinics Scrutinized

Battle Over CA Physical Therapy Intensifies

Physical Therapy Bill Delayed

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Without Your Input, POPTS Clinics Will Be Effectively Legalized Until Jan. 1, 2013, with the Legislature’s Pork Barrel Politics

It is on the Governor’s desk for signature right now.

You can submit your request to Governor Brown to veto this bill by going here:

http://govnews.ca.gov/gov39mail/mail.php

You may have heard by now that behind closed doors, without any public discussion, the powerful CMA lobbyists working thru back channels, have effectively overridden the legislative process.

Over the last few weeks, Senator Pro Tem Darrell Steinberg, inserted language into the SB 543 which will disallow the California Physical Therapy Board from enforcing the law.

Here’s how the language reads:

The entire bill can be found by clicking here.

Summing it all up, it has been the position of attorneys, counsel to the Department of Consumer Affairs, the Legislative Counsel, the CA Senate B&P x2, a vast majority of physical therapists and STOP POPTS that referral for profit is an avoidable conflict of interest.  Two emails to CA physical therapists generated a massive outcry against POPTS – remember the petition of 3500 signatures?

• It costs CA $233,000,000/year in needless care.  $8,500,000,000 (yes, that’s billion) of waste over the last 2 decades.
• It results in the delivery of substandard care – 9% of care in POPTS meets practice standards and 43% of care is delivered by unlicensed staff (physical therapy aides).
• It’s difficult to estimate the precise number of jobs lost due to POPTS – some estimate well into the thousands but no one really cares about that.  Evidence suggests that for every POPTS physical therapist employed, two physical therapist jobs in legal settings are lost.
• It allows the monopoly of the physical therapy profession by medical doctors.

Historically, the legislative process/lawmakers have addressed the issue agreeing that this POPTS/referral for profit is bad public policy.

• AB 1152, a bill to legalize physical therapist employment by medical corporations was defeat in July of 2009.
• AB 783 was defeated on June 13th, 2011
• AB 783 was defeated when brought up for reconsideration in June, 27 2011.

The CA Physical Therapy Profession will take a Huge Step Backward – Ancillary is a Physical Therapist’s Role According to Medical Doctors and the Politicians – Physical Therapists Should Not Stand for This…Unless You Are One of the Few that are Employed by Doctors.

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While you may think this is just a satirical cartoon, we would suggest it is daily common practice. California, its citizens, and independent physical therapy practices that are trying to hold on, are all getting screwed.

It’s not a double dip, or even a quadruple dip, but a DECUPLE DIP (10X) into the insurance company’s pocket and therefore, yours (the insurance company isn’t going to take a loss here)!

The fact is that doctors want to do everything they can to, as Dr. Grogan says,  monetize their patients:

-They prescribe drugs from their own dispensary at up to 1700% markup .
-They over-utilize x-rays
-They use ineffective modalities such ultrasound and e-stim 2-6x more than the independent physical therapy private practice.
-They over utilize MRI in which a new Stanford University study concludes “These increases in MRI use appear to lead to increases in low back surgery receipt and health care spending among patients of orthopedic surgeons“.
-They have conflicts of interest galore with the medical device companies and under reporting side effects .
-They have a conflict of interest in owning specialty hospitals and surgery centers .
-They see patients for almost 2x as many physical therapy visits.
-It’s no wonder spine surgeons are the highest paid doctors according to the American Medical Group Association(as reported by Bloomberg)

Think this is all just rhetoric and puffery?  Think again.

We recommend you read this story of greed, pain, suffering and death and then contemplate the AARP’s position this week about “surgeries you should avoid”.

If consumers only knew the facts, they would be just as pissed off as STOP POPTS is and they might just rebel against the special interest groups like the CMA, Hayashi’s pork-barrel politics and cronyism that’s contributing to the rapid deterioration of health care.

STOP the MADNESS!!!

PS: What happened to medical ethics?  The AMA’s position is “under no circumstances may physicians place their own financial interests above the welfare of their patients,”

AMA Council on Ethics and Judicial Affairs. Current Opinions. American Medical Association.

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