physician-owned physical therapy practices. James A. ... hire his own physical therapist to treat patients for $25 a .... University of Wisconsin School of Physical Therapy. Continuing ... Sponsor: San Diego District of California Chapter APTA.
Editorial In lieu of our usual editorial the editors have obtained permission to reprint an article written by Howie Kurtz which appeared in the Washington Star November 23, 1980. We feel the article is of great importance to all of our readers. We invite your comments in the form of letters to the editors and your support of proposals before the APT A House of Delegates regarding physician-owned physical therapy practices.
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James A. Gould George J. Davies
George J. Davies
Fee-Splitting: Therapists Fear It's on the Way A few weeks ago, Dr. Fred Nelson, an orthopedic surgeon in Rockville, says he received an offer from another doctor that many professionals might find hard to resist. The other doctor told Nelson he was gOing to hire his own physical therapist to treat patients for $25 a visit. "He said he would send back $5 to anyone who referred patients to this therapist, " Nelson recalled . "The $5 was to encourage my referrals, " Nelson said. Since he generally prescribes six therapy sessions every day, Nelson quickly calculated. The arrangement could have netted him $90 a day, or $15,000 a year, for doing practically nothing. But Nelson said he refused to participate because he considered the arrangement to be an illegal form of fee-splitting . Fee-splitting occurs when one doctor refers a patient to a second physician in exchange for a monetary payment, even though the first doctor does not render any service other than making the referral. Elva Davis, speaking for the Medical and Chirurgical Faculty of Maryland, said it is a violation of state ~aw for an independent therapist to kick back part of his fee to a referring physician . But if the therapist works directly for the doctor and shares the fees with him, she said , " that 's just a business arrangement the two of them have entered into ." Nelson offered his own insights into the therapists ' dilemma: "If I know I'm going to get a $5 kickback, unless I'm incredibly honest, I'm not
as likely to tell the patient he can manage with hot pads at home. The visit also would cost the patient an extra $5 because I'm scraping off my portion. " But while this particular offer was rejected by Nelson, a growing number of physical therapists in the Washington area are entering into these and similar arrangements with physicians that raise many financial and ethical questions for doctors and patients alike. Some therapists contend that these arrangements usually mean inflated costs for consumers, less convenient service, and an assembly-line approach that forces therapists to treat more patients than they can handle adequately. And sometimes these arrangements fall into gray areas. Richard Cress, for example, was working as a physical therapist in Gaithersburg when a doctor made him what he considered a questionable offer. The physician wanted Cress to work in his office, treating patients who needed physical therapy . But Cress was disturbed at the way in which the payments would be made. " He was offering to pay me $5 a patient, " Cress recalled . " But he would be charging them $20 to $25 a visit. He'd be extracting a fee for every physical therapy treatment I provided. " " He said he couldn 't see letting any revenue he generated from his office go somewhere else. He wanted to keep it right there ." Cress says he rejected the offer because he considered it unethical, although it is unclear whether it would be considered fee-splitting because Cress would have been a paid employee of the doctor.
159 Continued on p . 203
203
EDITORIAL
Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on September 30, 2016. For personal use only. No other uses without permission. Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Continued from p. 159
As a result of this trend, it has become far more difficult for many physical therapists to remain in private practice . Cress, for example, found that his business dried up when a doctors' group down the street hired several physical therapists . He now has an office in Takoma Park . One physical therapist, who asked to remain anonymous, works for a group of orthopedic surgeons in Silver Spring. He said the doctors pay him a flat salary but charge his patients $27 a visit, a higher fee than the $15 to $20 many private therapists charge . So despite the higher fees , he says he never reaps the benefits of his heavy caseload . " Last year my department grossed just under $200,000, " the therapist said . " After you subtract the overhead, they made $130,000 in pure profit from my services." By contrast, the therapist was paid a salary of $27 ,000 a year. The therapist is especially disturbed that he is forced to see about 30 patients a day , far more than he feels he can treat adequately. " They push you to see more patients," he said . " I was always complaining about my patient load ." The doctors, he added , merely channeled their patients to him without telling them they could
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get the same service closer to home or at a cheaper price. The therapists are not alone in forging new medical alliances. In recent years, many physicians have been setting up group practices that include laboratory, X-ray and other specialized area hospitals on a contractual basis. But some of these arrangements are coming under increasing public scrutiny. Donald L. Hiltz, a Rockville therapist who is also a local official with the American Physical Therapy Association of Maryland, says most of the area 's several hundred therapists are reluctant to speak out because they ' re afraid to antagonize the doctors who provide their referrals. He says about 85 % of the orthopedists in suburban Maryland now have physical therapists working for them, and that some charge as much as $45 a visit. But, Hiltz argued , " The exploitation is not so much in the overcharging as in the overutilization. A good therapist will see two or three patients an hour, maybe 15 a day. But some of these places are running through 40 and 50 patients a day. " While many of the patients need help for muscle and nerve injuries, he said, some may not need therapy at all .
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POST BOX 13, 4620 VAGSBYGD , NORWAY
MANU~l
SUMMER 1981
THE:RAPY COURSE:S
June 19-27 BASIC SPINAL AND EXTREMITY MANUAL THERAPY (E,S,) Location : La Crosse , Wisconsin Sponsor University of Wisconsin School of Ph ysical Therapy . Continuing Education Department Information: Barbara Sanders 2031 Cowley Hall University of Wisconsin at La Crosse La Crosse , Wiscon sin 54601
By Ola Grimsby
July 11-19 BASIC EXTREMITY AND SPINAL MANUAL THERAPY (E,S,) Location : San Diego , California Sponsor: San Diego District of California Chapter APTA Information James R Bernave 3927 B Waring Road Oceanside , Californ ia 92054
(714) 758-4770
(608) 785-8470 June 2B-July 3 APTA NATIONAL CONFERENCE , Washington , DC Mr. Grimsby wil l lecture on July 1, 1981 July 5-9 ADVANCED CERVICAL MANUAL THERAPY (S2) Location: Dallas. Texas Sponsor Northern District of Texas Chapter APTA Information: Mary Winegardner 3406 Wind ridge Lane Garland , Texas 75043
(214) 271-4763
July22-26 BASIC EXTREMITY MANUAL THERAPY (E,) Location Chi cago , Illinois Sponsor: Northwestern University Medical School Prog ram in Physical Th erapy Information : Sally Pierson Edelsberg Program in Physical Th erapy Northwestern University Medical School 345 E Superior SI , Room 1323 Chicago , Illinois 6061 1
(312) 649-8160
