Physician Owned Physical Therapy Practices: The Dollars Behind Your Referral; That Nobody Talks About

I’m a Physical Therapist (PT) first, but LOVE entrepreneurship and the thrill of taking a business concept and turning it into a thriving reality.  I’m all about free enterprise but as a co-founder and co-owner of a growing independently, PT owned practice I am finding it hard to accept the slowly growing trend of physician owned physical therapy clinics.

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I have been practicing physical therapy since 1995.  Back then the payment system was a “fee for service” system.  Basically, whatever you billed you received payment at 100%.  Then Healthcare Management Organizations (HMO’s) steam rolled the fee for service system significantly managing care and reorganizing the payment structure.  Thankfully this has toned down a bit since the early 2000’s and we are seeing less HMO management, but unfortunately ever decreasing reimbursement continues.  With the decreasing reimbursement and the need to pay overhead some PT clinics and physician’s office have had to increase volume to meet their financial needs.  I get it.  We have to be lean and mean but without sacrificing quality of care!  However, the means at which some will go to, to pay bills and maybe line their wallets is beginning to bother me.

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Most state regulatory agencies do allow for physicians to own a PT practice even though the state PT practice acts and our national association have some language against physician owned practices or POPTS (physician owned physical therapy services).  In Colorado, there are a handful of POPTS clinics in town all of which are orthopedic surgeon owned.  Without directly calling them out by name I can tell you this, they typically schedule PT patient’s/clients every 15 minutes and are often supervising 2 to 4 patients at one time.  Now that is some volume.  But what about the quality of care; the one-on-one, hands-on treatment that most post-surgical patient’s and in my opinion most patient’s require?  You can answer that one for yourself.  I get more complaints from patients that have been to one of those clinics about the lack of personal care and the feeling of being run thru a mill then I get from patients that came from private PT owned clinics.

On the clinical side, every time I see a post-operative patient that has left PT due to poor progress and more specifically adhesions (usually in the knee or shoulder) they were attending PT at a POPTS clinic or a strictly managed care/insurer like Kaiser.  Adhesion happens, but most of the time it is due to poorly managed post-operative care in PT as long as there were no major complicating factors like infection and/or an unusually long period of immobilization.

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The monetary benefit behind your referral is obvious.  There are people that do very well in these clinics however there is a misunderstanding that the care is better because it is connected with the surgeon’s office and since the surgeon sent me there I better do what they say.  Not necessarily true.  I recently learned of an arrangement with two Colorado orthopedic surgery clinics and a PT clinic where the Surgeons get a significant percentage of the billings from the PT services provided at the clinic on patient’s they refer.  My understanding is the physician’s office will bill for the PT services done offsite in a clinic that structurally, based on state documents, they really don’t own.  It sounds kind of dirty doesn’t it?

Wouldn’t you want to first go to a clinic that your surgeon recommends because they give outstanding service and have excellent published outcomes and secondly to a place that is convenient to your work or home so that attendance in the early phase of rehab is easy?  All PT clinics and PT’s are not created equal regardless of what they say on their web site.  I wish that wasn’t the case but it’s a fact of life as with most professions.

Rocky Mountain Spine and Sport does not and will not in any way participate in the devaluing of our profession or sell-out to a Physician group for referrals as this only hurts our practice and in my opinion leads to poor care.  We can also back up our statements of quality care with outcome studies.  Ask for it, we’ll provide it.

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So may you, the potential client/patient, ask questions about your referral and why you are being sent to a specific PT clinic.  May you also do your homework and ask questions regarding your care at the PT clinic before you sign up.

Eric Krell  - PT, DPT, BScPT, MTC
Follow @EKrellDPT