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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Strategies on Combating POPTS

Published February 18, 2009 10:09 AM by Lisa Lombardo

CSM 2009 Wrap-up: The APTA keeps a watchful eye on the legislative strategies states can use to fight encroachment of physician-owned physical therapy practices (POPTS). But there are other ways to stop what many therapists see as a major cause thwarting the autonomy of the PT profession.

Peter J. McMenamin, PT, MS, OCS, and Brian J. Tovin, PT, DPT, presented "Combating POPTS: Legislative and Non-Legislative Strategies for Every PT" on Wednesday, Feb. 11 at CSM 2009 in Las Vegas.

While the session was well-attended, both speakers expressed concern that it wasn't packed. The profession's ability to combat POPTS through legislative and legal means is directly related to its survival as an autonomous profession, McMenamin said.

"Can PTs have a viable and independent business model as part of Vision 2020?" he asked. "The interest is there-within 8 years we have seen a complete reversal of educational programs in this direction, from 20 percent of programs offering the DPT to 93 percent today. So it is market-driven. Direct access is also making progress, with full direct access in 14 states and provisional DA in 31," he said.

Strategies states are attempting to use to ban POPTS include laws against referral-for-profit (RFP); fee-splitting provisions for owners of practices, and professional corporation law, which is still a theory to deal with POPTS, McMenamin said.

POPTS are banned in South Carolina, Delaware and Missouri. All three states have language in their state practice acts that effectively bans POPTS; in SC, it is illegal for PTs to work for a POPTS. On the other hand, POPTS are deemed legal in Alabama, Tennessee and Rhode Island. McMenamin said in some of these cases, POPTS earned the right to exist in a state's practice act by essentially bartering direct access-physicians in the state backed direct access language in the PT practice act in exchange for the right to own PT practices if they chose.

"Many physicians assume that in states where they are allowed to own a POPTS, it will at some point become illegal, but they are willing to continue owning until that risk becomes reality," he said.

State chapters should never attempt to "go it alone" when developing a plan to eliminate RFPs.

"It has to be a chapter-wide effort, and you have to have your full board committed to it," McMenamin stressed. "Everyone involved must fully understand their practice act implications, and have a war chest to fight with." Other important steps include:

  • Establishing a POPTS task force;
  • Developing an educational mission for the chapter to inform about POPTS;
  • Developing a legal team with a lawyer to work for the chapter;
  • Creating a lobbying team for the chapter;
  • Conducting a SWOT analysis on PT autonomy to determine where support against POPTS lies;
  • Scrutinizing the language in the state practice act on fee-splitting prohibitions, direct access and licensure rules;
  • Building a base of state private practice PTs who can campaign on fighting POPTS.

The important thing to remember is that the profession still controls its own success, said Dr. Tovin. "Eliminating POPTS would have more of an effect on the profession's control than direct access does," he said.


I am aware we have direct access in most states but are there any states or rather insurance companies that don't require a physician referral to get reimbursed.  Also why don't we get the insurance companies to pay for healthclub memberships if they are supervised by physical therapists. We could also perform a musculoskeletal exam with a program designed specifically for that individual based on their history of musculoskeletal problems which would justify insurance reimbursement.

Patrick Thurman August 1, 2009 8:31 PM

I cant seem to find the answer to my question!!!

If a therapist forgets to write the clarification order or discharge order, can an assistant write this order/ without signing. What is Ohio regulations regarding this. Is it required that the ACTUAL therapist write clarification/discharge orders...does there have to be a signature on these orders?

JODY , therapy - PTA/ Rehab Director, SNF March 21, 2009 5:33 PM
Marion OH

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