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ADVANCE Perspective: Physical Therapy & Rehab Medicine

POPTS? What About HOPTS?

Published October 1, 2012 2:34 PM by Jon Bassett

I had an extended phone conversation recently with a practice owner in the Midwest. I'd called to interview him about a separate subject but we ended up spending most of our time chatting about the challenges facing the independent practice owner in his particular market. This gentleman -- who has years of experience owning a therapy business -- is witnessing first-hand the effects of a large local hospital system opening its own in-house hospital-owned physical therapy service (HOPTS), and encouraging its physicians to refer patients to it.

In some cases, the practice is subtle; in others, it's downright blatant. This practice owner's sister had a procedure performed in the hospital recently that necessitated physical therapy. Upon being discharged, the scheduling secretary wouldn't let her leave the office without scheduling her physical therapy appointment. Only because this patient happened to have a brother in the industry did she understand her patient rights fully, and make it forcefully known that she would be pursuing her therapy elsewhere. If this had been another patient, especially one not familiar with physical therapy and how the referral process works, it would be one fewer referral to an independent PT practice.

And it doesn't stop there. The gentleman I spoke with is an entrepreneurial-minded practice owner who has launched specialty programs through the years that his community has embraced and responded to. But every time he announces a new niche service, the hospital system blunts the move by opening a bigger, better-equipped one -- a million-dollar wellness building; a high-tech sports performance program for local school-aged athletes with the exact same program name.

He even had to give up his contract providing athletic training coverage to two local school districts, for which he was paid a nominal fee, when the hospital swooped in and offered to provide the same service -- plus all medical equipment -- to the school district for free.

"They're using it as another way to gold-mine patients," he said of the school district contract.

When I posed the question of whether his state PT association was aware of the issue, or has taken any steps in response, he lamented that probably 90 percent of licensed PTs in his state are hospital-based anyway, so they don't see it as a priority.

Some would say, that's just the way business is going in America. After all, how many mom-and-pop hardware stores or independent furniture retail outlets do you see anymore? Are we naïve to think that the health care market would be somehow immune to big-box centers stifling the independent businessperson?

The owner that I spoke with, who will be retiring soon and has a succession plan in place for his partners, takes the high road. He's not anti-business nor anti-expansion, and even recognizes that monopolies aren't all bad, as long as they recognize that they're monopolies and act ethically. But I couldn't help but feel that the pride of PT ownership is somewhat diminished when the corner physical therapy practice has to close up shop.

Have you felt any first-hand effects of HOPTS in your area?


"Upon being discharged, the scheduling secretary wouldn't let her leave the office without scheduling her physical therapy appointment"  This statement is the exact statement I heard from a patient leaving a physicians office.  I think the hospitals have gotten their playbook from the MD's and PT's that operate POPTS.  It is a model that works and until the public is aware that they have a choice it will continue to be a model that many will use to build a caseload.

Karen Drilling October 4, 2012 3:04 PM

I totally agree with the position of this article, but I don't agree that the PT in this case took the "high road" or that  "monopolies aren't all bad".  

Having a single health care provider source may seem like a nice convenience for many patients, until that single provider makes a unilateral decision (such as a large local hospital system near me that chose to opt of of a particular insurance network, and thus left a large segment of the local population without an in-network service provider.)  

A monopoly can also lead to decreased quality or care options over time, once all the private practice owners have given up shop. What good is APTA's push for direct access when there will be no private PT practices to "directly access"?

The only way to reverse this trend, in my opinion, is to teach more about business and the value of entrepreneurship in school and afterwards. If schools don't teach students how to start their own business, what are they implicitly telling them about the role of a PT?

I hope that more therapists start their own practices and take advantage of resources to get them started.

Joshua Cohen October 2, 2012 5:12 PM

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