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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Pinpointing POPTS

Published August 26, 2013 5:13 PM by Brian Ferrie

On Aug. 1, Rep. Jackie Speier (D-CA) introduced the "Promoting Integrity in Medicare Act," according to a press release from the American Physical Therapy Association (APTA), Alexandria, VA. This measure seeks to remove physical therapy and other healthcare services from the in-office ancillary services (IOAS) exception from the federal Stark lawsalso commonly known as self-referral. If enacted, it would effectively eliminate financial incentives from the physician-referral process. The APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception.

The self-referral law generally prohibits physicians from referring Medicare patients to entities in which they have a financial interest. It seeks to ensure medical decisions are made in the best interest of the patient on the basis of quality, diagnostic capability, turnaround time, and cost without consideration of any financial gain that could be realized by the referring physician. Originally intended for same-day services such as X-rays and blood draws, the IOAS exception allows physicians to bill the Medicare program for procedures that are meant to be integral to the physician's services and offered for patient convenience. 

"Unfortunately, using the exception in a manner not originally intended provides physicians with incentive to refer patients for services that may not always be necessary or typically provided on the same day of an office visit," the press release continued. "This not only increases utilization of services but also Medicare costs. Physical therapy services clearly do not meet the intent of the exception and self-referral by physicians has the potential to increase costs. Physicians and physical therapists have a longstanding professional relationship that serves patients well without the need for adverse financial ties or relationships."

The argument over physician-owned physical therapy services (POPTS) has raged in the profession for years now. This latest development is certainly a boost to the cause of those who oppose POPTS. On which side of the issue do you stand? What do you believe the future holds for POPTS?

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California Quandary

A perspective on the POPTS legislative battle from one therapist in the thick of it.


The concern should be bigger than POPTS. Physicians who own MRIs have been shown to order more tests than those of the same specialty who do not. Having an MRI increases the likelihood that patients will undergo an invasive procedure. Physicians who have an ownership interest in a surgical center have been shown to do more procedures than their colleagues of the same specialty who do not.This is bad for the health care economy because it drives prices up without necessarily improving outcomes or the quality of care. A physician does not have to own a PT clinic in order to communicate with the professional staff there.

Paul Weiss, PT, Dip MDT, Physical Therapy - Proprietor, Cedar Hill Physical Therapy November 23, 2013 4:03 PM
Greensboro NC

I have worked with a medical doctor, physiatrist,  who refers patients who need physical therapy to physical therapist that are employed by him.  This physiatrist also performs trigger point injections, cortisone injections and platelet rich plasma injections to treat musculoskeletal conditions.  Not all patient are referred for therapy- Only those that need physical therapy are referred.

Several strong points I would like to make in support of physician referral to employed physical therapists:

1. Communication is open and excellent- as I am sure you have experienced- when a physician refers to an "independent physical therapist" it is very hard  for the therapist to get a simple signed evaluation or progress letter back- the back and forth communication that the physical therapist has with the referring physician is often very limited- a great detriment to the patient's care. With a team approach of the physician and physical therapist working closely together- shared charts- close professional communication is much more likely- a great asset for the patient's care and recovery

2. Speaking of this bill proposed, which is intended to save the federal government money -this bill is all about "the Money"  it is not being presented in the best interest of  patient care- as of course you know the insurance companies are allowing fewer and fewer yearly physical therapy visits, Medicare in particular is requiring patient surveys and more detailed progress information-The insurance companies are Great Gate Keepers to patient's getting physical therapy services- it would be horrible for patients and patient care to have more layers for patients to get quality physical therapy

3.  I do not feel this bill is in the best interests of the patient- most importantly nor the physical therapist- whether self employed or employed by a physician group-

4. Big hospital systems refer internally for procedures, physical therapy, radiology etc. This allows the patient to get needed services in a timely, efficient and effective manner with the most important aspect of excellent communication among all providers-

5. Big Insurance business is already closely monitoring physical therapy patient care- again- limiting number of yearly visits, high copays- patient feedback and lots of paper work!!!

6.Allowing Big Government to add more barriers for patients to get physical therapy they need in a timely and efficient manner is not what is best for patients!!!

Please think of what's best for patients- this bill is not good for patients who need physical therapy.

Debra, Podiatry - Doctor September 2, 2013 6:40 PM

POPTS have always been a problem.  No matter how altruistic the physician is to begin with--stating they have the best care and interest of the patient in mind--the almighty dollar always wins out in the end. They begin to insist on more visits than needed, on more procedures than needed (quotas), and repeated renewals of prescriptions even if the patient is not responding to intervention.

I believe that physicians can only clearly and responsibly refer to PT if they have no financial interest in the PT clinic. I also believe this problem would go away if PTs and PTAs would take a stand and refuse to work for these physicians. We, as PTs who work for a physcian-owned facility, are as much a part of the problem as the physicians themselves. And again we come back to the almighty dollar--PTs tend to work for physician owned clinics because they tend to pay more--not because the care is better.  I don't care how many school loans you have to pay back it is just not worth it to sell your soul that way!  You do a disservice to yourself, the patients you treat, and the profession.

Melinda, Physical Therapy - PT, ARI September 2, 2013 11:42 AM
Santa Claus IN

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