Owning a PT and MD practice

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freddydpt

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Has anyone else thought about that?
Know anyone who's done it?
I saw a setup in NYC where a physician in FP sports worked right along side a PT clinic and I thought wouldn't it be cool to own both. Any challenges anyone forsees?

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This is my future plan...with the PT clinic I plan to be in partnership with my friend(a PT).
You don't want to treat as a PT or even refer to yourself, that is obviously wrong. But owning a clinic or being in partnership is not wrong...as long as you offer a choice to the patient.
 
In several states it is now illegal for a MD to own a PT clinic. They don't like the idea of referring to yourself for a profit. There are many places like this though.
 
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MSHARO said:
In several states it is now illegal for a MD to own a PT clinic. They don't like the idea of referring to yourself for a profit. There are many places like this though.

Right but I'll be a PT and an MD... will it still be illegal?
What states is it illegal? I was under the impression that an MD can own a PT clinic but they just have to disclose that they own the practice if they are referring to it.
 
I believe even though you will have both degrees and should be able to practice as both (in my opinion) you are held to your highest degree level and therefore can only treat as a physician once you obtain your MD. I'm not positive about this but that is what a professor of mine once told me. This is a touchy subject within the APTA.

-J
 
yep...

partnership may be different. Conflict of interest is a BIG deal. Giving patients OPTIONS is very very important.
It may not even be worth the trouble as PT is not necessarily big money.
 
Yeah, the conflict of interest thing is pretty big. I know for a fact that it is illegal in MO, and I am pretty sure that it is now also illegal for CA and IN (existing practices are okay, but no new ones.)

It is kinda like when physicians owned parts of labs in which they sent out tests to. They made a profit for every test they ran and that turned out to be quite a conflict of interest and an abuse of the healthcare system. I think that is pretty much illegal in most states now too.
 
Physician owned practices, especially among ortho specialists, is a common practice in Illinois. There are also lots of GP offices that sport "We now offer Physical Therapy" signs, yet who merely employ a PTA and refer patients for profit. If you are a PT/MD and have an understanding of what and how a PT business is run, there should not be a problem, even if you refer to yourself.
 
I'd be very surprised if the PTA's at GP offices could actually bill for PT services. They may be able to bill under a medical CPT code, but probably not PT. Unless IL's practice act is pretty weak. Most states require that PTA's only operate under the guidance of a licensed PT, not an MD. I know of many ortho clinics that use ATC's as physician extenders. Actually the NATA is actually pushing this role for athletic trainers pretty hard. In these settings they do the patient screening, measurements, and prescribe exercises, but they do not bill under PT codes. Or at least they are not supposed to. One of the major sports med groups in Indy is currently being investigated for violating this.

In Missouri (not IN however) it is illegal for physicians, chiropractors, etc to advertise that they offer PT unless there is a licensed PT there. However they are not allowed to have a financial interest. I am not sure if they are allowed to do this if they disclose it though...I'd have to look it up. Again, you would have to check your state's laws regarding whether it is legal or not to own a PT practice as an MD, but I know for a fact that in several states it is illegal.

Actually I just found it. It is MO Revised Statute 334.253. It states:

Physicians prohibited referral to certain physical therapists, when, financial relationship, defined--exceptions, effective when.
334.253. 1. A physician may not make a referral to an entity for the furnishing of any physical therapy services with whom the physician, physician's employer, or immediate family member of such referring physician has a financial relationship. A financial relationship exists if the referring physician, the referring physician's employer, or immediate family member:

(1) Has a direct or indirect ownership or investment interest in the entity whether through equity, debt, or other means; or

(2) Receives remuneration from a compensation arrangement from the entity for the referral.

2. The following financial arrangements shall be exempt from disciplinary action under this section:

(1) When the entity with whom the referring physician has an ownership or investment interest is the sole provider of the physical therapy service within a rural area;

(2) When the referring physician owns registered securities issued by a publicly held corporation or publicly traded limited partnership, the shares of which are traded on a national exchange or the over-the-counter market, provided that such referring physician's interest in the publicly held corporation or publicly traded limited partnership is less than five percent and the referring physician does not receive any compensation from such publicly held corporation or publicly traded limited partnership other than as any other owner of the shares of such publicly held corporation or publicly traded limited partnership;

(3) When the referring physician has an interest in real property resulting in a landlord-tenant relationship between the physician and the entity in which the equity interest is held, unless the rent is determined, in whole or in part, by the business volume or profitability of the tenant or is otherwise unrelated to fair market value;

(4) When the indirect ownership in the entity is by means of a bona fide debt incurred in the purchase or acquisition of the entity for a price which does not in any manner reflect the potential source of referrals from the physician with the indirect interest in the entity and the terms of the debt are fair market value, and neither the amount or the terms of the debt in any manner, directly or indirectly, constitutes a form of compensating such physician for the source of his business;

(5) When such physician's employer is a health maintenance organization as defined in subdivision (6) of section 376.960, RSMo, and such health maintenance organization owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy services or the health maintenance organization and the referring physician does not receive any remuneration as the result of the referral;

(6) When such physician's employer is a hospital defined in section 197.020, RSMo, and such hospital owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy service, or the hospital and the referring physician does not receive any remuneration as the result of the referral.

3. The provisions of sections 334.252 and 334.253 shall become effective January 1, 1995.



As for a PT/MD practicing both...do you really think that you would have time to do both? Maybe as a PMR doc, but you would still probably be delegating. It would probably be much less lucrative to practice PT part time and medicine the other part. .
 
MSHARO,

Thanks for the info!

As for a PT/MD practicing both... do you really think that you would have time to do both? Maybe as a PMR doc, but you would still probably be delegating. It would probably be much less lucrative to practice PT part time and medicine the other part

I'm just tossing around the idea a bit. I once heard a speech from a woman who practiced as a PA and a PT. She said she enjoyed the diversity of her week. I think I would enjoy the same thing, especially if I specialize. I really enjoy ortho exams and manual treatment, but the specialties I've been looking into don't really have that as a component of the job. I think I'm going through a phase right now where I have no clue of what I'll be doing with my life and I'm tossing out options 😳
 
Yeah, I hear ya. I had a hard time finally deciding to go into medicine because of the things that I would be giving up as an ATC, PT (such as being able to spend the time to really get to know my patients hanging out watching football practices, etc). I know it is going to be hard for me to let go of some of my PT instincts regarding my patient's care. My wife jokes what I am really trying to do is be a one man sports med team by going to med school. I can be the team athletic trainer, PT, and orthopedist all rolled into one! I'll perform the surgery, devise and implement the reha, tape the ankle and get them back into the game! I am kind of a control freak I guess.

One way I think that I will be able to satisfy both of my interests (and some of this is somewhat kidding around at this point) is that several of my PT friends are planning to open a practice nearby when I am finished with school. They are going to like it because they would have a consistent referral source, but I think this will help me and my control freak tendencies. We could bounce ideas off of each other, talk freely about plans of treatment, etc. I think it will help keep me involved in my patient's overall care, including the rehab side. I think that most of us know way too many physicians that we could probably write a note to in a foreign language and they sign it and send it back with no clue as to what it said. I plan on being involved and interested in the physical therapy that my patient's are receiving. Plus, I also think my friends like the idea of having an MD they can can call up at home and say you don't know what the hell you are talking about with that diagnosis. You are full of S#!t. It'll be fun!

Don't worry, you'll find the niche that satisfies you. Have you looked into PM&R much yet?
 
Does the PTA at the GP's office not need to perform an initial evaluation, create a plan of care, modify treatment depending on response of the patient, and finally discharge the patient from services? These are all things only PT's are allowed to do, sounds like the GP/PTA thing is kind of shady. That doc must make a killing on reimbursement by not paying a PT salary.

-J
 
As a PT who works for an Orthopaedic surgeon, I know this has been the subject of heated debate in this country. Check out the stark laws about physician self referral. They are federal laws concerning physician self referral of medicare/medicaid patients. Recently revised, these laws now allow for certain ancillary services to be performed in the doctor's office, PT included among others. The doctor I work for has spent thousands of dollars in legal fees to make sure we are compliant with this rule. The APTA dispises this rule and has made it their aim to have it repealed. I personally have no problem with the arrangement, nowhere else can one recieve such a high level of care.
 
i have no idea is this is helpful...........but i was recently seen (at an academic center) by an orthopedic surgeon, refered for PT which was done right out of the same office space....i mean, they shared a receptionist. it was called a 'sports medicine clinic'... i suppose that the academic nature of it made reimbursement less of an issue.
 
It may also depend on if the sports med clinic you went to was owned an operated by the school/hospital system, or if the physician owned it. If it is part of the larger hospital system, and the MD isn't making a direct profit by referring to the PT, that is different. But if he owns it, and gets a cut from every PT visit etc., that just brings up ethical and many cases illegal isssues. Are they over referring PT just to make more money etc?

I have also worked at a couple sports med clinics where the practice was owned by MD's and they had PT there. It definately makes things easier at times (communicaton with docs, getting scripts, etc), but now working at a free standing clinic, I definately their are some negatives to it, at least for the welfare of the PT profession, pt's rights, and responsible use of reimbursement. For example, let's say I have a patient who has a knee problem. I look at it and see that it should be looked at by an orthopod. The patient goes to the orthopod he refers them to PT, but tells them that they want them to go to their PT versus our clinic. Now they are going to PT, but they now get a chunk of change being seen there, instead of getting nothing by coming back to my clinic. Despite what the patient thinks or wants. To me, that gets a little sketchy when it comes to ethics.
 
MSHARO,

I agree with you. POPTS is hurting private practices. I think the APTA is working so hard to get direct access regulation simply because of their disdain for this type of practice. btw, I love that word, "sketchy". The PTA I work with uses it all the time. Must be a PT thing. 😀
 
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