PM&R interaction with HMO's- good or bad for its future?

[spreesbeers]

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Some people feel HMO's are cutting service of PM&R docs. In the hospital, instead of ordering a PM&R consult, HMO's have more frequently forced hospitals and IM physicians to directly order PT thus, bypassing the physiatrist.I would appreciate any further imput on the subject of HMO's impact on PM&R demand, and practice.

Are HMO's making it more difficult for doctor's to order PM&R consults?

If so, how would this affect the survival of the specialty?

Is there any danger for the specialty in this regard?

How will HMO's affect physiatry in the hospitals vs. out patient sevice?

Thanks for your time,
William Scott
Class 2002
New York College of Osteopathic Medicine