Posts tagged physician owned physical therapy practice
Staying With One PT Provider Associated With Decreased Cost And Surgical Risk

The statement, “Your treatment is only Physical Therapy if it is provided by Physical Therapists or Physical Therapist Assistants” rings true in today’s healthcare environment. Unfortunately, some high patient volume and Physician Owned Physical Therapy clinics in an effort to strengthen their bottom line utilize individuals such as technicians or aides to provide their treatments. These individuals lack the education, training, and most importantly licensure to safely and effectively provide care in a Physical Therapy clinic. The delegation of care from Physical Therapists to less educated and qualified personnel has also been shown to impact the outcomes for patients with low back pain.

In the journal Physical Therapy, researchers retrospectively analyzed the cost and clinical outcomes of patients with low back pain (Magel et al. 2018). Specifically, authors wanted to determine if the continuity of care (number of providers) was associated with low back pain outcomes and health care costs. Researchers found patients who experienced care from fewer Physical Therapy providers had a decreased likelihood of low back surgery. In addition, patients with greater continuity of care paid $800 less for their low back pain compared to those seeing greater numbers of providers. Although the study design cannot support a cause and effect relationship the evidence supports the use of fewer providers in patients with low back pain.

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PT Visits in Physician Owned Practices Comes at a Cost

Patients have a choice for where they attend Physical Therapy even if directed to a single PT practice by their physician. Unfortunately, physician owned physical therapy practices, either on or off site, are on the rise around the country and referrals are being driven to these practices due to financial incentives. These practices often utilize less qualified personnel (aides, technicians) to deliver PT services at a higher cost than independently owned practices. In addition, research shows these practices utilize a higher percentage of passive modalities (ultrasound) inconsistent with current medical research guidelines.

A recent article highlights the importance of choice when patients select a Physical Therapist after knee surgery.  Mitchell and colleagues researched Medicare data on 3,771 total knee replacements performed between 2007 and 2009 (Health Services Research. 2016).  Researchers divided these patients into three groups based on where they attended Physical Therapy and the financial relationship between the Physical Therapy clinic and the physician.  

1. 709 patients received PT a a clinic where there was a financial connection with the physician  

2. 2215 patients received PT at a clinic where there was no financial relationship             

3. 847 patients received PT at a clinic with an independent provider, but referring physician had a financial interest

The researchers found patients who received Physical Therapy at a physician owned clinic were seen for twice as many visits and received less individualized care.  Authors also noted a decrease in intensity at the physician owned clinics likely responsible for the longer plan of care.  Intensity was described as the amount of individualized interventions designed to improve range of motion, strength, and endurance.  These results are consistent with prior research demonstrating the key financial and quality differences between physician owned and non physician owned Physical Therapy practices.   

Patients are advised to research into the ownership of their Physical Therapy clinic and choose a Physical Therapist who can deliver the most effective and efficient interventions possible.   


35% Greater Cost For Physical Therapy Care At Physician Owned Practices

Currently, consumers have many choices of where to obtain Physical Therapy services for their pain and sports injuries.  One option includes a clinic owned by the physician, often an orthopedist or physiatrist, who refers the patient to the clinic in which he/she has financial ownership.  This arrangement, described as a physician owned physical therapy service (POPTS) has been around for decades as physicians try to increase revenue within their practices.  Unfortunately, this arrangement comes with a higher cost and poorer outcomes for patients.  

Mitchell et al. (JAMA, 1992) was one of the first researchers to describe the limitations of these arrangements as compared to privately owned Physical Therapy services.  The authors reported patients who were seen at a POPTS used 45% more visits at a 30-40% greater cost for the same diagnosis as compared to a PT owned practice.   Often this care is associated with a greater utilization of less educated and trained providers including Physical Therapist Assistants (PTA), aides, or technicians (Resnik et al. Health Res Ed Trust. 2006).  In comparison clinics who utilize only Physical Therapists document superior outcomes to those using more Physical Therapy extenders.  

An interesting study was just published looking at these two clinic settings in relation to patients with low back pain (LBP).   Mitchell et al. studied 158,151 patient visits for low back pain in Texas between 2008-2011 to determine the impact of clinic ownership on patients outcomes and cost.  Consistent with prior research, if a patient was referred to a clinic in which the physician had financial ownership he/she experienced a higher percentage of passive care including modalities like ultrasound as well as 35% greater cost per episode of care.  The utilization of passive care for low back pain is inconsistent with the latest medical research advocating for active treatments to reduce pain and disability and likely creates a longer episode of care for patients suffering with low back pain symptoms.  The greater cost is attributed to the use of "incident to" billing in physicians offices which allows them to bill a higher rate for the same service.  

physician owner physical therapy practice, low back pain,

The evidence has been consistent with POPTS, when physicians have an ownership in a service whether it be an MRI scanner or PT clinic the  utilization of these services increases.  In regards to POPTS, this increased utilization comes with poorer outcomes and an increased cost.  If you are referred to Physical Therapy you always have a choice on where you obtain these services.  I encourage you to do your research and find a local, knowledgeable PT.