"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, April 22, 2008

Doctor-owned Specialty Hospitals

It's not easy to see how physical therapy diagnosis and specialty-hospital physician ownership are related but I'm going to show you how I think they relate to each other.

First, a preamble.

Legislation attempting to limit physician ownership of specialty hospitals has been attached to a bill currently in the US House of Representatives.

This bill would not limit physician ownership of physical therapy.

The rationale for the bill, however, is that restrictions on physician ownership would save Medicare money (presumably from over-utilization). The American Hospital Association is for the bill while the American Medical Association is against the bill.

Here is a position statement by AMA immediate past president William G. Plested III who argues against the bill.

Specialty hospitals concentrate or 'cherry pick' the most profitable patients (eg: elective total knee and hip replacements) and take those patients away from community hospitals that also serve indigent patients in the emergency room.

Cherry picking concentrates the orthopedic (and the physical therapy) caseload so that only the surgeon's patients are seen by the physical therapist.

The physical therapist will have little opportunity to practice physical therapy diagnosis on a wide range of patient types.

Physical therapy diagnosis is based on the measurement of physical impairments and the link between those impairments and the patients' self-reported functional limitations.

Physical therapy diagnosis requires independent decision making by the physical therapist such as goals and interventions.

Post-surgical protocols are more straightforward and usually don't require the physical therapist to exercise the same level of decision making and treatment planning.

Physical therapy diagnosis also requires a discharge diagnosis to confirm or refute the initial diagnosis.

Re-evaluating the patient (and taking new measurements) to make the discharge diagnosis helps the physical therapist learn which interventions work best and which goals are most appropriate.

Physician owned specialty hospitals (and physician owned physical therapy) are, in the long run, detrimental to the development of physical therapists' diagnostic skills because of the 'deadening effect' of the ultra-specialized caseload they see.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.