Many Questions

By Tom DiAngelis, PT, DPT

I had a conversation with a member recently who was upset because one of the large hospital systems in his area is excluding private practices from participating in its network. A patient at his clinic is subject to a very high copayment, which means the patient will not come. This is certainly a concern anytime patient choice is limited, and a patient cannot access the provider he or she chooses. I know for many of you this is not new, but it is something we are going to see a lot more frequently with health care reform.

As I thought about this issue and discussed it with the member, I began to think: At times are we in private practice hypocritical in what we feel is appropriate versus not appropriate? How is this scenario different from many of the private practice networks around the country that limit participation? Is it not hypocritical that our peers in these networks do not allow other private practices in because of geographical restrictions? Why is it that a private practice network would not want to support and foster the growth of all private practices instead of being a “closed” network to some because of geography? As it turns out, the member who was upset about not being able to participate in this large system belongs to a private practice network that limits participation. Why is a limited private practice network okay, but a limited large system not? If the network has an exclusive insurance contract, wouldn’t that also limit patient choice and, potentially, their ability to access their physical therapists? Now, please don’t feel that I am passing judgment here; at one time I was a board member of a network that had geographic limitations for participation.

This led me to think about other areas where we might be hypocritical. The primary one that kept coming up in my mind was the referral for profit/physician-owned physical therapy services, or POPTS issue. We have fought hard against physicians owning their own physical therapy clinics and employing physical therapists, and we will continue to fight this battle. The APTA House of Delegates has strong positions against this practice, which I fully support. However, why is it acceptable for our private practices to employ occupational therapists, massage therapists, speech pathologists, and athletic trainers? Why is it acceptable for us to employ them and profit from their services? Is it only tolerable when we do it, but not when someone else does? I know some argue that we are not referring the patients to those other disciplines, but in reality there is plenty of cross-referral within a practice; in essence we often do refer. I have also heard the argument that it is different when we employ these other professionals because they are “like” professions. An interesting argument, but are we being a little hypocritical?

I am not saying that we are definitely hypocritical, nor that we are wrong. Obviously, as you see from the above, I don’t have the answers. I have many questions that I believe have different answers depending on the factors involved in each specific situation. That said, I think you have to make the best decisions for your business whether you are in networks or not and whether you employ other professionals or not. Then decide for yourself if you are a little hypocritical or not.


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