Letter from the CA PT Board.

Yes, the CA Board for PT found me with the help of an old employee of mine.  He fingered me and 3 other therapists in my practice.  I of course can't prove it, but you know when you know.  Given that he took it upon himself to personally call one of my therapists a month ago during business hours to let her know that "she was working illegally and should quit her job or face repercussions."  I think my deduction is justified.  This idiot in the same conversation had the gall to ask her if she would consider working for him!  God help us if this is where we are going.  Hi, I'm going to report you to the board and then presume you'd consider working for me since you will be out of a job!   The logic is staggering.  It is however, the kind of story that makes you feel all warm and fuzzy inside doesn't it?
That being said, I can't say I was surprised.  This individual's character is exactly the kind of disappointment I highlighted in my last post.  And the CAPTA pretty much empowered him to do it.  It leaves the kind of taste in your mouth that makes you not want to ever give another penny to the APTA.  And in case you were wondering, I've been a member since I was a student, for over 14 years.
Nevertheless, life is going on.  I am in the process of submitting my "plan" to become compliant with the assistance of a lawyer or two.  I can't really get into specifics at this time, but all I can say to my whistle blowing adversary, there is a significant chance NOTHING is going to change for 2011 as I work on complying.  And if plan A doesn't pan out, there are plans B and C behind doors numbered two and three.  So I hope he doesn't get his hopes up just yet that a moving van will be backing up to my front door any time soon.  
As he and many other out patient PT's are going to find, many of these clinics are not going to vanish.  Many groups will arrange rent back agreements to satisfy leases, possibly even arrangements to handle billing services (all of which is completely legal) and as a result, will continue to carry on healthy referral relationships with their ex-employers.  Who knows, they might even grow.... but how?  Can you imagine that the docs might be a little vengeful against their neighbors that forced them to dump their PT clinics?  Maybe they wouldn't be disappointed, seeing those smaller clinics in the community that lobbied against them, continue to struggle given that they have hurt their own practices.  If you think I'm far off, ask Paul Gaspar how many referrals he is getting now a days from his neighboring docs after being the primary whistle blower for the CAPTA on the AB 783 debate. They aren't exactly wrapping their arms around him for his good work in Sacramento.  At this point, shouldn't we all know there is policy and then there is reality.  We shall see which one has a bigger impact on the field of PT.
Given how this thing is playing out and how this is being handled, it strikes a chord in me that makes me want to work even harder to put characters like my snitching ex-employee out of business.  I will look forward to checking in on him in about a year to see how much different his bottom line looks when this all shakes out.  Stay tuned, as I will fill you in first hand as this process unfolds over the upcoming months.

CA PT Board posts a deadline

• Physical therapists working for POPTS in California have been given a deadline of September 1, 2011 to submit a "plan" for compliance to the board.  All physical therapists working for a POPTS should either find new employment or submit your compliance timeline prior to this date or face penalties regarding your PT license.  A letter was sent out to 155 therapists on 7/22/11 that had been reported to the board for being involved with a POPTS.   A copy of the letter can be viewed at the following link:  stoppopts.org.
• It should be noted that the board is not doing a systematic review of all clinics in California, nor is it sending this letter out to all its licensees, which in my opinion would be the correct thing to do.  If they were to do so they could immediately take out the excuse "I didn't know" from every therapist in the state that is working for a POPTS and hasten their ability to have their new ordinance take effect.  Isn't that what they are shooting for anyway?  More importantly, from a governance standpoint, they would be taking control of this issue in a clear voice, instead of letting the private practice special interest group be their mouthpiece.  
• To get a feel for what I am referring to, see: http://cppsig.com.  The amount of rhetoric that has come from this group regarding the topic of AB 783 has been unparalleled to any other debated issue I've seen come down the pipe in my twelve years as a therapist.  Note, they are the entity that has lobbied to stop POPTS over the past 2+ years.
• Please note, at this time, the board has chosen to send out these letters to only therapists that have been reported to be in violation of current California law by either the public or other therapists.  Who do you think the vast majority of these "complaints" have come from?  Yes, your guess is probably the same as mine; the complaints are coming from the same disgruntled private practice PT's that feel they are loosing business from their accused brethren.  
• As a matter of fact, all POPTS PT's that testified in front of the state congress at the beginning of the summer in support of AB 783 were all conveniently added to this list of 155 by the special interest PT group sitting across the isle from them.  So much for first amendment rights!?  If you don't believe me, ask a person who went and testified what they found in their mailbox this week.  
• As a result of how this matter is being handled, it has turned into a campaign of back biting and betrayal amongst our own profession.  PT's snitching on PT's in hopes of putting competing clinics out of business to better their own practice.  A very unifying message.  Bravo.  I'm sure the doctors couldn't be happier as they watch us rip the unity of the CAPTA apart.
• A final note.  For those of you that have participated in this noble practice of reporting other PT's to the board, if you think this is going to solve your problems, please review the reimbursement rates of your major insurance contracts before you breathe a sigh of relief.  The reality is: they aren't going to get any prettier in the coming months, with or without a POPTS around the corner, and that is the real anchor around your neck whether you want to admit it or not.  

Are POPTS really dead?

I am frequently reading the word fair in articles referring to the landscape of out patient physical therapy practice and the matter of POPTS; as in "It isn't fair that POPTS exist and monopolize patient referrals."  Since when has business ever been fair?  The defeat of AB 783 has been purported to be the great equalizer in California out patient physical therapy.  It is supposed to once and for all put a stop to physicians employing physical therapists and thereby, leveling the playing field by eliminating POPTS and referral for profit in the state of California.... hooray!  Well I have news for those of you that think this is the case.  As with most complicated issues, it just isn't that simple.

• First off, let's review the history of this matter.   Business arrangements between MD's and PT's that were deemed completely legal by the California Physical Therapy Association in 1990, magically became taboo two years ago when the California Private Practice Special Interest Group stumbled upon a piece of legislature from 1968 that provided a loop hole to move the anti-POPTS movement forward.  They quickly lobbied to change the code of the California Practice Act and made way for its recent interpretation of the Moscone-Knox Professional Corporation Act which is what AB 783 was intended to amend, making it legal for medical corporations to employ PT's.  For those readers that might not know, AB 783 was hung up in a state senate subcommittee in June that effectively killed the bill through 2012.   
• 2010 The PT Board voted unanimously that they can independently enforce this matter on its licensed members.
• Now that there is no impediment to their interpretation of The Moscone-Knox Act, and the Board can threaten the licenses of its members, POPTS should be finished due to the fact that medical corporations can't employ PT's and if they do their PT's loose their licenses, right?  Maybe.  At least that has been the backbone for the rhetoric published over the past month. 

First the PT Board of CA has to defend why this was deemed to NOT be a problem since 1968 until about two years ago.  If they can make that argument in court, there has been little mention about how they are going to address the fact that physician groups have taken out leases, purchased practices, and made significant capital investment on PT departments over the past 20 years based on the LEGAL interpretation that has been on the books since Stark II re-opened the door for this type of business practice in the early 90's.  If AB 783 is to be enforced via the California PT board, there surely will be law suits to follow that address the financial losses that will result from its enforcement.    These cases will not be heard overnight, and this litigation will surely slow the implementation of any such enforcement.  That could take many months to even years for its impact to be significantly felt in the PT community.   So let's slow down a little before we raise the victory flag and pat ourselves on the back.  The PT board to date (7/19/11) is still taking the matter under review, which means currently there is no official change in the business of out patient PT from a legal standpoint in California, regardless of what is being shouted from the bleachers of the private practice special interest group in California.
And if that isn't fair enough, let us not forget there is more than ample wiggle room in the laws of California business structure to create contract scenarios and even PT corporations that can provide services to medical groups.  These arrangements could effectively hold many referral patterns in place while the next shoe drops (see ACO in future blogs), all of which will be be completely legal. This fight is far from over my friends, and even if this battle is won, we are about to get an ACO wake up call in Southern California that will literally make all this minutia irrelevant in the very near future.