Since the Mitchell Study in 1995, there has been no published research on referral patterns of physician owned physical therapy clinics (POPTS).  Yes, there is very good Medpac data from June 2010 reporting ancillary services in physcians’ offices which clearly documents the growth and reports that “there are concerns that physician ownership could skew clinical decisions”. There are reports in prior publications which supports evidence that “physical therapy services ordered by physicians are not clinically appropriate” (Hendel et al. 2010, Office of Inspector 2006, Pham et al. 2009).  However, without recent data, there is no evidence that documents referral patterns of physicians who have an inherent conflict of interest in self-referal vs. physicians referral patterns who do not have their own physical therapy clinic or whether or not there are differences in clinical interventions between the groups or whether payor sources influence the episodes of care between the groups.  There have been several very recent studies in Health Affairs on the same topic in imaging.  Recency is critical because of significant reimbursement and healthcare delivery changes in the past 26 years.

While the POPTS or referral for profit (RFP) issue crosses clinical delivery, political, ethical, legal, and emotional issues amongst various parties, the only real area of agreement of parties on all sides of the fence is that we don’t have a recent unbiased study.  APTA has shown an unwillingness to move forward with a study and this is likely due to the justification that any publication produced by them would be biased.  Other parties with a vested interest including AMA, AAOS, public and private physical therapy companies, large national payors, state physical therapy chapters who have reserve funds far in excess of best practices (for some reason they forget that they are non profits tasked to provide member benefits) all have strong opinions on the issue yet have not commissioned a study of this type either.  However, all of them now have the opportunity to contribute and get this study done.

The Foundation of Physical Therapy which since 1979 is the largest national, non profit corporation that funds research needs in three areas:  scientific research, clinical research, and health services research.  They have approved a request for application (RFA) for a referral for profit study that will examine the key issues in RFP.  The Foundation is the best suited party for such a study since it is completely independent of any of the various parties and upholds the key rigor of scientific research process.  The study will likely be in the $350,000 plus range and is estimated to be complete in 2 years.

Which of those will be the first to step up and contribute to the Foundation so that we finally have recent research to reference?

@physicaltherapy

Disclosure:  I am a Trustee of the Foundation but as the readership of this blog well knows the opinions that I represent are mine