FW: summary of traditional referral relationships
Eric Eisenberg
Description
Collection
Title:
FW: summary of traditional referral relationships
Creator:
Eric Eisenberg
Date:
5/24/2012
Text:
From: <Email Address Redacted>
To: <Email Address Redacted>
Subject: summary of traditional referral relationships
Date: Thu, 24 May 2012 06:56:28 -0500
I'm with u all the way Brother.
Physician o and p practice is running rampant in Tampa as well as other lager metro areas in Florida. More so on the o side but with all the prefab prosthetic sockets out there now, it won't be long until that catches on as well. My biggest competitors in Tampa are sales reps introducing this cash cow to physicians everywhere.
I have a very busy spine surgeon in my office complex and see patient after patient walking out with very ill fitting TLSO &LSO's.
Most are Don Joy products. That's right, their in the spine business now as well as every other part of the human anatomy. Another very large Orthopaedic group in town with 20+ surgeons and 15+
PA's and ARNP's has a D J rep who camps out there and hires Athletic Trainers to fit various orthoses. Not well mind you but that doesn't seem to matter as long as the physicians get their cut.
This is driving me mad. I've practiced in Tampa since 1982 and every year it gets worse and worse. We are a licensure state and all the regulations we have to put up with not to mention the out of pocket to remain licensed seems to be all for not. When I have brought this situation up to the state O and P BOD's, the answer is the same. We only regulate the licensed practioners. There is nothing we can do about the non licensed reps working out of a physicians office. What kind of crap answer is that. It is just that, CRAP!
I only have about 5 years left of this ensuing torture before I ride off into the sunset. However, if you young ones out there with your soon to be a Masters required profession do not wake up and start some kind of campaign against this horrific trend, well you've
just waisted a bunch of time and money only to work for a physician for pennies on the dollar that you are worth.
Thanks for the post
I needed something to charge me up. One more BK to modify and then out of here until early tomorrow.
Take care and good luck,
Well, Eric, you should know by now, that we do not have health care here anymore. We have Health industry, and as such, answer to all your questions is - YES.
It's called integrated care and it's coming fast.
Btw, there's a great documentary on this, by some Swedes, Health industry(factory?) I believe. Straight down your lines. You can also watch Sicko, if you want to.
Sorry, not Swedes. Ice-men
<URL Redacted>
Hello Eric.........you are right on my friend.......speaking out is what we
need. You have hit the nail square on the head and I hope others will follow
and also speak out. Les C/O-E
Yes Eric, we will be extinct. I have a local group of 15 orthopedist, who are opening there own surgical center, P.t. Clinic and are major investors with the local for profit hospital. They have sales reps from Regional DME selling them braces. all prosthetics and custom orthotics go to Hanger because.... (the spine surgeon told a disgruntled Hanger patient this) they own stock in Hanger. Strict violation of Starks law, but impossible to prove.
It is impossible to compete with your referral sources
You are now seeing a trend I saw starting about 15 years ago. Just wonder, like you, what the future O&P practice will look like... Who knows? I'd like to think we could stand alone but it's going to be who provides the services for the cheapest. High quality is a given. Nobody perceives quality will diminish. It will be expected. Are you having to compete with others who are basically buying referrals or working for physician groups? That's been going on in Houston for 15 years and it isn't a violation of The Stark Amendment.
Ughhh..
I am BK from a motorcycle accident some 40+ years ago. There is a
hospital (non-profit haha) in Nashville, TN that had a local
prosthetics shop set up a small office within their hospital. So the
symbiosis between physicians and prosthetists may be nearer than your
query suggests.
couldn't agree more. Where I am at we are also seeing this type of situation and recently have had central fabs start soliciting Docs to sell custom items to them directly and then when they need an adjustment to go see the orthotist. It seems like accountable care organizations or intergrated heath organizations they are doing anything to keep everything with in a network. Much like you as an independent I feel like the traditional way of providing O and P is about to change drastically and not for the better.
Great topic, Keep me posted on your responses.
Thanks
This is why I retired. O&P is no longer the profession I entered in the 1960s.
Eric,
I can now erase the draft email that I had started! You are spot on with your message. Our industry leaders or associations are so scared of physicians that they refuse to approach this reality! I have asked a number of times for them to look at this and at the very least require physicians to hire Orthotist. Physicians are required to hire certified nurses, certified lab techs, but can place an 8$ an hour person in their office to fit ALL braces including customs! This is where our state board and their consumer protection arm should be screaming!
There was a study done back in the 90's that showed a significant increase (2/3 more) in brace prescriptions when a physician had a financial interest. We need to fight this! Congress has to understand that when a script pad becomes a check book there is a problem. Tell me how I can help
Eric,
Welcome to the private practice Physical Therapist's world. My wife and I have owned our our respective practices (Her's PT, mine O&P) for the past 18 years. We have been literally surrounded by what is referred to POPTS (phyisician owned physical therapy services) for over a decade. I am surprised it hasn't hit in the O&P field before now. I know of one clinician in Rockford Il who up until recently worked of a POOPS (physician owned orthotics and prosthetics service---Just made that one up!). He recently left to be an instructor at NUPOC in Chicago. We have been able to survive on the PT side, and infact have recently been flourishing. However, at any time, the docs can pull the plug. It's used to be all about relationships and we have been cultivating that for a long time. However, as the dollars get tougher to come by, those relationships dry up. I'm concerned for the future of ANY private practice. the docs already have given up the ghost to hospitals. Big box PT and O&P are an ever looming presence, and with reduced reimbursement by the criminal insurance companies I feel the only way to survive is volume, something the big boxs and hospitals can sustain. Good luck wherever you are in stemming the tide of the POOPS.
Thank you for posting this question. I am anxious to hear what is the
response. Our field is dominated by clinicians, and hence will be skewed
toward patient care. There appears to be a scarcity of funds for
healthcare and the management types will drive the field to what they
perceive is the most cost-effective. We all have seen disastrous mergers
and business ventures, so as a group, management types may not any better
business people in the end but will make a lot of waves in the process
To: <Email Address Redacted>
Subject: summary of traditional referral relationships
Date: Thu, 24 May 2012 06:56:28 -0500
I'm with u all the way Brother.
Physician o and p practice is running rampant in Tampa as well as other lager metro areas in Florida. More so on the o side but with all the prefab prosthetic sockets out there now, it won't be long until that catches on as well. My biggest competitors in Tampa are sales reps introducing this cash cow to physicians everywhere.
I have a very busy spine surgeon in my office complex and see patient after patient walking out with very ill fitting TLSO &LSO's.
Most are Don Joy products. That's right, their in the spine business now as well as every other part of the human anatomy. Another very large Orthopaedic group in town with 20+ surgeons and 15+
PA's and ARNP's has a D J rep who camps out there and hires Athletic Trainers to fit various orthoses. Not well mind you but that doesn't seem to matter as long as the physicians get their cut.
This is driving me mad. I've practiced in Tampa since 1982 and every year it gets worse and worse. We are a licensure state and all the regulations we have to put up with not to mention the out of pocket to remain licensed seems to be all for not. When I have brought this situation up to the state O and P BOD's, the answer is the same. We only regulate the licensed practioners. There is nothing we can do about the non licensed reps working out of a physicians office. What kind of crap answer is that. It is just that, CRAP!
I only have about 5 years left of this ensuing torture before I ride off into the sunset. However, if you young ones out there with your soon to be a Masters required profession do not wake up and start some kind of campaign against this horrific trend, well you've
just waisted a bunch of time and money only to work for a physician for pennies on the dollar that you are worth.
Thanks for the post
I needed something to charge me up. One more BK to modify and then out of here until early tomorrow.
Take care and good luck,
Well, Eric, you should know by now, that we do not have health care here anymore. We have Health industry, and as such, answer to all your questions is - YES.
It's called integrated care and it's coming fast.
Btw, there's a great documentary on this, by some Swedes, Health industry(factory?) I believe. Straight down your lines. You can also watch Sicko, if you want to.
Sorry, not Swedes. Ice-men
<URL Redacted>
Hello Eric.........you are right on my friend.......speaking out is what we
need. You have hit the nail square on the head and I hope others will follow
and also speak out. Les C/O-E
Yes Eric, we will be extinct. I have a local group of 15 orthopedist, who are opening there own surgical center, P.t. Clinic and are major investors with the local for profit hospital. They have sales reps from Regional DME selling them braces. all prosthetics and custom orthotics go to Hanger because.... (the spine surgeon told a disgruntled Hanger patient this) they own stock in Hanger. Strict violation of Starks law, but impossible to prove.
It is impossible to compete with your referral sources
You are now seeing a trend I saw starting about 15 years ago. Just wonder, like you, what the future O&P practice will look like... Who knows? I'd like to think we could stand alone but it's going to be who provides the services for the cheapest. High quality is a given. Nobody perceives quality will diminish. It will be expected. Are you having to compete with others who are basically buying referrals or working for physician groups? That's been going on in Houston for 15 years and it isn't a violation of The Stark Amendment.
Ughhh..
I am BK from a motorcycle accident some 40+ years ago. There is a
hospital (non-profit haha) in Nashville, TN that had a local
prosthetics shop set up a small office within their hospital. So the
symbiosis between physicians and prosthetists may be nearer than your
query suggests.
couldn't agree more. Where I am at we are also seeing this type of situation and recently have had central fabs start soliciting Docs to sell custom items to them directly and then when they need an adjustment to go see the orthotist. It seems like accountable care organizations or intergrated heath organizations they are doing anything to keep everything with in a network. Much like you as an independent I feel like the traditional way of providing O and P is about to change drastically and not for the better.
Great topic, Keep me posted on your responses.
Thanks
This is why I retired. O&P is no longer the profession I entered in the 1960s.
Eric,
I can now erase the draft email that I had started! You are spot on with your message. Our industry leaders or associations are so scared of physicians that they refuse to approach this reality! I have asked a number of times for them to look at this and at the very least require physicians to hire Orthotist. Physicians are required to hire certified nurses, certified lab techs, but can place an 8$ an hour person in their office to fit ALL braces including customs! This is where our state board and their consumer protection arm should be screaming!
There was a study done back in the 90's that showed a significant increase (2/3 more) in brace prescriptions when a physician had a financial interest. We need to fight this! Congress has to understand that when a script pad becomes a check book there is a problem. Tell me how I can help
Eric,
Welcome to the private practice Physical Therapist's world. My wife and I have owned our our respective practices (Her's PT, mine O&P) for the past 18 years. We have been literally surrounded by what is referred to POPTS (phyisician owned physical therapy services) for over a decade. I am surprised it hasn't hit in the O&P field before now. I know of one clinician in Rockford Il who up until recently worked of a POOPS (physician owned orthotics and prosthetics service---Just made that one up!). He recently left to be an instructor at NUPOC in Chicago. We have been able to survive on the PT side, and infact have recently been flourishing. However, at any time, the docs can pull the plug. It's used to be all about relationships and we have been cultivating that for a long time. However, as the dollars get tougher to come by, those relationships dry up. I'm concerned for the future of ANY private practice. the docs already have given up the ghost to hospitals. Big box PT and O&P are an ever looming presence, and with reduced reimbursement by the criminal insurance companies I feel the only way to survive is volume, something the big boxs and hospitals can sustain. Good luck wherever you are in stemming the tide of the POOPS.
Thank you for posting this question. I am anxious to hear what is the
response. Our field is dominated by clinicians, and hence will be skewed
toward patient care. There appears to be a scarcity of funds for
healthcare and the management types will drive the field to what they
perceive is the most cost-effective. We all have seen disastrous mergers
and business ventures, so as a group, management types may not any better
business people in the end but will make a lot of waves in the process
Citation
Eric Eisenberg, “FW: summary of traditional referral relationships,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/233631.
