POPTS, self-referral, and APTA's Vision Statement 2020.

To the Editor:

In a June 24 letter to Mark B McClellan, MD, PhD, administrator of the Center for Medicare and Medicaid Services, APTA wrote, "The APTA strongly supports the ban on physician self-referral." A few lines later, APTA said, "Situations in which physicians receive compensation as a result of referring for, prescribing, or recommending physical therapy services create a serious potential for abuse."

APTA's Vision Sentence states: "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health." APTA's Vision Statement 2020 says: "Physical therapists will be practitioners of choice in clients' health networks and will hold all privileges of autonomous practice."

Does this mean that we will have direct access and we will self-refer? What would be the point of having direct access if the patient then must see a physician for a referral? If we do have self-referral, doesn't that create our own potential conflict of interest? If we take the above sentence from APTA's letter to CMS administrator McClellan and substitute "physical therapist," it would read: "Situations in which [physical therapists] receive compensation as a result of referring for, prescribing, or recommending physical therapy services create a serious potential for abuse."

Another sentence in the Vision Statement calls for physical therapists to be "guided by integrity." My assumption is that all physicians and physical therapists are guided by integrity. If indeed we are requesting self-referral as suggested in our Vision Statement, then how do we justify our request without "creating a serious potential for abuse," or seeming hypocritical?

Regarding autonomous practice, will the DPT of the future have the ability to write pharmaceutical prescriptions within the scope of physical therapy? Or will the patient have to see a physician for that? If we are going to be the consumer's first choice for physical problems, we should be able to treat as needed. This also would include taking and reading x-rays, ordering other diagnostic studies, administering injections, and referral to other practitioners.

James J Toffolo, PT

Portland, OR

To the Editor:

In response to Mr Toffolo's inquiries, I'd like to clarify a few of the terms and concepts in the APTA Vision and statements to which he referred. First, the prohibition on physician self-referral that APTA strongly supports would prevent physicians from sending their patients to practices or facilities in which they have an ownership interest and can profit as a result of the work they refer to other practitioners. A prohibition on self-referral does not mean that a physical therapist or a physician would be prohibited from providing treatment to their own patients. Confusing as some practitioners find them, the Stark self-referral laws and regulations clearly are not intended to keep practitioners from delivering their own services to their own patients within their scope of practice.

As Mr Toffolo suggests, unrestricted direct access eliminates the physician's control of the referral and contributes to an environment where patients have the ability to choose their physical therapist free from the influence of the physician's investment interests. I join him in hoping that all physicians and physical therapists are guided by integrity. If they are, there should be no objection to eliminating arrangements that create an incentive to profit simply by generating referrals to other practices in which they invest.

Finally, I would encourage Mr Toffolo to examine the curricula of the many education programs that offer doctorates in physical therapy. There is nothing in them that I am aware of to suggest that prescribing pharmaceuticals, ordering diagnostic studies, or other strictly medical services will become part of the physical therapist's scope of practice. I am confident that future physical therapists at the doctorate, masters, or baccalaureate level will continue to work collaboratively with physicians and other health care providers to provide appropriate treatment for their patients.

Thank you for the opportunity to provide some additional information on the issues raised by Mr Toffolo.

Francis J Welk, PT, MEd

[Mr Welk is APTA Treasurer and chairman

of APTA's Task Force on POPTS.]

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