Advocating for the Abolition of NY Physician Self Referral

Dr. V. and Dr. S. violated the Stark Law, initially, they did not violate the law when they decided to lease a nuclear camera. Although the Stark Law prohibits self-referrals for Medicare and Medicaid, there are exemptions; physicians may perform DHS services if they ordered the service. Under the assumption that Dr. V and Dr. S. ordered the services, they were not in violation of the Stark Law.

This frees up the physician’s schedule to see only the medically necessary patients, whereas PTs can share the load of musculoskeletal evaluations. Mitchell and Lissovoy published a study in 1994 on the cost effectiveness of direct access to PTs. They found that the costs for PT visits were 123% higher when patients were first seen by a physician as compared to when they were seen by a physical therapist directly. Establishing close working relationships between medical doctors and PTs, with a 2-way referral of patients, is essential to reduce not only unnecessary referrals, but also improve patient satisfaction and create an efficient process for reducing overall medical costs.

So, I am going to clear up some of these myths. These myths are from a article I read called 7 Direct Access Myths Debunked. One topic is that it only applies to private outpatient Physical Therapy Practices. The truth is that is applies to many other areas as well like private pay home care or sports field and performing arts venues, etc. So it's not just applied for one group. If you really need serious go to a physical therapy clinic but you still might have to get approval from your primary care physician. Another Myth is that Direct access doesn’t exist in every state. That is somewhat true but there are different levels of direct access. A state my just limit the amount or put a limit on it. So a form of direct access does exist in every state so you just have to figure out what works best for you. Mississippi is one of the six states that has strict limitations that still require approval. Another myth is that allowing patients coming without a referral from their physician puts their health at risk. “Physical Therapist are doctoral-level medical professionals whose training and education make them more than qualified to not only conduct initial evaluations, but also recognize when a patient’s medical needs fall outside of their scope”(Andrus). Physical Therapist are doctors. They go to med-school like every other doctor does. They can see when a Patient needs therapy or not. According to Apta’s Guide of Professional Conduct it is required that PT’s should evaluate the patient for signs and symptoms of damage for therapy. A doctor would not just treat someone without evaluating

Privacy legislation and the legal complexities surrounding the ownership and management of patient information, many physicians are wary about when they may or may not release such information to patient and other parties. All patients have the right to the information in their medical records. In certain situations the physicians have the right to refuse the release of patient information to the patient, if the have any reason to believe that the disclosed information would have a reverse effect on the patient’s mental, physical, emotional health, or cause harm to a third party. When needed to be transferred a copy of the information may be sent directly from the former physician to the new one. In other circumstance the patient can receive the record themselves and hand it directly to the new physician. It is recommended that the original files are not released, instead a photocopy or scan of it may be sent. A physician may release patient information to lawyers and other parties when requested to do so only if the patient or the patient's substitute decision-maker has given authorization, preferably in writing, or if authorized by law or a court order.When information is

Katz states, “the conviction that physicians should decide what is best for their patients, and, therefore, that the authority and power to do so should remain bested in them, continued to have deep hold on the practices of the medical profession “(214).

Considering the provisions of the Stark law, it is clear that Congress enacted the law to curb the self-referrals that were prevalent among medical practitioners due to the sprawling specialty hospitals and health facilities (Choudhry, Choudhry, and Brennan 2005). Furthermore, Congress saw the need to prevent a physician’s referral decision that is dependent on a selfish, financial gain. The idea was to preclude “overutilization” of certain health care facilities that may arise from objectionable referrals and the resultant increase in health care cost (Staman 2010).

My first experience observing a physical therapist, commenced in the summer of 2014. At the time, I was given the opportunity to observe a physical therapist named Jennifer Moreland. Throughout my time observing her, I began to recognize she was not just a physical therapist with her patients. Many times, she took on the role of a consoler, cheerleader, friend and supporter for her patients. Reflecting back on this, I am able to see that the primary reason she has succeeded as a physical therapist; is due to her amiable, encouraging and empathetic nature. These character traits have allowed her to do more than heal patients' musculoskeletal problems. She has also been able to heal hearts, souls and minds by cheering, supporting, listening

According to nspcc (2017) "A referral is a appeal from a member of the public or a professional to the local authority child protection team or the police to intervene to support or protect a child." For a referral to be done correctly there are steps to follow , for example if a professional has concerns about a child's welfare , He/she must discuss with manager and / or agency's nominated safeguarding advisor including consideration of seeking parental consent .

Under the Affordable Care Act, more patients are becoming eligible for health insurance. With the influx of patients, private practices are spending less time with patients and more time with filling out paperwork to satisfy government requirements, all with the mandated intention of improving patient care.4 With this, I worry that as a future therapist, I will not be able to give my patients the one-on-one therapy and time that they deserve. If my patients do not get the therapy they deserve, I will simply be wasting their time and will not be practicing properly under my code of

They are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Start law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL). The FCA protects the Government from being overcharged by health care providers filing false claims. Under this law, specific intention to defraud is not required. The AKS prohibits the knowing and willful payment of remuneration to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (U.S. Department of Health & Human Services). The Physician Self-Referral Law, also known as the Start law, prohibits health care providers from referring patients to entities with which the provider or a family member has financial interest. The Exclusion Statute bans certain entities or individuals from participating in federal health care programs. If an individual or organization is excluded by the Office of Inspector General (OIG) Federal health care programs will not pay for services or items provided. The Civil Monetary Penalties Law allows for civil money penalties to be placed against an entity that knowingly submits fraudulent claims, violates Medicare agreements, making false statements on applications for participation in Federal health care programs, and violates the AKS, among other

I believe that my personal and professional growth and behavior as a physical therapist is of utmost importance. I base this firstly on my strong connection to those in society who are disadvantaged when it comes to physical therapy, and also on the movement system, movement being “the key to optimal living and quality of life for all people that extends beyond health to every person’s ability to participate in and contribute to society” (American Physical Therapy Association, 2013). This perspective, I believe, is aligned perfectly with the vision statement for the physical therapy profession – to transform society through optimization of movement to improve the human experience (APTA, 2013). After reviewing the vision statement, I strongly believe it will act as my guide by strengthening compassion, reinforcing advocacy, improving quality of service, and strengthening cohesion.

This week’s forum raises a fundamental question on the readiness of the United States physical therapy (PT) profession to integrate prescribing medication as part of its autonomous practice. Currently, the United Kingdom (UK) is the sole nation that has provided their PTs the authority to prescribe medication without any physician’s authorization (Chartered Society of Physiotherapy [CSP], 2012). The UK’s PTs journey in attaining an independent prescriber status underwent a rigorous process before it even came into effect in June 2012. Before achieving the independent status for prescribing drugs in 2012, the PTs in the UK already has supplementary prescribing rights since 2005 (CSP, 2013; Cooper et al., 2008). To adequately address the

“Professional integrity derives its substance from the fundamental goals or mission of the profession” (Wakin, 1996, para. 15). Meaning to say, individuals seek for a professional’s valued and ethical advice to which the professional holds their responsibility to maintain and exceeds the level of their expertise. For example, a general practitioner will treat a variety of patients, from all different walks of life with a plethora of different problems. It is their duty to diagnose and treat the patient to the best of their professional ability without prejudice. Another aspect of their duties is the principle of patient confidentiality. Medical professionals are legally bound to not divulge any information provided to them by their patients.

On September 8th, 2015, I first began interning for Dr. Dawn Cox and her staff of experienced Physical Therapists at PRANA Functional Manual Therapy in Lancaster, PA as a Physical Therapy Aide. Intermittently, on the first day of my internship, I would ask the therapists “Why choose Physical Therapy as a profession?” One of the Physical Therapists conveyed that aside from the substantial benefits a job provides, it was the intangible materials that gave the profession a meaning. As a student exploring the field of Physical Therapy, I have infallibly witnessed professionalism at PRANA and other Physical Therapy facilities through the therapists’ altruism towards patients -without violating ethical practices as professionals; their apposite use of communication with each individual at the workplace; and their sense of accountability when things go unforeseen.

An example would be if a practitioner had a husband or wife who was an inpatient; it would be unethical to go to the nurse’s station to look over their spouse’s chart. Simply being married does not provide any special treatment without authorization signed by the spouse (Erickson and Millar, 2005).