Gov. Quinn vetoes physical therapist bill

By Alejandra Cancino
Posted July 27, 2010 at 12:50 p.m.

Gov. Pat Quinn vetoed Friday a Senate bill that would have allowed doctors to legally hire physical therapists because those partnerships, he said, would increase costs for citizens.

In Illinois, patients must have a doctor’s referral to see a physical therapist. But physical therapists can bill insurance providers for their services independently, which is why Quinn vetoed the bill.

“Senate Bill 2635,” Quinn said in a letter to the General Assembly, “also incents medical professionals to increase the volume of services provided.”

Quinn added that the bill did not go far enough to “protect patient choice, restrict fee-splitting practices and limit self-referrals within the health care industry.”

The Illinois Physical Therapy Association has long opposed the hiring of physical therapists by doctors because that partnership, the association says, divides profits and becomes a form of fee-splitting, which is illegal.

Fee-splitting involves receiving a fee for referring a patient, which is banned in Illinois and other states to protect consumers and the health care system from conflicts of interest.

Peter J. McMenamin, former president of the Illinois Physical Therapy Association, believes the governor’s veto supports the association’s point of view against fee-splitting.

“Our efforts would be to try to help uphold the governor’s veto,” McMenamin said.

Doctors who have physical therapists working for them say that they are not shirking the law. Instead, they argue, they are legitimate employers, and that by hiring physical therapists they can better supervise therapy. Of the approximately 9,000 licensed physical therapists in Illinois, about 400 are employed by physicians, according to the Illinois State Medical Society.

Dr. Steven Malkin, president of the Illinois State Medical Society, who pushed for the bill, said in May that employment arrangements with physical therapists don’t amount to fee-splitting, because doctors don’t get a direct payoff for the referral. He said patients’ insurance providers typically are billed for the services rendered at the practice, and, in turn, the insurance providers send a check back to the practice, not to the doctors.

On Tuesday, Malkin said in a statement that the veto could jeopardize the jobs of hundreds of physical therapists employed by doctors and “will add cost and inconvenience to patients.”

“ISMS will work aggressively in the state legislature’s fall veto session to override this bad decision,” Malkin wrote.

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  1. Curious July 27, 2010 at 9:41 a.m.

    I’m curious as to why the physician group feels there is a need to supervise physical therapists on site. They are independently licensed health professionals, many educated at the doctoral level. The physicians don’t supervise pharmacists by hiring them to work in their offices. They trust the orders they request will be carried out by the professional.

  2. Charles July 27, 2010 at 10:27 a.m.

    I am so impressed that Governor Quinn has demonstrated the foresight and courage to take a stand to oppose Fee-Splitting in Illinois (Senate Bill 2635). It’s no wonder that physicians have pushed for this bill, as it would allow doctors to profit from making referrals to physical therapy services. It is well documented that this creates incentive for overutilization of services, and drives up health care costs to the consumer. The excuse that a physician feels that they can “supervise” the therapy better when it is provided by one of their own employees is “smokey” (and ludicrous) at best. Gov. Quinn made the right choice in veto of SB2635.

  3. DB July 27, 2010 at 7:18 pm

    The only reason the physicians were pushing for this bill was to keep profits in house. Do you really think the Illinois State Medical Society cares about physical therapists jobs? I was a patient and went to Illinois Bone and Joint for therapy after seeing the doctor there for back pain. It was like a busy restaurant with all the patients they were trying to cram in there. I was left alone alot of the times because my therapist was running around with two other patients there. It was like waiting for my waiter to come and refill my water, take my order, give me the check…the rest of the time, on my own. But they didnt delay on billing my insurance. That was right on time. All the time.

  4. Bdog July 28, 2010 at 6:32 pm

    As a physician, I can speak of the importance of having physical therapists hired, and overseen by, physicians. Therapists are not liscened physicians. Often times they do not understand what was actually done in surgery. By having a therapist that works with the physicians directly, patient care is improved. I have had many “outside” therapists try to improve motion in joints that I am trying to get to fuse. If they would read the prescription I write and of they worked under me to know what I am trying to accomplish with my surgery, this would not happen. Bad decision, Quinn

  5. ken July 28, 2010 at 8:39 pm

    Is is not ludicrous that by law an individual cannot hire another professional. If the employee does not desire to work for the employer they can refuse the job! This is simply a case of the physical therapist trying to create a market for direct billing of the insurance companies. As a patient it has been my experience that protocols and directions for PT are followed in a more precise fashion with therapy in doctors’ offices compared to ’strip malls’.

  6. David July 28, 2010 at 8:40 pm

    The next step will be a law NOT requiring the Physical Therapist to have a perscription from a physician, this is called Direct Access.

    The Physical therapist will then diagnose and treat patients with NO physcian involvment or oversight.

    Physical therapist bills will be enormous and they will have more incentive to “overutilize and drive up healthcare cost”
    Patients and Governors need to know that your best friend in healthcare is your physician.

  7. Ben July 29, 2010 at 12:31 a.m.

    David’s comments are merely a poor attempt of a scare tactic to make the public think that Physical Therapists are out to get all the healthcare money and harm patients. Physical Therapists are some of the best advocates for patients that there could ever be. If therapists were merely in their work for the money, they would become physicians and try to employ Physical Therapists to do the hard work of caring for the patients for them while they get the kick backs from simply making the easy decision to refer the patient to people who take the time provide the best care possible for the patients real problems and not simply offer them pain medication. The Physical Therapist has their own license to protect and lives by a strict code of ethics that is supported by the state board in which they are licensed and if the Physical Therapist were to ever have a patient present with something that was out of their scope of practice they would refer that patient to the appropriate healthcare provider. Physicians often refer their patient’s to Physical Therapists with little to no decsription of the patient’s problem ie “back pain” and the physical therapist os the one that takes the time to find what the problem is and treat it. Obviously if there are specific protcols from a surgeon that need to be followed a therapist will take the time to follow them, but maybe the surgeons should take the time to clearly identify those protocols if they really cared as much as they say they do about the patietnts they see. Why would you always need to pay a tow truck driver to tell you to go get your car worked at his companies shop when there might be a better mechanic that doesn’t overcharge in the same town. Do you think the mechanic needs to be supervised by the tow truck driver?

  8. Dean Aug. 4, 2010 at 11:33 pm

    Excuse me Bdog, but therapists actually are licensed. If your a physician, you would know that. Number two, why is it needed to hire your therapists? You can have them contracted out by therapist owned companies that are reputable and established (Athletico or Accelerated for example). That would be much more ethical. When the physician controls the DEMAND for therapy since a prescription is needed for it, then also wants to control the SUPPLY by hiring his own therapists, how is that ethical? How is that not anti-competitive? The AMA itself is and has been against fee splitting since 1930, so why is profiting off your own therapists different? Number three, if you had “outside” therapists working on your patients and were incompetent, maybe you need to be more specific in your protocols, or more involved in your patient’s care. Ever hear of a telephone? Why must the therapist be your employee for patient care to be maximized? Why don’t you hire your own pharmacist too and keep him in your office and make money off every prescription you write, then pass it off that it is safer that way and patient care improves. Why dont you buy an MRI machine and profit off every scan? You know, because “outside” MRI clinics are inferior. Study after study has shown increased therapy utilization by physicians who have financial interest in referring patients to therapy. That ends up being more expensive for all citizens. I mean, MedPac already did the research and came to the same conclusion. The American College of Radiology states on its site that physicians who refer patients to facilities in which they have financial interest are in violation of their code of ethics. So, how is hiring of therapists different when with every referral, the MD stands to profit from it? Another thing, just like the best physicians go on to open up their own practices, so too do the best therapists go on to work for themselves. In both cases, they are good, dedicated to their practice and strive to satisfy their patients fully. They have to or else their practice would suffer. If I’m a therapist who is spoon fed patients by my MD boss, what’s my motivation to be the best? I can be pretty average and still have patients coming through to see me. Thats why therapists who work for physicians (only 400 out of 9000 in Illinois) are usually new grads (cheaper) or burn outs that cant find much better work. The Director of Physical Therapy for Barrington Orthopedics (physician owned therapy) is actually an athletic trainer. Why? Cheaper.
    @Ken: if physicians are allowed to hire their own PTs, then jobs that are not physician owned therapy set ups will be much harder to come by, since more and more MDs will set up their own mini therapy offices. Plus, any competent therapist can follow directions, but most times the physician has no clue what’s going on unless it is something surgical. “Back pain,” “neck pain,” “shoulder pain.” That’s fine, its the therapist who is trained to figure that out. MDs are there to save lives, make sure its nothing serious, and perform surgery when indicated.

  9. Johnny Aug. 5, 2010 at 4:06 pm

    I am a Physical Therapist in N.C.. I applaud Gov.Quinn for his decision. I have been in this field for 15 yrs and I can attest to the fact that MD owned clinics are only in business for the profit. It is not in the interest of their patients and you don’t have to be an “MD” to figure that out. Thanks for the support Gov. Quinn. I work in conjunction with local MD’s who respect that when they refer to me that I will evaluate and treat pt’s repectively and not to over utilize services. Most therapist will have this same philsophy which is why we are Therapist with an ethical duty to do our best and refer to others when needed.