Attacks on physician ownership of physical therapy services (POPTS) in states across the country have prompted many orthopaedic surgeons to take political action to protect their practice models. Most recently, the Rhode Island Orthopaedic Society (RIOS), under the leadership of Mark A. Coppes, MD, was successful in getting legislation passed that preempts any attempts by the state’s physical therapy association to restrict the ability of physicians to offer these services in-office

The American Physical Therapy Association’s (APTA) “Vision 2020” plan calls for exclusive ownership and operation of physical therapy services. Physical therapy associations across the country are aggressively working to rewrite state physical therapy practice acts to restrict physical therapists from working for physicians. This tactic does not directly prohibit physicians from providing physical therapy services, but does ban physical therapists from working in a physician-owned clinic. As a result, patient access to the full scope of healthcare services is restricted and employment options for physical therapists are limited.

A preemptive move
In 2007, RIOS resolved to introduce legislation that would prevent this threat from emerging. Their effort was inspired by a similar initiative in Alabama, where legislation prevents the state’s physical therapy board from passing any rule that would deny physical therapists licenses or suspend them from practice for being employed by physicians.

Attorney Lenora Pate discussed the Alabama experience at last year’s State Societies Strategy Meeting in Washington, D.C., and the American Association of Orthopaedic Surgeons (AAOS) subsequently promoted the bill to state societies as model legislation.

Dr. Coppes spearheaded the efforts, with support from Board of Councilors representative Ira Singer, MD. Dr. Singer’s advocacy relationship with Rep. Peter F. Kilmartin led to the introduction of H7870 on February 26, 2008. This legislation would prevent the state’s physical therapy board from enacting any rule that would discipline physical therapists simply for being employed by physicians.

The state APTA chapter firmly opposed the measure, and even the state medical society was unwilling to support it fully. Nevertheless, RIOS decided to proceed. This independent political initiative was a first for the small society.

Help from the AAOS
RIOS sought grant funding from the AAOS Health Policy Action Fund and received $5,000 in March 2008 to help offset the cost of retaining Brian Goldman, a seasoned Providence lobbyist.

Mr. Goldman helped guide RIOS through the legislative process, introducing the society’s leaders to key legislators. RIOS leaders and several physical therapists employed by orthopaedic practices also provided convincing testimony before members of the General Assembly.

Careful negotiations with representatives from the state’s physical therapy association resulted in legislative language that satisfied both organizations. The final bill requires full disclosure to a patient if a physician refers that patient to a facility owned by the physician for physical therapy—already standard practice among orthopaedists.

The measure passed the state Senate in July and went into effect upon passage. RIOS intends to remain active in state legislative activities in the coming years, working with the larger medical community and serving as the leading advocate for orthopaedic interests in Rhode Island.

Charlene K. MacDonald, MPP, is manager, state legislative affairs, in the AAOS office of government relations. She can be reached at macdonald@aaos.org