Overall, in-office physical therapy gives physicians a greater role in the physical therapy services provided to patients, thus allowing the therapists and physicians to work together as a team, exchanging information and sharing ideas. Also, the relationship between therapist and physician affords frequent and immediate feedback to allow for the fine-tuning of therapeutic protocols that serves to improve patient outcomes. A 1993 study comparing on-site physical therapy delivered in physician offices versus other sites concluded that patients who receive on-site physical therapy lose less time from work and resume normal duties more quickly.1
Without question, the ability to exchange information on a patient in a frequent and timely fashion serves to reduce errors. According to another study, 70 to 80 percent of medical errors are related to interpersonal interaction issues. Interpersonal interaction is critical to patient safety and having better physician/therapist communication is what makes this possible.2
In addition, frequent and timely feedback between therapists and physicians reduces over-utilization of services. Consider the following examples.
1. If the doctor deems the desired outcome to have been achieved, then one can immediately discontinue services.
2. If the doctor determines another therapy modality is appropriate, then one can make a shift in a timely manner.
3. If it appears that physical therapy is not yielding desired results, one can consider other therapeutic techniques, including surgery.
Patients want and should have access to quality, comprehensive and non-fragmented care. Giving patients the option to choose the site of their care is vital and when patients get a choice, most will choose the site with the best outcomes and the most convenient site for them.
Lastly, in-office physical therapy offers patients direct and immediate access to the therapy after you have seen them (incident to). In fact, most of the time, we are able to schedule physician and physical therapy appointments at or near the same time and in the same office. This eliminates the need for patients to travel to two different appointments.
Negotiating The Rules And Exceptions Of Stark Law
Passed in 1989, the Stark I Law established the basics of what many refer to as “the self-referral laws,” prohibiting physicians from referring Medicare and Medicaid patients for “designated health services” (DHS) with which the physician has a financial relationship. However, there are many exceptions to the Stark Law, listed as “safe harbors” under Stark’s Rules.
While the first Stark Law mostly applied to clinical laboratories in medical physician’s offices, the law also had an “in-office ancillary service exception.” This exception encompassed services defined in Medicare as ancillary services for items such as in-office laboratory testing which physicians could perform in their own practices.
In 1993, Congress, led by Rep. Pete Stark (D-Calif.), decided that more services needed to be included as exceptions. Accordingly, Congress enacted Stark II, which expanded the list of exception services to include additional “designated health services,” one of which was physical therapy services.
There are now nearly 20 different exceptions included under Stark’s rules. While they all have their own qualifying provisions and details, for the purposes of DPMs, here is a short list of the exceptions under Stark rules.