Will Assembly Bill Help or Hurt Physical Therapists?

Paul Gaspar is pretty upset.

A physical therapist in the San Diego area and a board member of the  California Physical Therapists Association, Gaspar said a bill recently introduced in the Assembly threatens the livelihood of many physical therapists in California.

He said it would promote over-utilization of physical therapy, increase costs and lower quality of care.

The bill, AB 783  by Mary Hayashi (D-Castro Valley), was designed to protect physical therapists, not harm them, supporters say.

At issue is a pending ruling by the Physical Therapy Board of California, which is deciding whether or not independent physical therapists must contract with medical corporations. Hayashi’s office said that AB 783 is just a means of correcting legal language, to include physical therapists among the list of ancillary medical providers who can contract with medical corporations.

If the ruling decides that therapists can’t be affiliated with those corporations, it could potentially put therapists currently working with medical corporations out on their own and possibly out of business, Hayashi’s office said. A spokesperson for Hayashi said the bill is intended to address that possibility.

But Gaspar is buying none of that. He said the bill is a blatant power grab by some provider groups to transform independent  physical therapists into employees, and to make money off of them.

“We take exception to the fact that some medical corporations want to leverage control of physical therapists,” Gaspar said. “They want to do it by controlling the access point [of physician referrals] for physical therapists.”

If a physical therapist becomes dependent on a particular medical corporation for all work, a few things happen, Gaspar said: The corporation gets to take a percentage of the therapist’s work; providers tend to over-refer, driving medical costs higher; and patient care suffers.

“The pressure to turn over patients is higher,” Gaspar said. “There is pressure for the physical therapist to see more patients than they actually should be seeing.”

Gaspar said AB 783 would create a situation in which physicians would tend to “maximize” every prescription they write for physical therapy. If a provider writes a prescription for a maximum of 36 visits, physical therapists who are no longer acting as independent contractors might be pressured to utilize all 36 visits, whether or not they were necessary, Gaspar said.

“I can’t go against my clinical judgment just to run up the bills,” Gaspar said.

A Hayashi staffer, speaking on background, said that the bill is not about control, it’s about a potential threat to jobs in California. The policy change was not driven by pleas from physical therapists for protection, her office said, but rather was done to solve a specific problem in the language of the law.

The rhetoric over this bill has been ratcheted up too high, according to Rosanna Westmoreland of the California Medical Association, which supports the bill.

One publicity campaign accuses providers of getting organized kickbacks through the bill, and that’s just over the top, Westmoreland said.

“Many physical therapists are currently employed in medical corporations,” Westmoreland said. “If the physical therapy board were to say you can’t do that, and if all of a sudden you as a physical therapist weren’t able to practice, that would create a serious access issue in California.”

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