Today’s the day, and you can almost hear the spaghetti-Western showdown music in the background.
Is AB 783 good, as its author Assembly member Mary Hayashi (D-Castro Valley) says? Is it bad, as members of the California Association of Physical Therapists (CAPT) attest? Only one thing is definite about this bill to define some parameters of the hiring of physical therapists in California — it has been ugly.
A vote on the bill is expected today in the Senate Committee on Business, Professions and Economic Development. Last week’s scheduled vote was withdrawn by Hayashi, as she planned to meet with the opposition to craft a compromise solution.
That meeting didn’t go well.
“We met with all of the interested parties,” Â said Ross Warren, chief consultant to the committee. “We tried to address their concerns, and the answer was clearly no. We were trying to appease the physical therapy association, and we were unable to do that.”
“We were surprised when we walked into the meeting,” bill opponent Stacy DeFoe of CAPT said. “It became clear when we saw all the proponents of the bill lined up, and they made it clear that anything we wanted to discuss was off the table. We thought we were supposed to have some kind of discussion, but it didnât look like that,” DeFoe said. “It looked like an ambush, frankly.”
The bill, according to Warren, actually benefits physical therapists. This is where it gets a little confusing because, if it benefits therapists, why is the largest PT association in California against it?
Because that’s not all of the physical therapists in the state, Warren said. “Our bill is to continue to allow physical therapists to be employed by medical corporations,” Warren said. “That is the practice now. The board for physical therapists got some legal advice and made a ruling that we feel is inappropriate, that could result in the loss of jobs for thousands of physical therapists in California. And we want to correct that.”
The key puzzle piece to understand, Warren said, is that there are several different employment models for physical therapists. There are several thousand PTs who work for professional corporations in California, and Warren said they would stand to lose their jobs with the recent ruling by the Physical Therapy Board of California.
That’s simply not true, DeFoe said. The hiring structure of a small percentage of physical therapists — she estimates about 2% of the PTs in the state — would just have to change their financing relationship with physicians. That’s a far cry from the specter of thousands of lost jobs.
At its root, this is a fight over the financial structure of physical therapists’ employment.
“They want to codify a process that is not legal now,” DeFoe said. “When physicians are owning access to services [through their referrals] and they own those for-profit services themselves, it results in a conflict of interest. We don’t think that’s good policy, we donât think that’s good for consumers, or for our private practices.”
Physicians aren’t allowed to own their own pharmacy services, for the same reason, DeFoe said.
To DeFoe, it’s a consumer protection to keep medical corporations and physical therapy services separate. To Warren, it’s all about market forces, and that’s not the purview of a legislative committee or state policy, he said.
“Look, we’re not here to dictate who gets what in the marketplace. It’s hard to run your own business, it’s difficult out there. I don’t deny that. And it may be more difficult when medicine is moving toward integrated services, and the whole concept of professional corporations is to provide integrated services.”
The basic picture, he said, is that you have one group of PTs whose independence is threatened by professional corporations, and a second group of PTs who work for professional corporations who might find themselves out of work because of an arcane legal ruling by the state’s PT board.
DeFoe doesnât buy the argument that this whole fight is motivated by the board’s legal decision. In fact, a similar bill (AB 1152) was proposed by Sen. Joel Anderson (R-El Cajon) two years ago when he was in the Assembly, long before this question came before the PT board.
You can argue the details all you want, Warren said, but what matters is what’s happening right now.
“What I see is that thousands of people will be forced into unemployment. And the PTs who are upset by it say they can’t compete against professional corporations. I understand that private practices have been operating for 50 years, and they want to keep operating. But in terms of what we should do for them, I need something more in terms of making a policy decision. And I haven’t heard it.”
He may hear it today. A number of physical therapists are expected to attend today’s committee hearing.