‘Dazed and confused’: Physical therapy providers warn of cost, access, as Missouri fails to enforce law against doctor-owned clinic referrals

It’s supposed to be illegal in Missouri for doctors to refer patients to their own physical therapy clinics.

But it appears no one is enforcing the law – leaving medical providers in legal limbo and patients at risk of fewer and more expensive choices.

Signature Medical Group, which bills itself as “one of the largest private, multi-specialty medical groups in the Midwest,” owns Signature Physical Therapy-South County in St. Louis. But when the courts were asked to clarify whether that’s legal, they essentially punted – to the Missouri Board of Healing Arts (BHA), which critics say had already fumbled that ball.

Sources tell The Heartlander the BHA’s failure or inability to act has given “a green light” for physicians’ practices to refer patients to physical therapy clinics they own.

If others follow Signature’s lead, the resulting pressure could lead to the closure of smaller, privately owned physical therapy clinics, possibly driving up prices and reducing the number of clinics.

Sources tell The Heartlander not only does the BHA need to police physicians’ offices on the matter, but it also is duty-bound to refer complaints involving physical therapists – who supposedly are barred from working in such clinics – to the state’s Advisory Commission for Physical Therapists. That isn’t being done either, our sources allege.

With the BHA apparently not enforcing the law – and the courts unwilling to order it – the medical community is left uncertain what the rules are for doctors referring patients to their own physical therapy clinics.

Chris Marsh, a physical therapist and Government Affairs Chairman & Federal Government Affairs Liaison for the Missouri Physical Therapy Association (APTA Missouri), said there are unconfirmed rumors that other physician-owned physical therapy clinics may be sprouting in Kansas City, Columbia or Jefferson City.

APTA Missouri had filed complaints with the BHA about the Signature physical therapy clinic and the agency did nothing about it – leading APTA Missouri to file the lawsuit to clarify the law. The law wasn’t clarified, and apparently isn’t being enforced.

Physical therapy providers in Missouri “are just kind of dumbfounded that that has happened the way it’s happened. They just don’t know what to think, and they honestly don’t know what to do,” Marsh says.

“I don’t know if ‘dazed and confused’ is a good way of putting it or not, but just kind of dumbfounded that it’s turning out the way it’s turning out so far.”

And since the law is already on the books, Marsh says there doesn’t appear to be much else the Missouri Legislature can do.

Concerns about the situation are twofold, Marsh explains.

For one thing, it destabilizes the job market in the physical therapy field, while down the road perhaps threatening the survival of private clinics.

In addition, American Physical Therapy Association research shows that, while physician-owned physical therapy services in other states can yield good patient outcomes, “it takes more visits to get those good results.” That means more co-pays, more insurance payouts and the time and expense of traveling to the physician-owned clinics when a private one might be closer to where the patient lives.

Might an influx of physician-owned physical therapy clinics really mean the closure of other clinics and the driving up of prices?

“Oh, absolutely. Yeah. Absolutely,” Marsh says. “Eventually could get to that point.”

Marsh says well-meaning orthopedic doctors may be so focused on fixing body parts that they may not realize they’re prescribing therapy in a location convenient to them rather than patients.

“I understand that. They’re thinking about what they can do to help a person. So, I usually give them a little bit of a break on that. But still …”

So, with the law not being enforced what can be done? Marsh suggests Gov. Mike Parson – who has been “very supportive of physical therapy” – could look at the Board of Healing Arts and consider “who’s coming off the board, who to appoint to the board, those types of things.”

The Heartlander has reached out to Signature Medical Group and the BHA for comment.


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