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South Carolina Supreme Court denies petition for rehearing on POPTS decision
Physical therapists working for POPTS in the state are meeting challenges during the transition.
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Orthopedists in South Carolina recently lost another battle in the issue of physician-owned physical therapy services.
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Late last year, the South Carolina State Supreme Court denied the petition for rehearing by the South Carolina Orthopaedic Association (SCOA) and the South Carolina Association of Medical Professionals (SCAMP), according to M. David Mitchell, MD, immediate-past president of the SCOA.
After the initial Sept. 26 opinion by the South Carolina Supreme Court, South Carolina joined Delaware and Missouri as the only states where Supreme Court reinterpretations effectively banned physician-owned physical therapy services (POPTS).
Next steps
Mitchell told Orthopedics Today in a December 2006 article that South Carolina orthopedists are concerned that the reinterpretation will limit their ability to direct therapy for their patients. They also worry about the overuse of physical therapy without physician control.
SCOA plans to work with South Carolina legislators in the next session. "We'll ask for some type of legislation either through the Physical Therapy Practice Act or through the Medical Practice Act, or just another law to be passed that will allow physicians to employ physical therapists in their practices," Mitchell told Orthopedics Today.
SCOA will try to convince legislators that POPTS is important to patient care. Mitchell said that SCOA also applied to the American Academy of Orthopedic Surgeons (AAOS) for a grant to assist with legislative efforts.
Original decision
The South Carolina Supreme Court made its initial reinterpretation based on the majority opinion that prohibiting POPTS does not infringe on the practice of medicine or violate the equal protection rights of physical therapists who want to work for physicians.
It also said that POPTS calls into question who should be the primary beneficiary of physical therapy fees and offers potential financial conflicts of interest and limitations on consumer choice.
The AAOS filed an amicus curiae brief in the South Carolina Supreme Court case, arguing that the original trial court did not conduct an analysis on the possible benefits of POPTS and ignored the fact that POPTS is almost universally accepted in the rest of the country.
APTA's opinion
In a November 2006 newsletter, the American Physical Therapy Association (APTA) said it is ramping up efforts to mount similar challenges in other states by developing a grant program for individual states and conducting surveys on the value of consumers' direct access to physical therapy.
According to some physical therapists, APTA discourages physical therapists from joining POPTS early in the education process.
"Students in PT school are strongly encouraged not to work for physician-owned clinics ... which I think is unfortunate," physical therapist Ann Froneberger told Orthopedics Today. "Having worked in all situations ... the very best working situation for the patient and the therapist as far as being a team member is working for a physician-owned practice."
Froneberger previously worked for Orthopaedic Associates, PA in Spartanburg, S.C., where Mitchell also practices. As a result of the reinterpretation, she and her physical therapy colleagues broke away from Orthopaedic Associates. On Nov. 13, 2006, Froneberger became the owner of North Grove Physical Therapy LLC, a new company that leases space from Orthopaedic Associates.
The plight of existing POPTS
Leasing the space allows Froneberger and her colleagues to continue working closely with the orthopedists in providing patient care, but the transition was not easy.
"We have all had to get recertified to be providers for all the different insurances," Froneberger said. "We've had to get our own health insurance and our 401(k) had to be reissued at a ... higher cost because we are a much smaller company now."
"I'm a new employee again," said Dixon Reaves, a physical therapy assistant, now at North Grove. He worked for Orthopaedic Associates for 14 years. "I've had to let my liability insurance know about it."
Reaves also had to tell his liability insurer that he was under investigation for "unprofessional conduct." In a letter dated May 2, 2006, from the South Carolina Department of Labor, Reaves found out about the investigation, based on a complaint that "concerns your practice in a physician-owned physical therapy setting." He sent a copy of the letter to Orthopedics Today. He said his phone calls to the department of labor about the status of the investigation have not been returned.
Deadline never given
Froneberger said she received two similar letters and a phone call at the office. However, both Froneberger and Reaves said they were never given a deadline for terminating employment at a POPTS.
Instead, the South Carolina Board of Physical Therapy Examiners told them they would not lose their licenses if they separated themselves from a POPTS "in due process," Froneberger and Reaves said.
"South Carolina has been one of the test states to get a foot in the door with anti-POPTS," Reaves said. "I don't know if other states are going to fight as hard as we've been fighting, but if they don't it's going to be a done deal."
For more information:
- www.judicial.state.sc.us/opinions/displayOpinion.cfm?caseNo=26209.
- M. David Mitchell, MD, immediate past-president of the South Carolina Orthopaedic Association, Orthopaedic Associates, PA, North Grove Medical Park, Suite 1600, 1330 Boiling Springs Rd., Spartansburg, SC 29307; 864-582-6396; mdmmd@bellsouth.net. Ann Froneberger, physical therapist and owner, and Dixon Reaves, physical therapy assistant, North Grove Physical Therapy LLC, North Grove Medical Park, Suite 1600-B, 1330 Boiling Springs Rd., Spartansburg, SC 29307; 864-582-0019; dixon2@charter.net.