Why Is Delaware Putting Patients Last?

An outdated Delaware physical therapy law is keeping our healthcare system stuck in the past, preventing doctor-patient collaboration and locking in high healthcare costs for Delaware patients. This outdated Delaware law means:

Patients have fewer choices for physical therapy.
Physical Therapists have fewer job opportunities.
Delaware Small Business Owners are disadvantaged compared to large out-of-state conglomerates.

Delaware is the ONLY remaining state that hasn’t updated this antiquated law! Tell your lawmakers in Dover to support the PT Alliance in standing up for Delaware patients and small businesses now!

Dear [Lawmaker],

As your constituent, I strongly urge you to SUPPORT Senate Bill 245 and modernize Delaware physical therapy (PT) law to promote PT parity, break down decades of protectionism and create many new jobs.

Current antiquated 1983 law prohibits physical therapists from partnering with physicians to provide treatment in the same practice. This law was passed before the Stark Law, before the medical specialization boom of the 1990s and before the current new payment healthcare payment models – and its 1980s motives are costing Delaware in both dollars and local business ownership. Left to fend on their own in Delaware, private practice PT’s have been swallowed up by national PT corporations for more than two decades. Meanwhile, during the same time period, physicians, podiatrists and hand therapists have been merging together to create stable private practice groups to compete in the marketplace. Until the current law is repealed by passing SB 245, PTs cannot legally join them for this stability. As a result, more than 75% of the Delaware PT market is now either corporate or hospital based, whereas private practice PT has shrunk at an alarming rate to less than 25% of the market. This trend shows no end in sight in Delaware. Meanwhile, almost every single one of the other 49 states have modernized their laws to allow PTs and physicians to be in business together. In those states, private PT successfully competes in a free market and thrives doing so. By being able to integrate with other medical specialties, Delaware PT’s can keep local control over PT and stop the out-of-state corporate takeovers. There are many Delaware PTs who support SB245 and would appreciate the ability to partner with physicians.

The Delaware Physical Therapy Association, would have you believe that integrated PT is a conflict of interest and lowers patient choice. The actual Delaware data on medical services says otherwise: MRI, lab services, x-rays and outpatient surgery are just a few services that are protected as In Office Ancillary Services under Stark. Accordingly, they are also amongst the most available services across our state – there are plenty of patient choices and the free market is thriving. The integrated PT model is already being used by CCHS, UD, Geisinger and Kaiser to lower healthcare costs – and commercial payors and Medicare have already incentivized integrated payment models to lower healthcare costs. The State has a health benefits vendor that incentivizes the integrated PT model to deliver lowers costs in many other states. Yet that benefits vendor cannot deliver those savings to the State Employee Benefit Plan in Delaware until this law is updated.

Data from commercial payors from states doesn’t lie. As neutral 3rd parties, commercial payors audit for overutilization on an ongoing basis and assess for appropriateness with their own proprietary guidelines. With this data, the payors actually drive patients to low-cost centers – including integrated PT services. The OIG final 2014 report shows integrated PT has lower total costs and was stable, whereas costs for out-referred PT was more costly for Medicare and actually went up 41% over the course of the study. Importantly, research has shown orthopaedic surgeons in an integrated PT model actually refer less than other specialties who out-refer.

SB 245 will modernize Delaware law and permit PT parity – it repeals the protectionist, anti-competitive antiquated 1983 law. In Delaware, we have seen that a competitive marketplace ensures patient access and choice. Again, please SUPPORT Senate Bill 245 to repeal the law, allow PT Parity and help lower healthcare costs.

Thank you for your consideration.

Sincerely,
______

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As your constituent, I strongly urge you to SUPPORT Senate Bill 245 and modernize Delaware physical therapy (PT) law to promote PT parity, break down decades of protectionism and create many new jobs.

Current antiquated 1983 law prohibits physical therapists from partnering with physicians to provide treatment in the same practice. This law was passed before the Stark Law, before the medical specialization boom of the 1990s and before the current new payment healthcare payment models – and its 1980s motives are costing Delaware in both dollars and local business ownership. Left to fend on their own in Delaware, private practice PT’s have been swallowed up by national PT corporations for more than two decades. Meanwhile, during the same time period, physicians, podiatrists and hand therapists have been merging together to create stable private practice groups to compete in the marketplace. Until the current law is repealed by passing SB 245, PTs cannot legally join them for this stability. As a result, more than 75% of the Delaware PT market is now either corporate or hospital based, whereas private practice PT has shrunk at an alarming rate to less than 25% of the market. This trend shows no end in sight in Delaware. Meanwhile, almost every single one of the other 49 states have modernized their laws to allow PTs and physicians to be in business together. In those states, private PT successfully competes in a free market and thrives doing so. By being able to integrate with other medical specialties, Delaware PT’s can keep local control over PT and stop the out-of-state corporate takeovers. There are many Delaware PTs who support SB245 and would appreciate the ability to partner with physicians.

The Delaware Physical Therapy Association, would have you believe that integrated PT is a conflict of interest and lowers patient choice. The actual Delaware data on medical services says otherwise: MRI, lab services, x-rays and outpatient surgery are just a few services that are protected as In Office Ancillary Services under Stark. Accordingly, they are also amongst the most available services across our state – there are plenty of patient choices and the free market is thriving. The integrated PT model is already being used by CCHS, UD, Geisinger and Kaiser to lower healthcare costs – and commercial payors and Medicare have already incentivized integrated payment models to lower healthcare costs. The State has a health benefits vendor that incentivizes the integrated PT model to deliver lowers costs in many other states. Yet that benefits vendor cannot deliver those savings to the State Employee Benefit Plan in Delaware until this law is updated.

Data from commercial payors from states doesn’t lie. As neutral 3rd parties, commercial payors audit for overutilization on an ongoing basis and assess for appropriateness with their own proprietary guidelines. With this data, the payors actually drive patients to low-cost centers – including integrated PT services. The OIG final 2014 report shows integrated PT has lower total costs and was stable, whereas costs for out-referred PT was more costly for Medicare and actually went up 41% over the course of the study. Importantly, research has shown orthopaedic surgeons in an integrated PT model actually refer less than other specialties who out-refer.

SB 245 will modernize Delaware law and permit PT parity – it repeals the protectionist, anti-competitive antiquated 1983 law. In Delaware, we have seen that a competitive marketplace ensures patient access and choice. Again, please SUPPORT Senate Bill 245 to repeal the law, allow PT Parity and help lower healthcare costs.

Thank you for your consideration.