MD/PT Partners - National, L.L.C.
The Science of Various Legal Relationships Related to Physicians and Ancillary Services
The New MD/PT Partners Network

We need 1,000 more private practice physical therapists to service our growing network of physician contractors.
The concept is simple but the details are many - For the MD, we are simply a staffing agency supplying licensed care when and where the physician needs it.  For the PT, who has no direct relationship with the physician, we are a network that supplies patients that they previously were not seeing.  We are the supplier of staff, and the payer to the network providers.

Let’s start with the legal aspect.  My name is Doug Sparks and every time I hear “Stark” or "Kickback” I know that the person has not read our material nor seen our contract because we are unaffected by both.  We do not see Medicare patients and the physician is the billing provider and hence cannot kickback to himself. Because of this it does not matter what state you are in. Just Google, "physicians providing physical therapy in your state", and you will see hundreds if not thousands. If they can hire a PT or offer PT our program works for them.

Before I embarked on my 23+ years on the business side of the therapy industry, I spent eight years as part of a Wall Street group that created and packaged deals for wholesalers to sell to their retail clients.  We had two in-house attorneys yet regularly hired outside firms to verify our legal position.  We ALWAYS started with the legal and that’s what we did here.

In 2003, my partner, Sam Fontenot, PT, a therapist for nearly 40 years, and I approached a top healthcare attorney with a challenge to prove what we were suggesting was wrong.  After a very expensive five weeks of study, he said what we thought may be a niche’ was really a canyon of opportunity and he could not understand why this hasn’t been done before.  We then hired another top attorney and asked him to prove the first one wrong.  He could not, because every single component of our program has been done in healthcare for years, just not yet in therapy.

Since early 2004 we have completed over 370 contracts in 46 states.  Our clients have included hospitals and large corporate entities whose attorneys also agreed with our findings, usually in fewer than five minutes or before the appetizers arrived.  Our concept is simple but the details are many and we have paid dearly for this intellectual property.

I’ve sat with the head of a state’s medical association and the administrator of a large hospital chain who asked if our network could replace all PT/PTA employees in their system with our private practice PTs.  “I would love to dump all of that PT payroll” they said.  Another head of a group of 450 PCPs said, “we need the PT revenue but can’t afford the expense of space and clinics so your plan is perfect for us”.  Another head of an IPA with 150 physicians said, “we want your program all over our area because we can no longer afford to open offices that fail”.

Understanding the Mechanics
Simply stated, if you can hire a PT you can contract one.  If you contract one it must be at fair market value.  There are no Stark or kickback implications because the physician is the provider and the PT is only contracting the licensed care piece like a “staffing agency”.  Would you rather have an overpaid and, many times underproductive employee, or a private practice therapist who understands productivity yet still demands excellence? 

The premise is simple; a PT is a licensed extension of the physician, just like a PA or LCN.  In both of those cases the physician does not need to be present to treat and bill for services under his/her provider number; just like a PT does not have to be present for the PTA.  The term "direct supervision" only applies to unlicensed personnel with the exception of Medicare patients. So our model may be used in-house OR at a remote site such as the office of a private practice PT.  NOTE - We cannot meet the physician supervision standard for offsite contracts so Medicare patients are excluded from those contracts unless we send staff to you, or you send a PA to our site to a specially designated area just for you. The physician has no financial interest or control in the PT's clinic as he is only contracting the staff much like a staffing agency. Whether the PT goes on a home health visit, hospital contract, physician office visit, etc., he/she is only reimbursed for the codes of service being billed; the licensed care piece only. The physician isn't getting a special deal because he is paying fair market value. Again, the concept is very simple but the details to make this happen are many.

A top national healthcare attorney says, “Although statutes use the phrases “personal supervision” and “directly supervised,” the regulators have interpreted both of these to mean supervised to the extent otherwise required by law in a private practice setting. For example, a physical therapist in private practice does not require an on premises physician for the services to be covered, so “direct supervision,” does not actually require that a physician be in the office unless the staff member is not licensed.”

Examples - I went to see my PCP but he was in France on vacation, so I saw his PA.  According to the EOB, I saw the physician.  Later I got a flu shot and never saw the physician or the PA yet the EOB said I saw the physician.  That is because PAs and LCNs are licensed extensions of the physician’s care and may be billed under his provider number without him being present.  In another case my wife had a blood test at her PCP’s office and then blood was sent to a lab.  The EOB said that the PCP did the blood test.  In this scenario, we are the lab.  The PT does not appear on the claim because the physician is the provider. Finally, closer to home, my 93 year old mother-in-law died in January and we received EOBs for three different physician services from three different cities where we never went for care. Not only does the physician not have to be present, he does not even have to be in his/her office.

Can You Do Better on Your Own?  No!!
And here’s what happens when you go it alone, as told to me by a physician who considered our model, tried it on their own, and then came back to us - A group of 23 family practice physicians, through us, had the option to use a large existing PT facility and pay a percentage of collections after they received payment from insurance.  Instead they felt they could make more money by opening their own place, buying equipment and hiring a staff.  After nine months they closed their doors and came back to our model.  In the nine months they were open they spent $419,000 in out of pocket expenses and made only $14,000, split between 23 physicians.  Under our model they would have made over $170,000 in profit for the same nine months with no up front expense.

To recap, the physician has the right to hire or contract licensed staff.  If he chooses to contract then it must be at fair market value.  He is ONLY contracting for licensed care, much like a staffing agency, and he doesn’t pay us until he collects from insurance, also our industry standard.  What he pays is at fair market value based on national and regional benchmarks.  This allows him to keep a very nice profit.  You do what you do and we do what we do so neither side has any new responsibilities or expenses. 

This is truly one of the only opportunities in business where two parties can be raised to the next level financially by simply doing together what they each do separately every day.  Please follow the directions below and contact me at your earliest convenience so we can get together and walk through your possible scenarios.  With over 370 transactions completed in 46 states I’m very sure we have a model that fits you perfectly.  Thanks in advance for your time and interest. 

Doug Sparks
Co-Founder

PS – WE WERE NOT ON 60 MINUTES!!

When you have the success that we have been so fortunate to have, someone will always go after you. In this case it is the owner of a blog for physical therapists who do not believe a physician should ever be able to offer physical therapy. The Final Stark says they physician has the inherent right to do so.

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Recently you may have received a notification with the “60 Minutes” logo from the Evidence in Motion/MyPhysicalTherapySpace Blog.  The piece described a mock 60 Minutes investigation where questions were asked about physician based programs that would seem to be referencing our company.   I know that I have had a lot of them forwarded to me by partners, angry that someone without detailed knowledge would make such brazen comparisons. 

NOT SO says the website’s owner, Larry Benz.  After several emails with Larry I was assured that the piece had nothing to do with our company or model, but was rather a general description of programs of that genre.  Of course we are the only ones who have a legal approach to this, and its details are protected intellectual property.  Larry seems to be a decent guy so I will take him at his word.  I made him aware that our large corporate clients and hospitals do not like the implication that they would be involved in something illegal, and again he assured me this was a general piece and not directed toward us.  Nor would medical groups of 450, 250 and 150 physicians enter into a contract with a company operating illegally.  Glad to have that cleared up.