Joe Lucca, PhD, DPT, still remembers the awkward lunch he sat through in a meeting room at the Medical Society of Delaware almost 30 years ago.
Meeting with a group of area physicians of different specialties, who were members of the Medical Society of Delaware
, many of whom had been colleagues and friends, Dr. Lucca
expected a casual lunch but walked into an ambush.
"They had me for lunch, and then they 'had me for lunch,'" recalls Dr. Lucca
, who just days before had been instrumental in getting state legislation passed that would make illegal the fairly common business arrangement of physical therapists being employed by physician groups.
"There was a lot of talk of, 'how dare you do this.' They could not understand why I thought I had the right to propose and back this kind of legislation," said Dr. Lucca, who is professor emeritus of physical therapy at the University of Delaware in Newark, in addition to operating a Wilmington private practice and serving four terms as the president of the Delaware chapter of APTA.
He served two terms as president in the 1980s and two more terms from 2006-2010.
In examining his
state's practice act language, Dr. Lucca
had the idea to include the term "wages" in language drafted by the APTA that prohibited fee-splitting arrangements by physicians and physical therapists.
Essentially this outlawed the practice of PTs serving as wage-earning employees of physician-owned practices.
But it didn't go over well in the early stages, even among members of his
"I remember those meetings very well," said Dr. Lucca
"They were contentious.
Some of our members were working in the two or three POPTS
practices in the state.
But we made the case that this is the best way to level the playing field for all providers, not just physical therapists in private practice.
In Dr. Lucca's
belief, the legislation worked brilliantly.
In researching the effect of the legislation on PT practices, Dr. Lucca
discovered that in 1983, there were only 16 physical therapy companies listed in the Wilmington phone book-including those that were physician-owned.
In 1991, that number was up to 40 independently owned practices.
Currently, in Wilmington, there are 58 physical therapy listings, which included physical therapists in private practice, corporate practices and hospital satellite practices.
was quick to point out that he
did not mention physician-owned physical therapy practices in that report.
believes the increases in physical therapy providers observed in Wilmington have occurred in all three counties in Delaware, and in all urban, suburban and rural areas of the state.
"It's made practice so much more competitive," said Dr. Lucca
"There's much more choice [for the consumer], and we now have some remarkable practices in our state because of it.
The measure has not been formally challenged since its initial adoption.
In fact, a recent Delaware
Attorney General's opinion confirmed for the Delaware Physical Therapist Examining Board
, that the law unequivocally means that a physical therapist cannot receive any compensation or financial consideration from a referring physician, a business associate of that physician, or a family member of that physician.
may not have realized it at the time, but the Delaware model would lay the groundwork for physical therapy autonomy that the APTA still advocates to this day.
States across the country look to it when modifying state PT practice acts to outlaw physician ownership of PT services.
Modeling their language on the Delaware model, the South Carolina chapter inserted the word "wages" into its state practice act, which was ratified in 2006.
Section 40-1-110 of the act states that The South Carolina Board of Physical Therapy Examiners
may "restrict or refuse to grant a license and may suspend, revoke, or otherwise restrict the license of a licensed person who requests, receives, participates, or engages directly or indirectly in the dividing, transferring, assigning, rebating, or refunding of fees received for professional services or profits by means of a credit or other valuable consideration including, but not limited to, wages, an unearned commission, discount, or gratuity with a person who referred a patient, or with a relative or business associate of the referring person."
was quick to point out that "neither the Delaware nor the South Carolina law actually restricts a physician's ability to establish a physical therapy practice.
A physician can, if he
wanted, open a physical therapist practice in these states, but he
just cannot refer his
patients to it.
remembers a physician owner of a physical therapy practice often stating that he
did not refer many of his
patients to his
practice and he
did not need his
referrals to keep his
PT business going.
"The only thing that changed in that physician-owned physical therapy practice was his
inability to refer his
patients to his
practice," Dr. Lucca
"Several months after our law passed, the physician sold his
practice to his
chief physical therapist.
I always thought the sale of the practice at that time was telling.
also pointed out that not one physical therapist lost his
job when the new law was passed.
prefers not to use the term "POPTS" because the practice of generating income for just making referral goes beyond the physician/physical therapist relationship.
He uses the more general phrase "referral for profit" because he feels it would be just as unethical for a physical therapist to receive a kickback on a referral to another PT, physician, chiropractor or any other provider as it would be for a physician to generate a profit from making a referral to a PT.
"It just didn't sit right with me, from several [different] viewpoints," said Dr. Lucca
of the proliferation of POPTS businesses in the early 1980s.
In addition to continued lobbying and state-specific efforts, Dr. Lucca feels it's incumbent on PT programs to instill the importance of working in ethical and autonomous practice arrangements to students during school.
"There's a way to educate without vilifying someone else as being unethical," he