AB 1000 is Assembly Bill 1000. It began as two separate bills: AB 1000, a patient access bill sponsored by the California Physical Therapy Association, and AB 1003, a bill sponsored by the California Medical Association and the California Orthopedic Association. The latter would allow for any professional corporation listed in the Moscone Knox Act (i.e. physicians) to employ all professions included in the Business and Professions Code (i.e. physical therapists).
As it stands right now, the State of California Legislative Counsel has stated that it is illegal for physical therapists to be employed by any professional corporation except for those owned by physical therapists and naturopaths.
The net result of this legislative wrangling and hoo-haa is a classic example of short-sightedness and attempting to grab the scraps of patient access as they fall from the table. It reeks of permission-based professional "judgment", and it could end up being a long-term nightmare for both patients and physical therapists in the state of California.
The problem: these two issues should have never been morphed into one bill. Ever. Anywhere. They are two separate issues that have two significantly different incentives, goals, and results. "Compromise" would involve meeting at a mid-way point on the same issue, not throwing two disparate issues together in a flight of political gamesmanship. Oh, and it's not like there isn't a long history of these legislative battles in California. If I am not mistaken, two in recent memory – SB 924 and AB 783 - provided interesting examples of disconcerting and ugly politics at play.
Providing a patient with direct access to physical therapy has been shown to decrease the overall cost of care. Granted, AB 1000 only provides 45 days and 12 visits (more thoughts on that in a future post). But, it does allow patients a modest improvement in access to care, a small step in the right direction.
Providing a physician with the option of ownership of physical therapy services has been shown to increase the cost of care. Need another example of this problem? Can you say "imaging"? It is a conflict of interest. It is, simply stated, referral for profit disguised as "patient convenience". In this context, AB 1000 sends the California health care system down the wrong road.
AB 1000 was promoted as a "compromise" bill, but I would suggest that it is yet another example of the physical therapy profession seeking permission, and giving away the farm while doing so. It is a case of doing what is right "now" as opposed to doing what is right.
It is a case of focusing on the short-term gain, the illustrious "direct access" of 45 days and 12 visits. It fails to consider what is right long-term - maintaining autonomy and not promoting referral for profit issues within the health care system. Oh, and by the way, support of AB 1000 by physical therapists is effectively contravening our own APTA Code of Ethics (APTA):
"Principle 7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society"
Here's a news flash, people: direct access to physical therapy saves money. Referral for profit does not. Simple. So when the data is on your side, why ask permission? Stop begging for permission. Get patients involved. Show them where the problems lie. A little dose of truth-telling goes a long way. When patients are presented with greater costs and lack of choice, you can bet they will be changing legislators. Quickly - especially when health care costs consume 18% of the nation's GDP.
In my humble opinion, AB 1000 has an adverse long-term impact on both patients and the physical therapy profession. It also sets a precedence for what will be deemed acceptable in health care: 1) referral for profit, one of the greatest sources of over-utilization of services in health care, and 2) the power of Big Medicine in driving the discussion (and its own agenda). Frankly, neither of those will solve the problems of health care.
Do what is right. We are in this for the long haul.
Photo credits: osde8info