Delaware PT Alliance

Re: SB 245, PT Parity bill

February 10, 2022

Members of the Delaware General Assembly,

As providers of musculoskeletal care in Delaware, we help patients recover by coordinating daily with physical therapists (PT). Providers in Delaware have seen firsthand the corporate takeover of private physical therapy practices across the state (including acquisition by hospitals, universities, and venture capital firms). As a result, there has been a precipitous decrease in opportunity for physical therapists to join a small private practice and a subsequent decrease in ownership and decision-making opportunities. In fact, Delaware is the only state in the country that does not allow physical therapists to integrate their private practices with physicians. Physical therapy practices can be owned by larger entities such as national corporations, hospitals, or universities, but cannot integrate with other providers nor maintain their own ownership together in private practice. This restriction is arbitrary and does not apply to physicians, podiatrists, occupational therapists (OT), or optometrists – it only singles out and discriminates against physical therapists. This is an issue of PT Parity, and we are writing in support of the PT Parity bill because this discrimination needs to be addressed.

Physical therapy is fundamental to providing high-quality care for musculoskeletal disease and injury. Musculoskeletal practices across the country integrate physical therapy which promotes cost-effective care coordination and better outcomes for patients. The national healthcare trend toward ‘coordination of care’ is hindered in Delaware by dated regulation and this raises healthcare costs for everyone. The changing payment model from fee-for-service to bundled care mandates that physicians and PTs be covered together under the same bundled care of a specific patient. This means that coordination of care between physicians and physical therapists is more important than ever. Bundled care mandates are being recommended as it has been shown that collaboration between individual physical therapists and physicians helps to decrease health care costs and improve outcomes. Support for the PT Parity bill will therefore help to decrease health care costs in the State of Delaware.

Opponents to this proposed integration have stated that if the PT Parity bill passes, it will be the end of physical therapy practices in Delaware. That is fear mongering and not based on the real-life data we have from (literally) every other state in the country. In all three surrounding states, physical therapists enjoy robust opportunities to partner in a private practice setting or work in a corporate setting, but Delaware remains the last holdout in the country where those private practice integration opportunities are not permitted. Despite having a nationally ranked PT department at UD, we routinely lose good talent to the surrounding states because of this restriction on PT private practice. Delaware physical therapists cannot become owners in larger integrated private practices; they can only sell to a hospital or to a corporation. That means that there are fewer locally owned businesses. In Delaware, while some physical therapists have gone on the record in support of PT Parity, there are many physical therapists who support the bill but will not voice their opinion for fear of repercussion from their employer.

Local large institutions employ physical therapists as employees (not as owners or partners). This decreases the ability for physical therapists to be business decision makers. All the undersigned SB 245, The PT Parity Bill Page 2 of 3

doctors work pro bono for the University of Delaware, and we actively host and support their outstanding physical therapy program in clinical education. In addition, we all hold staff and leadership positions at Christiana Care having been instrumental in most musculoskeletal initiatives there. We do not speak for either institution, but we are clearly fully integrated as an essential part of their education and professional staffs. These institutions remain neutral on this legislation. Currently, they both integrate musculoskeletal care between “employed” providers and physical therapists and private practice should be afforded the same integration and cost-cutting opportunity.

Attached you will find a one-page piece on the merits of the proposed PT Parity legislation with statements of support from the Delaware Society of Orthopaedic Surgeons, Medical Society of Delaware, and local Delaware physical therapists (including those who have been on both sides of the corporate acquisitions).

This PT Parity legislation will:

1. Improve patient access, choice, and convenience
2. Lower cost and improve care coordination and
3. Deliver physical therapy parity and enhance provider collaboration.

We are readily available to review real-life data in the other 49 states and we ask for your support.

Signed,

(see signature page below)

Delaware Society of Orthopaedic Surgeons

First State Orthopaedics

Delaware Orthopaedic Specialists SB 245, The PT Parity Bill Page 3 of 3

Delaware Society of Orthopaedic Surgeons (DSOS)

Randeep Kahlon, MD, President

Steve Dellose, MD, President-elect

Matt Handling MD, Treasurer

Mark Eskander, MD, Secretary

Brian Galinat, MD, MBA, Program Chair , Treasurer, Medical Society of Delaware

Peter Townsend, MD, Board of Councilors, AAOS

First State Orthopaedics

Randeep Kahlon, MD

President, Delaware Society for Orthopaedic Surgeons

Past President, Medical Society of Delaware

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

Director, Orthopaedic Education, Division of Orthopaedic Surgery, Christiana Care

Jeremie Axe, MD

President, Medical Staff, Encompass Health

Director, Orthopaedic Education, Premier PT

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

David Sowa, MD

Co-Director, Delaware Shoulder to Hand Center

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

Eric Johnson, MD

Chief, Division of Orthopaedic Surgery, Christiana Care

Director Emeritus, Orthopaedic Trauma Service, Christiana Care

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

Jennifer Siefert, DPM

President, Delaware Podiatric Medical Association

Chief, Podiatry Section, Christiana Care Union Hospital

Teaching Faculty, Christiana Care Podiatric Medicine and Surgery Residency

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

Delaware Orthopaedic Specialists

Brad Bley, DO

Delaware Interscholastic Athletic Association (DIAA), Chair, Sports Medicine Advisory Committee

Assistant Program Director, Primary Care Sports Medicine Fellowship, Christiana Care

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware

Teaching faculty, Premier PT

Mark Eskander, MD

Affiliate Asst Professor, Department of Physical Therapy, University of Delaware