title: Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons' Ownership of Physical Therapy Services.
abstract: To examine whether the course of physical therapy treatments received by patients who undergo total knee replacement (TKR) surgery differs depending on whether the orthopedic surgeon has a financial stake in physical therapy services.
  
  
  
  Sample of Medicare beneficiaries who underwent TKR surgery during the years 2007-2009.
  
  
  
  We used regression analysis to evaluate the effect of physician self-referral on the following outcomes: (1) time from discharge to first physical therapy visit; (2) episode length; (3) number of physical therapy visits per episode; (4) number of physical therapy service units per episode; and (5) number of physical therapy services per episode expressed in relative value units.
  
  
  
  TKR patients who underwent physical therapy treatment at a physician-owned clinic received on average twice as many physical therapy visits (8.3 more) than patients whose TKR surgery was performed by a orthopedic surgeon who did not self-refer physical therapy services (p < .001). Regression-adjusted results show that TKR patients treated at physician-owned clinics received almost nine fewer physical therapy service units during an episode compared with patients treated by nonself-referring providers (p < .001). In relative value units, this difference was 4 (p < .001). In contrast, episodes where the orthopedic surgeon owner does not profit from physical therapy services rendered to the patient look virtually identical to episodes where the TKR surgery was performed by a surgeon nonowner.
  
  
  
  Physical therapists not involved with physician-owned clinics saw patients for fewer visits, but the composition of physical therapy services rendered during each visit included more individualized therapeutic exercises.
authors.affiliation: McCourt School of Public Policy, Georgetown University, Washington, DC. mitchejm@georgetown.edu.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Mitchell
authors.affiliation: Mathematica Policy Research, Washington, DC.
authors.forename: James D
authors.initials: JD
authors.lastname: Reschovsky
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Reicherter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D000072161:Orthopedic Surgeons / Q000191:economics*; D010067:Ownership / Q000191:economics*; D026741:Physical Therapy Modalities / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics; D012047:Rehabilitation Centers / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data*
keywords: Use of physical therapy; self-referral; total knee replacement surgery