Did Your Doctor Disappear Without a Word? A Noncompete Clause Could Be the Reason

Reprinted from the NY Times March 15th 2019 –

When Don Cue developed a bladder infection last fall, he called his longtime urologist’s office for a urine culture and antibiotics. It was a familiar routine for the two-time prostate cancer survivor; infections were not uncommon since he began using a catheter that connects to his bladder through an incision in his abdomen.

When Mr. Cue called this time, a receptionist told him that his physician, Dr. Mark Kellerman, no longer worked at the Iowa Clinic in Des Moines, a large multi-specialty group. She refused to divulge where he had gone.

“As a patient, ‘scared’ is too strong a word, but my feeling is, ‘What do I do now?’” said Mr. Cue, 58.

Flummoxed, he solved his immediate problem by taking leftover antibiotics he had in his medicine cabinet.

It was only later that he learned his doctor had been fired by the Iowa Clinic and planned to start a urology practice with clinic colleagues. And, under the terms of their contract with their former employer, the doctors were banned for a year from practicing within 35 miles of the clinic, and from recruiting former patients to follow them.

Contracts with so-called restrictive covenants are now common in medicine, although some states limit their use. Noncompete clauses — common in many commercial sectors — aim to stop physicians and other health care professionals from taking patients with them if they move to a competing practice nearby or start their own. But what may be good for business can be bad for patient care — and certainly disquieting for those whose doctors seem to simply disappear.

One survey of nearly 2,000 primary care physicians in five states found that roughly 45 percent were bound by such clauses.

Continuity of care is important, doctors say, especially for patients with ongoing medical issues. Cutting off access to a doctor is different from disrupting someone’s relationship with a favorite hairstylist or money manager, they say.

“When doctors want to move from one practice to another, if they’ve got good therapeutic relationships with their patients, you’d think that public policy would want them to continue to treat these patients that trust them,” said Judy Conti, government affairs director at the National Employment Law Project.

 

Help save the Early Childhood Direction Centers! They need our help RIGHT NOW

  NY State has terminated the contract with the Early Childhood Direction Centers, and all of them will close as of June 30, 2019.
As many of you know ECDC  as been an amazing resource for families and professionals helping to navigate the systems of EI, transitioning to CPSE etc. for the past 30 years.
It has been said that the NYS Board of Regents is very concerned about the ECDC closure and the lack of transparency in the process. The Regents are meeting this coming Monday, January 14th which means there’s a very short window to make our feelings known! We need to tell them what the ECDC has done for us and what the lack of that support will mean for families of young children.
Here is the contact info to let your concerns be known:
Betty A. Rosa
Chancellor
12th Judicial District
Regents Office, State Education Building, 89 Washington Avenue, Albany, N.Y. 12234
(518) 474-5889
Regent.Rosa@nysed.gov
T. Andrew Brown
Vice Chancellor
7th Judicial District
925 Crossroads Building, Two State Street, Rochester, NY 14614
(585) 454-3667
Regent.Brown@nysed.gov

Commissioner of Education and
President of the University of the State of New York
MaryEllen Elia
(518) 474-5844
Commissioner@nysed.gov

P-12 Instructional Support
Deputy Commissioner
Angelica Infante-Green
(518) 474-5915

Christopher Soriano
Assistant Commissioner Special Education
Email: speced@nysed.gov

PT and OT  Receives Significant Payment Increase from NYS Worker Compensation Board for 2019

On December 26th, the New York State Workers’ Compensation Board adopted regulations which substantially increase payment for PT and OT therapy services provided to injured workers effective April 1, 2019.

The conversion factor for PT and OT services increased from 21 to 30 percent across the 4 regions of the state. The average conversion factor increase across all 4 regions was 25.4%

Initial evaluations are capped at 18 RVUs, revaluations are capped at 15 RVUs and follow up visits are capped at 12 RVUs, all of which allow for a greater intensity/duration of medically necessary treatment to be provided per session.

The changes in the fee schedule will take effect April 1, 2019.

There is NO  hard cap of 12 visits/180 days.
I will post additional information as I find it out.

Let Kids Play. Doctor’s Orders.

Reprinted from the NYTimes  August 20 2018.  By Dr. Perri Klass, MD
Doctors should prescribe playtime for young children, the American Academy of Pediatrics says.

The most famous painting of children at play is “Children’s Games,” the 1560 work by Pieter Bruegel the Elder of a town square in which children from toddlers to adolescents (scholars have counted 246) are playing a range of timeless games. There are dolls and marbles and tiddlywinks, ball games and climbing games and riding games (scholars have counted 90 or so). The children are the only ones in town, and their activities offer a kind of taxonomy of play.

But some worry that our current culture is less friendly to play, and that children may not be getting the chance to explore all its possibilities. To try to address that, the American Academy of Pediatrics released a policy statement on Monday titled “The Power of Play: A Pediatric Role in Enhancing Development in Young Children.”

The statement characterizes play as intrinsically motivated, involving active engagement and resulting in “joyful discovery.” It summarizes extensive developmental and neurological research on play, and tries to tease out some of the specific developmental discoveries in peek-a-boo (repetitive games provide “the joy of being able to predict what is going to happen”) and Simon Says (builds impulse control and executive function). It also says that doctors should encourage playful learning for parents and infants by writing a “prescription for play” at every well-child visit in the first two years of life.

It’s a values statement because many who study play feel that it is under siege, even as new research emphasizes its importance in children’s development.

We’re in a climate where parents are feeling like they need to schedule every minute of structured time, and 30 percent of kindergartens offer no recess,” said Dr. Michael Yogman, chairman of the A.A.P. committee on psychosocial aspects of child family health and the lead author of the statement. To some, he said, “play is seen as irrelevant and old-fashioned.”

Dr. Benard Dreyer, the director of developmental and behavioral pediatrics at New York University School of Medicine and a past president of the American Academy of Pediatrics, said, “The old saying is, play is the work of children. Play is the way they learn and the way they develop. It’s important to understand how all of us, and especially parents, can encourage play.” “Kids develop 21st-century skills in play,” said Dr. Yogman, who is chief of the division of ambulatory pediatrics at Mount Auburn Hospital in Cambridge, Mass. These include social and emotional skills and executive function, “skills that are crucial for adults in the new economy, that help them collaborate and innovate.”

A fundamental job in pediatric primary care is to strengthen the parent-child relationship, he said, and play is important in that area as well. Even with a very young child, he said: “When a 3-month-old smiles and a parent smiles back, those kinds of turn-taking activities are not only far from trivial,” but are actually important for developing language and social-emotional skills, such as taking turns.

The stable relationships with parents and other caregivers that are built through these interactions are also important for helping children navigate stress and trauma and preventing what we have come to call “toxic stress” from damaging the child’s development.

 

California PTs OTs and STs – New Rules on Independent Contractors in Effect

California PT OT and STs –  the California Supreme Court issued a decision April 30th which results in  new legal standard for determining whether a worker is an independent contractor or an employee. This is a major development in California employment law that will cause many workers now classified as independent contractors to be considered employees in the eyes of the state.

Under the Court’s new “ABC” test, a worker is presumptively considered an employee under the California Wage Orders unless the employer can establish all of the following three elements:

  •  The worker is free from the direction and control of the person who hires him/her in connection with the performance of the work, both under the contract for the work and in fact;
  •  The worker performs work that is outside the usual course of the hiring entity’s business
  • The worker is customarily engaged in an independently established trade, occupation, or business of the same nature as the work performed for the hiring entity.

Now is the time for practice owners to look carefully at the nature of your relationship with therapists who work for you – misclassification falls on your shoulders, and I can tell you first hand that Labor and IRS Department audits are not fun, and misclassifications can  be very costly in terms of interest and penalties.

 

NYTPA is now an Approved ABA Provider in the Greater NY Area

Families living within 5 Boroughs of New York City, Long Island and Westchester can benefit from our team of Licensed Behavior Analysts (BCBA) and Behavior Therapists. We are ready to structure a program to address behavior goals, communication training and life skills essential for independence. Parents benefit from guidance and experience in the form of parent training and participation in the therapy. This program comes to you from an agency with 30 years of experience providing therapeutic and educational services across multiple modalities.

We make the process simple:
1.  Speak with our team and provide some basic information about your child.
2.  Once we verify insurance benefits, parents will need to provide proof of diagnosis and prescription for services.
3.  We will obtain authorization from the insurance carrier to assess, develop treatment plan and begin treatment.

We accept most major insurance plans including GHI, UHC, Fidelis Care, NYSHIP,  and Oxford. Our team is ready to help verify your benefits, eligibility and check whether you are covered. For some insurance carriers, the service can be provided at no cost.

If you’re a provider and know of a family or families who can benefit from this service, please feel free to pass along this information.  Please call our main office and inquire about ABA Therapy.
(718)264-1640
-Or-
Email:
ABATherapy@nytps.org
www.nytps.com 

A Lomgtime PT Colleauge Needs Our Help After Losing Everything in the Thomas Fires of California

Dr. Robert Donaldson, DC, PT, OCS, a longtime physical therapist, and his family lost his home in the recent Thomas fire.  A GoFundMe account has been set up by his friends – please consider helping out – this man has contributed to our field for decades.

Dr. Robert Donaldson, DC PT OCS and his wife Jacqueline need your help to rebuild their house. Their home of 33 years  and everything inside was lost in the Thomas Fire on Dec.4th 2017.   Bob has spent decades as a physical therapy helping individual patients and our profession as a whole. This is our opportunity to give back to them. Any donation, big or small, will be incredibly appreciated. The funds are directly deposited into their account.  Thank you in advance for your consideration. For details:

NYC Pay History Ban Took Effect October 31

Beginning October 31, 2017, New York City employers are prohibited from  questioning job applicants on their salary history, with violators facing civil penalties of up to $250,000.

Earlier this year, New York City Mayor Bill de Blasio signed into law a piece of legislation banning all New York City employers from questioning job applicants on their current or prior salary in an effort to  combat wage discrimination and inequity based on pay history.

Effective October 31, employers  are prohibited from doing the following:

  • Requesting salary information from applicants, whether on an application or at any time during the interview process.
  • Questioning an applicant’s current or previous employers about their salary history.
  • Conducting a search for publicly available records or reports in order to learn an applicant’s salary history.
  • Relying on salary history in determining an applicant’s compensation if they become aware of an applicant’s salary history.

It is not an unlawful practice if an applicant voluntarily and without prompting discloses their salary history.  The law also permits an employer to inquire into an applicant’s desired salary or salary range.

The New York City Commission on Human Rights is responsible for enforcing the law and  may penalize violators up to $125,000 for an unintentional violation, and up to $250,000 for violations that are the result of willful, wanton, or malicious conduct.

All New York employers (private and public) are encouraged to review all application materials and  job postings to ensure  compliance  by October 31, 2017. All employees involved in the hiring process should also be familiar with the law.

 

 

Looking Into the Future for a Child With Autism As my son’s limitations became clearer, I found it harder every year to write a vision statement for his I.E.P. Then he showed us how.

Reprinted from the NYTimes – written by 

How do you write about the happy life you hope for your child to have when you have a hard time picturing it yourself?

For 18 years, I’ve dreaded the yearly ritual of writing a “vision statement” for an Individualized Education Plan, or I.E.P., for our son, Ethan. He has autism and, as any parent of a child with significant special needs knows, the yearly team meeting to develop the I.E.P. can be emotional and fraught. For us it has felt, at times, like an annual adjustment of expectations downward. In theory, the vision statement is a lovely idea — an opportunity for parents to articulate the optimistic future they envision for their child five years down the road. In reality, as Ethan grew up and his limitations — cognitive and behavioral — became clearer, I found it harder every year to write the short paragraph. We came to see he couldn’t live independently, get married, work in a job without support — but if those are the givens, what does a hopeful future look like?

This year, as Ethan turned 21 and completed his final year in the school system, he shocked us by writing his own vision statement. Reading his words made me realize how wrong I’d been for years, trying to articulate what my son’s future should look like.

While Ethan was still in elementary school, our vision statements included the same wish list I imagine every parent of a child with autism probably has: better communication, fewer meltdowns, more independence. When he was 12, I got more pragmatic, “We wonder if Ethan’s love of farm machinery might one day become an employment opportunity.” At 13, after a successful stint in the middle school chorus, I wrote, “Ethan would like a future in music, perhaps as a professional singer?” At that point Ethan was still working on using a Kleenex to blow his nose. A future as a singer was far-fetched, I knew, but I wrote it as a way of saying: Ethan does have abilities. We’re serious about developing them.

This is the great challenge parents face in these yearly meetings: You’re fighting for teachers to help your child work toward a future that, with every year, feels as if it’s growing narrower and bleaker. When it’s clear he’ll never understand money well enough to make change, you cross off the possibility of working in any retail job. When he can’t stop rubbing his nose or touching his mouth at work, all food service opportunities dissolve as well. When his self-talk disturbs the nursing home residents where he genuinely likes volunteering, another door closes.

After six months, we got a jolly report. “He’s fun! And a pretty good worker for about one to two hours a day.” After a year, we were told he’d made it onto a landscaping crew. “What do you do on the crew?” we asked.

“Stuff,” Ethan said and listed a few machines we assumed he was watching other people operate. He could mow a lawn, we knew, but he couldn’t use a leaf blower. Or a weed whacker. We’ve lived with Ethan for 21 years. We know his limitations.

At our last I.E.P. meeting a representative from the farm came and read a report from Ethan’s “Crew Captain.” We heard that, indeed, Ethan was operating those machines, safely and effectively, along with this final line: “Ethan makes us laugh every day.”

I could hardly believe it. I stole a look at his dad and smiled.

This meeting fell at a particularly demanding time in my life and I’d arrived without writing a vision statement ahead of time. When I started to apologize, the vocational coordinator — a young woman who’d struggled for four years to find a job placement for Ethan — held up her hand. “It’s fine. Ethan wrote his own this year.” Apparently he’d dictated it to her on a recent visit to the farm. A few minutes later, he read it aloud:

“After I graduate from high school I plan to work at Prospect Meadow Farm until I retire and live at home with my family as long as I can. I’d like to keep taking classes at Berkshire Hills Music Academy. For fun, I want to play Special Olympics basketball, go to our cabin in Vermont and the shore in New Jersey, mow lawns, and collect business cards. My goals for the future are to take the PVTA bus into town to make purchases, and someday learn how to drive a zero-turn lawn mower.”

For a full five seconds after he finished, no one said anything. I looked across the table at his speech therapist who had known him since he was 14 years old. She had tears in her eyes. I did, too.

Not simply because Ethan had articulated his own entirely reasonable vision statement, but because it incorporated every aspect of his present life that brings him joy. After years of fabricating visions for a future we never honestly thought possible, Ethan was offering one that was both optimistic and breathtakingly simple: I want my life to keep looking the way it does now.

Here’s a great read for all pediatric therapists about selected current NDT

Whether you need a refresher or are new to NDT, here’s an informative read by Gerard J. DeMauro, PT, MSPT, C/NDT

The Conceptualization of NDT-Based Handling Techniques for Infants: Two Perspectives  

Preface   The article is intended to provide both general and more detailed information on the NDT (NeuroDevelopmental Treatment) / Bobath frame of practice applicable for infants with and/or at risk for cerebral palsy and related neuromotor disorders.  Readers, including habilitative therapists, will benefit from an update of theories and concepts applicable to this approach.  It is also intended to orient those less familiar with NDT and thus may be of interest to healthcare professionals involved in the examination, evaluation and/or referral of infants for therapeutic assessment and/or treatment.  Below, the most current and comprehensive operational definition of NDT is included.  Its review includes NDT’s role in the management of infants as well as children with CP and related disorders throughout their lifespan.  The NDT frame of reference is also applicable to adults with strokes and head injuries.
Click here to access the full article.

Gerard J. DeMauro, PT, BS/MS, C/NDT has been a physical therapist for nearly 40 years. In addition to teaching, Gerard still maintains an active private practice in NYC, and is available to present at workshops for therapists, educators and parents on topics related to physical therapy practice in pediatrics. You can email Gerald directly  at Gdemauro101@aol.com  to ask any questions, or to make arrangements for specific presentations related to the pediatric practice of physical therapy.