Direct Access to Physical Therapy: Cost-Effective & Faster Recovery
Last month we explored the role of a physical therapist in a changing healthcare landscape. Part 2 will discuss the issues of direct access to physical therapy.
What is State “Direct Access” to Physical Therapy
“Direct access” means consumers have the right to obtain services from a licensed physical therapist without having to first obtain a prescription or referral from a physician. Healthcare reform is shifting health care into a value based system driven by cost-effective outcomes. Consumers are free to choose between physical therapists and providers that give value and provide positive outcomes. Direct access laws vary between each state depending on the state’s practice act. At this time 48 states allow for physical therapist without physician referral, 18 states have unrestricted direct access, and 2 states (Michigan & Oklahoma) require a referral by state law for physical therapy treatment. Wisconsin is a direct access state where one does not need a prescription or referral of a physician for physical therapy services. Direct access may eliminate the delay of healthcare services that may result with higher medical tests and treatments, decreased functional outcomes, and decreased consumer satisfaction.
Direct Access at the Federal Level & Medicare
A 2005 revision to the Medicare Benefit Policy Manual (Publication 100-02) describes the Medicare beneficiary to be able to go directly to a physical therapist without a referral or visit to a physician; however the patient must be “under the care of a physician”. Once the physical therapist creates a plan of care, the plan of care must be certified by a physician within 30 days of the initial therapy visit. Once approved, recertification of the plan of care is required if the patient’s condition changes, long-term goals changed, or within 90 calendar days from initial treatment.
Direct Access & Public Safety
Indeed, It is the utmost importance to ensure consumer safety and minimize harm to the public. Although the risk of a health care provider missing an underlying condition is always present, physical therapist have low rates of malpractice and incident of claims or complaints filed against them. Physical therapists have extensive training in the examination, evaluation, diagnosis, prognosis, and intervention of patients with functional limitations and disabilities. Physical therapists assist patients to get appropriate care and refer to a medical provider when signs and symptoms are outside the scope physical therapy practice. The Federation of State Boards of Physical Therapy affirm that direct access does not jeopardize the health, safety, or welfare of the patient/clients. In fact Health Providers Service Organization (HPSO), the leading liability insurer of physical therapists in the United States, states in a January 10, 2013, letter,
“Direct access is not a risk factor that we specifically screen for in the underwriting of our program nor do we charge a premium differential for physical therapists in direct access states. We currently have no specific underwriting concerns with respect to direct access for physical therapists.”
Cost-effectiveness & Faster Recovery
The change of healthcare reform aims to provide affordable and accessible care to people for a healthier and happier society. Can physical therapy help with healthcare reform in a positive way? A study from Georgetown and John’s Hopkin’s University explored if direct access to physical therapy services are cost-effective in total paid claims and length of care provided. The researchers found that:
“The total paid claims for physician referral episodes to physical therapists was 123% or 2.2 times higher than the paid claims for Direct Access episodes. The total paid claims averaged $2,236 for “physician referral” episodes as compared to $1,004 for Direct Access episodes. When expressed in terms of actual reimbursements, the difference in total paid claims per episode was $1,232.
Physician referral episodes were 65% longer in duration than PT Direct Access episodes.”
Similarly, a study from the Journal of Health Services and Research reviewed 62,707 episodes of physical therapy claims over a 5 year period and found that direct access to a physical therapist for outpatient care had 27% fewer visits and lower average costs on average for an episode of care. The study also showed that direct access to a PT also maintained the continuity of care within the overall medical system and showed no difference in health care use over 60 days. A recent study published in Military Medicine found that direct access to physical therapist decreased use of radiology and medication, and had higher return-to duty for patients. In comparison to family practice physicians, PT’s used radiology in 11% of cases vs a 90% rate with family practitioners, PTs used medication 24% of cases vs a 90% rate with family practitioners, and the return-to-duty rate was 50% higher when having direct access to a PT.
A Virginia Mason Medical Center study examined the “Old versus New approach” in managing low back pain. The study showed lower total healthcare costs to back pain treatment with standardizing a path with direct access to a physical therapist. The study found less wait times for appointments, MRI utilization dropped from 15.4% to 10%, and only 6% of people lost time from work.
“Put the physical therapy in front. That’s also what a lot of medical literature suggests. The hospital made the change, and also worked with its team of employers to eliminate extra steps in the medical maze for patients”. – Excerpt from a “A Novel Plan Helps Hospital wean Itself Off Pricey Tests” in The Wall Street Journal (2007).
In addition to lower health care utilization, direct access empowers people to control their own care. By becoming more pro-active and independent with personal health care decision making, one can become more satisfied with their care and lead to better outcomes.
Therefore, Can physical therapy help with healthcare reform in a positive way? YES!