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  • Tara Albright DPT

Direct Access and why it matters?


Background

Recent research has shown the significance of receiving early physical therapy intervention to reduce cost of care, increase speed of receiving care and improve patient outcomes. A study tracking patient records in the Military Health System for a 2-year period in 2010-2011 found improved outcome in individual’s experiencing knee pain when they received early physical therapy intervention. Of the patients who received physical therapy for their knee pain, individuals who physical therapy first required fewer visits for initial care as well as continued follow up in a two-year period, had overall lowered costs associated with care they received, and had lower instances of receiving expensive imaging and prescription medications. These results showing the significant impact of having early access to physical therapy services highlights the importance of patients understanding direct access and how they are able to seek physical therapy services without the need for them to first see their regular physician.


What is Direct Access?

Direct access refers to an individual’s ability to seek and receive physical therapy evaluation and treatment without the need for a physician referral. All 50 states, DC and the US Virgin Islands feature some form of direct access, but the exact level of access patients have to receiving care varies in some jurisdictions.

Levels of Direct Access


Limited Patient Access

      Three states (Alabama, Missouri, and Mississippi) have limited patient access to physical therapy. This means that patients may be able to receive physical therapy for certain conditions such as previously diagnosed injuries/conditions, prevention, or in certain setting such as inpatient or home health settings without referral from the patient's physician.


Direct Access with Provisions

      There are 27 states, D.C, and the Virgin Islands which allow patients to have direct access to physical therapy services with provisions. Provisions may include a time limit on receiving physical therapy services or the requirement of physician referral for specific treatment interventions.


Unrestricted Direct Access

      There are 20 states which allow patients to have unrestricted direct access to physical therapy services without any restrictions. In these states, patients are able to have complete access to any physical therapy services without restrictions.


Colorado Direct Access

Colorado is one of the 20 states which give patients unrestricted direct access to physical therapy. In Colorado, physical therapists are responsible for referring patients to another qualified professional if it is deemed that the patient’s condition is outside the scope of a physical therapists training. Colorado also restricts physical therapists from making diagnoses, but this does not limit a physical therapist’s ability to evaluate and provide treatment for patients.

Direct Access and Medicare

Medicare beneficiaries are able to receive access to physical therapy as allowed by state laws and regulations in which they are seeking care. Medicare removed the need for a physician referral prior to receiving physical therapy services in 2005. While a physician referral is not required, Medicare beneficiaries do need to be "under the care" of a physician. The physician who is managing care for the patient must certify the physical therapy plan of care through signing the physical therapist's documentation which includes the plan of care within 30 days of the initial physical therapy appointment.

Direct Access and Other Insurances

Each insurance company may have their own restrictions regarding patients seeking direct access to physical therapy services. Some insurance companies may require a physician referral, a physician certification, or prior authorization before patients are able to see a physical therapist. The easiest way to determine what your insurance requires is to call and ask prior to attending your physical therapy visit to ensure your visit will be covered by insurance. There is also the option of cash pay for physical therapy services. Patients can seek direct access to physical therapy and bypass their insurance company’s requirements for a referral by choosing to pay out of pocket for any physical therapy services received.


Benefits of Direct Access

There are many benefits to allowing patients to have direct access to physical therapy services. Direct access allows patients to receive care faster, bypass potentially expensive diagnostic tests/imaging, and reduce total number of visits (physician and physical therapy) to reduce overall costs of care.

Faster Access/Reduced Number of Appointments

Without direct access, patients may face extended waiting periods in order to first see their physician, potentially undergo further testing, and then wait for a physical therapy appointment once it is eventually recommended by their physician. With direct access, patients are able to cut down on the amount of time they are waiting while they are experiencing pain or difficulty with daily activities. Direct access allows patients to begin with a physical therapy visit in which they may even start treatment the first day to begin working on reducing their pain and improving their quality of life.

Reduced Need for Further Diagnostic Tests

Without direct access, patients may initially see their physician who often could recommend further tests or imaging to determine their plan of care. The results of these tests/imaging are often inconclusive and are associated with high costs. Direct access allows patients to bypass these steps and start receiving treatment faster and without the associated costs, saving both time and money.



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