5 Surprising Truths about Physical Therapy Direct Access

Ah, direct access: One of the of the most powerful—and simultaneously, most perplexing—legal concepts in the physical therapy field. There’s a lot of misinformation floating around on this topic, and teasing out the truth isn’t always easy. So, I thought I’d take this opportunity to put some of those rumors to rest by sharing five direct access truths that you may find surprising:

1. It’s not just for outpatient private practices.

You might not think of an acute care setting as a place where patients would seek out physical therapy services directly. But, more and more large hospital and health systems are starting to provide direct patient access to physical therapists. In fact, this practice is actually pretty common outside of the US—and based on the results other countries have seen, I’d say it’s high-time we pushed for this trend to catch on here at home. According to this resource, a London-based hospital that added staff PTs to its walk-in center experienced a massive uptick in patient satisfaction, with 90% of patients indicating they were likely to return to the center in the future rather than going elsewhere to receive care.

And here in the US, smaller, resource-strapped hospital organizations are beginning to experiment with this model as well. Case in point: Frances Mahon Deaconess Hospital—located in the small northeastern Montana town of Glasgow—recently implemented a policy allowing patients to “self-refer themselves to physical therapy services, therefore bypassing the need for an extra physician appointment.” In its official news announcement, the hospital explained that the new model is not only “easier for the patient, but research suggests that in appropriate cases, allowing direct access to physical therapy can lower healthcare costs, reduce requirements for diagnostics imaging, and provide more expeditious resolution of the patient’s symptoms.”

2. Many insurances will reimburse for physical therapy services without a referral.

Even when the law allows for direct access, many practitioners are reluctant to treat patients with traditional third-party insurances. Why? Because providers assume insurers won’t pay for services rendered without a physician referral. But, you know what they say happens when you assume.

In reality, many insurance carriers don’t have a referral requirement—although some still do. The moral of the story? Regardless of whether or not a patient came to you via direct access, it is always a best practice to verify the patient’s insurance details. And actually, thanks to the growing popularity of high-deductible health plans (HDHPs), patients are footing a greater portion of the bill for all types of care—not just physical therapy. So, I’d recommend not only performing a benefits check on each patient, but also getting an idea of what that patient’s out-of-pocket cost will be. Then, clearly inform the patient of his or her upfront financial responsibility before you begin treatment. This will prevent the patient from getting a surprise bill in the mail several weeks or months later—something that could turn them off from physical therapy for good.

3. There’s a huge untapped demand for direct access physical therapy services.

If you’re part of the camp that thinks marketing to direct access patients isn’t worth the trouble, think again. While it’s true that the current pool of direct access patients is relatively small, it’s important to step back and look at the larger (read: longer-term) picture. As I’ve expressed before, “Of all patients with neuromusculoskeletal issues, only about 8% seek out rehab therapy.” That means 92% of the patients who could benefit from physical therapy treatment fail to obtain it.

Now, humor me for a second, and think about what it would be like if that number were flipped and 92% of patients with neuromusculoskeletal issues did seek out physical therapy as a primary care option. That’s where things are going—if we push them that way, that is. To do that, though, we have to capitalize on current market conditions. As I already mentioned, patients have more of a financial stake in their care than ever before. They are voting with their dollars, so to speak, and that gives physical therapists—who provide treatment that is just as effective as, and less expensive than, more traditional care options like surgery and prescription painkillers—a huge leg-up on the competition. But, we have to unify in our effort to promote our value—to educate the world about what we do and why patients should choose to come to us first. And if we keep clinging to a referral-heavy business strategy, that’s not going to happen.

4. Direct access patients achieve better results—and are more satisfied with those results—than referral patients.

This probably has to do with the psychology of direct access patients. After all, they made the choice to seek out—and pay for—physical therapy care. So, they’re more inclined to justify that decision by getting the most out of their treatment. And the data seems to support that argument. In fact, this study, published in Physical Therapy (PTJ), showed that:

  • “patients reported a higher level of satisfaction when they received physical therapy through direct access versus physician referral,” and
  • “patients receiving physical therapy through direct access versus referral had better outcomes at discharge.”

The same study also noted a “decreased cost in the direct access group…likely due to decreased imaging, number of physical therapy visits, and medications prescribed.” Furthermore, this APTQI research report indicated that total spending for Medicare patients with low back pain who accessed physical therapy first was 75% lower compared to patients who underwent surgery first and 19% lower compared to patients who received injections first. And for patients with high out-of-pocket costs (i.e., those with HDHPs), that difference represents a pretty substantial amount of savings. (For a shareable, social-ready infographic highlighting these and other eye-opening data points about the cost-efficiency of a PT-first treatment approach, click here.)

5. Direct access is available in all 50 states.

I’m still flabbergasted whenever I interact with people in the PT industry who aren’t aware that patients can see a physical therapist on a direct access basis in all 50 states—plus Washington, DC and the US Virgin Islands. I think the root of their confusion, though, is that because direct access law is determined at the state level, the degree of direct access available—and the stipulations surrounding its application—varies widely from one state to another. In some states, patients are free to obtain physical therapy treatment on a totally unrestricted basis; in others, therapists can only provide initial evaluations without involving a physician. So, yes—the physical therapy profession still has a lot of work to do on the direct access front. But, it’s important work, which is why I encourage all of you to get involved in legislative advocacy efforts in your state. At the very least, I urge you to embrace direct access to the greatest extent your state’s law allows. After all, the more patients who come to us first, the greater the chance that other prospective patients will catch wind of this opportunity. And that’s exactly the kind of snowball effect the physical therapy industry needs.

Curious about the level of direct access that exists in your state? Consult with your state APTA chapter—or check out this handy resource. Want to learn more about general direct access best practices? Check out this webinar.

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