The Reality of Direct Access

There’s no doubt that the healthcare landscape is changing. PT profit margins are decreasing and insurance reimbursements continue to fall. As we face these changes—and we must face them—it’s time to embrace the power of direct access.

Some of you might be flexing your direct access muscle right now—bringing in new patients and creating new relationships with other healthcare providers. If that’s the case, bravo and well done. But if you haven’t taken the direct access plunge yet, I urge you to do so. Here’s why:

Direct Access in Your State

Some form of direct access to physical therapy is available in all 50 states—including DC and the US Virgin Islands. At the very least, a PT can perform an initial evaluation in every state without a referral. This means we can become the starting point for a patient in pain. We can evaluate and either treat or refer out to a healthcare provider we trust.

However, before you jump right into treatment, be sure you know your state’s regulations,  because direct access regulations vary from state-to-state. That being said, even if you have limited direct access, it’s valuable to take advantage of what access you do have. Don’t throw it away; an initial evaluation can be a key to future visits and referrals. When unlimited direct access becomes a reality, you’ll be happy you acted early. If you want a brief overview of the direct access regulations in your state, visit WebPT’s blog. And as always, consult your state’s practice act, a PT compliance expert, or your attorney with state specific questions.

Equally as important as knowing your state regulations, if you treat Medicare patients, know that Medicare regulations take precedence over your state’s direct access laws. Beyond Medicare, commercial payers can decline reimbursement in accordance with their own regulations. Whether your concern is with Medicare or your commercial payers, as Tom Ambury explains, thorough and clean documentation is crucial. If you’re confident your services are medically necessary, then ensure your documentation supports that.

The Bottom Line

We can become a viable referral source for other healthcare providers. Think about it: You form your own network of professionals. Then, if—during an evaluation—you decide that a patient needs care outside of your expertise, you can refer to one of the professionals in your network. Undoubtedly, there will come a time when that professional returns the favor. Direct access gives you the power to pave a two-way referral street, which brings more cash into your clinic.

Beyond benefitting your bottom line, you have the opportunity to save your patients’ time and money. When a patient comes straight to you for care, he or she avoids costly and unnecessary visits to his or her MD. You also have the added benefit of being in control of the clinical decisions for that patient, from the start of care to discharge. With direct access, you can also work on growing your cash-based wellness services. So, for example, when a patient needs an exercise plan—from weight loss to athletic training—he or she should come to us first.

Embrace It

Direct access is not something to fear. As always, if something is outside of your scope of expertise, you should be able to recognize it. You’re the expert, and you know when it’s appropriate to treat—or not treat—a patient. Direct access doesn’t change that.

Therapists often cite the fear of litigation as a reason for avoiding direct access. Don’t let that be your excuse. As long as you’re treating appropriately, documenting thoroughly, and conducting proper research, litigation isn’t something you need to worry about. In terms of liability, research has proven that direct access is not a risk. In fact, a recent study regarding direct access in military healthcare facilities (published in JOSPT by Josef Moore) showed that “Throughout the 40-month data collection period, there were no reported adverse events resulting from the PTs’ diagnoses or management, regardless of how patients accessed physical therapy services. Additionally, none of the PTs had their credentials or state licenses modified or revoked for disciplinary action. There also had been no litigation cases filed against the US Government involving PTs during the same period.”

The reality of direct access is this: we are the experts; it’s about time we act like it. Arm your staff with a direct access policy. Train your employees, so they have the confidence to handle direct access patients with the same care and expertise you expect of yourself. Review your payer contracts, and negotiate to receive reimbursements for direct access patients, if necessary.

Direct access has to start with a conversation. Start one in your clinic with your patients and staff, among your trusted referral sources, in your community, and even online. As therapists, we can take responsibility for our bottom line, generate business, and improve patient care by using direct access as our tool.


Want to learn more about direct access? I recently hosted a webinar that covers everything you need to know about direct access in 45 minutes. Watch it here. Have a direct access question? Ask it in the comments below.

About the Author

Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT

As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.

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