Stuff You Should Read

Direct Access to Physical Therapy Associated With Lower Costs and Fewer Visits

I seldom get into professional politics on this website, it would rather share ideas, educate, and grow together.  But a new study was recently published showing that direct access to physical therapy, rather than seeing a physician first, was shown to be associated with lower costs and fewer visits.  This is a huge step towards direct access and autonomy for the physical therapy profession.

The APTA discuss some of the study in a press release last week:

[box]The study, published ahead of print September 23 in the journal Health Services Research (HSR), reviewed 62,707 episodes of physical therapy using non-Medicare claims data from a Midwest insurer over a 5-year period. Patients who visited a physical therapist directly for outpatient care (27%) had fewer visits and lower overall costs on average than those who were referred by a physician, while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.[/box]

Follow these links for more information:

This is a pretty important research study and we should do our best to spread the word – so please tweet this page, share on Facebook, +1 it on Google, Stumble it, poke my wall with it (I don’t know what I am talking about…), or whatever new and exciting way you can share this using social media!  Just click the buttons to the top, side, and bottom of this post!  THANKS!

15 replies
  1. Dan Pope SPT
    Dan Pope SPT says:

    Very refreshing to see some published research in the area of saving some healthcare bucks and giving some credit to Physical Therapists as autonomous practitioners. Thanks !

  2. Joe Brence
    Joe Brence says:

    We are required to determine an ICD9 code for all patients–direct access or not. Most referred patients will be given the same ICD9 code which was given by the physician.

    We do not refer for diagnostic imaging on a general consumer level. PTs who work within the military system often do have this privilage though. We refer to an appropriate MD if we believe further pathology is suspected that would warrant an image.

  3. Dale Giessman
    Dale Giessman says:

    Is a PT allowed to make the determination of ICD9 diagnostic code or does this come from the referring physician. Also can you refer for diagnostic testing (x-ray, MRI, EMG)?

  4. Joe Brence
    Joe Brence says:

    Direct access gives us the ability and expectation to determine whether or not an individual is appropriate for physical therapy. Once appropriateness is determined, the clinician makes an autonomous assessment on why they believe the patients ankle hurts, is not moving correctly, etc. and provides interventions to improve. We are required to give an ICD9 code, but there are some grey areas on what is considered a PT diagnosis vs. a medical diagnosis. I am not sure what you mean by the ability to diagnose by license?

  5. Dale Giessman
    Dale Giessman says:

    Joe, I’m not making a claim about one’s ability to differentially diagnose, direct access however requires the ability to diagnose by license. If the PT world obtains this then I think you would have a better shot at it.

    Please understand that I’m not against PTs and direct access, we’ve fought our own battles in the discriminatory health care system.

  6. Joe Brence
    Joe Brence says:

    “Most PTs have a much better working knowledge than the average general practitioner related to neuromusculoskeletal issues but we have to remember that not all pain is generated by the neuromusculoskeletal system and thus the additional education related to differential diagnosis is essential.”

    There was an article out in 2005 in BMC Musculoskeletal Disorders by John Childs which looked at the ability of PTs to differentially diagnose. A standardized examination was used to assess PTs knowledge of the management of musculoskeletal conditions and compared the results to other medical professionals. The results indicated that PTs had a higher level of knowledge in the treatment of musculoskeletal conditions when compared to all subgroups of physicians except orthopedic surgeons.

    I am not sure where this comment is coming from Dale…Evidence supports that we differentially diagnose well as well as detect when a patient is not in within our realm of care. If you disagree, I challenge you to cite one piece of evidence to support your position.

  7. Theresa
    Theresa says:

    The biggest problem in most states is not the ability to have direct access, but getting insurance companies, including Medicare, to pay for this service. In Pennsylvania, more and more insurance providers will not pay for PT unless prescribed by a physician.

  8. Dan
    Dan says:

    Same way I feel about ATs, especially at the high school level. No reason to go to the ER for what is clearly a minor ankle sprain…same with general knee or general low back pain. In my experience, non-specialized docs just prescribe meds for pain, rest as treatment, and another costly follow up visit.

  9. Kyle Ridgeway PT, DPT
    Kyle Ridgeway PT, DPT says:

    See the blog post above for more specifics about some of the research related to PT’s ability to SCREEN medical conditions and the safety of direct access….

    Although PT’s do not diagnose, they are trained in medical screening and determining the appropriateness of an individual for physical therapy. In other words, while we may not be able to diagnose an occult medical conditions, our schooling and training teaches us to determine if a condition is NOT a neuromusculoskeletal condition we can treat.

    PT’s know and are trained to recognize when pain can be generated from other medical conditions/sources. In addition, even if a patient is referred from a physician or multiple physicians, we still examine and evaluate an individual to determine their appropriateness for PT. As examples, I have sent plenty of patients back to a physician or referred them out even though they were referred directly from a physician. These included individuals who had DVTs, a runner with a stress fracture, and a kid that ended up having rheumatologic condition. Did I diagnose these conditions? Absolutely not.

    No additional training is required for a PT to have direct access, it is an inherent part of our schooling and training. We are trained to assess if this person is appropriate for PT OR if they need to be referred out:
    -Before returning to PT
    -In conjunction with continued PT

    Bottom line: Direct access is safe. PT’s possess the knowledge, skill set, and screening skills to practice in a direct access environment. More and more research is indicating that direct access to a physical therapist and/or early treatment by a physical therapist in conditions such as low back pain (including work related low back pain) result in superior outcomes and less costs.

    PT’s are examining, evaluating, and screening every patient they see.In fact, some research has indicated that PT’s screen for potential red flags at a higher rate than primary care physicians.

    And you are correct, the research supports that PT’s all more knowledgable in regards to orthopaedic conditions than ALL physicians except ortho surgeons.

    It is time to recognize the professional skill set and knowledge of physical therapist’s and leverage it for better health outcomes in our broken health care system.

    • Dale Giessman, DC
      Dale Giessman, DC says:

      Hey Kyle, not being critical just sharing what I think the argument against PT having direct access. I see you went on to receive your DPT which does take that x-tra step toward differential diagnosis. I have worked with PT’s for many years (shared office) and it was evident that the diagnostic skills were not there all the time. But this is probably true for my profession as well as the entire healthcare delivery system. Good and not so good practitioners. Unfortunately there is a hierarchy and I like you am not at the top, regardless of our knowledge and abilities. Even though chiro has excellent outcomes for musculoskeletal (far better than standard medical care) and similar to PT we are still excluded from many insurance plans. I like you continue to push for an even playing field and non-discrimination in healthcare delivery.

      • jake
        jake says:

        Chiro has excellent outcomes for musculoskeletal system? That was a joke. Show me the evidence. Chiro is only better in marketing themselves than PTs by calling themselves Physician.

  10. Dale Giessman, DC
    Dale Giessman, DC says:

    I believe PT should be direct access for certain diagnosis but the hang up seems to be that PT’s cannot diagnose. Most PTs have a much better working knowledge than the average general practitioner related to neuromusculoskeletal issues but we have to remember that not all pain is generated by the neuromusculoskeletal system and thus the additional education related to differential diagnosis is essential.

  11. Jeffrey Driban
    Jeffrey Driban says:

    Has anyone evaluated how direct access will influence patient safety, collaboration with physicians, liability insurance costs for clinicians as well as clinics? other fields like athletic training have a form of direct access but it’s traditionally with standing orders from a physician.

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