Direct Access Physical Therapy: Q & A

Many healthcare consumers are unaware of the fact that they are free to access the services of a physical therapist without a physician referral. Every state allows for evaluation and some form of treatment without a physician referral. This has been the case in the state of New Jersey for almost 15 years, yet most of the patients that we work with in our Barnegat and Manahawkin physical therapy clinics are unaware of this. Most continue to believe that they must first visit another health care provider before seeking the services of a physical therapist. When we educate people about direct access we are greeted with a bit of surprise and many questions. Below are a few of the common questions we receive about Direct Access.

Direct Access saves time, saves money, and improves outcomes.

What are some of the advantages of accessing the services of a physical therapist first?

Directly accessing the services of a physical therapist saves time and money. Consumers are able to avoid wait times to see physicians and avoid delays in treatment while further testing might be pursued. Often these tests are not necessary and can potentially slow or negatively impact recovery (MRI for Low Back Pain>). A 2014 systematic review concluded that direct access controls health care costs and promotes high quality healthcare1. Compared to accessing physical therapy through a physician referral, those who directly accessed services were more satisfied with care, were prescribed fewer medications, underwent fewer diagnostic tests, and achieved better overall outcomes in fewer physical therapy treatment sessions. We have observed similar findings at both our Barnegat and Manahawkin physical therapy clinics. Patients who access our care directly achieve better overall outcomes in 20% fewer treatment sessions.

Are physical therapists qualified to deliver direct access services independent of physician referral?

Yes. Physical therapists are licensed healthcare professional who hold doctoral degrees. Physical therapists undergo extensive training in differential diagnosis and medical screening. This entails distinguishing non-serious musculoskeletal problems (low back pain, rotator cuff problems, meniscus tears, arthritis, etc) from more sinister potentially life threatening conditions (cardiac disorders, cancer, etc). Physical therapists at BSR Physical Therapy have also undergone more extensive residency, fellowship, and board certification training which focus further on these diagnostic skills. Physical therapists are not trained to make or confirm serious diagnoses but we are able to recognize when patients do not belong in our clinics and need an appropriate medical referral. We routinely refer patients to other medical specialists based on our physical exam or when the patient is not progressing towards their goals. Physical therapist’s clinical examination skills are on par with or better than most other healthcare professionals (Evidence here). How many other healthcare providers are going to spend one full hour actively listening to their patients in order to elicit all their concerns and then perform a comprehensive physical examination?

Will insurance companies cover direct access physical therapy services provided without a physician referral?

More and more health insurance companies are now covering physical therapy services without a physician referral. This is because of emerging research evidence showing cost savings with this approach2. At our clinics our front office professionals verify all health insurance benefits before starting treatment. In the majority of instances (>75% of cases) we are finding that a physician referral is not necessary to access and cover physical therapy care.

Approximately 10% to 20% of our patients access physical therapy care directly and this number is on the rise. Healthcare consumers are saving time, money, and achieving superior outcomes with greater convenience when directly accessing physical therapy. Health insurance companies are now recognizing these advantages as well. As health care reform continues to evolve, the health care consumer is becoming a more active participant in their own care. Direct access to physical therapy is here to stay and growing.

References:

  1. Ojha H a, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14-30.
  2. Pendergast J, Kliethermes S a, Freburger JK, Duffy P a. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Serv Res. September 2011:1-22.