On January 6, 2011, Hawaii passed direct access legislation
and joined the ranks as the 46th state to allow direct
access to physical therapy services without a physician
referral. With last year's healthcare reform and the
discussions surrounding it, the cost and efficiency of
healthcare has been brought to the forefront of every
American's mind. Now, more than ever, physical therapists
are poised to be the solution to rising healthcare costs
related to the treatment of musculoskeletal injuries by way
of direct access to physical therapy services.
In corresponding with American Physical Therapy Association
(APTA) reimbursement specialists, each insurance provider
has different policies in regard to direct access, however,
more and more are allowing it due to its cost effectiveness.
A study of insurance claims made to Maryland’s Blue Cross
Blue Shield from 1989–1993 shows that episodes of physical
therapy care for acute musculoskeletal conditions were
shorter and more cost-effective ($1,004 vs. $2,236) for
direct access PT compared to physician-referred PT. Also,
physician-referred clients had 67% more therapy visits and
60% more office visits compared to direct access clients.
The researchers show that more medication, injections, and
imaging studies were utilized in physician-referred clients,
impacting the total of paid claims per episode of care.
Claims that utilized direct access were 137% cheaper
overall. With direct access, clients can see a physical
therapist earlier and hopefully prevent conditions from
becoming chronic issues that are less receptive to
conservative treatments. Allowing for direct access in our
practice will not only decrease the cost of care but also
improve patient outcomes.
Due to unrelenting lobbying by the APTA, state-level PT
associations, and grassroots efforts by physical therapists,
direct access is available in most states with the exception
of Michigan, Indiana, Tennessee, and Alabama. So, how has
this changed our practice? The Direct Access Utilization
Survey conducted by the APTA in February 2010 found 55% of
surveyed PTs (in nine polled chapters) are utilizing direct
access and educating their clients about it. Over 80% of
private practice PTs have utilized direct access compared to
just 34.2% of health care system/hospital-based outpatient
PTs. Of the practitioners that utilize direct access, 69%
reported that direct access clients constituted 10% or less
of their client base. 60% of practitioners utilizing direct
access market directly to consumers, with the three most
effective strategies being building relationships with
existing customers, participating in community events, and
advertising. 43% of practitioners utilizing direct access
reported they market directly to non-physician referral
sources including coaches, athletic trainers, personal
trainers, and nurse practitioners with face-to-face
interactions being most effective.
Many primary care practitioners including physicians, nurse
practitioners, and physician assistants are aware of
physical therapy services for the treatment of
musculoskeletal disorders. I'm happy to see more and more
urgent care and emergency room referrals for evaluation and
treatment for diagnoses like sciatica, back pain, and ankle
sprain. However, where we as physical therapists really need
to focus our message and marketing is to the general public.
Are physical therapists thought of as the practitioner of
choice for musculoskeletal injuries and pain? Does the
general public know what physical therapy is and what it can
do for them? Do they know that they can go directly to a
physical therapist without a physician referral?
Healthcare reform and the victory of gaining direct access
in Hawaii provides every physical therapist with an
opportunity to have these conversations with each patient.
It's as simple as telling them at discharge, "If you have
any other musculoskeletal problems in the future, you are
not required to see your physician prior to coming, just
make an appointment for an evaluation." However, we can do
better. Grassroots efforts are needed from every physical
therapist establishing PTs as trusted practitioners in the
treatment of musculoskeletal disorders. Get into the
community more. Do health fairs. Volunteer at endurance
athletic events such as 5Ks or century rides. Write an
article for a newspaper or magazine. Comment on news
articles pertaining to PT. Establish or write for a blog.
Discuss specialty practices in PT with each patient. Give
community presentations on topics in PT. The benefits to
your patients, practice, and profession will be tangible and
rewarding.
As you can see, physical therapy has an immense opportunity
to be a solution to rising healthcare costs through the use
and promotion of direct access. Most insurance companies
allow direct access, but as the utilization survey found,
not all PTs are utilizing direct access. This is in part due
to the general public’s lack of awareness of physical
therapy and the benefits of our services. Efforts by the
APTA to improve client awareness of physical therapy and
direct access can be made more effective by the grassroots
efforts of each and every physical therapist. With these
changes in mindset and practice, physical therapists can
make a measurable impact on the cost and quality of care.
You can find additional resources on direct access at the
reference link below including a general overview,
rationale, laws by state, and the Mitchell cost
effectiveness study at
www.apta.org.
Last revised:
January 11, 2011
by Monique Serpas, PT, DPT
References
·
APTA | Direct Access in
Practice. (2010). Retrieved December 28, 2011, from
http://www.apta.org/AM/Template.cfm?Section=Practice_Management_
and_Administration&CONTENTID=72804&TEMPLATE=/CM/HTMLDisplay.cfm
·
APTA | Direct Access Resources.
(2010). Retrieved December 28, 2011, from
http://www.apta.org/AM/Template.cfm?Section=Top_Issues2&TEMPLATE
=/CM/HTMLDisplay.cfm&CONTENTID=73240
·
Mitchell, J. M., & de Lissovoy, G. (1997). A Comparison of Resource
Use and Cost in Direct Access Versus Physician Referral
Episodes of Physical Therapy. Physical Therapy, 77(1), 10
-18.
