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What is Patient Access? Patient Access allows you, the patient, to choose physical therapy treatment without needing to see another healthcare provider first.   Next »  Learn More About Patient Access
Did You Know? Starbucks and Aetna participated in a study of back pain. Results show baristas back to work in two days with direct access to physical therapy versus two weeks through physician referral.   « Previous Next »  Learn more
Did You Know? The National Black Caucus of State Legislators supports the adoption of legislation that permits access to physical therapists without a physician referral.   « Previous  Learn more

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View a diagram of the old approach vs. the new approach to physical therapy.

What is Patient Access (Direct Access)?

Patient Access (Direct Access) - current law in Texas prohibits you from directly accessing your physical therapist for treatment. You must go through costly office visits first.  Full unfettered Direct Access allows a consumer to go directly to a physical therapist for treatment without a referral from other healthcare providers.  There are currently 16 states in the U.S. with full unfettered Direct Access.  Additionally, 32 states have some form of Direct Access, including Texas.  To call what Texas has “Direct Access” is baffling, as a consumer must be referred by a physician if they choose to see a physical therapist for treatment.  Currently in Texas, a consumer may choose to go directly, without referral, to a chiropractor, a podiatrist, a massage therapist, an acupuncturist and even a personal trainer for injuries; yet they cannot go directly to a physical therapist without a referral.  Physical therapy is the last profession that has a “gatekeeper,” yet are some of the most educated health care providers of all.  Many physical therapists are at the doctorate level (Doctorate of Physical Therapy, DPT).  Beginning in the fall of 2009, any students enrolling in Physical Therapy school in Texas universities must achieve a Doctorate of Physical Therapy (DPT).

Problem Statement:

Consumers seeking alternatives to prescription medications and surgery are choosing physical therapy for the prevention and treatment of conditions affecting movement and function, only to find arbitrary, unnecessary, and costly access barriers.

Almost 20 years ago, the Texas Legislature agreed that patients could only directly access physical therapy for an evaluation or for treatment of a previous injury under a prior referral for a limited period of time. The access restrictions put in place in 1991 were not based on data or evidence of the need for prior referral. Restrictions are still in effect today and there is still no proof or documentation that such measures are doing anything more than increasing the costs to patients. 

It is time to allow consumers direct access to physical therapists so that consumers can benefit from the real cost savings associated with conservative management of movement and function-related conditions.

How to address the problem?

The Texas Physical Therapy Association stands firmly in support of access without ANY arbitrary barriers.  The TPTA is working with legislators to allow consumers Direct Access to physical therapists.

  • Consumers are primarily affected — they will have fewer barriers to working with physical therapists. They will not have to pay for “rubber stamp” referrals and they can choose a conservative approach to conditions affecting movement and function.
  • Physical Therapists will be able to serve the consumers who seek them out for the prevention and treatment of conditions affecting movement and function.
  • Payers can expect lower costs that may cause them to follow the lead of some payers who do not require physician referral under their payment policies.

Reports, Statistics and Analysis:

  • An analysis of Blue Cross-Blue Shield claims showed that the total paid claims for physician referral episodes to physical therapy was 123% higher than the paid claims for direct access episodes. In addition, physician referral episodes were 65% longer and resulted in 60% more office visits than direct access episodes. (Mitchell J, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997; 77:10-18.)
  • According to the Texas Medical Association, Texas ranks 43rd in shortage of primary care physicians.  Any limitation to timely access affects a consumers access to needed physical therapy services.
  • Wall Street Journal article - Virginia Mason, along with Aetna, streamlined its approach to back-pain treatment. Patients got in faster and employers, insurers and patients saved money.
  • A video produced by an ABC affiliate in Pennsylvania shows how Consumer Direct Access functions.
  • Dallas Morning News article on Starbucks / Aetna study showing baristas with back pain back to work in two days with direct physical therapy, as opposed to two weeks with physician referral.
  • Texas Tribune article with Texas Medical Association commenting that the new health law very well may force more physicians to consider restricted practice models. This will only add to the already severe shortage of access to primary care physicians.
  • The average patient in Dallas and Houston waits roughly 20 days to see a primary care physician, according to a 2009 survey by the consulting firm Merritt Hawkins and Associates.
  • The National Black Caucus of State Legislators supports the adoption of legislation that permits access to physical therapists without a physician referral.
  • American Legislative Exchange Council adopts resolution on patient access to Physical Therapists' services without current professional practice restrictions regarding referral.
  •  Georgetown University and Johns Hopkins University study showing costs for physician referral to physical therapy is 2.2 time higher, 65% longer in duration and generate 60% more medical office visits than patients with direct access to physical therapists.
  • Physical therapists are educated, at a minimum, at the masters’ degree level.  Many now hold doctorates. By the end of 2009, all eleven accredited PT Programs in Texas will have a Doctorate of Physical Therapy (DPT) program, phasing out the Master's programs.
  • CNA Insurance Companies, a leading liability insurer of physical therapists, says "At this time, direct access is not a risk factor that we specifically screen for in our program because it has not negatively impacted our claims experience in any way. In addition, we do not have a premium differential for physical therapist in direct access states, nor do our competitors – a strong testament to the fact that direct access to physical therapy services has not increased the risk exposure presented by physical therapists."
  • United States Military – There is no evidence showing that physical therapists pose an excessive risk of misinterpreting patient signs and symptoms.  The military has long utilized physical therapists without referral and has done so safely and effectively since the early 1970s.
  • 16 states currently have a similar form of patient access with no increase in liability claims or in disciplinary actions.
  • Starbucks and Aetna partnered with Virginia Mason to find a new way to deal with back pain, the leading complaint of Starbucks’ baristas.  Most who went directly to a physical therapist returned to work within two days, as opposed to those who went thru the physician referral process which took, on average, two weeks.  The story was featured in the Dallas Morning News.
  • A video produced by an ABC affiliate in Pennsylvania shows how Consumer Direct Access functions: http://www.thepittsburghchannel.com/video/18891587/index.html

Direct Access saves consumers time and money, an average of 23%, on physical therapy services with direct access. It is time to give Texas consumers Direct Access to physical therapy.  Call, write or visit your legislator TODAY.

Visit our "How Can You Help" page for more resources and ideas.

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