What is Patient Self Referral (Direct Access)?
Patient Self Referral to Physical Therapy (Direct Access) - current law in Indiana prohibits you from directly accessing your physical therapist for evaluation and treatment. In order to access your Physical Therapist you must first undergo unneccesary and costly office visits. Direct Access legislation in 48 other states allows consumers to go directly to a Physical Therapist for evaluation and/or treatment without a referral from another healthcare provider.
Physical Therapists are safe, accurate, and effective in their evaluation and treatment of musculoskeletal conditions. In addition, Physical Therapists have been working in direct access environments in the United States since Nebraska introduced legislation in 1957. No state has ever repealed any legislation regarding patient access to Physical Therapy services.
Currently in Indiana, 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 Physical Therapists are some of the most educated health care providers of all. All Physical Therapists graduating from Indiana's 3 Physical Therapy schools will graduate with a Doctor of Physical Therapy (DPT) degree and must pass a national licensure exam before practicing.
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.
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 Indiana Physical Therapy Association stands firmly in support of access without ANY arbitrary barriers. The INAPTA 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.)
- Indiana faces a primary care physician shortage which is expected to grow with time. 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.
- 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.
- The average patient wait in metropolitan areas has grown secondary to a physician shortage based on 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 currently educated at the Doctor of Physical Therapy degree level.
- 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 Indiana consumers Direct Access to physical therapy. Call, write or visit your legislator TODAY.
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