by Rebecca Lingrfelt, DPT
The role of the physical therapist in delivering health care to you is changing! Now most patients, depending on your insurance company, can come directly to the physical therapist (PT) after an injury without a doctor’s visit beforehand. This means you get to the people who are going to help you most more quickly, and we call this direct access. A good article was published recently examining the effects of direct access to the PT, and the abstract can be viewed at http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01324.x/abstract. The study reviewed over 62,000 claims comparing patients in an outpatient setting ages 18-64 who were “self-referred” (came directly to a physical therapist) and “physician-referred” (got a prescription and was sent by a physician to do PT).
The major findings of the study were that self-referred patients ended up having fewer visits and lower costs of care among all ages, genders, injuries, and severity. Self-referred patients used 86% the number of visits that physician-referred patients used and cost 87% of the physician-referred group. Additionally, the self-referred group had lower overall healthcare use outside of physical therapy, including physician visits, diagnostic testing, or surgery. This means that the insurance is paying less overall, which will eventually cost the patient less in insurance premiums if the general trend is allowed to continue. More importantly, the physical therapist does not replace the physician’s role in the healthcare realm but only provides a different point of contact to begin the healthcare process. The study reported most of the self-referred group still were in contact with a physician during and after PT even though they did not initially consult a physician. Previously, there was concern that the physical therapist was not qualified to adequately diagnose a person’s injury, would not know how to refer to the appropriate source, or overuse resources without a physician referral. The study concluded “concerns about patient safety, missed diagnoses, and continuity of care for individuals who self-refer may be overrated.”
This is very significant for the profession of physical therapy. It now becomes more of the patient’s decision to go to a physical therapist rather than waiting to be sent by a physician. Insurance companies have already begun to encourage trying physical therapy prior to other healthcare due to the low cost and the effectiveness of PT alone now. Thomas DiAngelis, the president of the American Physical Therapy Association’s Private Practice Section, stated regarding the article, “When patients choose direct access to a physical therapist, it does not mean the end of collaboration with their physician, nor does it diminish continuity of care. We believe the results of this study will support our efforts to work with legislators and physician groups to establish policies that reduce unnecessary regulations, improve access, and build models of delivery that best serve the patient and the health care system. Although this study focused on direct access, it is not about the provider. It is about the patient. It means better opportunities to provide the proper care to those who need it, when they need it.”
Dr. Lingerfelt is a Physical Therapist at Boston Sports Medicine