Direct Access Physical Therapy Improves Care and Cuts Costs

Freedom to Choose

Fourth of July has to be one of my favorite times of the year. Between the great cook-out food, red, white, and blue desserts, American flags and streamers everywhere, and spectacular firework displays enjoyed by kids of all ages, there is really nothing not to love about a special day set aside to celebrate our freedom.

So it was only natural as I thought about what would be appropriate to write about in our opening letter this month, that choice in physical therapy care and our freedom of direct access to such care was the first thing that came to mind. Historically, HMO’s at one time would dictate a small pool of medical providers you could choose from for your healthcare, be it physical therapy or anything else, and your primary physician was the “gatekeeper” to physical therapy. Fast forward 20 years, and we are now on the verge of the most open insurance panels ever, with a near majority of insurance companies granting direct access and nearly complete choice among all local physical therapy providers. This is great news for patients, because this will decrease the time to begin actual care for patients who already know that physical therapy is the best treatment for their medical problem, and decrease overall costs by avoiding unnecessary tests, medications, and appointments with other providers.

This new trend in care is supported by early research focused on the costs and quality of care provided via direct access to physical therapy. One such study published in the journal Health Services Research in 2011, found that the 27% of patients who had claims for physical therapy through a Midwestern insurance company who accessed a physical therapist directly for outpatient rehabilitation had fewer visits and lower overall costs compared to patients who were referred by a physician. Better yet, the patients who utilized direct access demonstrated no difference in health care visits in the 60 days after the bout of physical therapy, indicating no loss of continuity or quality of care.

For anyone in healthcare or for patients who might be concerned that a physical therapist might miss something that a physician would catch in that first visit, this too is being actively researched. A study published in 2005 in the Journal of Orthopedic & Sports Physical Therapy studied patients in the military, of which 45% accessed physical therapy directly. In the over 40 months of data analyzed, there were no reported adverse effects of physical therapy management and treatment over this time period, whether the patient had seen a physician first, or if they had seen the physical therapist directly. While physicians are highly trained in the use of imaging and medications to address orthopedic injuries, physical therapists are very experienced in fully evaluating patients prior to any treatment being performed to ensure that the patient does not have anything beyond the scope of physical therapy that would need to be referred elsewhere. With a high level of suspicion for any red flags in particular when the patient has not previously seen another medical providers, physical therapists can very safely and effectively treat patients via direct access in a timely fashion.

As we celebrate Independence Day this month and reflect on all of the freedoms we enjoy, let’s take some time to be thankful for all the things that make our everyday lives easier. In this recent era of government scandal and mistrust, some changes being made in Washington and corporate America actually make sense and will aide in reducing costs AND improving our quality of life. Just another reason to raise our flag high and display our pride as innovative Americans on July 4th and every day of the year!

Sparklingly yours,

Jill Murphy
Owner/Physical Therapist
MotionWorks Physical Therapy