Direct Access for Physical Therapists

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Direct Access for Physical Therapists

• Why Now?

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What is Direct Access?

• Direct access is the legal right of the public to
  seek and receive an examination, evaluation, and
  interventions by a physical therapist without the
  referral of a physician.
• (APTA Board of Directors, 2000.)

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Reasons for DA

• Current Trend in Healthcare Reform - Increase
  Access/Reduce Costs
• Solution Direct access to services provided by
  healthcare professionals
• Direct Access allows consumers greater choice in
  seeking treatments for impairments, disabilities
  and movement disorders.

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Reasons for DA

• Direct Access to Physical Therapy is all
  about..
• Greater Consumer Access to Healthcare!

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Missouri is one of the Few

• 43 States Have Direct Access by Omission or
  Provision
• Oldest Nebraska 1957, California 1968, Maryland
  1979, Arizona 1983
• 6 States Evaluation Only (Including MO)
• 2 States No DA Alabama and Indiana
• Many states working to eliminate provisions

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APTA Vision Statement

• By 2020, physical therapy will be provided by
  physical therapists who are doctors of physical
  therapy, recognized by consumers and other health
  care professionals as practitioners of choice to
  whom consumers have direct access
• for the diagnosis of, interventions for, and
  prevention of impairments, functional
  limitations, and disabilities related to
  movement, function, and health.

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Doctors of Physical Therapy

• As of January 2002, no programs accredited at
  the Bachelors level.
• 164 accredited DPT degree programs
• 45 accredited MPT degree programs

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(No Transcript)
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Why Direct Access?
Patient
Provider
Payer
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Benefits of Direct Accessfor the Patient

• Choice of provider
• Less visits
• Convenience/flexibility
• Earlier intervention
• Decreased out-of-pocket expense (copays, pharmacy)

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Consumer Access

• Millions spent out-of-pocket for injury and pain
  management in health clubs and spas
• Consumers should have equal access to licensed
  PTs as they do unlicensed and unregulated
  providers.

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Benefits of Direct Accessfor the Physical
Therapist

• Autonomy as a provider
• Increased credibility
• Contract directly as entry-level provider
• Schools, Industry, Fitness, Performing Arts,
  Prevention/Wellness
• Prevention/Wellness vs Treatment
• Earlier intervention ? clinical efficiency

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Benefits of Direct Accessfor the Payer

• Decreased costs when referral not
• required
• Physician Visit Costs
• Possible unnecessary diagnostic or pharmaceutical
  costs
• Decreased number of claims to process
• Increased customer satisfaction

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Benefits of Direct Accessfor the Payer

• Decreased number of claims to process
• Physician visits
• Diagnostics
• Pharmacy
• Appeals

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Benefits of Direct Accessfor the Payer

• Increased customer satisfaction
• Less out-of-pocket expense
• Faster access to help
• Faster return to work

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Potential cost savings Shoulder tendinitis
(Medicare 2003 Fee Schedule)
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Direct Access Does NOT result in higher physical
therapy costs.

• Cost per visit were 123 higher when patients
  were first seen by a physician prior to PT.
• Claims paid under direct access to physical
  therapist were 1,232 less than physician
  referred.

Mitchell, Direct Access Versus Physician Referral
Episodes of Physical Therapy, Phys Ther 77(1),
Jan 97.
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Direct Access Does NOT promote over-utilization

• Physician referral episodes of care generated 67
  more claims and 60 more office visits

Mitchell, Direct Access Versus Physician Referral
Episodes of Physical Therapy, Phys Ther 77(1),
Jan 97.
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Will Direct Access increase liability?

• Since 1994, the APTA endorsed liability carrier
  has not reported an increase or change in claim
  pattern that reflects negatively on Direct
  Access. The underwriter (CNA) agrees.
• Underwriter does not charge a premium in states
  with Direct Access.

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Will Direct Access increase liability?

• Legal liability remains unchanged
• We are not shielded by medical referral

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Expansion of Scope of Practice

• Part of PT practice in US since 1957 (Nebraska)
• PTs in the majority of states already practice in
  a Direct Access environment
• No change in scope of practice

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Can Physical Therapists make a diagnosis?

• Medical diagnosis interruption of normal
  cellular processes
• vs.
• Diagnosis of impairment, functional limitation,
  or disability loss of function, restriction of
  ability to perform task, inability to engage in
  activity

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Can Physical Therapists make a diagnosis?

• CVA vs. Hemiplegia
• Rheumatoid Arthritis vs. Joint inflammation,
  joint deformity, muscle weakness and inability to
  turn keys
• MS vs. Balance deficits, weakness and decreased
  sensation
• Diabetes vs. Abnormality of gait

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Can Physical Therapists make a diagnosis?

• PTs must validate symptoms and physician
  diagnosis which could change since M.D. visit
• PTs must determine if condition is still within
  scope of practice

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Important APTA Contacts

• Justin Elliott, Associate Director,
  Justinelliott_at_apta.org
• Shana Sexton, Assistant Director,
  Shanasexton_at_apta.org
• APTA Website Advocacy- State Government Affairs
  -Top Issues
• http//mptac.missouri.org/newsletters.htm
• PT Magazine Article
• Direct Access Facts and Evidence
• Mitchell Study
• Book Data, Evidence and Research Supporting
  Direct Access (available 2007) from APTA