Direct Access

What is Direct Access?

When you are in pain and need help, the last thing you want is to have care delayed.  Direct Access laws allows patients to be seen and treated by a physical therapist without a physician’s referral. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients seeking physical therapy treatment. Eliminating arbitrary barriers results in timely, more effective care.

Every state in the U.S. allows for some type of direct access but many have restrictions or rules to follow.  In the state of Utah, the direct access law allows physical therapists unrestricted access to evaluate and treat patients without the need to have a physician referral.  However, some insurance plans do require a referral before paying their portion of Physical Therapy claims.

Are physical therapists qualified to deliver services independent of referral?

Absolutely. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities. All accredited entry-level physical therapist education programs currently culminate in a Doctor of Physical Therapy (DPT) degree. Physical therapists are qualified to recognize when a patient presents with signs and symptoms inconsistent or outside the scope and expertise of the physical therapist and when the patient should be referred to a physician.

Is there a concern that if a physical therapist initiates treatment without a referral that they will miss a patient’s underlying medical conditions?

The risk of any health care provider missing underlying conditions is always present. However, Physical therapists have long received training in recognition of patient examination findings that are unusual for conditions appropriate for physical therapy management.  Most importantly, physical therapists consider their role in protecting the public’s health, safety, and welfare as extremely important.

Is there research that supports the use of the Direct Access model to initiate Physical Therapy?

Yes. A recent study in 2011 highlighted many of the benefits to patients who received physical therapy treatments through direct access compared to those who were referred by a physician first.  In this study which looked at almost 63,000 cases, researchers found that self-referred patients had fewer PT visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year. It was also concluded that health care use did not increase in the self-referred group, nor was continuity of care hindered.

(Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research. Published ahead of print September 23, 2011. DOI: 10.1111/j.1475-6773.2011.01324.x)

In Summary

if their injury is not treatable via PT or their injury requires possible diagnostic imaging, then our PT’s have relationships with the best surrounding medical practitioners and can give the patient advice about the best place to seek further medical attention.

Direct Access allows patients to receive the physical therapy care that they need with less overall cost but without sacrificing outcomes.  Direct Access does not mean the end of collaboration with physicians but helping patients quickly receive the care that they need in the most cost-effective way.   For further information on Direct Access, please click here.