|
Physical Therapy
Direct Access
- Physician referrals to physical therapy were designed to screen
patients for more severe medical problems. However, many states allow
direct access to physical therapists for evaluation and treatment for
less severe problems and rehabilitation services.
- Physical Therapy practitioners are competent medical screeners as a
result of their training of the body systems and musculoskeletal
responses to testing. A medical doctor diagnoses patho-anatomically
(at a tissue or microscopic level), while a physical therapist diagnoses
a movement pattern dysfunction (the possible root cause of the chief
problem). Those things that do not fit a musculoskeletal movement
pattern dysfunction warrant a closer look by a medical doctor.
- The doctor/therapist relationship should be enhanced with direct
access as both can work together to help efficiently restore a patient's
function. A simple example is the prescription of
anti-inflammatory medication or an injection to a patient with shoulder
pain while the therapist works with the joint stiffness and weakness
that predisposed the person to the original injury.
- 43 (now 44) states and the insurance companies that reimburse under direct
access to a physical therapist realize a cost savings of approximately
$1,200 per patient episode of care.
- The total paid claims for “physician referrals” to physical
therapists was 123% or 2.2 times higher than the paid claims for “direct
access” to physical therapists.
- Total paid claims averaged $2,236 for "physician referral" episodes
as compared to $1,004 for “direct access” episodes.
- Physician referrals for
physical therapy generated 60% more medical office visits than patients
with direct access to physical therapists.
Physical Therapy is Cost Effective in "Direct Access" Setting
In a study (by Jean Mitchell PhD) conducted to determine whether direct
access to physical therapy services provided by a licensed physical therapist is
cost effective, it was found that:
- The total paid claims for physician referral episodes to physical
therapists was 123% or 2.2 times higher than the paid claims for Direct Access
episodes. The total paid claims averaged $2,236 for "physician referral"
episodes as compared to $1,004 for Direct Access episodes. When expressed in
terms of actual reimbursements, the difference in total paid claims per
episode was $1,232.
- Physician referral episodes were 65% longer in duration than Direct Access
episodes.
- Physician referral episodes generated 67% more physical therapy claims and
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.
|
