Direct Access

New York State law, Chapter 298 of the Laws of 2006, permits physical therapists (with a minimum of three years of clinical experience) to treat patients without a physician referral as of November 23, 2006. This patient right has been termed Direct Access. Direct access to physical therapy is your opportunity to be evaluated and treated by the licensed physical therapist of your choice without needing to see your physician first in order to obtain a prescription.

The American Physical Therapy Association (APTA) discusses Direct Access as follows:

  • Today’s environment of health consciousness, pursuit of physical fitness, and the promotion of a concept of wellness is tempered by the need to control the escalating costs of health care. One goal of the state legislatures in the 1990s has been the reform of the burgeoning health care system. Two areas of intense legislative focus have been how to increase access while still achieving cost containment. One of the most effective tools for cost control and increased access is easily attainable yet often overlooked and underutilized by the legislatures – that of direct access to the services provided by health care professionals.
  • Physical therapy is the case in point. Entry into the profession and practice of the profession are stringently regulated by all states. As highly trained health care professionals, physical therapists have a proven track record of effectively treating millions of patients. Physical therapists are well-qualified, both through formal education and clinical training, to evaluate a patient’s condition, assess his or her physical therapy needs and, if appropriate, safely and effectively treat the patient. Physical therapists are also 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. APTA’s Guide of Professional Conduct advocates that physical therapists should assist patients in receiving appropriate medical care when the physical therapist’s examination and evaluation reveals signs and symptoms inconsistent with a condition that can be appropriately treated with physical therapy or needs a physician’s care and expertise.
  • The professional training and expertise, which characterize physical therapists, has been recognized by 42 states. These states have removed the out-dated provisions requiring a referral by a physician, from their statutes. Further, these states and the insurance companies that reimburse under direct access will realize cost savings of approximately $1,200 per patient episode of care according to the results of a recent study by Dr. Jean Mitchell and Dr. Greg deLissovoy of Georgetown University and Johns Hopkins University, respectively.

Requiring a physician referral to initiate physical therapy can result in delays in the provision of physical therapists’ services to individuals who would benefit from treatment by a physical therapist. Delays in care result in higher cost, decreased functional outcomes, and frustration to patients seeking physical therapy treatment. Commonly, patients will delay and often avoid visiting their physician altogether. By eliminating the referral mandate, physical therapy services can be initiated in a timely manner.

Notice of Advice:
At the beginning of direct access treatment, the physical therapist is obligated by law to advise the patient in writing of the possibility that the treatment may not be covered by the patient’s health care plan or insurer without a referral from a physician, dentist, podiatrist, or nurse practitioner, and that the treatment may be a covered expense if rendered with a referral.

However, in recent months an increasing number of insurance plans, namely Blue Cross/Blue Shield, have allowed clients to use direct access with appropriate reimbursement for physical therapy services. You should contact your insurance carrier to find out if your policy allows for direct access to physical therapy services.

Given today’s health care environment and the need to control health care expenditures, direct access to physical therapy services is an excellent option. Physical therapists are highly trained health care professionals who can help many people with many different conditions. Legally permitting individuals direct access to a licensed physical therapist was the first necessary step. Now, as more insurance companies properly reimburse for physical therapy services through direct access, you have the opportunity to save time and money, thereby expediting your treatment, relief, and getting you on the road to recovery.