Professional Documents
Culture Documents
Physical Therapy
What is Direct Access?
• Definition
o The legal right to seek and receive the examination, evaluation,
and intervention of the physical therapist without the requirement
of a physician referral.
http://holidays.uslegal.com/state-holidays/ohio-legal-holidays/
What Information Needs to be Given
to the Physician?
o Chiropractic organizations
direct access puts patients at risk
PT education is inadequate in relation to diagnosis
and pathology
APTA’s Response to Opposition
• Physical Therapists are adequately trained and
are qualified to recognize when a patient needs
referral
• APTA’s Guide of Professional Conduct
advocates that Physical Therapists should even
assist patients in finding appropriate medical care
• Physical Therapists have a low incidence of
malpractice and complaints filed against them
APTA’s Response to Opposition
• Health Providers Service Organization (HPSO),
the leading liability carrier, does not consider a
PT a higher risk because they practice without
referral
• There has been no increase in claims against
physical therapists in states with direct access
• No states prohibit a physical therapist from
performing a diagnosis
o A PT diagnosis is essential an order to guide the PT
in selecting the appropriate interventions
Pros and Cons to Direct Access
Pros Cons
• Results in timely and more • Increased liability and
effective manner responsibility
• Referrals cause delays in PT • Risk of PTs missing underlying
services which can increase health conditions
cost of healthcare
o Increase cost of healthcare
o Decrease functional outcomes
o Increase patient frustration
• Increased autonomy
• Increased accessibility and
individual choice for patients
Dutch Direct Access Study
• The Netherlands got direct access in 2006
• Senate
o Read twice and referred to the Committee on Finance
on 4/30/09
Ohio’s Support for the Bill
• The House of Representatives has 2 co-
sponsors in the state of Ohio
o Congressman Steven LaTourette (OH-14)
Geauga, Lake, and Ashtabula counties
o Congressman Michael Turner (OH-3)
Montgomery, Clinton, Highland, and northern Warren
counties
• If member of APTA,
o http://www.apta.org/AM/Template.cfm?
Section=Government_Affairs&Template=/aptaapps/GovtAffairs/lac.cfm
Cost-Effectiveness of
Direct Access
• The total paid claims per episode of PT:
o Physician referrals = $2,236 on average
o Direct access = $1,004 on average
Physician referral episodes were 123% or 2.2
times higher than direct access episodes
• Physician referral episodes were 65%
longer in duration than direct access
episodes
Implementation of Direct Access
into Southwest General
and LifeWorks
• The following are the
steps taken by the
University of
Wisconsin Hospital
and Clinics Authority
o Wisconsin is a
provisional direct
access state like Ohio
Implementation of Direct Access
into Southwest General
and LifeWorks
• Initial Step: Staff Consensus
o Does everyone truly want to work with direct access
within the clinic?
• Program Emphasis:
o Clinical “Red Flag” Recognition
o Plain Film Indication Guidelines
Direct Access Training Program
Includes:
• Required Readings, Lectures, and
Discussion Sessions
• Patient Case Series Take-Home
Assignment
o Discussed cases with physician
o Questions for take-home assignment on next
slide
Take-Home Assignment Questions
When Training Program
Completed …
Passed Failed
• Able to practice • Not able to practice
through direct access through direct access
• Assigned a provider • Able to take the
number by the House training program again
and Medical Staff
Affairs Office so that
therapists could
directly refer patient to
radiology
Pilot Program: How Did it Start?
• Direct Access patient care slots placed in
therapists’ schedules
o If not filled within 24-48 hours, other patients were
scheduled
• Education and Marketing
o Presentations were made to individuals who were
fielding patient calls
Receptionists
Nurses / Nurse Practitioners
Physician Assistants
o Placing flyers in physician offices and public locations
within the area of service
Evaluation of Pilot Program