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Grace Garza

Professor Moore

ENG 1301

28 March 2018

Direct Access

Direct access is where an individual can be evaluated and treated by a physical therapist

without a physician mandating an in-office visit or a needed referral (Direct Access at the State

level ). A physical therapist is a board certified trained specialist who majors in bodily movement

and rehabilitation. The goal of physical therapy is to promote patient’s ability to move, restore

function, reduce pain and prevent possible disability. As of January 1, 2015, all of 50 states, the

District of Columbia, and the US Virgin Islands allow patients to seek out assortment of

treatment levels to be seen and examined by a physical therapist. Direct access is allowing the

patient to skip the intermediate process of being evaluated by a physician in ordered to be given

a referral for a physical therapist (Leemrijse, Swinkels and Veenhof). Direct access in physical

therapy is a controversial topic because patients often have to have a doctor’s recommendation in

order to receive treatment.

Statistically lower costs are required by the patient who is able to seek a physical therapy

treatment without a physician referral. In comparison, direct access sessions encompassed fewer

numbers of services, substantially leading to less cost. Patients who are self-referred would have

fewer PT visits and lower allowable amounts. These statistics clearly show that being self-

referred to physical therapist is considerably less expensive to an individual, compared to

someone who needs permission from their doctor. In addition, insurance companies incur less

charges when direct access is available to the patients because the middle man/physician is not
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being paid. In addition, further expenses are reduced by having less medical interventions such

as imaging, prescriptions and various injections administered. Under the circumstances allowing

direct access to a physical therapist has improved patient responsiveness. Patients response rate

has been shown to increase at an improvement rate of seventy-two percent.

Furthermore self-referred patients have acknowledged a more pleasurable experience by being

given a choice in their treatment, as well as having a stable support system thus developing more

self-confidence compared to being restricted by a doctor’s recommendations and treatment plan.

On average self-referred patients referred themselves only six physical therapy sessions

compared with a physician referral of eight sessions(Leemrijse, Swinkels and Veenhof). A major

motivation towards gaining mobility and improvement is having the autonomy in constructing

your personal treatment plan. Similar to having a “fast pass” at a carnival, skipping the line and

going all the way to the front. Patients being able to take advantage of direct access grants

themselves, self-improvements with personal preference of healing process and flexibility to

patient’s schedule.

Customer service is the key to success, along with properly marketing to your clients as

well to your business. Discussing with your patients about the new treatment option of coming

without a doctor’s referral and just going directly to the physical therapist allows an the PT to

extend an open invitation to friends and family to come. Also having additional promoting

information about “Direct Access” in exam rooms, waiting rooms and even at the check in desk

which they would be noticed at point of entry and exit. Building a client status list is

perspicacious. “One of the goals of APTA's "Move Forward" branding initiative is to promote
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the profession of physical therapy to the outside community with important messages regarding

the role of the physical therapist in improving movement.”- (Direct Access in Practice ).

Improper patient diagnosis from missing data, incomplete records, and incomplete exams

could lead to extreme disarray, increasing a liability risk that can be perused by neglecting to

provide the patient from overviewing all possible treatment options. Following the chance to

further injury, delivering unwanted pain and suffering (Sahrmann). Lacking the special

equipment such as an X-Ray machines, that takes digital images of bones and selective dense

internal masses and infections, following with a CT/CAT Scan that also takes digital images of

bone, soft tissues, blood vessels and internal growths. Understanding symptoms that a patient is

describing could be the first indication that a patient is in need of further evaluation. Such as

introducing a stress test to assimilate the discomfort level, then transferring to an alternative as in

digital imaging (X-Ray and CT/CAT Scan) enhancing furthering additional needed information.

With possibility of severity of needing a physician’s assistance to proceed further care. Physical

therapist offices aren’t equipped with specialty equipment that a referring physician’s office

normally would have provided.

Physical therapist has unique medical services that are valuable treatment options to

patients, but not all insurance companies will cover the payments. The known insurances

companies that will comply with coverage of the physical therapy visits are Medicare and many

HMO’s. However, other companies will allow “out of network” services, meaning they are not

in an alliance with the current provider leaving the individual to pay the difference. Services that

an insurance company won’t cover are fitness and wellness training programs, sports

performance enhancements and with some health educational classes (Understanding Payment
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for Physical Therapy services ). To many of individuals these classes have significant value, and

will permit the needed payment.

With direct access, patients who wish to go straight to a physical therapist are not

obligated to have a referral from a physician, therefore damaging relationships with referral

sources. Many professionals (attorneys, physicians, dentist and others) rely on referrals to not

only to build up client intake but to also build a sustainable reputation. “Direct access laws

eliminate the legal requirement for a written referral”- (Direct Access: How it can change your

Practice ). The difference is now that physical therapist doesn’t need a referral for their patients.

But giving time to develop a “personal circle” with other professionals who also are under the

same circumstance that can act as both, the recipient and the referral. Direct access damages

professional references by excluding the mandating referral, thus belittling other professional

resources.

The infamous saying, “no pain, no gain” is applicable to the controversial notion that a

doctor’s referral is not necessary for an individual to receive physical therapy. For instance, an

individual must endure the pain of attending physical therapy treatments to improve their health.

However, an individual does not need to suffer the burden of paying extra money for a doctor’s

referral in order to pursue physical therapy. In the end, for the patient to gain mobility and

strength, the pain should reside in the recovery process rather than his/her bank account.
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Works Cited
Direct Access at the State level . n.d.

Direct Access in Practice . n.d. 20 12 2017.

Direct Access: How it can change your Practice . n.d.

Leemrijse, Chantal J, Ilse Swinkels and Cindy Veenhof. Direct access to physical therapy in the

netherlands: Results from the first yeat in community - based physical therapy. 8 August

2008 .

Ojha, Heidi A., Rachel s. Snyder and Todd E. Davenport. Direct Access compared with referral

Physical Therapy Episodes of care: a Systematic Review. 1 January 2014.

Sahrmann, Shirley A. Diagnosis by the Physical Therapist- A Prerequsite for Treatment: A Special

coomunication . 1 November 19988.

Understanding Payment for Physical Therapy services . n.d.