What is Direct Access?
Direct Access allows an individual to bypass the usual physician visit-referral process, and proceed straight to the evaluation and treatment of an injury by a physical therapist. [http://www.apta.org/StateIssues/DirectAccess/FAQs/]
Sounds well and good, a definite advancement in care; a streamlining of the recovery process. But there is a backlash; physicians often want you to visit them first, and arguably with good reason. Some injuries are, after all, more severe than others; a broken leg, for instance, requires more than just physical therapy. Some argue the Physical Therapist is unqualified to fully diagnose a patient, especially if the patient is not coming with X-rays or CAT scans in-hand. Historically, physicians have been the diagnosticians, their role has been to prescribe testing, medication and treatment; physical therapy often chief among them.
Direct Access is a State regulated healthcare issue, and though most States do allow for some form of Direct Access, it’s often bundled with provisions that require you to be under the care of a physician in order to receive coverage. Coverage extends to Medicare and Medicaid, and some private insurers, but it’s not universally true. As of 2005, the Medicare Benefit Policy Manual cited that Medicare beneficiaries may receive physical therapy without a referral. Yet despite this change on the Federal level, many States are still fighting for the right to forgo the physician referral. [https://www.webpt.com/blog/post/medicare-and-direct-access]
In Texas, for example, 15,000 physical therapists have been lobbying lawmakers for direct access to patients in a contentious legal battle with the established medical community. This has resulted in the formation of Texas House Bill 1263, which seeks to grant Texas citizens direct provisional access to Physical Therapy. It will be debated and voted on in the 2015-2016 legislative session. In the meantime, Texas remains one of a handful of States that prohibit Direct Access.
But not everyone agrees that Direct Access is beneficial, particularly members of the entrenched medical community. Dr. Marc DeHart of Texas Orthopedics believes that requiring a referral better protects patients. “There is the possibility the therapist, with only three years training after college, have the knowledge to make an adequate diagnosis on every occasion,” argues Dr. DeHart to KXAN News. “The problem of direct access is that they could miss things.”
Physical Therapists in many other states including New York, tend to think that restricting Direct Access belittles the role that Physical Therapists play in diagnosis and recovery. The individual has every right to see a doctor prior to receiving physical therapy if they feel an injury is severe enough. As a means to streamline the recovery process, Direct Access helps those without insurance save money while receiving proper care.
Beyond the qualities of its namesake, Direct Access has enabled Physical Therapists to change how we think about Physical Therapy, not only as a treatment that a physician prescribes, but as a sustainable, preventative, and accessible form of care that those in need can seek and obtain on their own.