Why is Direct Access to Physical Therapy Important

The Time Has Come for Nationwide Access to Physical Therapists Under Medicare

  • Direct access eliminates the burden of unnecessary visits to physicians. The referral requirement can cause delays and denials of services provided by physical therapists. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients. Direct access to physical therapists improves the accessibility to rehabilitation services.
  • Direct access to physical therapists does not promote overutilization or increase the cost of health care. A 1994 study on the cost-effectiveness of direct access to physical therapists found that the costs incurred for physical therapy visits were 123% higher when patients were first seen by a physician than when they went to a physical therapist directly.1 This study also showed that physician referral episodes generated 67% more physical therapy claims and 60% more office visits than did episodes when the patient went directly to the physical therapist without a physician referral.
  • Licensed physical therapists are well qualified to provide services independent of referral from physicians. Physical therapists are educated at the postbaccalaureate level and receive extensive education and clinical training to be able to practice without a referral. Thirty-nine states currently have some form of direct access by a licensed physical therapist. It is time that Medicare beneficiaries have the same access.
  • Liability insurers and the Federation of State Boards of Physical Therapy affirm that direct access does not jeopardize the health, safety, or welfare of the patients/clients seeking physical therapists' services without referral. Health Providers Service Organization, the leading liability insurer of physical therapists in the United States, indicates in a March 22, 2001, letter that "direct access is not a risk factor that we specifically screen for in our program because it has not negatively impacted our claims experience in any way. In addition, we do not have a premium differential for physical therapists in direct access states."2


1. Mitchell JM, 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. 

2. Health Providers Service Organization, in a March 22, 2001, letter to the American Physical Therapy Association, on file. 

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