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Direct Access: The Truth About Seeing a PT First

Maybe you’ve tweaked your back from a make-shift workspacethinking this set-up will only be temporary – but it has been weeks. Maybe you’ve pushed yourself a little too hard preparing for what was supposed to be your first half-marathon and that ache in your knee won’t go away, even after a couple days off. Maybe you simply took a funny step off the curb on your nightly walk and are feeling a little twinge in your ankle. 

Sometimes, when you’re suffering from an ache, pain, or injury, you have a pretty good idea what you’re dealing with and might be able to pinpoint the cause of it. That’s not always the case, but when it is, wouldn’t you rather get right to your physical therapist to begin treatment? 

One thing we can leave in the pre-COVID past is the many hoops that you needed to jump through before getting started. The first stop was your primary care physician, who often refers you to an orthopedic specialist, who would then write you a prescription for physical therapy. That process alone took several weeks and a few insurance co-pays. The way we access healthcare and doctors has changed, and we are facing a new reality—for the better! 

COVID-19 has changed the way we live. The way we go to the store or see our doctor has been streamlined by cutting out a few steps and most importantly, saving a few dollars! Heading directly to your physical therapist is the new normal and it’s called direct access 

WHAT EXACTLY IS DIRECT ACCESS? 

No smoke and mirrors here – it’s just what it sounds like! Direct access is the ability to directly access your physical therapist without a physician referral or prescription. 

HOW DOES IT WORK? 

Direct access is regulated at the state level. Some form of direct access exists in every state, though the specific laws vary. Some states have no rules, while others have limits on the number of visits or the time period for which patients can seek physical therapy before a doctor’s prescription becomes necessary. At the very least, though, every state allows a patient to receive an evaluation without a referral. If you’re interested in learning more about Direct Access Laws, we recommend visiting the American Physical Therapy Association’s site.  

SO SHOULD I TAKE ADVANTAGE OF IT, OR SHOULD I SEE MY PHYSICIAN FIRST? 

Your physical therapist’s goal is to ensure that each patient receives the highest quality of care available, that they’re able to access that care quickly, and that it’s the right care for them. Our patients are seen within one to two days of calling or requesting an appointment online, an upgrade from the average 24 days to see your primary care physician or orthopedic surgeon. And of course, if your condition is beyond what we can treat, we’ll immediately refer you to the appropriate physician or specialist. 

WHY DOES DIRECT ACCESS REALLY MATTER TO ME? 

Let us give you four good reasons. 

1. Early access saves money! Over 50% in back pain costs alone. It also often prevents the need for further healthcare. Over 13 million Americans see their doctor each year for relief from chronic low back pain. The right physical therapy within 14 days of the onset of pain minimizes the average total cost of care by 50%. That’s a lot of money each year! 

  • Low back pain patients who receive physical therapy immediately after the pain begins and adhere to their treatment plan spend $3,000 a year in associated healthcare costs. Those who delay receiving physical therapy and do not adhere to their treatment plan spend $6,000 per year for all kinds of healthcare. 
  • At your first appointment with a physical therapist, you’ll receive a personalized treatment plan based on your evaluation and will begin implementing the plan that day. The primary care physician to orthopedic specialist to physical therapist pathway is likely to put you well over the 40-day mark before you’re even in the door to see a PT. 

2. PT Over Pills. Physical therapy is a CDC-recommended alternative treatment plan to addictive opioids and can prevent the need for surgery, costly imaging, and injections. 

During COVID-19, most chronic pain interventions fall under the elective category, meaning that some patients have had to postpone treatment.  The Centers for Disease Control and Prevention (CDC) released guidelines in March 2016 urging prescribers to reduce the use of opioids in favor of safer alternatives in the treatment of chronic pain. Physical therapy is one of the recommended nonopioid alternatives and here’s why: 

  • Physical therapists treat pain. Opioids mask it. 
  • “Side effects” of physical therapy include improved mobility, increased independence, decreased pain, and prevention of other health problems through movement and exercise. Opioid side effects include depression, overdose, addiction, and withdrawal symptoms. 
  • Physical therapy is effective for numerous conditions, and the CDC cited “high-quality evidence” supporting exercise as part of physical therapist treatment for familiar conditions like low back pain, hip and knee osteoarthritis, and fibromyalgia. Opioid effectiveness for long-term pain management is inconclusive in many cases. 

Additionally, physical therapy has been found to be as effective as surgery for conditions including, meniscal tears and knee osteoarthritis, and lumbar spinal stenosis. Plus, you don’t have to worry about side effects, risk of infection, etc. that are associated with surgery. 

Lastly, a 2015 Health Services Research study found that the average cost of care was shown to be $4,793 more if a patient had an MRI first vs. seeing a physical therapist first. The study also shows the increased use of other services like additional diagnostic imaging and medication when the MRI is done prior to physical therapy. 

3. Your physical therapist and your orthopaedic surgeon have equivalent diagnostic accuracy. 

Clinical diagnostic accuracy by physical therapists and orthopaedic surgeons on patients with musculoskeletal injuries are statistically the same. Both provider types had significantly greater accuracy than that of nonorthopaedic providers. (As in, double the accuracy!) 


4. Seeing your PT first/Direct access can lead to higher satisfaction and better outcomes for patients.

It’s typically thought that patients are more likely to stick with a plan when it’s physician recommended because they trust their doctor’s expertise.  However, research shows that’s not the case. A 2014 study suggests that patients who received physical therapy through direct accessi.e. directly from their PT (vs. physician referral) had a higher level of satisfaction and better outcomes at discharge. This study also highlighted decreased costs in the direct access group vs. the referral group, which can likely be attributed to decreased imaging, fewer visits, and less prescription medication. Sensing a theme yet? 

LET’S RECAP. 

Whew. Am I right?!  Let’s wrap it up with a little recap of the biggest benefits of direct access, or your right to directly access physical therapy services without a physician referral or prescription. 

  1. Quicker access to the care you need. Our patients are seen within two to three days of scheduling an appointment, while it takes an average of 24 days to see your primary care physician or orthopedic surgeon. 
  2. Less associated costs and reduced need for additional healthcare services. The right physical therapy within 14 days of the onset of low back pain minimizes the average total episodic cost of care by 50%. These costs are saved by avoiding surgery, imaging, and prescription medication. 
  3. Better outcomes and higher satisfaction. Patients who received physical therapy through direct access (vs. physician referral) had a higher level of satisfaction with their care and better outcomes at discharge. 

At the end of the day, we’re by no means recommending you avoid your primary care physician altogether. But, in the instances when you know physical therapy is what you need, isn’t it better to get straight to the source and begin recovery right away? And this way, you’ll be ready to make an informed decision on the best choice for you.

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