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Easing Restrictions on Seeing Physical Therapists


New Louisiana bill would offer direct access to physical therapy--more in line with other states’ policies

By Debra Wood, RN, contributor

Louisiana inched closer to joining the majority of states allowing patients direct access to physical therapists when the state Senate passed a bill granting patients access to physical therapy without a prescription or referral from a physician.

“With more than 50 years of experience in the states, direct access has been proven to be safe, cost effective, and it improves outcomes,” said Justin Elliott, vice president of government affairs for the American Physical Therapy Association (APTA). “Physical therapists are educated and trained to practice via direct access. The data, research and facts show direct access makes sense, particularly in today’s changing health care environment.”

Patients in Louisiana may soon have access to physical therapists without a prescription or referral from a physician

The Louisiana Senate passed SB 291 on April 5, 2016, by a margin of 31 to 7. The bill states that the physical therapist shall provide notice to the health care provider of the patient’s choice within 15 days of starting treatment, and if after 30 business days the patient has not made measurable or functional improvement, the PT must refer the patient to an appropriate health care provider. The bill has now gone to the Louisiana House of Representatives for consideration.

The Louisiana Orthopedic Association has voiced opposition to the bill, Elliott said. He called it “regrettable and unfortunate that the association has chosen to deliberately spread misinformation and falsehoods regarding the ability of physical therapists to practice under direct access as well as to make insinuations about the safety of direct access.”

A national perspective

All 50 states and the District of Columbia allow some sort of direct access to physical therapy. Nebraska was the first state to offer it, in 1958.

Eighteen states provide unrestricted direct access, 25 states and the District have typically a visit limit or time limit, such as for 30, 60 or 90 days. And seven states have limited policies. Louisiana has had one of the most restrictive PT direct access laws in the country. It limits direct access to treating a patient who has been diagnosed with a condition in which PT services are appropriate and informing the provider who made the diagnosis, as part of a home health or nursing home plan of care, or for wellness services.

Benefits of direct access to physical therapy

Direct access saves patients time and money, because they do not have to visit a physician prior to receiving physical therapy services. That also frees up the physician’s time to see more serious patients needing medical care.

Whether a direct access or referred patient, the physical therapist will complete an assessment, determine a diagnosis and develop a plan of care and goals. The PT evaluates at each visit how well the patient is meeting those goals, and must provide accurate documentation in both scenarios. Physical therapists know to refer the patient to a physician if the problem appears out of the PT scope of practice or the patient is not meeting the anticipated goals.

Research, including a 2015 study from Seton Hall in New Jersey and a 2014 study from Temple University in Philadelphia, has shown physical therapists can safely evaluate, treat and manage direct access patients.

Reimbursement issues

Medicare allows for reimbursement for physical therapy through direct access for evaluation and treatment, but by the end of 30 days, the physical therapist has to provide the plan of care to the patient’s physician, who must sign it. Additionally, direct access has to be allowed by state law for Medicare reimbursement.

Many commercial payers are starting to do so as well, according to APTA. For instance, United Health in California will pay for direct access for PT services.

Direct access also provides the opportunity for the PT to provide services on a pro bono basis, such as in a free clinic, or caring for patients who opt to self-pay.

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