Direct Access to Physical Therapy. What Is Direct Access and Why You Should Care.

by Proclinix, February 22, 2018

By: Dr. James H. Cassell IV, PT, DPT

In the past, patients were required to see a physician to receive a prescription for physical therapy prior to attending physical therapy. As of January 2015, all 50 states have adopted “direct access” in various shapes and forms. Direct access allows patients to see a physical therapist without seeing a physician for a prescription beforehand, thus directly accessing physical therapy services.

Direct access is a great achievement by the American Physical Therapy Association (APTA). The APTA argued against the medical boards that having the physician visit was an unnecessary and costly step in the health care process. This visit not only delayed treatment for the patient, but placed the cost of an additional co-pay on the patient, and the cost of a physician visit on the insurance companies. The medical boards, obviously wanted the visit to be required and argued that physical therapists didn’t have the education to make a diagnosis. Nowadays, physical therapy students must attend 3-3.5 years of graduate school, depending on the breakdown of the courses, following 4 years of a science-based undergraduate degree. Upon completion of the curriculum, students graduate with a Doctorate of Physical Therapy (DPT) degree. The students then need to pass a licensure exam in their respective state.

The DPT curriculum has progressed greatly over the years, as the degree was originally a bachelor’s, which progressed to a master’s and is now currently offered as a doctorate. The curriculum at each school varies slightly, but all accredited programs are governed by the Commission on Accreditation in Physical Therapy Education, ensuring that all programs cover what is necessary to be an entry-level physical therapist. The curriculum includes: cadaver dissection, movement analysis, kinesiology, pharmacology, examination and interventions, among other topics. This knowledge base prepares students to be autonomous practitioners.

New York is typically one of the more stringent states with regards to health care law, and it is no different with direct access. New York did not begin allowing direct access until 2006, whereas many states made this change in the ‘80s and ‘90s. Further, New York requires that a physical therapist have a minimum of three years full-time experience before they are allowed to see patients without a referral. Many states have no experience requirement, as the DPT students receive after 3 years of graduate school more than adequately trains providers to treat patients without further instruction from a physician. Lastly, patients in New York may only be treated for 10 sessions or 30 days, whichever comes first, before they are required to have a prescription.

Patients may be wondering if using direct access will place an extra burden on them financially. Most health insurance companies in New York do not require that a patient have a prescription on file before seeing a physical therapist, and these insurance companies will reimburse for the visit regardless of whether or not the patient has a prescription on file. There are a few cases where a prescription is required, mainly Medicare and Worker’s Compensation; these prescriptions need to be updated regularly. Additionally, a small percentage of insurance policies do require a prescription, though it is not consistent from one insurance company to another, so it is advised that patients check their benefits prior to attending physical therapy. Some practices, such as ProClinix Sports Physical Therapy & Chiropractic, will check health insurance benefits for the patient.

Direct access has been a giant step in the right direction of getting patients timely health care and decreasing financial burden on the health care system. As a patient, do not be afraid to seek physical therapy treatment without a prescription, as the time spent waiting could be time spent healing.