In August 2018, Gov. Bruce Rauner, R-Ill., signed into law a bill that would allow patients in Illinois to seek out the services of a physical therapist without a referral from a physician or orthopedic surgeon. This expands previous policies on direct access to physical therapy for patients.
“We had the ability to do an evaluation of a patient, but we could not follow up with treatment unless we had the physician OK the plan of care,” Michael Riley, PT, president of the Illinois Physical Therapy Association, told Healio.com/Orthopedics.
Direct access to physical therapy
When establishing direct access to physical therapy in Illinois, Riley noted the Illinois Physical Therapy Association met with other medical practitioners to identify appropriate criteria. These include reporting to the patient’s physician what the treatment plan is within 5 days of the patient being seen.
“If later on [the patient] went back to the orthopedic surgeon or back to that physician, then they would have a record that they had some therapy during that course of time,” Riley said.
For patients who do not have a physician, the policy would allow for physical therapists to refer patients to a physician as needed.
“We feel we are going to be able to be a good referral source for the medical network, be it an orthopedic surgeon, a neurosurgeon or just a general practitioner, depending on the patient’s malady,” he said.
However, criteria for direct access may differ depending on the facility. According to Riley, most hospitals still have bylaws requiring a physician’s order for physical therapy in a hospital-based environment. He added Medicare also “requires a physician’s sign-off on a plan of care within 30 days of being seen.”
Advantages of direct access
Once direct access to physical therapy is fully implemented, Riley believes it will provide greater access to health care for patients and be seen as a cost-effective option.
“I think it is going to take a little bit of time to evolve as to how it is going to work but I do believe that overall, the winner in this particular case is going to be the general population who has greater access to health care,” Riley said.
Similar to a dependence on the accuracy of physicians to determine that physical therapy is needed to resolve a clinical condition, concerns have been raised about whether physical therapists will be able to provide accurate screening for injuries that are not amenable to therapy. Brian J. Cole, MD, MBA, professor and vice chair in the department of orthopedics at Midwest Orthopedics, Rush University Medical Center, noted that a well-trained physical therapist is capable of doing the diagnostic assessments and evaluation needed for proper treatment.
“It is a fine balance between diagnostic capability and filtering the proper patients for treatment solely on the therapist’s assessment without the benefit of objective diagnostic testing vs. an immediate referral to a physician to more accurately hone in on a diagnosis,” Cole told Healio.com/Orthopedics. “I think that is the obvious balance that needs to be struck. Ideally, preventing an unnecessary physician visit will improve access, efficiency and the cost of care. The onus, however, is on the physician and/or therapist to simply get it right early in the process. Patient benefits may limit the total amount of therapy they may have for a specific diagnosis which emphasizes the importance of diagnostic and therapeutic accuracy at the outset.” – by Casey Tingle
Disclosures: Cole and Riley report no relevant financial disclosures.