By Dr. James H. Cassell IV
In the past, in order to receive physical therapy patients were required to see a physician and obtain a prescription in advance. As of January 2015, all 50 states have adopted direct access in some shape or form. Direct access allows patients to see a physical therapist without a physician’s prescription, thus making it easier to access physical therapy services.
Direct access is a great achievement by the American Physical Therapy Association (APTA). The APTA successfully argued before the medical boards that requiring a visit to a doctor was an unnecessary and costly step in the health care process. It not only delayed treatment, but increased costs to the patient and the insurance companies. The medical boards wanted the visit to continue to be required and argued that physical therapists didn’t have the education to make a diagnosis.
Nowadays, physical therapy students must attend three to three-and-a-half years of graduate school, depending on the breakdown of the courses, following four 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 an exam to become licensed in their respective state.
The DPT curriculum has progressed greatly over the years. Originally, only a bachelor’s degree was needed, but requirements progressed to a master’s degree. Now the curriculum is offered as a doctorate.
Curriculum varies slightly at each school, but all accredited programs are governed by the Commission on Accreditation in Physical Therapy Education, ensuring that every program cover what is necessary to be an entry-level doctor of physical therapy. The curriculum includes cadaver dissection, movement analysis, kinesiology, pharmacology, examinations and interventions. This knowledge base prepares students to be autonomous practitioners.
New York is typically one of the more stringent states with respect to health care, 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 1980s and ‘90s. Furthermore, 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. The experience students receive after years of graduate school more than adequately trains providers to treat patients without further instruction from a physician.
As a further safeguard, 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 wonder if using direct access could place an extra financial burden on them. Most health insurance companies in New York do not require that a patient have a prescription on file before seeing a physical therapist. These insurance companies will provide reimbursements 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 as a result of Medicare and worker’s compensation. These prescriptions must be updated regularly. Additionally, a small percentage of insurance policies do require a prescription. However, that requirement is inconsistent from one 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 major step in the right direction toward getting patients timely care and decreasing financial burden on the health care system. As a patient, don’t be afraid to seek physical therapy treatment without a prescription, as the time spent waiting could be time spent healing.
Dr. James H. Cassell IV is a doctor of physical therapy at ProClinix Sports Physical Therapy & Chiropractic in Armonk. For questions regarding direct access, please call 914-202-0700 or e-mail firstname.lastname@example.org.