Why Shouldn't Direct Access Be aDopted?
The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) believes physical therapy services – and all Medicare covered services – should be provided under the supervision of a physician to ensure that all underlying medical conditions of the patient have been properly diagnosed to clear them for physical therapy treatment or other services. Mark DeHarde, President of the NAAOP, states, “physical therapists simply do not have adequate education, training, and experience to provide professional orthoses and prostheses services and related orthoses and prostheses technology”.
Though this is a viable argument, direct access has been part of physical therapy since 1957. The citizens of Nebraska have had access to unrestricted physical therapy care for more than 40 years. Sixteen other states presently have access to unrestricted care also; not to mention communications to the APTA from the Federation of State Boards of Physical Therapy and leading liability carriers such as CNA confirm that physical therapist’s liability rates and the incidence of complaints against them from the public are extremely low and do not differ between states in which patients have access to this legislation and the states that do not.
In fact, in 1974, the U.S Army was facing a severe shortage of physicians and a high level of musculoskeletal injuries due to military training. The Army sought to relieve the problem; they allowed physical therapists and occupational therapists to join their ranks to assume responsibility for musculoskeletal evaluations without a physician’s supervision; giving another example of the successfulness of physical therapy treatment in the absence of physician involvement.
Though this is a viable argument, direct access has been part of physical therapy since 1957. The citizens of Nebraska have had access to unrestricted physical therapy care for more than 40 years. Sixteen other states presently have access to unrestricted care also; not to mention communications to the APTA from the Federation of State Boards of Physical Therapy and leading liability carriers such as CNA confirm that physical therapist’s liability rates and the incidence of complaints against them from the public are extremely low and do not differ between states in which patients have access to this legislation and the states that do not.
In fact, in 1974, the U.S Army was facing a severe shortage of physicians and a high level of musculoskeletal injuries due to military training. The Army sought to relieve the problem; they allowed physical therapists and occupational therapists to join their ranks to assume responsibility for musculoskeletal evaluations without a physician’s supervision; giving another example of the successfulness of physical therapy treatment in the absence of physician involvement.
It’s also argued that if the direct access legislation were to pass it would not make a significant difference due to the fact that Medicare and third-party payers would still require a physician referral. Although it’s true that payment would not be guaranteed, direct access gives physical therapists the ability to work with payers to demonstrate the cost effective benefits of early intervention and physical therapy care. Many important roles of a physical therapist fall outside of what is covered by third-party payers such as school-based pediatric physical therapists[1] and direct access gives physical therapists longer reins when it comes to exploring more of these roles. There are many physical therapists that would like to exploitthe multiple opportunities outside of the traditional medical models for physical therapy but without direct access that will not be possible.
[1][1] School-based pediatric physical therapists are able to provide service to a child who qualifies for special education if that service is necessary. That treatment must be directly related to their ability to participate in special education and access a free and public education. These costs are covered by the school, free of charge to the family (Labandz).
[1][1] School-based pediatric physical therapists are able to provide service to a child who qualifies for special education if that service is necessary. That treatment must be directly related to their ability to participate in special education and access a free and public education. These costs are covered by the school, free of charge to the family (Labandz).