The importance of Direct Access to Therapy Services
There are many components that make up a healthcare system and one that is currently the subject of much debate is accessibility. Patients want to be able to access quality healthcare services and coverage in a timely matter. Their needs may include gaining entry into the healthcare system, accessing a location where the needed services are provided and finding a provider with whom the patient can trust and communicate with freely, according to the U.S. Department of Health and Human Services. It is an element that impacts a patient's overall physical, social and mental health status, his or her prevention of disease and disability, the detection and treatment of health conditions and quality of life.
Direct access: Is it a dream or a reality?
A subjective aspect of the U.S. healthcare system is the use of gatekeepers, which enforce that patients need referrals from a primary care physician to receive certain speciality services depending on their health insurance coverage plan. A new emerging trend in the field of medicine is the concept of direct access, in which an individual doesn't need a referral to see a specialist and the services provided are covered by their insurance policy as long as they are in network.
The fight for autonomy continues
One field of medicine in particular that can benefit from direct access is physical therapy. Physical therapists work to rehabilitate patients to maintain, recover or improve their physical abilities. Access to physical therapy still is reliant on a prescription or referral in some states, despite that physical therapists are professionally trained and licensed in some areas, according to the American Physical Therapy Association. This autonomy is something that the field has fought for over the course of the last two decades, and so far measures have been accepted in 46 states.
Money wages war against health
The concept of well-being can often be overlooked as healthcare costs continue to escalate. Controlled costs and increased access aren't two things that normally coincide with each other, but direct access gets the closest to meeting both needs. What's so great about direct access?
ISSA Physical Therapy addresses the case simply - early and appropriate intervention leads to better outcomes, which results in fewer visits and decreased healthcare costs that lead to few bills to health insurance companies, a decreased risk that the patient will develop a chronic condition or disability and the increased chance that the patient will be generally more happy. With that said, the overarching goal of direct access is that specialists will be better able to serve their patients, creating a more efficient practice and increased patient satisfaction.
Direct access allows patients to refer themselves to therapy, both empowering them to be their own personal health monitor and making them more proactive about their healthcare needs. Being able to schedule their own appointments can help patients avoid taking unplanned time off of work. When consumers are in greater control of their healthcare, they tend to be more satisfied with the services, according to the World Confederation for Physical Therapy.
Not only does direct access increase patient satisfaction, it has the potential to cut down medical costs. It eliminates that gateway step of having to schedule an appointment with a primary care physician to get evaluated and then finally be given a referral, preventing a bill for that primary appointment before therapy even begins. On a physician's end, not receiving these kinds of patients can cut down on their administration costs and scheduling if the office is usually backed up, allowing them to place greater focus on patients that need primary care services and not rehab.
Why are states and federal programs hesitating?
Currently, the federal insurance program Medicare has yet to approve direct access. The Medicare Patient Access to Physical Therapists Act aims to improve access to rehabilitation serves without the requirement of a referral for Medicare patients. In some states, third-party payers are refusing to reimburse costs for physical therapy services if a physician does not provide a diagnostic label, according to the Journal of the American Physical Therapy Association (APTA). The journal also features an article discussing how the American Medical Association (AMA) has previously claimed that direct access to physical therapists poses a threat to the safety of the public and that unless physical therapists have the same training and education that orthopedic surgeons have, they cannot safely treat patients without a referral from a physician. The APTA refuted that there was no evidence that direct access threatens the safety of patients and that the AMA had made a false claim against them.
Chiropractic organizations also point out that patients may be putting themselves at risk when they decide to receive physical therapy without a referral. Their reasoning is that physical therapy education does not provide adequate training in diagnosis and pathology. However, the APTA argues that physical therapists receive enough education for recognizing examination results that are unusual for conditions appropriate for physical therapy management. In addition, it is not their core job responsibility to diagnose a patient and then refer them to a physician.
APTA promises to continue the fight
The APTA has claimed that they won't back down on the fight for direct access until it is implemented in all 50 states. Direct access across the nation will help the field of rehabilitation therapy improve as a whole. Patients can receive the care they need in a way that is most convenient for them, while therapists can have complete autonomy and not have to rely on a referral to treat patients. Allowing increased accessibility can ultimately cut down costs and allow businesses to save money to improve their services as a whole.
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