How to Make Direct Access to Physical Therapy in New York Work – Pediatrics

In the American Physical Therapy Association’s (APTA) summary of state physical therapy direct access laws, only 6 states included a specific clause for children with therapy needs. These include Alabama, Louisiana, Mississippi, New Mexico, Wisconsin, and Wyoming (APTA, 2015). The advantage to this is that physical therapists in these states know the specific qualifiers that allow them to provide direct access to children. The downside is that it consequently restricts the practice of direct access to only a specific niche in the pediatric population such as children with developmental disabilities or children in special education programs, depending on which state they practice. This means that children with rehabilitation needs who do not belong in these two categories still need a referral prior to receiving physical therapy. The direct access language used by the state of New York however is open-ended and essentially allows therapists to provide treatment to all patients, including children, with any rehabilitation needs. The state allows a licensed therapist over 21 years old and practiced full-time no less than 3 years to render treatment to any patient for 10 visits or 30 days, whichever comes first, as long as the therapist provides written notification that services without a referral might not be covered by the patient’s health insurer and keeps it on file (APTA, 2015).

What we need to do as a profession is to create a way to make direct access operational and sustainable. It is crucial that we work with insurance companies and educate them about the benefits of direct access in lowering health care costs. Ojha, Snyder, and Davenport (2014) found that the cost of health care is less in direct access versus physician-referred episodes of care due to a decrease in number of therapy visits needed, less adjunctive testing prescribed, and fewer drug claims reported (pp. 21-22). We should also, as individual professionals, talk to physicians who refer to us and discuss how direct access can positively affect our health care system. They should be made aware that direct access will not undermine their role in the patient’s plan of care. Ojha et al. (2014) concluded that direct access will not negatively impact the way patients seek physician consult throughout the course of their rehabilitation (p. 25). A reduced demand for physician consult and care from other practitioners is not to be expected if direct access to physical therapy is fully implemented (Ojha et al., 2014, p. 25). It is also our responsibility to inform the public of what direct access to physical therapy is and how we, as a profession, could be their provider of choice for rehabilitation needs. APTA (2003) listed core values including, but not limited to, social responsibility and excellence that should direct us in this endeavor. When we communicate with patients, other health professionals involved in the plan of care, insurers, and business partners or employers to name a few, we allow for the creation of a stronger rehabilitation team that could provide cost-effective health care with optimal outcomes. Other core values in physical therapy such as accountability, altruism, compassion/caring, integrity, and professional responsibility should guide us in our path towards the full implementation of direct access (APTA, 2003).

References:
American Physical Therapy Association (APTA). (2003, August). Professionalism in physical therapy: Core values. Alexandria, VA: APTA.
APTA. (2015, January). A summary of direct access language in state physical therapy practice acts. Retrieved from http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf
Ojha, H. A., Snyder, R. S., & Davenport, T. E. (2014). Direct access compared with referred physical therapy episodes of care: A systematic review. Physical Therapy, 94(1), 14-30. doi:10.2522/ptj.20130096