When advocating for your patients and the profession, you now have a valuable resource-new evidence that suggests that "the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases."1

Published ahead of print September 23 in the journal Health Services Research (HSR), the study found that self-referred patients had fewer physical therapy visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year. In addition, overall related health care use-or care related to the problem for which physical therapy was received, but not physical therapy treatment-was lower in the self-referred group after adjustment. Examples of this type of care might include physician services and diagnostic testing. The study also found that individuals were similarly engaged with the medical care system during and after their course of physical therapy care, suggesting that continuity of care did not differ between the 2 groups.

The study, funded by a grant from APTA and its sections on Health Policy and Administration and Private Practice, retrospectively analyzed 5 years (2003-2007) of private health insurance claims data from a Midwest insurer on beneficiaries aged 18-64 in Iowa and South Dakota. A total of nearly 63,000 outpatient physical therapy episodes of care were analyzed-more than 45,000 were classified as physician-referred, and more than 17,000 were classified as "self-referred" to physical therapists. Physical therapy episodes began with the initial physical therapist evaluation and ended on the last date of services before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of physical therapy.

Earlier research has supported direct access to physical therapists, but the new HSR study is by far the most comprehensive to date. Not only did it look at a far more extensive number of episodes than previous research, but it also controlled for illness severity and other factors that could have affected the patients' outcomes.

"Physical therapists have long known that direct access to our services is safe and effective," said APTA President R. Scott Ward, PT, PhD. "The elimination of referral requirements and other restrictions has been a priority of APTA for decades. This study provides further evidence that direct access to physical therapists could go a long way toward helping to make health care more affordable and accessible for all. We encourage researchers and insurers to continue to further investigate this important issue that could have a profound impact on patient care."

APTA believes the results of this study could have significant implications for the US health care system and will support members' efforts to work with legislators and physician groups to establish policies that reduce unnecessary regulations, improve access, and build models of delivery that best serve physical therapy patients and the health care system.

"A Comparison of Health Care Use For Physician-referred and Self-referred Episodes of Outpatient Physical Therapy" was led by Jane Pendergast, PhD, professor of biostatistics and director of the Center for Public Health Studies at the University of Iowa. Coauthors of the study were Stephanie A. Kliethermes, MS, a doctoral candidate in biostatistics at the Center for Public Health Studies, University of Iowa; Janet K. Freburger, PT, PhD, research associate and fellow at the Sheps Center for Health Services Research and a scientist at the Institute on Aging at the University of North Carolina, Chapel Hill; and Pamela A. Duffy, PT, PhD, OCS, CPC, assistant professor, Public Health Program, at Des Moines University.

1. Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Services Research. Published ahead of print September 23, 2011. DOI: 10.1111/j.1475-6773.2011.01324.x.