No referral needed

 

Can I see a Physical Therapist without a referral?

As a Physical Therapist, one of the most common questions I get from patients is “Does my husband/wife/brother/child/etc. need a referral to come see you?” The answer to this question is ‘no’, but just like everything in healthcare, it can be a little complicated because it depends a lot on where you live. I will try and unwrap this question as best I can.

All fifty states have some form of direct access. Direct access means you can go straight to a Physical Therapist without a referral from your physician. However, there are 3 main types of direct access:

1) Limited access. This is the most restrictive form of direct access because it means they can only evaluate and provide limited treatments in certain patient populations or under certain circumstances. There are 6 states that this applies to: Alabama, Illinois, Mississippi, Missouri, Texas, and Wyoming.

2) Patient access with provisions. Under this form of direct access, you can go to a Physical Therapist without a referral but there are some restrictions related to time, visit limits, or referral requirements for specific treatments such as needle EMG or spinal manipulation. There are 26 states that are included in this form of direct access. Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Washington, and Wisconsin.

3) Unrestricted access. With this form of direct access, there is no limitation whatsoever for treatment without a referral. There are 18 states where this is allowed. Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Kentucky, Maryland, Massachusetts, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Vermont, West Virginia.

If you are still reading you are probably asking the obvious questions. Why do some states have more restrictions than others? The answer to that question is all about politics. What type of direct access your state allows, and thus how easy it is for you to go to a PT without a referral, is something that was decided by the legislators in your state, probably without you even knowing about it. At some point laws were passed that allowed for direct access with or without provisions in your state. If you don’t like the way your state has restricted your choice on how and where to spend your hard earned healthcare dollars, you should talk to your local representatives and encourage them to support less restrictive direct access bills as they are presented in the future.

“But my insurance is Medicare, so how does that change things?”

The follow up question I usually get from patients is “My dad has Medicare, so does he need a referral to come see you?” The answer to this question, once again, is ‘no’. For the longest time, Medicare required a Physician visit and referral prior to initiating PT. However, that changed in 2005 when revisions were made to the Medical Benefit Policy Manual. Since 2005, Medicare has not required a referral for PT. They do, however, require that the patient with Medicare be under the care of a physician. What this means is that the patient must have an established physician who can sign a plan of care set up by the PT. So, as long as you have a physician who knows your situation and is willing to sign off on that plan of care without seeing him/her first, you don’t need a referral for PT even if you have Medicare.

“Is it safe to see a PT without a referral?”

The next question that usually comes up in my conversations with patients who want me to see their friends or family is “Are PT’s capable of diagnosing and treating my family member?” The answer is unequivocally ‘yes!’ Physical Therapy is a doctorate level profession just the same as an MD or DDS and PT’s are musculoskeletal experts who are very capable of screening for signs and symptoms that would indicate a more sinister pathology, such as something that is not related to the musculoskeletal system (i.e. cancer, infectious disease, aneurysm, vascular claudication, etc.) Patients have been seeing a PT without a referral in the military system since the Vietnam War. Since then, there has never been any documented cases of increased harm due to a patient seeing a PT prior to seeing an MD. In fact the opposite is true because patients who go to a PT first commonly experience quicker recoveries combined with decreased cost. Additionally, there was an article published in the Journal of Orthopedic and Sports Physical Therapy in 2005 by Josef H Moore and colleagues that looked at how good different providers are at diagnosing a specific musculoskeletal pathology in the clinic without prior imaging and then comparing it to an MRI after the fact. The findings of this study revealed that non-orthopedic providers (family practice, internal medicine, emergency room physicians, etc.) were the least accurate, where Orthopedic surgeons and PT’s were the most accurate. There was no difference in accuracy between the Orthopedic Surgeons and the PT’s.

What does all this mean?

The 2 main take home points of all my ramblings are:

  • You don’t need a referral to see a PT regardless of your insurance, but depending on what state you live in, there may be some restrictions.
  • PT’s are capable and trained to be the first healthcare provider you contact for your musculoskeletal complaint.
  • You have a choice about how and where you spend your healthcare dollars. #opt4pt today!

 

neely-darrenptBlog post provided by Darren Neeley DPT, OCS, FAAOMPT, CSCS.

Darren is a Physical Therapist at Intermountain Medical Center Physical Therapy. He treats all orthopedic conditions but specializes in back pain, neck pain, headaches, and chronic pain. To schedule an appointment with Darren please call 801-507-2050. More information about conditions he treats can be found here.