New Texas Study Shows Patients Benefit from Direct Access to Physical Therapy

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Patients immediately seen by physical therapists had lower costs, underwent fewer tests and procedures. Texas Physical Therapy Association says study is significant for current legislation.

A recently published study by the University Health System in San Antonio found that neuromuscular patients who accessed physical therapy immediately at an urgent care center underwent fewer tests and procedures resulting in significantly lower health care costs compared to patients referred to physical therapists for a separate visit.

According to the Texas Physical Therapy Association, the findings are significant for physical therapy patients in Texas, which is one of only four states that still require a physician’s referral before patients can access physical therapy services.

The year-long study found that patients immediately seen by physical therapists as part of an inter-professional care team at a San Antonio urgent care clinic ultimately underwent half as many physical therapy procedures, MRIs and CT scans as patients referred to a physical therapists to be seen at a later time. Patients in the study were treated for conditions such as spine pain, extremity pain or dysfunction, gait instability, and neurologic diagnoses only needing physical therapy.

There was a 50% reduction in total costs associated with patients who were able to start physical therapy almost immediately. Patients also reported higher satisfaction in a follow-up survey compared to patients referred in the usual way, a process that delayed the start of physical therapy treatment by an average of three weeks.

Co-authored by two physical therapists, two medical doctors and a pharmacist, the study appears in the May issue of Physical Therapy Journal of Policy, Administration and Leadership.

“This study shows that immediate access to physical therapy can offer significant medical and financial benefits to neuromuscular patients,” said Matthew E. Walk, a San Antonio physical therapist, co-author of the study and member of the Texas Physical Therapy Association. “Immediate physical therapy evaluation and intervention can speed patients along the path to recovery and eliminate unnecessary tests and procedures that increase the cost of care.”

Forty-six states have already allowed physical therapy treatment without a referral, meaning more than 200 million Americans have better access to care than Texans. Once approved, no jurisdiction or state has repealed direct patient access to physical therapy treatment.

Texas legislators are considering removing the physician’s referral requirement as proposed by Rep. Richard Peña Raymond of Laredo in HB 1263.

The bill contains provisions requiring physical therapists to have at least one year of experience, proof of advanced training and liability coverage in order to treat a patient without a referral. It also limits treatment to no more than 45 days or 20 visits, after which time a referral from another provider would be required to continue care.

HB 1263 does not allow physical therapists to practice medicine or treat patients outside their scope of practice. The treatments physical therapists are allowed by the state to administer would not change, and therapists would still be required by law to refer patients to another healthcare professional for conditions requiring treatments outside of physical therapy.

The legislation recently cleared the Public Health Committee in the Texas House of Representatives with overwhelming support.

“Texans are tired of this unnecessary requirement delaying their treatment and prolonging their pain,” said Michael Connors, PT, DPT, OCS and President of Texas Physical Therapy Association (TPTA). “We still have a lot of work to do, but I’m hopeful Texas legislators will do what’s right for Texas patients.”

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