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Self-referral to PTs Shown a Safe Way to Lower Costs

The role of primary care in gatekeeping access to physical therapists meets a serious challenge from a large analysis of claims data.

Do patients with a musculoskeletal condition really benefit from seeing a primary care doctor rather than going straight to a physical therapist (PT)? A large retrospective study on the question contends that they may not. In the case of physical therapy for these diagnoses, it appears, the gatekeeper model may be achieving exactly the opposite of its intended result: Better care for lower costs.

Not surprisingly, the new report is greeted with enthusiasm by members of the PT community. "Outstanding work," wrote one respondent an online newsletter of the American Physical Therapy Association (APTA), which sponsored the study. "Our profession needs to be released from control. We can save the government tremendous money with direct access." 

The study of self-referral for physical therapy is about to appear in the journal Health Services Research. University of Iowa biostatistician Jane Pendergast, along with another biostatistician and 2 physical therapists, retrospecively compared 5 years of insurance claims records associated with physical therapist visits that were referred by a primary care doctor (45,210) or initiated without a referral (17,497).

Self-referral was associated with a 14% reduction in visits and a 13% reduction in costs, the analysis showed. There was also lower utilization of health services for the same condition among self-referred patients during the 60 days following the first visit to the PT. The study data were adjusted for age, health status, and other demographic factors.

An earlier analysis of self-referral to physical therapists showed it to be more cost-effective than primary-care gatekeeping, but the current study is considerably larger and benefits from adjustment for potentially counfounding factors.

According to APTA, direct access to physical therapists is allowed by law in all but four states and accepted by many insurers.

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