Two Shades Of Patient Access To Physical Therapy

The litmus test of patient access to physical therapy is quite simple. Ask the patient.

Pose the question: in your state, irrespective of payer guidelines, do you have the ability to freely seek evaluation and treatment from a physical therapist? Go ahead, I dare you. I double dog dare you. Ask.

In 33 states, the answer will be a distinct "no". Just 17 states will give you a "yes". We have 50 shades of patient access, 33 of which are permission-based. Each state is different.

The physical therapy profession has conjured up a variety of phrases to describe the many shades of patient access in the United States. “Unfettered”. “Restricted”. And all sorts of variations.

But ask a patient, and there are just two shades - yes and no. The haves, and the have-nots. So why must we make these silly claims? And just who does it benefit?

I have to admit that my two favorite shades of patient access these days – those that seem to get used most frequently - are "restricted direct access" and "direct access to evaluation". Ugh.

"Restricted direct access" is an oxymoron. You are restricted in doing something that, by definition, inherently involves freedom of choice. "Direct access to evaluation" - the latest hip shade of access - means that you can be seen by a physical therapist, but you may or may not be able to be treated by one.

Question: how many patients want to spend money on having someone perform their evaluation who then says "Well, Mr. Smith, thanks for your money, we know what your problem is but we can't do anything about it".

What makes these two shades even worse is that their usage has become acceptable vernacular.

Based on the definitions of the APTA, I practice in the "direct access" state of Texas. Really? Again, ask a patient and they will indicate that no, they do not have the choice to freely seek evaluation and treatment from a physical therapist in Texas.

There are just two shades of patient access - yes and no.

Our professional association - the APTA - continues to skirt the harsh realities of professional autonomy and direct patient access via the language that is used. But who wins with language like this? Nobody. Well, perhaps one group - the APTA. "Direct access to evaluation in all 50 states" sounds like progress, doesn't it? And progress is good, no? "Progress" helps to rationalize decisions made by the profession as a whole over the past 25 years, initiatives that have thus far failed to generate hard data to support their initial rationale.

Let's start with getting some language that truly reflects where we are - and where we have, sadly, been for the past two decades - and build on it from there. It is time for some truth-telling for patients and for clinicians.

We have 17 states in which a patient can freely, of their own choice, see a physical therapist for evaluation and treatment. Suddenly it becomes a compelling case for personal rights and freedom of choice. Tell it like it is. Please.

Photo credits: withassociates

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