News Flash: Another Study Confirms Direct Access Saves Money

I just received a news flash from the American Physical Therapy Association. Across the news wire today, this news just in from the journal “Health Services Research”: direct access to physical therapy saves money.

Wow. Holy Redundant Research, Batman. Another study confirms the obvious that was noted back in 1994 – 17 years ago.

Pardon my sarcasm, but it really doesn’t require any great rocket science to figure that physician-gatekeeper-referred physical therapy is going to cost at least one more visit than non-physician-gatekeeper-referred … if not more. Of course, that would be a doctor’s visit – or two or three. If all other things remain equal, of course.

Two studies, 17 years apart, and we have varied levels of “direct access” attained in various states over that time period. Obviously, something just isn’t sinking in. What prevents direct access from becoming the standard of care in this country?

The APTA press release notes that the study

“… found that patients who visited physical therapists directly for outpatient care had fewer visits and lower overall costs on average than those who were referred by a physician, 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”.

So not only does direct access save money on physical therapy, it saves money on overall health care use as well. Then, they go on to the hard data -

“Researchers 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”

The study, which will appear in the journal “Health Services Research”, can be found here.

The release also makes note of a 1994 study

“… (which) analyzed 4 years of Blue Cross Blue Shield of Maryland claims data and found that total paid claims for physician referral episodes to physical therapists were 2.2 times higher than the paid claims for direct access episodes. In addition, physician referral episodes were 65% longer in duration than direct access episodes and generated 67% more physical therapy claims and 60% more office visits.”

Compelling, yes? Of course it is. There is a significant value to research that provides evidence and rationale to change the system as we know it, and to move the health care system forward with the long-term benefit of the patient foremost in the plan.

That is all good. But we had this data 17 years ago, and we are still struggling with the issue, in need of yet another “landmark study” to prove the point. Let’s face it, the powers-that-be aren’t listening, haven’t been listening, and frankly, probably won’t be listening with the release of this study. Why? Because they are not about to change the economically lucrative status quo without a big fight – a fight that has nothing to do whatsoever with what is right for the patient.

I can already hear the excuses from the AMA … “patient safety” … “biased since it was sponsored by the APTA” … yada yada yada in their best Seinfeld-ian manner. We’ve heard it all before – since 1994, and probably much earlier. It may be another supportive piece of research, but I suspect the kick-back from the status quo will only get more virulent.

Beware the Scope Of Practice Partnership, its exhorbitantly-funded tentacles coming soon to a legislator near you.

Reference: 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

Photo credits: epSos.de