Over the past 20 years, more states have granted patients direct access to physical therapy without a physician referral. Although the state of Arizona has already offered this type of access for several years, it was not until recently that insurance companies began paying for physical therapy without a physician referral.
The main reason for this change comes from the mounting data that proves visiting a physical therapist first might actually reduce costs and improve the overall outcome of injury rehabilitation.
Historically, the process from injury to recovery has been to see a physician, try medication, receive diagnostic imaging, rest, and hope for a resolution. If the problem was not resolved, the next step was to try physical therapy, and maybe some sort of medical intervention such as injections or surgery. However, because of the increasing cost of medical care, insurance companies and patients have been looking for methods to lower the cost of rehabilitation.
One of these methods is to try PT first for musculoskeletal problems. It was recently reported that 53.9 million people have one or more musculoskeletal disorder(s) per year. When visiting a physician first, these disorders typically result in medical costs averaging $3,578. This estimate consists of the average cost for physician treatment, imaging, medication, hospitalization, surgery, and more.
When looking at patients who went to physical therapy first, there was an average savings of over $250 in one study, and over $1,000 in another. Overall, there were substantial savings across the board with less imaging, less medication, and even less treatment.
Similarly, a study looking at patients with low back pain reported significant savings in costs. Again, these savings came from PT first’s role in reducing emergency room visits, imaging such as X-rays and MRI, and opioid use. This study also found a 9% increase in the completion of functional goals when using PT first.
Physical therapy has evolved greatly over the past 20 to 25 years, as have the patients it serves. Due to costs and other factors, the goal now is to fix the problem as soon as possible with as little healthcare use possible. Physical therapy enables the therapist to treat the cause of the pain early on and to begin the rehabilitation of restoring the proper mechanics that may be causing the pain.
We are also trained to recognize when physical therapy is not the proper or best first course of action and can point patients in the best direction. The physician-physical therapy team is still the standard when dealing with musculoskeletal problems. This team will always be present for and critical to the care of a high percentage of patients. However, as healthcare evolves, the evidence in favor of a physical therapy first approach continues to grow.
If you have any questions regarding direct access to physical therapy in Arizona, please contact your nearest Foothills Sports Medicine Physical Therapy clinic.
.7Ojha, H.A., et al ; Direct Access Compared with Referred Physical Therapy Episodes of Care: A systematic Review. Physical Therapy. January 2014
Frognar, B.K. et al; Does Unrestricted Direct Access to Physical Therapy Reduce Utilization and Health Care Cost. Healthcare Cost Institute. A Policy Brief. 2016