Direct access means the removal of the physician referral mandated by state law to access physical therapists’ services for evaluation and treatment. Every state, the District of Columbia, and the US Virgin Islands allow for evaluation and some form of treatment without physician referral. However, many of those states continue to impose arbitrary restrictions on direct access, or only allow for treatment without referral under very limited circumstances.
It is important to consider the potential that direct access has to enhance the practice of physical therapy and the care we give our patients. Direct access allows physical therapists to:
- Develop more collaborative relationships with other health care professionals.
- Compete in all markets where “referral for profit” is a problem by marketing directly to consumers.
- Be responsible for all clinical decisions related to physical therapy patient care.
- Soften the impact of declining insurance reimbursement by offering cash-based services in the areas of prevention, fitness, and health promotion.
- Save patients valuable time and money otherwise spent obtaining unnecessary referrals.
- Improve patient access to care.
In Indiana, the following provisions apply to providing physical therapy services via direct access:
- May evaluate and treat for no more than 24 calendar days (will change to 42 calendar days on 7/1/19) beginning with the date of the initiation of treatment without a referral. If additional treatment is needed, the PT shall obtain a referral from the individual’s provider (physician, podiatrist, psychologist, chiropractor, dentist, nurse practitioner, or physician assistant).
- Order or referral from a physician, osteopath, or chiropractor is required for spinal manipulation. Referring physician, osteopath, or chiropractor must have examined the patient before issuing the order or referral. “Spinal manipulation” defined as “a method of skillful and beneficial treatment by which a physical therapist uses direct thrust to move a joint of the patient’s spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity.”
- Order or referral from physician, osteopath, or podiatrist is required for sharp debridement. “Sharp debridement” defined as “the removal of foreign material or dead tissue from or around a wound, without anesthesia and with generally no bleeding, through the use of: (A) a sterile scalpel; (B) scissors; (C) forceps; (D) tweezers; or (E) other sharp medical instruments; in order to expose health tissue, prevent infection, and promote healing.”