Why Oppose PT “Direct Access”?

To: NAAOP Members

From: Mark DeHarde – NAAOP President

Why has NAAOP opposed the proposal by the physical therapy trade association to remove from Medicare the requirement to obtain a physician’s referral before physical therapy services can be provided to a patient? Why should the wider O&P community continue to vigorously oppose direct access?

In 2003, NAAOP joined a coalition of organizations including the ACA, AAOP, AOPA and various physician and rehabilitation groups, in opposing Medicare Direct Access. The legislation authorizing this change to Medicare law presented serious concerns for our patients, our profession and the fiscal health of the Medicare system. NAAOP believes physical therapy—and all Medicare-covered services—should be provided under the supervision of a physician to ensure that all underlying medical conditions of the patient have been properly diagnosed to clear them for physical therapy treatment or other services. Moreover, since a growing number of states now include orthotics and prosthetics (or some portion of O&P) in their PT state practice acts (and in many states where our profession does not have O&P licensure), NAAOP is very concerned about the possibility of patients receiving comprehensive O&P services from physical therapists who simply do not have adequate education, training and experience to provide professional O&P services and related O&P technology. If Medicare were to eliminate the requirement for a physician referral, the provision of O&P services by PTs in the coming years may accelerate dramatically, as would traditional physical therapy services.

Physical therapists are our primary colleagues in the care of our patients. Each O&P practitioner enjoys relationships with PTs that are crucial to patient care, and the PT’s role in the rehabilitation process is fundamental to good outcomes. We wholeheartedly support the ability of physical therapists to directly provide temporary splints to patients and therapy training in using definitive O&P technology that O&P practitioners provide. But this does not justify support for PT Direct Access.

Rank and file physical therapists have no interest in providing comprehensive O&P services, and generally do not consider themselves qualified to provide them. But their leadership in Washington and the state capitals have ambitious plans for amending all 50 state practice acts to include comprehensive O&P care within the PT’s scope of practice. This goal, coupled with PT Direct Access at the federal level, is the “one-two punch” aimed at our profession and our patients. North Dakota is the PT’s most recent “victory” in this area, where the state law was just rewritten to explicitly include orthotics and prosthetics in the PT scope of practice. One must ask the question; is this really a victory for patients?

The O&P community must unify now and draw a line in the sand to assert that patient outcomes and safety are the highest priority and that provision of comprehensive O&P services requires the necessary education, training and experience that only members of the O&P profession possess. Ultimately, this set of issues must be dealt with at the federal level with a proper definition of “qualified practitioner” and facility accreditation, as well as through state-based O&P licensure. All of these efforts must flow from a proper definition of the clinical scope of practice for comprehensive O&P services and the demonstrated core competencies that O&P clinicians are uniquely qualified to provide in order to safely deliver the intended clinical and functional outcomes.

PT Direct Access is NOT in the best interests of O&P patients or, for that matter, all rehabilitation patients. Please communicate this message to your congressional representatives and state legislators and be vigilant in reiterating the message. The PTs outnumber us, will outspend us, and are more organized at the state level. Our patient-centered message and our passion for providing our patients with the highest quality care are out strongest assets. Join with me and NAAOP in advancing this cause.