No Referral Necessary: Go See Your Physical Therapist - ReFORM

No Referral Necessary: Go See Your Physical Therapist

We all get aches, pains, and injuries from time to time.  Maybe you rolled your ankle trying to make a cut during your flag football game.  Or perhaps the countless hours you have been putting in at the office have turned your neck and/or back into a hot mess.  Often these symptoms will improve with time or a change in your routine.  However, sometimes things can linger longer than expected, causing you difficulties with your job, hobbies, and even daily living activities.  If this is the case, it may be worth your valuable time to consult a medical professional.  Now, before you go scrolling through your contacts for your physician’s digits, let me suggest a different choice for your primary caregiver: your neighborhood physical therapist.

In 2004, the Ohio state government legalized direct access to physical therapy care, meaning that it is FULLY LEGAL and REIUMBURSABLE to consult and seek treatment from a physical therapist without a physician’s referral.  In my experience, it seems that very few people in the Northeast Ohio region, whether it be current patients, friends, or even my own mother (love ya, Mom), are aware of this important fact.  In our area, the typical progression of care looks like this:

Injury -> Physician Visit -> Medication Prescription -> X-ray -> Physical Therapy Referral

Of course, this pathway can ultimately help you to achieve a full recovery.  However, I would argue that one could reach the same great results SOONER and CHEAPER by eliminating those middle 3 steps.

Physical therapists are experts at musculoskeletal evaluation and treatment.  They use the same measurements and movement tests as orthopedic physicians to come up with possible causes for symptoms.  General practitioners and internal medicine doctors excel at maintaining general health for their patients, but they mostly defer to the specialists (that’s us) for matters of joint, muscle, or even nerve-based pain.  So if you are pretty darn sure that the reason for your problem is one of these areas, initially consulting a physical therapist could save you both a medical bill/co-pay, unnecessary medications and tests, and expedite your healing and recovery.

But do not just take it from my admittedly-biased opinion.  A research article published in 2013 compared many care-based categories between patient episodes that began with a physician’s referral and those that started with a direct access visit to a physical therapist:  The results were pretty one-sided:  patient outcomes and satisfaction were superior and the number of required therapy visits, images, prescribed medications, and additional physician visits were reduced for patients that consulted a physical therapist first through direct access.1  If you want to talk dollars and cents, another study found that on average, there was a reduction of $2,736.23 per episode of care for low back pain when direct access to a PT was utilized.2  Given that at any given time, 31 million people in the U.S. are experiencing low back pain 3, that could add up to some serious savings.

If you are still a little worried about not being checked out first by your physician for fear of missing some serious underlying issue, let us try to put your mind at ease.  The wily veteran clinicians at Relevation Physical Therapy and Wellness have all received their doctorate degrees in physical therapy, and this required them to complete clinical courses in “Differential Diagnosis”, which is a fancy way of saying, “If it’s not that, then it could be this, this, or this.”  There are certain signs and symptoms referred to as “red flags” that we have been trained to search for.  So, if things just do not add up during your evaluation or initial treatment, your therapist will be quick to recommend that you go get checked out by your doctor before continuing with rehab.  Sometimes getting a patient to the appropriate professional can be just as gratifying as personally providing the treatment.

So maybe you are finally coming around to this whole “direct access” thing (Woo-Hoo!), but you do not feel totally cool about cutting your doctor completely out of the loop.  Luckily, neither do we, and neither does the State of Ohio.  In the Land of Buckeyes, the law states that a physical therapist must acquire a physician’s referral to continue treatment if the patient’s care exceeds 30 days from the time of the evaluation.  Also, it is a standard of practice that PTs conduct a “progress note” every 30 days to assess improvements and goals, so sending these reports to a patient’s doctor to keep her abreast of what is happening is something we would already do.  As therapists, we embrace the team concept in regards to patient care.  Through direct access, we are simply trying to help that team to run more efficiently.

Let us review: direct access to physical therapy, which is both fully legal and largely covered through personal insurance plans, has been shown through research to do the following: 1) provide great patient outcomes and high satisfaction 2) lead to fewer physician visits, x-rays, and medication prescriptions 3) stimulate a quicker overall recovery.  Plus, the research also suggested that there was no increased risk of harm to the patient by consulting a physical therapist without a physician’s referral.  FASTER, CHEAPER, BETTER, SAFE.  What a nice group of words, right?  So the next time that “thing” acts up because of the changing weather, your cruddy desk chair, or a hole you didn’t see during your nightly run, why not cut to the chase and consult your PT?  According to the stats, you will be glad that you did.

David J Skrajner, PT, DPT

1) Ohja et al. Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review, PHYS THER January 2014 94:14-30; published ahead of print September 12, 2013, doi:10.2522/ptj.20130096

2) Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs, 2012. Spine 2012; 25:2114-21.

3)  1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.