This year was the fourth time that Texas Physical Therapists had a proposed bill in the Texas legislature that would grant what we consider Direct Access. Before a bill can even be voted on by the House and Senate, it has to be given a “Hearing” within a committee (the “Public Health Committee” in our case). If it receives a majority vote by the committee members, it can then be brought to the floor for a vote. I usually fell asleep in my government classes, so I may be off on a point or two; but I believe that’s generally how it goes in Texas.

In preceding years, our Direct Access bills never even made it into a committee hearing, but things changed yesterday! We finally received a hearing! Keep your fingers crossed for us, because it’s obviously a long process before anything becomes law.

How Direct Access affects private physical therapy practices

I’m actually not writing to explain the Texas legislative process or to describe the events at the Texas Capitol yesterday. I’m writing to explain how the Direct Access issue affects me as a Cash-based Physical Therapist who rarely gets referrals directly from Physicians. The majority of my patients come from word-of-mouth referrals or finding my practice online (either Google search or review sites like Yelp). When I discuss my practice with other Physical Therapists, I often get the question, “If your referrals are mostly word-of-mouth and rarely from Physicians, how do you deal with the Direct Access issue?” Here is what generally happens when a new patient calls to schedule an appointment …

Getting a referral for physical therapy

Sometimes the patient was told by her Physician that she needs Physical Therapy and already has a referral. (I’m going to avoid the awkward he/she stuff and just use the feminine). If she doesn’t have a referral, it then becomes a question of whether or not she can avoid a trip to a Physician (or Chiropractor, Nurse Practitioner, Podiatrist, Dentist, etc). To see if this is possible, I go through the following questions:

  • “Have you seen any other Health Care professionals for this injury/pain?” If so, the prospective patient may be able to call that office and ask them to fax one without having to go in for another appointment.
  • If the answer to the above question is “No,” I ask her if she has a relationship with any Medical Doctors or Chiropractors anywhere. Would any of them be willing to fax a script without the patient needing to come in to see them? Does she have any Doctors in the family, even in another state, who would be willing to write a referral?
  • If the answers are all still “No,” but she does have an established relationship with a Physician in the area, I ask her to see if she can get in for a visit soon. If she can’t get an appointment soon enough, I then suggest a local urgent care center.
  • If that’s not an option either, I suggest she find a Primary Care Physician in the area who does not have a long wait. If it’s not a rural area, there is usually someone who can squeeze them in for a short visit within a day or two.
  • If she doesn’t see any of the above as good options and wants to see her busy orthopedist, then she may just have to wait a while. At that point, I explain the difference between the treatment given at a POPTS and the treatment I give, and that it is always her choice where she receives PT. It is not uncommon for some orthopedists who own a PT clinic to steer the patient that way.

I have lost prospective patients due to the direct access issue and to Orthopedists convincing them to use their own PT. It’s a bummer, but as you can see from the list of questions and options above, most people who are adamant about coming to your clinic will be able to get a referral fairly quickly. If it is an emergency (ex: a newly sprained ankle, but needs to be ready for competition in a few days), I explain that their best bet is to go to the urgent care center to get an x-ray and a referral.  Then I can see them that evening.

Every State has different laws so if you are not in a Direct Access state, don’t assume that the methods above are fully applicable to you too. Check with your State Board to get the needed details. If you’re adding cash-pay services to your current or future practice, you’ll have to market directly to the public, so you’ll also have to know how to handle those calling without a referral. The above info should provide some guidance.

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