The fight for direct access to physical therapy has been raging for a while—we’re talking several decades—and as with any long-standing controversy, rumors abound. So, in the interest of removing some grist from the gossip mill, let’s tackle a handful of the biggest direct access myths out there:

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Myth #1: Direct access only applies to private outpatient physical therapy practices.

Truth: One of the most pervasive myths in the therapy industry is that direct access only benefits providers who practice in private outpatient settings. However, as this APTA article explains, not only are therapists in “major hospital and health systems...successfully treating outpatients without referral,” but they’re also providing therapy services in a direct access capacity “in private-pay home care, in industry, on the sports field and performing arts venues, in school systems and pediatric centers, and through admission orders in ICUs and other in-patient settings.”

Myth #2: Payers will not reimburse physical therapists for services provided without a physician referral.

Truth: Therapists should never, ever assume that an insurance company requires a physician referral as a condition of coverage for rehab therapy services. Why? Well, in the words of the APTA, “information from both payers and physical therapist providers indicate very positive trends toward reimbursement without referral.” Translation: many insurances will reimburse for rehab therapy services without a physician referral, although some do still require one. But verifying insurance details for any patient is a best practice anyway—and that principle applies whether a patient is self-referred or not.

Myth #3: Direct access doesn’t change the market for physical therapy.

Truth: Many direct access skeptics harp on the fact that it’s one thing to have a law on paper, and quite another for that law to effect any real change. While some in the PT industry might question the immediate business benefits of direct access, the truth is that the market for direct access services exists—it’s just that many potential direct access patients have not yet realized that they want or need physical therapy. While it could take some time for industry-wide marketing efforts to gain enough traction to successfully create demand among those consumers, individual practices can still leverage the power of direct access to increase their bottom lines—one patient at a time. As physical therapist and PTPN cofounder Michael Weinper says in this Today in PT article, “PTs need to be able to convert a client into a customer, like chiropractors and dentists do...Our research shows that people trust their therapists more than their primary doctor or friends on where to go for a gym, how to stay fit.”

So if, for example, you implement a cash-pay fitness program for post-treatment patients, you can retain the business of the patients you already have—only in a more customer-based capacity—even after they’ve completed their therapy programs. To that end, physical therapist and practice owner Jason Waz advises: “Focus on your patient group as if they were lifelong clients...Call a few days later and check up on them...Be available through email 24/7.” A few more tips for marketing to your individual network of current and past patients: Advertise your cash-pay service offerings with blurbs in your clinic newsletter, posts on your social media pages, or signs in your office—and make sure people know they can book an appointment with you directly, without a physician referral.

Myth #4: Direct access patients don’t “buy in” to rehab therapy as much as physician-referred patients do.

Truth: The logic behind this argument is that because patients completely trust their physicians’ expertise, they’re more likely to stick with a program suggested by a physician than one they sought on their own. But that sentiment doesn’t really fall in line with the data. In fact, this study, published in Physical Therapy (PTJ), showed that:

  1. “patients reported a higher level of satisfaction when they received physical therapy through direct access versus physician referral,” and
  2. “patients receiving physical therapy through direct access versus referral had better outcomes at discharge.”

The cherry on top? The above-cited study highlighted a “decreased cost in the direct access group...likely due to decreased imaging, number of physical therapy visits, and medications prescribed.” Talk about a win-win.

Myth #5: Direct access doesn’t exist in every state.

Truth: While it’s true that total, unrestricted direct access to physical therapy isn’t available in every state, what many people don’t realize is that there are different levels of direct access. As this PT in Motion article explains, “The term can describe degrees of access, from unrestricted patient access to all the services a PT has to offer, to patients' ability to receive an evaluation from a PT (who must then refer the patient back to a physician before commencing treatment), to requirements that patients obtain physician referrals only for certain interventions specified in the practice act.” And, as of this year, some form of direct access is available in all 50 states and the District of Columbia. What does that mean for PTs? Well, as WebPT Founder and COO Heidi Jannenga explains in this Evidence in Motion blog post, “...in every single state, we now have the ability to at the very least perform an initial evaluation for anyone who walks into our clinics.”

Yes, some states still restrict the type and quantity of services physical therapists can provide on a direct access basis, and yes, the PT industry still has a lot of ground to cover in the push for unlimited patient access to physical therapy across the board. But the important thing is that the groundwork is there, and the momentum shows no signs of slowing. As Jannenga writes, “Direct access to therapy has shifted from being the exception to being the rule.”

Myth #6: Direct access will give physical therapists a huge increase in patient volume.

Truth: While pro-direct access legislation certainly lays the foundation for increased consumer demand for physical therapy services, it doesn’t directly translate into more patients. For PTs to convert this newfound business opportunity into actual business, they’ve got to flex their marketing muscle. As physical therapist Bill Whiteford says in this PT in Motion article, “Getting word to the public about our services has been a challenge in this profession...In wellness and fitness, people could see anyone and everyone, as long as it wasn't a PT. Now that that's changed, we really have to become the profession of choice.” At the very least, PTs should consider adding cash-pay options to their current menu of services. (For tips on how to do that successfully—even with little to no upfront investment—check out this blog post.)

Myth #7: Allowing patients to bypass their primary care physicians puts their health at risk.

Truth: Ah, the liability argument—a concern as old as the direct access movement itself. The problem with this long-held contention among direct access foes is that it’s rooted in pure misconception. Today’s PTs are doctorate-level medical professionals whose training and education make them more than qualified to not only conduct initial evaluations, but also to recognize when a patient’s medical needs fall outside of their practice scope. In fact, as stated in this article, the APTA’s Guide of Professional Conduct “advocates that physical therapists should assist patients in receiving appropriate medical care when the physical therapist’s examination and evaluation reveals signs and symptoms inconsistent with a condition that can be appropriately treated with physical therapy or needs a physician's care and expertise.”

Furthermore, direct access proponents argue that those worried about physical therapists serving as the initial point of patient contact aren’t giving the patients themselves very much credit: “Whenever opponents of direct access talk about the percentage of patients with serious pathology, they assume that all of them would visit a physical therapist under direct access if given the privilege. We know this is simply not the case,” physical therapist Ryan J. Grella writes in this ADVANCE for Physical Therapy & Rehab Medicine article. And the hard data doesn’t lie; Grella continues, “Direct access has been around since the 1950s. Liability and claims data indicate that there is no difference in patient safety between physical therapists practicing in direct access states and those that still require a physician referral.”


History has taught us that any challenge to the status quo is bound to breed concern—and that creates an environment ripe for myth-making. What direct access rumors have you heard? Share ’em in the comment section below, and we’ll do our best to debunk ’em.

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