We’ve all heard some variation of the sad story about the poor, defenseless physical therapy practice having its business sucked dry by the big, bad physician-owned physical therapy practice next door. And PT Mike Manzo—who founded New Jersey-based Atlantic Physical Therapy Center (APTC) with his brother Dave in 2001—could very well have found himself living out that tragic tale.

According to Mike, that familiar anecdote was all-too-common in New Jersey about five or six years ago. At that time, many large orthopedic groups were opening their own physical therapy practices and, obviously, referring their ortho patients to those PTs. “The group right next door to us opened their own PT practice,” he said in a recent interview with WebPT. “It hit us hard.”

But Mike and Dave weren’t about to put their hands up in surrender. “So many of our former patients were going to these orthos and getting steered to physician-owned PTs,” Mike said. “But they [the patients] were unhappy.” So, the Manzos put their heads together to figure out how to get those patients back. “We knew there had to be a way to bypass those physicians,” Mike said.

Even though direct access to physical therapy has been available in New Jersey since 2004, Mike said that for many years, it existed “more in theory than in practice,” with many payers continuing to require a physician-generated script as a condition of reimbursement for physical therapy services. But the Manzos started keeping a list of insurances that did cover direct access services—and training their clinic staff on how to handle direct access patients according to insurance benefits. At the same time, they launched an internal campaign to educate existing patients about direct access. “We thought, ‘We have clients who come in, love us, and get better—so let’s just make sure we educate them and let them know they can come to us first,” Mike said. “It’s all about seizing the opportunity to educate [patients].

When patients say they wish they had come here in the beginning, that’s when you can say, ‘Well actually, you could have.’”

Once they implemented their plan, Dave and Mike started tracking the number of direct access patients they saw and then comparing that figure to the volume of patients they received from other referral sources. “Year by year, direct access started climbing up the list,” Mike said. Eventually, direct access was starting to compete with APTC’s top referring physicians.

And now? “Direct access is our number-one referral source,” Mike said.

But the benefits of embracing direct access don’t end with attracting more self-referred patients; in fact, one of the most impactful effects of APTC’s direct access-heavy patient population is that it has helped the practice build stronger relationships with referring physicians. Yes, it might sound counterintuitive, but as Mike explains, it actually makes a lot of sense. “Now, because so many patients are coming to us first, we’ve become a referral source to many doctors—we’ve never had so much success with forming relationships with referring providers as we have with being a referral source,” he said. “I remember I used to try inviting them to dinner, or to go golfing, and none of that stuff ever really worked. And now, all of a sudden, I’m getting phone calls from doctors who want to take me golfing.”

The key to capitalizing on this opportunity, Mike says, is that PTs need to own their position as frontline healthcare providers. “We’ve got to seize our role as PTs and understand that we’re not this subservient group,” he said. “Who is best suited to evaluate a musculoskeletal issue? We are. In our clinics, we’ve evaluated doctors, and they’re just blown away by the level of our expertise.”

But in addition to trusting in their own knowledge and expertise, PTs must know how to recognize when—and when not—to send a patient to another medical professional. “If you do a very thorough PT examination and there’s anything that doesn’t jive with your musculoskeletal mind—if what you’re seeing just doesn’t add up in any way—then you should refer them out, right then and there,” he said.

And really, the option to refer out should put the infamous liability argument—a favorite crutch of direct-access naysayers—to bed for good. “Liability is of very little concern to me,” Mike said. “We’ve seen zero effect on malpractice insurance. None whatsoever.”

To fellow therapists who are just starting to venture into direct access territory, Mike offers one simple piece of cautionary advice: don’t expect things to change overnight. “You’re not going to put a sign out in front of your clinic and have people come flooding through your doors,” he said. “But over time, even if you do nothing more than internal education [to staff and current patients], you’ll see an increase every year of direct access episodes of care.”

That said, Mike—like many leaders in the PT industry—believes direct access is the single  most important opportunity available to PTs in today’s medical landscape. “It’s a win for the patient because they’re getting the appropriate care sooner; it’s a win for us because we’re developing relationships that are on a more peer-to-peer level; and it’s a win for the payer because in so many cases, there’s no need for things like X-rays, MRIs, pain meds—or seeing many different doctors before going to PT to actually get better.”

So, armed with the power of direct access, PT practices large and small are anything but defenseless; they’re a powerful, integral piece of the modern healthcare puzzle.

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