Direct access means that a patient can seek physical therapy services without a physician’s referral. That’s not only empowering for the patient, but also for you as a private practice therapy provider—and what better time to feel empowered than National Physical Therapy Month (NPTM). That being said, physical therapists aren’t capitalizing on direct access for a number of reasons, as Heidi Jannenga pointed out in her recent founder letter. But patients aren’t helping either. In a new NPTM-themed article, the APTA debunked the top seven myths of physical therapy. Number one? Direct access: “A recent survey...revealed 70% of people think a referral or prescription is required for evaluation by a physical therapist. However, all 50 states and the District of Columbia (DC) allow patients to be evaluated by a physical therapist without a physician’s prior referral.”

There are certainly ways to improve patient knowledge about direct access, many of which involve marketing (as tomorrow’s blog post will highlight). But that’s only half the battle. Your practice needs to be knowledgeable as well.

If you work in a private practice setting, here’s what you and your staff need to know:

  • the direct access laws and practice act for your state, including the requirements associated with referrals and any required certifications, as well as the rules for your payers;
  • whether you’d like to provide cash-pay services based on an established cash-based fee schedule;
  • whether you’d like to offer any programs previously limited by referral requirements; and
  • the facts associated with direct access. Here’s what the APTA lists:
    • “Direct access is optional for physical therapist clinicians.”
    • Physical therapy liability claims related to direct access have not increased.
    • “Referrals are still and will likely continue to be an important component of health care delivery for all professions.”
    • “Knowledge of when not to treat is as important as knowledge about when to treat.”
    • Regardless of whether a patient self-referred, communication with the other relevant healthcare providers is essential, and therapists therefore should maintain a list of healthcare providers for referring patients.
    • “The standard of care for physical therapy services is no different for patients who are seen by referral and those who are seen by direct access.”

The APTA also suggests therapy providers complete the following coursework:

  • Medical Imaging and Rehabilitation
  • Pharmacology and Rehabilitation
  • Screening for Medical Disorders
  • Professionalism in Physical Therapy

So, how can you ensure everyone at your practice is well-informed? Training, of course. Here’s how to coach up your team on all things direct access:

1.) Organize your materials. Your staff is going to learn the ins and outs of direct access, so map out what you want them to know and by when. Then, prepare all the literature you want them to review. I also recommend creating a lesson plan or syllabi with corresponding time tables. The more organized you are, the better you’ll be able to administer training.

2.) Get the team together. Meet with your team to introduce the topic of direct access and review the training plan as well as your expectations.

3.) Investigate coursework and certifications for clinicians. Whether you go with the APTA’s suggested coursework detailed above or acquire certifications based on your state’s direct access laws, make sure you do your due diligence when it comes to continuing education and that you provide these opportunities to all relevant staff at your practice.

4.) Conduct group lectures. Depending on how large your practice is, you may want to group your staff based on their roles (e.g., front office, back office, and clinicians and assistants). Then, provide a lecture on direct access. Once you complete the presentation, conduct a Q&A and provide literature for their review.

5.) Follow up on the literature and practice. Meet with those groups again to review the literature, answer questions, and practice patient-provider interactions through role-playing. (Hint: This means you’ll need to prepare direct access scenarios. Check out this direct access myths post for inspiration.)

6.) Practice more. Continue with the role-playing activities, administer quizzes on the literature, and hold individual touch-bases to ensure everyone on staff feels confident in discussing direct access with prospective and current patients as well as referrers and payers.

7.) Observe, educate, lead, and follow up. In reality, training never ends. Incorporate direct access knowledge into your employee performance review program and hold people accountable. Ensure that everyone stays abreast of your state’s practice act and direct access laws, and should anything change, be sure to retrain appropriately.

For additional resources on equipping your staff with direct access knowledge, check out these resources from the APTA (note that you must be an APTA member to view these materials):


Did you train your staff on direct access? Share your experience and pointers in the comments.

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