Haacke 1

Chase Haacke Prof. Kade Parry English 1010 November 20, 2013 Self Referral to Physical Therapy The field of Physical Therapy has had a long history of controversy in the medical world behind whether or not a patient would need a doctors referral to receive treatment. Although currently 46 states allow physical therapists to evaluate and treat patients without a prior physicians referral, Medicare and some private health insurance companies still require a physicians referral before payment for the physical therapy services. In recent studies, patients that receive treatment from a physical therapist by self referral have required fewer visits to the physical therapist. However, the biggest concern that physical therapists have while rendering services is that they might not receive payment for the services they provide without a doctors referral. The issue that is being discussed and explored is the difference between patient self referral and physician referral to physical therapy. The issue that has risen has generated a great deal of exasperation to physical therapists in the field. Physical therapists play an important role in todays healthcare system. As trusted healthcare experts in restoring and improving motion, they contribute to their patients quality of life by keeping them healthy, fit, and active during their rehabilitation. In many instances, physical therapists have helped patients by avoiding surgery and long-term use of prescription medications. In work related injuries, physical therapy is often the last course of treatment utilized before the patient is released to return to work. The issue that raises whether or not its necessary to see a physician first before being treated.

Haacke 2

In the article-Putting Patient Self-Referral Into Practice(20-21)-;there are several physical therapists that have been using the Self-Referral practice as more than 70% of their patient clientele. While the states where these physical therapists live allow self-referral, it makes it rather difficult to market the practice without physician referral; so theyve had to become more creative. Despite the creativeness of the physical therapists marketing gimmicks, it does not always persuade patients to see a physical therapist. In Oregon, for example, where selfreferral for physical therapy has been permitted since 1993, a collaborative organization supported by the business communitythe Oregon Health Leadership Councilrecently launched a 2-year pilot program to persuade individuals with acute lower back pain to go see a physical therapist without seeing a physician first(23,24). The self referral program to see a physical therapist resulted in fewer visits, less days missed from work, and lower cost to the patient. In many other cases, the overall patient satisfaction rate is extremely high for when they use self-referral over physician referral as a result of the pilot that was launched. An article by Jane Pentergast; she argues that regardless of the state allowances for self referral, Medicare and some U.S. private health insurance plans require a physician referral for reimbursement of outpatient physical therapy services. Selfreferral, therefore, is primarily dictated by the provisions of patient health insurance coverage and is less likely in insurance plans where the physician serves the gatekeeper for physical therapy services. The goal for physician referral or gatekeeping is to provide comprehensive and coordinated care, reduce ineffective and duplicated care. By doing this process, it reduces overall cost to the patient.

Haacke 3

Physicians and physical therapists opposing to self referral to physical therapy argue that health care costs would increase dramatically due to overuse and/or inappropriate use of a physical therapist. Coordination of care would suffer due to decreased physician-therapist communication. In an article, written by Jane Pendergast-Health Service Research-(634)opponents also argue that a physician examination is necessary to correctly diagnose and assess a patients medical condition before initiation of physical therapy. While the physician referral is more accurate and is lead by a coordinated diagnosis, patients have seen that the cost effectiveness of physician referral was less than effective. The cost effectiveness of physician referral presses more onto the matter of physician owned-physical therapy. The conflict of interest arises when a physician refers his patients to a physical therapist that is staffed by the physician. While the business relationship between the physician and the physical therapist might be more cost effective for the patient; it is a controversy that has raised questions and oppositions in the physical therapy profession. The opposition of the issue has created an unfair competition for physical therapists who own their own private practices. In a recent debate on the topic of physician referral-to-profit, it has shown that quality of care and cost for the patient goes up dramatically. In a recent article Pentergast argues that proponents of self referral assert that physical therapists are educated appropriately to diagnose and treat conditions within the scope of physical therapist practice. The argument contests that self referral for patients can improve the quality of care they receive, decrease wait times, and lower health care costs by eliminating unnecessary physician visits. Pentergast also argues in the article that research studies have explored the issue of self referral by examining the skills of physical therapist relative to physicians.(635,636)

Haacke 4

In another article, Jette states; No other health profession has patient access to its services so severely limited, and few other health professions are so demonstrably well qualified for practice without referral, than Physical Therapy.(1619) Jett also concludes that by 2020, physical therapy services will be provided by physical therapists who have a doctorate in physical therapy. Jette also argues that promoters of self referral can extend patients choice of health care providers, provide access to services that promote prevention and wellness, and reduce delays with receiving physical therapy services. In a recent study conducted regarding to experienced physical therapists that received patients through self referral, were tested on their knowledge and diagnostic abilities. Although the study was not directly compared to that of physicians who were tested on the same knowledge, it was concluded that the knowledge of experienced physical therapists was greater than that of physicians(1620). Opponents of self referral argue that physical therapists may overlook serious medical conditions because they may not bela ble to refer a patient directly for diagnostic testing and are not trained to make medical diagnosis.(1621) Jette argues the clinical decision making of physical therapists or referral to a medical professional was appropriate for patients seeking physical therapy services without physician referral. It was also examined the factors associated with making appropriate decisions. Jette also argues that during a study conducted on these issues showed that physical therapists were only able to locate 9 out of 17 red flag items with patients with spinal conditions. One example of a symptom that was overlooked was weight loss which only 5% were actually documented by physical therapists. It was also found that only 25% of physical therapists would contact a physician when the probability of deep vein thrombosis in patients with MS conditions was high.

Haacke 5

As with any controversy in the medical field, there are going to be a lot of pros and cons to an argument to persuade their audiences one way or the other. Personally, I feel that self referral versus physician referral is an excellent practice. The self referral program minimizes the frequency of appointments with the physical therapist. Also, the physical therapy self referral takes less time away from work for patients by eliminating the extra appointment of seeing the doctor first. I think the fact that insurance companies using physicians as gate keepers to receive treatment is redundant as physical therapists have enough knowledge to provide an accurate diagnosis. Physical therapists can help evaluate and decide the level of treatment needed based on the symptoms and properly decide the frequency of visits based on that evaluation. I feel that physical therapy does not always receive the credit for their extensive knowledge or their abilities as a medical professional. So the self referral program, to me, proves that physical therapist practice is just as valuable as a regular medical doctors would be. Now that Physical Therapy has a doctorate program available, the need to see a physician at all is almost moot. To conclude my argument, I am pro self referral because physical therapists have more control of their practice, cut out unnecessary doctor visits, and provide appropriate care for patients.

Haacke 6

Decision Making ability of Physical Therapists: Physical Therapy Intervention or Medical Referral-Diane Jette, Kerry Ardleigh-pg( 1620,1621)

A Comparison of Health Care Use for Physician-Referral and Self Referred Episodes of Outpatient Physical Therapy-Jane Pendergast-pg(635-636)

A Comparison of Healthcare Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Thereapy-Jane Pendergast-pg(664-666)

A Global View of Direct Access and Patient Self Referral to Physical Therapy: Implications for the Profession-Tracy Bury and Emma Stokes-pg(449-459)

Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools?-J Bone-pg(13171320)

Self Referral in Physical Therapy: Does it Matter?-Pamela A Duffy, Michael Johnson, and Jane Pendergast-pg(634-654)