As of January 2015 all 50 states, the District of Columbia, and the US Virgin Islands have some form of direct access to physical therapist services. APTA conducted a survey in 2015 of physical therapist (PT) members in the 50 states and DC to gauge the extent to which PTs manage patients who come to them via direct access, and to identify existing barriers to implementation. A report published in 2017 analyzes the survey results and examines potential next steps to increase PTs’ use of direct access.
The 2015 survey is a follow-up to an initial survey APTA conducted in 2009 of PT members in select chapters. (Because direct access was not available in all states at the time, the survey was not sent to members nationwide.) The purpose of the survey was to determine the extent to which these PTs used direct access in practice, the variation in its use in different practice settings and geographical locations, and reasons for the variation. Respondents also provided input on strategies they were using to successfully implement direct access.
Links to both survey summaries are below. The survey results provide insightful data that will be useful in determining the types of resources and activities that can help increase the use of direct access in physical therapist practice. For more details about either survey, contact email@example.com.
Direct Access Utilization Survey Report 2017 (.pdf)
Direct Access Utilization Survey Executive Summary 2010 (.pdf)
Podcast & Videos
Podcast: Improving Access to Care for Medicare Patients - 8/8/12
Video: Direct Access Models of Care Webinar - 6/14/12
Podcast: Direct Access in Practice - 6/24/10
Direct Access in Hospital-Based Settings
Allowing patients to have direct access to physical therapist services in hospital-based outpatient settings has become a priority for many physical therapists. The process for implementing this change is specific to each setting but often depends upon the relationships between the physical therapist and both the hospital administration and the medical community.
Additionally, there are specific Medicare regulations that dictate how order for rehabilitation must be handled in hospitals that participate in the Medicare program. These regulations apply to all patients receiving rehabilitation services in Medicare certified hospitals, including non-Medicare beneficiaries. A resource is available which provides an explanation of this regulation and suggestions for compliance.
Direct Access in Hospital-Based Outpatient Settings
Direct Access and Medicare
Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or a visit to a physician. Learn more on Direct Access and Medicare.
Preparing for Direct Access in Your Practice Setting
APTA has prepared several resources to help physical therapists successfully integrate direct access into clinical practice.
Direct Access Checklist for Clinicians (.pdf)
Helps physical therapists overcome potential barriers to direct access and addresses issues of clinical preparation, referral relationships, payment, and marketing.
Direct Access Checklist for Managers, Practice Owners, and Administrators (.pdf)
Helps managers, owners, and administrators consider both challenges and opportunities in the implementation of direct access.
Direct Access: A Resource for Implementation (.pdf)
Provides a road map that should be useful both clinicians and to practices interested in making physical therapist services available to the public without referral.
Implementing Direct Access in Physical Therapy Practice: A PT 2012 Panel Presentation
This online course will discuss findings from the 2009 APTA Direct Access in Practice survey, including the extent to which direct access in being used and the barriers and perceived barriers to its use in different settings and geographic locations.
Payment for Physical Therapist Services With Direct Access
Managed care contracts and insurance companies often have no requirements for a referral for physical therapy. Check your contract or payer policy to be sure. Many insurance companies now recognize the cost savings and improved access to care that come with direct access and do not require a referral for payment. Don't assume that there is a referral requirement unless you know for sure. If you have questions about payment for physical therapist services provided without referral, or if you are able to share information about payment for services in your region or clinical setting, contact firstname.lastname@example.org.
Marketing Resources for Direct Access
As a part of the new branding initiative, APTA has developed public relations and marketing resources to help physical therapists market directly to consumers and other potential sources of patient/client referrals, including patient handouts. Be sure to download the "Choosing Your Physical Therapist" handout to leave in your waiting room.
One of the goals of APTA's "Move Forward" branding initiative is to promote the profession of physical therapy to the outside community with important messages regarding the role of the physical therapist in improving movement. For more information on the branding campaign, visit BrandBeat.
Research Supporting Direct Access
There is a growing body of research to support the use of direct access in physical therapy. This section includes articles and other sources of data on this topic.
Unrestricted Direct Access Makes a Difference for LBP Patients - 11/8/19
Health Services Research Direct Access Study Toolkit
Advocacy for Direct Access
Direct Access at the State Level
Provides information on laws or advocacy efforts related to direct access at the state level. You will find valuable information about obtaining direct access in your state; links to your state practice act and regulations; arguments in support of direct access; and several helpful resources and articles related to cost effectiveness, and safety. Information on these pages will help you advocate for direct access in both clinical settings and legislative arenas.
Direct Access at the Federal Level
Provides information on direct access at the federal (Medicare) level.
International Summit on Direct Access and Advanced Scope of Practice
In October 2009, APTA led a conference that investigated advanced models of physical therapist practice both in the United States and internationally. The event was cosponsored by APTA, the Canadian Physiotherapy Association (CPA), and the World Confederation of Physical therapy (WCPT) and included participants from more than 20 countries.
Conference speakers presented research, best practice models for direct access and advanced/extended scope of practice, and international perspectives on policy and leadership in physical therapy. The following resources are available from the International summit:
The States of Direct Access
All across the nation consumers have "some form" of direct access to physical therapist practice services. What does that mean? What work remains?
PT in Motion (October 2016)
Direct Access: How It Can Change Your Practice!
This article was written to help dispel myths and encourage use of direct access in practice. It has been published in several chapter newsletters across the country.
Direct Access: Exploring New Opportunities
This article provides ideas on how to use direct access in different practice settings.
PT—Magazine (February 2002)