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  • Study: Primary Care Physician PT Referral Rates Dropped 50% Between 2003 and 2014

    Over the past 20 years, there have been vast gains in direct access to physical therapists (PTs), and most providers and clinical practice guidelines recommend physical therapy as a "first-line treatment" for many musculoskeletal conditions. However, researchers found that physician referral to physical therapy for these conditions declined between 2003 and 2014, while referral to specialist physicians increased.

    In an article published in the Journal of General Internal Medicine (citation only available for free), authors analyzed 12 years of primary care physician (PCP) data from the National Ambulatory Medical Care Survey. The survey includes patient and visit characteristics, physician diagnosis, services, and tests ordered, including physical therapy. Authors included APTA members Janet K. Freburger, PT, PhD, and Samannaaz Khoja, PT, PhD.

    For all musculoskeletal-related visits, the rate of referral to a PT dropped by 50%, from 94.4 per 1,000 visits, to just 42.9. The decrease in referral rates "followed similar trends" for each of the 3 diagnostic subgroups that researchers examined: arthropathy, spine, and soft tissue disorders. At the same time, referrals to specialist physicians increased at approximately the same rate.

    Authors are unsure whether the results are due to "more appropriate" physical therapy referral or "missed opportunities" for referral, but they note, "Had the decrease in [physical therapy] referral rates reflected more judicious use of specialists by PCPs, we would have expected a similar trend for referrals to physicians."

    Whatever the underlying cause, researchers think the trend isn't exactly in sync with the way health care is evolving.

    "As primary care moves to value-based payment, the need for multidisciplinary, team-based care and care delivery by non-physician providers will be necessary to deliver high-value care," authors write.