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Physical therapists in the military have established a strong track record as primary care providers for those with musculoskeletal issues, albeit in limited situations. Could that success be expanded to all settings within the U.S. Department of Defense? In a move strongly supported by APTA, a powerful congressional committee has requested that DOD find out.

In a directive issued to the department by the House Appropriations Committee as part of the National Defense Authorization Act for 2023, lawmakers requested that the Secretary of Defense submit a report to the House Armed Services Committee that explores the feasibility of allowing PTs throughout the DOD to serve as primary care neuromusculoskeletal experts. In its statement, the committee acknowledges the importance of neuromusculoskeletal care in ensuring troop readiness, but voices concerns that "service members face significant administrative burdens when seeking care from physical therapists." The lawmakers believe that allowing PTs to serve in this primary care capacity could help ease that burden. The report is due by June 1, 2023.

The committee backs up its opinion with evidence — namely research published in 2021 that tracked patient data from the Joint Base Lewis-McChord physical therapy service line, where an algorithm was used to identify service members appropriate for receiving primary care from a PT. The study found that seeing a PT first was associated with an estimated $3.6 million in reduced utilization costs, lower rates of referral to specialty care, and decreased rates of long-term disability.

The study bolstered APTA's advocacy efforts around the inclusion of PTs in primary care, particularly in the military. Those efforts gained traction with the influential appropriations committee, which incorporated parts of the association's recommended language in its directive.

Currently, PTs within the DOD routinely provide primary care for musculoskeletal conditions when they are working at the troop level in garrison or during deployment; additionally DOD has been experimenting with PTs as primary care providers in other military settings for more than 20 years.

APTA Federal President Andrea Crunkhorn, PT, DPT, believes that the directive will allow DOD to reconsider how these roles have worked in the past and collect the data needed to move forward.

"Most of these efforts are home grown, the result of a therapist with the passion and ability to persuade the local command to allow primary care physical therapy in a brick-and-mortar facility," Crunkhorn said. "When those therapists leave, these efforts often fall away. And a change in the command team can also stop these efforts, as not all senior leaders believe in the need or utility of primary care physical therapy."

The new focus will require DOD to look at the results of these earlier efforts, she added, saying that the the directive will spur DOD to look at patient and business outcomes, data that's "essential to the future of primary care physical therapy in DOD fixed facilities."

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