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APTA's ongoing advocacy to promote PTs as entry-point providers has led to a significant win for the profession: The U.S. Department of Defense has announced that it's now positioned to allow physical therapists to act as primary neuromusculoskeletal providers across all DOD settings.

The latest developments come by way of a DOD report that analyzed the feasibility of allowing PTs throughout the department to serve as primary care neuromusculoskeletal experts. That analysis, mandated by the House Appropriations Committee in late 2022, reaches an unequivocal conclusion: System-wide implementation should move forward.

"It is entirely feasible for physical therapists to serve in a primary care [neuromusculoskeletal expert] role throughout the DOD," the report states. "Physical therapists employed in the DOD already have the credentialing and privileging to perform this role. There is research to suggest that direct access to [physical therapy] is safe, effective, and will improve patient outcomes, military readiness, preservation of the force, and reduce costs."

APTA, in collaboration with APTA Federal, pressed for the study as a way to expand on existing research conducted at the Joint Base Lewis-McChord physical therapy service line that found seeing a PT first for musculoskeletal care was associated with an estimated $3.6 million in reduced costs. APTA and APTA Federal advocacy resulted in a request for the DOD study, and reference to the earlier research, as part of the 2023 National Defense Authorization Act.

PTs within DOD routinely provide primary care for musculoskeletal conditions when they are working at the troop level in garrison or during deployment, and DOD has been experimenting with PTs as primary care providers in other military settings for more than 20 years through its Direct Access to Physical Therapy program. However, the program hasn't been implemented across all DOD-related settings.

The report recounts a DOD initiative to leverage its direct access program as the avenue for taking PT primary care system-wide. The project gathered information on the existing physical therapist direct access programs, best practices that facilitated direct access in military treatment facilities, and barriers to implementing direct access, then used that information to implement a phased-in program that will extend to all DOD-related settings by the end of 2025. In the meantime, DOD is tracking data on utilization, patient volume, and other elements.

According to Brian Allen, APTA congressional affairs specialist, DOD's announcement is a major win for patients in the military system that will help propel entry-point provider advocacy in the civilian realm.

"The value in seeing a PT first, both in terms of cost and outcomes, has been well established within the military health system, and the DOD decision is a clear acknowledgement of that reality," Allen said. "APTA applauds this expansion and looks forward to tracking outcomes that we are confident will help make the case for an elevated primary care role for PTs in the broader health care system."

The DOD findings are consistent with results of a landmark study, conducted by APTA, that analyzed the cost-effectiveness of seeing a PT first for eight common conditions including low back pain, tennis elbow, and carpal tunnel syndrome. Visit "The Economic Value of Physical Therapy in the United States" webpage to learn more.

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