As a practicing physical therapist in the state of Georgia, and over 35 years of clinical experience in this healthcare field, I am writing to you today to gain the support of your insurance company, Blue Cross Blue Shield of Georgia (BCBSGA) in the recent achievement of direct access for physical therapists in Georgia. Currently, patients in the state of Georgia now have direct access to physical therapists without the requirement of a physician referral; however under the current health care system physical therapists are still prevented from providing necessary medical treatment to patients, on the account of that services rendered under direct access are not reimbursed by BCBSGA. This extra step places a burden to the consumer by increasing …show more content…
Their privileges have expanded beyond the typical scope of physical therapy practice to efficiently perform musculoskeletal evaluations in a direct-access, physician-extender role, including referring patients for appropriate diagnostic imaging tests, prescribing certain analgesic, nonsteroidal anti-inflammatory, and muscle relaxant medications, and referring patients to all medical specialty clinics. Additionally, in 2005, Virginia Mason Medical Center in Seattle, Washington initiated a physical therapy direct assess model for patients with low back pain which resulted in decreased costs per episode of care in the first year, partly due to the reduction in the number of MRI scans ordered. Lastly, in 2007 the University of Wisconsin Hospital & Clinics implemented an outpatient physical therapy direct access program. A comparison of the direct access and physician referred patient episodes of care revealed cost savings in the area of diagnostic imaging. There was 92% more plain film radiography and 193% more advanced imaging procedures in the physician referred episodes. These findings were consistent with previous studies that MRI use dropped by approximately one-third when patients were initially seen by a physical …show more content…
As a healthcare provider involved in the management of patients with musculoskeletal disorders, physical therapists having the capability to order diagnostic imaging is beneficial to differential diagnosis in screening for a medical referral. Furthermore, I have shown that physical therapists having the ability to refer for imaging improve the efficiency of healthcare delivery, particularly in combination with direct
This frees up the physician’s schedule to see only the medically necessary patients, whereas PTs can share the load of musculoskeletal evaluations. Mitchell and Lissovoy published a study in 1994 on the cost effectiveness of direct access to PTs. They found that the costs for PT visits were 123% higher when patients were first seen by a physician as compared to when they were seen by a physical therapist directly. Establishing close working relationships between medical doctors and PTs, with a 2-way referral of patients, is essential to reduce not only unnecessary referrals, but also improve patient satisfaction and create an efficient process for reducing overall medical costs.
As a district physical therapist manager overseeing twelve different facilities, it is important to adhere to the compliance standards and ensure other physical therapists and physical therapist assistances are attaining such standards. In this particular example, it was important that the district manager took responsibility for looking at the audits instead of relying only on the hired auditor. Two red flags were brought to the manager’s attention when reviewing the detailed reports: re-evaluations and modality charges.
Under the old Georgia Physical Therapy Act, a physical therapist was allowed to examine and evaluate of patient or client without a referral source. The only treatment a physical therapist could provide without a referral source was in the area of fitness, wellness, or prevention that was not related to an injury. Effective July 1, 2015, the current Georgia Physical Therapy Act grants physical therapists limited direct access, or the terminology used in the act is self-referral. Under the new practice act a patient who self-refers can be seen by a physical therapist for a maximum of 21 days or eight visits before required to have a referral from the patient’s provider. (Georgia Physical Therapy Act, 2015). A stipulation is that a written disclosure must be provided to the patient that the physical therapy diagnosis is not a medical diagnosis. (Georgia Physical Therapy Act, 2015). Additionally, a provider referral is not required for patients who return for treatment within 90 days that have been previously diagnosed with a chronic musculoskeletal condition (Georgia Physical Therapy
So, I am going to clear up some of these myths. These myths are from a article I read called 7 Direct Access Myths Debunked. One topic is that it only applies to private outpatient Physical Therapy Practices. The truth is that is applies to many other areas as well like private pay home care or sports field and performing arts venues, etc. So it's not just applied for one group. If you really need serious go to a physical therapy clinic but you still might have to get approval from your primary care physician. Another Myth is that Direct access doesn’t exist in every state. That is somewhat true but there are different levels of direct access. A state my just limit the amount or put a limit on it. So a form of direct access does exist in every state so you just have to figure out what works best for you. Mississippi is one of the six states that has strict limitations that still require approval. Another myth is that allowing patients coming without a referral from their physician puts their health at risk. “Physical Therapist are doctoral-level medical professionals whose training and education make them more than qualified to not only conduct initial evaluations, but also recognize when a patient’s medical needs fall outside of their scope”(Andrus). Physical Therapist are doctors. They go to med-school like every other doctor does. They can see when a Patient needs therapy or not. According to Apta’s Guide of Professional Conduct it is required that PT’s should evaluate the patient for signs and symptoms of damage for therapy. A doctor would not just treat someone without evaluating
In regards to health care legislation, Ms. Rademeyer feels that the large restrictions and limitations on reimbursement has adversely affected the accessibility of comprehensive rehabilitation programs, thus putting more responsibility on the patients as well as the physical therapists (Rademeyer, 2015). She also feels that, even though the requirement for fees to be guided by outcome is a good opportunity for accountability in physical therapy services, there is a big need for balance between the limitations and the outcomes to avoid a negative impact on chances for full recovery of some patients (Rademeyer,
The purpose of this research study is to determine through statistical evidence that physical therapist do or do not play a major role in helping patients with chronic diseases.
Gainesville Physical Therapy is a full-service physical therapy clinic that is located in Gainesville, Georgia. Gainesville Physical Therapy has celebrated its more than 25 years of excellence. Their experts treat a vast of physical conditions of the spine, shoulder, hip, knee, wrist/hand, ankle/foot, elbow, and more. Gainesville Physical Therapy specializes in sacroiliac joint dysfunction, back and neck pain, postural re-education, post spinal surgery, joint replacements of the knee, shoulder and hip, knee injuries / post-surgical, osteoarthritis, etc. Gainesville Physical Therapy is also an expert in the assessment for the orthotic needs, shoulder injuries / post-surgical rehabilitation, hand therapy, sports injuries, orthopedic injuries,
When she sees a patient for the first time she talks to them about the doctor’s report and asks specific questions about their injury or experiences leading up to the need for physical therapy. Megan explained how important it is to make the patient feel comfortable and keep a positive attitude towards the patient’s recovery. These consultations were the most interesting to sit in on because it allowed me to observe the therapist’s ability to take the patient’s information and create a diagnosis and treatment plan for the injury or pain described. Megan may have multiple patients at a time so she stressed the importance of keeping up with each patient and why the physical therapy techs are so helpful. Scheduling is another job of the therapists that is important in keeping the clinic running smoothly. There is also paperwork that has to be filled out for every patient after every visit about their
Ever since I was a kid, it has been my life goal to help as many people I can. I have moved around in many different areas of the medical field, but no career had caught my eye as much as physical therapy. As an athlete, I have been in and out of the physical therapist’s office for a majority of my life. Each time I have went I could not help but be beyond grateful for what these people have done for me; they have given me the ability to play the sport I love despite all the hiccups. Physical therapy is a dynamic field within the field of medicine because as a physical therapist one can make a difference in the lives of his or her patients, enjoy job security, and enjoy a rewarding and personally satisfying career.
I am the physical therapy team leader at a pediatric outpatient physical and occupational therapy clinic. This clinic evaluates and treats children between the ages of birth and 21 years with a variety of conditions, including, but not limited to: developmental delays, orthopedic and neurological conditions, brachial plexus injuries, torticollis and plagiocephaly, and autism spectrum disorders. Occasionally, the therapists will evaluate and treat an adult patient with developmental disabilities. The clinic is open five days per week with four occupational therapists, three physical therapists, one physical therapist assistant, and a Spanish-speaking interpreter. As the physical therapy team leader, I work with the occupational therapy team leader to suggest, establish, and implement new programs at the clinic, under the direction of the therapy manager.
billion annually due to fraud and abuse of the system. Physical therapists can play a major role in
Since the Affordable Care Act (ACA) signed into law in March 2010, a few things have changed in the provision of physical therapy services, in specific productivity standards and reimbursement in outpatient physical therapy clinics. The Affordable Care Act has resulted in an increased demand for physical therapy services primarily due to the construction of the Health Insurance Marketplace. This created new health insurance options to help Americans acquire health insurance, who previously were not able to afford it. Although the ACA is a very extensive and complex piece of legislation, it has ultimately resulted in more individuals who are eligible for physical therapy services. This increased demand not only comes from the ACA but also from reimbursement cuts from insurance companies, subsequently causing physical therapists to overload their schedules as a means to offset these cuts. These demands are without factoring in the aging baby boomer population, which is expected to increased the physical therapist need by 30% from 2008 to 2018 (cite). Physical therapy is about providing the best patient care, however patient care is also a business and businesses are centered on revenue. Below are some of the current proposed solutions along with personal solutions and insight on the productivity issue.
This research project addressed concerns from opponents and included statistical data to support the fact that direct access to physical therapy (PT) does not cause harm, improved patients’ outcomes and is cost-effective when comparing the number of visits of the direct access group with the physician-referred group.
The concept of evidence based medicine (EBM) emerged in the early 1990s led to the development of evidence based practice (EBP) in physical therapy later in the decade1. The aim of EBP is to increase the quality of care and decrease the needless variation in practice. EBP can be defined as, making clinical decision about the patient care plan using the latest evidence from research2,3. Applying the EBP may reduce medical errors, challenge beliefs based views and help balance risks and benefits in patient care2. The important of EBP arose from the fact that nearly 30-40% of patients do not receive treatment according to the current research evidence. Surprisingly, 20-25% of provided care is harmful or not needed4. For example, despite the
According to Direct access utilization survey done by APTA in 2010 state with unrestricted direct access for more then 10 years 69% therapist report that their direct access patient contain only 10% of their patient population and this 10% consist of former patient, their relatives and friends. Even though most of the reimbursement companies including medicare doesn’t required initial referral from physician, 64.7% therapist identified reimbursements limitation is one of the primary reason behind lower number of direct access patient (APTA 2010). I work for one of the largest and lidding health care provider company in United state and company policy dictate that we have to have physician referral in order to evaluate and treat patient in all settings.