What is “direct access”? It is the ability of the patient to choose to be seen by a physical therapist without requiring a physician’s referral. In California (unlike in most other states), due to the strength of the California Medical Association direct access is not permitted. What that means is that the insurance company will not pay for treatment delivered in a physical therapist office unless a physician recommended it.

Let me give you a little background. Most US states have direct access at this time. Along with that, the Kaiser Permanente system and the US military use physical therapists as primary care providers for musculo-skeletal problems. In the 20 or 30 year history of the military, the Kaiser Permanante system or other states’ direct access policies, no increased risks were recorded in patient care. This comes from HPSO, the biggest malpractice insurer in the country. On the other hand, when orthopedic tests have been administered to orthopedists, physical therapists and primary care practitioners (internists, pediatricians, family practitioners) the orthopedists averaged 86%, the physical therapists 82% and the primary care providers………….28%.

Yet when, this month, the California Physical Therapy Association (CPTA) met with representatives of the California Medical Association (CMA) they were met with bitter hostility and were told that they would endanger patients with underlying medical conditions due to inadequate education. Keep in mind that they have absolutely no data to back their claims up, while the CPTA has done countless studies demonstarting patient safety in a physical theapist as a PCP model.

What seems to be the problem? It is called a “turf battle”. It shouldn’t be. Why? Because care for musculo-skeletal conditions is delivered safely by physical therapists at a cheaper cost, saving money in the long run.

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