PT Autonomy

[dcscott325]

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Hello,

I will be starting PT school this June and just have a few questions about the scope of autonomy for PTs...

I understand that most states don't require referrals for PT, but are these state regulations or insurance regulations? How do insurance companies play a role in this (it is my understanding that they often want referrals for just about everything!)

Also, as PTs are able to diagnosis a disorder, are you also able to prescribe the necessary testing to confirm your diagnosis (ie: x-rays, MRI, etc). And how to you overcome the pain management obstacle when medications are needed to supplement your pain-relieving exercises? Would you then have to refer them out to their GP?

I'm just trying to figure out the benefits of direct access care in physical therapy when so many issues still seem to rely on MDs.

Thank you so much for any info you can provide!

 

[WarriorPT]

Direct access (i.e. "referrals") is determined at the state level. Yes, insurance companies play a role in this. However, federal legislation (i.e. Medicare) will influence state legislation. PT legislation is also countered by lobbyists who do not want to see physicians and their subordinates lose their preferred provider status.

Our diagnoses are PT specific, not medical. They pertain to function, and while military PTs can order MRIs/X-rays, typical (civilian) PTs cannot. Also military PTs can prescribe pain medication, but this is only permitted after a few years of supervised practice.

I find pain medicine to be helpful when initiating PT for an acute MSK case. However, pain medicine for chronic pain sufferers ultimately does very little (from what my patients tell me). Yes, there is relief initially, but it fades. They have to be responsible with their pain meds. Simply running out of pain meds does not prompt me to stop therapy. Honestly it does the opposite. I can get a better understanding of a patient's MSK pain when it isn't controlled medically.

PTs have made some great advancement in patient care. Our footprint in Wash D.C. is small, which is to say our lobbyist are minimal. There is also disagreement between the "old guard" PTs and the modern PTs. Many PTs still refuse to treat without a referral.

Good luck!

______________________
OP Ortho Physical Therapist

 

[DesertPT]

A majority of the states allow some form of direct access to physical therapy, however a majority of insurance companies require a physician referral to PT before they will pay for it. There are several states that do not have direct access or have minimal direct access, and there are of course some insurance plans that pay for PT w/o a referral. If you Google PT state practice laws/direct access laws, you'll find all the information you want.