Direct access to Physical Therapy services was first written into a state’s law (Nebraska) in the 1950s and since has been shown in the literature to be safe, effective, and less costly than seeing a physician first for musculoskeletal pain. Due in part to its’ cost effectiveness large organizations including fortune 500 companies and the U.S. Military have utilized direct access to provide musculoskeletal care for their personnel. Depending on the research study you reference patients seen by a Physical Therapist first for their musculoskeletal pain can expect to save $1000-1500 per episode of care. The only surprise left in this method is why some state’s legislatures restrict access to Physical Therapy services based on arbitrary time limits and restrictions. A recent research article examines the impact of direct access on patients based on level of their state’s restrictions.

Garrity and colleagues completed a retrospective analysis of close to 60,000 patients with low back pain with either commercial or federal (Medicare) insurance (Physical Therapy. 2020). The completed two analyses including examining the impact of seeing a Physical Therapist first in either a restricted or unrestricted direct access state, as well as, a second analyses examined the costs associated with either seeing a primary care MD or PT first. As expected those patients seen by a Physical Therapist in more restrictive states had significantly higher costs than patients seen in unrestricted states. This is due in part to restrictions requiring Physical Therapists to refer to physicians, regardless of patient presentation or progress, based on arbitrary laws (ex. 2 weeks, 30 days, etc.). In comparison, patients seen in unrestricted states utilized 13% and 32% lower costs at 30 and 90 days, respectively. This study adds to our collective understanding on the clinical and cost benefits of direct access to Physical Therapy services.

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