#PTDirectAccess as a Mindset through the Continuum of Care #APTAcsm

Direct Access is a hot topic for outpatient physical therapists. Many may feel pursuing the ability to practice to their full potential within a direct access environment is fundamentally a private practice outpatient issue. But, do we need to take a broader view of what the term direct access represents? Physical therapists in all settings need to have a stake in pursuing direct access for our profession. And, not just the legislative logistics of direct access, but also the mindset. Direct access is more than legislative semantics and private practice marketing. The education, knowledge, training, mindset, and approach to direct access patient care is not specific to private practice nor the outpatient setting.

While many states have some form of direct access, Allan Besselink states “you either have it or you don’t.” Assessing direct access laws by state illustrates that only 18 allow true unrestricted direct access. Allan comments:

It is time for physical therapists to simply say NO to accepting anything less than true direct access. We should not just accept the scraps as they fall from the table. In accepting anything less, we do a disservice to our profession by viewing ourselves as deserving of and accepting of a subservient role in the health care arena. Worse yet, we do a disservice to our patients who look to us as advocates for cost-effective and quality conservative care.

Direct access is something a patient either has – or doesn’t. There is no in-between. Physical therapists should not play in-between either.

In absence of profound legislative change from state to state what actions can each individual therapist, educator, and student perform tomorrow to advocate for and illustrate the value of direct access? Can we adopt a direct access mindset. Join Karen Litzy, PT, DPT, Kyle Ridgeway, PT, DPT, and Ann Wendel, PT, ATC, CMTPT at #APTAcsm to discuss not the logistics, but the professional mindset of #PTDirectAccess through the continuum of care from acute care to home health to outpatient orthopedics.Follow and utilize the #PTDirectAccess hashtag during #APTAcsm to ask questions, tweet about the session, and share resources on direct access.

Learn how to be an effective part of the medical team to address the needs of today’s patient, healthcare consumer, and other professionals. A direct access mindset contains the potential to add much value to all settings of care.

Recognize benefits of adopting a Direct Access Mindset across all physical therapy settings

Identify the key benefits of experience in the acute care setting as preparation for spotting red flag incidents, differential diagnosis, understanding medical treatment, and the team based approach in all other practice settings.
Describe ways that physical therapists can form partnerships with other medical professionals who see the value, and necessity of direct access to physical therapy.

To conceptualize and discuss these ideas

Define role of PT as part of the medical team & global health care system: acute care to home health to outpatient clinics
Outline key points of a direct access mindset
Examples of other providers who already value consulting and referring to physical therapists across the continuum

Discuss and illustrate the potential value of physical therapists

Across a variety of diagnoses as well as in risk reduction in both pathologic and healthy populations
Via ideal acute care practice
By connecting acute care to a direct access mindset
In potential direct access in various settings
How does acute care facilitate, reinforce, and contribute to direct access?

Direct Access Through the Continuum of Care
Thursday, February 5, 2015
11:00 AM – 1:00 PM
Room 205 Indiana Convention Center

Your state, setting, patient population, title, or practice act do not dictate your mindset. Listen to Ann, Karen, and Kyle discuss why it’s time to approach all of practice with a direct access mindset.

Physical therapists, it’s time to own it.

3 Replies to “#PTDirectAccess as a Mindset through the Continuum of Care #APTAcsm”

  1. Resources

    Physical Therapist Training & Knowledge

    1. Bury T, Stokes E. A Global View of Direct Access and Patient Self-Referral to Physical Therapy: Implications for the Profession. Physical Therapy. April 2013;93(4):449-459.
    2. Jette DU, Ardleigh K, Chandler K, McShea L. Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral?Phys Ther. 2006;86(12):1619-1629
    3. Childs JD, Whitman JM. Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists knowledge in managing musculoskeletal conditions. BMC Muscoloskelet Disord. 2005;6:32
    4. Childs J, Whitman J, Pugia M, Sizer Jr. P, Flynn T, Delitto A. Knowledge in Managing Musculoskeletal Conditions and Educational Preparation of Physical Therapists in the Uniformed Services.Military Medicine [serial online]. April 2007;172(4):440-445.
    5. Moore JH et al. Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons, and Nonorthopaedic Providers. JOSPT. 2005.
    6. Physical Therapist’s knowledge, decision making & direct access. Kyle Ridgeway. AAOMPT Student Special Interest Group Blog. 2009
    7. Boissonualt W. Diagnostic and procedural imaging curricula in physical therapist professional degree programs. JOSPT. 2014

    Cost & Potential Cost Savings

    1. Mitchell JM, Lissovoy G. A comparison of resource use and cost in direct access vs. physician referral episodes of physical therapy. PTJ. 1997
    2. Ojha HA et al. Direct access compared with referred physical therapy episodes of care: a systematic review. PTJ. 2014.
    3. Early Rehab Program Saves $818,000 per year.
    4. Lord et al. ICU Physical Rehabilitation Programs: Financial Modeling of Cost Savings.
    5. Virginia Mason. Occupational LBP Care Pathway. http://www.wsj.com/articles/SB116857143155174786
    6. Center for Healthcare Solutions

    Emergency Department

    1. APTA Resource Center. Physical Therapist Practice in Emergency Department.
    2. Lebec MT, Cernohous S, Tengarge L, et al. Emergency Department Physical Therapist Service: A Pilot Study Examining Physicians Perceptions. Internet Journal of Allied Health Sciences & Practice. 2010;8(1)
    3. Kesleloot L, Lebec MT. Physical Therapist Consultation in the Emergency Department: A Multiple Case Report Describing Three Arizona Programs. Journal of Acute Care Physical Therapy. 2012;3(3)224-31

    Acute Care & Hospital

    1. Arena R et al. Increasing Referral and Participation Rates to Outpatient Cardiac Rehabilitation: The Valuable Role of Healthcare Professionals in the Inpatient and Home Health Settings. Circulation.
    2. Engel H et al. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. PTJ. 2013.
    3. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, Brower RG, Fan E. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010 Apr;91(4):536-42


    1. Ojha H, Snyder R, Davenport T. Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review. Physical Therapy [serial online]. January 2014;94(1):14-30. Available from: Academic Search Premier, Ipswich, MA.
    2. Boissonnault WG et al. Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report. PTJ 2010.


    1. New Vision & Role for Physical Therapist in Athlete Management. Matt Sremba, DPT. Paul Mitalski. Conatus Athletics. http://ptthinktank.com/
    2. Cross PC et al. Management of Acute Sports Injuries and Medical Conditions by Physical Therapists: Assessment via Case Scenarios. International Journal of Sports Physical Therapy. 2011.
  2. I am a second year DPT student at Ohio State and have become very interested in the topic of Direct Access, however I am having trouble understanding why we are having difficulty getting third party payers to buy-in to the idea of direct access. We have proven through Mitchell et al. that it saves them money and that we are more than capable of recognizing red flags. What is keeping them from acknowledging us as a primary provider for musculoskeletal issues?

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