A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy

Jean M. Mitchell, Gregory De Lissovoy

Research output: Contribution to journalArticle

Abstract

Background and Purpose. Access to physical therapy in many states is contingent on prescription or referral by a physician. Other states have enacted direct access legislation enabling consumers to obtain physical therapy without a physician referral. Critics of direct access cite potential overutilization of services, increased costs, and inappropriate care. Methods and Results. Using paid claims data for the period 1989 to 1993 from Blue Cross-Blue Shield of Maryland, a direct access state, we compiled episodes of physical therapy for acute musculoskeletal disorders and categorized them as direct access (n=252) or physician referral (n=353) using algorithms devised by a clinician advisory panel. Relative to physician referral episodes, direct access episodes encompassed fewer numbers of services (7.6 versus 12.2 physical therapy office visits) and substantially less cost ($1,004 versus $2,236). Conclusion and Discussion. Direct access episodes were shorter, encompassed fewer numbers of services, and were less costly than those classified as physician referral episodes. There are several potential reasons why this may be the case, such as lower severity of the patient's condition, overutilization of services by physicians, and underutilization of services by physical therapists. Concern that direct access will result in overutilization of services or will increase costs appears to be unwarranted.

Original languageEnglish (US)
Pages (from-to)10-18
Number of pages9
JournalPhysical Therapy
Volume77
Issue number1
StatePublished - Jan 1997
Externally publishedYes

Fingerprint

Referral and Consultation
Physicians
Costs and Cost Analysis
Blue Cross Blue Shield Insurance Plans
Therapeutics
Office Visits
Physical Therapists
Legislation
Prescriptions

Keywords

  • Direct access
  • Episode of care
  • Physical therapy
  • Physician referral

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Health Professions(all)
  • Orthopedics and Sports Medicine

Cite this

A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. / Mitchell, Jean M.; De Lissovoy, Gregory.

In: Physical Therapy, Vol. 77, No. 1, 01.1997, p. 10-18.

Research output: Contribution to journalArticle

Mitchell, Jean M. ; De Lissovoy, Gregory. / A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. In: Physical Therapy. 1997 ; Vol. 77, No. 1. pp. 10-18.
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