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 language | English (US) |
|---|---|
| Pages (from-to) | 10-18 |
| Number of pages | 9 |
| Journal | Physical Therapy |
| Volume | 77 |
| Issue number | 1 |
| State | Published - Jan 1997 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy
AU - Mitchell, Jean M.
AU - De Lissovoy, Gregory
PY - 1997/1
Y1 - 1997/1
N2 - 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.
AB - 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.
KW - Direct access
KW - Episode of care
KW - Physical therapy
KW - Physician referral
UR - http://www.scopus.com/inward/record.url?scp=0031021718&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0031021718&partnerID=8YFLogxK
M3 - Article
C2 - 8996459
AN - SCOPUS:0031021718
VL - 77
SP - 10
EP - 18
JO - Physical Therapy
JF - Physical Therapy
SN - 0031-9023
IS - 1
ER -