A bill passed in the last legislative session in Texas allows patients to see a physical therapist without a physician referral. HB 29 became a law in the summer, and will allow physical therapists to treat a patient for 10-15 days without a referring physician. Not everyone was happy with the development, but proponents say that earlier access to a physical therapist could bring down imaging costs and even reduce opioid addiction.
Prior to the law’s passing, Texas was one of only two states that didn’t allow physical therapists to treat a patient without a doctor’s referral. Before the law went into effect on Sept. 1, physical therapists could only treat a patient after referred by a physician, but now a patient can arrive at the door of a physical therapist, get an evaluation, and be treated for up to two weeks before a physician referral is necessary to continue treatment.
“We have been working to remove barriers that make it difficult for patients to access their physical therapist for a long time. We are thrilled the legislature is helping by making direct access to physical therapists the law,” said David Browder, Chief Executive Officer of Texas Physical Therapy Specialists via release. “We know that early access to physical therapy is important to decreasing the length and severity of many musculoskeletal injuries.”
Similar bills have come before the Texas Legislature before, but none have been successful until now. With legislators looking to increase accessibility and affordability while reducing opioid use, increasing access to physical therapists can aid with all three. Both physical therapy and opioids help treat acute and chronic pain, and for some cases, early access to physical therapy can avoid interaction with highly addictive opioids. With 29 cosigners this time around, the bill flew through both houses.
A study from the University of Washington published in Health Services Research showed that when patients saw a physical therapist prior to a physician, they had a 89 percent lower chance of receiving an opioid prescription, 28 percent less chance to have imaging done, and 15 percent lower chance of an emergency department visit, but also a 19 percent higher chance to be hospitalized.
Other data from Health Services Research said that costs were less than half for patients who had early access to a physical therapist compared to those who waited three months to a year to visit a physical therapist.
“We have significant data that shows that earlier access to physical therapy for common musculoskeletal conditions significantly reduces need for imaging, and is likely to reduce it by 29 percent,” says Dr. Thomas Werner, who is the program director of the doctor of physical therapy program at the University of St. Augustine in Dallas. “Following an injury, most folks don’t move, but need to increase mobility at all levels of recovery. If we can get people sooner rather than later, the healthcare provider’s job is easier.”
“The demand is there,” Werner says. “As we know, getting into our MD’s office is often times a problem. This allows intervention to begin, sooner.”
A physical therapist can also give a more detailed evaluation and clearer information to a physician than a patient might to describe their injury, Werner says. “With more disciplines working together, it will only improve the care and the outcome.”
“With earlier access, cost of care is reduced,” Werner says. “The longer they go without being seen, the costs increases. Catching things earlier decreases cost.”
Those who spoke against the legislation last summer were members of the Texas Orhtopedic Association, Texas Medical Association, the Texas College of Emergency Physicians, the Texas Society of Anesthesiologists, and the Texas Academy of Family Physicians, who all may lose patients if a physical therapist gives a patient the information and exercises they need before they make it into a physician’s office. There are also worries that a the different between training might lead to misdiagnoses if a patient doesn’t see a physician first.
But Dr. David Teuscher, an orthopedic surgeon from Beaumont who was past president of the Texas Orthopedic Association, says physical therapists have been great members of his teams, including training and work in the military. He says there is no animosity between physicians and physical therapists, and think they can work together. “We are all a team; there is no animosity here,” he says. “Patients don’t care how much you know until they know how much you care. If you play as a team, you can win.”
