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Health Services Research Direct Access Study
"A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy"
What the study/data shows :
- Reviewed 62,707 episodes of physical therapy using non-Medicare claims data from a Midwest insurer over a 5-year period.
- Found that patients who visited a physical therapist directly for outpatient care had fewer visits and lower overall costs on average than those who were referred by a physician, while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.
- A total of nearly 63,000 outpatient physical therapy episodes of care were analyzed – more than 45,000 were physician-referred and more than 17,000 were "self-referred" to physical therapists.
- Physical therapy episodes began with the physical therapist initial evaluation and ended on the last date of services before 60 days of no further visits.
- Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of physical therapy.
- Researchers found that self-referred patients had fewer PT visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year.
- In addition, overall related health care use – or care related to the problem for which physical therapy was received, but not physical therapy treatment – was lower in the self-referred group after adjustment. (Examples might include physician services or diagnostic testing.)
- Potential differences in functional status and outcomes of care were not addressed.
- Health care use did not increase in the self-referred group, nor was continuity of care hindered.
- The self-referred patients were still in contact with physicians during and after physical therapy.
- Data consistently showed lower use in the self-referral group, after adjusting for key demographic variables, diagnosis group, and case mix.
- Data also found that individuals in both groups were similarly engaged with the medical care system during their course of care and afterwards.
What researchers concluded as a result of the data:
Researchers suggest "the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases."
"Concerns about patient safety, missed diagnoses and continuity of care for individuals who self-refer may be overstated."
The findings "do not support the assertion that self-referral leads to overuse of care or discontinuity in care."
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