Today’s Challenge---Tomorrow’s Opportunity

Survey to determine use, barriers, and secrets of success

Support for chapters Resources for members

Nine chapters selected for participation

1800 respondents Survey looked at:

• Utilization• Barriers• Member needs

•Utilization >50% reported seeing patients without referral

but percentage of direct access patients <10% in most cases

Use of direct access varied by setting (11.6% of PTs in hospital settings to 81.3% of PTs in private outpatient settings)

Use varied by state (37% in newer direct access states to 82.6% in states with longer history of direct access)

Majority of patients seen via direct access are former patients or family/friends of patients

•Payment 74% of respondents seeing direct access patients reported NO denials for payment for lack of referral

Although reimbursement often mentioned as a barrier to direct access, there’s an indication that this barrier may be more perceived than real in many situations.

Marketing• PTs reported difficulty letting the public know

about their direct access services• Marketing tools and materials for consumers

and non-physician referral sources were frequently requested resources.

• www.apta.org/practicemarketing

PTs Comfortable with Clinical Abilities PTs Worry About Damaging Referral

Relationships Certification Requirements Pose a Barrier

Employer requirements that patients have a referral impose a significant barrier to direct access. • Prevalent in hospital-based outpatient settings &

often relates to Medicare & other compliance requirements

• Still common in practices mostly due to concerns about payment & referral source relationships

• Respondents indicated a need for help to remove employer/hospital/institutional restrictions

Success, Success, Success!

Wonderful examples of innovation

Great stories of practice growth

Payment concerns Referral source relationships Marketing Employer restrictions Encouraging PTs to Embrace Change

Improved access FOR patients• Faster access• Fewer visits• Decreased cost and time

Improved access TO patients• Allows PTs to compete

With POPTS With Hospital Organizations With Other Providers

Promotes professional autonomy Supports collaborative (not

hierarchical) relationships Promotes a level of practice that is

consistent with PT education

Ability to provide fitness, health promotion, prevention & other cash based services that are not traditionally covered under insurance plans

Health Care Reform and Payment Reform will likely change the way we provide care and get paid for our services

Referral requirements could be a barrier to participation by PT practices in integrated delivery models such as Accountable Care Organizations (ACOs)

Inter-professional models of care delivery are being promoted.

Right provider for the right patient at the right time

Prevention and health promotion will have increased support under health care reform. Direct access will be critical for physical therapists to play an important role in this area.

Technology & tele-health are becoming more widely used & accepted, especially in under-served areas

Shortage of primary care physicians may provide opportunities for PTs to become both the entry point & the manager of some patient conditions, but only if there is direct access

Review payer contracts and begin negotiations to remove referral requirements

Redefine existing referral relationships• Collaborative—not hierarchical• Referrals should go both ways• Ask for information---not permission• Educate referral sources about direct access

—arm yourself with facts!

Build new key relationships• Non-physician health care providers• Industry• Hospital administrators• Coaches, trainers, parent groups

Prepare PT clinicians both clinically and professionally• Take advantage of provisions in current

direct access law and use it now• Conduct a “readiness” assessment• Support PTs through the upcoming change

in practice to ensure success

Emphasize internal marketing to current and former patients—build a community!

Begin marketing efforts directed toward consumers now.

Get members excited about practicing with direct access• Have speakers at chapter and district

meetings• Publish articles in newsletters and on

websites• Provide case examples of direct access in

different practice settings• Direct access is important for ALL members

regardless of practice setting and regardless of whether they personally use it

Begin conversations with payers now(A word of caution about the payment issue)

Begin training new chapter leaders with new energy to take this forward

Plan a victory tour to educate and inform members

Plan presentations at chapter and district meetings on the “how to” once the legislation passes---to keep the momentum

Educate PTs in hospital based outpatient settings about the specific requirements to implement direct access in their facilities

Help members & chapters network with one another

Education for hospital based outpatient facilities

Articles, podcasts, webinars & resources at www.apta.org/directaccessinpractice

Presentations at chapter & national meetings

Marketing support Data

Make a Difference!• For your patients• For your practice• For the profession