Though it hasn’t made big headlines, a bill passed this spring by the General Assembly is a major step forward for Hoosiers who want more choice, greater efficiency and lower cost in their health care.
HB 1034, which became law July 1, gives Indiana residents direct access to physical therapy, meaning that a person can be evaluated by a physical therapist and receive up to 24 days of treatment without first obtaining a physician’s referral. The new provision also allows nurse practitioners and physician assistants to refer patients for physical therapy without the additional step of obtaining a physician’s approval.
Until now, Indiana was the only state that did not allow direct access to evaluations by physical therapists, and one of only three states that did not allow even limited access to treatment without a referral. Efforts to change the law date to the 1980s but repeatedly were derailed by lobbyists representing other segments of the health care industry. Credit is due to the bill’s author, Rep. David Frizzell; to its Senate sponsor, Patricia Miller; and to the Indiana Chapter of the American Physical Therapy Association for its tireless work in educating legislators and the public.
The change acknowledges key trends in health care, including the promotion of wellness to control costs and the fact that, as demand for primary care exceeds the availability of family physicians, patients are accessing care through a variety of channels. Just as nurse practitioners and physician assistants play increasingly vital roles in the health care system, physical therapists also fill a niche, which focuses on improving or restoring mobility, using their specialized knowledge of movement and the human body.
Physical therapy is a logical first choice for many kinds of patients, including athletes with sprains and strains, adults with everyday aches and pains, and patients with chronic conditions such as Parkinson’s disease or multiple sclerosis who need occasional guidance to manage mobility problems. Research has shown that patients who visit a physical therapist directly for outpatient care have fewer visits and lower overall costs on average than when referred by a physician. (As always, patients should work with their insurance providers in advance to ensure that physical therapy services are covered.)
A longtime concern about direct access was that physical therapists might fail to identify signs and symptoms that should be evaluated by other health care providers, but studies from direct-access states have shown this fear to be unfounded. At accredited programs such as the Krannert School of Physical Therapy at the University of Indianapolis, the state’s leading producer of physical therapy practitioners, the curriculum already prepares students to screen and evaluate patients in a direct-access environment, collaborating with physicians and other professionals as needed. A doctoral degree, earned through years of rigorous classroom and clinical training, is now the standard credential for new physical therapists entering the field. In light of the new law, these well-trained practitioners have more reason to stay in Indiana.
In time, perhaps Indiana will join the 17 states that have eliminated arbitrary time limits and allow unrestricted access to physical therapy services.
For now, at least, Hoosiers should applaud their elected officials and celebrate a common-sense move that promises to reduce unnecessary appointments and fees, speed patients’ recovery and give all of us a stronger voice in our health care.
STEPHANIE KELLY Dean College of Health Sciences University of Indianapolis