His situation is not unusual in today’s health care environment, yet I am surprised. Monday: primary care physician; Wednesday: rheumatologist; and Friday: orthopedist—this is a week in the life of a 65-year-old man who suffers from excessive joint pain due to rheumatoid arthritis.

My first reaction was: what about a physical therapist? No such luck. His physician had so far denied his request to see a physical therapist. Thus, he had no option but to follow his physician’s plan for his painful condition.  

As physical therapists know, their patients often arrive at the clinic with not just one problem, but with a myriad of conditions that affect one another and make the patient’s functional capabilities difficult. In states where patients have direct access to physical therapists, patients can get a head start in treating discomfort from conditions such as rheumatoid arthritis. Though physical therapists must notify patients’ physicians about any intended treatment, direct access may be the first step in making physical therapy a regular part of a patient’s health care regimen. Medicare patients are awaiting such a luxury.

As this issue of Physical Therapy Products arrives in your mailbox, the 2005 Annual Conference and Exposition of the American Physical Therapy Association (APTA) will be under way in Boston. One of the APTA’s pressing issues is to support and encourage the passage of the Medicare Patient Access to Physical Therapists Act (HR 1333), which was introduced by Congresswoman Melissa Hart (R-Pa) and Congressman Earl Pomeroy (D-ND).

“Medicare direct access to physical therapists will allow patients to select a physical therapist as part of their health care team to address functional impairment and limitation, disability, or change in health status,” says Justin Moore, PT, director of congressional affairs of the APTA. “Active consumer involvement in health care decisions results in more efficient and effective delivery of health care services, including physical therapy.”

According to the APTA, in addition to eliminating the physician-referral requirement, the legislation would lower patient costs and increase functional outcomes. In its 1994 study, A Comparison of Resource Use and Cost in Direct Access Versus Physician Referral Episodes of Physical Therapy Background and Purpose, the APTA found that direct-access visits were shorter, encompassed fewer numbers of services, and were less expensive than physician-referral visits. Lower severity of the patient’s condition, the overutilization of services by physicians, and the underutilization of services by physical therapists, were cited as reasons for the data supporting direct access.

If HR 1333 garners enough support and passes, it would broaden patients’ options for finding solutions to manage their health care. As the 65-year-old patient continues to seek medical professionals who will effectively treat his pain, direct access for Medicare patients will help him include a physical therapist in his circle of trust of health care specialists.