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Physical Therapists Fight Mandatory Referrals

Physical therapists are pushing a bill to allow them to treat patients without a physician referral. The measure faces stiff opposition from physician groups, which say it could present a health risk to patients.

Chase Bearden hopes to convince lawmakers that he, and other's needing physical therapy, should be allowed to go to a physical therapist without getting a doctor's referral first.

For Chase Bearden, physical therapy is a constant. At 17, the former high school gymnast broke two vertebrae in his neck during a routine practice and was paralyzed from the chest down. Now Bearden, 34, who went from being an athlete to learning to maneuver in a wheelchair, routinely visits his physical therapist to work his back and shoulders and stay agile.

But Bearden can't go straight to his therapist — under Texas law, anyone who wants to see a physical therapist has to first see a physician and get a referral. For a recurring condition like Bearden's, a referral must be updated annually — meaning another trip to the physician, and another co-pay. This legislative session, Bearden is trying to convince lawmakers that for him and others in need of routine physical therapy, direct access is vital.

“Just getting into a doctor takes three or four days,” said Bearden, who has maintained an active life, playing wheelchair rugby and working as director of advocacy for the Coalition of Texans with Disabilities. “In that amount of time, I could have made the issue even worse.”

A bill that would allow physical therapists to treat patients without a referral is scheduled for a hearing before lawmakers on Wednesday, along with a series of other bills aimed at expanding the so-called "scope of practice" of certain practitioners.

Dr. Susan Bailey, president of the Texas Medical Association, said referrals are necessary to protect patients and to make sure they get the treatment they actually need. A patient who shows up to the physical therapist with a sore back could actually have a kidney infection or a perforated ulcer, Bailey said, ailments physical therapists aren't trained to recognize or treat.

“We believe it’s a patient safety issue,” she said. “Physical therapists do a wonderful job, but they are trained to give therapy — they’re not trained to diagnose."

But Paul Hardin, executive director of Texas Physical Therapy Association, said allowing direct access to a physical therapist would cut down on costs for patients and will get them the treatment they need quicker than if they must wait to see a doctor first. Hardin pointed to a 2005 study that showed back-pain patients who went directly to a physical therapist reduced their costs by half, and went back to work sooner than their counterparts who went to a doctor first.

Hardin said 17 states currently allow some form of direct access to physical therapists, as does the military. And he said that currently, all kinds of practitioners can refer a patient to a physical therapist, from a physician to a dentist, chiropractor or nurse practitioner. A physical therapist should be just as able to know when a patient needs physical therapy as any of those practitioners, Hardin said.

“This is about giving the educated consumer the choice to go to a physical therapist,” he said. 

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Health care State government 82nd Legislative Session Texas Legislature