RE: Merits of Direct Access

December 8, 2004

Ron,

When I fax over a prescription to a physician with a PT dx,the

treatment, frequency, and duration written on it, I am in essence

providing direct access because I am the expert in clinical decision

making for musculoskeletal and neurological impairments in physical

therapy. Last time I checked, my physician did not graduate from an

accredited PT program. I do not pretend to know what a doctor's job

is and I don't think that most physicians know what a therapists job

is. You even wrote that most MD's don't know what the scope of

practice is for OT's. So how can it make you feel " better " that a

physician is " supervising " or " agreeing " with your treatment plan?

Therapists have been practicing autonomy (or without MD direction)

for years. It's called calling the doctor's office and specifically

telling them what you want your script to read or what treatment you

want to perform for your pt. As long as you can have that

intellectual conversation with the physician, they will agree with

you. I am thrilled that Ohio now has direct access. Hopefully, it

will evolve into truly changing our practice and role in the health

care community.

Botkin, MPT, PT

>

> When one speaks of 'direct accesss' there are really two

concepts:

>

> (1) Consumer direct access and (2) Medicare direct access

>

> CONSUMER DIRECT ACCESS: implies that consumers can legally

access

> therapy services without the need for a physicians' referral.

Typically,

> this occurs at the State level and is worded in a profession's

practice

> act. In states with consumer direct access, a client can simply

walk-in

> off the street and receive therapy services. These client's are

almost

> always 100% self-pay because third party insurance does not

recognize

> this type of therapy as medically necessary because it is not

ordered by

> a physician

>

> MEDICARE DIRECT ACCESS: implies consumer direct access that

may be

> recognized as medically necessary and thus may be reimbursable.

Medicare

> direct access will occur at the National level and be

administered

> regionally by Medicare's fiscal intermediaries.

>

> In Florida, as in many states, OT has consumer direct access. I

am not

> sure about PT in other states, but I believe in FL., PT's have

consumer

> direct access and can legally provide a certain number of visits

without

> a physician referral.

>

> To my knowledge no therapy services currently have Medicare

direct

> access.

>

> I provide the above because I wish to hear reader's comments

on the

> merits and drawback of direct access- both consumer and Medicare

types

> of access:

>

> For one, I do not believe that eliminating physician referrals,

for any

> reason, is a good idea. In general, physicians have a more

complete

> picture of client's medical history than any one single

profession.

> Because the patient's medical record should be the central

repository

> for all medical information, a referring practitioner should

have easy

> access to many different types of medical information.

Educationally, a

> physician is better trained and experienced to manage the

myriad of

> needs that some compromised patients experience. Hopefully,

referring

> physicians also include therapy services documentation as part of

their

> overall decision making process regarding patient care,

however, my

> experience with this is less than positive.

>

> Of course, the reality is that for the most part, physicians

are not

> innately involved in therapy care, especially as it

relates to

> occupational therapy. Typically, I fax my plans of care and

they are

> signed by the doctor and then returned. I imagine that most

doctor's

> never read nor understand my plans. I know that most

physician's don't

> even no what an OT does. So, in reality, nothing will really be

lost by

> going to direct access.

>

> I have treated a few clients without physician involvement , but

I feel

> 'better' having physician oversight for my treatment. Maybe it's

just my

> inexperience as a practitioner or liability concerns, but I am a

little

> unsure about not having a line of protection.

>

> So, I am undecided on direct access in general. What do YOU feel

about

> the merits and drawbacks of direct access.

>

> Thanks,

>

> Ron Carson

December 8, 2004

Hello :

You ask a good question to which I have no good answer. I just know that

it does. However, I have a sense that in the near future, because of

conversations like this, that I will feel differently about direct

access.

Ron

===============<Original Message>===============

On 12/8/2004, rbotkin@... said:

v> So how can it make you feel " better " that a

v> physician is " supervising " or " agreeing " with your treatment plan?

December 9, 2004

Hi Ron,

I wish to address the specific statement below

Your comments:

I have treated a few clients without physician involvement , but I

feel

'better' having physician oversight for my treatment. Maybe it's just

my

inexperience as a practitioner or liability concerns, but I am a

little

unsure about not having a line of protection.

My Response:

I believe that we as therapists need to step up to the plate on the

issue of our professional responsiblity. Far too many therapists, and

particularly those providing care in institutional settings, want

increased professional autonomy and independence from the constraints of

physician oversite but are reluctant to accept the consequences of this.

Those consequences are significant increases in responsibility and

expectations of accountability in a free market system without being

able to rely on the physician fall back.

As a clinician well before I was an administrator I felt there were

many cases that could have been effectively managed by me as a

professional therapist without the need for physician management.

Medically stable conditions such as traumatic brain injury, and

repetitive strain injuries come quickly to mind. I could have provided

the care at much less cost and much more efficiently than having to

navigate the world of orders and authorizations. Conversely, there were

cases that were referred to me that clearly required better medical

management than was being provided at the time of intake. In Washington

State we have a clause called " duty to refer " stating that when we

observe an active pathology in a patient not receiving physician care,

we have a duty to refer that patient to the appropriate medical

practitioner. Failure to do this can result in disciplinary action from

the state but more importantly can result in an adverse outcome for my

patient. I am confident of my treatment skills and my abilities to

produce a quality outcome in the patients I treat. I am equally

confident that I can recognize when additional resources are needed.

If we want to truly be recognized as professionals within the medical

model we have to have the confidence and courage to step up and take the

responsiblity that comes with that. I believe those clinicians who are

successful in private practice do this on a regular basis and I support

their efforts towards direct access. I just wish I could see the rest

of our colleagues somehow step up, stop thinking of ourselves as 9-5

employees and take our place in medicine, with the benefits and the

risks.

Redge L MS OTR/L

Director of Rehabilitation Services

on Hospital

Bremerton, WA 98310

Administrative Assistant:

Wanda Kotte: wandakotte@...

December 9, 2004

I would like to add one more comment to those made by Redge; any licensed

professional who thinks that " physician oversight " offers any liability

protection, is sorely mistaken. If that were the case, PTs would never be

sued, let alone lose those suits, since " oversight " exists the vast majority

of the time.

Aegis is a nonexistent when you yourself are regulated.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Merits of Direct Access