Merits of Direct Access

[Guest guest]

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