It’s A Gray Area:

I will get this fact out of the way at the beginning: My wife is a physical therapist, and she owns and manages her own physical therapy practice in the City of Orange. So maybe I have a bias.

Having said that, I want to call your attention to a change that should be made that will reduce the costs of effective health care and increase the general fairness of the health-care system. What is that change? Allow “direct access” for physical therapy in California.

What does that mean? Today patients who are covered by health insurance can go for evaluation and treatment to their chosen chiropractor, acupuncturist, marriage and family counselor, or psychologist and have those visits reimbursed by their health insurers without being first required to obtain a prescription from a physician. But to go to see a physical therapist, patients must first obtain that prescription. This, of course, requires patients to spend extra time and money before they can obtain their physical therapy.

How did this disparity occur? Probably, it has been perpetuated because the physical therapists simply have not had as strong a political lobby as the other health-care professions. But it originated in 1965, when then-State Attorney General Thomas Lynch issued an opinion that interpreted the Legislative intent of the Physical Therapy Practice Act to require access to a physical therapist only after a prescription from a physician. And this opinion was rendered even though it was and still is contrary to the protocol of Medicare and many managed health-care plans.

Currently, 44 states allow some form of direct access for the patients/consumers to physical therapists without a prescription. But California does not. That means that, on the average, the costs to patients in California are 123% higher than those in other states. And that hurts everybody, except the physicians.

In addition, the Wall Street Journal cited a study by Seattle’s Virginia Mason Medical Center that found that putting “physical therapy in front” when treating patients with back pain generally resulted in less time waiting for appointments, fewer MRIs, and a decrease in time lost from work for the patients.

Why do these positive results occur? Recently Consumer Reports published a survey of more than 14,000 patients that showed physical therapist and other “hands on” therapies outranked treatment by other medical specialists for back pain.