1. Today’s Challenge--- Tomorrow’s Opportunity

2. Direct Access How Has It Changed Our Practice?

3.  Survey to determine use, barriers, and secrets of success  Support for chapters  Resources for members

4.  Nine chapters selected for participation  1800 respondents  Survey looked at: Utilization Barriers Member needs

5. Utilization  >50% reported seeing patients without referral but percentage of direct access patients <10% in most cases  Use of direct access varied by setting (11.6% of PTs in hospital settings to 81.3% of PTs in private outpatient settings)  Use varied by state (37% in newer direct access states to 82.6% in states with longer history of direct access)  Majority of patients seen via direct access are former patients or family/friends of patients

6. Payment  74% of respondents seeing direct access patients reported NO denials for payment for lack of referral  Although reimbursement often mentioned as a barrier to direct access, there’s an indication that this barrier may be more perceived than real in many situations.

7.  Marketing PTs reported difficulty letting the public know about their direct access services Marketing tools and materials for consumers and non-physician referral sources were frequently requested resources. www.apta.org/practicemarketing

8.  PTs Comfortable with Clinical Abilities  PTs Worry About Damaging Referral Relationships  Certification Requirements Pose a Barrier

9.  Employer requirements that patients have a referral impose a significant barrier to direct access. Prevalent in hospital-based outpatient settings & often relates to Medicare & other compliance requirements Still common in practices mostly due to concerns about payment & referral source relationships Respondents indicated a need for help to remove employer/hospital/institutional restrictions

10.  Success, Success, Success!  Wonderful examples of innovation  Great stories of practice growth

11.  Direct access is my largest “referral source”. Over 30% of my patients come to our practice directly. PT in Washington

12.  In school settings, we no longer have the hassle of getting a physician referral every time a teacher asks for a PT consultation. This is a huge time saver and allows children to get the services they need more quickly. PT in Massachusetts

13.  During a difficult time for our practice when we had trouble getting insurance contracts and physician owned practice were on the rise, I found that direct access kept us in business and provided a new practice model that was soon thriving. PT in Colorado

14.  My patients have greatly benefited from direct access. I see many patients with BPPV and when they are dizzy, they need to be treated quickly. When they call, I can usually see them the same day. Direct access provides a great safety net for these patients since they know that they can get immediate help when they have problems. PT in Pennsylvania

15.  With direct access, I am the primary provider within my scope of practice. I am responsible for my patients. This increased professional responsibility may be stressful but is much more satisfying----& I believe it results in better outcomes for my patients. PT in Colorado

16.  Payment concerns  Referral source relationships  Marketing  Employer restrictions  Encouraging PTs to Embrace Change

17. Why is Direct Access So Critical to Our Practice?

18.  Improved access FOR patients Faster access Fewer visits Decreased cost and time

19.  Improved access TO patients Allows PTs to compete  With POPTS  With Hospital Organizations  With Other Providers

20.  Promotes professional autonomy  Supports collaborative (not hierarchical) relationships  Promotes a level of practice that is consistent with PT education

21.  Ability to provide fitness, health promotion, prevention & other cash based services that are not traditionally covered under insurance plans

22. Health Care Reform and Payment Reform will likely change the way we provide care and get paid for our services

23. Referral requirements could be a barrier to participation by PT practices in integrated delivery models such as Accountable Care Organizations (ACOs)

24.  Inter-professional models of care delivery are being promoted.  Right provider for the right patient at the right time

25. Prevention and health promotion will have increased support under health care reform. Direct access will be critical for physical therapists to play an important role in this area.

26. Technology & tele-health are becoming more widely used & accepted, especially in under-served areas

27. Shortage of primary care physicians may provide opportunities for PTs to become both the entry point & the manager of some patient conditions, but only if there is direct access

28. Preparing for Direct Access What YOU Can Do Now

29.  Review payer contracts and begin negotiations to remove referral requirements

30.  Redefine existing referral relationships Collaborative—not hierarchical Referrals should go both ways Ask for information---not permission Educate referral sources about direct access— arm yourself with facts!

31.  Build new key relationships Non-physician health care providers Industry Hospital administrators Coaches, trainers, parent groups

32.  Prepare PT clinicians both clinically and professionally Take advantage of provisions in current direct access law and use it now Conduct a “readiness” assessment Support PTs through the upcoming change in practice to ensure success

33.  Emphasize internal marketing to current and former patients—build a community!  Begin marketing efforts directed toward consumers now.

34.  Get members excited about practicing with direct access Have speakers at chapter and district meetings Publish articles in newsletters and on websites Provide case examples of direct access in different practice settings Direct access is important for ALL members regardless of practice setting and regardless of whether they personally use it

35.  Begin conversations with payers now ( A word of caution about the payment issue)

36.  Begin training new chapter leaders with new energy to take this forward  Plan a victory tour to educate and inform members  Plan presentations at chapter and district meetings on the “how to” once the legislation passes---to keep the momentum

37.  Educate PTs in hospital based outpatient settings about the specific requirements to implement direct access in their facilities

38.  Help members & chapters network with one another  Education for hospital based outpatient facilities  Articles, podcasts, webinars & resources at www.apta.org/directaccessinpractice www.apta.org/directaccessinpractice  Presentations at chapter & national meetings  Marketing support  Data

39.  Make a Difference! For your patients For your practice For the profession

40. Thank You! Nancy White, PT, DPT, OCS Associate Director, Practice APTA nancywhite@apta.org