title: US hospital-based direct access with radiology referral: an administrative case report.
abstract: OBJECTIVE
  Legislative gains in the US allow physical therapists to function in expanded scopes of practice including direct access and referral to specialists. The combination of direct access with privileges to order imaging studies directly offers a desirable practice status for many physical therapists, especially in musculoskeletal focused settings. Although direct access is legal in all US jurisdictions, institutional-based physical therapy settings have not embraced these practices. Barriers cited to implementing direct access with advanced practice are concerns over medical and administrative opposition, institutional policies, provider qualifications and reimbursement. This administrative case report describes the process taken to allow therapists to see patients without a referral and to order diagnostic imaging studies at an academic medical center. Nine-month implementation results show 66 patients seen via direct access with 15% referred for imaging studies. Claims submitted to 20 different insurance providers were reimbursed at 100%.
  
  
  CONCLUSIONS
  While institutional regulations and reimbursement are reported as barriers to direct access, this report highlights the process one academic medical center used to implement direct access and advanced practice radiology referral by updating policies and procedures, identifying advanced competencies and communicating with necessary stakeholder groups. Favorable reimbursement for services is documented.
authors.affiliation: a University of Illinois at Chicago , Chicago , IL , USA and.
authors.forename: Aaron
authors.initials: A
authors.lastname: Keil
authors.affiliation: b University of New England Physical Therapy Program , Biddeford , ME , USA.
authors.forename: Suzanne Robben
authors.initials: SR
authors.lastname: Brown
mesh_terms: D000046:Academic Medical Centers; D003406:Credentialing; D003952:Diagnostic Imaging / Q000191:economics; D017048:Health Care Costs; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008504:Medical Staff Privileges / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D017146:Models, Organizational; D019982:Organizational Case Studies; D059825:Physical Therapists / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D010814:Physical Therapy Department, Hospital / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D011050:Policy Making; D024382:Professional Role; D016730:Program Development; D011872:Radiology Department, Hospital / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D012017:Referral and Consultation / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014481:United States
keywords: Advanced practice; direct access; imaging