Retrospective analysis of physical therapy utilization by the specificity of the diagnosis and order written on the referral.
BACKGROUND
Arguments against reimbursement for direct access to physical therapy (PT) are that a physician examination is necessary to diagnose and that there is a potential for increased cost.


OBJECTIVE
To determine what percentage of PT referrals had a specific diagnosis and treatment orders. Additionally, specific and non-specific diagnoses and treatment orders were compared in regards to PT units billed, average visits per referral, and average cost per referral.


METHODS
The charts of 1,000 patients treated in outpatient PT underwent a retrospective chart review. Interferential statistics were used to determine if there was a statistically significant difference between specific and non-specific diagnoses and treatment orders in regard to PT units billed, average visits per referral, and average cost per referral.


RESULTS
Twenty-nine percent of all referring diagnoses were non-specific in nature and 58% contained treatment orders that were non-specific. Charts with a specific diagnosis had a statistically significant higher utilization as compared to non-specific diagnoses (p ≤ 0.001). Patients with a specific treatment order also displayed a statistically significant larger average in billed units, average visits per referral, and average reimbursement per referral than those without a specific treatment order (p ≤ 0.0001).


CONCLUSIONS
Our findings suggest that a physician diagnosis and referral may not be required to direct care for patients seeking PT services. Third-party payers that require a physician referral for PT services may be delaying access to healthcare and increasing costs.
a Department of Rehabilitation and Sports Medicine , University of Connecticut Health Center , Farmington , CT , USA.|b Physical Therapy Program , University of Connecticut , Storrs , CT , USA.
Sean P
SP
Riley
a Department of Rehabilitation and Sports Medicine , University of Connecticut Health Center , Farmington , CT , USA.|b Physical Therapy Program , University of Connecticut , Storrs , CT , USA.
Vincent
V
Tafuto
c Department of Rehabilitation Sciences and Center for Rehabilitation Research , School of Health Professions, Texas Tech University Health Sciences Center , Lubbock , TX , USA.
Jean-Michel
JM
Brismée
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D018588:Fee-for-Service Plans; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D009819:Office Visits / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies
Direct access; physical therapy; reimbursement