A new Texas law going into effect September 1, 2019 will make it easier for the state’s healthcare consumers to access short-term treatment from a physical therapist.
During the 86th Session this spring, the Texas Legislature passed House Bill 29, which removes the requirement to obtain a prescription for therapy prior to receiving physical therapy treatment. The following are the main provisions of the measure:
Beginning on September 1, 2019:
- Patients will be able to choose to see a physical therapist without a prescription for either 10 or 15 CONSECUTIVE business days. (How many treatment days are available for each case will depend on the specific post-graduate training of each individual therapist.)
As of November 1, 2019:
- Patients choosing to see a physical therapist without a referral will be asked to sign a disclosure stating that they understand that physical therapists do not make “medical diagnoses” of illness or disease.
Until now, Texas had been one of only two states that do not allow access to physical therapy treatment without a referral.
Removing barriers to physical therapy care can drastically decrease the societal costs of having workers miss work due to injury or having elderly citizens lose their independent living status. In addition, studies consistently show a correlation between early physical therapy treatment and significant reduction in the use of opiod pain medications for musculoskeletal pain issues, which affect nearly half of the U.S. adult population. Pharmacologic pain management prescriptions cost the health care system $854 billion dollars annually, and more than 115 deaths occur each day due to opiod overdose.
Early access to physical therapy has been shown to also significantly lower’s patients’ out of pocket costs for medical care, as well as insurance costs, for a variety of musculoskeletal health issues. For example, a study by Health Services Research of patients with low back pain found that patients who were able to see a physical therapist at the first point of care had a 15 percent lower chance of requiring an emergency room visit to manage pain, as well as a 28 percent decreased probability of needing costly medical imaging. Additionally, these patients had a remarkable 89 percent lower probability of utilizing an opiod pain medication prescription. All of these benefits result in significantly lower costs of total medical care, as well as in better functional outcomes for the patient.
Physical therapists’ expertise in optimizing movement and musculoskeletal function for patients of all ages has a significant impact on keeping Texans healthy and involved in their work and daily activities. A physical therapist’s ability to keep patients healthier also decreases the systemic costs of some of the most prevalent disease processes in this country, such as cardiac disease and diabetes.
As a result of the new law, patients will be able to access a physical therapist directly, without stopping first at another medical practitioner’s office. Here are several scenarios in which quicker access to a physical therapist will be helpful:
- A patient having a flare-up in back pain after working in the yard on the weekend will be able to choose to see a physical therapist for hands-on treatment and pain management as soon as they wish. Often, mechanical pain episodes such as this will respond and resolve within several treatments during a short period of time, particularly if the problem is addressed quickly. Being able to access care quickly can result in less missed work or missed recreational activity due to joint and muscle pain.
- Patients with known chronic health issues will be able to periodically check in with their physical therapist for maintenance care and/or “tune-up” treatments. For example, someone experiencing neck or back pain associated with a progressing pregnancy, or knee arthritis acting up because of a recent long car trip, or lowered endurance after a recent cancer treatment, will now have an easier way to seek physical therapy treatment rather than having to first request a prescription from their physician.
- Patients with injuries that are likely to ultimately require complicated care will be able to get a physical therapist’s advice about how to manage their condition until further imaging or surgical consult is possible. If someone has significantly injured a joint or muscle, for example, and is having difficulty moving around and participating in normal activities, it will be possible for them to seek guidance from a physical therapist about how to use a sling, crutches or a brace, or how to revise office or bedroom set up to aid functionality in this interim period. Caring appropriately for an acute injury can smooth the path of longer-term care by limiting compensations in movement that can create unrelated pain and/or allow additional mechanical issues to develop. Decreasing the wait time between injury and assessment by a health care provider will help to streamline this process.
- Well-care and preventative care for the musculoskeletal system will be more readily available. Consumers are already able in some instances to choose to see their physical therapist directly for general assessments or check-ups to help keep their bodies in optimal working condition. Strong, mobile joints and muscles are a powerful tool in the management and prevention of health issues such as heart disease, diabetes, depression, and dementia. Once people are more accustomed to seeing a physical therapist as a primary care resource, they will hopefully be more inclined to ask for advice and activity recommendations BEFORE a significant problem compromises daily function. This will ultimately save both individuals and the community in time and health care costs.
While House Bill 29 will improve Texans’ ability to access a physical therapist quickly, it stops short of enabling patients to utilize physical therapy services without barriers. Longer-term care expected to extend past the initial 10-15 consecutive day interval allowed by the bill will continue to require a prescription. Hopefully, patients needing ongoing treatment will find that the process of obtaining a prescription will be streamlined after House Bill 29 takes effect, as communication patterns between physical therapists and other health care providers adapt to the new law’s stipulations. Future legislative efforts by the Texas Physical Therapy Association and the Texas Board of Physical Therapy Examiners will undoubtedly be forthcoming to adjust legislative measures with the aim of optimizing health care access for Texas’ physical therapy consumers.