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eCapitol News: Interim Study

Wednesday, September 11, 2013   (0 Comments)
Posted by: Amy Lee
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The House Public Health Committee heard an interim study Tuesday regarding patient access for physical therapy services. Rep. Arthur Hulbert presented the study stating Oklahoma is one of two states that does not offer direct access to Physical Therapy services. "Basically this study [Interim Study 2013H13-006] is to help increase access to care without increasing costs," said Rep. Arthur Hulbert, R-Fort Gibson, who requested the study. "We will be looking to see the norms and what the standards are."
Currently in Oklahoma, Hulbert said, patients must be referred to a physical therapist by a physician or third-party provider. Hulbert said there are some exceptions regarding access to care including children under the Individuals with Disabilities Education Improvement Act of 2004.
"Some concerns are will patients be placed at risk without a third-party or physician referral?" Hulbert said. "The summary: 48 states, US Armed Forces has the ability to access care without a referral. Oklahoma is one of two states that doesn't allow this."
The Healthcare Providers Service Organization, HPSO, released that "direct access is not a risk factor that we specifically screen for in the underwriting of our program nor do we charge a premium differential for physical therapists in direct access states."
Hulbert said HPSO monitors for risks and has not noted trends pertaining to direct access states regarding physical therapy.
"If there was any type of safety risk, insurance companies would be the first to pick that up," Hulbert said. "In a study [by Mitchell and Lissovoy] showed costs savings of $1,232 per episode. Total paid claims was 123 percent or 2.2 times higher…"
During questions, Hulbert said direct access has not been repealed in any state and it is not proven to impact insurance premiums. Hulbert said costs and services both rise when a physician referral is involved. Because Oklahoma is one of two states not offering direct access, Hulbert said Oklahoma is losing 15 to 20 percent of physical therapy graduates to direct access states.
"Right now, Oklahoma functions at the most restricted level as 17 states have unrestricted access, 9 states require a referral if no progress is made and 15 states require a referral or consultation within a time frame…" Hulbert said.
Representatives with the University of Oklahoma and Langston University both said students are prepared to practice at a direct access level. Students take a rounded course load of exams, assessments, interventions and plans of care, said Elizabeth Beasley, with Langston University.
"Students are trained to detect whether results require a need for a physician in each of their courses," Beasley said. "Students are trained in evaluation of many items including pulmonary conditions…
Two physicians attended the study and both are in opposition of direct access care. Points made included that a physician should be the primary consultant because a physician looks at the patient as a whole. Another point made was direct access puts patients at risk, particularly is the problem cannot be found without some sort of imaging tests.
Hulbert said the most common referrals for a patient to see a physical therapist is back or shoulder pain. Today, Hulbert said most insurance companies require physical therapy before an x-ray or magnetic resonance imaging be used on the patient.
"In Oklahoma, physical therapy is one that is restricted," Hulbert said. "Occupational therapy has direct access. Physical therapy is one of the highest educated and most restricted providers in the state of Oklahoma."
The committee also was scheduled to hear Chair David Derby's Interim Study 2013H-83, which would examined

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