low back pain evaluation

Study: Direct Access to Physical Therapy Lowers Cost, Speeds Recovery

In Physical Therapy by Seth Peterson, Physical Therapist Oro Valley

From new patient phone calls to current patients wanting to be seen for another musculoskeletal condition, one of the most common misconceptions we see in our practice is the issue of direct access. If you know that you’ll end up in physical therapy, or that you have a problem that physical therapists treat, can you just go straight to it? Will insurance pay? Will the physical therapist provide an accurate diagnosis?

Is Direct Access to Physical Therapy an Option?

In Arizona, and in most states in the U.S., nothing is stopping you from going straight to a physical therapist. You can just pick up the phone, call, and get in for a visit. The only “catch” is that some insurance plans try to stop you from doing this by requiring a pre-authorization. These plans are very rare. But, if you have one, it can be a headache. We often hear from patients that think Medicare requires pre-authorization. They do not.

Is Direct Access to Physical Therapy a Good Thing?

That is exactly what a recent study attempted to do. Before we get to that, let’s consider the evidence from another country. In the UK, patients who had direct-access had lower health care costs, improved outcomes, less disability, and more patient-centered care.(Miller et al, 2017) The idea supporting direct-access is that patients will have these benefits:

  • Get treatment on their first visit (not after seeing multiple providers)
  • Get fewer unnecessary tests (like MRIs that don’t help direct treatment)
  • Get fewer unnecessary procedures or medications (another study we covered in a blog showed an >80% reduction in opioid prescriptions)
  • Get education right away on how to move in a way that immediately helps to reduce the pain

Now, back to the study.

The Study

A study by Hon et al(2020) was just published where they looked at 66 studies that had evaluated whether direct access to physical therapy in the US had any impact on cost and outcomes when compared to physician-first systems.

The results? Starting with physical therapy cost less money, led to faster recovery, AND led to a better recovery than starting with a physician.

The results? Starting with physical therapy cost less money, led to faster recovery, AND led to a better recovery than starting with a physician. Why? Other studies have looked at reasons that drive healthcare costs and spending, and we’ve covered these in other blog posts. Starting with physician-led care more often leads to unnecessary testing and delays treatment that can actually help. By the time physical therapy begins, it is often too late for a full recovery to occur. 


Sandra Hon, Richard Ritter, Diane D Allen, Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis, Physical Therapy, , pzaa201, https://doi.org/10.1093/ptj/pzaa201

Miller J, Barber D, Donnelly C, et al. Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial. Trials.