When Geoff Klein was a physical therapist in private practice in Boulder in 2009 and 2010, about 20 percent of his patients came to him without a referral from a physician. He valued not only the extra business but also the opportunity to forge a closer clinical connection with the people he treated. “I developed a relationship with many of them,” Klein said. “If they had a degenerative issue, for example, I could just ask them to come back in for another appointment.”
Today, Klein is an outpatient orthopedic physical therapist at University of Colorado Hospital. He still works in a “direct access” state that allows patients to see physical therapists without a physician referral, but Klein’s caseload doesn’t include any. That’s
because the hospital’s bylaws prohibit him and all of his colleagues from doing so. Klein and his physical therapy colleague Kelly Albers, PT, would like to change that. They say direct access streamlines the caredelivery process, improves patient satisfaction and reduces costs.
Now they want to put those contentions to the test with a direct access pilot project at the hospital’s AF Williams Family Medicine Clinic in Stapleton and the Boulder Family Medicine Clinic. They hope to launch the program next January. “Direct access is about getting patients into the clinic sooner,” Klein said. “That frees physicians up to see sicker patients, and it saves patients a copay for an office visit to a physician.”
Immediate seating. In a direct access environment, a kid who,say, twists his ankle playing soccer would see a physical therapist right away for an evaluation, treatment and education, instead of waiting to see a physician for a referral, said Albers, who worked
in hospital-based and outpatient clinics in Minneapolis that had direct access. “If we can work on patients sooner, they will heal quicker,” she said. “That can be a win for the organization and for insurers.”
Direct access also could help the hospital immediately tap into a large pool of potential patients – its own employees. Because of the hospital’s bylaws, the CU Health Plan, which covers thousands of staff from UCH, the University of Colorado and University Physicians, Inc., requires a physician referral for physical therapy services, even though the plan administrator, Anthem, does not. But prying the doors open a bit wider for patients at UCH has proved to be a challenge. In fact, this is Klein’s second attempt. He began working on direct access in earnest in 2011 after he was promoted to the hospital’s physical therapy “specialist” position, which grants physical therapists four hours per week to conduct research, mentor and develop projects. A pilot in the Anschutz Outpatient Clinic did not sign up a sufficient number of people, primarily because so many of the clinic’s clientele are Medicare patients who have multiple conditions and require a plan of care signed by a physician.