Lowering costs of health care - by Judge Jim Gray

I will get this fact out of the way at the beginning: My wife is a physical therapist, and she owns and manages her own physical therapy practice in the City of Orange. So maybe I have a bias.

Having said that, I want to call your attention to a change that should be made that will reduce the costs of effective health care and increase the general fairness of the health-care system. What is that change? Allow “direct access” for physical therapy in California.

What does that mean? Today patients who are covered by health insurance can go for evaluation and treatment to their chosen chiropractor, acupuncturist, marriage and family counselor, or psychologist and have those visits reimbursed by their health insurers without being first required to obtain a prescription from a physician. But to go to see a physical therapist, patients must first obtain that prescription. This, of course, requires patients to spend extra time and money before they can obtain their physical therapy.

How did this disparity occur? Probably, it has been perpetuated because the physical therapists simply have not had as strong a political lobby as the other health-care professions. But it originated in 1965, when then-State Attorney General Thomas Lynch issued an opinion that interpreted the Legislative intent of the Physical Therapy Practice Act to require access to a physical therapist only after a prescription from a physician. And this opinion was rendered even though it was and still is contrary to the protocol of Medicare and many managed health-care plans.

Currently, 44 states allow some form of direct access for the patients/consumers to physical therapists without a prescription. But California does not. That means that, on the average, the costs to patients in California are 123% higher than those in other states. And that hurts everybody, except the physicians.

In addition, the Wall Street Journal cited a study by Seattle’s Virginia Mason Medical Center that found that putting “physical therapy in front” when treating patients with back pain generally resulted in less time waiting for appointments, fewer MRIs, and a decrease in time lost from work for the patients.

Why do these positive results occur? Recently Consumer Reports published a survey of more than 14,000 patients that showed physical therapist and other “hands on” therapies outranked treatment by other medical specialists for back pain.

So, conservative physical therapy treatment not only is less invasive and less expensive, but often works better than other approaches.

To become licensed, physical therapists must graduate from a physical therapy program accredited through the Commission on Accreditation for Physical Therapy Education.

And, since January of 2003, only physical therapists who have obtained a master’s or doctor’s degree can even be considered for that accreditation.

Of course, if any health-care professionals determine that a patient has symptoms or conditions that are outside their field of expertise, they must refer the patient to the appropriate health-care professional.

But otherwise, just as in any other profession, the patient and consumer should be able to choose which health-care professional to see and trust for evaluation and treatment. And this is particularly true today, when the health-care industry is in such a crisis.

In an earlier column we discussed the benefits of allowing pharmacists to dispense to patients all non-addictive drugs except antibiotics without a prescription, and that not allowing this result affirmatively wasted the patients’ time and money.

The reasons are the same for physical therapists. Direct access would allow these educated and skilled health-care professionals to practice their profession and, along the way, would also reduce the costs and waiting time for treatment.

What can be done about this situation? At the moment, there is a bill that will be voted upon in the California Legislature in the next two weeks to provide direct and equal access for patients to physical therapy. It is Assembly Bill 721, and it merits your support. All it would take is for you to spend a few minutes to contact your representative in Sacramento and voice your support for this measure.

Direct access is a common-sense approach to health-care delivery that will save you time and bother, eliminate the burdens and costs of unnecessary visits to physicians, and often lead to quicker pain relief and recovery from injuries when you need them most. And along the way it will also provide for more basic fairness in the health-care field in general.

To me, that is a win-win situation for everybody. But it won’t be implemented without your help.



JAMES P. GRAY is a retired judge of the Orange County Superior Court. He be contacted at JimPGray@sbcglobal.net. www.judgejimgray.com