Proposed legislation could increase Alabama patients’ access to physical therapists

A prefiled bill would reduce the number of physician referrals a patient in Alabama needs to get physical therapy. 

The legislation, SB 13, sponsored by Sen. Tim Melson, R-Florence, would only require a doctor’s referral for the first physical therapy visit. Any subsequent visit related to the initial visit would not require a referral. 

A law passed in 2012 requires most patients get a referral from a physician for each visits. The law provides exceptions for children with a diagnosed developmental disability and nursing home patients.

“You got a hip problem and it’s the same pain again, you ought to be able to go see [a physical therapist] without having to go to a doctor and get referred again,” Melson said.

The state senator said that having to get referrals for injuries that have already been evaluated only delays treatment.

“Let’s say, I’m out on the farm in rural Alabama, and I’ve been getting physical therapy for back pain and all of a sudden it flares up again, whatever the treatment, whether it’s heat, ultrasound, whatever,” Melson said, “I may have to wait two more weeks to get into my doctor just to refer me to this person I was gonna go to anyway.”

Melson said this is something he’s looked over the last few years as an attempt to form a compromise between physical therapists, who want direct access to patients without referrals, and physicians, who would prefer to keep the current system in place.

Messages seeking comment were left with the Medical Association of the State of Alabama, which represents physicians in the state. 

Kathy Miller, executive director of the Alabama Board of Physical Therapy, said they don’t have an official stance on the bill, but that they don’t have a reason to oppose it.

“Our role and responsibility is to protect public interest through state statutes that’s in place,” she said. “And based on evidence from states with direct access for physical therapy, there’s no indication that direct access to PT will pose an increased threat to public safety or danger.”

According to the American Physical Therapy Association, Alabama is one of three states in the U.S. with “limited direct access.” This means that access to physical therapy care is only available under certain criteria. 20 states have what is considered unrestricted direct access, while 27 states have direct access with some provisions/restrictions.

In a statement, the Alabama chapter of the American Physical Therapy Association said the current restrictions did not serve anyone. 

“These restrictions do not recognize the professional training and expertise of the licensed physical therapist, nor do they serve the needs of those patients who require physical therapy but whose care is unnecessarily interrupted by these restrictions,” the statement said.

A 2018 review of nearly 1,600 studies suggests that direct access to physical therapy resulted in fewer treatments, visits to physicians, imaging tests, non-steroidal anti-inflammatory drugs and less need for secondary care. Patients also reported higher satisfaction with the service compared to physician-referred treatments. Additionally, direct access was associated with lower costs per patient. But patients had a higher education level and were younger in age. They also tended to have less severe conditions and were mostly experiencing issues related to the spine.