One of the most heated political battles of the current legislative session pits doctors against physical therapists. The two groups of medical professionals are squaring off over state Sen. Fred Mills’ bill to allow patients “direct access” to physical therapy without a doctor’s referral.
Current law in Louisiana requires patients who could benefit from physical therapy to get a doctor’s referral first. The vast majority of other states allow patients to access physical therapy without a doctor’s referral.
Mills, R-Parks, and other supporters of his Senate Bill 291 say the measure would save time and money — and improve patient care by letting people get needed physical therapy immediately, before their conditions worsen. They note that patients often have to wait weeks before they can see specialists who ultimately refer them to physical therapy anyway — but during that interim a relatively minor injury can get a lot worse.
Opponents of the bill include orthopedists who say the measure could threaten patient care because physical therapists cannot order X-rays that could detect more serious conditions, such as cancer. Supporters say that’s a “scare tactic” and note that 43 other states already allow direct access, and those states consistently report better patient outcomes — at lower costs — than Louisiana.
Moreover, patients in Louisiana can already seek treatment directly from chiropractors, massage therapists and personal trainers without a doctor’s referral — and physical therapists typically have significantly more medical training than those providers.
Both sides are lobbying lawmakers hard — and taking their cases to the public.
This fight is not just about patient care. It’s also about money. Requiring people who need physical therapy to first get a doctor’s referral means that the referring docs get to charge the patients — and their health insurers (or Medicaid) — for office visits, examinations, possibly X-rays and other forms of treatment before referring them to physical therapy.
In fairness, there are many cases in which a patient will not need physical therapy, and in those cases a treating physician will prescribe other forms of treatment after a thorough examination. It’s also true that both disciplines are trained to detect serious medical conditions during the initial examination process.
Supporters of SB 291 say concerns about cancer and other catastrophic illnesses have been addressed by an amendment that senators placed on the bill before they approved it by a lopsided 31-7 vote. The amendment requires every physical therapist to notify a patient’s health care provider within 15 days of commencing treatment — and to refer a patient to “an appropriate health care provider” after 30 days if the patient “has not made measurable or functional improvement.”
Supporters say the bill’s current form keeps treating physicians in the loop and gets patients to their doctors quickly if physical therapy does not produce real results. The Louisiana Medical Association (LMA) still opposes the measure, however.
SB 291 now awaits action by the House Committee on Health and Welfare, where its future is uncertain. It could come up for a committee vote this Wednesday (April 27).