Summitting the Direct Access Peak


Applying 7 steps toward sharing our diagnostic abilities!

By Lynn Steffes, PT, DPT

As a huge proponent of direct access in physical therapy I am stunned at how often some degree of direct access is available by law and accessible through many third-party payers and yet poorly exploited by both patients and physical therapists themselves.

I am convinced that one of a private practice’s greatest opportunities to continue to gain market share in your community lies in maximizing direct access. What are the underlying barriers to direct access? Many people believe that it might be law or third-party payment, but I think it is much more than that.

For five years, I have had doctor of physical therapy students in my home state of Wisconsin (which has been a direct access state for over a decade) survey individuals about their perceptions regarding physical therapy.

A few of the key questions have been related specifically to direct access.

  1. Can you seek services of a physical therapist without a physician referral?
    1a. If your response is “yes,” would you seek those services?

The trend over the past few years has been an increasing number of “yeses”—an awareness that direct access is possible. However, many report that they would not go directly to a physical therapist for fear that:

  1. Their insurance would not cover therapy without a physician referral.
  2. They believe that they must first visit their medical doctor to “determine what is wrong” or “to be given a diagnosis so the physical therapist knows what to do.”

Bottom line the survey says… I can see a physical therapist, but they cannot diagnose the problem. This is a huge barrier that we must overcome!

7 Simple Steps to start your climb

  1. Study your individual state’s direct access laws and develop policies that maximize your use of them.
  2. Study your top five third-party payers and know their specific policies of the need for referrals and develop policies that maximize them.
  3. Script your entire team on the strongest direct access policy application. Focus first on your receptionists and anyone involved in the intake process.
  4. Create a simple direct access message and post it on your website, put it in your consumer collaterals, publish it in your patient welcome packet, and send it as a follow-up email reminder after discharge.
  5. Each time you call to verify benefits for a new patient, determine the specific direct access policy, and, if available immediately, educate your patients about its availability for their future care. Be sure to tell them that this applies also to their family members (and coworkers) who are on the same policy.
  6. Create a strong narrative approach to therapist’s history taking and examination—demonstrating that we are able to medically screen for red flags /other diagnoses and that we are capable diagnosticians without the costs and risks of imaging. Be certain that your patient understands that you would seek additional medical consult if needed—either during the evaluation or later in the course of care. Let them know that you will communicate with their physician or other health care team members with or without a referral as needed and agreed to by the patient.
  7. Reference your training and restate your ongoing assessment over the course of care and reemphasize direct access for additional care.

Begin your climb today!


Lynn Steffes, PT, DPT, is president and consultant of Steffes & Associates, a national rehabilitation consulting group focused on marketing and program development for private practices nationwide. She is an instructor in five physical therapy programs and has actively presented, consulted, and taught in 40 states. She can be reached at

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