Do I need a doctor’s referral?

Direct Access to Physical Therapy is Here! On January 1, 2014, a new California law was enacted which allows California consumers direct access to Physical Therapists. Direct Access is your ability to be evaluated and treated by a licensed Physical Therapist without first seeing your physician for a referral.

Benefits of Direct Access:

Quicker access to the treatment you need and deserve.
While each patient case is different, clinical research shows that Direct Access should
result in fewer overall treatment sessions
•save you time and money.

There are some limits with this new legislation.
If direct physical therapy care is to exceed 45 days or 12 visits, whichever comes first, you must be referred (e.g., to a medical doctor) for a medical diagnosis.

I value the relationship I have with my patients and their physicians. I will continue to foster this this relationship by notifying a patient’s physician of our evaluation findings and providing updates on the treatment plan as needed. 

What happens during my first visit?

During your initial evaluation, we will discuss your medical history, current problems/complaints, pain intensity, what aggravates and eases the problem, how this is impacting your daily activities or your functional limitations, and your goals with physical therapy.
I will perform an objective evaluation including:

Palpation – Touching the around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
Range of Motion (ROM) – I will move the joint(s) to check for the quality of movement and any restrictions.
Muscle Testing – I will check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
Neurological Screening – I may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
Special Tests – I may perform special tests to confirm/rule out the presence of additional problems.
Posture Assessment – the positions of joints relative to ideal and each other may be assessed.
I will formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient’s input. Treatment plans often include home programs, patient education, short-term/long-term goals, as well as setting goals and expectations for recovery. This plan is created with input from you, me, and your doctor.

How long will each appointment/treatment last?

Both the initial visit and follow up appointments generally last one hour. You will be seen one-on-one by me for that hour (not by an assistant, student or intern), either at your home or in my office, depending on your preference. 

Will you be in contact with my doctor?

If there is a referring doctor, I will be in contact with them. 

Will my physical therapy be covered by insurance?

Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. California does not legally require patients to see their physicians before seeing a physical therapist. Most of the time all you have to do is ask your doctor if physical therapy is right for you.

Why should I choose a private physical therapist?

Who is better to see, a PT that works for a physician or a PT that owns a private practice? I leave it up to you to draw your own conclusions but here are some facts. The studies indicate the cost was greater for patients who attended a physician-owned physical therapy practice (both gross and net revenue per patient were 30% to 40% higher). (1) Another study indicated that licensed and non-licensed therapy providers spent less time with each patient in physician-owned clinics and physical therapy assistants were substituted for physical therapists. (2)

Another older study concluded: “Therapists who had treated patients through direct access were significantly more likely to believe that direct access had benefited them professionally and benefited their patients than were therapists who had not practiced through direct access.”(3)

I believe that I can provide you with the highest quality of care available and do it in a cost-effective manner.  You will work only with me and your case will be managed only by me from the beginning to the end of your experience with me.

Mitchell, J., Scott, E., Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
“Joint Ventures Among Health Care Providers in Florida,” State of Florida Health Care Cost Containment Board, 1991.
Domholdt E, Durchholz AG. Direct access use by experienced therapists in states with direct access. Phys Ther. 1992 Aug;72(8):569-74.
Federal Office of the Inspector General May 1, 2006 – This report calls into question billing processes done by non-physical therapist owned practices.



How do I make an appointment?  

It’s easy.  Call 415-279-0092 or email me at swmadding@gmail.com

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