Direct Access: Bringing Balance to the Referral Relationship

Balance is a critical component of any good relationship—personal or professional. For too long, the relationship between physicians and physical therapists was seriously out-of-balance—and that pushed us into a toxic pattern of codependence and resent. Historically, we have put nearly all of our eggs in the physician referral basket—but that’s only because it was the only basket we had. In other words, we relied almost completely on physician referrals to keep our doors open. Some of us still do. And that dynamic has left us feeling beholden to—and in a way, inferior to—physicians.

But with direct access, we have the opportunity to step up and claim our rightful role as doctorate-level medical professionals—emphasis on “doctor.” We have the leverage we need to bring balance to the PT-physician relationship. Because when patients seek our services directly—when they come to us first—we become the medical initial point of contact. That means it’s up to us to determine the proper route of care for each self-referred patient—and it could very well involve sending that patient to a physician or other medical provider. Essentially, direct access turns the tables—or to be more accurate, balances the scales—in the referral game.

However, the power to refer does more than validate our position within the medical community at large. Yes, bringing balance to our relationships with physicians is incredibly important, but from a business standpoint, the true benefit of direct access is that it gives us a tool to strengthen those relationships in a meaningful way. I mean, let’s be honest—goody baskets, lunches, and golf rounds only go so far, and over time, these superficial marketing efforts can put a not-so-superficial dent in your budget. Plus, the ROI just isn’t there—no matter how delicious those goodies are. But sending actual patients—now that’s something that will stick with your docs long after the last cookie is gone. And when they come across patients who could benefit from physical therapy, guess which therapist they’re going to recommend?

Now, I know there are a lot of skeptics out there who are questioning the benefits of this shakeup to the status quo. Some are worried that it might ruin the relationships they’ve worked so hard—and so long—to build. But from what I’ve seen and experienced, the potential benefits far outweigh the negatives. Take Dave and Mike Manzo, for example. I had the pleasure of hearing the Manzos speak at WebPT’s recent Ascend business summit. There, they explained how they have successfully harnessed the power of direct access to completely revolutionize their business, Atlantic Physical Therapy Center (APTC) in New Jersey. But it didn’t happen overnight. Little by little, they started putting more effort into educating their staff—and their patients—about direct access. Eventually, that effort evolved into regular direct access-centered training sessions for all clinic staff, the use of educational signage in their clinics, and even social media plugs. Fast-forward six years, and direct access has become APTC’s number-one referral source—and their net revenue per visit has increased by 25% to boot. And how has that affected their relationships with referring physicians? Well, as Mike recently said in an interview for the WebPT Blog, “We’ve never had so much success with forming relationships with referring providers as we have with being a referral source.”

Many of you are probably already doing this on a small scale. For example, let’s say a former patient calls to tell you she fell and injured her shoulder. When she went to the emergency room, the doctor told her to see an orthopedic surgeon in the next few days. She calls you to ask for your recommendation. This is an opportunity for you to recommend an ortho who regularly refers to your clinic already. But if that is as far as you take it, you’re not fully capitalizing on that opportunity. You could put in a call to the ortho’s office on behalf of the patient to get an appointment on the schedule—something that could go a long way in strengthening your rapport with both the patient and the physician’s office. This is your chance to sit in the driver’s seat—the power seat. Don’t let it pass you by!

Now, I realize that not everyone will experience the same level of direct access success as the Manzos—and I also realize that, due to variations in state regulations, it’s tougher to capitalize on direct access in some states than in others. But the main thing to keep in mind is that, in the grand scheme of things, our opportunity to truly flex our gatekeeper muscle is a big one. After all, what goes around comes around. And now that PTs can be on the giving side of the referral equation, we have one more way of getting to the receiving side.

About the Author

Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT

As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

One response to “Direct Access: Bringing Balance to the Referral Relationship

  1. Ishita says:

    This is a very interesting and informative post on direct access not only from a business stand point for a PT but also improving the PT- physician relationship. I think our patients can greatly benefit from direct access as well because they have to jump though less hoops, can reduce unnecessary medical cost from physicians that traditional tend to prescribe drugs and further tests to almost every patients for financial advances.
    I am a PTA student and I was interesting in finding out what your thoughts are on PTA’s eventually being able to treat direct access patients after the initial evaluation because as of now PTA’s cannot work with direct access patients.

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