Brik Stratton PT, MPT utilizes functional dry needling to optimize muscle function and manage soft tissue dysfunction.
Brik Stratton PT, MPT utilizes functional dry needling to optimize muscle function and manage soft tissue dysfunction. Credit: Courtesy / Stratton Rehabilitation

Texas is known for being an alluring place to live: a can-do attitude, economic growth, robust cities with expansive opportunity, and vast outdoor adventures are but a few of the reasons so many Americans choose to become Texans.

However, the luster of the state quickly vanishes if you’re a family of six with a child living with a chronic condition that requires extensive use of healthcare services, or even if you’re the average Texan who experiences low back pain (LBP), the second most common cause of disability in U.S. adults, which amounts to $100 to $200 billion in total costs annually. A portion of direct costs associated with LBP stem from expenses incurred from medical imaging, like MRI, which has been shown to be of little to no utility in the treatment of people living with chronic LBP.

Although strikingly different, both preceding scenarios necessitate the use of healthcare services, and the costs associated with these services are spiraling out of control. According to the Texas Healthcare Spending Report, the State of Texas spent almost $43 billion on health care in fiscal year 2015, which represented 43.1% of the budget that year. So what, or who, is to blame for these exorbitant healthcare costs?

It seems the most likely culprits are: new medical technology and prescription drugs, uncompensated and indigent care, chronic disease, aging population, and increased utilization and provider shortages. Interestingly, many of these skyrocketing healthcare costs could be abated with patient education by promoting healthy lifestyle choices. Yet physicians, on average, report spending only 13-16 minutes with patients. Furthermore, a 2013 study found that internal medicine interns spent only 12% of their work day involved in direct patient care.

Here are more sobering statistics:

As Texans, we must explore untapped resources to battle these growing healthcare costs, and shortages of healthcare providers. Physical therapists (PTs) play unique roles in collaborative healthcare teams by serving as musculoskeletal experts. PT education now requires completion of a clinical doctorate to be licensed. A doctor of physical therapy (DPT) is trained following a comprehensive curriculum including specialized neuro-musculoskeletal assessment and management, cardiopulmonary, medical imaging, pharmacology, evidence-based practice, and differential diagnosis.

Additionally, many PTs pursue further specialty and subspecialty education, including residencies and fellowships, in areas of clinical interest. PTs are used in many countries throughout the world as primary care providers to save valuable healthcare dollars. In fact, Texas is one of only three states in the U.S. that does not allow its constituents to access PTs without a physician referral. In other words, even if a Texan wanted to pay out-of-pocket to receive treatment for a new neuro-musculoskeletal condition, this would be in violation of current state law.

Joseph Elliott PT, DPT, performs a thorough, hands-on physical examination to properly identify neuro-musculoskeletal impairments.
Joseph Elliott PT, DPT, performs a thorough, hands-on physical examination to properly identify neuro-musculoskeletal impairments. Credit: Courtesy / Stratton Rehabilitation

Even the U.S. military allows members to access PTs without a physician referral because of the salient benefits. It is critical to point out that there has been no increased risk to the patient as a result of seeing a PT without a physician referral.

Instead, jurisdictions allowing direct access to PTs enjoy decreased costs and improved patient satisfaction, as well as faster access to care. However, substantial legislative obstacles are precluding Texans’ ability to access PTs. Below is a short summary of the legislative initiatives in place to right this wrong:

  1. Patient Access Bill: SB 728 (State Sen. Van Taylor) and HB 2118 (State Rep. Stephanie Klick)
    1. This bill would allow Texas patients to access PTs for a limited period of time without a physician referral (30 days). After 30 days, a physician referral is required to continue treatment. Texas patients would join patients from 47 other states that currently allow this healthcare model.
  2. Medicaid Rate Restoration
    1. The budget cuts to Texas Medicaid funds total $2.4 billion, severely limiting reimbursement for therapy services, thereby decreasing access for Texas patients. Those physical therapy clinics that see a large percentage of Medicaid patients would be forced to see fewer patients, close their clinic doors, or seek additional funding in order to maintain the current level of care.
  3. Sunset Bill: SB 317 (State Sen. Robert Nichols) and HB 4069 (State Rep. Cindy Burkett)
    1. This bill would support the continuation of the Texas Board of Physical Therapy Examiners and Executive Council of Physical Therapy and Occupational Therapy Examiners as an independent entity. This organizations help maintain high-quality care through establishing continuing education standards in a cost-effective manner praised by its efficiency by the Sunset Commission.
  4. Licensure Compact Bill: HB 2765 (State Rep. Travis Clardy)
    1. This bill would allow licensed PTs to practice in multiple states, bypassing the administrative process to obtain licensure in a separate state. The Compact will improve access to PTs, especially in rural areas with a significant shortage of healthcare personnel.

Texas continues to fall behind the national standard when it comes to health care, but Texans have an opportunity to rectify some of the current shortcomings. Because the Texas Legislature meets biannually, it is paramount that lawmakers take action to avoid depriving Texans of accessing qualified healthcare professionals to manage their neuro-musculoskeletal needs for at least another two years.

Contacting legislators to have your voice heard is essential to a thriving democratic process, and now it’s as easy as sending an email or making a phone call. As our country moves toward a proactive healthcare model to improve patient access, reduce healthcare spending, and improve patient outcomes, it is critical that Texas joins the movement – or else it risks lagging behind for two more years.

Dr. Richardson is currently a physical therapist at Stratton Rehabilitation specializing in outpatient orthopaedic care. He earned his bachelor's in kinesiology from the UTSA in 2009, and his doctor of...

Dr. Sandoval is currently an assistant professor at The University of The Incarnate Word School of Physical Therapy. He earned his bachelor's degree in PT from Université de Montreal in 1990, a master’s...