Integration of Rehabilitation Care from the Acute to Community Setting: The Role of Physician Referral

Investigators: Janet K. Freburger, PT, PhD; Samannaaz S. Khoja, PT, PhD; Timothy S. Carey, MD, MPH

Objectives: To examine trends of primary care physician (PCP) referral to physical therapy (PT) and other physicians and to identify factors associated with PT referral.

Data/Setting: Office-based ambulatory care practices in the U.S.

Design/Methods: Analysis of data from the National Ambulatory Medical Care Survey (2003–2014). We calculated adjusted rates of referral by year and examined predictors of PT referral in multivariate models.

Results: PT referral rates declined from 19.9/1,000 visits in 2003-2004 to 11.4/1,000 visits in 2013-2014 (p=0.01), while physician referral rates increased from 88.7/1,000 visits to 115.1/1,000 visits (p<.001). 71.5 percent of visits referred to PT were for musculoskeletal conditions. Physician and practice characteristics associated with a decreased likelihood of PT referral for musculoskeletal conditions included narcotic prescription; being the patient’s PCP; and Medicare patient revenue>50%. Physician and practice characteristics associated with an increased likelihood of PT referral included being a doctor of osteopathy; practice ownership by a health plan/HMO; private insurance patient revenue>75%; and managed care patient revenue<25%.

Conclusions: PCP referral to PT declined, and varied by insurance coverage and physician and practice characteristics. A better understanding of the role of physical therapists in primary care is needed as care delivery moves to value-based payment.

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• Freburger J. Temporal trends in ambulatory care physician referral to physical therapist for musculoskeletal conditions: Analyses from NAMCS years 2003-2014. University of Pittsburgh.