A comparison of hospital-based and private outpatient physical therapy practices

A paucity of data exists about the delivery of contemporary adult outpatient physical therapy services in the United States. Although many debates about this issue have taken place within the physical therapy profession, assumptions about practice patterns have generally not been studied. This article reports some of the first-year findings from a 3-year survey research effort begun in September 1988 by Mathematica Policy Research Inc for the American Physical Therapy Association. Analyses are based on survey data from national probability samples of physical therapy facilities and discharged patients from 155 hospital-based and 166 private outpatient practices. The primary goal was to compare outpatient physical therapy practice patterns in the hospital-based and private practice settings. Findings reveal considerable homogeneity in private and hospital-based outpatient physical therapy practices. Hospital-based and private practices serve predominantly young, white adults who have private health insurance and a prevalence of orthopedic impairments. In both settings, direct access to outpatient physical therapy services was the exception and not the rule. Even in states in which direct access without a physician's referral was permitted by law, the majority of outpatient physical therapy was provided with a physician's referral. Most respondents in direct-access states indicated that reimbursement requirements were the major reason for needing a physician's referral to provide outpatient physical therapy.