Direct Consumer Access to Physical Therapy in Michigan: Challenges to Policy Adoption

The projected shortage of atleast 44,000 primary care pro-viders1 and the 32 million newly insured individuals resulting from the federal Patient Protection and Affordable Care Act of 2010 (PL 111-148)2 will require that the United States closely examine the deployment of the nation’s health care providers. A diverse and highly specialized workforce provides opportunities for a variety of disci-plines to function in primary care roles to improve access and reduce cost by eliminating unnecessary pro-vider visits. However, redeployment of a discipline may be limited in some states due to restricted scopes of practice. “Direct access ” is the term describing the ability of a patient to go directly to a physical therapist without a prescription or referral from a physician. Physical therapists are trained to function as primary care providers for musculo-skeletal problems, have the potential to help mitigate the substantial pro-jected primary care provider short-age, and are able to currently func-tion in this role in 46 states.3,4 Michigan is 1 of 4 states that con-tinue to require physician prescrip-tion or referral, which prevents the public from directly accessing the care of a physical therapist. The purpose of the present analysis is to examine why the most recent attempts to pass direct access legis-lation in Michigan failed in order to direct future legislative efforts. The Policy Analysis Triangle approach, developed by Walt and Gilson,5,6 was selected as the policy analysis framework because it is comprehen-sive in its consideration of the many other factors beyond the merits of a policy that influence its devel-opment and adoption. Walt and Gil-son based the framework on their observations that policy adoption and implementation failure occurs because most policy analyses focus on content of the proposed policy rather than on the context, pro-cesses, and actors involved in pol-icy adoption and development. This analysis, therefore, also will consider those additional factors