Although 46 states allow physical therapists to evaluate and treat patients without a prior physician referral, Medicare and some private health insurers still require a physician referral before payment for outpatient physical therapy services. Is a physician "gatekeeper" still necessary for quality of care and cost containment? In "A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy," a recent article in Health Services Research--an article that moderator Linda Resnik, PT, PhD, OCS, calls "the strongest and most important paper on this topic to date"--Pendergast and colleagues compared patient profiles and health care use of patients who received physical therapy after physician referral and patients who received physical therapy through self-referral. After adjusting for key variables, including disease severity, they found that the self-referral group had fewer visits and lower overall health care costs than the physician referral group, with no differences in outcomes. In this discussion podcast, Resnik is joined by Jane Pendergast, PhD, and Pamela Duffy, PT, PhD, OCS, CPC, 2 of the authors of the study, and Michael Johnson, PT, PhD, OCS, a direct access advocate at the state and federal levels, to discuss how the study was conducted and its implications for health care policy and quality.