PACT PT: Improving Veteran access to same-day physical therapy

An innovative practice at VA is giving Veterans with musculoskeletal pain (pain in their muscles, ligaments, tendons and bones) a quicker recovery, even for Veterans in rural areas. Traditionally, providers prescribed pain medication while patients waited to get imaging services like X-Rays and MRIs and meet with orthopedics or other specialists. Only after that did patients receive physical therapy (PT) referrals. 

This model increased health care costs and delayed the patient’s recovery and return to normal activities. But today, Veterans can receive same-day physical therapy in over 86 VA facilities because of the VA Patient Aligned Care Team’s (PACT) proactive and personalized approach: PACT PT.

“Physical therapy in primary care settings has helped Veterans get the care they need when they need it most. Veterans are very pleased to be seen the same day and leave with the tools they need to treat their pain before they travel home,” said Kieth Biel, nurse practitioner at Sioux Falls VA.​

Origins of PACT PT

Embedding PT in primary care teams began at James A. Haley VA in Tampa in 2008, followed by implementation at Des Moines VA in 2016 to increase rural access and decrease wait times.

The VA Midwest Health Care Network continued to embed physical therapists within primary care clinics. This was part of its strategic initiative to improve Veteran access, reduce costs and improve Veteran and staff experience.

At the 2020 VHA Shark Tank Competition, the program, now called  “Embedding Physical Therapy in PACT,” was named a Promising Practice with plans to expand to other VA facilities.

“I think this program has a significant impact in keeping Veterans here within the VA system and adds access to care especially in rural settings,” said Ashley Cassell, physical therapist at Minneapolis VA. “That’s a key piece of PACT PT, embedding PTs in the rural VA clinics and developing training to support those areas that are sometimes a little bit harder to reach.”

From 2022 to 2023, VA reported the number of Veterans receiving physical therapy in rural and highly rural areas had increased by 500 percent.

Impact of PACT PT

Today, VA intends to make PACT PT available in every VA health care system by 2025. VA has found that early PT intervention with a physical therapist not only improves access to care but also improved Veteran outcomes requiring fewer visits. It also has the added benefit of potentially decreasing medications and Veteran dependence on them.

Because of PACT PT, “we are maximizing the time allotted for the nurse and the primary care provider to spend with the Veteran,” said Mark Havran, from VA’s National Physical Therapy office. PACT PT can also reduce the wait time for hands-on PT treatment from 20-30 days to just a few minutes.

“By embedding PTs within primary care, you’re bringing the specialist to the Veteran as opposed to all these departments being siloed and in their own respective areas,” noted Christopher Rowedder, physical therapist at Des Moines VA. “You are bringing experts to the Veteran and creating this one-stop shop where they can be managed appropriately and efficiently.”

A matter of trust

Havran observed that PACT PT can enhance Veterans’ trust in VA. “They know they will receive equitable care even at a rural small VA clinic,” he added.

A Veteran from Sioux Falls agreed. “I noticed an improvement after one visit without taking medication, and I was able to return to work the next day. I am grateful for this service.” ​That’s one of the most important outcomes of PACT PT. Veterans can quickly resume meaningful activities, restoring their quality of life.

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