PITTSBURGH -- The health care crisis facing Pennsylvania is an obvious dilemma, but for some with mobility problems, a solution may exist in an option that's existed since 2004, but very few know about.

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Cindy Feldman had knee surgery one year ago, but playing tennis caused a flare-up, prompting her to take advantage of Direct Access.

"It was frustrating to wait for an appointment for a physician -- wait so see that physician, and pay that co-pay -- knowing you were going to end up here anyway," said Feldman.

Under Direct Access, a patient can go directly to a physical therapist without a doctor's referral, and in most cases, insurance will pick up the tab.

Feldman's son was recently hit by a puck while playing hockey and a call to physical therapist Mary Lee Beach was the first one she made.

"And Mary Lee looked at his foot and said, 'You need to go for an X-ray,' and sure enough, it was broken. We did end up at the physician and he ended up in a boot," said Feldman.

UPMC and Pittsburgh Penguins Orthopedic surgeon, Chip Burke, said it is a reverse of the system in which the patients were channeled through the doctor first.

"It has allowed some of the patients with overuse injuries to go and be seen and get started on their treatment, and our therapists are very qualified," said Burke. "If they suspect there is anything they cannot treat, they work to send the patients to us."

Pennsylvania took a long time getting the system in place.

In 2002, it was the 44th state to legalize Direct Access to physical therapy.

It took two more years for the state board to come up with regulations to govern it.

A physical therapist must have two years experience, a Direct Access certificate, adequate liability coverage, continuing education and a 30 day treatment limit for one condition before a physician is consulted.

Some physicians, podiatrists and chiropractors opposed Direct Access, claiming physical therapists didn't have sufficient training to diagnose and that malpractice cases would increase.

"There are studies out there from our two malpractice carriers that there has been no increase in malpractice claims whatsoever," said Beach.

Chiropractor and Pitt professor Dr. Michael Schneider said opposition was more about turf wars than public health issues.

"If physical therapists show they are competent in seeing people off the street, why do we need a middle man of the medical doctor to tell them to go to see a physical therapist?" said Schneider. "How are we going to increase access to affordable healthcare if you always have to see a medical doctor for every medical condition?"

But Center for Rehab Services CEO Paul Rockar stresses a team concept.

"Can't emphasize enough that it is important for every physical therapists and consumer to realize that we are still a part of the team and the physician is there for us to consult and send them on," said Rockar.

A John Hopkins study conducted with Blue Cross Blue Shield of Maryland found it saved 60 to 75 percent of health care costs.

Medicare Part B does not pay for physical therapy without a referral, but is moving in that direction.