Health care is often in the center ring of the modern media circus. And as a healthcare professional, I’m sure you’ve been caught in the crossfire of at least one or two debates on the subject, unless you’ve been living under a rock for the last few years, that is. As I’ve watched this conversation unfold, I’ve noticed a concerning trend: physical therapy, and the professionals who provide it, is increasingly left out of the discussion.
I’ve heard plenty of theories on why physical therapy is so often overlooked. Some argue it’s the result of MDs’ long-held bias toward PTs, while others say it stems from a problem with branding the profession itself. No matter the cause, the outlook is the same: PTs need to find a place at the healthcare table. If we don’t, physical therapists will be pushed out of the room altogether.
That said, we won’t be able to come up with an informed strategy on how to positively impact the future of our profession if we don’t understand where we’re at currently. That’s why my team and I recently set out to collect unbiased information from professionals across the entire industry. Our mission was simple: we wanted to gain a better understanding of the current state of rehab therapy and deliver valuable findings that would spark constructive dialogue. We distributed this survey across multiple specialties, settings, and regions, and we’ve spent the last several months aggregating and preparing our survey results to deliver to the general public. (You can see the full, comprehensive report of our survey here or view the survey webinar here.) We tried to get the most accurate picture of the rehab profession we possibly could, and we were thrilled to receive more than 5,000 responses from professionals in every corner of the industry, from skilled nursing and hospitals to private practice and home health.
Some of the survey results were surprising, while others, as you can probably imagine, came with little shock. But I found all of it to be very telling about where we are as a profession, and what the future may hold. So, this month, I wanted to share with you all my biggest takeaways from the State of Rehab Therapy in 2017 survey:
1. Therapists don’t consider themselves “businesspeople.”
We asked providers about their motivating factors for pursuing, and sticking to, a career in rehab therapy. We found that the number-one driver for therapists and assistants is having a career path that allows them to help people, and that’s something that I can relate to and makes me immensely proud to be a part of this amazing profession. Conversely, providers ranked the prospect of opening a therapy practice as their least important motivating factor.
I’ll be frank here: this response didn’t come as a shock, but it definitely has me concerned. I think it’s indicative of our need to adjust our approach to physical therapy education. I’ve been beating this drum for a long time, and I will keep beating it until the educational powers that be recognize the importance of business education. PT students should not only learn the basic principles of business, but also appreciate the opportunity it represents. PTs are often accused of having the “Peace Corps gene,” and the survey results appear to support that conjecture. But, possessing an altruistic spirit doesn’t have to condemn you to a life of living from paycheck to paycheck, and future generations of therapists should learn how to maximize not only their treatment outcomes, but also their career potential.
2. Clinics should be proactive about maximizing reimbursements.
As part of the survey, we asked respondents to provide an estimate of the average amount they bill per claim versus the average amount of reimbursement they receive. About 40% claimed around 50 to 70% of what they bill. In reality, this adjustment rate isn’t abnormal. In fact, a 50% adjustment rate is what we had in my clinic 10 years ago. That said, it’s likely that some practices aren’t maximizing their financial gains, which isn’t doing their bottom line any favors.
During the webinar, we discussed what we believe is the optimal way to set a clinic fee schedule for maximum reimbursement. We know that every payer has their own fee schedule, which is usually non-negotiable in terms of what they will pay per CPT code billed. And every clinic has a clinic fee schedule, which must account for maximum payment for all of these insurances. When a practice determines their fee schedule amounts, it’s important that they take these insurance fee schedules into careful consideration. If Insurance A offers a higher reimbursement rate for a particular CPT code than any other in-network payers, then that CPT code should reflect Insurance A’s rate on the clinic fee schedule. Ultimately, clinics should be focused on the consistency of the adjustment rate, if that starts to increase, then it’s important to understand why as well as identify when a payer is possibly changing its fee schedule.
When we examine this number, we also need to consider the patient’s financial responsibility. We all know the cost of health care is skyrocketing, and much of that increased cost comes at the patient’s expense. That means a larger chunk of your revenue is coming directly from your patients’ pockets. And if a clinic fails to collect a patient’s payment, that cost comes at the clinic’s expense. In fact, only 21% of patient balances that aren’t collected at the point-of-service are ever collected. And as we discussed during this webinar, that’s part of why it’s crucial to build your clinic’s payment policy around collecting patient payments upfront whenever possible.
3. We can’t be our only advocates.
We also asked individuals to rank their biggest frustrations, and once again, the results, while not surprising, revealed a lot about what’s holding the profession back. Any healthcare provider will tell you that the massive amount of documentation and paperwork they complete on a daily basis is a big mood-killer, so we weren’t shocked to find that the primary frustration among therapists is completing paperwork. Interestingly, though, providers listed “feeling pressure to compete with co-workers and other clinics” as their lowest-ranked frustration, which seems to contradict the perceived, and often discussed, environment of competition among therapy providers.
Now, even though my team and I get a lot of marketing-related questions from clinics looking to differentiate themselves from their competitors, I think that more globally speaking, we tend to view MDs, surgeons, chiropractors, and even massage therapists as our main competitors for neuromusculoskeletal patients. The real problem is that instead of working collaboratively with these other disciplines, we’ve drawn lines in the sand over what modalities and treatments are ours versus theirs. It may be difficult to hear, but this mentality hasn’t done us any favors in terms of our reputation in the greater medical community.
Of all patients with neuromusculoskeletal issues, only about 8% seek out rehab therapy. If we want to tip the scales in our favor, and see more of the patients who could benefit from our care, we need to learn to play nice with other professions. We need our colleagues outside of the rehab therapy space to understand and respect what we do, that way, they feel confident sending their clients our way in the appropriate cases. Furthermore, if we want to be taken seriously in the overall healthcare conversation, we need others to advocate on our behalf.
We also can’t neglect our existing patients in the fight for new patients. Patient relationship management platforms and patient outcome tools have made it easier than ever to stay engaged with past and present clients while simultaneously improving their overall satisfaction. By making patient satisfaction a priority in your practice, you can make your current patients into the physical therapy profession’s biggest advocates.
4. Healthcare reform has bred fear and uncertainty among rehab therapists.
Reform, it’s a scary word no matter what industry you’re in, so it’s no wonder that when we asked therapy professionals to rank the biggest threats to the industry, the top three responses were all tied to healthcare reform and regulation. Declining reimbursements, insurance regulations, and government regulations were the clear leaders in the threats department, with more than 75% of respondents ranking these options in their top five. Furthermore, we found very little variation in these rankings based on individual role, number of employees per company, or practice setting.
In the face of so much uncertainty, it’s easy to feel like the odds are stacked against us. For those of us working in small practices, especially, it often feels like we are minnows in an ocean filled with very large, well-financed sharks. But this is no time for fatalism. Now more than ever, we all must band together and support advocacy efforts at every level, from local to national. We need individuals who know what it’s like in the trenches advocating on our behalf and representing us at the healthcare table. After all, if we’re not speaking up for ourselves, then who is?
Even if you’re not prepared to start your run for office just yet, you can make an impact. Get out and talk to other healthcare providers. Meet with MDs, chiropractors, and other physicians. Not only will you increase visibility for yourself, but you’ll also be acting as an ambassador for the entire PT profession. You may even find that you share a lot of common ground with other types of providers, and building cross-discipline relationships will only strengthen our power as therapists.
Another exciting trend in health care, and one that I believe can lay the groundwork for positive change, is the growing presence of cash-based business models. Hopping on the cash-based bandwagon not only helps stabilize practice revenue streams, but it also presents a lucrative marketing angle and an opportunity for increased patient engagement. If we want to show current and potential patients the true value of what we do, providing them with comprehensive, cash-based wellness services that complement their health goals is a good place to start. It’s all about improving the PT brand, and we can measure that improvement with the number of patients who are willing to pay out of pocket for our services. It’s a lofty goal, but one that I truly believe could pay off, no pun intended.
The bottom line is that, in the face of change, we too must change. If we’re not proactive about setting ourselves up for success in this new era of health care, then we will get left in the dust. That’s why my team and I set out to collect this data. As a healthcare provider, it’s my duty to prioritize the wellbeing of others. And as a business owner, I must make data-driven decisions, which I know can be the catalyst for meaningful, lasting change. We live in an age where vast amounts of data are available to us at the click of a button, and I believe that we have a responsibility to use this information to improve our patients’ health. Whether you’re collecting information about the state of rehab therapy or you’re tracking data such as patient outcomes and satisfaction, you possess the tools to determine the efficacy of your treatment. And as you continue to make informed, data-driven decisions, you won’t just be benefiting your business and your patients, you’ll be improving the image of the entire PT brand.
The points I discussed above barely scratch the surface of everything we discovered during the analysis of our findings, so if you’d like to get the full summary of our State of Rehab Therapy survey, you can find the complete, downloadable version here. It’s my hope that this information will serve as a call to action. It’s clear that PTs have a lot of work to do if we want to maximize our potential, as both caregivers and businesspeople. But, there’s power in numbers, and if we band together to boost our visibility, and our brand, and make a concerted effort to work with, rather than against, the other members of our patients’ care teams, we’ll cement our status as the premier neuromusculoskeletal experts for generations to come.
About the Author
Heidi Jannenga PT, DPT, ATC/L is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.
