In the past month, I’ve seen firsthand the tenacity and true grit of the physical therapy profession. Some days, it feels like everything’s hanging by a thread, and yet, PTs have proven resilient in the face of unprecedented adversity—and I, for one, am incredibly proud of how our industry has banded together to persevere through such uncertain and turbulent times.
But, there is still more work to be done to ensure we can all thrive on the other side of this—and when you’re in the trenches, it can be tough to clearly see what, exactly, those to-dos are. So, I’ve spent the past few weeks compiling as much information as I can to help PT private practice owners work on their businesses during a time when they can’t necessarily work in their businesses. In addition to condensing all of those resources down into a series of posts for my company’s blog—you can take a look at my first two posts here and here—I wanted to share this advice with the EIM community. I know this is just the tip of the iceberg, but it is my hope that this guidance will help set therapists up to withstand the challenges ahead—because while we’ve already weathered a lot of this storm, there will certainly be more challenges to come as we start rebuilding what was lost.
1. Review large cash expenses.
If your practice has taken a serious financial hit, the first thing you should do is assess how you can lower some of your overhead costs. In light of the current economic situation, landlords and leasing offices may be willing to play ball—that is, negotiate with you to reduce, delay, or defer rent payments. After all, they don’t want to lose you as a tenant once business picks back up.
A few options to consider include:
- Rent deferral (i.e., postponing rent payments—or a portion of those payments—for a certain period of time),
- Rent abatement (i.e., suspending rent payments—or a portion of those payments—for a certain period of time),
- Rent reduction (i.e., reducing rent payments for a portion—or all—of the term left on the lease), and
- Loan conversion (i.e., converting past-due rent payments into a loan that can be paid over time while the tenant continues to pay the current rent).
Another option would be reaching out to your company’s insurance benefits carrier (e.g., Aetna, BCBS, or UnitedHealthcare) and asking to negotiate deferred payments or payment reductions for a period of up to 90 days. Also, for practices with fewer than 500 employees, the CARES Act has supplied financing opportunities.
2. Scrutinize payer contracts.
Payer contract negotiations are often placed on the back burner. I doubt many of us relish in the thought of going up to bat against our payers and demanding more money for our services. But the truth is we should be doing exactly that—now more than ever. So, take a look at your current contracts, verify that the payer is holding up the current terms, and evaluate whether those terms are actually meeting your financial needs (i.e., that you are getting paid more than your cost per visit). If not, reach out to those payers ASAP. You may be surprised by how many insurance companies are willing to meet with providers right now to discuss contracts. Remember: You have nothing to lose by simply asking.
3. Assess your staffing situation.
As business owners, reducing staff is the last thing any of us want to do. In many cases, our team is like family, and making the decision to furlough employees or cut hours is excruciatingly difficult. However, according to my company’s own research, PTs across the country have experienced—on average—a 50% patient attrition rate as a result of the pandemic, with some areas seeing a much higher percentage drop. If you’ve decided to keep your clinic up and running during this time—which is an option if you’re located in a state that has deemed your services essential—consider:
- temporarily reducing hours;
- imposing mandatory use of paid time off (PTO) or vacation time;
- asking employees to take voluntary unpaid time off (you may be surprised at how many employees are willing to do this if it means preserving their position);
- furloughing staff (i.e., imposing temporary unpaid leave that allows employees to retain their benefits eligibility); and
- laying off staff (i.e., terminating employees with the possibility of rehiring them in the future).
Of course, before you take any of these actions, be sure to confer with your practice’s legal counsel.
4. Clean up your documentation process.
If there’s one thing I’ve heard time and time again, it’s that there never seems to be enough time to treat patients and complete documentation. Of course, as an EMR company, WebPT has made great efforts to mitigate this issue, but the fact remains that documentation is a large part of every physical therapist’s day—and that often means some notes are left undone and some claims are left unfiled. If that’s the case in your clinic, there’s money on the table—and you’ve never needed that money more than you do now. So, while business is quieter than usual, take advantage of the extra time by having your therapists:
- complete any billable documentation from the last 90 days;
- finish up outstanding discharge notes; and
- create or adjust documentation and home exercise templates in your EMR.
These efforts not only help you maintain cash flow, but also set you up to hit the ground running when business ramps up again. And believe me, these small improvements to your documentation workflow really do make a huge difference.
5. Collect on outstanding A/R.
Completing documentation and filing outstanding claims isn’t the only way to maintain cash flow—now or at any time. This business slowdown proves the importance of collecting copays and coinsurances at the time of service. But if you haven’t always done so, you also have a little more time to focus on bringing your A/R up to date. Specifically, I recommend:
- having your front office staff review and correct any claim denials immediately;
- pursuing past-due patient balances from the last 30 days—while remaining empathetic and delicate during the collections process so you don’t lose those patients in the future; and
- weighing the pros and cons of—and then possibly leveraging—the Medicare Accelerated and Advance Payments Program.
6. Plan for MIPS reporting.
We’ve received many questions from WebPT Members who are participating in the Merit-Based Incentive Payment System (MIPS) this year. Most are wondering if they’re still expected to report. The truth is, if you’re still seeing patients, you’re still on the hook for submitting MIPS data. With that in mind, now is the time to dig into the requirements, so you’ll understand how to not only participate in light of the COVID-19 crisis, but also maximize your incentives. Based on our research, it seems that many outpatient practices struggle with the improvement activities category in particular, so I’d recommend focusing on how your practice will fulfill that requirement to the best of its ability. If you need some help navigating the ins and outs of MIPS, download this free guide my team put together.
7. Complete con-ed requirements and annual training.
PTs who’ve found themselves with a sudden surplus of time should be using it to further their skills and fulfill their CEU requirements. Many platforms offer online courses that therapists can complete in the comfort of their own home, so why not knock those out con-ed units while you have the time?
This is also an excellent time to complete any in-clinic training. Even if you’ve already scheduled annual staff trainings (e.g., HIPAA, sexual harassment, or other HR-related training) for later in the year, use this time to get it done now. Alternatively, this could be a good time to review your existing training programs and identify gaps or areas that need improvement.
8. Identify and implement ways to improve the patient experience.
The patient experience has never been more important, and that will only continue to be the case on the other side of the pandemic. Self-isolation as a result of social distancing measures has left many patients craving connection and support. As PTs, we are perfectly positioned to offer that by delivering an outstanding patient experience. But, that experience isn’t going to look the same as it did two months ago. So, as you map out any changes to your business—adding tele-rehab services, for example—think about how you will determine whether those changes are meeting the mark. If you haven’t already, I recommend implementing Net Promoter Score® (NPS) tracking in your practice, which is an excellent indicator of the experience your patients are receiving. NPS uses a zero-to-ten scale to measure how likely a patient is to recommend your services to a friend or family member. In other words, you’ll be able to get a pulse on how loyal your patients are. When administering the NPS survey, you should also give patients an opportunity to leave additional feedback about your services, billing process, and anything else that might impact their experience.
If you’re already collecting meaningful patient experience data, then you have plenty of objective information to point you toward areas in need of your attention—whether that’s your billing and collections process or your customer service and facilities.
9. Track and organize KPI metrics.
Finally, take some time to:
- review the specific key performance indicators (KPIs) you use to run your business, and
- organize that data into an easy-to-read dashboard so you can review it consistently and make adjustments as needed.
In times of economic uncertainty, data is critical to keeping you abreast of any changes to your business—and informing your decisions on how to address those changes.
I know the world (and our industry) is chaotic right now—and the fact is, it’ll probably remain that way for a while. While I’m optimistic about the future, I’m also a realist—and I know that we can’t wait around for things to return to the way they were before when, to be frank, that day will never come. But change—however painful it may be—is inherent to life. And as long as we prepare ourselves for the change to come, I know it will ultimately be a good thing—especially when we’re in it together.