As the culmination of another orbit around the sun is upon us, there is no better time to take a look back as we prepare to move forward, to appreciate what we’ve accomplished and what we’re grateful for before we set our goals for 2023 and beyond. There was plenty this year to feel good about, despite some of the challenges we faced. Top of mind for me is how grateful I am to see so many friends, co-workers, and colleagues in person again. Both Ascend and PPS 2022 served as fantastic reminders of the power of human connection, and most importantly, hugs. With years having gone by seemingly in a flash, it was amazing to reconnect with familiar faces, and to meet new folks as well. The experience reminded me of the kindness, camaraderie, and genuine caring that exists within our profession.
It’s that generosity of spirit that I hope we never lose sight of in our work. After all, we entered this profession to help people—to work with them so they can achieve richer, fuller, pain-free lives. And we’re accomplishing that goal every day in practices across the country, regardless of any headwinds or regulatory obstacles that may get thrown our way. That in and of itself is worth celebrating as we head into the new year. With that as our foundation, here are a few more wins I think we should take a moment to appreciate as we look back on 2022.
Patient awareness of physical therapy is growing.
We’ve long lamented physical therapy’s place in the healthcare landscape and waited for the day when we as PTs would get our due as first-line providers—particularly among patients who could benefit from PT but aren’t currently receiving it (more on this in a bit). And while direct access laws have helped open the door, we’ve had to continue to make our case to those we’re trying to attract. Fortunately, it seems like those efforts are finally bearing fruit.
In a recent study sponsored by the APTA, 33% of surveyed patients would go to a PT without a referral—a 10-point increase from 2016. And nearly 40% of respondents considered their PTs to be more knowledgeable than their primary care physicians in diagnosing and treating injuries, improving their physical activity and mobility, and preventing future injuries. Moreover, the overwhelming majority of surveyed patients left with a positive perception of physical therapists—something backed up by WebPT and Clinicient’s PT Patient Experience Report.
These are significant gains in patient awareness, to be sure, but we are still just getting started. If we’re going to continue pushing these numbers higher, we must keep up the marketing push for self-referrals as well as working with self-insured employers to incorporate PT into their benefit packages. This will require building on our existing education efforts about the “PT-first” approach for any musculoskeletal issues. Another part of that effort is improving our collection of outcomes data and financial ROI data so that we have something to show patients, employers, payers, and referrers just how effective PT is. We are making good progress and building momentum, and can’t let our foot off the gas now.
The 2023 final rule offered some positive developments.
I realize that the mention of the final rule might prompt an involuntary groan from most, but hear me out. While the 2023 Physician Fee Schedule did contain some bad news—the conversion rate is shrinking yet again, and permanent telehealth remains in limbo—there’s also some good news sprinkled within worth celebrating.
The Medicare Part B monthly premiums and annual deductible have decreased.
Medicare patients can breathe a sigh of relief, as CMS actually lowered the monthly premium for Plan B to $164.90—a $5.20 decrease from the 2022 amount—and the annual deductible from $233 to $226. While this might not benefit PTs directly, it’s great news in this time of rising inflation for the many Medicare patients PTs are seeing. After all, every penny counts for many patients, especially as we continue to grapple with the affordability of healthcare services (PT or otherwise).
The therapy threshold is increasing for next year.
We can also appreciate that the 2023 annual therapy threshold is increasing from $2,150 to $2,230 for both physical and speech therapy as well as occupational therapy. Unfortunately, the targeted medical review threshold remains at $3,000 through 2028, thanks to guidelines established in the Balanced Budget Act of 2018.
Virtual direct supervision will stay in place for 2023.
Some of the wins we saw were temporary—telehealth will only last as a reimbursable service until 151 days after the end of the public health emergency (PHE), which is currently slated to expire January 11, 2023. Fortunately, despite the end date for the PHE, virtual direct supervision will stay in place through 2023—which means it will continue to run through the entire calendar year. Why the difference? You could spend your career trying to figure out why CMS does what it does sometimes, so for now let’s appreciate what we did secure in this year’s final rule.
Legislation could enshrine some needed changes for PTs.
We know better than to wait on CMS to help PTs of their own volition—that train might never leave the station. That’s why advocacy efforts within the PT industry are so important to shaping a better profession. With the collaboration of entities like the APTA and APTQI, who together represent a large majority of outpatient PT practices, one united and stronger voice on behalf of the profession was heard in 2022. For that, credit and thanks are due to APTA CEO Justin Moore, APTQI Executive Director Nick Patel, and PT-PAC Director of Congressional Affairs Mike Matlack, who were key to making deeper inroads with legislators and CMS.
And we’re seeing the benefits of that advocacy play out right now in legislation that’s winding its way through the halls of Congress.
- The SMART Act would delay—for a year—the 15% reduction in Medicare payments for services provided by physical therapy assistants (PTAs) or occupational therapy assistants (OTAs). A potential cut to pay for PTA or OTA services would be significant for any clinic, but would hit particularly hard in rural areas, where access to health care is already a struggle and PTAs and OTAs are essential in understaffed settings. Along those lines, the act would also standardize the supervision requirements for PTAs and OTAs from direct to general, which would also help to further access to care, especially in those rural areas.
- The Expanded Telehealth Access Act would add PTs, OTs, and SLPs to the list of providers who have permanent Medicare telehealth privileges. We’ve seen just how useful telehealth has been during the pandemic, and while you can’t replace in-patient treatment as the foundation of physical therapy, telehealth as proven to be incredibly beneficial in augmenting that care while reducing costs—especially with the addition of remote therapeutic monitoring. And given that older adults make up a significant portion of both Medicare PT patients and telehealth users—not to mention represent a significant force in advocacy and electoral politics—it’s in our best interests to continue to fight for telehealth privileges.
- The Improving Seniors’ Timely Access to Care Act would mandate that Medicare Advantage establish an electronic prior authorization system. Electronic prior authorization systems can reduce the time for providers to receive decisions and the administrative burden placed upon front offices. Given that prior authorization has become increasingly burdensome over recent years, and that those burdens and bottlenecks can delay treatment by as much as 25%, any relief for providers is a win for themselves and their patients. The good news is that the House has already passed the bill, so we now need to turn our attention and our advocacy to the Senate.
If recent history has taught us anything, it’s that hard work and loud voices can still produce results when it comes to politics and legislation—which is why it’s important for every PT to call, write, and email their legislators about these bills. If you’re not quite sure how to get started, the APTQI has an assortment of pre-built letter templates to help you make an impact.
PT is well-positioned for a digital health world.
Technology can be a touchy subject within PT. Some believe that the rise of digital solutions mitigates the importance of clinicians. Specifically, that more technology in treatment means less pay for providers and worse care for patients. Personally, I don’t agree with that take—there’s no machine that can replace the insight we offer as trained caregivers and the relationships we build with patients. And I’ve yet to see a robot that can replicate the hands-on work PTs do on a daily basis.
That doesn’t mean that technology won’t continue to expand within PT in the coming years; we have seen the power and reach of telehealth in expanding access to care, not to mention how PRM systems and digital home exercise programs have enabled PTs to engage and educate patients even when they are not within the walls of the PT practice. I believe the future is in a hybrid model that uses technology to adjunct and boost the ability and efficiency of a therapist. If we’re ready to fully embrace it, technology innovation is accelerating to meet the demand.
Digital musculoskeletal is the next big thing.
If you follow the digital health trends, you’ve probably noticed the rise of digital musculoskeletal (MSK) companies in the news and at the tradeshows. MSK costs have doubled to $20 billion over the past decade, and with little to show for those billions as far as improved outcomes, there’s plenty of room for businesses looking to offer better solutions. That’s why we’re seeing boom times for digital MSK fundraising as investors look to hop onto the next big thing.
And while those companies are collecting headlines and big checks, I think PT is quietly poised to benefit from the underlying trends of reducing costs and increasing revenue that we see with digital health for a few reasons:
- Digital PT increases access to care. If you have patients struggling to make it to your clinic for treatment, digital PT is the key to making care accessible to anyone. With telehealth, HEP and RTM, PTs are able to offer care to patients who might have otherwise come in infrequently—or skipped treatment altogether.
- Patients can save money with digital PT—and providers can see more patients. Cost is another barrier to treatment for many patients. By combining remote care with in-office visits, PTs can reduce the overall cost of treatment by $93 per visit, on average—without sacrificing the frequency or quality of visits. And with fewer in-office visits, clinicians can see more patients in a day—improving productivity, but also providing some flexibility to clinicians.
- You’ll see improved outcomes with digital PT. Lack of patient engagement is a barrier to improving patient outcomes—so how better to solve the problem than the ability to engage with patients in their homes? With more information on adherence, a greater ability to track progress and adjust treatment as necessary, and an easier way to communicate between visits, you can help make patients active participants in their treatment. That heightened engagement produces better outcomes—and more raving fans of PT.
If you’re skeptical of using fundraising trends as a bellwether for digital health, just look at what we’re seeing in the new guidelines from CMS. The introduction of RTM CPT codes in the 2022 final rule demonstrates just how important digital health is to CMS’s notion of the future, and how valuable they think RTM specifically will be to rehab therapists moving forward. I feel confident saying that digital health will continue to grow and become part of the norm moving forward.
Our ability to connect can help us build a better tomorrow for our profession.
The pandemic brought to light stark differences in access to care, based on a multitude of factors. Fortunately, the tide began to turn in 2021, and over the past year we have seen that improving diversity in the rehab therapy workforce has become more of a priority within the profession. The expansion and growth of groups like the NABPT, the APTA’s Minority Scholarship Award, and my own scholarship program Rizing Tide are having an impact on supporting some of the best and brightest of the future PT leaders. Strategic plans put in place years ago are also starting to bear fruit for many forward-thinking PT programs who prioritized diversity in their student recruiting practices.
Collaboration between academia and industry will be the most important part of getting this right for the future of our profession. Data, research, and agreement on key progress indicators will be key to our diversity and access efforts—with the caveat that healthcare data must help and not hinder the goal of delivering the best care everywhere and to everyone. Allowing for the fact that we have made significant progress in improving awareness and access to PT care, both remain central problems of our profession. If we are going to expand our reach, we have to grow our workforce.
We need new ideas to tackle the PT shortage.
We hear a lot about the “90% problem”: the oft-cited statistic that 90% of people who need PT will never get it, or will never even seek it out. And while we are moving the needle on that cohort, we begin to look further upstream to determine if we’re even going to have enough PTs in the near future to handle the patients we currently have, let alone new ones.
The APTA put out a report this fall highlighting the current staffing issues within PT, noting that the vacancy rate for PTs was at 17% among the surveyed clinics. WebPT’s State of Rehab Therapy report also found that turnover rate was at 9% overall among rehab professionals, with PTs as the role with the highest turnover. Worse yet, our report also found that of the 70% of respondents who said they were considering a professional change, 14% were considering moving into a non-clinical healthcare role, and 13% were thinking about getting out of health care altogether.
If we’re going to increase that PT pipeline into something more than a trickle, we need to continue to embrace fresh approaches to finding new PTs. This year brought renewed interest on how the current educational requirements could be doing more harm than good for young PTs, and perhaps deterring interest students altogether. I’ve also discussed how we can start to address the lack of diversity within the industry, and how our unconscious biases might be closing our profession off to an entire pool of diverse candidates. Larry Benz and John Childs presented some very compelling research and progress updates at PPS 2022 on the increasing personnel requirements for additional PTs with the growing “PT-first” strategy. We should also be exploring options like high school internships for underrepresented groups, as well as mentorships for undergraduates.
We also can’t ignore the importance of implementing innovative retention strategies to keep the talented PTs we have, and help them develop professionally. I am always in awe of our next generation of PTs during poster presentations and interactions I have had through my scholarship program interviews. The pipeline is strong and the future of PT is bright—particularly if we continue to adapt our practices to embrace technology, utilize hybrid models of patient interaction, and continue to advocate the value of our profession in 2023 and beyond.
In thinking about the state of PT and what we can be thankful for professionally, I couldn’t help but think about The Grinch Who Stole Christmas—more specifically, those Whos down in Whoville who gathered together to celebrate Christmas morning, despite the fact that their houses had been picked clean the night before. Maybe it’s not a perfect metaphor—we don’t exactly have our own Grinch, although CMS and some insurance companies seem to be auditioning at times—but I think it’s apt. Yes, we have our problems, but what we also have—what no one can take away—is our pride, sense of purpose in what we do, growing business prowess and the professional community we have in one another. And I think that’s worth singing about.