I can confidently say that rehab therapists take pride in their work and care about the profession; anyone who puts forth the time and effort—and takes on the considerable student debt—to become a therapy professional does so because they’re passionate about helping others. However, despite all that zeal, I can’t say that we’ve done a great job addressing the systemic, decades-long issues that continue to plague our profession.
As a profession, we enjoy flexible work schedules, variety in practice specialty, and diversity in workplace options. Perhaps it’s this multitude of choices that has contributed to the lack of an instilled culture of connectedness in our profession, but we have yet to figure out how to rally and unify within our ranks. Coming off the heels of the 2023 proposed rule, in which our industry is facing yet another pay cut, I worry rehab therapy professionals are beginning to (or have already) become numb to life at the short end of the stick. Why? Because we’re letting change happen to us, rather than responding to change in a way that would better position our industry.
Simply highlighting these problems, however, isn’t going to do anything to fix the current malaise within rehab therapy, though. Instead, let’s examine rally around a plan on how we can move the rehab therapy industry forward.
Yesterday’s problems remain today’s problems.
Therapists today are contending with many of the same issues that they and others have been fighting for years: respect within the healthcare community, steadily declining reimbursement rates, and the challenges of patient adherence and retention. And if those weren’t enough, new therapists are now entering the profession with larger-than-ever student loan debt and a burgeoning burnout crisis.
Rehab therapy remains fragmented.
Unfortunately, creating a united front within the rehab therapy community to tackle these issues is challenging, to say the least. As I noted in my recap of the 2019 Graham Sessions, many therapists put up barriers between themselves and others in the field based on age, experience, practice environment, and even qualifications and background. So, we can’t be surprised when we see little response to collective efforts aimed at advancing the cause of rehab therapy.
We also see division between the camps that have sprung up over industry-wide debates:
- Those adopting cash-based models versus holding to traditional, insurance-based models
- Proponents of embracing technology in practice versus those who would rather keep technology at an arm’s length
- Those who see burnout as a pressing issue versus those who think it’s a figment of the Millennial imagination.
Social media, which serves as a great platform for those on both ends of these extremes, has only served to push either side further apart, making it that much more difficult to bridge the gap and find common ground on the collective challenges we face—particularly with CMS.
Where do we go from here?
Perhaps our biggest shortcoming as an industry—and thus our greatest opportunity—is in owning our role as primary care providers. If we want to demonstrate our ability to operate effectively in that role, we need to make use of tools that enable us to collect and share data that demonstrates our impact and help us better treat our patients. Additionally, we must connect with our workforce meaningfully to keep them engaged in their work (and our mission) so that they’re able to communicate our profession’s value proposition in the years to come.
With that said, let’s work through these changes from the top down.
Data is key to our profession’s survival.
If I’ve said it once, I’ve said it a thousand times: we need to collect and analyze more and better data to make more informed business and clinical decisions. Better data is the number one thing we need as a profession if we are to not only survive, but thrive. In this modern-day healthcare landscape, data is key to not only driving better patient care decisions, but it also informs the value of rehab therapy to payers, referral sources, employers and patients—essentially, all those who impact our industry’s financial health.
Although we are improving, we have not fully embraced the discipline of collecting data nor built the muscle of sharing it effectively. We see the consequences of our ineptitude in these areas with the continued cuts to PT, OT, and SLP insurance payments. Year over year, CMS shares its plans to make mostly incremental cuts to rehab therapy services, but our collective commentary submitted during the comment period has continued to miss the mark, resulting in many sequential payment cuts.
Perhaps we’ve grown accustomed to the cuts. We see a 1% or 2% cut here and there and think, “Well, that isn’t so bad.” But if we take a look over the past five years, the accumulation of these cuts packs a much greater punch:
- CY 2018 Physician Fee Schedule: -2% cut
- CY 2019 Physician Fee Schedule: -3% cut
- CY 2020 Physician Fee Schedule: -8% cut
- CY 2021 Physician Fee Schedule: -9% cut
- CY 2022 Physician Fee Schedule: 0% cut
- CY 2023 Proposed Physician Fee Schedule: -1% cut
During this time, the conversion factor has also dropped considerably from $36 to $33.59 (and potentially will drop further to $33.09 if the proposed PFS goes into effect, an unprecedented low not seen since the 1990s). This nearly $3.00 reduction is incredibly concerning, especially in light of the fact that inflation rates have climbed to 8.525% as of July, 2022, after rising to 9.1% the month previously—the highest inflation spike we’ve had since 1981. And this cut is on top of the 15% payment differential for PTA or OTA treatment visits.
If we want to reverse these trends, and keep pace with mounting business costs, we must make a compelling case with cold, hard facts to demonstrate just how critical rehab therapy is to improving the quality of life of all Americans and reducing the overall cost of health care. That starts at the individual level with a commitment to better patient outcomes and more informed decisions, and organizations and clinics must support those individuals and their mission by providing the tools and technology needed to collect and analyze that data.
Tracking and analyzing patient outcomes within your practice is crucial for not only your business’s viability but our profession as a whole—and yet today’s students aren’t getting sufficient education on outcomes tracking tools. In our 2022 State of Rehab Therapy report, we found that just 19.5% of students reported using outcomes tracking technology in their course of study; contrast that with the fact that additional training on clinical technologies was the second-most desired addition to rehab therapy curricula. In addition, we are missing the mark on establishing the discipline and culture of perpetuating data-driven decision-making and planning.
Implementing outcomes tracking prevents therapists from having to rely upon anecdotal evidence in treating patients. If you’re not tracking outcomes, you are missing an important opportunity to connect with your patients to show progress, validate their efforts, and adjust for or control certain risk factors. And the results are critical in making the case for the value of rehab therapy to payers, particularly for proponents of the PT-first movement.
Remote Therapeutic Monitoring
Remote therapeutic monitoring (RTM) is another (somewhat new) service that can help rehab therapists extend care beyond the walls of their clinic, thus producing better patient outcomes and patient adherence. With the ability to track a patient’s self-reported outcomes and home exercise program compliance, therapists can use RTM to understand what’s working and make adjustments to create better HEPs. It’s another example of technology providing better data and a mechanism for more meaningful interactions with patients resulting in improved outcomes.
Better data requires better technology.
Despite the overwhelming evidence to its benefits, a fair number of technology skeptics remain within the rehab therapy ranks. The skepticism is understandable, but if we hope to remain competitive in the rehab therapy world as the premier providers for MSK, there has to be a role for technology. It’s not a replacement or substitute for therapists, as my esteemed colleague Larry Benz points out; rather, the right technology used correctly can augment and improve therapists’ work with patients—and expand the pool of potential patients.
Added as a billable service for rehab therapists during the pandemic, telehealth is an alternative avenue for therapists to reach more patients, more frequently. It’s also an additional revenue stream for clinics at a time when those are sorely needed, and a lower cost option for connecting with patients in rural or limited access areas of the country, allowing us to chip away at the 90% of Americans who need therapy but don’t receive treatment.
But if clinicians want telehealth as a permanent fixture for rehab therapy, we’re going to have to push for it. The 2023 proposed rule offers a continuation of billable telehealth services for rehab therapists only through the public health emergency (PHE) and an additional 151 days past its end. Contacting your senators about the recently-passed House bill that would extend the waiver for billing telehealth services through 2024 is a great way to add your voice to those advocating for permanent telehealth services.
In my rehab therapy predictions for 2022, I discussed why diagnostics testing is a great way for physical therapists to expand their clinical reach. There’s evidence that electromyography (EMG), nerve conductions study (NCS), and musculoskeletal ultrasound testing lead to more accurate diagnoses and higher reimbursement rates.
Empowering therapists to make use of diagnostics only furthers our push to be considered as primary care providers. Diagnostic testing allows rehab therapists to understand and treat the underlying cause of a patient’s condition, rather than just the symptoms. Patients who receive ultrasound or EMG testing ultimately experience 62% better patient management than those who don’t receive it. What’s more, patients who receive these additional treatments have a higher PT visit return rate than their counterparts.
Data can also be used to improve employee satisfaction.
One finding that jumped out in our aforementioned report is the number of therapists considering making a career change out of clinical work. According to our survey, 27% of respondents were considering moving into non-clinical roles or leaving healthcare altogether, with another 15% considering a new role within the clinic. And many are actually following through on career moves: our profession’s turnover rate is roughly 9% this past year, which is higher than the current healthcare industry average of 3.7%.
What was most surprising, though, was just how unprepared many practice owners are to deal with the current retention and burnout issues. There was a significant misalignment between the reasons that employers cited for their employee resignations and the reasons employees provided to us. In addition, the strategies that employers undertook to improve retention did not match up to what employees actually wanted.
This gap suggests that we can do more to connect with if we not only want to hold onto these talented providers, but support them to work at the top of their licenses.
Use surveys to gauge employee satisfaction.
Multiple forms of communication (in-person or anonymous) are key to connecting with your teams and collecting valuable feedback. Clinics are (hopefully) familiar with using Net Promoter Score® surveys to measure how patients are feeling about their experience; but, did you know that it can actually be used in a similar fashion for your staff? By tweaking the question slightly, you can collect intel on how your staff is actually feeling about their work experience. A few additional questions to probe more into the reason behind their numerical ranking can provide feedback on what they might love and also what they might like to change. An employer-initiated request for feedback, and subsequent actions taken based upon that feedback, nurtures a culture of
inclusiveness, respect, and caring.
Regular communication goes a long way.
Pairing the use of technology to collect anonymous survey data with regular face-to-face meetings with your staff helps to strengthen your relationships and get down to the essence of employee-employer relations:
- What are the employee’s professional goals?
- What are the expectations of the employer and clinic or company goals?
- What parts of clinical care do the clinicians excel at? Where could additional training or support benefit them?
- What do employees value in an employer/manager/workplace?
- What motivates the employee?
- How can the employer help manifest the employee’s goals?
Whether it’s scheduling regular one-on-ones or the occasional off-site lunch, when paired with regular satisfaction surveys, consistent communication will ensure a regular feedback loop and thus help promote alignment between employer and employee.
Every one of us knows how valuable rehab therapy is to our patients, and the potential for us to have more of an impact on public health as a whole. But we have failed to create a story that highlights our efficacy, and specifically why rehab therapists are the premier provider to treat the growing number of MSK patients in this country. Technology and data will not only augment and improve our work and connection with patients, but it will also help us solidify our place as primary providers in the value-based care landscape of the future.