For several years, I have been making #physicaltherapy predictions with the most recent in 2020 and 2019. Despite the pandemic, I think many of them were accurate. Heidi Jannenga has likewise listed hers this year and for several years we have done podcasts around our similarities and differences.  In June of 2020, I did 2 podcasts on #physicaltherapy predictions in a post-COVID world. They can be found here and here.  As it turns out, June was a bit early to make these predictions but I still stand by them. To recap, here is a list of them with a full explanation in the podcasts.

• Conferences and education will/should change to a hybrid model that allows learning to happen online, reducing the amount of onsite contact
• There will be regulatory impacts that will cause higher costs to the clinic
• Integration of delivery systems, like Telehealth, to augment but not replace physical therapy
• PT staffing models are going to change with a better understanding of labor costs
• The financial acumen of the average physical therapy practice is going to need to increase to stay competitive
• Physical Therapy has to be a part of the health care disparity solution via optimization
• Doubling down on non-clinical factors, like therapeutic alliance, empathy, compassion
• Refocusing on chronic pain pandemic
• Integration of behavioral health into physical therapy
• Physical therapy patients need to feel confidently safe at the clinic
• The role of physical therapists in public health will become more popular

For 2021, here are my top #physicaltherapy predictions (some of them are part of the post-pandemic time period as well) and in no particular order:

1. Physical therapy will become much more integrated with behavioral health.

As noted, there is a doubling of mental health issues during Covid. Americans are heavier, more addicted, more anxious, fearful, and more prone to substance abuse than anytime in our history. The vast expansion in online and behavioral health interventions is duly noted and outside of primary care, the uptake and success of Telehealth in behavioral health by any measure is successful (contrary to our profession-more on that later). Physical therapy has been screening for depression for years and this along with other validated instruments will be commonplace. Bundles of research show that exercise and movement are successful therapies for mental health issues and that is precisely our key role. This tremendous editorial in JOSPT, Musculoskeletal Physical Therapy After COVID-19: Time for a New “Normal” by Auliffe, O’Sullivan, O’Sullivan, and Whiteley is spot on. Citing that this is our Elizabeth Kenny movement, the authors successfully argue in my opinion that it is time for musculoskeletal physical therapists to grasp the opportunity provided by the COVID-19 pandemic to provide care that is (1) primarily active, (2) focused on self-efficacy and self-management, and (3) far less reliant on passive therapies. It is likely the same physical therapists that believe they didn’t go into the profession to be a salesman that also believe we don’t provide behavioral interventions. Self-efficacy for example, has significant #physicaltherapy research underpinning (for a refresher, please consider reading the chapter on self-efficacy in Called to Care). Basics in cognitive behavioral therapy and pain neuroscience provide additional competencies for PT’s. Collaborating with professionals in behavioral health will occur with great frequency. We have asked EIM to create additional courses and certifications for PT’s to understand their role and limitations in behavioral health.

2. Virtualization of #physicaltherapy visits as a replacement for hands-on numbers will continue to decline from Covid highs.

We have this incredible habit in our profession of folks becoming self-anointed specialists who then can train the world and the number of these so-called “telehealth experts” became front and center for a few weeks in 2020 and our entire profession became united in making CMS and others pay for Telehealth. It worked until it stopped working. Despite relaxing of HIPAA and other rules, just a short few months after the peak shutdowns across the U.S., patients started to return to clinics and Telehealth fell faster than WeWork. Why? Patients wanted to come back in and most PT’s hate it and think it is substandard. While Telehealth and digitalization are gaining significant uptake and investments in many areas of medicine, our profession can’t be displaced easily. This doesn’t mean that Telehealth doesn’t have a role in our profession-it does. It is an adjunct, a delivery method that in the right patient at the right time with the right dose can provide value. It simply means that Telehealth can’t replace us and it shouldn’t. There are two general groups trying to convince the world though that it can replace traditional in-clinic visits. Platforms sold to primarily surgeons to eliminate or disintermediate the expensive PT and corrupt middle manager work comp players who profit by providing less physical therapy without regard to quality or outcome. Much noise will be made about all of this in 2021 but the ones that count-patients will access us in record numbers and some of that access just might be via the delivery of Telehealth as an adjunct but not a replacement. Lastly, there is no doubt that care for patients of all types will grow “outside a provider’s four walls” including PT (think medicare part B at home rather than clinic) but more of this will be via monitoring, diagnostics, hospice growth, and pharmacy as the Doordash and Instacart’s of the world look to expand their reach-a key difference is it is easy to forget how much healthcare is regulated which will constrain too much growth.

3. MIPS growth will be significant and become the outcome standard for a growing number of players including payors.

In addition, the number of MIPS players in physical therapy will consolidate.  Like it or hate it, MIPS is the law. While mandated use of it isn’t significantly greater in 2021 than 2020, the ability to gain a bit over 7% in medicare reimbursement is attractive given the cuts in medicare. More importantly, a more universal outcome standard for all of our patients has been created. The good news is that the implementation is far
easier and much more intuitive, replacing the esoteric “health-related quality of life” which nobody really understood anyway with validated instruments that are impairment or function-based. Not surprisingly, 20 plus years of outcome data tell us that we don’t make an obese, diabetic patient free from being overweight or diabetes but we do improve their function and movement so that is precisely the type of outcome tools we should be using to justify our interventions. MIPS requires the use of these tools on more than just your
medicare patients and this data is what payers will adopt gradually as the data sets become significant. Even physician-owned PT, hospitals, and rehab agencies will have to play despite not being required simply because it will become a more standardized way to compare providers. Hopefully, the unscrupulous middlemen of the work comp world will adopt these validated standards rather than their BlackBox, proprietary evaluations of physical therapy clinics which heretofor criteria has simply meant those locations who accept the lowest rates or have the lowest utilization so the middlemen companies can profit at the patient’s expense.  I suspect there will be a reduction to 3 or 4 major mayors in the MIPS/outcome business given the huge costs and regulations.

4. Direct to employer and self-insured care will continue to rise while value-based care will be at a stalemate.

As profits continue to escalate to health insurance companies (so much so they gave some money back in 2020!), the question of value and role of traditional insurance will become greater as contrarians see the role of insurance companies decreasing with a continued rise in HDHPs, cash-pay, consumer health models, and increased employer direct-contracting and self-insuring.  Providers took the major hits in 2020 and coming out of COVID, there aren’t a significant number of providers looking to take on more risk and let’s not forget, even CMS has indicated that value-based care programs have not met the goals. Financial pressures to providers including #physicaltherapy will continue to further consolidation and while many more groups will be poised to deal with value-based care, the investments necessary (e.g. analytics, data, conveners) coupled with risk will not have many dipping more than their toes in 2021.

5. After a sideways year in growth in 2020 for the obvious, the profession will grow by double digits in 2021.

There are more direct access, personal and concierge PT’s becoming commonplace and a groundswell of population health issues driving musculoskeletal care to its best and lowest cost providers via a preferred pathway model of care-and That is Us!  There is reason to be optimistic.

6. PT schools will continue to expand in new programs, expanding programs, and multiple cohorts.

Universities despite lots of government subsidies during COVID are hurting and graduate medical program expansion is just what the doctor and the Deans, CFO’s, and Provosts are ordering. COVID is best thought of as an accelerator and many in higher education are passing innovative programs and changes at a record pace. Higher intensity (shortened programs) will become much more common as it is no longer fashionable for USC to make fun of EIM OPM programs given similar passing rates and much better ROI for 2 year programs. Despite saying never, even our most reticent academics participated in zoom meetings and found out the old adage of teaching an old dog new tricks doesn’t apply to dogs or academics. Much of the pressure to change is both financial and growing demand for those paying the bills, notably students and their families!

Thoughts?

Happy New Year to friends and colleagues.  To a successful, healthy, #physicaltherapy year

@physicaltherapy