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PT is Great—But We’re Having a Tough Time Proving It

August 30, 2021 • Advocacy • Heidi Jannenga

PTs face many upcoming challenges—to the point where it feels overwhelming. Student debt is mountainous; CMS continuously cuts our Medicare payments; we haven’t secured long-term telehealth privileges; the PT compact is still incomplete; our industry lacks diversity; physical therapy is often too expensive for the members of lower socioeconomic classes—and the list goes on. But of all the challenges that we face, I believe that our biggest roadblock (and perhaps the key to minimizing that long list of challenges)  is our lack of market penetration. In other words, countless patients—and even other healthcare providers—don’t know what PTs are capable of accomplishing. And so PTs are sidelined for other treatments (like opioids)—and our funding is threatened year after year.

We know that physical therapy is ridiculously impactful and cost effective—but no one else seems to. Why the heck is that?

PTs don’t have enough readily available data proving the value of our profession.

In the scientific world—and especially in the healthcare industry—data is king. Peer-reviewed studies dictate the direction of medical treatment for years to come, and payers from CMS to United Healthcare use that data to establish overall payment rates, policies, and even individual contract rates. So, why do payers keep giving PTs the short end of the stick? It’s simple: They haven’t seen the data that proves physical therapy will:

  • Improve patient outcomes more effectively than other treatments, and
  • Save them money.

This could be due to a variety of reasons. One of the major problems that plagues scientific academia is that studies are too often locked behind paywalls, barring people (and insurance carriers) from accessing the data that could encourage them to make significant changes to their policies. It could also be due to failed communication practices. For instance, the Journal of Orthopaedic & Sports Physical Therapy is a reputable publication that has published thousands of PT studies—but how often have PTs taken those studies to insurance actuaries to help educate them when negotiating for better rates and regulations?

The data that we do have available simply isn’t getting to the right place—and, at times, it can be difficult to find. When you Google studies about physical therapy, the ones that pop up are less than ideal.

Even our foundational knowledge is under question.

Recently, I (assisted by WebPT’s content team) wrote a guide to building home exercise programs (HEPs). As I compiled this information, I wanted to reference studies and research proving that:

  • HEPs are effective; and
  • HEP adherence improves patient outcomes.

Unfortunately, I struggled to find research that backed up either of those points—both of which are treated as givens in the PT workforce. Not only did I struggle to find research around that topic, the studies I did find flew in the face of those assumptions. For instance, I found one study claiming that patients who receive a total knee arthroplasty may not need to see a PT, and can instead follow a self-guided HEP plan with similar outcomes. And I found another study (in the JOSPT, no less) claiming that HEP adherence had no bearing on the outcomes of older patients with chronic knee pain.

Studies like these severely hurt our advocacy efforts and attempts to bolster the PT profession—not because they exist, but because of what their results could mean about how we approach care, especially if we are not adhering to or evolving with the research. How many therapists are still using phonophoresis in their plans of care? If patients aren’t progressing more quickly or avoiding costly surgery when they see a PT, then we need to reexamine the care that we provide in the clinic, and ensure that we’re providing treatments that lead to the best outcomes. If HEP adherence really has no bearing on patient outcomes, then we need to reevaluate HEPs wholesale, and study them to determine how we can make them better—or if medical science has evolved past the need for them.

Data can move mountains for us.

The heading of this section says it all. If we begin collecting (and sharing on a wide scale) good, peer-reviewed data about the benefits of physical therapy, we’ll be better equipped to prove our worth in the healthcare continuum. We can prove that physical therapy is the best, most cost-effective solution to so many problems that plague US patients—from chronic low-back pain and opioid addiction to preventative and proactive treatment.

Payers are already asking us for our data.

We know that payers are already hurting for PT data. Take the 2022 proposed rule as an example. CMS spent several pages explaining that it wasn’t planning to classify rehab therapy CPT codes as eligible telehealth services because it hadn’t seen trustworthy data proving that virtual therapy is effective. Following that spiel, CMS said, “We continue to encourage commenters to supply sufficient data for us to be able to see all measurements/parameters performed, so that we may evaluate all outcomes.”

You can’t get more straightforward than that: CMS is seriously hurting for data, and it’s telling us that if we want to make progress, we need to prove that our goals align with patient interest.

We must beware outdated and bad information.

As I mentioned above, scientific fields are always evolving, and we must be careful not to rely on outdated information just because it suits our needs. Take ultrasounds, for instance. The research vouching for ultrasound therapies in PT is old and outdated. The reality is that ultrasounds aren’t really helpful at all; they don’t go deep enough to truly help patients. Yet, we keep performing them. Perhaps this is because it takes time for research to proliferate and many are resistant to change. Perhaps this is the case because academic systems are slow to change and continuing education focuses on teaching new techniques—not revisit old, debunked techniques. In any case, these are not acceptable excuses for falling behind the times.

If we want to earn and retain our respect in the medical industry, then we need to promote good information—and avoid the bad—in all aspects of our treatment. This includes information about COVID-19—from how we protect patients in the clinic to how we talk about the FDA-approved vaccines. In this case, skewed facts and bad information is jeopardizing the world’s ability to move beyond the pandemic. This misinformation is rampant even among non-physician healthcare professionals—which is incredibly disheartening, not to mention irresponsible.

As healthcare professionals, we have an obligation to promote good science and operate based on facts—not baseless and unverified theories that fly in the face of research.

_________________

All that said, I believe the future of the PT profession looks incredibly bright. I believe that we can move this profession forward and prove our worth to the world. We must prioritize collecting and sharing the data to do it.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC, is the co-founder and Chief Clinical Officer of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for the rehab therapy profession on a national and international scale. She’s an APTA member,...

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––– Comments

Chad

Commented • September 1, 2021

I believe, the issue is the profession itself there are too many in our profession that are not willing to fight against the cuts because they don’t believe one person can make a difference! Just think if you had everyone in your office send in letters or call our constituents we could change the tide but it’s up to us as a profession to wake up! Too many in our profession are cookie cutter and don’t care to improve their skill set because to them it’s just a job not a passion. This mentality can skew the results of a research project and make it seem like there’s no benefit in PT. These professional need to have a passion for the profession or reignite their passion, improve their skill set and be willing to move mountains to make their patients better then we can prove physical therapy can make a difference. If we as a profession can instill the passion in students, show them the value of continued education to make them a better clinician and encourage early student involvement in our profession instead of the importance of how much they get paid once they get out things can change!

Jon W.

Commented • August 31, 2021

Thanks for highlighting this important topic. I agree with all of the points you brought up except one, the future of the PT profession looks incredibly bright. Unfortunately we have been making the argument about the importance of research in earnest since the late 1970s and where has it gotten us? As you stated most research is inaccessible due to payment walls. Where is the altruism in providing research results only if you pay for them. I have found articles that I wished to read that could only be bought for 40 to 50 dollars. That certainly impedes our universal goal to use evidence-based practice. A possible compromise is to allow publishers to hold onto articles for 3-5 years and then they should become available to all for free. At least research a few years old would be more accessible. In addition, the body of research available is this large fragmented mosaic with no focus on the big picture or the areas of greatest need in PT. This issue feeds into the larger issue that our leadership in physical therapy can't get out of it's own way. If there are specific needs to legitimize our profession then the APTA should fund research in those specific areas, or at least help to guide the topics of most urgency. The PT profession keeps going, business as usual as the ship goes down. With all of the research done in the last 40 years, we still can't prove the overall effectiveness and benefit of PT care. I hate to be pessimistic about our future, but I haven't seen much change in the last 20 years that gives me much hope, with the exception of the growing success of cash-based practices. If we need research to continue getting payment from insurance companies, and we have been at it for 40 years and our current research isn't getting the job done, then the best option is to stop relying on insurance reimbursement. That looks like the best way out of our current plight but that would take a monumental shift in thinking and philosophy.


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