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The Odyssey of the PT Patient: Why the Pre-Care Experience Matters

February 26, 2021 • Advocacy • Heidi Jannenga

When we describe the patient experience or the patient journey, we usually begin the story the moment the patient walks through the doors of a PT clinic—or maybe the moment a patient reaches out to schedule an appointment. The problem is that both of these starting points describe the patient journey as it relates to us—therapy providers.

In reality, the patient journey doesn’t begin with a patient’s initial evaluation—or even with the patient’s initial call to schedule an appointment. Many patients complete a journey of Homeric proportions before they ever set foot in your clinic, and that journey shapes their perception of PT in general—and your care specifically—before you’ve even begun treatment.

There are a myriad of barriers, challenges, and influences that affect a patient’s pre-care experience—all of which PTs must identify and tackle together. But sometimes showing is better than telling, so let’s follow the path of a patient named Odysseus as he tries to seek treatment for his undiagnosed Achilles tendinopathy.

Many patients don’t even know they need to see a PT.

Our hero Odysseus is always on the go, but lately, the back of his heel has started to hurt, and it’s gotten a little stiff. Ice packs and rest aren’t helping much, and walking and running are becoming more painful—but Odysseus doesn’t know where to go to address his ailments. An emergency clinic feels excessive, and he doesn’t think a massage would help, as he has used his Theragun® at home with no improvement.

PT awareness is low.

Odysseus doesn’t know that he should see a PT—and he isn’t an outlier. Awareness of physical therapy (including who PTs are, what conditions we treat, and how we address those issues) is low. After all, 90% of the patients who could benefit from physical therapy never receive it. And a 2016 survey of patients with neck or back pain revealed that only 6% of patients would seek treatment from a physical therapist if cost were not an issue—roughly the same number as those who would opt for massage therapy.

This is what we mean when we talk about brand awareness. PTs could help countless people live without pain—but that doesn’t matter if those patients don’t know about us. This is why it’s so critical for us to market ourselves with general awareness in mind. It’s not just about branding our individual clinics; it’s about showing the entire medical community and consumer population who we are and how we help people.

Patients think PT is for major injuries.

Patients may not seek treatment from a PT because they assume physical therapy is for post-op rehabilitation patients—or those with major injuries. At least, that’s what some patients revealed in this Reddit thread. They didn’t think that their mild (in their eyes) back or neck pain was worthy of a trip to a PT clinic—especially when the pain was not sports-related.

And that was another interesting revelation in the aforementioned comment thread. While some patients associate physical therapy with debilitating, life-altering injuries, others believe it’s mainly designed for serious athletes. This leaves them feeling intimidated and afraid that they’ll be looked down upon for not being particularly athletic.

This is another area where brand awareness could help. It’s on us to ensure potential patients understand that we are capable of meeting a variety of needs.

This means patients often consult a physician first—and that physician may not understand the value of physical therapy.

Because our favorite patient, Odysseus, is not sure where to find help for his injury, he decides to visit his primary care physician in the hopes of being directed to the right specialist. At the office, his doctor recommends that he rest the injury and take NSAIDs, offering a prescription for strong pain medication if needed. The PCP also suggests that Odysseus may need more diagnostic testing (e.g., an MRI or a consultation with an orthopedic surgeon) if his condition doesn’t improve over the next month. His doctor does not recommend PT.

Physicians don’t always recognize when physical therapy is appropriate.

Anecdotal evidence is far from the end-all, be-all of mapping out cause-and-effect relationships, but patients in the above-linked Reddit thread mentioned that their physicians didn’t even think to refer them to a PT for their musculoskeletal pain. Beyond that, this study found that PT referral rates steadily dropped each year between 2003 and 2014. This could be due in part to improved direct access laws—but probably not much. WebPT’s 2019 State of Rehab Therapy report found that 78.8% of rehab therapy organizations require physician referrals before providing treatment. There’s certainly no shortage of musculoskeletal problems, so this implies that physicians aren’t referring their patients to PT as much as they could—or should—be.

Brand awareness is once again the culprit here. This is why it’s so critical that we form mutually beneficial partnerships with referring physicians—and evangelize our services across the entire healthcare continuum. Patients aren’t the only people who need to know more about physical therapy.

Patients must then find a good PT in their area who not only treats their injury type, but also accepts their insurance.

For argument’s sake, let’s say Odysseus is familiar with PT and actually knows that he should seek treatment from a physical therapist. He hops on Google, finds a highly rated therapy provider in his area, and calls to make an appointment—only to be told that this particular PT doesn’t treat his injury type. Not one to give up, he repeats the process again with another clinic—only to find that it doesn’t accept his insurance and doesn’t offer a cash-pay option. Beginning to feel defeated, he calls one final clinic—only to find that he must obtain a physician referral due to the constraints of his insurance plan.

It’s not always easy to find and access PT.

As our valiant hero has demonstrated, PT is not always the most accessible type of care—and when patients do seek it out on their own, they often face roadblocks. Many PT clinics specialize in treating a certain area of the body or working with a specific population (e.g., elderly patients). That’s a great thing, but patients need to know ahead of time (ideally when they first interact with your marketing materials) what—and who—you treat in your clinic. Beyond that, some payer reimbursement rates for PT services are so low that the clinics accepting them barely break even—or, in some cases, take a loss—which means clinics are starting to opt out of in-network relationships with common payers. And that represents yet another barrier for patients.

To top it all off, even though some form of direct access to physical therapy exists in all 50 states, many payers still require physician referrals as a condition of reimbursement. This makes some clinics hesitant to advertise directly to patients. Luckily, some revamped marketing efforts could fix this. Include your PT specialty (and the areas of the body you treat) on your website and in your marketing materials. And if you can, find out which of your payers require referrals. That way, you can accurately market your services to those patients whose plans allow for true direct access.

After that, many patients face uncertainty about their treatment and its cost.

Still nowhere near the end of his patient journey, Odysseus has finally found a PT who can treat his heel pain—now diagnosed as Achilles tendinopathy. He scheduled his first appointment, but he has absolutely no idea what to expect when he shows up. Can he wear his work clothes? How long will the initial visit take? What sort of treatment will he receive? Will it hurt? How much will it cost?

Patients don’t always know what to expect from PT.

As we’ve already established, PTs have some issues with overall brand recognition, and only a small percentage of patients who could benefit from physical therapy have actually received PT treatment. As such, many patients don’t know what to expect when they first go to an outpatient clinic. They may not know what to wear, how long the appointment will take, or—perhaps most importantly—how much it will cost.

Luckily there’s an easy way to address this. Simply ask your front desk staff to provide this information to new patients when they schedule their initial evaluation. (Even better if your website’s FAQ page supplies this information as well.) Educating new patients proactively will help you deliver a smoother patient experience—not to mention avoid patient sticker shock.

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The patient journey is often long and arduous. For some, like Odysseus, you might even describe it as epic. And as our hero demonstrated, it’s crucial to remember that the journey begins long before a patient physically enters your clinic. Still, it is possible—and best practice—to smooth out the wrinkles in the patient “pre-experience,” and thus ensure patients get the most out of their treatment.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC/L, is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated...

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Billy Cioffredi

Commented • March 7, 2021

Heidi, Your comment on the value of 'pre-care' when people first arrive at your office is spot on, if it's not already part of your overall patient experience. But it was your story of Odysseus and his journey to actually arrive at the PT clinic that spurred me to comment. Physical therapy has been my career for 41 years. The challenges and barriers that you outline in your article were true at the early stage of my career and I believe is an accurate description of the landscape now. What has been the best solution to these challenges for me has been to provide a service based in highly competent clinical skills matched with equal competence of genuinely 'caring' for our patients, and then appropriately marketing our good outcomes. I appreciate any support that the APTA or PPS section can provide or teach me to improve marketing and public relations skills, but it is no substitute for providing an exceptional patient experience in one's local community. I feel privileged for the opportunity to care for the patients I have treated and it is been my responsibility to earn their trust. And by extension and through each of our staff, our organization has earned the trust of our community. We encourage each of our staff to create their own following of patients who would prefer to see them if and when they need follow-up care. I know there are many practices across the country that provide outstanding care and service like we do. But I've lived through the days when massage therapy was just beginning in our community and hearing colleagues comment with arrogance that "they don't do massage therapy". I've lived through the explosion of the personal training industry hearing similar comments, while the massage and personal training industry was providing what was needed and wanted by the public and receiving cash for their services. We take students at our clinics and try to do an honest job in preparing them for the working world. I query most students about their other experiences and it saddens me when I hear stories where supervision and mentoring was limited at best. And it saddens me when we receive too many patients who have had a previous experience elsewhere that, for a variety of reasons, was just unsatisfactory. And I'm not referring to the occasional disgruntled personality, or mishandling error that any of us can make. There is still an inconsistency in the standard of care and an entire patient care experience in our profession. I believe the responsibility is ours alone to create an exceptional professional identity where patients are eager to seek us out for our expertise and the courteous, pleasant experience they have with the entire organization we represent.

Jon Waxham

Commented • February 26, 2021

Heidi, Great job in summarizing the challenges we currently face in PT, declining reimbursement, road blocks to direct access and most importantly a complete lack of awareness about who we are as a profession and what we can do for those 90% that never get to us. Unfortunately the APTAs new public service announcement while doing a nice job encouraging physical activity, barely mentions what PT is or how it benefits those with pain or mobility issues. If I didn't know what PT was before, I certainly wouldn't know to seek it out afterward. We need to find a way to create a national marketing campaign that is much more enlightening about how we can help that 90%. In addition we need to educate the Family Medicine and General Practitioners about the benefits of PT. Have any of our representative reached out to their association and offered to speak at their annual conference? Seems like a great way to collaborate since most practices still rely on MD referrals. Thank you for continuing to advocate for our profession, I just wish it led to more action by our Association.


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