2021 was a mixed bag, if I’ve ever seen one. As we emerged from the mayhem that was 2020, many of us (myself included) hoped that this year would shepherd in some calmer times—or maybe even a sense of normalcy. In some ways it did, and in some ways it didn’t—and I imagine everyone’s “year-end pros and cons lists” are just a little bit different. One thing I’m sure we can all agree on, however, is that it would have been difficult to predict the way this year unfolded. Nevertheless, I’m going to take a crack at predicting how 2022 will unfold. (I love a good challenge, after all.)
Without further ado, here’s what I see coming down the pike in 2022.
Revenue and service payments will continue to decline.
It pains me to include this prediction in this post; I’d love nothing more than to be completely wrong about this. However, I think we need to be realistic about the downward trajectory of PT payments. The past couple years have seen some truly wonderful legislative wins for physical therapists—but they’ve also seen some enormous revenue backslides. CMS first announced its decision to reduce therapy assistant payments in 2018, and the overall 9% cuts to Medicare followed just a year later. While industry advocates fought long and hard to overturn both pieces of legislation, they were not fully successful. The therapy assistant payment differential applies in fewer situations now—but it’s still around. As for the 9% cut, advocates managed to convince Congress to reduce them—though these reductions are only temporary and are largely influenced by the pandemic.
Of course, both of these payment reductions stack on top of the other payment reductions that affect Medicare providers, including (but not necessarily limited to) the:
- Multiple procedure payment reduction (MPPR),
- Sequestration reduction, and
- Pay-as-you-go (PAYGO) reduction.
It’s a little disheartening to see the cuts laid out like this (especially as we watch inflation skyrocket). It’s even more disheartening to see that they’re beginning to form a trend.
PTs can adapt to this trend—and potentially reverse it—but it will take time and effort.
Now, I’m not saying this trend is set in stone. In fact, with dedicated advocacy efforts, I firmly believe that PTs can prove the worth of our services and make a strong case as to why we can’t endure more cuts. However, this will only happen if many more PTs take up an active role in supporting their professional organizations, like the APTA, PT-PAC, and APTQI—and that means contributing financially. Only then will we amass the influence we need to make lasting change.
Until then, PTs will need to cope with declining reimbursements by reducing inefficiencies in their front office, increasing patient volume, diversifying revenue streams, and scheduling assistants more strategically. I’m not saying that increasing patient volume is the only answer here, rather it’s efficiency and a diversification strategy (whatever that looks like in your clinic).
Rehab therapists will see tangible drawbacks for failing to embrace technological change.
I’ve said it before, and I’ll say it a million times more until everyone’s on the same page: We now live in a digital world, and it has changed everything. If you told me 20 years ago that I could use an app to place an order at the grocery store, someone would do my shopping for me, and leave the bags at my door (all without speaking a word to anyone) I would have looked at you like you had just grown another head. But clever technology and convenience are pillars to a good customer experience now—and rehab therapists are falling way behind the times.
We do not have permanent telehealth privileges. We don’t prioritize the use of software that makes scheduling and bill-paying easy for our patients. We rarely give precedence to patient convenience because we’re so used to the patient-drives-to-the-office-multiple-times-a-week healthcare models of the past. And I believe we’re about to see some consequences for not adopting technology fast enough.
Non-medical digital health startups are on the rise.
Rehab therapists are gaining some new competitors: digital musculoskeletal care (digital MSK) companies. These companies do not provide health care—and they do not always staff licensed practitioners. Instead, they position themselves as wellness services (with a strong musculoskeletal care component) that patients can access from the comfort of their homes. And frankly, they’re booming. Private equity firms are investing in digital MSK left and right because they’ve finally seen how many patients need musculoskeletal care—and digital MSK companies are providing what they see as the most convenient solution for patients.
I don’t mention this to scare everyone, but rather to galvanize the masses. We must invest in technology. We must modernize our care practices. We must focus on the patient experience and offer convenience and efficiency in addition to great outcomes. And I believe we can begin to do that through the use of telehealth.
It’s time to fight for telehealth privileges.
If PTs want to keep telehealth in their back pockets (and trust me, we do), then all PTs who are actively providing remote care need to collect data to create a compelling case that proves telehealth’s efficacy. The Centers for Medicare and Medicaid Services (CMS) are asking insistently for outcomes data for telehealth visits—and that’s something we can only provide for a limited time. Once the COVID-19 public health emergency draws to a close, we’ll no longer be able to provide telehealth to Medicare beneficiaries—or collect that outcomes data.
In addition, we also have to petition Congress to pass legislation that permanently places PTs on the eligible telehealth provider list. Although CMS can approve telehealth services, only our legislators can approve new telehealth providers. This “eligible professional” designation is what PTs, OTs, and SLPs need in order to deliver and get paid for telehealth services.
So, this is where we take a stand. We collect data; we share patient stories with Congress (in a HIPAA-safe way); and we support the organizations that are already pushing for telehealth privileges.
Innovative academic programs will dictate the future of the industry—and they will thrive most.
PT patient care practices aren’t the only thing that needs to evolve in our profession—our academic programs (i.e., DPT programs) need to innovate as well. The problems with our DPT education programs are fairly clear cut:
- They’re too expensive;
- New grads are not learning how to use technology in the clinic (e.g., telehealth, EMRs); and
- DPT programs are not attracting a diverse student population.
I believe the programs that take initiative and alter their content, structure, and recruiting processes to address these problems will alter the course of our profession for years to come. Hybrid programs or accelerated program models are the schooling experience of the future—and so are the programs that teach new grads how to provide high quality remote care or document in some kind of EMR system. Technology is embedded in our profession, and we need to equip the minds of the future with the tools they need to succeed.
The push to improve diversity in the rehab therapy industry (and be more inclusive) will sustain itself.
The information that the PT industry is racially and ethnically homogenous is not all that new. The Bureau of Labor Statistics has reported on this information for years—and the APTA began talking about the problem years ago. For its part, WebPT confirmed that non-white therapists are vastly underrepresented in the industry when the team compiled the annual State of Rehab Therapy Report. We’ve known about this for a while.
But since the events of 2020, I’ve witnessed a huge cultural shift around Diversity, Equity, and Inclusion (DEI) initiatives. Everyone seems to understand that strengthening DEI efforts is essential to expanding clinical reach, driving culturally competent care, and improving patient outcomes. Here are some of the movements I’ve personally noticed:
- The APTA has renewed its efforts to attract non-white students to the profession;
- Big rehab therapy companies are joining the CEO Action coalition (an organization dedicated to promoting inclusive workspaces);
- Industry conferences are hosting more sessions about DEI and cultural competence;
- New scholarship organizations are cropping up; and
- Much, much more.
To me, this feels like a lasting change rather than a reaction to a one-time public upheaval. We’ve turned a corner in the conversation—or at least we’re peeking around the corner! We may not have all the answers yet to break down the systemic barriers that have shaped the racial and ethnic status of our industry, but we’re moving forward.
The “PT First” approach will become a more accepted clinical pathway for patients to follow.
Right now, PT does not come first in the patient journey. In fact, sometimes it feels like patients try just about everything other than PT first. They seek diagnoses from physicians or orthopedic specialists. They try self-medicating with over the counter drugs (or sometimes even prescription painkillers). Patients frequently even get surgery for common musculoskeletal ails before ever stepping foot in a PT clinic.
In 2022, I foresee that beginning to change—so long as business owners in the rehab therapy space practice what they preach and encourage that clinical pathway. As companies get bigger, they have the bargaining power and flexibility to dictate more of their healthcare coverage—including PT coverage. Through these policies, companies can nudge their employees toward For instance, WebPT carries PT as a secured benefit and gives all insured employees a reduced copay when they see a PT—no matter how many times they see that PT.
Beyond that, we know that some other companies are beginning to move in this direction. The ones that support digital MSK (as frustrating as that may be) are encouraging employees to seek conservative care that’s grounded in movement—not pharmaceuticals. There’s a change coming, and I believe we can lead it.
We will continue to elevate our profession as new challenges arise.
If there’s one thing that’s always certain, it’s that PTs are resilient. No matter what trials and tribulations are thrown our way, I trust that our industry will find its path and make it through. Even though there are some mountains on the horizon that we need to summit, I not only believe that we can—I know that we can. A brighter future is ahead of us. I know it.
What are your predictions for the coming year? What do you think about mine? Feel free to reach out with your thoughts and we’ll chat about it!