It’s a new decade, and the future is bright—or at least, it could be! That was the overarching message when our expert PT soothsayers, Dr. Heidi Jannenga, PT, DPT, ATC, Co-Founder and Chief Clinical Officer of WebPT; Dr. Dianne Jewell, PT, DPT, PhD, FAPTA, WebPT Director of Clinical Practice, Outcomes, and Education; and Dr. Scott Hebert, PT, DPT, WebPT Director of Product Management, joined forces to make seven predictions about the future of rehab therapy. Unfortunately, our clinical clairvoyants didn’t have enough time to address all of the queries that filtered in during the hour-long webinar, so we compiled all of the most frequently asked questions and answered them below. Can’t find an answer that addresses your most pressing future fear? Feel free to drop it in the comments, and we’ll do our best to give you a top-notch answer!
Telehealth and Technology
How do I bill—and get reimbursed—for telehealth as a physical therapist?
Getting reimbursed for telehealth is difficult and state-legislated, so the first step is to check your state practice act to determine the rules for administering and billing for telehealth services. (This WebPT article on telehealth billing is another great initial resource to consult.) On that note, licensure is a major consideration—especially when you’re using telehealth across state lines. In many states, you can’t treat outside of your state without having a license in the state where the patient is receiving treatment. This is an area where advocacy is needed at the state level. As of the publish date of this post, 21 states are part of the PT Compact, which provides license reciprocity to member states.
Furthermore, if you’re interested in adopting telehealth in your practice, make sure you review your commercial payer manuals and contracts to get a better understanding of how they define and restrict it. When it comes time to renegotiate those relationships, be sure you can speak the payer’s language. This will increase your chances of obtaining coverage from that payer.
In the meantime, providing telehealth services on a cash-pay basis is a great alternative, and some would argue patients are more than willing to pay for that convenience.
How can brick-and-mortar practices make telehealth more profitable?
We’ve actually written quite extensively about this on the WebPT Blog. Check out the following posts:
Can PTs legally provide wellness services?
In most cases, yes; however, the rules are ultimately determined by each state practice act. So, you must understand these rules to determine what you can and cannot provide. Then, in order to garner patients, you must clearly demonstrate the value of your services—specifically, why wellness and fitness services provided by a licensed therapist are a huge benefit (e.g., PTs’ expertise in mobility directly relates to patients’ wellness and being).
What are the legal or liability implications of providing wellness and fitness services?
That depends on your state practice act and professional liability insurance. We recommend reaching out to a local healthcare attorney to discuss the implications for your particular practice. Regardless of your state’s law, though, providing services that are related to your clinical education—but don’t require it—may put you in a tricky situation. As we explain in this blog post, “rehab therapy providers should always be aware of the expectations that come with therapy licensure—even when those providers are rendering services that are secondary to their main function...In other words, if the therapist’s qualifications include the skills necessary to administer aid in an emergency situation or detect early risk factors for certain health issues, then he or she could be held legally accountable for failing to do so.”
Does providing wellness and fitness services devalue PT as a doctoring profession?
While many PTs argue that PTs who provide wellness services are—consciously or unconsciously—devaluing physical therapy as a doctoring profession. During the webinar, Hebert disagreed with this sentiment, explaining that ultimately, the value of physical therapy lies in a PT’s ability to improve a patient’s health. And it’s important to note that PTs can tap a greater depth of musculoskeletal knowledge than wellness professionals when they are providing those services to patients. So, while PTs and wellness professionals can deliver the same service, the physical delivery—and the decision to deliver it—is what differentiates PT-provided wellness services from regular wellness services. On top of that, as we explain here, “if you’re concerned that adding wellness services could hurt your competitive edge by making you seem less “doctor-y,” keep in mind that many physicians offer ancillary services as well. In fact, research from Medical Economics found that 94% of medical practices offer some kind of ancillary service, so this certainly isn’t a trend that’s unique to rehab therapy.”
Is offering nutrition advice within a PT’s scope of practice?
According to the APTA, “Nutrition is part of the professional scope of practice for physical therapists.” However, “because each state has its own jurisdictional scope of physical therapy practice, PTs should check their state practice act, which may be silent on nutrition. If that is the case, PTs need to turn to state laws governing nutritional practice, which like physical therapy practice acts are adopted by each state.”
Is it possible to get payers to cover nutrition and overall wellness services in a private PT practice setting—or will patients have to pay out of pocket?
Many nutrition and wellness services aren't covered by insurance, but patients are often willing to pay for these types of services out-of-pocket. Such cash-based offerings can help offset decreasing insurance reimbursements in your practice. If you’re interested in starting a cash-based wellness program in your practice, consult our free guide to adding cash-based services.
Do you recommend selling retail items in a private practice clinic (e.g., nutrition bars, drinks, Swiss balls, or TheraBands)?
Absolutely! This is a great way to dip your toe into the cash-based pool. We actually have an upcoming blog post that will focus on how to add retail items to your practice, so be sure to subscribe if you haven't already!
If PTs expand into preventive and wellness care, how will we continue to draw a line between ourselves and personal trainers/athletic trainers?
At the end of the day, the main differentiator between PTs and personal or athletic trainers is that PTs have undergone more training, received more education about the human body, and developed a much higher caliber of clinical expertise. PTs can provide skilled, masterful, and most importantly, evidence-based care—whereas personal trainers cannot. The best way for PTs to ensure that prospective patients know this is to advocate for themselves—to communicate that they do, in fact, have this expertise.
Do you believe that increased patient access to providers via channels like text and email actually contributes to the therapist burnout problem?
According to Hebert, while it’s possible that opening communication channels between therapists and patients could open the door to burnout, it’s not a guaranteed cause-and-effect scenario. Providers (and clinics as a whole) need to set guardrails for themselves and establish realistic expectations with their patients. So, let your patients know that you’ll only respond during a specific set of hours—and adhere to that. Just because a communication channel exists, it doesn’t mean you have to use it 24/7.
Do you foresee large therapy companies moving away from pushing high productivity rates?
A lot of that depends on the culture of the organization, so it’s hard to make a blanket statement. However, we do foresee more therapists opting to work for practices that prioritize staff (and patient) wellbeing. That—combined with the shift toward more value-based care—might encourage more large therapy companies to stop focusing purely on productivity and instead focus on provider impact and care quality.
If our clinic decides to move away from productivity goals, what other goals should we measure?
We actually wrote an entire post on alternative performance metrics that clinics can use in lieu of productivity rates. We also explained why it’s in every clinic’s best interest to move away from productivity goals in this blog post.
How do PTs go about getting recognized as a profession rather than as a service?
Unfortunately, changing this classification will literally take an act of Congress, because physical therapy is recognized as a service (and not a profession) under a Medicare statute. The good news, Jewell believes, is that this might actually be the perfect moment for action. CMS has recognized that there’s an education differential between PTs and PTAs, which means that it is poised to officially recognize PTs’ medical authority. Physical therapists just need to decide how to organize this advocacy push—and communicate that to their representative organizations (e.g., the APTA).
The Merit-Based Incentive Payment System (MIPS) appears to be a case of zero-sum budgeting. Will the rest of the healthcare space follow this reimbursement trend?
According to Jewell, “CMS is already reevaluating [the MIPS] program.” That being said, the budget-neutral piece is set in statutes, which means that changing it would require congressional action. So, if you want this change, advocacy is your best avenue. Per Jewell, PTs and other providers need to get in front of Congress and explain why these programs don’t have the desired effect. As for whether the rest of the healthcare community will follow this trend, as our hosts mentioned, payers tend to move in packs. It’s clear that they care about value-based payment, and it’s easier for them to follow in the footsteps of existing programs than it is to create their own from scratch.
Can I access other therapists’ past MIPS scores?
In theory, yes. CMS has announced its intention to make providers’ MIPS scores completely public-facing. At the moment, you can view providers’ MIPS scores on Physician Compare as a star rating.
Is MIPS participation worth it for rehab therapists?
Unfortunately, that’s a decision your therapists—and your clinic—are going to have to take on themselves. MIPS ROI can change depending on your clinic’s patient and payer populations, budget, cashflow, documentation process, software access—and so much more. It’s difficult for us to say with any certainty whether MIPS is worthwhile for an individual therapist or clinic. That said, we’re working on creating a couple different resources that may be able to help therapists and clinics get a better pulse on their MIPS ROI. Keep your eyes peeled on the blog for more information! (And if you haven’t already subscribed to our blog, be sure to do so!)
Will an individual MIPS score follow the individual even if he or she participated as a group?
Yes; MIPS performance is attributed to each individual in the group.
Can you speak to the additional quality measures that CMS introduced this year?
CMS made a swathe of changes to the MIPS quality category for the 2020 performance year—cutting, adding, and changing quality measures with abandon. This year, the PT and OT specialty measure set contains 14 different process measures and seven outcome measures, for a total of 21 reportable measures.
PTs and OTs were able to report some of these measures last year (e.g., the diabetes measures), but they didn’t make their grand appearance in the specialty set until 2020. Other measures (like the ones concerning dementia) are entirely new for PTs and OTs.
For more information about MIPS and its quality measures, check out this comprehensive guide to the program.
I’m concerned that MIPS reporting decreases quality time with patients and increases documentation time. How can we efficiently report for MIPS?
The best way to report for MIPS without multiplying your documentation time is to team up with a reliable software or service that will take on the brunt of the reporting burden for you. An ideal MIPS software will integrate with your EMR, so all you have to do is check some boxes and write a line or two when prompted. If you’re interested in seeing WebPT’s MIPS solution, check out this page about how to stay profitable.
How will value-based payment models and decreasing reimbursements impact pediatric clinics?
It is possible for children to qualify for Medicare coverage, so pediatric clinics could potentially be affected by CMS’s changes to its reimbursement practices. At the end of the day, it boils down to the clinic’s patient population. If the clinic sees ten children each year who are covered by Medicare, then these cuts will only minimally affect the clinic’s budget—and the clinic likely will not qualify to participate in MIPS.
Considering all of these Medicare cuts and burdensome reporting programs, does it make sense to step away from Medicare altogether?
There’s no easy answer to this question, largely depends on your payer mix, referral relationships, and practice trajectory. For some practices, it may not make financial sense to continue seeing Medicare beneficiaries. Others, especially those with a large Medicare client base, may need to continue with Medicare and make other operational changes in order to remain profitable. For more advice on how to maintain or increase revenue in the face of dwindling payments, check out this blog post about profits and efficiencies.
With decreasing reimbursements, can we expect to see an increased or decreased use of assistants—and how will that impact care quality?
According to Jewell, regardless of payment rates, practice administrators need to be smart about how they deploy staff members in their practices—and that requires using data to measure the quality of care they’re providing. Don’t leave quality to chance; start understanding how well your practice is actually performing now, and then take regular measurements to monitor your progress as you make changes to roles, responsibilities, and referrals.
While there’s nothing we can do about the impending payment differential, there is still plenty of work to go around, both in individual practices and collaborative care models. We’ll also see more potential for PTAs to play a bigger (and more cost-effective role) in telehealth by monitoring and progressing patients.
Do you foresee PTAs transitioning to a bachelor’s degree?
According to Jannenga, there have been a lot of questions swirling about whether PTA salaries will decrease as a result of the payment differential—and whether transitioning PTAs to a bachelor’s degree-level education would make a difference. We don’t think so. While classroom education is important, PTAs know their effectiveness comes from on-the-job training and continuing education in speciality areas. What needs to change is how practice administrators optimize assistant and therapist roles—similar to how physicians work with physician assistants and nurse practitioners.
Any suggestions about how to handle California’s Timely Access to Care law? We are struggling to get patients in within the required time frame because we receive so many new patients.
Here’s something to noodle on: if your clinic has a high enough patient demand, it may be time to invest in a new hire or expand your practice. If you’re not interested in opening another clinic—or you can’t currently afford a full-time therapist—consider hiring a part-time therapist, a PTA, or a therapy tech. Then, take a serious look at your scheduling structure. You may be able to shuffle around job duties (e.g., allowing PTAs to take on a bigger role in patient treatments) and free up your therapists so they can take on more new patients.
Which outcome measures should we use to collect data? Can you provide examples?
The outcome measures you choose to track will largely depend on your practice type and specialty; however, generally speaking, we recommend using evidence-based, industry-accepted tests that are already familiar to—and respected within—the healthcare community at large. Here are some of the OMTs that are included in WebPT’s fully integrated outcomes tracking software.
- Dizziness Handicap Inventory
- Oswestry Low Back Pain Questionnaire
- Neck Disability Index
- Lower Extremity Functional Scale (LEFS)
- Hip Disability and Osteoarthritis Outcome Score (HOOS)
- Modified Falls Efficacy Scale (MFES)
To learn more about these measures and how to use them, download this free reference guide.
What types of data should practices collect—and how should they do it?
At the very least, every practice should be tracking outcomes data and patient loyalty data.
How should we measure and monitor the patient experience?
We believe the best way to measure the patient experience is by measuring loyalty—specifically, using Net Promoter Score® (NPS®) surveys. As Hebert explained during the webinar, you can track and correlate loyalty with a patient’s likelihood to complete a course of care—which makes it invaluable to a PT practice.
How will private practice PTs continue to compete with physician-owned physical therapy services (POPTS) or hospital-owned PTs?
As Hebert noted, we’re in the era of patient-consumer choice. Today’s patients have more control over their own care paths than ever before—and more access to information about potential providers than ever before. It’s possible to attract these patients, but you have to start by setting yourself apart. Differentiate your practice by developing a niche that’s not accounted for within those networked systems—or by investing in specialty equipment like anti-gravity treadmills or aquatic pools. Build up a great reputation online (e.g., with good reviews) and in your community. Additionally, Jewell recommends continuing to cultivate interpersonal relationships with the physicians who work in these competing settings. If they know that you are the best equipped to rehab a particular patient (i.e., because you have objective outcomes data to prove it), then they may refer out of the system. This is especially true considering the ongoing shift to a value-based model of care delivery.
What are your suggestions for negotiating payer rate increases?
We actually put together an entire guide on this topic, which you can download for free.
Given the high cost of the PT doctoral degree and the trend of ever-decreasing reimbursement for PT services, is the doctoral degree still viable?
Heidi Jannenga actually spoke to this issue in this post for Evidence in Motion. In summation, yes, the DPT still has value—up to a certain amount of debt. That said, we hope to collect updated data on student debt and the PT education system in our 2020 rehab therapy industry survey.
It may be time for us to blow out the candles and put away our crystal balls—but your foray into the future doesn’t have to stop here. If you have a question about your professional forecast, feel free to leave a comment below!