For too long, the PT profession has been dealing with a pair of particularly difficult problems: trying to establish a clearer picture of the value we provide and trying to reflect that value in the payment received for our services. We’re all well aware of the latter problem as it remains the topic of panel presentations at every conference, the primary concern raised when advocating to Congress, and something that invariably bubbles up as the defining problem facing our industry today. However, at the heart of both of those issues is our profession’s ongoing problem with data collection and analyzation, which continues to hinder our ability to demonstrate our value objectively.
That is why I am elated—and somewhat relieved—to see the APTA publish a pair of reports, “A Physical Therapy Profile: Demographics of the Profession, 2021-2022” and “The Economic Value of Physical Therapy,” to further the conversation objectively around both the makeup of the profession, the role of PTs in producing better outcomes for patients, and cost savings for payers. Here are some of those reports’ key findings to see how they compare with our State of Rehab Therapy (SoRT) report—and the important takeaways to help strengthen the case for changes needed within the profession and from payers.
PTs are among the most essential healthcare providers.
Over the last five years, change has been no stranger to our profession, with many practices having to pivot on a dime. Coming out of a life-altering event like the COVID-19 pandemic and the shortage of healthcare providers, new opportunities for physical therapists have exponentially expanded into avenues like emergency medicine, public health, and direct-to-employer contracting. Therapists are taking on more responsibility and widening our reach, and we appear to be making headway on the “90% problem finally.”
Although we have shown significant attrition of therapists leaving clinical care, the APTA report pulled from Bureau of Labor Statistics (BLS) data shows that PTs are the fifth-largest clinical occupation in healthcare, with just over 225,000 PTs as of 2021. That equates to about 72 PTs for every 100,000 people nationwide, which is up from 65 per 100,000 in 2017. And that figure may be on the conservative side: because the BLS data does not take self-employed therapists into account, the total number of PTs may be higher. For example, the Federation of State Boards of Physical Therapy (FSBPT) lists over 238,000 PTs, which include self-employed therapists.
We’re still struggling with a staffing crisis.
However, the yellow flashing warning signs for the future remain bright. From our own SoRT report, we saw over 11% of the workforce resign in 2022—up from 9% the previous year. That finding is corroborated by a report from Definitive Healthcare that found 22,000 physical therapists are estimated to have left the workforce in 2021, with only 12,000 graduates from PT programs entering the workforce the same year.
By improving clinic workflow efficiency, expanding our recruiting pool for DPT programs, and evolving to a hybrid plan of care model, clinics and companies can drive improved visit utilization and patient outcomes. However, utilization rates and improved outcomes can only be shown if practices mandate the use of clinical outcome tools and are intentional in improving the diversity of their workforce.
The pipeline of diverse PTs is improving.
Across the 2022 and 2023 SoRT reports, we found that the percentage of non-white rehab therapists had improved slightly over previous years—something that was reflected in the APTA’s report. The 2022 SoRT report and the APTA’s reporting on the demographic makeup of the profession were roughly aligned with Black/African-American representation at 4.9% and 4.2%, respectively. The APTA/Census data also found Asian Americans at 12.2% to be closer to mirroring the nation’s population as compared to 5.8% in the SoRT report.
What’s most compelling is the APTA’s look into growing diversity among the ranks of new PTs. According to the data cited from the Commission on Accreditation in Physical Therapy Education (CAPTE), the percentage of minority graduates from DPT programs has risen from 20.9% in 2016 to 26.4% in 2021. What’s more, the percentage of accepted students from underrepresented populations stands at nearly 32% as of 2022, per data from the Physical Therapist Centralized Application Service (PTCAS).
This data validates that the efforts put into Diversity, Equity, and Inclusion (DEI) efforts by DPT programs and other organizations are paying off. Although we are certainly moving in the right direction, we are not done. Dropout rates continue to be higher and first-time pass rates for licensure exams are lower for DPT students from historically marginalized racial backgrounds. There’s still ground to be gained to create a truly representative profession and expand our opportunity to reach patient populations that don’t even know what a physical therapist can do for them.
We have some dollar figures to attach to PT’s value.
One of the most gratifying parts of being a PT is bringing relief and happiness to a patient as they regain function. Unfortunately, CMS and insurance companies are all too ready to affix a dollar amount to our services—and that figure is invariably far below what we know we’re worth. Fighting back against constant cuts to payment for services has been a slow uphill battle, and without the right data to back our case for better pay, we’ve lost too many of these fights for too long.
We have long discussed the downstream cost savings to the overall healthcare system that PTs can provide. Finally, in the APTA’s report on “The Economic Value of Physical Therapy in the United States,” the authors were able to calculate the net financial benefits for eight conditions per episode of care:
- Osteoarthritis of the Knee: $13,981
- Carpal Tunnel Syndrome: $39,533
- Low Back Pain: $4,160
- Stress Urinary Incontinence: $10,129
- Lateral Epicondylitis: $10,739
- Vascular Claudication: $24,125
- Falls Prevention: $2,144
- Cancer Rehabilitation: $3,514
Lots of research and analysis went into coming up with the calculation formulas, so I would recommend to anyone interested in the methodology and underlying studies to give the report a deeper dive. Calculating a value for these eight conditions is a great start, and I look forward to future reports that will expand the demonstration of cost savings to a larger array of conditions. For now, having this objective data alongside your own clinic benchmarks will serve you well in discussions with insurance companies for contracting and rate negotiation, as well as direct-to-employer contracting. In today’s world of rising interest rates and employee benefits, cost savings are top of mind for their leadership teams.
We must use hard data to demonstrate our value.
Data and analytics are the keys to our success as a profession moving forward. Understanding objectively how your patient is progressing, as well as how well your clinic or company is performing, should be table stakes at this point. However, it's also about knowing how to interpret the data and use it for clinical and managerial decision-making. We all have to believe that data is like gold and that we all have to own some of that data.
Looking at the 2023 State of Rehab Therapy report, only 51% of organizations overall are collecting outcomes data—and when we discuss other types of data, the numbers only go down from there. Just 49% of practices are gathering clinical data, 44% are collecting financial data, and 38% have patient satisfaction data. While therapists aren’t trained to be numbers crunchers, respondents made clear in the report that a lack of guidance and poor processes make effective data collection nearly impossible in many practices—further explaining those low numbers.
In today’s healthcare environment, data collection has become more of a requirement than an option if you want to ensure financial success. It starts with outcomes tracking, which should be part of your clinical workflow for every patient, not just for those Medicare patients because it's required.
Our value is reflected in patient satisfaction.
One particularly noteworthy highlight from the APTA’s “The Economic Value of Physical Therapy'' report focuses on the net benefit of PT in terms of quality of life and dollars spent. Spoiler alert, PT’s net benefit was positive for all eight conditions. It's not rocket science to understand that patients’ satisfaction will rise when their healthcare dollars are spent right. Let’s take the all-too-familiar patient with carpal tunnel syndrome (CTS). How often have we seen patients with CTS and found an issue in the cervical spine or shoulder girdle? And yet patients often opt for the carpal tunnel release and inevitably their overall satisfaction with their outcome and subsequently their provider nosedives. Armed with the APTA’s report, we can now show that the net benefit of PT for patients with CTS is—on average—$39,533. That is a huge cost savings to the system and the patient. Imagine patients’ satisfaction and overall improvement in their quality of life if their care was directed to PT first.
To boost this value proposition, we must track our patients’ level of satisfaction. Using Net Promoter Score® surveys throughout an episode of care can help produce the outcomes and reflect the satisfied patients that can influence insurance companies to reconsider your value. And it’s all connected—happier patients make for better outcomes, and patients’ quality perceptions of their care can produce a 17% to 27% variation in financial metrics, according to this study.
Diversify your practice and reach a broader community.
Furthermore, we can take the eight conditions highlighted in the APTA’s report and translate them into an often untapped source of patients in our local communities. Let’s look at PT’s net benefit ($4,160) for acute low back pain (LBP). One study found that 32% of workers with low back pain are unable to return to work after one month. Combine this with the fact that the CDC estimates that workers’ health (and their families) costs $1,685 per employee per year, or $225.8 billion annually in terms of lost productivity, and the APTA’s findings offer a huge boon for employers and employees alike.
The net benefit PT has for these patients becomes a huge number to highlight in population health and direct-to-employer contracting. Take this data—plus the seven other conditions—the APTA has collected for you and leverage it with your greater community. Not only can these groups benefit from our services, but this diversification will go a long way in improving the overall health of your business.
I don’t know a single PT who has not at one time or another felt they were undervalued in the greater healthcare system. Unfortunately, it’s often the elephant in the room, plaguing some of the more thought-provoking conversations industry leaders have had to drive change in our industry. And to make matters worse, many of these conversations often resort to finger-pointing at organizations like the APTA for an overall lack of advocacy. But like most important things, it takes a village and we can’t rely on one entity to do it all. The APTA has provided a valuable resource that sheds light on the value our profession brings to patients and healthcare as a whole.
To quote the late Tip O’Neill, “All politics is local.” Well, the advocacy efforts and data collection practices we need to make our collective situation a better one start in our own backyards. Evidence and key objective measures remain the key to our work, and if we want a more diverse, more prepared, and better-paid workforce, we must get better at collecting, analyzing, reporting, and making data-driven decisions profession-wide. Let’s do this!