It all happened in an instant—or at least it felt like an instant. One day, we were living our lives as normal—going about our work days, our family and social obligations, our routines. Then came news of the outbreak, the pandemic, the national emergency—all in such rapid-fire sequence that before we even had time to process it, we were reeling from the shock of having our lives turned upside down. As we began to realize just how big of a threat COVID-19 posed to this country—to our families, friends, colleagues, and communities—we grappled with the sheer magnitude of what we, along with billions of people across the world, were facing. To say the scope of this crisis is grand would be an understatement; it’s gargantuan.
Glimmers of Normalcy
While there have been glimmers of normalcy over the past two months—the sun is still rising every morning, the birds are still chirping, and my now-homeschooled daughter is starting to grasp long division—not more than 15 minutes go by without remembering that the world has changed. Families have experienced tremendous loss; businesses have closed their doors; and people are scared and unsure about how to navigate this strange new reality—one filled with face masks, repetitive hand-washing, and physical distance.
Quite frankly, I don’t believe our world will ever be the same again. In fact, I don’t expect us to return to even a semblance of normalcy as we previously defined it for a long time. And while that realization is certainly unnerving, I find that it can also be liberating. After all, change brings about possibility. It brings about growth, evolution, and the potential for something better.
A Heavy Time—and a Gift
This is a heavy time; but in a lot of ways, it’s also a gift. It’s a pause, a reset, a time out to recognize that much of what we were doing before wasn’t actually working. The fallout has been catastrophic, but the pandemic itself was not solely responsible for that fallout. In many ways, it was merely a straw—highlighting all the ways in which we’ve already run our camels into the ground.
Am I feeling the pressure of the current moment? Absolutely. The WebPT family includes more than 500 employees and 80,000 therapy professionals who are on my mind every minute of every day. We know from our data that 30% of our Member clinics have closed; they are seeing no patients and submitting no claims, which means they’re earning no revenue. We are doing everything possible to make sure that they can open their doors again soon, but it’s hard to know for certain when they will be able to resume patient treatment.
I am also an eternal optimist. I feel strongly that we—as individuals, as a profession, and as a community—will come out of this stronger than we went in. That is, if we use this time to our benefit.
Sustainability and Efficiency
My mantra right now is “sustainability and efficiency.” It’s the lens through which I’m looking at everything my team and I are doing. So, I’m constantly asking:
- “Are there process improvements that can provide efficiency gains?”
- “Is this a short-term response that will require rework in the near future?”
We don’t have the luxury of wasting our resources on things that are weighing us down instead of propelling us forward—and neither do you, which is why I would encourage you to apply this mantra to your own daily decisions as well.
After all, we have the opportunity right now to shape our new normal—to impact the state of things when we reopen our doors to in-clinic appointments. We can be thoughtful about how and when we share our vision of the future with our staff, and we can intentionally refocus our efforts on the things that matter most to us and our patients. We’ve always had the power to enact real change, but now we also have the time.
Tactical To-Dos and Big-Picture Questions
I’ve talked about some of the tactical next steps you should be taking to improve your business operations in this blog post, this blog post, and this blog post—everything from handling tough staffing decisions and negotiating with vendors to reduce your interim overhead, to pursuing relief funding and catching up on CEUs. We’ve also covered some financing options for small businesses in this webinar and this blog post—as well as the ins and outs of working remotely and billing for remote therapy services. Today, though, I want to focus on some bigger-picture questions that I believe you must answer for yourself in order to shape—and make the most of—your new normal:
1. Are your patients the ones you want to be seeing?
There has never been a better time to reevaluate your patient base—and your passion. I’ve seen too many therapists open their net to all patients out of fear that narrowing their niche will limit their success. But months, years, even decades down the road—when they’re treating, say, Medicare patients post-knee surgery—they finally realize that their true passion lies in treating triathletes. By that point, the dissonance between aspiration and reality is only holding themselves (and their patients) back. Imagine how much you can excel in your profession—not to mention delight in it—if you’re truly doing what lights you up most inside, working with the patients you’re most excited to help. This is the perfect time to dust off that business plan that you started long ago and start putting it into action.
On a slight tangent, are you also surrounding yourself with the colleagues and mentors who propel you to be your best? Often in times of crisis, we see people’s true colors. Is your network one that lifts you up or holds you back? I know I have leaned on my tribe tremendously during this time to:
- Get honest feedback on critical decisions;
- Learn from their process changes; and, of course,
- Shed a few tears in the occasional moments of exasperation that creep in.
It is imperative that you understand you are not going through this alone.
2. Are you earning what you deserve?
I’d be surprised if anyone reading this answered affirmatively, because no payer is paying rehab therapists what they deserve. But that’s not just on insurance companies; we’ve historically accepted low-ball contract terms and remained in-network with payers that aren’t even able to cover our visit costs. Truth is, every business—regardless of size—should have a three-to-six-month emergency cash reserve for situations like this one, but that’s nearly impossible for practices that rely on sub-par reimbursements.
So, what can you do?
First off, negotiate your payer contracts.
You may be surprised at the number of payers that are willing to come to the table to discuss improved terms during the current situation. And you have nothing to lose by asking for what you deserve—a rate schedule commensurate with the value you are providing beneficiaries. At the very least, you should be getting more per visit than it costs you to provide that visit.
Before you meet with a payer rep, arm yourself with data and confidence; then, go for it. (For a complete guide to preparing for payer negotiations, download this free resource.) Worst case scenario: If a payer isn’t willing to budge, and it’s really hurting your bottom line to remain in-network, then it may be time to consider stepping out. While that’s never an easy decision to make, now is the time for tough decisions—ones that will ultimately improve the efficiency and sustainability of your practice and ensure you have what you need to properly care for your patients for years to come.
Second, explore new revenue opportunities to provide value to your patients.
Ever thought about partnering with a nutrition professional? What about a massage therapist? Or, how about a physician? Are you also a certified personal trainer who wants to create online injury prevention programs for patients to follow? There are as many unique ways to structure a practice as there are rehab therapists, so get creative. (Check out this free guide for inspiration.) How can you provide enhanced value to your patients in a way that feels deeply aligned with their needs—and thus, charge what you deserve for your time, service, and expertise?
There is no better time than the present to act on this, as our profession is not alone in shouldering the financial burden of reduced patient volume and forced clinic closures. Take the lead and think about this in the context of COVID-19 and beyond.
Third, optimize your billing and collections.
Underbilling is a real issue in our industry, and that’s a problem. We should not be leaving any money on the table—whether that’s due to not coding correctly, not submitting claims during the timely filing window, or not collecting patient balances at the time of service. These are all improvements that you can and should be making now to ensure you consistently receive the money you’ve earned.
3. Is there room for improvement in your clinic operations?
Beyond billing, every practice has operational inefficiencies. Now is the time to root those out and solve them—before patient volume picks back up and your focus reverts to clinical care. Take a good, hard look at every interaction a patient has with your practice—and identify areas where there are gaps or waste. Are there hiccups in the patient’s flow from scheduling an appointment to submitting final payment for services received? Are your staff members bogged down with certain tasks along the way? To find out, ask yourself:
Chart every step of every process, interview your team, and review your patient loyalty data to identify any squeaky parts in what should be a well-oiled-machine. Then, find and implement solutions. Curious how others in your network handle these issues? Contact your peers in your area. Collaborate—instead of competing—and you may learn some best practices that help our entire industry succeed on the other side of this.
4. Are you standing up for what you believe in?
This is a big one. Too often, I hear rehab therapists complaining about the current state of things—in many cases, understandably so—but we can’t afford to play the victim in our professional lives any longer. There is no other way forward than to stand up for what we believe in and demand the legislative and regulatory change that will support us and our patients—not only through this pandemic, but in the decade to come. After all, any changes we achieve now will likely last beyond the current crisis. Need some ideas for how to get involved? Here are a few of my recommendations:
- First off, let’s acknowledge that advocacy works. As of last week, CMS has designated PTs, OTs, and SLPs as eligible telehealth providers during this crisis period. But, we must continue to push to make this status permanent once the emergency status is lifted. Even if you’re not an APTA member, I urge you to support PPS’s continued advocacy effort to solidify pro-PT telehealth regulations. There’s strength in numbers.
- The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (House bill 4932/Senate bill 2741) is bipartisan legislation intended to “expand the use of telehealth services and ease restrictions on telehealth coverage under the Medicare program” for all rehab therapists. Lending your support here is so easy; simply contact your local representatives and ask them to support this bill. If passed, PTs, OTs, and SLPs would be considered permanent eligible providers of telehealth services under Medicare—and we know that many commercial payers end up following Medicare’s lead.
- We can’t lose sight of the 8% cuts that are slated to hit our Medicare payments in 2021. Instead, we must continue to sound the alarm—especially given the current situation—because our industry will not be able to sustain that type of revenue reduction as we recover from this pandemic. We have to get in front of this and stop it before it goes into effect next year—and that is going to require all hands on deck.
I’ll leave you with one more set of questions to ponder: Who do you want to be during this crisis? What kind of a leader? What kind of a colleague? What kind of a human? How do you want to show up for your business, your staff, and your patients in this time of massive uncertainty? Personally, I choose to be a guiding light. I choose to set a steady course for my business that leads us through this pandemic and out the other side—stronger, more connected, more resilient, and more empowered to carry out our mission in the world. I know you choose the same. So, use this time. Work on your business. Find clarity. Prioritize efficiency, sustainability, and setting yourself up for a bright future—and we’ll all make it through this, together.