To most people, Graham Sessions probably sound like something that would take place next to a crackling campfire—with a bag of jumbo Jet-Puffed marshmallows, a bar of creamy Hershey’s milk chocolate, and a box of crisp Honey Maids. When I attended my first Graham Sessions last year, I was initially disappointed to discover that this beloved annual event had nothing to do with s’mores. What I soon realized, though, is that this forum—often touted as a PT “think tank”—offers food for thought much more substantial than my favorite summer-camp treat.
When I left Savannah, Georgia, last January, I took with me a year’s worth of inspiration to fuel my efforts to both celebrate and educate this amazing community of healthcare professionals. In my eyes, PTs truly are superheroes—and as a former collegiate runner, that feeling is as much personal as it is professional. So, when I found out that I would have the opportunity to not only attend the 2016 Graham Sessions, but also do so in my own backyard here in Phoenix, I was thrilled (and also a tiny bit jealous of all of the out-of-towners who got to stay at the world-famous Arizona Biltmore).
As Graham Sessions namesake Patrick Graham explained, the beauty of this meeting is that it’s purely about having conversations. There’s no agenda, no committee, no formal worksheet of post-meeting to-dos and assignees. Still, many of this year’s attendees—particularly those hailing from the millennial generation—expressed a desire to return home with action items, or, as one attendee put it, “homework.” Being a millennial myself, this request resonated with me. And although I completely understand and appreciate the purpose of this event—and realize that there’s probably a laundry list of initiatives that arose as a direct result of discussions from past Graham Sessions—I decided to frame this recap post around actionable statements. Yes, they are broad, and each one requires a more detailed list of sub-actions, but I’ll leave those to the people with the PT brainpower (i.e., the folks I had the privilege of meeting and hearing from this past weekend). So, without further ado, here’s part one of my compilation of the nine things PTs must do to take over the world, as told at the 9th Annual Graham Sessions (be sure to check back tomorrow for part two):
1. Reach patients at the population level.
As one attendee so succinctly put it, “What’s our market? It’s pretty much anyone with a body.” Unfortunately, according to numbers cited by another speaker, the segment of that market that PTs actually are reaching is miniscule: out of all the patients physical therapists should be seeing first (i.e., cases in which PT should be the medical entry point), only 7% begin their treatment journeys with a physical therapist. “That’s an absolute disaster,” that speaker continued.
The challenge, then, is scaling physical therapy to make it both accessible and recognizable to “the every person.” There’s no simple solution to that quandary, but most attendees seemed to agree that the manner in which PTs currently market themselves—and consequently, the manner in which the general public perceives physical therapy—isn’t working.
“For a long time, we’ve allowed ourselves to be defined as injury rehabilitationists,” one speaker noted. “I think it’s gotten to a point that it’s a personality crisis.” After all, just because an individual isn’t injured doesn’t mean he or she couldn’t benefit from seeing a physical therapist—and those potential clients are exactly the people therapists must reach to truly own their position as the go-to experts for all things movement-related. But capturing that market segment means cutting out the insurance middle man and embracing a direct-to-consumer sales mindset—at least in some cases. To take that evolution a step further, one attendee challenged PTs to reset the way insurers view physical therapy care. “We should emulate private practice like we’re dentists,” that attendee suggested. “How many of you see a dentist two times a year? Do you have all of your teeth?” Her point: PTs are actually “life course developmental therapists,” and they should position themselves—to consumers as well as insurance carriers—as “life course physical therapy care providers.”
On that note, another attendee posed this question to the audience: why do I sit back and wait for patients to come to me after they hurt their backs shoveling snow, when the real problem is they weren’t ready to shovel snow in the first place? “I don’t think that I can truly improve the human experience until I can have access to people earlier in their lives,” that attendee continued. “We need to get the horse in front of the damn cart, and that’s going to be a lot of work.”
2. Assume the role of a primary care practitioner.
While cash-based services certainly have the potential to open PTs to a much broader market, some attendees cautioned against embracing cash-pay as the magic bullet for ensuring the survival and prosperity of the PT profession. Their argument: third-party insurance isn’t going away anytime soon, and for PTs to maximize their potential within that payment paradigm, they must claim their rightful position as primary care providers. As one speaker commented, “Unless we’re recognized as the primary care practitioner for the musculoskeletal system, things won’t change.”
Yes, the insurance system may evolve, and yes, consumers may begin to recognize the value physical therapists bring to the table—and thus, be willing to pay for physical therapy services out-of-pocket. Some already are—and that’s great. But cash-pay alone cannot elevate PTs to the position they deserve to occupy within the healthcare continuum. To explain why, one attendee offered a brief history lesson on health insurance in the US: for more than half a century, employers have offered healthcare coverage as a form of compensation—and employees have come to expect that coverage. “Very few people who are insured are going to go outside of their insurance,” added another attendee, who went on to explain that the “majority of our practice is still going to be paid by someone else—not the patient.” And the majority of those patients are not—and may not ever be—willing to foot the bill for the total cost of care, regardless of the benefit they receive from that care. For that reason, another attendee argued, therapists should focus their efforts not on trying to overhaul the current system, but rather on positioning themselves to be successful within that system.
That means PTs must gain recognition—from consumers, insurers, and their colleagues within the healthcare community—as primary care practitioners. Only then will PTs have the opportunity to meet the needs of all the people who could benefit from physical therapy care—whether those people know it or not. “We are rockstars of the healthcare continuum,” another speaker proudly stated. “We have a lot of people’s needs to meet, and we have a lot of incredible tools. Let’s explore all of them.”
3. Look outside of traditional third-party insurance contracts.
On the flipside, several attendees urged therapists to not necessarily abandon third-party insurance contracts altogether, but to (1) stop accepting contracts that don’t cover their costs, and (2) look beyond contracting with insurance companies exclusively. On the first point, one speaker indicated that if all members of the profession made a “tacit commitment” to walk away from any contracts that fail to cover provider costs, then the payers would have no choice but to offer better contracts. “I’m not trying to foment a boycott,” that speaker clarified. Rather, he said he wanted to promote a spirit of “coopetition”—a hybrid term he coined to describe a combination of cooperation and competition among therapists.
Furthermore, PTs must stop viewing the contracting process with tunnel vision. Healthcare is changing—and so is the structure of insurance contracts. In fact, the party signing on the other dotted line doesn’t necessarily have to be a traditional insurance carrier. With employers starting to take a larger role in employee health plans—according to one speaker, 70% of American employees are insured under an employer self-funded plan—PTs have a huge opportunity to cut out the insurance middleman entirely. “The playing field has shifted,” that speaker pointed out. “Someone else is paying the bill. There’s someone else we can make our case to.” Plus, as another speaker explained, employers are eager to find ways to offer better benefits at a lower cost—and PTs are perfectly poised to fill that demand. “I just feel like employers are ready to have this conversation,” he said. “They’re sick of getting screwed.” And to those therapists wondering how to go about landing that kind of deal, another attendee offered a few simple words of advice: “You just have to go out and knock on the door.”
4. Standardize the definition of physical therapy care and ensure consistency in the quality of care delivery.
To effectively own their roles as the neuromuscular experts of the medical community—and to secure payment rates commensurate with the value of their care and clinical expertise—physical therapists must not only define the elements of that care in a clear and uniform manner, but also ensure that all therapists consistently achieve a high standard of care quality. Sure, in comparison to other medical disciplines, physical therapy is a relatively new field (it’s been around for about a century, for all you history gurus). But that does not excuse PTs’ inability to accurately describe who they are and what they do—especially when they constantly point to consumer misconceptions about physical therapy as one of their biggest barriers to realizing their full potential as a profession. “I believe physical therapy is the most underutilized and the most misunderstood [discipline] with the greatest potential in all of health care, and that it’s our own fault,” one speaker stated. So, how do therapists shed the sometimes negative image they’ve created for themselves? Well, aside from shelling out a cool $4 million for a 30-second Super Bowl spot—which, by the way, was a fairly well-received suggestion from one attendee—the answer seems to lie in shifting priorities.
According to the speaker previously quoted in this section, PTs are holding themselves back from maximizing their impact on a global scale because they are too focused on competing against one another locally. For example: One therapist promises to treat X condition in Y number of visits, while another claims to be able to do it in two fewer visits. The casualty in this battle for ever-shorter episodes of care? Quality. “We cut our own throats,” that speaker went on to say. “We have something of value, but we didn’t aim high enough.” The good news? This battle is far from over.
By using the tools at their disposal—like outcomes tracking, benchmarking, and quality data collection—PTs can not only set the standards their profession so desperately needs, but also hold each other accountable for adhering to those standards. And when patients, payers, and other medical providers realize they can expect the same high level of care—and the same results—from every single practicing therapist, the problems of misconception, underutilization, and undervaluation will fade into oblivion.
5. Stop demonizing corporate PT.
In the private practice space, there’s a tendency to equate the “big guys” with the “bad guys”—but the deep-seated underground conflict between small, independent private practices and large, multi-clinic chains detracts from the common mission to move the entire PT profession forward. At least, that’s the perspective one Graham Sessions panel urged attendees to consider. Consolidation is happening—not just in the PT private practice space, but across the healthcare spectrum. But small, independent practice owners shouldn’t necessarily see that trend as a threat. In fact, it could actually be an opportunity. Why? Because large practices hold negotiation power—and they can wield that power in a way that benefits the entire profession.
As one attendee explained, size makes a practice “relevant enough to walk away from deals”—something smaller practices might not have the luxury of doing. Furthermore, large practices are able to collect large quantities of data—and in the quest to prove the value of physical therapy to payers, bigger data is always better. “If you’re going to go in-network, size gets you in the door, but value keeps you there,” said that same attendee. Speaking of value, one of the less obvious benefits of large practices’ data collection potential is the ability to drive accountability, foster evidence-based practice, and ultimately, raise the standards for quality care delivery across the PT industry.
The more this discussion progressed, the more people seemed to agree that there’s room in the PT space for practices of all sizes—from the mom-and-pop to the mega-corp. “We’re in an ecosystem,” one attendee explained. “When we open our eyes and look outward, there’s a huge ocean [of potential patients]...If we look at it that way, then it’s okay to specialize. We don’t need to be in competition with every other therapist.”
There you have it: the first five things PTs must do to take over the world, as told at the 2016 Graham Sessions. Hungry for s’more? Be sure to check out tomorrow’s post, where I’ll round out the recipe for PT world domination (hint: it doesn’t involve marshmallows). Missed this year’s meeting—or just want to keep the conversation going? Add your two cents in the comment section below.