As I pulled my scarf high up over my wind-chapped cheeks, dodged a car that nearly hit me as I made my way across the crosswalk, and heard the L train rattle the platform above my head, it wasn’t hard to imagine the likes of Al Capone or John Dillinger leading police on a wild goose chase through downtown Chicago. There’s no doubt that the Windy City is rich with history, but last week, Chi-Town was abuzz with talk of the future—well, a small part of the town, at least. That’s because at this year’s APTA Private Practice Section Annual Conference, the consensus was clear: the future is bright for physical therapists. But, there’s one caveat: in order to realize that bright future, PTs must be ready to embrace the changes ahead.
The future of physical therapy lies in telehealth.
During this year’s conference, more than one session touched on the need for physical therapists to embrace telehealth technology. But, many in the industry aren’t sure how—or why—they should implement it. During his session on telerehab, Darwin Fogt, physical therapist and CEO of eWellness Healthcare Corp, spoke to this challenge. As he put it, telehealth is an effective tool for keeping patients engaged with their providers—especially in cases involving patients who aren’t able to attend PT sessions regularly. Fogt urged attendees to “think of telehealth as a way to mitigate cancellation rates” for patients who:
- travel frequently,
- live in isolated areas, and
- have busy day-to-day lives (e.g., patients who are business owners or single parents).
In other words, while this technology can by no means replace face-to-face visits, it can serve as an effective engagement tool—one that helps keep patients on track with their plans of care. In Fogt’s own words, “Telehealth does not discount our skillset.” In fact, it should augment—and even enhance—a PT’s skills. And by connecting with their patients remotely, therapists have even more opportunities to demonstrate and promote the value of those skills. Fogt also highlighted telehealth’s potential as a digital marketing lead-driver. For example, he was able to generate new patients—sans physician referral—by using social media to offer free initial consultations/injury assessments via phone or video chat.
Industry changes are coming.
As PTs are well aware, Medicare does not currently reimburse physical therapists for telehealth services—something Fogt attributes to an oversight on CMS’s part. Add to that the current lack of interstate licensure reciprocity, and it’s plain to see that there are some significant barriers keeping PTs from effectively leveraging telehealth technology.
While we have seen some momentum on the telehealth front, many PTs would probably argue that change is not happening quickly enough—especially considering that, per the 2018 final rule, CMS still does not recognize physical therapists as eligible providers of telehealth services. On a more positive note, though, 14 states have now signed on to the interstate licensure compact, which could make reciprocity a reality in the very near future. And while this initiative hasn’t left the development stage as of yet, Fogt urges providers to prepare for this onslaught of change. After all, once PTs have a clearer path to practicing across state lines, the telehealth conversation will become even more relevant—and thus, will likely draw even greater support among rehab therapy leaders. In other words, the push to expand PTs’ telehealth treatment capabilities is far from over.
PTs must treat the entire population, not just individuals.
As reform efforts continue pushing providers to simultaneously (1) increase the quality of health care in the US, and (2) decrease the amount Americans spend on health services, it’s becoming quite clear that we need to have a healthier population from the start. But according to Mike Eisenhart, PT, a partner at Pro-Activity Associates, this isn’t a realistic goal if we continue to address health care at the individual patient level. Eisenhart joined Heidi Ojha, DPT, a faculty member at Evidence in Motion, and Holly Johnson, DPT, the owner of PT Pros Harlan Clinic, on a pop health-focused panel. In addition to offering their unique perspectives on approaching population health from a PT standpoint, the three panelists provided attendees with examples of how they can contribute to population health initiatives right now in their own practices.
According to Ojha, only 8% of Americans with musculoskeletal pain see a physical therapist— and PTs are in an ideal spot to address the needs of that particular population. After all, PTs are the only providers who have undergone intensive study of musculoskeletal pain and whole-body movement. (Even physicians complete only conservative study in this area over the course of a few weeks.) As she put it, “we need to pitch that we’re of equal or better value to primary care providers, [which means] we need to provide better outcomes at the same, or lower, cost.”
So, to that end, Ojha set out to study the effectiveness of the direct-to-employer wellness program at Temple University through the lens of population health. She found that in this model, success hinges on the employer’s understanding of the efficacy of PT when it comes to treating and preventing workplace injury. Specifically, she advises PTs who are pursuing such arrangements to focus on conveying:
- The cost-effectiveness of early physical therapy intervention. (PTs do not prescribe opioids, rarely order imaging, generally do not refer patients to surgery, and achieve outcomes similar to their physician peers.)
- The fact that PTs can assess and diagnose patients without a physician referral.
- Positive employee outcomes (e.g., their ability to lift, bend, and return to work in a timely manner after injury).
A lack of standardization is holding PTs back.
During the discussion on population health, Ojha pointed to the lack of standardization in the physical therapy space as a roadblock to PTs becoming the go-to healthcare providers for not only treating, but also preventing musculoskeletal disease and injury. Several other sessions highlighted lingering industry-wide inconsistencies in:
- Treatment techniques, and
- Education requirements.
This has given way to practice variation, which, in turn leads to confusion about what PTs do, how they do it, and what differentiates it from other care options. And as Peter Kovacek, DPT, the owner of Kovacek Management Services, noted during his session on the PT value gap, this has negatively impacted the public’s perceived value of physical therapy. By standardizing industry staples like terminology and continuing competency expectations, PTs can actually combat this value problem. Providers can also employ tools they already use on a daily basis to measure—and then promote—patient outcomes and, thus, improve the public’s perceived value of physical therapy.
While PTs certainly have their work cut out for them, the general consensus among PPS 2017 attendees was one of optimism: the outlook is good for the future of physical therapy—that is, as long as we’re willing to work with, and not against, each other. Furthermore, while history certainly has a place in the Second City, there’s no room for dwelling on the past in the physical therapy industry.
Were you at this year’s PPS conference? What were your major takeaways? Share your thoughts in the comment section below.