Earlier this year, we surveyed nearly 7,000 PT, OT, and SLP professionals on the current state of the rehab therapy industry, asking questions on everything from salary and student loan debt to payer mix and patient dropout. We then compiled their responses into our comprehensive State of Rehab Therapy in 2018 report and hosted webinar during which Dr. Heidi Jannenga, PT, DPT, ATC/L, president and co-founder of WebPT, and Nancy Ham, WebPT CEO, offered their take on some of our most noteworthy data points. During the webinar (which you can view here), we collected tons of audience questions—way more than we could answer live. So, we amassed them into the following FAQ, organized by topic. Don’t see your question below? Leave it for us in the comment section at the bottom of this post, and we’ll do our best to provide an answer.
Can you elaborate on NPS tracking?
Net Promoter Score® (NPS®) is a simple—yet powerful—metric that measures patient loyalty. To begin tracking your practice’s NPS, ask your patients one question at specific intervals throughout their course of care: on a scale of zero to ten, “how likely are you to recommend [practice name] to a friend?” NPS is measurable and standardized. Plus, it’ll help you segment your patients into Promoters and Detractors so you can:
- immediately identify unhappy patients and remedy the problem in near real-time to keep them engaged in their care, and
- tap happy, loyal patients to write you online reviews and serve as brand ambassadors and evangelists, thereby increasing word-of-mouth referrals.
You can implement NPS manually—using paper surveys and Excel spreadsheets, for example—or take advantage of software such as WebPT Reach that will automate the entire process for you (including following up with your most satisfied patients to request online reviews). Remember: Most patients really want to promote their therapists. You just have to make it easy for them to do so—and then let the glowing reviews start pouring in.
On the flip side, you can jump in to remedy any issues that are negatively affecting your less-than-satisfied patients’ experience in your practice. Interestingly enough, we’ve found that more than half of the time, the things patients are frustrated with have nothing to do with their clinical care. For example, they may be upset with extended wait times or problems finding parking. And these issues are usually incredibly easy to remedy—which means you can easily move those patients up the scale from Detractors to Promoters (and prevent them from dropping out of care early).
How can you improve your NPS?
As we mentioned above, more than half of low NPS scores arise from non-clinical issues—everything from a lack of chemistry with a particular therapist to an overly perfumed waiting room. The good news is that these issues are easily remedied—and the sooner you do so, the better chance you’ll have at retaining the patient and keeping him or her engaged in his or her care. But, you absolutely must be able to access your NPS data in order to get at these issues as well as identify larger trends.
WebPT Reach is a great platform for not only implementing NPS, but also monitoring and responding to feedback. The system makes it easy to identify your Promoters and Detractors and then take appropriate action—for example, calling a displeased patient to learn more about his or her situation and make it right. Because the ability to dig into this type of data is so crucial to improving the perceived value of rehab therapy and retaining patients, we’ve made WebPT Reach accessible to all therapists—whether or not they use WebPT for documentation. And if you’d rather go the DIY route, you can download a free software tool or implement NPS manually. The bottom line is that even if you don’t use our software, we want you—and every rehab therapy practitioner—to experience the benefits of NPS tracking.
Given that PT salary levels are based on performance, how should a therapist’s patient volume factor into his or her salary?
As Heidi—a former large clinic director—explained during the webinar, she has never equated therapist performance to patient volume. After all, a therapist may see a lot of patients in a day, but that doesn’t mean those patients are receiving high-quality care—or, perhaps even more importantly, that they are leaving their appointments feeling satisfied with the care they have received. Instead, we recommend focusing on more qualitative data points—like outcomes scores and NPS. This will give you a better idea of how well each therapist is meeting his or her patients’ goals and expectations—both of which factor into a patient’s perceived value of the care he or she is receiving. This, in turn, impacts your clinic’s reputation in your community and thus, the number of referrals—from patients and physicians alike—that you will receive in the future. This cycle of value drives business, and you should be rewarding the therapists who contribute to that cycle in a positive way.
How do we close the gender salary gap?
Closing the gender pay gap will require all of us to work together. First, women need to step up their salary negotiation game. Between the data in this year’s industry report and our existing salary guides, there’s a ton of salary information available to help you better assess the amount you should be aiming for. And if you’re earning less than what you should, then it’s time to have a calm, data-driven conversation with your manager You could start by saying something to the effect of, “My understanding is that the average salary for my position and experience is X—and I’m currently earning below that. I’d like to have a conversation with you about why.”
Statistically, women don’t ask to have salary discussions as often as men do—and both men and women managers react more negatively to women asking about salary than they do to men. So, if you’re in a leadership role, take it upon yourself to not only look at your own biases, but also evaluate those that may exist within your practice. If there are salary disparities among employees in your clinic, ask yourself why.
To make any real headway on the matter, both men and women must work together, because as it stands, most clinic owners are men. So, men must be more cognitively aware of the issue—and make an effort to be more objective in their salary decisions. Look at the data, and be strong advocates for your employees.
As a clinic owners and managers, how can we use data to make more objective salary decisions?
It’s a good practice to implement outcomes tracking and NPS data as part of your performance review process. That way, you can see who on your staff is doing well—both clinically and with respect to patient satisfaction—and who is struggling (regardless of their gender). Also, you can use a PRM platform to identify those staff members who are generating more referrals for your practice—and thus, may deserve a compensation increase.
Did the salary numbers in the report compare wages only, or did they also account for benefits?
The report looked at wages only. But, benefits are a hugely important factor as well. If you’re not able to move the needle on salary numbers during a negotiation, you may be able to generate significant value by adding benefits. And we’re not just talking about insurance and retirement. There are plenty of ways you can get creative with your employee benefits packages. For example, you could offer to cover an employee’s continuing education costs.
Could the gender pay gap have anything to do with the number of hours male therapists are working versus the number of hours female therapists are working?
As Heidi and Nancy discussed during the webinar, there are a variety of factors that may affect the rehab therapy gender pay gap, including differences in hours worked per week, preferences regarding work-life balance, and tendencies toward particular practice settings. While we did not dive into every possible factor, we hope this data will serve as a jumping-off point for a much larger discussion around what we can all do to ensure gender pay equality across each role type.
Does the salary data in the survey include hospitals or just private practices?
The salary data in the survey reflects a wide variety of practice settings, although the majority of respondents (53.7%) work in outpatient private practice.
Can clinics raise reimbursement rates from insurance payers for services provided by more experienced PTs or those with advanced degrees? In our experience, we get the same reimbursement regardless of a therapist’s amount of experience and education.
Payers will not provide differential reimbursement to individual providers on the basis of experience or education. That being said, when it comes to increasing your clinic’s overall payment rates, data talks. A therapist might hold multiple advanced degrees or have decades of experience, but if that provider doesn’t have the data to prove that his or her experience leads to better patient outcomes, then payers aren’t likely to budge. That said, if you can prove that you produce better outcomes, you can leverage this data to renegotiate your payer contracts. For additional information on successfully negotiating payer contracts, download our free guide to contract negotiation here.
From a work-life balance and salary perspective, what clinical environment do you think is most promising for a new grad to consider when looking for a first job?
There is no hard-and-fast rule about which clinical environment will provide you with the salary and/or work-life balance you’re looking for—especially because everyone’s definition of work-life balance is different. That being said, it’s important to have clear intentions around what you’re looking for in your first job out of college—or any job for that matter—and to play an active role in the interview process. That way, you can get a true feeling for the culture of each potential employer. Be sure any role you’re considering meets your requirements for both cultural fit and salary. That’s the best way to foster a long and happy employment relationship, regardless of which side of the hiring table you’re on. (For more crucial post-graduation to-dos, take a look at this checklist for new-grad PTs, OTs, and SLPs.)
Our practice is in a direct access state, but patients don’t know that they can see us without a referral. How can we change that? After all, we’re only one clinic.
First off, never underestimate the power of one practice. You can have a lot more impact than you may think—and it starts with prioritizing your digital marketing efforts. As our presenters mentioned during the webinar, the vast majority of patients research their healthcare options online before making any decisions. This represents one of your biggest opportunities to reach them. So, make sure that your website is not only easily findable online, but that it also promotes the fact that patients can see you without a referral and clearly explains the different conditions and diagnoses that you’re well-equipped to treat. Stellar reviews and testimonials from other patients are a big help here, too. Basically, you want to ensure that every qualified patient who lands on your site understands the value of what you offer—and the fact that there’s no need to see a physician first. Then, repeat that strategy for patients in your office. Make sure all of your patients know the full scope of the value you provide—and that they can (and should) come back to see you in the future if they ever experience an issue that you are qualified to address. Additionally, encourage them to refer their friends and family members to your clinic. That will help improve the number of direct access patients coming through your door.
It’s also important to educate your staff on how to handle direct access patients. WebPT recently performed a secret shopper experiment where we called numerous physical therapy practices in Arizona—a state with full direct access—to make appointments without any physician referrals. In about seven out of every ten calls, we experienced resistance from front office personnel who insisted we needed to see an MD first.
Medicare requires that a physician sign a patient’s POC. How do you handle that with direct access?
As Heidi mentioned during the webinar, seeing patients first—regardless of whether you need a signed POC per Medicare or a referral following an initial evaluation in a state without full direct access—puts PTs in a power position. After all, you get to use your clinical expertise to help the patient determine his or her next steps. If the patient is a great candidate for physical therapy, then you can reach out to a PT-friendly physician in your network—thereby affording you another opportunity to strengthen that relationship. In other words, seeing patients first enables you to not only ensure your patients receive the very best care, but also become a referral source and a peer to other medical providers. It’s a huge opportunity for physical therapists—not necessarily an obstacle.
How many times can a patient use direct access per calendar year?
As far as state laws are concerned, there is no set number of direct access visits a patient can use per calendar year. However, some insurance plans impose limitations on the number of physical therapy visits they will cover within a given benefits period. You should always check for this when conducting benefits verifications for new patients. And to learn about specific direct access laws per state, you can download our free guide to direct access laws here.
How much should we be spending on marketing? Is there a percentage of revenue that’s standard?
Based on our survey data—which revealed that the vast majority of rehab therapy executives were either spending nothing on marketing or weren’t sure how much they were spending—we’d say there’s a good chance you should be spending more than whatever you are right now. But, generally speaking, a good initial target is 5 to 8% of revenue. While that might seem like a lot considering that rehab therapy clinic budgets tend to be pretty tight, the fact of the matter is that you have to spend money to make money.
We’d recommend that you start by tracking your existing referral sources. In many cases, you’re probably not generating as many referrals as you could be, and creating a simple referral report will help you not only identify your most lucrative marketing opportunities, but also avoid throwing money into initiatives that aren’t producing any results. By keeping tabs on your referral marketing spend—and measuring your results—you can spend your money more wisely.
And don’t forget about marketing—especially online—directly to the patient. While marketing to patients is fairly new—most rehab therapists are used to bringing boxes of donuts to their local physicians’ offices—it’s incredibly important, especially given the sheer number of patients (about 90%) who could benefit from physical therapy but aren’t receiving it. Reaching patients directly is a great way to not only boost your clinic’s bottom line, but also help those patients who really need your services. That means optimizing your online presence, first and foremost. And if that’s not something you’re comfortable doing on your own, you may want to consider engaging services to help you. At the very least, download our free marketing ebook here.
Just remember that contrary to common belief, this type of marketing isn’t only for the “big guys.” As Nancy mentioned during the webinar, her personal physical therapist runs a single-provider practice that has a great online presence and a wonderful approach to ensuring patient loyalty and retention. So whether you have one clinic location or 100, make sure you’re putting thought and effort into making yourself stand out online.
How do online reviews actually affect the number of new patients we receive?
Online reviews directly impact search rankings. So, the more quality reviews you amass, the more likely your practice is to show up in local searches—for example, when a potential patient Googles, “physical therapy in Phoenix.” Thus, you want to garner as many positive reviews as possible to ensure you’re findable online.
Plus, social proof is playing an increasingly important role in patients’ healthcare decisions. So, when a patient reads firsthand accounts from other patients who have had positive experiences in your clinic, it can be a powerful selling tool.
Is there a stat in the report that shows 90% of patients referred to PT don’t go to PT?
No, the statistic mentioned during the webinar refers to the number of patients who suffer from a condition that physical therapists are well-equipped to treat—but never make it in to see a PT. As Heidi wrote here, “only 9.58% of all patients who could benefit from seeing a physical therapist ever do (based on data from this source and this one). That means 90.42% of those patients are missing out on the extremely valuable care that we are uniquely able to provide.”
How does WebPT Reach help practices generate online reviews?
WebPT Reach automates the entire review process by using NPS to identify your already-pleased patients—and then asking them to provide you with an online review. Thus, you have a constant flow of happy patients providing positive reviews, which positively impacts your search ranking and generates new patients.
What tools are available within WebPT to identify patients who have dropped out and assess therapist productivity and effectiveness?
WebPT has a full suite of reports to assist with everything from identifying patients who have fallen off the schedule to tracking patient outcomes and satisfaction scores achieved by your staff. Additionally, PRM software like WebPT Reach can help you better optimize your interactions with past, present, and future patients. With current patients, you can create automated cadences of personalized outreach to ensure continual engagement throughout the course of care. With past patients, you can distribute updates about your clinic and the services you provide, thus re-engaging them, reinforcing your value, and encouraging them to visit you again in the future if the need ever arises. And finally, by helping you improve your online presence—including your collection of patient-authored reviews—a software like Reach can help you communicate your value to prospective patients, thus making those patients more likely to seek care from you rather than the clinic down the street.
Can you provide a list of all the resources the presenters mentioned throughout the webinar?
Here are links to all the resources Heidi and Nancy mentioned during the presentation:
- The WebPT Blog: A continually updated resource covering everything from business best practices to regulatory changes—all tailored specifically to outpatient private practice PTs, OTs, and SLPs.
- Modern Marketing Decoded: A Guide for Rehab Therapists: A comprehensive e-book covering everything you need to know about private practice rehab therapy marketing—from driving more traffic to your clinic website to writing a newsletter that people will actually read.
- The State of Rehab Therapy in 2018: The full report that served as the basis for the webinar.
- Physical Therapist Salary Guide: Our existing PT salary resource providing salary averages broken down according to factors like setting and state.
- Untapped Potential: The Art of Discovering and Selling Your PT Value: A past webinar in which Heidi and special guest host Tannus Quatre discuss the concept of value in the current US healthcare landscape, untapped sources of value that many PTs aren’t aware of, and strategies for pinpointing audience-specific value drivers and using them to attract and retain patients.
- The Real Root of the PT Brand Problem: A recent founder letter Heidi wrote detailing the many reasons rehab therapists struggle to not only retain patients, but also tap into the market of the 90% of patients who could benefit from therapy services but never access them.
- The PT’s Guide to Direct Access Law in All 50 States: A comprehensive, easy-to-digest guide detailing the rules around direct access in each individual state.
- Study: Primary Care Physician PT Referral Rates Dropped 50% Between 2003 and 2014: A PT in Motion article on the study showing that, despite data promoting physical therapy as a first-line treatment for many neuromusculoskeletal conditions, physician referrals to physical therapists for such diagnoses decreased by 50% between 2003 and 2014.
- How Patients Use Online Reviews: A Software Advice article that cites research showing that 72% of patients use online reviews as the first step in finding a new healthcare provider, and 82% of patients use online reviews at some point in the provider evaluation process.
- How Women’s Low Expectations Perpetuate The Gender Pay Gap: A Forbes article that cites data around the gender disparity in student salary expectations.
How is the PTA role changing? Did you uncover any trends with respect to PTA responsibilities?
While we didn’t include any questions specifically related to PTA responsibilities in this year’s survey, there is a lot of discussion unfolding around this topic on other channels. For example, this recent EIM blog post sparked quite a bit of debate about whether PTAs generally are—or should be—performing joint mobilizations. We will certainly consider this discussion as we formulate the question list for next year’s survey.
How can we advocate for our profession?
The first step is to get involved with your professional organization. For physical therapists, that’s the APTA. You can start by downloading the APTA Action app. There, you’ll be able to review and participate in state and national PT advocacy efforts. Right now, the APTA is involved in working with insurance companies to promote PT as first-line intervention. This is a particularly meaningful time to be having these conversations—especially given the current opioid crisis. In fact, as Heidi mentioned during the webinar, we should all be using data that demonstrates the efficacy and cost effectiveness of our care when we are negotiating our payer contracts. It’s imperative that we come to the table with objective information like outcomes scores and NPS data.
How can we positively influence the insurance industry regarding copay rates and our status as specialists?
The best way to influence third-party payer policy is to establish and continually reinforce the value of the services you provide using objective data—including, of course, outcomes and NPS data. At the individual practice level, you can more confidently negotiate with payers when you’re armed with data that demonstrates the efficacy and cost-effectiveness of the care you provide—as well as your patients’ high satisfaction levels. On a larger scale, though, it’s going to take a unified, industry-wide effort to improve the reputation of rehab therapists and solidify our value with patients, other healthcare providers, and payers alike. As Heidi wrote here, we have a branding problem that still hinders our entire industry, but there are clear paths to effecting change.
In light of recent healthcare reimbursement cuts, has there been an increase in clinics switching to a private pay model or adding private pay services to their service lines? Have you touched on this in any surveys you’ve sent out?
Anecdotally, the answer is yes. We’ve heard of many more therapists adding cash-pay wellness services to their offerings in order to take advantage of the booming health and wellness industry—and combat shrinking insurance payments. While a good number (20.1%) of the individuals surveyed reported that their organizations operated solely on a cash-pay basis or with a hybrid model (i.e., cash plus some commercial payers), we don’t have data that shows how many new providers have hopped on the cash-pay bandwagon. That being said, we do have a number of articles and resources you may find helpful if you’re considering providing cash-pay services, including this free webinar we co-hosted with cash-based PT expert Dr. Jarod Carter.
How did you determine what percentage of patients completed their course of care?
The data from our survey was wholly dependent on participant responses. So, that percentage was based on each respondent’s estimate of the average percentage of patients completing their care plans within that respondent’s organization.
Did the survey include data for cash-based practices?
Many of our survey respondents reported working in either a partly or wholly cash-based setting, so we were able to glean some insights unique to cash-based services and cash-only practices. Download the full report to learn more.
Whew! That’s a lot of questions—and a lot of great data. But, if you’re still hungry for more, be sure to download the full industry report here, and leave any lingering questions in the comment section below.