In our first webinar of 2017, WebPT’s co-founder and president, Heidi Jannenga, teamed up with CEO Nancy Ham to discuss the current and future healthcare trends that will impact PTs, OTs, and SLPs. (Missed it? No worries; you can view the complete recording here.) As always, we received quite a few questions during the presentation—way more than we could address live. So, we’ve put them all here, in one handy Q&A doc. Scroll through and check them out, or use the link bank below to skip to a particular section. And if you still have a question after reading through these, feel free to post it in the comments section; we’ll do our best to find you the answer.
How can rehab therapists capitalize on the initial telehealth wave? Can we get paid for it?
Telehealth is truly brand new—as are the legislative initiatives that address it. Although Medicare has included rehab therapists in telehealth rulings, they aren’t included overall—and there are no standard CPT codes therapists can use to bill for services provided via telehealth. One of the biggest challenges holding the industry back from breaking into the telehealth market right now is therapists’ inability to treat patients across state lines. Many state practice acts simply won’t allow it, which is why—as Heidi noted during the webinar—everyone in the PT industry should advocate for the Interstate Licensure Compact for Physical Therapy, which would enable therapists to treat in states that have a reciprocal relationship with their licensing state.
How do you think PTs will fare using telehealth services when we are traditionally so "hands on" with our patients? Can this practice be effective for PTs like it is with MDs?
Because many physical and occupational therapy services require "hands-on" treatment, telemedicine is not optimal in every situation. For example, therapists would not be able to perform manual therapy or manipulations via telehealth. However, it can be beneficial for patients requiring exercise instruction or supervision. Alternatively, it would make sense to offer telehealth services as a form of transitionary care for patients who have reached their therapy goals but still wish to receive treatment on a maintenance care basis. When appropriate, offering telehealth services—and not scheduling unnecessary in-person appointments—frees up treatment space for patients who truly require in-office care.
How can I stay up to date on legislative changes in the telehealth field?
Bundled Payment Programs
How can a single, independent private practice get involved in a payment bundle? Won’t the hospital use its own PTs?
If you sit back and do nothing, then yes—the hospital probably will send patients to its own outpatient therapy providers. But, if you market yourself, your practice, and the quality of your outcomes, then you may be very well be able to develop fruitful relationships with hospitals. After all, the hospital is interested in the same thing you are: returning patients to the very best health after post-acute care (i.e., post-surgery). If you can demonstrate your value—your ability to help the hospital achieve that goal—then there’s a good chance that the hospital would be interested in working with you as part of a payment bundle.
Have you heard of any practices having success with payment bundles or ACOs?
Absolutely. As Heidi and Nancy mentioned during the webinar, private payers are actually moving forward with payment reform more quickly than Medicaid and Medicare. So, we have several Members who have actually used their outcomes data to demonstrate their high performance in order to negotiate agreements that enable them to take advantage of alternative payment models.
ACA and MACRA
How can private practices leverage cash-based services to help contend with the negative financial impact of the ACA?
At the end of the day, this requires a shift in mentality: you’re no longer marketing to referring physicians. Instead, you’re marketing directly to consumers. But, we still haven’t reached a point where the majority of patients understand who rehab therapists are and what they do. Thus, the industry must adopt better communication and education standards to ensure that patients who may not be familiar with rehab therapy—and the benefits of this type of care compared to other, more invasive treatments—understand what the industry has to offer. Developing and publishing case studies and testimonials is a great place to start—as is getting really comfortable on social media. Remember, direct access—in some form, anyway—is now a reality in all 50 states; it’s about time we use it.
When will Medicare institute a value-based payment model?
Medicare has been moving toward a value-based model for some time, now. And with the introduction of MIPS—and its parent legislation, MACRA—that shift will become even more apparent. While rehab therapists were not eligible to participate in some of Medicare’s past value initiatives—including the Value-Based Modifier (VBM) program—they will eventually become eligible to participate in MIPS, which includes elements of VBM, PQRS, and other quality-focused initiatives.
In the age of the ACA, our caseloads have been cut due to high premiums. How do we combat this?
So much is in the air right now with the ACA, but with Tom Price being confirmed as the new Health and Human Services secretary, there’s a good chance the ACA will not survive as-is over these next four years. In the interim, though, your practice could explore revenue diversification strategies, as Heidi emphasized during the Q&A portion of the webinar.
Should I use FOTO for outcomes?
FOTO was a thought leader in our industry with respect to the prominent role outcomes would play in the future of health care. However, the adoption of FOTO has been limited because its OMTs are too rehab specific. At this juncture, with the move to a more collaborative model of care delivery, the therapy community must look toward adopting outcome measures that are readily understood—and used—by providers of all disciplines. That is the only way the data rehab therapists collect will be meaningful to other providers in a patient’s care team.
If we start using more standardized outcome measures, how can we continue to do national benchmarking?
WebPT has actually been able to do accomplish this using standardized outcomes measures. As a result of our vast Member base, we have the largest largest contiguous outcomes data set in rehab therapy. Through our outcomes platform, WebPT Outcomes, we’re able to not only create benchmarks and meaningful data analysis, but also risk-adjust our data to account for comorbidities. And, because our tests are easily understood by providers of all disciplines—and easy for patients to complete—we’re in a better position to foster meaningful information-sharing across the care continuum. That means, for example, that a patient’s PT, spine surgeon, and primary care physician will all be able to use the same tests to better measure the patient’s progress and quantify the effectiveness of each treatment discipline.
Is there a Medicare-recommended outcomes tracking software?
While there are a handful of outcomes tracking tools available to outpatient rehab therapists—including FOTO, Optimal, AMPAC, NOMS, and our very own Outcomes—there is not one system specifically recommended by the Centers for Medicare and Medicaid Services.
What are the security concerns associated with interoperability?
There are always concerns when it comes to securing protected health data, which is why HL7 and FHIR standards exist. Fortunately, WebPT is in a position to make the necessary investments to ensure we stay ahead of cybersecurity issues. In the last year, we’ve hired a chief information security officer, a complete information security team, and our new CEO, Nancy, whose last company exchanged more than five billion transactions a year using HL7 and FHIR. In addition to stepping up our technical chops, we’re also working with several industry coalitions to ensure we’re successfully able to communicate with systems across the country.
The Future of WebPT
What is WebPT doing to further promote interoperability? Does WebPT have any relationships with other EMRs and EHRs?
Yes, we do. In fact, we’ve completed dozens of system integrations—everything from connecting our platform to small physician systems all the way up to large hospital ones, like Cerner. Through those integrations, we’ve successfully exchanged not only patient and registration information, but also billing and documentation data. Furthermore, over the next few years, we plan to significantly ramp up our integration and interoperability programs.
Why isn’t WebPT allowing providers to submit PQRS data when the APTA is recommending that therapists continue to report this information?
While we here at WebPT are huge proponents of providers continuing to collect outcomes data to prepare for MIPS, the information from CMS as to how providers should go about submitting that data—as well as how CMS will be able to accept it—has been murky, at best. We’re continuing to work closely with CMS to extract the necessary details for us to move forward with a reporting process that works. We’ll keep everyone updated as we learn more.
Is there room for private practices in this new environment of consolidation?
Absolutely—and we are completely confident in saying that. You can see what’s already taken place in the medical world: sure, some physicians have jumped on the consolidation bandwagon, but others have decided that they started their practices independently, and they’d like to maintain control over how they treat their patients and manage their staff. The ones who have successfully managed to remain independent, though, have not sat back on their laurels. They’ve made some big changes, including investing in better systems, improving their access to data and business intelligence, and getting significantly more aggressive in asserting their value and driving business to their practices. Staying independent in a consolidating market requires you to step up your game, hop into the driver’s seat, and build on those crucial relationships with your patients, payers, and fellow providers. And the key is to make those changes now, when you see the writing on the wall—not after it’s too late.
We are confused by direct access in our state. We have it, but one of our payers still requires an MD referral. Why is that?
We would recommend first understanding the degree of direct access that exists in your state—and that means you must become very familiar with your state practice act. (For a primer on the direct access laws for each state, check out our four-part direct access series.) Some states only allow you to do an initial evaluation, after which you must get a physician involved in the patient’s plan of care. Medicare requires this as well—but it’s still a good thing, because once the patient is in the door, you, as the therapist, are in the driver’s seat. That means you can refer the patient to your PT-friendly physician for next steps.
Once you’ve got a solid understanding of your state’s requirements, familiarize yourself with your payer contracts. Some insurance companies will explicitly defer to the state practice act. In that case, if you know your state is more lenient than your insurance company is being, you may be able to convince your payer to honor your state practice act. Getting to know your insurance contracts is important when it comes to understanding your payment rates as well.
How can we best handle situations in which patients don’t understand their deductibles, copays, and coinsurance costs?
The best way to ensure that a patient understands his or her deductible, copay, and coinsurance cost is to verify that patient’s benefits prior to his or her first appointment and be very clear about the patient’s financial responsibility upfront.
High copays, deductibles, and coinsurances have been hurting our business. How can we show patients we’re worth the cost of our services?
In many cases—and this seems to be an increasingly common problem post-ACA—patients believe that being “covered” for therapy means that they won’t have any out-of-pocket expenses. Once they learn that this isn’t the case, they may become frustrated, angry, or simply cancel their appointments. Unfortunately, there isn’t an easy fix for this situation, and it’ll only become more prevalent as copays are continue to increase. The best advice we can give is to not only ensure you’re being very clear with patients upfront to avoid cost-related surprises later, but also up your game when it comes to the value that you provide. Patients today are really more like consumers, and they want to feel like they are receiving the value they are paying for. The patient experience—which encompasses everything from the first interaction a patient has with your clinic to the last—now matters more than ever before. Patients are paying attention to the way they’re greeted by your front office staff, their experience working with your billing team, the educational resources you provide, and the relationships they build with your clinical staff. It’s no longer solely about clinical outcomes—although that’s still incredibly important.
If you’re noticing that patients aren’t showing up for their first visits after learning about the cost of treatment, consider adjusting your phone script to promote the value you provide for each patient’s specific condition. For example, if your patient is experiencing low back pain and your clinic happens to have exceptional outcomes data demonstrating your skill in treating this condition in record time, you could relay that information—or provide a comparison as to how patients typically fare when receiving PT for low back pain versus more invasive intervention.
Which social media platforms should I use to better connect with current and potential patients? How do I ensure I’m staying compliant?
Your patients are already using social media to inform their healthcare decisions, so there’s no question that healthcare providers should be using them, too. The sooner you learn the ways of Facebook—as well as Instagram and maybe even Twitter and Pinterest—the better your practice will fare. That being said, as a healthcare provider, you do have some compliance concerns to take into consideration, like ensuring that you never post anything about your patients that would put you in breach of HIPAA. To learn more about ensuring social media compliance, check out this post; and to assess your clinic’s HIPAA compliance, take this quiz.
Still scratching your head over the top healthcare trends that will impact rehab therapists in 2017 and beyond? Leave us your biggest brain busters in the comment section below, and we’ll do our best to get you a response.