WebPT recently conducted an industry survey of thousands of rehab therapy professionals across a wide variety of settings, specialties, and geographic regions. Our goal: To capture an accurate snapshot of the demographics, trends, frustrations, and motivations that shape our businesses, our future outlook, and our potential for success in this environment of change.
In last week’s webinar, WebPT President and Co-Founder Dr. Heidi Jannenga, PT, DPT, ATC/L, and WebPT CEO Nancy Ham shared the results of that survey and provided action items based on the data collected. Not surprisingly, our attendees had quite a few questions about the survey results—too many for Jannenga and Ham to tackle during the presentation. So, we created this handy FAQ doc, complete with the most common questions—and their answers. Scroll down to check them out.
What’s the best way to collect outcomes data? I’ve heard about the APTA registry—should I join?
The best way to collect outcomes data is via WebPT Outcomes—the first fully integrated outcomes tracking software. WebPT—unlike the APTA registry—doesn’t require you to enter your data twice, because what you enter into your documentation automatically flows into our outcomes database. Now, the APTA has implied that it will eventually integrate its registry with EMRs, but to our knowledge, that has not happened yet.
What’s the difference between EMR and EHR?
While these electronic systems share many similarities—they both contain digital records of patient information—EHRs are usually generalists (i.e., large, hospital-based systems) whereas EMRs are specialists (i.e., systems designed to address the specific needs of a particular group of providers). While the interoperability conversation has primarily centered on EHRs as a result of CMS’s now defunct Meaningful Use program, EMRs are just as capable of seamlessly exchanging relevant data—and that’s really the best of both worlds, isn’t it? By adopting a highly specialized EMR (one designed to meet your specific needs) that also integrates with other systems, including EHRs, you’ll be setting your practice up for success in an increasingly connected healthcare world. For an article and infographic that dive deeper into this topic, click here.
How will telehealth affect the future of PT?
Telehealth has quickly become a popular mode of care delivery in general medicine. We’ve seen a particularly high adoption rate in the fields of dermatology, psychology, and primary care. Younger patients, especially, tend to choose providers who offer telehealth services. So, for those therapy practices that are able to leverage telehealth technology in some way now, there’s no reason not to do so. That said, therapists are still facing a lot of challenges when it comes to getting paid for services delivered via telehealth, which is why it’s so important that PTs, OTs, and SLPs advocate for legislation that would remove some of those barriers and constraints. The industry also needs to be proactive in developing the technology that will support effective delivery of telerehab services.
How can I use WebPT to maximize payments under MACRA, MIPS, and value-based payment models?
It all comes back to data. All of those programs are designed to reward high-quality, low-cost providers, and you need data that proves you fit the bill. So, if you’re not already doing so, then you absolutely must collect data. You must measure, track, and analyze patient outcomes to not only promote clinical best practices within your own organization, but also obtain the highest possible payments from your insurance carriers. And this data isn’t just something you’ll need down the road (i.e., when PTs, OTs, and SLPs finally become eligible for MIPS in 2019); it’s something you can—and should—be using now. In fact, some therapy practices are already starting to present this data to private payers—as well as to orthopedic medicine providers that are currently participating in payment bundles—with the goal of obtaining better payments through reimbursement structures that incentivize care quality. And WebPT Outcomes can help you do all of that. We’ll also be introducing a MIPS primer feature in our product later this year to ensure our Members are ready to accurately collect and record MIPS-required data points—and we’ll distribute plenty of educational resources to prepare those Members for MIPS success.
What are some other benefits of adopting WebPT?
Designed by therapists, for therapists, WebPT aligns with rehab therapy workflows, allowing you to easily create custom evaluation profiles, complete auto-scored outcome measurement tools, and select from the most current evidence-based tests available. Plus, when you pair the WebPT EMR with one of our billing solutions, you’ll enjoy cleaner claims and faster reimbursements—without having to deal with double-data entry. To learn more about the benefits of a WebPT Membership, check out this article—or, click here to schedule a complimentary tour of the platform.
Based on what you’ve personally heard and observed in the industry, do you think it’s becoming more common for independent therapy practice owners to sell to larger companies?
Earlier this year, Jannenga wrote an article outlining her predictions for 2017 and beyond—and one of those predictions had to do with the continued push for consolidation within the industry. While there will always be a market for independent private practice rehab therapy, Jannenga wrote, “private equity money continues to flow, and debt remains cheap—which is why many enterprise-level companies accepted funding in 2016. Now, they’re hungry to meet those growth numbers, which means we’ll see a significant uptick in clinical consolidations this year. After all, large companies and hospital systems are on the hunt for new clinics to add to their portfolios.”
Is physical therapy’s perceived diminishing value due to an increased industry-wide dependence on prescription medications?
First of all, we don’t actually think that physical therapy’s reputation for providing value is diminishing; it’s just not growing at the pace it should be. There’s definitely been an increase in medication use as a result of the opioid epidemic; unfortunately, some physicians do take the easy road by prescribing pain medication instead of working toward achieving a long-term solution. Furthermore, there’s been an increase in the number of orthopedic surgeries performed in recent years. However, research is beginning to demonstrate that this type of intervention doesn’t actually produce the best results. In fact, one of our webinar attendees shared with us that the National Institutes of Health (NIH) launched an initiative to explore the benefits of PT over surgery and opioids.
In other words, we have data on our side, and there’s truth in data. As a result of these findings, larger healthcare systems and organizations are beginning to understand that rehab therapy is a low-cost, high-outcomes solution (especially when compared with long-term medication use and surgery). Thus, we should start seeing more and more patients who are experiencing orthopedic and musculoskeletal issues seeking out physical therapy. However, we must continue to convey our value. As it stands, 92% of patients who would benefit from PT aren’t getting it—and it’s on us as a profession to educate those patients and push forward with the effort to make sure they receive the care they need.
How can I get involved in industry advocacy efforts?
If you’re not already a member of the APTA, then that’s a good place to start. And if you’re already one of the gang, consider becoming more involved with your regional section or state chapter. You can also head to the APTA’s legislative action page to contact the government officials who are responsible for ensuring that pro-PT bills get signed into law. While you’re at it, grab your phone and download the APTA Action app from Google Play or the Apple App Store to connect with congressional representatives, view live updates on important initiatives, and donate to the PT-PAC.
You should also be reaching out to your representatives to encourage them to support and/or sponsor the bills that are beneficial to our industry. To do so, you could send an email, or you could stick with the tried-and-true phone call or handwritten letter.
No matter how you go about advocating for the profession, though, the important thing is that you do. We all must take action with the intent to improve our industry—for ourselves, our patients, and our peers.
Is the APTA’s Vision 2020 still relevant?
According to the APTA, this vision statement “succeeds Vision 2020, which was adopted by the House in 2000 and was influential in guiding the profession over its 13 years. Although elements of Vision 2020 are not explicitly mentioned in the current vision or its guiding principles, the values of Vision 2020 remain significant to the successful fulfillment of the new vision.”
Where do rehab therapists stand with respect to the proposed replacements for the Affordable Care Act? How will it impact our industry?
You’ve probably heard that the new healthcare bill would result in a higher population of uninsured patients as well as cuts to coverage for patients insured through Medicaid. The strength of that impact, however, will vary by state—especially in terms of Medicaid coverage. That’s because, as explained here, “Both the state and the federal government pay for Medicaid, and under both GOP bills, the federal contribution would go way down over the next 10 years and beyond. States would have to make tough decisions, including considering limits on who is eligible for that funding, reductions in services covered or limits on what they pay providers and insurance companies.” For those Americans who remain insured, many could face higher premiums, which could lead them to put off or forego treatment that they otherwise would have sought out. It could also lead them to sign up for less robust plans that provide less coverage for rehab therapy services.
Why do you think some therapists still refuse to adopt EMR technology? What is WebPT doing to bridge this gap?
While the majority of rehab therapists have made the switch from pen and paper to electronic solutions for documentation, billing, and practice management, there is still some hesitation among many therapy providers when it comes to making that leap. Whether this hesitation is spurred by the difficulties associated with adopting a new system or merely a preference for paper, practices that don’t take advantage of new technology are absolutely doing themselves a disservice in terms of growth. As for WebPT’s role in all of this, we offer free training and education throughout the onboarding process to make this transition as painless as possible. WebPT Members also have access to our team of documentation and compliance experts, who provide ongoing support every step of the way.
Why aren’t rehab therapists involved in quality-based incentive programs offered by insurance companies?
Actually, there are some—though not many—rehab therapy practices that have successfully participated in, or even negotiated for, value-based payment models. (Learn more about PT participation in payment bundles here and here.) Part of the reason rehab therapists have been overlooked for many of these programs is that they have not been included in national reform efforts aimed at promoting the shift to value-based care—which means they haven’t really been on the quality-based care radar. For example, PTs, OTs, and SLPs were excluded from participating in the recently introduced MIPS program for at least two years. Furthermore, rehab therapists have not historically prioritized outcomes data collection, which means they lack the historical data necessary to prove the value and efficacy of their care. And as anyone who has ever attempted to negotiate higher payment rates knows all too well, insurance companies typically rely on data to direct payment-related contract changes.
For those payers that pay significantly less than my clinic’s fee schedule—is there a “breaking point” at which we should drop our contracts with them?
As we’ve discussed in the past, the decision to drop a payer isn’t one that should be taken lightly, because it could cause a decrease in your revenue—at least in the short term. That being said, “if you’re accepting patients from a payer that isn’t paying you enough to cover the clinical costs associated with seeing those patients, then you’re losing money every time you see that payer’s patients.”
I have a small practice—is it really feasible for me to participate in alternative payment models or bundles?
Small practices can absolutely benefit from participating in alternative payment models and bundles. We’ve actually written several articles to help therapists decide if participating in models such as the Comprehensive Care for Joint Replacement (CJR) program is right for them. You can check them out here, here, and here. And even if you decide not join a formal bundle, if your outcomes data is excellent, then you may want to consider negotiating for a risk-based payment model with your payers.
Why is the percent of billed amount collected a useful figure? We set our fee schedule for maximum payment from out-of-network payers, which is often much higher than in-network payers. Doesn’t this make the number relatively useless?
You are correct that therapy practices aren’t typically reimbursed the full amount that they bill. As Ham explained during the webinar, “Payers rarely reimburse the full amount billed. They usually cover a percentage, and the amount they cover may be below the clinic’s overall rate schedule. Furthermore, each insurance contract is different, which means each will reimburse a different percentage of the clinic’s standard rate for any particular service. But, the clinic still bills the same ‘full amount’ for each service, regardless of which insurance company is receiving the bill. This is why the clinic is not always paid the full amount.” According to Jannenga, a 50–60% adjustment rate is acceptable; the important thing is to keep tabs on “the consistency of the adjustment rate.” If that rate starts to increase, “then it’s important to understand why as well as identify when a payer is possibly changing its fee schedule,” she said.
Business and Operations
How do I know if it’s time to hire another therapist or assistant? Is there an optimal ratio of PTs to PTAs?
This can depend on a lot of things, chief among them: your budget. You want to make sure that you have enough steady business to support the addition of another employee. Keep in mind that many therapists and assistants are willing to work part-time hours, so that might be a good strategy for “testing the waters” before you take the plunge and bring on another full-timer. You will also want to consider the types of patients you typically see. Are most of them repeat clients? Or are you seeing a constant stream of new patients and referrals? The more new patients you see, the greater your need for licensed therapists who can perform and bill for initial evaluations—rather than PTAs or OTAs, who cannot conduct evaluative visits. If you have a solid—and growing—base of “regulars,” on the other hand, then you may be able to get by with hiring an assistant to help manage patient flow during your busiest times.
Does WebPT have contacts for PTs who want to open or expand a clinic or practice?
We here at WebPT pride ourselves on being thought leaders—and connectors—in the industry. One of the ways that we encourage rehab professionals to be better in business and achieve their practice goals—whether that be opening a new practice, growing an existing one, or expanding into a new location—is to broaden their network through engagement with their peers online or in person at events such as Ascend 2017. At this year’s Ascend conference, WebPT Members and non-Members alike will have the opportunity to network with hundreds of fellow rehab therapy professionals and learn from industry experts about the topics that matter most. Plus, in terms of educational resources for everything from running a business and improving employee engagement to maximizing billing and negotiating payer contracts, there’s no better resource than the WebPT Blog.
With respect to patient volumes, is there any difference between opening and operating an independent practice versus running a clinic that is part of a franchise?
If you’re running a private practice in an area with lower reimbursements, then to meet your revenue goal, there’s a good chance you’ll have to offset lower payments by treating a higher volume of patients. And that would be no different in a franchise model. The main difference between these two types of organizations is that with an independent private practice, you—as the practice owner—have 100% ownership. In a franchise, on the other hand, you would typically have a small percentage of the ownership. But while the company maintains majority ownership, it will also provide you with things like employee benefits, EMR and other technology/software, infrastructure (including, in some cases, your actual office), and clinic equipment. The overarching company also typically provides employees with educational opportunities—both business- and treatment-related. So, you have to weigh those factors against owning a smaller piece of the pie. Furthermore, keep in mind that in a franchise, you won’t necessarily have control over the company culture or the payer mix (and the insurances with which your organization contracts can impact patient volume).
Do you have an example of a good patient-relationship management software for therapy providers?
We highly recommend WebPT Reach. It’s a patient relationship management (PRM) software designed specifically for musculoskeletal health and wellness providers, including physical therapists. With this product, clinics and hospitals can engage and communicate with their patients, deliver relevant content (including home exercise programs and blog articles), and keep tabs on patient progress.
How and when do you recommend distributing NPS surveys?
As far as we’re concerned, Net Promoter Score (NPS) is an incredibly important customer satisfaction metric that every business—regardless of industry—should be tracking. As Jannenga wrote in this article on the subject, “To begin tracking your practice’s NPS score, you’ll need to ask your patients one simple question: on a scale of zero to ten, ‘how likely is it that you would recommend [practice name] to a friend?’ Piece of cake, right? You can do so using a free survey tool—such as SurveyMonkey or SurveyGizmo—or via paper (and then manually entering your data into a spreadsheet).” As for when you should be administering this survey to your patients, in this guide to NPS, WebPT’s Charlotte Bohnett recommends doing so at discharge as well as at different points throughout the episode of care.
Don’t see your question listed above? No sweat. Write us a note in the comment section below and ask away. And feel free to give us your two cents on the state of rehab therapy. We’re eager to hear what you think.