Last year, I laid out a handful of predictions for 2016—and what do you know? Most of them were spot on. In fact, much of what I covered—think interoperability, the importance of data collection, payment reform, and the push toward private practice consolidation—are all holding strong and will surely continue into 2017 (well, barring any unforeseeable curveballs to the state of health care as we know it, that is). In the meantime, though, here’s what I think we can plan on—and how we can continue to kick ass—in the new year:
As a result of the recent healthcare reform efforts—namely, those answering the call for more integrative, collaborative care—hospital systems will continue to stretch into outpatient healthcare markets as they acquire or partner with more and more private practice rehab clinics. Thus, the need to share and exchange patient information and data across healthcare sectors that were previously siloed will continue to grow—at an even faster pace. In 2017—and beyond—interoperability among software systems will be much less of a nice-to-have and much more of a mission-critical must-have.
As much as I foresee interoperability in health care becoming a future necessity, I also predict that technology will face a few barriers—because unfortunately, achieving interoperability is not nearly as simple as linking two individual systems. Why? First, it’s rare that two software systems actually speak the same language—even when they use “standard” interoperability languages such as HL7 and fire. After all, these languages are anything but standard, because not many systems actually comply with them to the letter. Second, it takes a lot of time—along with additional technology layers and solid application program interfaces (APIs)—to designate and identify all the data points that need to be exchanged. With all that in mind, I believe the interoperability frontier will be forged by a few technology companies (like WebPT, of course) that are prepared to take on the work.
Not only is interoperability important for providers, but it’s also crucial for our patients. Providers must be able to share each patient’s information and outcomes data with other members of that patient’s care team—especially before the patient’s first visit with a new provider. This type of streamlined data exchange will produce better outcomes and decrease the risk of negative medication and treatment interactions. Furthermore, it’ll help reduce spending by preventing the patient from receiving duplicate treatments.
Of course, none of this is possible without the necessary technology piece I mentioned above. Emerging EMR connectivity—like WebPT’s ability to exchange patient data, documents, and billing information with other systems—and HIPAA-compliant text messaging will enable networks of providers to discuss and inform one another rapidly. In other words, as I mentioned last year, the writing’s on the wall: in this new interoperable world, faxing will no longer be a staple of healthcare communication. In place of the fax machine, we’ll see technology that allows for real-time information transfer.
From an efficiency standpoint, it makes sense for hospitals—which continue to expand their exclusive networks—to serve as the point of entry for many patients, many of whom will end up seeing a physical therapist at some point in their care episode. In an interoperability-optimized world, this means the hospital would collect the patient’s demographics, insurance information, and past medical history before sending that information—and a referral—to the outpatient rehab therapy EMR. As an outpatient provider, you would then only need to verify with the patient that his or her information was correct; you wouldn’t have to re-collect the same information again—and that time savings could really add up.
In addition to managing all of the billing for patients under their purview, hospitals also may want to handle scheduling therapy appointments to ensure patients’ compliance with their care plans. This increasing demand for data-sharing and communication will make it necessary for all EMR and EHR systems to allow for the receipt and transmission of this type of information. In other words, always-on, niche web-based systems continue to be the platforms of choice (as opposed to the siloed server-based ones of yesteryear). In fact, despite the hospital network expansion, it’s critical that outpatient PT clinics maintain their own EMR systems—ones that are specifically designed for a therapist’s workflow. In this age of interoperability, there’s absolutely no reason to suffer—or leave money on the table—by using the hospital’s EHR system when it doesn’t support the compliance and documentation needs of rehab therapists. After all, those are critical issues—and alleviating them can make transitioning into a hospital network that much more lucrative for both parties. It just may require you to stand up for what’s right for your practice and providers.
In the years to come, software automation that enables seamless information transfer will be immensely helpful—for providers, payers, and patients alike. It has the potential to produce mounds of meaningful data at every level, from the way the healthcare system as a structure is faring, all the way down to the manner in which a single patient is responding to a specific course of treatment. And that’s huge. There’s so much potential there for us to use that data to inform decisions that will impact us all.
That being said, there are several software solutions on the market right now that are promising to completely “automate” the clinical-decision making process, and that’s concerning. Enabling and automating information exchange among providers and healthcare systems is one thing—even clinical decision support (CDS) that suggests tests and measures and identifies red flags and potential plans of care are fine—but automating the clinical-decision making process is something else entirely. It takes the knowledge and experience of the clinical decision-maker out of the equation, which could jeopardize not only the strength and accuracy of the data we collect, but also our value as PTs and our ability to serve as primary care providers. Plus, payers will reject cookie-cutter canned responses on the first audit. While top-notch software is integral to the data collection and analysis process, it’s no substitute for a provider’s education, knowledge, and skill. And this is a slippery slope for us—we’re fighting to demonstrate our value, but willing to let a computer program tell us what to do? This has failed in the MD world before, so let’s learn from those past mistakes and not let history repeat itself in our industry.
2. The State of Private Practice PT—and the Continued Push for Consolidation
Private practice rehab therapy will continue to live long and prosper—sorry, couldn’t help myself; it’s the Trekkie in me. But in all seriousness, there always will be a market for private practice, and so it will remain an integral vehicle for patients to receive rehab therapy. However, there continues to be a strong push toward consolidation—and it’ll only grow stronger in 2017. 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.
If you find yourself being asked if you’d be interested in selling—either part or the entirety of your practice—it never hurts to listen to the proposal. After all, when you know what’s on the table, you’ll be better able to make an informed decision—one that’s right for you, your family, your patients, and your business.
To prepare yourself for consolidation opportunities, here are a few things you should know to ensure you wind up with exactly what you want (we wrote about some of these in this post):
- Your valuation (i.e., how much your company is worth)
- Your goals for your practice (do you want to keep growing it or exit?)
- What you need financially in order to reach your goal
- The role you personally want to play in your business going forward
- The type of arrangement that would fit your professional and personal plans
- The values, ideas, and strategies you want in the person or company you’ll be working with
You also should make sure your financials are clean and that you have a team of business-savvy people who you trust to keep your best interest at heart as they help you understand the ins and outs of the proposal. For example, is it a merger or acquisition? How should you handle a cash, equity, or combination deal? You’ll want to consult with folks who have this kind of knowledge so they can help you not only make the decision, but also guide you through the transition, if you decide to accept.
As a result of the shift toward more patient-centric practices—à la the Triple Aim—next year, some clinic owners may face the decision of whether to bring on staff members with specific specialties (such as metabolic specialists, dietitians, psychologists, massage therapists, and medical doctors) to better serve their patients in the name of collaborative care. More and more collaborative care models are showing signs of success and gaining traction. And that’s no surprise, because provider teams can approach patient treatment more holistically, thereby minimizing the patient’s chances of experiencing further injuries and conditions that would require future clinical intervention. This model is not only wonderful for patients, but also beneficial to PTs, as it allows us to take on a more relevant role in the treatment of population health issues such as diabetes, obesity, and heart disease. It also helps us position ourselves to provide preventive care—as opposed to reactive intervention. As rehab therapists, we have the opportunity to be at the forefront of this—to really lead the charge toward a more unified care approach—especially when it comes to those population health issues I mentioned above.
The EMR Landscape
Now, the push for consolidation isn’t only affecting PTs; EMR companies are feeling the shift, too. There are simply too many disparate systems that aren’t evolving fast enough, and private equity investors see this as an opportunity to create larger companies that have the resources to keep up with the pace of healthcare change. We’ve already seen shifts in our industry that indicate bigger movements: in 2016 alone, TherapySource became Casamba, and PTOS went out of business. While it may not feel like these changes are good (especially if you were a PTOS user), this transformation—this tightening up—will help enable software companies to provide the type of technology (e.g., interoperability) healthcare providers need to thrive in the new era of health care.
With respect to the current state of physical therapy technology, I’m proud to say that WebPT has never been more stable. That’s because we’re private-equity backed, we’re number one in market share, and—as a result of those two factors—we’ve been able to evolve our company and our software. Over the last few years, we’ve adapted our platform, products, and support to effectively serve every outpatient rehab therapy business—from single-therapist clinics to multi-location enterprises. And this dedication to outpatient therapy—regardless of clinic size or practice setting—will definitely continue into 2017 and beyond. You can count on it.
3. Healthcare Reform
Obviously, times are a-changin’ when it comes to health care. You don’t need anyone’s predictions to tell you that (the end of PQRS, the new CPT codes, and the adoption of ICD-10 are merely a few of the changes that have already come to pass). But, 2017 brings with it another wave of changes:
Value-Based Payment Models and Outcomes Data
Now, much of this is already happening, but I foresee private insurance companies being the ones to take the value-based payment model and run with it. In fact, I think it’ll be non-Medicare insurance companies that accelerate the pay-for-performance trend even faster than Medicare can—thanks to their use of outcomes data.
And speaking of outcomes data: Collecting, analyzing, and—key word here—using outcomes data will be even more important in 2017, because what we amass now will serve as the foundation for future payment reform. Not only that, but measurable data will enable us to provide better patient care, collaborate in more meaningful ways, and gain better insight into how our clinics—and our industry—is functioning.
And it won’t be long until the measurement tools themselves will become standard for certain diagnoses (e.g., all providers will use Oswestry for patients with low back pain). That’s because all providers involved in a particular patient’s plan of care must be able to not only understand the scoring of the most-frequently used tools, but also use the same tool to track progress across the patient’s entire care experience. Although the tools won’t necessarily be perfect in every single case, they will provide data that’s understood across all providers in the healthcare continuum—and much of that data should be rehab therapy-specific, because we play such an important role in patient recovery.
This section will be short and sweet, because while MIPS starts in 2017 for the rest of healthcare community, PTs, OTs, and SLPs have—as usual—been left out of the equation. But that doesn’t mean that we should sit back and rest on our laurels. We must continue to collect and report data in the interim. If we don’t, then in two years—when we are required to join in the quality data-reporting fun—we’ll be severely behind, and that could put us at a serious disadvantage in terms of future payment rates.
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4. A Change in the Rehab Therapist Mindset
What’s that I see in my crystal ball? Is it a bird? A plane? No, just a super-massive shift in rehab therapists’ mindsets. It’s going to be a big year for #BizPT—I’m willing to bet on it. Thanks to the rise of #FreshPTs (with fresh mindsets), social media, innovative academic institutions, and free content available to help us shape our businesses, the rehab therapy community is ready to take control of our practices.
In the past, many of us who chose this profession because we wanted to help people have had a hard time accepting the fact that we’re also running a business. But that’s changing—fast. More and more providers are understanding that they can—and must—do both: they can be a phenomenal therapist while also being knowledgeable about business (thereby increasing their chances of being successful). In 2017, this trend will continue, with an increasing number of therapists understanding how a business operates. That means knowing—and being able to apply—the fundamentals of company culture, profitability, profit and loss, salary matrices, and ownership principles. This is a great thing, because this level of knowledge is crucial to our ability to elevate ourselves as professionals.
No matter what you might have thought in years past, social media has a place in rehab therapy practice. After all, patients are actively using it to inform their own healthcare decisions, so it only makes sense that providers use it, too. In 2017, more and more practices will use social media to connect with prospective patients, keep current patients informed, and engage former patients post-discharge. Social media sites are no longer reserved for the younger generations. The sooner you learn the ways of Facebook—as well as Instagram and maybe even Twitter and Pinterest—the better your practice will fare.
Direct Access, Referrals, and Marketing
While every state allows for some form of direct access, many practices still aren’t taking advantage of the ability to see patients first. That’s going to change in 2017 as more and more therapists across the country hop into the driver’s seat when it comes to marketing directly to patients. While that may require some dollars upfront, it’ll be worth it in the long run, as it’ll enable us to see patients first, effectively diagnose and treat, and—like true primary care practitioners—refer them to the appropriate provider, when necessary. This will improve our relationships with our patients—because we’ll no longer be ancillary providers treating under a doctor’s orders—as well as with the rest of the healthcare community. The referral flow will soon become a two-way, equally trafficked street.
I don’t know about you, but I’m really looking forward to 2017. Change is inevitable, and that’s a good thing. We need to work together to make that change what we want it to be—something positive for the state of our profession, our clinics, our staff, and our patients. After all, it’s going to take hard work, lots of planning, and most importantly, consistent follow-through to see these changes come to fruition. This is a great time to be in practice—and it’s a great time to be a rehab therapist. Wishing you all and your supportive loved ones a very happy and prosperous new year!