Running a successful practice can be challenging—especially given the current payment climate. Add in the potential pitfalls of making a bad hire and the staggeringly high percentage of patients who drop out of therapy before completing their course of care, and you have a veritable minefield to traverse. So, don’t make it harder than it has to be by convincing yourself (or your staff) that you can’t take direct access patients in your state. As it stands, there aren’t even any states without direct access to physical therapy—because every state allows patients to receive at least an initial evaluation from a qualified PT before they must obtain a physician referral to continue treatment.

And that’s all you need to step into your role as a primary care coordinator. So, up your marketing game to include prospective patients; then, use your clinical expertise to help direct those patients to the type of treatment that is the most likely to benefit their condition or injury. If it’s physical therapy, great! You can send patients to a PT-friendly physician for a referral that allows you to move forward with treatment (if you’re not in a state that allows unrestricted direct access to physical therapy). And if it’s not physical therapy, then you can refer the patient to a provider who would be a better fit (with the added bonus of strengthening your network). Either way, you get to the be the one ensuring that the patient receives the very best treatment—and maybe (just maybe) that patient will explore a solution other than surgery, injections, or pain meds.

Misguided notions around direct access aren’t the only misconceptions preventing PT practices from realizing their full business potential. Here are five more:

1. “We can’t use patient names in testimonials.”

You can—as long as you obtain prior written permission from the patient. Otherwise, you’re committing a HIPAA breach—and that could land you in hot water. If you’re wondering whether including names is worth the extra effort of obtaining permission, then consider how an unattributed testimonial may appear to a prospective patient: perhaps a little fishy. On the other hand, including names can aid in garnering trust and lending some legitimacy to your testimonials. In this article, Strive Labs co-founder Ryan Klepps uses Champion Physical Therapy and Performance as a great example of a practice that uses its website wisely by keeping its “messaging simple—and back[ing] it up with social proof via testimonials.” You’ll notice that Champion’s website features plenty of testimonials paired with the source’s name—and picture, which is a nice touch. And you can bet the clinic has a signed permission slip for each and every one of them.

2. “When patients stop coming to therapy, it’s because they’ve gotten better.”

If only this were actually true. Unfortunately, according to research conducted by the Strive Labs team, 30% of patients drop out of physical therapy during the first three visits, and 70% won’t complete their entire course of care. While a small percentage of these patients may have experienced a miraculously speedy recovery, most bail before meeting their functional goals—and that’s not good for patients or providers. (In fact, according to WebPT president Heidi Jannenga, early patient dropout is a $6 billion dollar problem for the industry at large.) While this is clearly a systemic issue, there are things that you can do to improve patient retention in your clinic—the first of which is admitting that you have role to play in keeping patients engaged in their care. From there, be sure you’re:

  • Prioritizing the patient experience;
  • Collecting and acting on patient feedback;
  • Connecting with patients between appointments by sending them relevant content;
  • Providing access to a secure communication channel that patients can use to reach you;
  • Using a multimedia HEP program that enables patients to track their progress; and
  • Reaching out to patients who fall off the calendar to get them scheduled for their next appointment.

While small practices may be able to do all of the above manually without the risk of having patients fall through the cracks, mid- to large-sized practices—and ones that are growing—may benefit from adopting patient relationship management (PRM) software to help automate the process and improve engagement.

3. “We can’t post anything on social media.”

Sure you can. There are plenty of super-successful healthcare practices that use social media to share relevant content and market to patients. And considering that many people are now researching potential providers and treatment options online before ever setting foot in a provider’s office, social media is a great platform for connecting with prospective patients at the beginning of their care journey. Just like any communication tool, though, you best use it thoughtfully—and remember that everything you share, post, comment, and like will exist in the Interwebs permanently. That’s why any business that uses social media should have clearly written policies and procedures for interacting with patients online, emphasizing the importance of never posting anything that could even remotely be construed as personal health information (PHI) without obtaining written permission from the patient.

4. “Our patients are satisfied—just look at our satisfaction scores.”

Satisfaction scores can be misleading—especially if you’re:

  • using a survey method that isn’t sensitive enough to capture meaningful differences between patient responses, or
  • only administering surveys at discharge (hello, sampling bias) and in the clinic (hello, environmental bias).

All of this can leave you with an artificially inflated score that doesn’t actually represent your patients’ experience with your clinic. Instead, opt for a standardized, valid, and reliable measurement tool that truly captures your patients’ feelings about your clinic. And while you’re at it, we recommend measuring loyalty instead of satisfaction. As Strive Labs co-founder Scott Hebert explained during this webinar, “Satisfaction is easy to achieve: you simply meet a customer’s expectations. Loyalty, on the other hand, is a little harder won, because you have to exceed those expectations. And in today’s competitive and increasingly value-based, patient-centric healthcare marketplace, exceeding expectations is crucial.”

In our opinion, Net Promoter Score® (NPS®) is the best metric available for measuring patient loyalty. According to this NPS resource, it’s a “proven metric [that has] transformed the business world and now provides the core measurement for customer experience management programs the world round.” And the very best PRM software on the market has NPS tracking built-in, so you can automate the entire process, including asking your loyal patients to write you online reviews and testimonials.

5. “We can’t see Medicare patients past the therapy cap—or threshold.”

While the therapy cap has officially been repealed, there’s still a targeted review threshold in place. But, you can—and should—provide medically necessary services above that threshold. Failing to do so could hinder your patients’ progress. Simply affix the KX modifier and ensure that your documentation supports the continuation of care. As WebPT’s Kylie McKee explained here, on February 9, 2018, the Senate voted to repeal the Medicare therapy cap effective on January 1, 2018. However, providers are still required to “track total claim amounts for Medicare beneficiaries and apply the KX modifier to claims exceeding the $2,010 threshold [for 2018],” said Mckee. “…the targeted review process will now apply to therapy claims exceeding $3,000 for each individual patient.” In the comments of the same post, WebPT’s Brooke Andrus further clarified that “claims above $3,000 may be targeted for special review by Medicare to ensure they meet the requirements for reimbursement.” But, a little extra Medicare scrutiny shouldn’t deter you from doing what’s best for your patients. Just be sure your documentation is defensible.


There you have it: five misconceptions and misunderstandings that may be hurting your PT practice (six if you count the first one about direct access). Have any others you’d like debunked? Share them in the comment section, and we’ll do our best to set you straight.