I think we can all admit that 2021 was as unpredictable as it was—well—strange. While last year certainly wasn’t all bad, rehab therapy, like so many other industries, experienced many ups and downs and twists and turns. Now, as we wipe the slate clean and start a new year, can we (hopefully) expect a little more consistency? I think we can. Because despite the turmoil of last year, we did achieve some notable wins along the way. This is an important reminder to remain hopeful—as well as adaptable—as we stare down the challenges before us.
To help describe what we can expect in 2022, I’ve called upon a few industry experts and colleagues and solicited their thoughts on what’s to come.
The PT-first movement will gather steam.
What better place to begin our 2022 outlook than with the prioritization of PT-first treatment paths? Convincing the wider public to adopt a PT-first mindset is the cornerstone of tackling our 90% problem, and it’s what we continue to fight for. While it often feels like an uphill battle to educate others about the value proposition of PT, there are indications that we’re turning the corner.
In addition to recent research demonstrating the increased need for PT in the oncoming decade, the latest data also reflects that post-COVID health outcomes have increased the value and need for PTs as primary providers. But that’s not all. “In a span of years, consumer behavior has changed,” says Larry Benz, DPT, OCS, MBA, MAPP, president and CEO of Confluent Health. “We went from no copays to an expectation of copays; from not acknowledging mid-level practitioners to desiring them.”
Benz has assessed that—with the right messaging and outreach—we can “migrate from PT being seen as an intervention and referral profession to a direct pathway of care.” And I tend to agree. To change public perception of what PT is—and its value—we need to continue to unite as an industry, which means:
- Creating a unified brand (e.g., better informing the public about specialties within PT);
- Working to better understand the social needs of our patients (e.g., gaps in care);
- Continuing to discuss and advocate legislative initiatives that improve patient care; and,
- Supporting, educating, and encouraging new PT grads about the PT-first movement.
“The obstacles are not our patients; they have shown their consumption can change,” Benz says. “It’s us advocating, messaging, and highlighting the data and evidence that already exists. But we have to get our own companies all-in before we can convince others.”
If technology is not prioritized, PT and patients may pay the price.
Many of us have no problem recognizing that we live in a digital world. We (and I’m guilty, too) order groceries, gifts, and pretty much whatever we want and have them delivered to our doors in a matter of days or hours. Yet, technology inside rehab therapy clinics isn’t so easily embraced. And the reasons for this—as well as the solutions—are complex.
It’s not uncommon in our industry to fear technology advancements out of concern that our in-person value may become obsolete. But, however understandable this way of thinking is, it’s not what’s best for us or our patients. By embracing software that helps with scheduling, billing, and patient outcomes (as examples), we are meeting the patient where they are—which is a desire for convenient, more accessible care options—and in doing so are ultimately helping us be more effective practitioners. Nothing replaces the human touch, and we must remember that when weighing the pros and cons of embracing technology.
There is a path forward.
“To expedite the adoption of technology we must financially incentivize all stakeholders—clinicians, patients, payers, etc., '' says Richard Leaver, PT, MBA, MA, CEO of Alliance Physical Therapy Partners. “We must explain its value proposition—of which financial compensation is one part. Any technology must not only help with outcomes and satisfaction but also be cost-effective.”
I also agree with Lever that “legislators and payers have a responsibility to support laws and changes in rules and reimbursement models to facilitate the adoption of technology solutions.” But, we are going to have to work hard to make this happen. Look at telehealth: It’s a perfect example. To ensure Congress understands how imperative telehealth is to providing value to our patients, we must collect and submit outcomes data—in addition to anecdotal information such as patient stories—that proves it.
“Leveraging technology is instrumental in helping us deliver patient care in a manner that not only addresses the existing challenges, but secures and maintains our position as the primary musculoskeletal solution for the future,” Lever says.
PT education programs will struggle to serve students—unless they adapt.
The challenges of accepting and adopting new technology aren’t faced solely by PT clinics. The rehab therapy educational pipeline has also been slow to embrace progress. For example, of the roughly 265 PT programs currently available, 255 of them are traditional brick-and-mortar three-year programs, according to John Childs, PT, PHD, MBA, CEO of Evidence in Motion.
This means that hybrid (a mix of in-person and virtual learning) and accelerated (two, versus three-year) DPT programs aren’t widely accessible at this time. This is of major concern for students who come from disadvantaged socioeconomic backgrounds and who may not have the luxury of driving hours to reach a traditional classroom—or the luxury of renting a living space in a college town. The other problem is continually skyrocketing student debt. The current average balance of PT education debt is $116,183.
Accelerated two-year programs allow students to reduce their education debt. And hybrid options widen accessibility. Only a few DPT programs have adopted these education formats:
“When you do an apples-to-apples comparison of the opportunity cost of paying tuition for that third year versus earning an income, the ROI is easy to compare,” Childs says. “It’s a no-brainer to understand that going into an accelerated program, on the whole, is going to be more cost-effective. You're going to pay off your student loans sooner than you otherwise would.”
Ultimately, I—like Childs—think change is coming. To be competitive, higher education will need to innovate its curriculum models. “I think we'll see the applicant pool voting with their feet,” Childs says. “And I think, you'll start to see a softening in the applicant demand for these traditional three-year programs.”
Advanced diagnostics could see an uptick in PT clinics.
There is yet more that can be done to help PTs expand their clinical reach, adopt new technologies, and use education as a tool to enhance their value. Research demonstrates that diagnostic testing in the field of PT—like electromyography (EMG), nerve conductions study (NCS), and musculoskeletal ultrasound testing (NCS)—can result in higher reimbursement rates and improved accuracy in patient diagnoses.
“One hour of physical therapy at the nationwide level reimburses $97,” says Dimitrios Kostopoulos, DPT, MD, PHD, DSc, ECS, co-founder of Hands-On Companies. “This is data from the peer-to-peer benchmark study from the private practice section of the APTA. When you spend the same hour to perform an EMG with neuro-ultrasound, that reimburses $700 nationwide.”
Additionally, clinical studies show PT patients who received diagnostic ultrasound and/or EMG experienced 62% better patient management. At that point, the question becomes not “why expand into advanced diagnostics,” but rather “why not?” Diagnostics have a high return, and they can support our continued journey toward evolving into primary care providers. Because of this, I believe we’ll see an increase in the implementation of advanced diagnostic testing.
We will continue to work on improving PT diversity—starting with cultural mastery.
The lack of racial and ethnic diversity in PT has been prevalent for some time—and we have the data to prove it. According to the 2021 WebPT State of Rehab Therapy Report, roughly 77.4%—or more than three-quarters—of rehab therapy professionals are white. By contrast, according to 2020 US Census data, 60.1% of the US population is white and not of Hispanic descent.
“Some of the lack of diversity stems from systemic racism,” says Oluremi Onifade, PT, DPT, M.Ed, CCVT, CCI, co-founder of the National Association of Black Physical Therapists (NABPT). “And I think the education system in itself, honestly, also deals with this.”
On top of a lack of diversity in PT representation, we also struggle to provide services to patients in certain geographic locations. “I would say right now there is definitely a lack of exposure to physical therapy,” Onifade says. “If we're going to go into certain neighborhoods, where do you go to see people that are different? One, of course, is lower, socioeconomic places. You'll go into those areas that are highly populated with Black and brown people. But then, when you do, do you see physios and PTs in general? You don't necessarily tend to.”
Yet, despite these challenges, there have been efforts made to improve diversity, equity, and inclusivity in our industry, including:
I challenge us to continue adding to this list. And I know we can.
“I think, when we use cultural competency, we limit ourselves,” says Onifade. “What is being culturally competent? What does that mean to people? I think that, in itself, it is surface level. I think how we need to move forward trying to decrease health disparities and treating people how they should be with their culture in mind—it needs to get to a point where you're a cultural master.”
We have turned a corner and will keep on moving.
As PTs, we know the value of movement. I believe that although moving forward can feel too slow at times, every step counts. We have come a long way—even in a year’s time—much further than many of us will give ourselves credit for. I do believe we’ve turned a corner in advocating for ourselves and our patients, and the proof is in the progress we have and will continue to make. Let’s keep moving and improving. I believe in us and all we do.
We’d love to hear about your predictions for our industry. Drop a line below to share what you think is coming down the pipe for rehab therapy in 2022.