Founder Letter: 3 Lessons Rehab Therapists Learned in 2020

It’s been one hell of a year. I don’t think any of us predicted what a roller coaster ride 2020 would be—though if you did, you should pick up some lottery tickets! We’ve been adapting to (and preparing for) sharp twists and turns and precipitous drops since mid-February, and we’ve hardly had a moment’s rest since then. Turns out that living through multiple historic events in the space of a few months is pretty dang tough.

But even though 2020 is a year I’m sure most of us would like to leave behind, it’s worth remembering that times of adversity and change can help us find our inner strength and reconnect with our core values. Throughout the year, we’ve had to think on our feet and become masters of adaptation, resilience, and empathy—and because of that, I truly believe we’ll enter 2021 as better therapists and more compassionate people. We simply have to internalize the lessons we learned this year and apply them to the future. 

Lesson 1: We were not well-prepared for the worst-case scenario. 

One day, the world felt relatively normal. The next, patients started canceling appointments left and right, and many states enacted a full economic lockdown, preventing clinics from seeing patients who were willing to venture out into the world. It was a true worst-case scenario: revenue streams dried up practically overnight, and it took weeks for the government to enact legislation to help clinics crawl out of this freshly dug financial rut.

Less prepared clinics—the ones without multiple months of savings or a robust disaster recovery plan—felt the financial weight of the pandemic right away. But even the better prepared clinics—the ones with excellent cash flow and strong business continuity plans—were caught off guard. Our favorite word became “unprecedented”—because who would have thought to prepare for something like this?

I’ll freely admit that we were also caught off guard at WebPT. I like to think that we have a solid, comprehensive business continuity plan that addresses most catastrophic hypothetical situations. We’ve completed numerous crisis response simulations, covering everything from widespread power outages to national defense threats. But I gotta admit, during those first few weeks of the pandemic, we were scrambling. Not a single one of our disaster recovery plans comprehensively outlined how to get all of our employees out of the office and working safely at home in a matter of days. 

Applying this Lesson in 2021 and Beyond

If there’s one benefit to living through a worst-case scenario, it’s that you know how to prepare for the absolute worst in the future. For instance, all clinics are now well aware of the importance of having three to six months’ worth of cash savings on hand and ready to go. These emergency funds will help you ride out the initial shockwave of crisis situations, giving you time to plan and adapt your business without immediately having to worry about furloughing staff or defaulting on your rent. 

Additionally, all clinics should create comprehensive business continuity plans that outline—in detail—how they will continue to operate in the wake of a catastrophic event. While it’s impossible to know exactly which type of misfortune may befall your clinic, you can use your geography to help you narrow the list of possibilities. (If you live in a southern coastal state, for example, you’re more likely to face a hurricane than a wildfire—and vice versa for west-coast clinics.) But whatever the disaster, clinics can generally craft a plan using these guidelines: 

• Diversify your revenue; 
• Establish open communication; 
• Explore technological solutions (e.g., telehealth); 
• Invest in patient communication and retention tools; and
• Plan for temporary partial or complete closure. 

Maximize your current cash flow.

Part of preparing for the worst is ensuring that your clinic performs regular billing check-ups. Having revenue tied up in A/R is bad for clinic cash flow—even when the financial stakes aren’t so high. When clinics are strapped for cash, it’s vitally important that their claims don’t get held up by avoidable denials. To help safeguard your clinic's future, you’ll want to ensure your claims are cleaner than ever. 

Lesson 2: We can benefit from stepping away from traditional clinic models.   

In some ways, adapting to the pandemic felt like a creative exercise. Clinic leadership had to craft a plan—with practically no notice—that adjusted operations such that their businesses could stay open while minimizing the risk of infection for staff and patients. But that was only the half of it—in some cases, these plans had to support ever-fluctuating patient volumes. (Some clinics went from seeing no patients to seeing nearly 100% of their normal volume within a few weeks.) 

Because of these new demands, we had to create and implement new strategies for scheduling and staffing. For some clinics, that meant weaving telehealth appointments into the mix of in-person appointments. For others, it meant physically rearranging the treatment space to accommodate the CDC’s six-foot social distancing guidelines and staggering work schedules to reduce the number of people in the clinic at any one time. 

Applying this Lesson in 2021 and Beyond

Working within these constraints tested the limits of our resilience and flexibility, but the serendipitous discovery here is that the traditional clinic model—one in which everyone shows up at the office to provide (or receive) in-person therapy—may not be the most effective or efficient. Consider this: 

• Staggering schedules can lengthen clinic hours, giving patients more scheduling flexibility.
• A hybrid in-person and telehealth service model gives therapists and patients more flexibility, resulting in fewer no-shows and cancellations—and potentially allowing therapists to occasionally work from home. 
• In-house billers and (some) front office workers can also work from home—thus reducing business overhead. 
• Clinic leaders can automate more tasks than they may have originally thought—by using a patient communication and engagement platform or offering digital patient intake forms that flow directly into an EMR, for example. 

What I’m hinting at here is that when the pandemic finally ends and we can resume our normal lives, it may not be in our best interest to revert back to old habits. We should keep the process changes that work best for us and create a new status quo—one that better serves ourselves and our patients. 

Lesson 3: We can successfully advocate for our interests. 

One of the few silver linings to 2020 was the definitive proof that our advocacy and lobbying efforts work. In the past few years, we’ve struggled to make headway against legislation that hurts our profession (consider the upcoming 9% Medicare payment cuts and the PTA and OTA payment differential). But in 2020, we scored a notable number of legislative wins. 

Roughly a month after the pandemic hit the US, the government deemed PTs, OTs, and SLPs essential workers. This helped cement our authority as medical experts, allowing outpatient clinics to continue serving patients and bringing in revenue. Rehab therapists also used the power of advocacy to successfully lobby commercial and state payers for telehealth privileges during the pandemic. Not only did we successfully pull that off, but we also managed to convince CMS to change its telehealth rules—if only temporarily.

And finally, while this lobbying success wasn’t COVID-related, it was still a huge win for rehab therapists: CMS finally gave PTAs and OTAs the go-ahead to provide outpatient maintenance care. This aligned the standards for both inpatient and outpatient therapy, and—again—bolstered our medical credibility and authority. 

Applying this Lesson in 2021 and Beyond

Knowing that we can successfully lobby for our interests in the legislative arena—especially during a pandemonius pandemic—is deeply reassuring. We may not know what regulatory challenges the future will throw our way, but this year has proven that we have the tools and capacity to fight for legislation that benefits and safeguards our profession.

This is especially important considering the obstacles we know await us. As of this article’s publish date, the 9% payment cut to outpatient Medicare therapy services is still barreling down the pipeline. Plus, CMS has yet to make PT, OT, and SLP telehealth privileges permanent; they’re set to expire at the end of the public health emergency. 

Take action. 

Luckily, industry advocates are in the process of introducing these problems to federal legislators, and two bills (H.R. 8702 and H.R. 8755) have entered the House. While those bills do have some bipartisan support, the battle is not yet won! We need to continue to push for our interests—we need to appeal to our federal representatives and encourage them to join the fight to protect rehab therapists and our patients. 

Check out the advocacy efforts spearheaded by APTA, AOTA, ASHA, or APTQI for more details on how to get involved. Or, download WebPT’s own advocacy templates for therapists and patients.

This year may have felt like riding a rickety, anxiety-inducing roller coaster, but we have an incredible opportunity to take the lessons we’ve learned and apply them forward. This could be a gamechanger! We can definitively prove our value as we assert our medical authority, contribute to the COVID-19 recovery effort, and help the country prepare for another pandemic. We simply have to seize the day!