CSM 2023: Defining PT’s Value (Before Someone Does it for Us)

After an eight-year hiatus from attending the APTA’s Combined Sections Meeting (CSM)—and suffering through a weird winter in Michigan—I was excited to hop on a plane for sunny San Diego. But, after three hours of weather delays and de-icing, I arrived in a rainy, windswept city. Ever the optimist, I took heart that this still beat the ice storm I left behind and that I was about to mingle within the world’s greatest gathering of neuromusculoskeletal experts. And thus, my CSM 2023 experience began.

After the first day of presentations, I began to see a theme emerge from the collection of speakers I heard from: that we need to define what our value is to the greater healthcare world. “Value” is not a new term to the healthcare lexicon, but in an era of declining reimbursements, PT staffing shortages, and student debt, the idea of bringing value to our profession extends beyond the federal programs rooted in value-based care (VBC)—it describes an ideal for how to remain sustainable in the future.

How do we elevate the PT industry?

At events like CSM, I love the panel discussions most. Different from the traditional research or poster presentations—which are important in their own respect—panel discussions provide an opportunity to hear from multiple viewpoints on thought-provoking topics that invigorate the audience. And at a time when too many of us are focusing on problems, these panel discussions provide a way forward and look to create solutions—the first of which is elevating our profession within the framework of our definitive value. 

But, what is our value, really?

I think we can all put some sort of spin on what we think—or feel—value is to us as a profession, but what is it to patients, payers, or the population at large? In the CSM presentation, “Addressing the Value Conundrum in PT: Insights from Payers, Health Systems, and Researchers” the eclectic panel provided insight into why value has become such a hot-button word and why we should have started caring about it years ago (to be fair, WebPT has been beating this drum for quite some time). 

To help simplify the definition of value, the panel referenced a formula that was originally coined by Michael Porter, PhD: value is derived from outcomes over dollars spent. Looking at this from a healthcare lens, you can see how this ties directly to the tenants of VBC. To this end, the panelists described how we are well positioned in the greater healthcare community to impact outcomes for patients, payers, and regulators alike, but many outside our circles are ignorant to this fact. And as I sat there listening to the speakers delve into this subject, one point stood out—if we do not define our value, then someone else will do it for us.

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What does the research tell us?

One of the panelists made a comment I think all outpatient orthopedic PTs would agree with: “PTs should be able to serve 80-85% of spine-related dysfunction in patients.” And the research supports this—overwhelmingly so. Another panelist mentioned that insurance companies love predictability and are fearful of unexpected costs. The fee-for-service (FFS) model is irrevocably tied to unexpected costs as there is no determination for how much a given cohort will cost at the end of an episode of care (EOC). With the wealth of data at our disposal, we can make predictable insights into the cost of our services and utilize informed decision-making to guide clinical practice. Yet, we remain at the mercy of our 90% problem, with patients continuing to see urgent care treatment first, resulting in unnecessary imaging, medication prescription, and even surgery. And thus, the cycle of FFS overutilization continues. 

How do we effectively define—and prove—our value?

Physical therapy has a value proposition of producing better better outcomes for less cost to the patient and payer, but, as of now, we have fallen flat advocating for this. In the previously mentioned value conundrum presentation, the late Congressman Tip O’Neill was quoted as saying, “all politics is local,” which the panelists took a step further to say, “all healthcare is local.” Every PT can do something to grab the nearest seat—or bring their own—to the table with insurers and regulators in an effort to assert our value within the greater healthcare continuum.

Bring value to patients through evolving technologies.

Remote therapeutic monitoring (RTM) has been a buzz term for the past year and a half. Introduced in 2022, RTM has filled a void that many therapists—myself included—have sought to close. True outcomes occur beyond the clinic walls with patient adherence to their HEP, but getting this across to patients can be an arduous task. Now, we can be reimbursed for the time spent outside of a typical treatment session talking to patients over the phone, promoting home exercise adherence, or ensuring optimal tolerance to therapy interventions. Perhaps no presentation had more attendees than the one hosted by Rick Gawenda, PT, Founder and President of Gawenda Seminars and Consulting entitled, “Understanding RTM as it Applies to Outpatient Physical Therapy.”

In this presentation Gawenda discussed the benefits of RTM, including how it can help clinics generate new revenue, expand patient reach, and improve patient outcomes. And given that regulators have already signaled VBC as the future for health care, utilizing RTM can also provide PTs with a digital, data-driven method to demonstrate their worth. 

Digital MSK solutions like RTM are not meant to be a panacea, though. Rather, we can use a variety of advancing technologies to improve our own practice models. Examples of this include:

• a data analytics platform to guide clinical decision-making and track outcomes;
• patient relationship management (PRM) tools to keep patients engaged and connected;
• online scheduling platforms that improve access to care; and/or
• a PT-specific HEP platform that give therapists greater insight into patients’ activity levels and progress when they’re not in the clinic. 

Like it or not, advancing technologies will continue to enter the PT field as an extension of our current practice. If we embrace their value, we can meld it with hands-on care to positively impact more people and demonstrating our value to a broader audience.

Boost value by diversifying staff roles.

Last year, the World Health Organization estimated 1.71 billion people have MSK conditions globally. And in 2015, 124.1 million US adults reported having an MSK issue. With this vast pool of patients there is near limitless potential to bring value to those affected by MSK dysfunction. Unfortunately, we have a supply shortage of PTs due to issues like burnout, early retirement, and educational costs, leading to a backlog of patients many practice owners are grappling with currently. Is there something that can be done to remedy these situations and give a new meaning of value to the type of work clinicians do? Let’s start by diversifying our roles as clinicians. 

A few roles staff PTs may be well equipped to jump right into include:

• championing and leading digital health initiatives at their clinic;
• providing wellness services like strength and conditioning, mental health, or weight loss;
• working in emergency room care settings;
• branching into public health with smoking cessation or diabetes management; 
• providing outreach to rural or underserved communities; or
• treating patients through a mix of in-clinic care and at-home outpatient care.

By breaking the traditional mold of what it means to be a physical therapist, we can start to make the profession more sustainable for current and future PTs.

Cultivate value with hybrid care models in PT practice.

Relying on insurance carriers as the sole mode of revenue is not going to solve long-term value problems for PT practices. As such, cash-based PT services have grown significantly in the last decade, proving there is a sustainable revenue source outside the insurance game. To avoid alientating Medicare patients, many practices have opted for a hybrid approach, operating both in- and out-of-network. But cash-based models are not the only hybrid care option available to PTs.

Direct-to-employer relationships are also becoming more tangible for PT practices. As outlined by the presenters for “Employers and Industrial Rehab: The Gateway to Direct Pay Revenue and New Patients,” PTs are perfectly positioned to bypass traditional insurance or worker’s compensation models and go straight to employers. This serves as a win-win-win (where my Office fans at?) where employers can cut costs, employees don’t get stuck in the worker’s compensation cycle, and PT practices can further diversify their revenue streams—on their terms.

The presenters were quick to point out that PTs should not silo themselves to PT only. They should be pitching other services like:

• ability management, 
• ergonomics assessments, 
• wellness clinics, 
• early jobsite interventions (e.g. walk-arounds), and
• OSHA first-aid.

Whether through cash-based PT or direct-to-employer models, hybridized care means finding value in more than one revenue stream. 

Grow practices through staff retention.

Circling back to the topic of staffing shortages, staff retention is top-of-mind for the majority of private practice owners. However, in our 2022 State of Rehab Therapy report, rehab therapy industry executives and clinic owners cited “managing employee happiness” as the biggest company challenge. So, we know that fresh ideas on how to boost morale and generate staff buy-in are proving difficult for practice leaders, which is what this next presentation helped to address.

In “Intrapreneurship: Improving Employee Satisfaction and Retention through an Innovative Model,” the presenters outlined methods to get staff PTs involved in their workplace beyond one-off salary increases. This included a series of examples in which employers worked with their PTs to identify their own passions, merge them into the practice, and created additional revenue streams for both parties. Examples included therapists taking on roles like:

• creating a lifestyle or diet management subscription plan for new and former patients,
• taking on the retail sales of the clinic and spearheading the program, and
• starting a program for breast cancer patients that provides them with supplies for lymphedema management and other related issues.

Engaging staff in intrapreneurship will only lend to growing the business together, thereby increasing the clinic’s value within the community, which can ultimately have an impact on the profession. Furthermore, this will show our co-workers that they, too, are valued in a practice that puts culture and personal growth at the top of company principles. It may take a bit of creative thinking to find strategies that work for a given practice, but the juice is definitely worth the squeeze.  

Break away from siloed thinking.

For many years after graduating from my manual therapy focused DPT program, I fell prey to the dogma that it was PT or bust. It took several years and forced interactions with other healthcare providers to see that staying within the PT silo will inevitably degrade our value to the industry. In short, we are stronger together. 

As Julie M. Fritz, PT, PhD, FAPTA noted at CSM, VBC is also about looking downstream beyond a patient’s EOC. How can we cooperate with other disciplines to improve the patient experience and quality of life? By networking with primary care physicians, nurse practitioners, or physician assistants, PTs can show how we can share the load, improve patients’ lives, and lift up the value of MSK care models that are PT first. Let’s break out of siloed thinking and commit to welcoming new perspectives as an opportunity to advance our profession.

This year, I made a point to attend presentations and panel discussions that focused on enhancing practice management while also creating solutions to elevate the PT profession. I came away with a sense of pride and urgency. Pride for the fact that I can call myself a physical therapist, and urgency to start defining what that means to others outside our circle. If we continue to bring this notion of value to the table, the problems facing our industry will wither while we thrive. 

Have any thoughts on CSM from this year, or maybe a burning question? Drop us a line in the comment section below.