FAQ: Combat the Cut: How to Offset Payment Reductions in 2021 and Beyond

Introduction

Payers have been throwing uppercuts and jabs (read: payment cuts and regulatory restrictions) at rehab therapists for years. Nowadays, PTs, OTs, and SLPs are experts of bobbing and weaving—sidestepping less-than-ideal payer policies like Muhammad Ali himself. But there’s always room to learn another thing or two about combating payment reductions, which is why rehab therapy business expert Dr. Heidi Jannenga, PT, DPT, ATC, WebPT Co-Founder and Chief Clinical Officer, hosted an hour-long webinar to train up rehab therapists. During the webinar, we were overwhelmed by attendee questions, so we compiled and answered the most common ones in this FAQ. 

Don’t see an answer to your burning question? Feel free to leave it as a comment at the bottom of the page, and our team will do its best to knock out an answer!

Medicare

Is it worth it for PTs to contract with Medicare anymore?

That depends on your individual clinic finances and your payer mix. If you’re losing money when you treat Medicare beneficiaries, then no—it’s not worth it to contract with Medicare. Ultimately, your clinic is a business, and you need to bring in revenue with each and every patient. But if a majority of your revenue comes from Medicare, or if you’re still turning a profit when treating Medicare beneficiaries, then you probably want to stay contracted. 

Will the cut increase back to 9% in 2022?

The bill that reduced the 9% cut has a year-long shelf-life. So yes, it is possible that the full 9% cut will return in 2022—though it doesn’t have to. If rehab therapists successfully advocate against further cuts, they may be able to shift Medicare’s reimbursement trajectory in their favor. 

Will other payers follow Medicare’s lead with respect to the sweeping 3.6% cut and the 15% assistant cut?

It’s possible. Commercial payers often end up adopting regulatory and reimbursement policies similar to Medicare’s. This is why the rehab therapy industry worked so hard to advocate against both of these cuts when they were first announced—and why rehab therapists must continue to advocate for better payments in the future.

How will the Medicare cuts impact Medicaid payments?

Medicaid is separate from Medicare and is run at the state level. Some states may choose to adopt Medicare’s changes, while others may not. We recommend reaching out to your state Medicaid program to see what changes will affect you in 2021. 

Can outpatient clinics provide mobile PT to Medicare beneficiaries under Part B?

We actually wrote an entire blog article on how to provide in-home care under Medicare Part B, which you can read in this blog post.

Is MIPS a viable way to mitigate Medicare’s payment cuts?

Probably not. As of February 2021, the MIPS program has not awarded a payment adjustment higher than 1.88%—and that includes the exceptional performance bonus. This is because a large majority of program participants have thus far met or exceeded MIPS reporting criteria—thus lowering the pool of money available for CMS to fund incentive payments. For a deeper dive into the pros and cons of participating in MIPS, check out this blog post.

Therapy Assistants 

How has the reimbursement reduction for PTA and OTA services impacted the job market for assistants? Will practices continue hiring assistants?

It’s tough to say, as the cuts have not officially taken effect. However, as Jannenga stated during the webinar, PTAs and OTAs play a valuable role in the clinic. Even with the rate reduction, there are opportunities to leverage assistants in order to increase overall patient volume—quite possibly to the point that you can make up for the payment reduction (and then some). The job market may be a little unstable for assistants as clinics try to figure out new service models that will allow them to be profitable while still using PTAs and OTAs, but Jannenga is confident there will be many opportunities for assistants in the future as alternative service models (e.g., cash-based therapy, in-home therapy, and ancillary services) become more popular.

Do the PTA and OTA modifiers only apply to original Medicare, or do they also apply to Medicare Advantage?

Medicare Advantage policies typically follow Medicare’s guidelines, but this may vary from plan to plan. Your best bet to find out if the modifiers are necessary is to reach out to the individual carrier.

Should we limit our PTAs and OTAs to working with non-Medicare patients?

Ultimately, that’s up to you. However, Jannenga advises against limiting your assistants to working with commercially insured patients. If you schedule your assistants strategically, you may be able to use them in a way that actually increases your patient volume—with little to no added stress on your therapists. Additionally, be sure to include assistants in your strategy for providing other clinic offerings—like home visits, wellness services, and cash-based therapy.

Marketing

What are your thoughts on advertising on Yelp instead of Google?

Here’s what our resident paid advertising expert, Josh Golden, has to say: “There are a lot of different algorithm factors that go into both platforms.”  Your budget, competition, and strategy are just a handful of the factors that will influence your ability to advertise successfully.

That being said, according to Golden, “Yelp has more factors that could be out of your control—and they’ve been known to manipulate their rankings to upsell companies. Yelp may try to sell you a higher ranking by offering you enhanced features, more reviews, more positive reviews, more check-ins, and more critical keywords in reviews—none of which you have no control over. Before committing to a Yelp campaign, check your competition’s listings, and hop on Google to check how well Yelp organically ranks for local PT keywords. In the end, advertising on Yelp and Google fall into two very different marketing strategies. If you can run a campaign that helps you organically rank high on Yelp, that may be the way to go. (Just remember that it's easy to scroll past paid listings on Yelp.)”

Can you elaborate on how to measure and manage NPS®?

Tracking Net Promoter Score® (NPS®) is an easy way to gauge how your patients feel about your practice and see how likely they are to promote (or detract from) your business. All you have to do is ask your patients, “On a scale of 0–10, how likely is it that you would recommend [practice name] to a friend?” From there, you can identify which patients are the most likely to sing your praises to others—and then tap them for reviews and testimonials. On the flipside, you can also identify patients who are at risk of dropping out of care—and intervene proactively to address any issues. To learn more about the ins and outs of NPS, check out this blog post. And to learn more about how WebPT Reach automates NPS tracking (and so much more), go here.

How can we make sure our social media activity is secure and HIPAA-compliant?

Remember: Any marketing activity is HIPAA-compliant so long as you’re not sharing patient information. If a patient interacts with you on social media, do not acknowledge that they are a patient. Do not discuss any information relating to a specific patient or a patient’s treatment. Beyond that, be sure to follow the tips explained in this blog post on HIPAA compliance in marketing.

Any suggestions for patients who don’t have a Google account and thus cannot leave a Google review? 

Good news; you don’t have to have an account to leave a Google review! Patients can leave these reviews anonymously—which is an excellent option for any patients who don’t use Google. 

What is the best way to market to the geriatric population?

The best way to reach the senior population is through a two-pronged approach focusing on both digital and traditional forms of marketing. This may come as a surprise, but the vast majority of seniors use the Internet on a daily basis. And according to this infographic from MedAlertHelp, 82% of seniors “use search engines to gather information on topics of interest.” Furthermore, 66% use the Internet to find health or medical information. If you’re taking advantage of Google Ads, your clinic will appear at the very top of their search engine results whenever they search for PT-adjacent topics. And with Facebook ads, you can get your clinic in front of senior Facebook users—and you may be surprised by how many seniors are active on Facebook. As cited in this blog post, nearly half of all Americans over the age of 65 are Facebook users.

That said, even in today’s digital-focused society, traditional marketing efforts still have merit—especially when it comes to seniors. A few creative ways to market to offline include:

• contributing to local newspapers or magazines,
• running television or radio ads,
• teaming up with a local news station to host a guest spot, and
• expanding your professional and referral network.

Culture

What are the components of an employee burnout mitigation program? Who in the clinic should implement this sort of program?

Addressing employee burnout should fall to either a clinic owner or HR director. Burnout mitigation programs will likely look a little different from clinic to clinic, as reasons for burnout will vary from setting to setting (e.g., some therapists may burn out from being overworked, while others may burn out from feeling too emotionally invested in their patients). 

That said, all successful burnout mitigation programs require an open, transparent environment, as this allows for honest discussions about state of mind. You won’t be able to address your burned out employees’ concerns if they don’t feel comfortable sharing what ails them.

Beyond that, clinics can provide an Employee Assistance Program (EAP)—a program that offers confidential assessments, counseling, and follow-up services to employees. Tech platforms like Zenovate or LifeGuides are also really excellent for improving employee wellbeing. And finally, advocate for your employees to take time off. Let them know that it’s okay (and expected) for them to use all of their vacation time before the end of the year—and don’t penalize them for using it. For more burnout-fighting ideas, take a look at this blog post.

What are some ideas for employee recognition programs?

Some clinics opt to implement formal recognition programs. This may include:

• Naming an employee of the month (based on feedback from supervisors or even a full-staff vote);
• Recognizing and rewarding employees who achieve certain certifications or complete continuing education coursework; or
• Regularly highlighting employees who uphold your clinic’s core values (for example, by handing out small gift cards during weekly staff meetings).

Beyond these sorts of superficial programs, though, it’s important to actively nurture a culture of appreciation and engagement—for example, by offering opportunities for career growth, regularly checking in with staff members regarding their professional goals, and remaining transparent about the state of your organization. You can learn more about all of these objectives in this blog post and this blog post.

Miscellaneous

What is the difference between mobile PT and home health therapy?

When we discuss mobile physical therapy and home health therapy on the WebPT Blog, we often use the terms interchangeably as the two are functionally the same. If we’re getting technical, “mobile PT” simply refers to the mode of delivery (i.e., physical therapy that can be delivered anywhere outside of the clinic setting, including the patient’s home) while “home health” refers to the location (i.e., physical therapy delivered in the patient’s home). Additionally, “home health” often refers specifically to care delivered via a home health agency—which typically bill under Medicare Part A, whereas outpatient mobile PT providers may bill under Part B.

Can providers accept cash from patients even when the providers are in-network with the patients’ insurances?

Probably not. Many preferred provider agreements prohibit in-network providers from offering cash-pay services to covered patients. If you want to provide cash-pay services to a patient who’s covered by an in-network provider, your best bet is to check your individual contract to see what restrictions you must adhere to. 

Do you think PT salaries will decrease as a result of the assistant reimbursement reductions?

It’s tough to say. Ideally, clinics will find other ways to offset these payment cuts—either by reducing costs or revamping their service models. However, if these cuts keep coming, some practices may have no choice but to reduce PT salaries. We’re a long way from there, however, and PTs have a huge opportunity to advocate against these cuts and safeguard the future of the industry.  

How do you suggest using telehealth in the long term (i.e., beyond the public health emergency)?

While nothing will replace the hands-on care rehab therapists provide, now that patients—and PTs—have experienced the ease of telehealth, the demand for virtual services is likely here to stay. As many practices that track NPS® have discovered in the past year, patients appreciate and enjoy having virtual care options—and that’s likely due, in part, to the convenience factor.

After the public health emergency has ended, telehealth services will remain essential to patients who are:

• frequent travelers,
• immunocompromised, or
• older and/or dealing with mobility issues.

That said, some payers (e.g., Medicare) and states have only allowed rehab therapists to provide telehealth services provisionally in response to the current health crisis, which means therapists need to advocate for its continued use. For a deeper discussion on the role of telehealth beyond COVID-19, take a look at this blog post. 

Need tips on how to dodge a particularly tricky one-two punch from payers? Drop your question below, and we’ll get right to it!