FAQ: PT After Crisis: Recovering, Reopening, and Refocusing on the Future

Introduction

The COVID-19 pandemic hit the PT industry like a wrecking ball—and now clinics across the nation are beginning to pick up the pieces and learn how to treat patients in this new, virus-laden world. To help PTs navigate this new healthcare landscape, Heidi Jannenga, PT, DPT, ATC, WebPT Co-Founder and Chief Clinical Officer, and Nancy Ham, WebPT CEO hosted an hour-long webinar discussing the impact of the pandemic and strategies for reopening. We received so many questions during the live event—too many for our expert hosts to answer—that we compiled the most frequently-asked questions and answered them below. Don’t see the answer you’re looking for? Leave a comment at the bottom of the page and our team will help ya out. 

Financial Management

Where can we trim expenses to make up for lost revenue?

Unfortunately, labor costs tend to be organizations’ highest expenditure, which may mean that—in order to stay afloat—you have to change how you staff and pay your employees. The next expense to consider is rent. If you haven’t already called your landlord to renegotiate the terms of your lease, do that immediately. In some cases, you may be able to pay less rent for a number of months and defer the increase until next year to give yourself some extra breathing room. Depending on how you envision your practice on the other side of this crisis, now may also be the time to reduce your operational footprint.

Beyond that, we recommend reviewing your expense register, reaching out to your vendors, and exploring more cost-effective product options. Further, reduce or minimize luxuries (e.g., travel or conference budgets) as much as possible. Some states are even adjusting their CEU requirements, so therapists have more opportunities to complete their courses online. This can significantly reduce the cost to attend a course and obtain credit.

Finally—in addition to looking for ways to trim expenses—we also suggest looking at ways to increase your revenue streams. Consider specializing in a new niche or offering alternative services (like dry needling or wellness services) to your patients.

How much cash should my clinic have in reserve?

A good rule of thumb is to have three months’ worth of cash on-hand to cover operating expenses (i.e., disaster reserves), and another three months on top of that. Accumulating that much money might sound intimidating, but it’s doable. Start by trimming expenses where you can, negotiating better deals with your landlord and vendors, and looking for additional revenue streams. 

Should my clinic schedule more PTAs or techs since they’re less expensive than staff PTs? 

Possibly yes—where it’s appropriate. PTAs and therapy techs play an essential role in patient treatment, but how you schedule them will depend on your payer mix. (Some payers, like Medicare, strictly limit how techs and/or PTAs can assist with treatment.) But, at the end of the day, initial evaluations, reevaluations, and a handful of critical treatments can only be furnished by PTs and OTs, so you need to schedule enough therapists to keep up your patient volume. Once your patient volume begins returning to normal levels, that might be a good time to start bringing assistants and tech back into the clinic. 

How can we project revenue if our therapists do not complete their notes in a timely fashion?

Start by setting clear expectations with your staff members about completing their documentation in a timely manner. This is important for creating accurate revenue projections and ensuring that your practice is maximizing its cash flow—which is essential right now. In the meantime, you should still be able to implement the first revenue projection strategy that Jannenga and Ham discussed during the webinar: Simply multiply your weekly or monthly new patient volume by the average visits per new patient and average revenue per visit. That formula should help you project your revenue.

As a mobile PT (i.e., I come to you), is this a good time to boost my cash offerings?

That depends on your client base—who they are, what insurance carriers they use, and how likely they are to pay for a service out of pocket.

Safety Protocols 

What should I do if a patient does not want to wear a mask during a PT visit?

To avoid this situation from the get-go, make a concerted effort to set expectations with your patients before they come to your clinic. If you have a mandatory mask policy, tell patients about it when they first call to make an appointment. When you send an appointment reminder, inform patients—yet again—that a mask is required inside the clinic. The day of the appointment, consider making yet another call to patients to remind them to wear a mask. Additionally, post your mandatory mask policy outside your clinic’s doors so patients see the reminder before they walk into the clinic. If a patient forgets to bring a mask but is willing to wear one, consider keeping some masks on hand that you can hand out as necessary.

At this point, if the patient is still unwilling to wear a mask, you have the right to turn them away in the name of maintaining a safe environment for your staff and other patients. 

What should we do if a patient is under physician orders to not wear a mask? Should we excuse these patients from the mask requirement?

According to Veda Collmer, JD, OTR, WebPT’s Chief Compliance Officer, if a doctor orders a patient not to wear a mask, then the clinician should not enforce the mask requirement. As an alternative, providers may offer telehealth or isolated in-clinic services. According to Collmer, “If the clinic has capabilities to sequester the patient during his or her visit and the provider is wearing a mask, the risk of spreading infection is mitigated.” That may require “providing service in a private room or scheduling the patient when the clinic has a low volume of patients.”

Do you have any tips for cleaning small tools such as therabands, foam wedges, or other items with porous surfaces? 

Per CDC guidelines, you should clean soft, porous surfaces by removing “visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces.” Once clean, “launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.” If you are unable to launder these items, the CDC recommends cleaning them with “products that are EPA-approved for use against the virus that causes COVID-19 and that are suitable for porous surfaces.” You can view the list of EPA-approved cleaning agents on this page.

Mergers and Acquisitions 

We’re thinking about selling our practice, but we’re worried that we won’t get its full value in the current economy. But, with revenue down, we’re also worried about continuing to lose money. At what point are we better off selling for a lower price instead of waiting it out and continuing to lose revenue?

This really depends on your clinic’s cash reserves and its ability to weather the storm. But, it is important to note that selling your practice and continuing on as normal aren’t your only two options. More and more clinics are entering into alternative merger and acquisition relationships that don’t involve a full sale for pennies on the dollar. For instance, some companies are willing to step in and take on operating expenses (or temporarily pay staff), until revenue begins to pick up, putting both organizations in positions to prosper. Remember, there are good companies out there that want to forge mutually beneficial partnerships for years to come.

Would it be beneficial for us to enter into a partnership with a clinic in a different area or region that is less impacted by COVID-19?

Potentially, yes. Prior to the pandemic, many organizations preferred to merge with—and acquire—clinics inside specific, limited geographic regions. But now, there is budding interest in reaching into new spaces. For example, individuals and organizations that had a strong presence in urban areas are beginning to consider expanding into rural areas, which (generally speaking) have been less affected by COVID-19. There’s something to be said about finding strength in numbers—but make sure you pursue business opportunities and relationships that ensure balance. You must be able to support one another through the ebbs and flows.

Is this a good time to acquire the practice of a retiring practitioner that comes with referral resources and active patients? These are very uncertain times and I am not sure if it's a good investment.

Ultimately, that depends on the state of your finances and the finances of the practice that you’re looking to acquire. However, if you believe that you found a good deal and a beneficial acquisition opportunity, then it may behoove you to strike while the iron is hot. Nancy Ham suggests working out an acquisition deal where you don’t have to pay the entire cost of the practice up-front. For example, you could potentially partner with the retiring practitioner and work with them side-by-side for a time before completely acquiring their business. 

Telehealth Services

Do you think telehealth will remain a covered service for PTs, or do you expect that it will return to being largely non-covered in the future?

We think that telehealth is here to stay—at least, for a while. The most recent spike in COVID-19 cases indicates this crisis will probably not end any time soon, and CMS Administrator Seema Verma is talking openly about telehealth’s benefits for providers and beneficiaries. That said, we don’t want to sit on our laurels—we want to ensure that telehealth will become a permanent fixture in the PT industry. That’s why it’s so important that we participate in industry-wide telehealth advocacy efforts. 

If insurance carriers stop paying for telehealth after the pandemic, how will this affect the hybrid therapy model?

It’s tough to say. If states allow therapists to continue providing telehealth after the pandemic (but insurance carriers stop paying for it), then the fate of the hybrid model lies in the hands of patients. If the patients in your community feel like telehealth is providing a lot of value, then they may be willing to pay for these services out of pocket. If that’s the case, your clinic could continue to provide telehealth on a cash-pay basis. 

Is the payment rate for telehealth different than the payment rate for in-person services?

Sometimes. Prior to the pandemic, payers reimbursed telehealth services at a lower rate than in-person services. However, due to COVID-19, many payers (e.g., Medicare) are currently offering pay parity for telehealth and in-person services. Some states are even requiring pay parity (e.g., Arizona). Check with your PT state board, your individual payers, and your payer contracts to learn more about telehealth payment in your area. 

Do I need to get credentialed with insurances for telehealth, specifically? If so, how do I accomplish this?

If you’re already credentialed with a payer, then you shouldn’t need additional credentialing to provide telehealth. However, we would still recommend reaching out to individual payers to determine their specific telehealth guidelines.

What is a good ratio of in-clinic visits to telehealth visits for each patient? For example, should we do one in-clinic visit per week and two visits via telehealth?

That entirely depends on the patient, the specifics of his or her condition, and the capacity and state of your clinic and team. Unfortunately, telehealth is largely uncharted territory for PTs, and there’s little guidance about telehealth best practices. With that in mind, this is an excellent opportunity to begin collecting data to identify trends and best practices for this new hybrid PT delivery model.

I work in a subacute setting and we have older clients who have limited access to smartphones or computers. How can they receive telehealth services?

Unfortunately, without access to—or comfort with—technology like smartphones, tablets, and computers, this population may not be best served via telehealth. However, older patients are beginning to ramp up their technology usage and improve their technological savvy. While your current set of patients may not be best served by telehealth, that could change in the near future. 

Marketing Strategies 

Fewer patients feel comfortable attending therapy in our region, so competition has skyrocketed. What are some good strategies and tactics for out-marketing these competitors?

Make sure you understand and actively communicate your data-backed value proposition (i.e., why patients should seek your services, specifically), and consider offering new services that address the unique problems created by the pandemic (e.g., offering remote, PT-led exercise sessions to gym-goers). 

Communicate with the patients you’ve seen in the past, and tell them about how your clinic is keeping patients safe—whether that’s by providing telehealth services, or by adopting rigorous infection control standards inside your clinic. Additionally, try reaching out to your old referral sources. Check in and see how they’re doing and—if they’re open—tell them that you’re open for business and that you’re operating with patient safety at top of mind. 

And finally, make sure your public-facing information (e.g., your social pages and your website) communicate this same information. If patients are brave enough to venture into a PT clinic, they’ll likely want to know how you’re keeping them safe.  

Other than offering and marketing telehealth visits, how can we make up revenue lost due to decreased patient volume?

Start by looking at your billing processes and ensure that you’re coding properly (e.g., correctly applying the 8-minute rule) and maximizing your time with patients. If you have PTAs or OTAs on staff, try strategically scheduling them in a way that allows your therapists to see more patients. Additionally, ensure that you’re collecting patient balances at the time of service—and make time to review and clear your outstanding accounts receivable.

This is also a great opportunity to get creative with your suite of services and find new ways to provide value to your patients—and community. For example, many gyms are closed, which means a PT-guided personal training visit could be a great service to offer to the community. 

How can we get patients excited about telehealth?

A great way to get patients excited about telehealth is by talking about how it promotes accessibility, safety, and convenience. Telehealth is a great way to provide critical care to at-risk groups—or people who are in contact with someone in an at-risk group. Whatever the case, your patients can access care from the safety of their homes. Plus, telehealth therapy is convenient. Patients don’t have to worry about planning for a 20-minute commute to the clinic—they can sit down in their living room and join the videoconference within seconds.

Miscellaneous

Can we complete initial evaluations via telehealth?

Sometimes; it varies from state to state and from payer to payer. Reach out to your PT state board and check your state practice act to determine if you can legally provide initial evaluations over telehealth—and contact individual payers to determine if they cover remote evaluations.  

Any idea how this is impacting the rehab therapy job market—particularly for new grads?

It’s difficult to say for certain—especially since the situation is continuously evolving. We imagine that, because of the recent increase in furloughs and layoffs, there are fewer job opportunities available for new graduates. That said, we’re not yet sure how this situation will play out over the next six months to a year. If seasoned therapists decide to explore early retirement, for instance, job opportunities for new grads might actually increase in number. But, of course, this is just speculation—and job markets are going to vary by region.

Are there any educational programs or training courses that focus exclusively on rehab therapy treatment for late effects of COVID-19?

Yes; the APTA Cardiopulmonary Section recently developed this video series, which offers clinical advice for treating post-COVID patients in the outpatient physical therapy setting. The APTA has also developed numerous educational resources and CEU courses for treating COVID-19 patients, which you can access in the APTA Learning Center.

How can I ensure employees who are on social media are not damaging my clinic’s reputation with their social activity? 

If you don’t already have one, create a company social media policy that each employee signs at their date of hire. This policy should ask employees to represent only themselves when they post online—not the company—and it should discourage them from tagging or referencing the clinic where they work. Additionally, consider providing a staff outlet where your employees can speak in a safe environment (maybe through a bi-weekly video conference call). If your staff feels heard by management, they’re less likely to take to social media to air their grievances. 

Still got some questions?  Drop 'em below and our team will do its best to find you some answers.