FAQ: The State of Rehab Therapy in 2019

Earlier this week, WebPT’s fearless leaders, Dr. Heidi Jannenga, PT, DPT, ATC, and Nancy Ham, CEO, revealed the results of our annual State of Rehab Therapy survey and discussed the national trends that affect rehab therapy professionals on a daily basis. The presenters didn’t have enough time to address all of the thought-provoking questions we received from our audience, so we compiled an FAQ for y’all to read at your leisure. Can’t find the answer to your question? Leave it in the comment section at the bottom of the page, and we’ll do our best to find you your answer!

Mergers and Acquisitions

I’m not interested in entering into any M&A (merger and acquisition) transactions. How can I continue to operate as an independent practice and compete against large firms?

For smaller independent practices going up against large regional or national companies, marketing directly to patients is absolutely crucial. Pinpoint your differentiator—the thing that sets you apart from the competition—and make sure that message reaches your target patient population (as well as potential referral sources) by optimizing your marketing and advertising strategy. (To learn how to do that successfully, check out our free guide to modern physical therapy marketing.)

Furthermore, keep in mind that M&A isn’t the only route to achieving power in numbers. As Jannenga mentioned during the webinar, there are other ways to join forces with fellow independent practitioners—by getting involved with a management services organization (MSO), for example.

How do you foresee the M&A climate evolving in the coming years?

We know that the pace of M&A is accelerating. The cycle of clinics opening, growing, acquiring, and selling will likely continue. Health care is a business, after all. So, what does that mean for you? First, make sure you’re taking advantage of any opportunity to become more business savvy. In addition to educating yourself on M&A—and evaluating whether such a transaction would benefit your organization—explore opportunities with MSOs, franchises, and other types of business networks. Finally, we’d highly recommend attending industry events and conferences—specifically, business-focused ones like Ascend—to meet and network with other business-minded rehab therapy professionals and experts.

With respect to mergers and acquisitions, how important is cultural alignment between clinics if those clinics operate in different states?

According to Ham, cultural alignment is always important—regardless of whether you’re joining a company across the street or across the nation. People need to be inspired by belonging to an expanding community—and that can only happen if all entities involved are aligned. You can’t overinvest in culture and communication, and nothing good is going to come from having one kick-off meeting and thinking you’re done. Additionally, Ham suggests being careful about languaging post-acquisition—specifically, steering clear of “us vs. them” terminology—and avoiding blame for past decisions.

How do you evaluate cultural alignment?

In terms of evaluating your M&A opportunities for cultural alignment, check out the company’s website, Glassdoor reviews, and patient reviews. You may want to reach out to past employees to gauge their experience with the company as well as reserve plenty of time for lengthy discussions with the company’s current leadership team. As Ham explained, when WebPT acquired Strive Labs, their founders spent six months quizzing us about our culture and goals. Only after they felt we were both striving toward the same mission—that is, to empower therapists to achieve greatness in practice—did they allow us to begin discussing finances. So, take your time, and research a company thoroughly before signing on any dotted lines. If it doesn’t align with your company’s values, walk away.

Physician Marketing Strategies

What are some strategies for marketing to physicians? Is it more important than patient marketing?

To learn winning strategies for increasing physician referrals, check out this blog post or our recent Ditch the Donuts webinar. For an in-depth discussion on the impact of patient marketing versus physician marketing, read this blog post. Ultimately, regardless of how you split your marketing efforts, we recommend leveraging marketing automation to help you better segment your audience and tailor your messaging appropriately. This will not only save you time, but it also will make your marketing more effective.

Don’t we need to market to physicians to make sure they refer patients to us before prescribing medication? Isn’t that more important than marketing directly to patients?

As Charlotte Bohnett, WebPT Director of Demand Generation, mentioned during the webinar, patient marketing and physician marketing are both important, but the importance of marketing directly to prospective patients has grown tremendously in recent years. That’s because more and more patients are researching treatment options on their own before seeing their physician—if they ever see their physician at all. Many are self-referring to physical therapy or going to their physician specifically to request a PT referral.

How do you convince PCPs who don’t believe in PT that we have value? What do you do if a patient’s primary care physician doesn’t want to sign a physical therapy POC?

According to Jannenga, this is a prime example of why all physical therapists should be collecting outcomes data, because that will provide the foundation for an objective discussion about the value of your services (and our profession as a whole). Beyond that, we recommend encouraging the patient to communicate with his or her physician about his or her positive experience with physical therapy. The more times physicians hear positive results directly from their patients, the better. In terms of getting the POC signed, Medicare does not explicitly require that the patient’s own primary care physician sign the POC. This means you can refer the patient to any PT-friendly physician in your network to approve the plan of care before you begin treatment.

Declining Reimbursements

My practice has tried to negotiate with some low-paying payers, but their best offer is still significantly worse than some of the other payers I’m contracted with. I’m considering dropping these plans, but I’m sad that my patients would have to start paying out of pocket. What are others doing in this situation?

Unfortunately, there is no easy answer to this question. As Ham mentioned in a prior webinar, there are times when it might be worth remaining in network with a payer that isn’t up to par with its reimbursements if going out of network would cause problems for your practice (e.g., an issue with top referrers, a drop in the number of new patients you see, or some of your current patients not being able to receive the care they need). That’s why she recommends considering the whole picture before cutting ties with a particular payer. All that said, in some cases, it’s simply not in your best interest to remain in a situation where you’re not getting paid what you know you deserve. You may lose some patients, but you also may be surprised at who’s willing to continue seeing you after you go out-of-network, especially if you’re able to provide value that those patients can’t receive elsewhere.

Rehab therapy claim reimbursements are declining across a wide swathe of payers. Will this affect the industry landscape in a significant way? Do therapists have to worry about losing their jobs?

Thanks to the aging—but active—baby boomer generation as well as greater attention on the growing opioid crisis, there’s plenty of demand for physical therapy. And that demand is expected to increase in the coming years. In fact, according to the Bureau of Labor Statistics, physical therapist employment is expected to grow 28% from 2016 to 2026, which is “much faster than the average for all occupations.”

Have practices started preparing for the PTA billing change (i.e., the lower reimbursement rate for assistant-provided services)? Is appending a modifier the solution?

Beginning in 2022, Medicare will only reimburse 85% of the cost of services provided in whole or in part by a therapy assistant (as noted by affixing the CO or CQ modifier to the claim). As we explain here, “while the 15% payment reduction will not go into effect until January 1, 2022, providers must begin submitting the new PTA and OTA modifiers on January 1, 2020.” In terms of preparation, we recommend training your staff on the use of these new modifiers and evaluating additional ways to offset this reduction in revenue (e.g., improving retention).

Student Debt

What do you think needs to be done to solve the student debt crisis?

A lot. This issue is not unique to PT; it’s a national crisis, and it starts at the academic level. As Jannenga mentioned during the webinar, that means the profession must re-evaluate the skill sets necessary to entering patient care as a doctoring provider upon graduation. As she explained, physical therapy made a massive leap from requiring a two-year degree to a three-year degree. This significantly increased the cost associated with becoming a physical therapist, but students didn’t necessarily realize any additional value. According to Jannenga, there’s a lot of opportunity to streamline that additional year—and perhaps even shorten it—via alternatives like online classes. 

Are there any government or state programs that incentivize private practices to offer debt reduction to new grads? I know that hospitals and nonprofits have similar programs.

There’s a bill that’s currently sitting in the House called the Employer Participation in Repayment Act of 2019. It’s a very short amendment to the current tax code that would allow employers to make tax-free payments toward their employees’ student loan debt. The bill hasn’t been voted on yet, and it has a long way to go before it becomes a law (if it ever does), but it would seriously help employers who want help make good-faith contributions to employees’ loan balances. 

What are employers offering in the way of student loan assistance?

The amount of assistance employers offer varies based on budget and industry, so it’s tough to say. However, we recommend taking a look at this website. It discusses what Staples, Penguin Random House, and Fidelity Investments offer to their indebted employees. 

Patient Dropout

I was absolutely stunned to learn that only one in ten rehab therapy patients complete their POC. How did you arrive at that statistic?

The “one in ten” statistic came from our 2018 Industry Report. We surveyed 6,864 professionals in the rehab therapy space and discovered that on average, only one in ten rehab therapy patients complete 91-100% of their care plan. 

Is a hard-nosed no-show policy a deterrent to patients? 

That depends on what you mean by hard-nosed. We believe that a consistent and reasonable no-show policy is a great way to establish expectations and hold patients accountable for attending their booked appointments—especially if you explain the reason for the policy. That said, we also believe that there are extenuating circumstances that warrant some leniency. For example, if a patient with an immaculate attendance record has an emergency the day of his or her appointment, it might be worth granting an allowance.

Miscellaneous

What are some signs of therapist burnout? Is there a way to maximize your staff’s performance (i.e., productivity) and not burn them out?

When people are burnt out, they seem more tired and less engaged in their patients’ care. Their attendance usually starts to suffer; they may ask to leave early semi-regularly, or they might burn through their PTO and sick time. The best way to figure out if your staff is burnt out is to be observant: find the time to go out on the care floor, and watch your PTs at work. You can gather a lot of information just by observing the tone of their conversations and the atmosphere of the care floor—and by watching how patients respond to treatments. Patients will feel the negative effects of a burnt-out provider before anyone else, because the quality of care they receive starts to decline. If you track your patients’ Net Promoter Score® (NPS®)—which speaks to their satisfaction and loyalty—they will likely help you identify unhappy therapists. 

If you want to prevent burnout from burning through your staff’s ranks, start by collecting business metrics. Answer questions like, “What’s the highest number of patients your providers see on the day-to-day?” Or, “What’s the minimum number of patients you need to see each day so you don’t go out of business?” Once you have an understanding of these data points, you can start to set reasonable expectations for your staff. The enemy of burnout is open, honest communication. If you regularly talk with your therapists about their workload and how they’re feeling in the clinic environment, you can address pain points before they become too severe. 

Which outcome measurement tools (OMTs) should PTs, OTs, and SLPs be using? How should we track them?

Bohnett recommends using “measures that are non-proprietary,” meaning they are accessible to all providers. If you use proprietary tests, your referring providers won’t necessarily understand them. For tools, we recommend WebPT Outcomes. We have the largest data set in the country, which means you can see how your outcomes compare to other providers across the country—and you know that data will be comprehensive and accurate. 

We can’t compete with salaries offered by large corporate clinic chains. What else can we do to attract quality therapists and therapist assistants?

While salary is important, it’s not the be-all, end-all for most new hires—especially if you provide a desirable company culture and other work-life perks that a corporate clinic cannot. Furthermore, as we explain here, “benefits are a huge part of the salary equation—and a high-value benefit package can go a long way in hiring and retaining top talent. It can also help you ensure you’re providing commensurate value to your staff if you really can’t budge on actual salary numbers.” 

How do we compete with chiropractors when their services cost less?

Focus less on the price point and more on the value of the services you provide—especially over the long term. After all, patient-consumers are willing to pay more for services that they believe are going to help them meet their goals. Outcomes data is also essential here, because you can use it to demonstrate the objective value of your care.

What’s the difference between patient satisfaction surveys and Net Promoter ScoreⓇ (NPSⓇ)?

While satisfaction surveys measure satisfaction, NPS measures loyalty, which we believe is a much more actionable metric (plus, the NPS process is simple, standardized, and easy-to-digitize, thereby eliminating some of the common biases associated with satisfaction surveys). To learn more about NPS, check out this resource and this one.

Are there patient volume or practice income benchmarks for adding additional clinicians?

Unfortunately, this answer will vary from practice to practice—but it’s safe to say that if your therapists’ schedules are absolutely packed to the point where you’re turning patients away, it’s probably time to hire an additional headcount. Keep in mind, though, that you don’t necessarily have to hire a full-time therapist. You may want to bring a part-time PT, contractor, or per diem therapist—or perhaps hire a PTA instead.

What resources did you share during the presentation?

• The Physical Therapist's Guide to Contract Negotiation
• Cash-Pay Resources
• Ditch the Donuts: Referral Marketing Strategies that Actually Work
• The State of Rehab Therapy in 2017
• The State of Rehab Therapy in 2018
• The State of Rehab Therapy in 2019

Rehab therapists are some of the most hardworking, caring, and driven professionals out there, and they deserve an industry that supports them to the fullest extent. We have a long way to go before we get to that point—but we’re making some great headway, and here at WebPT, we’re optimistic about the future! If you have any questions about our data or the trends we observed, feel free to ask us below.