FAQ: The State of Rehab Therapy in 2022: Big League Insights for Long-Term Wins

Introduction

What’s the fix for rehab therapy’s diversity issues? How can clinics manage provider burnout with productivity concerns? How many baseball puns can be shoehorned into an hour? We tackled these questions and many more in our webinar, “The State of Rehab Therapy in 2022: Big League Insights for Long-Term Wins” with the 1927 Yankees of panels: Heidi Jannenga, Co-Founder and Chief Clinical Officer of WebPT, TaVona Boggs, Owner of Thrive Network, Larry Benz, President and CEO of Confluent Health, and Keaton Ray, Co-Founder and COO of MovementX.  

Much like an actual baseball game, our session ran a bit long, but was chock full of interesting statistics and left attendees wanting more. Fortunately, we’ve got postgame coverage for you, with a lineup of the most frequently asked or otherwise unanswered questions we received.

Diversity, Equity, and Inclusion

Do you think rehab therapy’s lack of diversity has a direct impact on rehab therapists’ ability to treat patients?

As Boggs noted both in our State of Rehab Therapy report and during our webinar, diversity in and of itself isn’t going to address shortcomings in reaching and treating underserved patients; what’s needed is greater cultural competency among all therapists if they’re going to better treat patients of all backgrounds. That said, diversity within the industry continues to lag behind the overall US demographics, so building a profession that is more representative as a whole should remain a central mission of rehab therapy.     

Staff Retention, Recruitment, and Productivity

How many sick days and vacation days should be given to staff?

In our webinar, Ray laid out a compelling case for why MovementX offers unlimited time off to its staff. Her team works with clinicians to reverse-engineer goals based on their salary requirements and desired work-life balance, and this approach has worked to engage and motivate employees to meet their own targets rather than targets set by the company. And with employees motivated to achieve their own goals, there’s not as much concern about clinicians wanting to take excessive time off. We’ll dig into this further in the next question.

That said, each company has to make its own decisions about what leadership is comfortable with for a sick day/vacation policy—and then balance that with what your employees want.  

How does an organization flourish if its PTs have unlimited time off?

Given this question is right in Ray’s strike zone, we lobbed it over to her. Here’s what she had to say:

“It’s understandable that this may seem like a challenge for many workplaces, but it’s a challenge we are proud to innovate around to meet the needs of our workforce. Each month we take a poll of our staff to see when they plan to take time off. Then, we work with them one-on-one to make sure there is adequate coverage from other therapists for their patients (or arrange telehealth visits if/when needed). 

Regardless of how many people you have on staff, the reality is that patients are very loyal to their providers, so vacation coverage is only half of the equation. Instead of trying to scramble to make up short-term productivity losses every time someone wants time off, we have built these time-off trends into our unit metrics of the business. This means that ‘unexpected’ time off is actually planned for in our bottom line. We’ve spent a good amount of time studying time-off trends and surveying our workforce to help make the unpredictable more predictable. 

With that said, we also have the benefit of a workforce that predominantly works on a commission basis. Our productivity goal as a company is actually the financial goal that the PT sets when they join us, so PTs tend to be very responsible with how they manage their schedules. Overall, we try to build into our culture the importance of life outside of work and have seen PTs take month-long trips to Europe on the regular. ”  

What productivity metrics can we use in our clinics that are not volume-based?

This is a terrific question and one that ties in perfectly with the topic of employee satisfaction and retention. As Meredith Castin points out in this blog post, therapists don’t like to be seen solely as billing machines, with their worth tied only to the number of patients they’re seeing every day.  That’s why clinics should be introducing other metrics to demonstrate clinician productivity, like:

• Outcomes measures that track patient results demonstrate a provider’s value to both your clinic and payers. 
• Net Promoter Score® surveys that show how many of a provider’s patients are leaving as promoters that will recommend your clinic to others. 
• Continuing education and professional growth that demonstrate a provider’s commitment to further developing their clinical and professional skills.   

Any recommendations for employee engagement services or platforms?

Always with the aim of encouraging good financial stewardship, we recommend breaking out the ol’ laptop and doing a bit of research on what really drives employee engagement today, and see if you can drum up a few ideas or programs that will work for you organization. (At the risk of sounding like a bunch of braggarts, we suggest starting with the WebPT Resource Library as we’ve created quite a few pieces of content on employee retention and engagement over the past couple of years—including our 2022 industry report).

If there is room in the budget, however, here are a few employee experience platforms built specifically with the healthcare worker in mind:

• UPshow
• Cooleaf
• Press Ganey

Remember that vetting new software requires dedicated time, so don’t be discouraged if the first product you demo isn’t a sound fit—and remember that you don’t need to (nor should you) make this decision alone. With a keen understanding of your why, your goals, and your budget, along with your key stakeholders’ feedback, the right solution will eventually come along. 

Which resources do you think are best for recruiting therapists?

Here is a handy list of the top 10 recruiting platforms (with both free and paid options) specific to the PT industry. 

Business Growth

What is your best advice for a new DPT opening up their own clinic?

It’s practically impossible to parse all the information that a new clinic owner needs when they’re first starting out into a single point, so perhaps the best advice is to recommend that you enter into it knowing what you want your clinic to be, and how you want it to operate. What sort of business model and compensation model do you want to operate? Is yours a specialty clinic, or a multidisciplinary one? What about credentialing and contracting with payers? And what kind of software are you going to use? (We have some suggestions on that last point.)  

No two clinics (or clinic owners) are exactly the same, nor are the locations and communities they enter when they open their doors. What’s most important is that prospective owners sit down and determine the path they envision for their clinic, so that they can make decisions with that goal in mind.  

If you want more in-depth insights on what new clinic owners need to consider, check out this guide on starting a PT practice.

Our new clinic is having trouble with patient volume, particularly in that referral sources send patients to larger chain practices even though we are closer. What are strategies for increasing our patient flow?

Patient volume is a common concern for therapists, especially as reimbursements continue to decline. Fortunately, there are a few different approaches that can help clinicians attract more patients.  

Direct-access marketing. Direct access laws should be a tremendous boost to rehab clinics everywhere, but too few are marketing effectively (if at all) to potential direct-access patients. No need to worry if you’re a marketing novice; we’ve got you covered with a guide on marketing your PT clinic and a download on modern marketing practices.   

Referral marketing. Speaking of webinars, we just so happen to have one on referral strategies that actually work. We’d definitely recommend giving it a watch when you have a moment, but the high-level takeaways are that prompting current or past patients to recommend you online and elsewhere, as well as reaching out to physicians in your area, are great tools for getting your clinic on the radar of more potential patients.   

Community involvement and engagement. Most people don’t fully know what PTs do, or are aware of the PT clinics in their area. One way to remedy that is to get involved with community events to raise awareness and educate people in your area so that they’ll more readily seek out therapy—and when they do, they’ll come to you   

Don’t just take our word on the potential impact of community engagement; our 2022 Ascend Innovator of the Year, Dr. Josh Funk, notes that his clinic gets less than 20% of his business from referrals, and instead leans upon the network of relationships they’ve built with sports leagues, fitness centers, and other businesses for the bulk of their clients.  

Reimbursements and Alternative Revenue Streams 

With reimbursement from payers continuing to decline, how have clinics been able to keep up with increasing salary demands?

This is a great question, and an incredibly timely one to boot. Our panelists talked quite a bit about the benefits of diversifying revenue streams to combat declining reimbursements (and give your bottom line a bump). Chief among these strategies were:

1. Adding or increasing cash-based service offerings in your clinic: This was actually the top revenue diversification strategy cited in our 2021 State of Rehab Therapy report. As such, we wrote about this topic in-depth and even went so far as to create a comprehensive guide that not only discusses which cash-based services are most common in the rehab therapy field but also how to incorporate them into your practice.
2. Ramping up your direct access marketing efforts: Also referred to as patient-centered marketing, this strategy may require a shift in the way you market your practices—but, marketing to patients has become a very viable option as some form of direct access is now available in every state. We break it all down in this rehab therapy marketing guide.

We would be remiss if we didn’t mention taking a different approach when it comes to keeping up with increasing salary demands—namely, in the form of creative compensation models. As Jason Wambold described in this blog post, “Fixed salaries plus bonuses is a payment model that is no longer sustainable, and we are estimating that these traditional models will be obsolete in 12–15 years. Clinics that make the switch [to an alternative compensation model] now would have an advantage over others who continue to hold off, as it gives them time to perfect their strategy—and address the challenges stemming from declining reimbursements to strengthen their clinics, empower their therapists, and set themselves up for financial success after a year that hasn’t been the kindest in that regard.”

What are strategies for working with payers to negotiate better rates?

This is a great question—and one that came up a few times during the webinar. Fortunately, we have a slew of resources dedicated to this topic already. First and foremost, we recommend downloading our complete (and free) guide to payer contract negotiation. We also have a couple of quick and easy reads to help you get the most out of your payer contracts:

• How to Negotiate Payer Contracts (Part 1): Making a Plan
• How to Negotiate Payer Contracts (Part 2): Taking Action
• Tales from the Table: How PTs Have Successfully Negotiated Payer Contracts

Burnout

I feel rehab therapists are getting burnt out due to the increased paperwork and frustrating authorizations needed to treat their patients. How should a practice handle this?

This is definitely a common sentiment shared by many rehab therapy professionals at the moment. As mentioned during the webinar, one-third of the rehab therapy workforce is burnt out—and it’s not just our industry. In a series of articles published in May of 2022, the US Surgeon General stated, “Confronting the long-standing drivers of burnout among our health workers must be a top national priority. And if we fail to act, we will place our nation’s health at risk.”

So, what do we do? We’ve outlined quite a few strategies in two previous blog posts; however, to focus on the specific issue here (haggling with prior authorizations), we recommend a few things:

• Know your payers’ authorization processes very well—especially your top payers.
• Make sure your insurance verification process is rock solid.
• Open the lines of communication between providers and billers.

We dive into each of these further in this article, as well as provide some additional tips in the event you’re unable to obtain prior authorization for a service you believe should be approved. Check it out!

Students

How has student loan debt impacted your individual career goals, decisions, and satisfaction?

Student loan debt has become a drag on the rehab therapy profession as a whole, and in particular those carrying that debt. Student debt was the fourth-biggest concern regarding the future success of rehab therapy in our 2022 State of Rehab Therapy report, and with good reason: half of the graduates we surveyed were leaving school with over $70,000 in debt, and nearly 34% had over $100,00 in debt. Contrast that with the fact that half of all surveyed therapists were making or expecting to make between $60,000 and $90,000, and it’s easy to see why a growing number of therapists are considering career changes, with a desire for a higher salary and better work-life balance. 

Here’s what Boggs had to offer about her own experience:  

“The only thing I knew to do was to pick up extra jobs, so I worked at a nursing home and doing home health after working at the hospital to make extra money to pay off the debt. I ended up paying off $60K in debt in one year. I was determined, and also exhausted. I would not recommend that, but I could definitely see someone paying down the debt with a plan over a few years with focused determination.” 

Additionally, this 2021 article outlines a slew of PT student loan payback and forgiveness programs.  

Technology

Are there any other technology trends not covered in the report that you believe we should be aware of?

One of the biggest future tech trends in rehab therapy is remote therapeutic monitoring (RTM). For clinicians worried about declining reimbursements and what value-based care might mean for rehab therapy, RTM presents a tremendous opportunity. With RTM, therapists can interact with more patients on a daily basis and improve adherence and outcomes, and the right RTM platform makes it easy to bill for your work with each patient.  

Where do you see telehealth headed in the future? And considering that patient interest in telehealth is so low, how can we get patients to buy into remote care?

At WebPT we’re believers in the importance and efficacy of telehealth, and the need to make it a permanent part of rehab therapy. But telehealth’s status as a billable service remains somewhat tentative. The 2023 proposed rule would keep telehealth available to rehab therapists throughout the public health emergency (PHE) and an additional 151 beyond its expiration, but the status beyond that is unclear. The House of Representative has passed a bill that would extend the waiver for telehealth billing through 2024, but it’s awaiting a vote in the Senate.   

As for getting patient buy-in for telehealth, education is key. As with anything else in therapy,  clinicians need to demonstrate not only how telehealth would work but also illustrate the value of telehealth and remote care as a part of their treatment. Patients may worry that telehealth would become a substitute for in-person treatment, and a poor one at that. Explaining how telehealth can serve to augment their treatment plan and make it easier for them to attend every appointment can address patient reservations. 

And that, as they say, is the ball game. Thank you to all who attended our webinar—but, if you missed it live, we’ve always got a replay ready for ya. For any other questions pertaining to our report findings, feel free to drop ‘em in the comments below! We’ll do our very best to answer them.

P.S. Due to the amount of cash-based questions we received, we are preparing a special cash-pay FAQ edition, set to publish later this week. Look alive!