Founder Letter: 4 Bold Predictions for 2025

With 2024 squarely in our rearview mirrors, it’s time to look ahead to 2025—which means it’s time for my annual predictions of what I think will happen in the year to come. Like most predictions, it’s impossible to hit the mark on every one, but I must admit we are batting a pretty good average based on last year’s outlook. If you check out last year’s predictions, you’ll see that I talked about the continuing financial pressure on the industry—and how that pressure would lead to more acquisitions and mergers in 2024. I also said that we’d see a faster adoption of AI within healthcare and an increase in cash-pay services, which I feel pretty confident in saying we’ve seen over the last year. Of course, like baseball it’s best not to think about the misses, like my prediction that Medicare Advantage would see a decline. (More on that later.)

Although budgets should be finalized for 2025, it's always a good exercise to review some of the factors in play that rehab therapists should be thinking about in the profession, in the greater healthcare arena, and in the world at large. So, without further ado, here’s what I think is in store for 2025.  

1. The Trump administration makes significant changes to healthcare. 

The new year brings a new administration, and if early returns are any sign, we could be in for a wild ride in healthcare. We are in the midst of leadership confirmation hearings as we publish this article, with some key figures playing important roles in influencing the potential for significant change in healthcare. Robert Kennedy Jr. has raised the most eyebrows as the likely next Secretary of HHS. Meanwhile, the advisory body known as the Department of Government Efficiency (DOGE), led by Elon Musk and Vivek Ramaswamy, is set to earmark what they deem wasteful spending in the government. There are plenty of areas for them to focus on, but when it comes to wasteful and non-ROI spending, one could see significant time spent on healthcare, which now represents 22% of federal spending.

We have already experienced the Musk influence as Congress tried to pass a funding bill in December that included some positive measures for rehab therapists for 2025. Ultimately, that bill was replaced by a more temporary measure to keep the government open until March 14, 2025, but did not include the fee schedule increases for rehab therapists and only extended the telehealth provisions until March 31, 2025. As the inauguration dust settles, we, of course, will again be lobbying hard to get some of those provisions back into the next bill.  But here are some other areas that I predict this administration will have impact on:

Medicare Advantage will get a push from the government. 

Despite backlash from healthcare provider groups, including the APTA, Medicare Advantage plans will continue to garner support and grow in lives covered. Project 2025, a conservative policy blueprint, suggests promoting Medicare Advantage programs, which are provided by private insurance plans, over traditional Medicare. This could lead to a shift toward privatized options within the Medicare system. That sort of change will also push private PT practice owners to really think hard about whether to continue to accept these MA plans or drop them and go out of network. We have already seen this trend increase in 2024, and it will continue in 2025. 

Public sentiment about insurance companies will reach a critical mass. 

I do anticipate some significant public pushback as the spotlight will shine bright during the trial of Luigi Mangione for the murder of UnitedHealthcare CEO Brian Thompson. While most of us were horrified by what happened and condemned this act of violence, the attention and visibility of the motive has drawn national attention to insurance companies that have made an art of denying care. With over 100 million Americans owing $220B in medical debt, he has been lionized by Redditors and others on the internet fed up with the perceived greed of insurance companies. It’s hard not to empathize with the shared stories of harm done by insurers. Although some debt relief has been granted this week, the root of the problem needs to be addressed, and there’s a chance that we will see a groundswell in favor of a new direction. Still, as far as predictions go, it’s hard to bet against the overwhelming profit of these publicly held insurance and healthcare entities. 

The effort to repeal the ACA will get new life. 

While specific plans regarding the Affordable Care Act (ACA) have not been detailed, previous efforts to repeal or modify the act suggest potential changes that could affect healthcare coverage for millions of Americans. At a time when we’re pushing to expand access to care in rehab therapy, losing the ACA would severely undercut those efforts with underserved communities. 

The continued rise of MSK conditions gives digital MSK a golden opportunity.

I have written about the expansion of telehealth services and the declining adoption in the outpatient PT sector following the initial acceleration during the COVID-19 pandemic. However, with the continued shortage of PTs and the increasing demand for PT services, digital services are going to need to be part of the answer to reach more patients suffering from MSK ailments. Musculoskeletal (MSK) conditions are now the leading driver of health care costs - with 1 in 2 Americans developing an MSK injury. Chronic pain is also closely connected to mental health issues such as anxiety and depression, which can lead to absenteeism and decreased workforce productivity – and which, in turn, can compound health care costs.  

The cost of MSK has now exceeded $420B—that’s billion with a “B”—and it's simply not sustainable. Although healthcare is currently only a small part of their overall revenue, Amazon doubled down on digital MSK with its partnership with HingeHealth in December 2024. This trend could go either way in raising more awareness of PT  adding to the number of patients seeking PT services, but more likely, it will influence the behavior of patients to question whether in-person visits are really necessary—or at least for a full 10-12 visit episode of care. 

Patients and practices will make big changes to adjust to new realities.  

While overall economic indicators suggest the economy is in good shape, consumers have still felt inflationary pressures that are negating that growth and causing real financial pain for the average family household. Clinic owners continue to see their margins diminishing with the continued rising costs of clinic consumables, thus making the decreased overhead of telehealth visits more enticing to both patient and provider. 

The RFK Jr. appointment shouldn’t overshadow the nomination of Dr. Oz as director of the Center for Medicare and Medicaid Services (CMS). My prediction is that the not-so-great-but-powerful Oz, together with RFK Jr.’s vision, will attempt to put greater attention on population health issues as they try to “Make America Healthy Again”—not that I think this country has been all that healthy in a long time. Assuming that comes to pass, that would favor practices implementing cash-based wellness services alongside their insurance-based PT treatment services for dysfunction.  Due to the continued rise in deductibles and decreasing overall medical coverage for PT services, more patients will be opting into paying cash for their PT visits in 2025. The percentage of ash-based services will increase as a source of revenue in the payor mix of most practices across the US, despite location, as patients demand more value for their money and get more comfortable paying cash versus using their insurance to gain an overall improved patient experience.

Other predictions beyond the administration: 

2. The PT shortage will continue to grow as more clinicians opt out of direct patient care and the pipeline of new PTs continues to shrink. 

The growth of digital healthcare companies (and EMRs) looking for subject matter expertise has provided an avenue for clinicians to jump into the world of technology as product managers, sales associates, and success managers. Let’s face it: a PT's relationship-building and problem-solving skills can be directly transferable to building software.  I should know; after jumping the patient care ship 15 years ago, I have now equalized my time as a clinician and non-clinical PT. (Wow, I am getting old!) 

We also can’t forget the student debt issue, which continues to plague our profession. New grads are seeking to extinguish their financial obligations as fast as possible, and now there are varying opportunities that allow them to use their clinical knowledge to have an impact while also allowing for more work-life balance and schedule flexibility.  Practice employers will in turn need to get even more creative with the compensation packages, which will include more variable compensation based on patient loads.  Those providers who are willing to see the patients will be paid more than those looking for non-clinical roles in the practice. And with the rise of cash pay services, look for clinicians to increase their take-home pay through a percentage given per visit versus a flat rate per visit or a salary wage.

More new grads will opt for travel contracts.

Those new grads who want to stay in patient care will be heavily enticed by traveling PT companies. As we’ve seen in recent years, the Millennials and Gen Z’ers value different things than previous generations; they’re not driven solely by money and security but rather put high value on things like culture and new experiences. That’s why I believe we’ll see an increase in new (or new-ish) grads opting to take travel PT contracts in the next few years. With the shortage of PTs, contract therapists will be in higher demand. Travel PT organizations are appealing with the freedom to travel for a year or more to see the country and explore options of places to eventually settle down, all the while knocking down the student debt due to earning higher wages.  And given all the talk around burnout and overwork, there’s certainly an appeal to taking on roles with an end date. 

3. AI in healthcare will continue to expand but experience some growing pains.

It’d be hard not to notice the explosion of AI we’ve seen everywhere, including healthcare, over the last year. And it makes a lot of sense: AI is the hottest trend in just about every industry, and as I’ve laid out in an article I wrote about AI’s place in rehab therapy, I truly believe it has an incredibly important role to play in helping to address some of the efficiency challenges we’ve dealt with for years. 

That said, I do worry that the prevalence of AI everywhere could create a bit of fatigue among both consumers and workers—healthcare providers included—about AI, at least temporarily. This article from Neil Sahota lays out some of the root causes for the fatigue that I believe we’ll see start to grow in 2025:

Constant technological change is stressful. It’s hard enough to keep up with even the gradual adoption of new technology—and AI has grown exponentially in the short time it’s been in the public consciousness. It’s mind-boggling to try and keep up with the latest developments in AI—particularly if you feel like you might be falling behind others in your field.  

Most people don't fully understand what AI does. Everyone’s heard of AI at this point, but there’s still a large number of people who don’t fully understand what AI does, which leads to a bit of apprehension about what it could do. In the case of rehab therapy, I've heard comments from some worried that insurance companies will use AI to, if not get rid of PTs entirely, undercut our work and our payments. There is definitely some truth in all of that, but not in the very near future (at least the PT replacement part.) Fear of the unknown is real and slows adoption.

Many of those who do understand AI have unrealistic expectations. The next group is those who do have a better understanding of AI but have still allowed themselves to get carried away with the hype of AI as an instantaneous game-changer for everything. When AI turns out not to do the miraculous things they expect or more accurately, harder to implement to access the benefits, they end up disenchanted.  

I don’t think that AI is going anywhere anytime soon, but I do believe that in 2025, there will be a more tepid adoption curve as we streamline the best ways to leverage the potential efficiencies and workflow changes needed to maximize the benefits. I think we will also see more attention paid to the SLM (or small language model) vs LLM (large language model) for a niche market like PT in order to fine tune the machine learning needed in solving more specific tasks. WebPT will play a major role in these advancements moving forward.

4. Medical advances will change the role of PT in the recovery process.

Medical science is making big leaps forward that are changing how MSK conditions are treated, and that could have a major impact on how we as rehab therapists approach our work with patients. 

Regenerative medicine could be a game-changer in accelerating the natural healing process and reducing recovery time. Specifically for rehab therapy, treatments using stem cells and platelet-rich plasma (PRP) could be used for conditions where physical therapy has proven ineffective to avoid surgery. As this article from HSS points out, PRP injections could reduce the need for opiates or anti-inflammatory medications. And this study from Abhishek Vaish and Raju Vaishya notes that stem cell therapy can “not only alleviate symptoms but also addresses the underlying pathology, offering more reliable and effective therapeutic solutions,” making it a promising potential treatment for MSK conditions, “including Osteoarthritis (OA), ligament injuries, tendon degeneration, and cartilage defects.” 

The more immediate impact that will be felt is the advances in both orthopedic and prosthetic technology that will significantly reduce the amount of recovery time—and PT—needed for patients post-surgery. Tools like augmented reality allow surgeons to view pre-operative imaging during a procedure without opening up a patient beyond what’s necessary, making for less invasive surgery. We’re also seeing a rise in the number of keyhole surgeries or robotic surgeries that are minimally invasive. The relatively new Jiffy Knee procedure for knee replacements emphasizes preserving muscles and tendons by using specialized tools to slide them aside during surgery rather than cutting through them, again accelerating recovery time; according to the Jiffy Knee website, 99% of patients are ready to start outpatient PT two days after surgery, and 50% have little to no pain within two weeks post-procedure.     

Medical advances are only going to make these procedures better and more efficient over time, reducing the volume of post-surgery patient visits needed per episode of care.

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So there you have it, that’s what I think will be in store for 2025. Huge shoutout to Larry Benz and his predictions article for 2025; I love our annual predictions dual and I definitely agree with many of his projections as well. And I’m always curious to hear what other people think, so if you’ve got some strong feelings about the trends you expect to happen in 2025 drop a line to copy@webpt.com.