Founder Letter: How COVID-19 Has Changed Physical Therapy Forever

There is no question that the current global situation is going to leave a mark. Regardless of how you feel about the pandemic—and the regulations being implemented to address it—the past three months have changed us. To what end? It’s not yet clear, but the one thing I do know is that we have a choice in how we approach this new phase—as individuals, as practice owners, and as a professional community. Sure, I have my thoughts on how we can set ourselves up for success in the months and years to come—business acumen and access to capital are two things that come to mind—but I also have more than a few unanswered questions about the shape our industry will take on the other side of this.

That’s why I thought I’d use my monthly letter to this community to open the floor for discussion on some of the things I’ve been reflecting on. I’d love to hear your thoughts on these topics—as well as any others that you’d like to add to the mix—in the comment section at the end of this article. While we might not be able to solve any of the challenges discussed today, open dialogue can help generate momentum, and that’s exactly what we need right now.

Things are trending up—but is it enough?

I’m a big proponent of data. Anecdotes and stories have their rightful place, but data is so, so important—which is why my team has been actively analyzing data from our more than 80,000 Members to shed light on trends around new initial evaluations, patient visits, and appointment cancellations. What we found won’t surprise anyone: almost all rehab therapists experienced a massive patient drop-off in mid-March, but in the last several weeks, things have begun to trend up again. This implies that the industry is rebounding, but at what rate and to where?

As of mid-May, 29 states were in the process of relaxing restrictions on elective surgeries, and we expect this will translate into more physical therapy referrals and more overall visits. In fact, in a recent webinar Definitive Healthcare shared data illuminating a significant pent-up demand for elective surgeries in some of the country’s largest metro areas, including New York City, Phoenix, Los Angeles, Dallas, and Atlanta.

Additionally, cancellation rates hit a new low since this crisis began (17.8%), and the ratio of initial evaluations to total visits is now holding steady at around 10%, signaling that new patient volume is on the rise. As of late May, the national average for daily patients seen per therapist was 6.6. For reference, this number was 8.8 in January, prior to the pandemic.

That said, at one point, 30% of our Members weren’t seeing any patients at all, and those apparent clinic closures were mostly small businesses. Will the bounce-back be big enough to allow them to recover—or is the damage already too great? Even before the pandemic unfolded, the rehab industry had been skewing toward more consolidation as larger corporations absorbed smaller ones. Now what? Will there be even greater incentive for small private practices to sell, given the financial toll of COVID-19?

Will consolidation or independence prevail?

Or, will government incentives for entrepreneurs—something we expect to see as the economy recovers—be enough to keep solo practitioners in business? Will a renewed desire for independence and self-sustainability be enough to motivate employees who were laid off or furloughed from large companies to leave corporate PT for good and strike out on their own (or with a partner)? Could this actually be the pendulum swinging back from consolidation toward the resurgence of independent practices? Time will tell, and we will undoubtedly know more about consumer sentiment and spending confidence when the initial government stimulus package and Medicare uplift runs out—and when the federal unemployment supplements expire.

Difficult situations often bring clarity, which means many providers may be itching to make a move that will allow them to serve who they want to serve—and treat how they want to treat—for the remainder of their careers. Others may have to make difficult choices about where to go from here if they have been forced to permanently close their practice in the wake of the pandemic. In essence, the status quo isn’t the status quo anymore, which naturally brings about instability—and change. Are you facing a fork in the road? You’re not alone, and it’s worth spending some time right now to get clear on what you believe will be the best next move for you.

What does a successful business model look like now?

States are beginning to open again, but many patients—especially those who may be higher-risk—may not want to come back to the clinic for a while longer. While telehealth is an extremely promising alternative method of care delivery—especially now—and a true game-changer for the industry, it cannot (and will not) ever replace hands-on care. So, some amalgamation of the two is necessary. Plus, most of the regulations that permit rehab therapists to perform—and bill—for these services are set to expire at the end of the public health emergency. So, what are rehab therapists to do? As I explained here, patients and providers alike will greatly benefit from having the permanent ability to provide remote services as necessary—ideally weaving telehealth into a patient’s care journey in conjunction with in-person visits so as to provide optimal value.

But getting to that place will require a shift in how we view care delivery and structure our businesses, processes, and marketing efforts. After all, we’ve historically leaned heavily on our identity as hands-on providers. Our hands are our tools. So, how do we now convince patients that we have value to offer behind a screen, too? Furthermore, how do we ensure we’re actually providing that value in practice? Of course, all of this is rather moot if we don’t successfully advocate for these telehealth expansion rules to extend beyond the shutdown.

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Can we make telehealth permanent?

To that end, the APTA, WebPT, and others are currently advocating for passage of the CONNECT for Health Act, legislation that would “ease restrictions on telehealth coverage under the Medicare program.” I would encourage every PT reading this to support this effort—and to enlist your patients to do the same. While this is only one step toward securing permanent telehealth privileges at the federal level, it’s a big one—and we absolutely must strike while the iron is hot (i.e., now, while the importance of telehealth is getting global attention).

Can we get ahead of the looming pay cuts?

Speaking of advocacy, I’d be remiss not to mention that now is also the time to sound the alarms regarding the pending 8% Medicare payment cut. Unless we band together with other impacted providers to repeal this, come 2021, we’ll all face yet another major financial blow—one we may never truly recover from. Most of you know me as an eternal optimist, but I believe that this cut—on top of everything else we’re facing right now—could very well cripple the profession. And that would be absolutely devastating for providers and patients alike. So, what can you do?

• Contact Congress.
• Send a letter to your representatives (here’s a free template).
• Encourage your patients to reach out to their representatives.
• Use social media to comment to CMS Administrator Seema Verma and your legislators.

We must make our collective voice heard—and we must do so now.

Are additional safety measures necessary?

Pre-pandemic, rehab therapists operated in close proximity to their patients—and their colleagues. We are a hands-on profession, after all. But how will nearly three months of “social distancing” impact our willingness to get close and personal with patients again? How will our patients—even those who are not considered high-risk—feel about being in the clinic? How do we handle the fear that will naturally linger?

For everyone’s peace of mind, additional emphasis on safety practices, hands-free intakes, and touchless payment processing may be a necessary part of doing business—and a necessary component of your patient communications. Then again, best practices for this next phase will likely vary greatly depending on the population you serve as well as where you practice. Your state may have specific guidelines for resuming operations, and the industry may very well establish its own guidelines for things like masks and personal protective equipment (PPE). Even if they aren’t established for you, though, practice leaders must make these decisions for themselves. What will you choose? What measures will you implement for your employees and patients?

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There’s a lot up in the air right now—and a lot to process about the current situation and what it means for the future. And that’s on top of taking time to grieve for all that has transpired. My hope is that by starting a dialogue on what is to come, we can move forward together—we can actively shape a version of tomorrow that is supportive of our profession, our teams, and our patients. How do you think the current situation has impacted rehab therapy? Tell me your perspective in the comments below.