Founder Letter: More Than Recovery: 6 Ways for Rehab Therapists to Reboot in 2021

We made it, folks! We finally closed out 2020, and it’s time to open a brand-new chapter in 2021. I’m not going to spend much time talking about how difficult this past year was for our country and our profession. Instead, I want to look forward to the future—because even though 2020 was fraught with personal and professional challenges for us all, I believe it taught us some invaluable lessons. And as we focus on recovering from this tumultuous year, we need to tap all of the wisdom we’ve gained. So with that, here are six ways that we can recover, reboot, and prosper in 2021. 

1. Diversify your revenue streams. 

For years, business and investment leaders have touted the importance of revenue diversification, saying that it’s an excellent way to safeguard a business’s financial health. The events of 2020 proved those leaders correct. When stay-at-home orders ramped up and elective surgeries were put on hold, clinics that relied heavily on one type of revenue (e.g., from post-op rehab services) saw their cash flow dry up almost instantly. But clinics that had established different service lines (like mobile PT or telehealth) had other sources of income to keep them afloat. 

Shaking Up Your Caseload

But beyond safeguarding your bottom line during difficult financial times, diversifying your revenue (e.g., by offering wellness or sports-specific programs) can help you acquire more and different types of patients—thus expanding your reach to a more diverse population. This opens  doors to be more creative with patient acquisition. Instead of relying on referring physicians to get patients through your door, for example, you could attend sports conventions to attract athletes—or host gentle yoga classes for postpartum mothers. Plus, many alternative revenue streams are cash-based—and thus, are not beholden to insurance changes and constraints.

Tapping into New Markets

When we take the initiative to seek new patients who have unique therapeutic needs, we have the opportunity to enter untapped patient markets. And remember, there’s an enormous untapped market just waiting to be breached: 90% of patients who could benefit from seeing a physical therapist never do. If we can find ways to reach new patients, it will help us establish our value at the population level—potentially enabling us to reach underserved patients who could seriously benefit from the services we provide.

Improving Population Health

Tapping into underserved markets—and reaching a wider swathe of patients—in turn enables us to more effectively impact health at the population level. According to this data from The Commonwealth Fund, the US, when compared to 10 other high-income countries, “has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average.” Furthermore, the US has the lowest life expectancy, and we see 50% more hospitalizations due to hypertension and diabetes. 

Additionally, we are currently in front of a major opportunity with recovering COVID-19 patients—especially those with long-haul COVID-19. Most patients who have the virus recover within 10 days to two weeks. But, there are some people who continue to exhibit symptoms for more than four weeks—sometimes for months—and develop more severe illnesses such as strokes, lung function abnormalities, or kidney dysfunction.

Physical Therapists and Occupational Therapists are perfectly positioned to help mitigate all of these ailments. We can help people learn how to move without pain and how to safely strengthen their bodies. Doing this at scale will help us establish rehab therapy as a huge asset in preparing our nation for future pandemics or health crises. After all, healthier populations typically aren’t hit as hard by diseases or viruses. 

2. Rework clinic operations. 

Last year, businesses across the country were forced to reinvent themselves practically overnight to meet the new demands of a virus-laden world. That rapid rate of change was a burden on clinics and businesses in general—but the widespread drive to innovate and adapt radically changed some aspects of our industry, and it reminded us that change isn’t always a bad thing. In fact, many clinics could speed up their recovery efforts by leaning into these new operational strategies and structures to increase efficiency and reduce overhead.

Modifying Scheduling Practices

For rehab therapists, gaining the opportunity to provide telehealth services was one of 2020’s greatest silver linings. Patients and therapists enjoyed having the option to provide or attend remote appointments, clinics reduced overhead, and patient outcomes were largely unaffected by this change in appointment medium. Going forward, therapists can continue modifying their clinic schedules to incorporate previously underleveraged services—like telehealth or mobile visits. These services offer unique value to patients—and they empower teams to conduct more appointments with less physical clinic space. 

On that note, I’d like to mention that if we intend to adopt this hybrid model of care and make it the future standard of PT—as I truly believe we should—then we’ll need to adjust PT school curriculum. If we want new grads to provide excellent remote care out the gate, then they will need introductory coursework on the technology they may use as well as an overview of virtual appointment best practices, including appropriate treatment plans, communication challenges, and basic tech support skills. 

Introducing Alternative Employee Compensation Models

There are other, less common ways to revamp operations and strengthen business performance and recovery. Consider alternative employee compensation models. These payment models take a step away from the traditional salary or hourly wage and instead offer dynamic pay options to employees, essentially allowing therapists to earn compensation based on the value they deliver. Adopting these compensation models can reduce overall labor costs. But more importantly, they often draw team buy-in and encourage collaboration. 

One of the most common alternative compensation models used in the rehab therapy industry is a fixed-pay, performance-based hybrid plan. As explained in this blog post, this plan “generates a therapist’s total salary from two buckets—base pay and performance-based pay.” This provides security for the therapist, while allowing the employee to earn more for doing truly stellar work. 

Another common alternative compensation model is a revenue-sharing plan. With these plans, therapists are “paid a percentage of the expected revenue from that therapist’s monthly billing.” This plan ropes therapists into the business side of things, encouraging them to support the overall success of the practice. 

Auditing Your Tech

Another area of clinic operations that could use some attention in 2021 is software, systems, and services. While there are many wonderful pieces of technology and equipment that aim to help rehab therapists, not all tech is created equal, and some give you a bigger bang for your buck than others. Many clinics can improve efficiency by scouring the market for the best solution for their clinic and then—once that solution is in place—ensuring that they’re using each tool to the fullest potential.

Part of this process involves auditing your tech stack for redundancies and inefficiencies. For example, if you’re using an unintegrated EMR and billing software, then your clinic could be spending too much time on double-data entry, and data may not always match between the two systems. This is where combining forces and finding an end-to-end integrated solution will save you time and ultimately, benefit your bottom line. 

3. Revamp your business strategy. 

Now is an excellent time to revisit and potentially rethink your overall business strategy. Mergers and acquisitions did not slow down during the pandemic, and it may behoove clinic owners to consider their long-term goals. Do you want to continue running your clinic as a small business until you retire? Do you want to start a franchise? Do you want a large organization to buy your clinic? Do you want to find a business partner? 

Landing on an answer is crucial, because it will determine your trajectory in the coming years. 

Working with Investors

If you want to exit the PT industry and sell your clinic—or if you simply want to partner up with an investor—there’s a lot of opportunity right now, as many investors see this economic dip as the perfect time to snap up promising businesses. Some PTs are wary of the M&A trends occurring in the industry, but remember: you ultimately are in charge of your clinic and business. It’s important that you evaluate all your options (even ones you wouldn’t have considered a year ago) and make the right move for yourself and your practice. There is no single path to success; perhaps selling your business or partnering up is the right choice for you. 

Forging Your Own Path

That said, if small clinics feel comfortable forging their own path and remaining independent, there’s plenty of opportunity for that, too. Because the pandemic hit small businesses fast and hard, there’s been a renewed focus on shopping local. Small clinics can capitalize on that trend and ask patients to get PT from their hometown therapist rather than a corporate chain. 

Beyond that, I believe there’s a huge opportunity for small clinics to cooperate with their peers—specifically with their so-called competitors. I know that sounds like it came out of left field. But consider this: no one practice or provider can be everything to every patient. Your competitor may be able to provide value to your patients that your clinic cannot—and vice versa! Developing a mutually beneficial referral program may help you form relationships and connect with other practices in your area. This type of “co-operatition” can help us strengthen the entire PT community—and that’s a goal we should all share as we rebound from this crisis. 

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4. Make mental health a priority. 

One of the cornerstones of recovery in 2021 is an intentional focus on mental health. In any given year, roughly one in five US adults struggle with mental illness. That number has only risen since the COVID-19 outbreak, and one study reports that roughly 40% of US adults experienced adverse mental or behavioral health effects since the start of the pandemic. From a compassionate standpoint, we should endeavor to help those in our lives cope with—and ultimately address and master—their mental illness. And from a pragmatic standpoint, poor mental health can severely limit workplace performance.

Destigmatizing Mental Health

I know it can be tempting to throw PTO or wellness packages at employees in an effort to improve their mental health. And while these are kind gestures that are often very appreciated, clinic leaders will never be able to fully address their employees’ mental health concerns without a supportive culture. Mental health is still a deeply stigmatized topic, and mental health organizations have reported that people with mental illness are considered less promotable, receive lower wages, and “have less access to quality jobs.” 

The best way to chip away at the stigma is to foster a culture of mutual respect. As we wrote in this blog post, “If [employees] trust you and feel supported by you—if they respect you and feel respected in return—they’ll feel less vulnerable when opening up about these topics. If you normalize conversations about mental health and sustain judgement, that will help foster open, honest communication.”

Implementing a Plan

If employees come forward and express that they’re struggling with their mental health—you’re on the right track. That means you’ve created a culture that values honesty and open communication. But the buck doesn’t stop there, because without an actionable plan, leaders won’t be equipped to help their employees improve workplace mental health. I suggest creating an organization-wide template for a customizable mental health plan. Then, individual leaders and employees can collaborate when needed to find solutions that will help struggling employees work on their mental health and (if necessary) get back on track at work. 

Taking Care of Yourself

Your employees aren’t the only people who may be suffering from poor mental health. If you’ve noticed yourself growing more listless, burned out, detached, or negative, it may be time to evaluate your own mental state. Try focusing on the things in life that recharge you. If you love spending evenings with your family (or if you treasure drinking your morning coffee in quiet solitude), then block out time to do those things. If you feel burned out at work, take a break if you can. The work will be there tomorrow—but you need to take care of yourself so you’re in a good enough state to complete it.

Don’t try to push through tasks that drain you; instead, reinvent the task so it’s neutral—or maybe even enjoyable. (For example, if you’re suffering from Zoom fatigue, try scheduling telephone meetings and walking around the block while you’re on the call.) 

And above all, if you need professional help—seek it. There is no shame in speaking regularly with a therapist; unpacking your emotions, frustrations, and exhaustion is deeply important. 

5. Increase diversity across the PT profession. 

We are better for all our differences. When we interact with people who’ve had different life experiences and who hold different perspectives about the world, it gives us an opportunity to learn, grow, and ultimately become sharper, more compassionate people. This is especially valuable in a professional setting, as cognitive diversity helps teams solve existing problems more efficiently and spot potential problems before they arise. 

That said, our profession is far from diverse. In fact, according to the 2019 State of Rehab Therapy report, nearly 80% of rehab professionals are white and, while nearly 70% are women, men still hold the majority of C-level roles. In other words, we’re missing many different perspectives in leadership positions—and across the industry at large. 

Challenging the Status Quo

In order to increase diversity in the PT profession, we must be willing to look critically at our own clinics and acknowledge when we’re not doing enough to eliminate bias during the hiring process. We’re all subject to implicit biases, or “the shortcuts that our individual brains use to filter, sort, and store the information that we collect every day. Unfortunately, these shortcuts use intuition and generalization instead of objectivity, which means our biases often point us in the wrong direction.”

While we can’t eliminate our biases completely, we can learn to identify them and work against them when they do crop up. This is where formal diversity, equity, and inclusion training could seriously benefit your organization. 

Broadening PT Student Recruitment

Now, I don’t want to cast blame on clinics for not hiring a diverse workforce, because the reality is that the PT candidate pool is almost as homogenous as the industry. I believe we have an opportunity here to look critically at student recruitment and admissions practices in an effort to fuel diversity. Perhaps we’re not putting as much effort toward recruiting in traditionally non-white localities. Maybe PT admissions requirements ask for too many extracurricular activities, barring low-income students from entering the program at all. In any case, there’s a lot of work to be done. 

6. Ramp up your advocacy efforts. 

In order to successfully recover and reboot for the rest of this year, PTs, OTs, and SLPs must go all-in on advocacy. The 9% cuts—now approximately 3.6%—served as a huge wakeup call. We cannot be complacent and assume that our reimbursements (and overall financial health) are safe. Instead, we must be proactive and petition on behalf of ourselves and our peers. 

We know that advocacy works; we saw a couple significant victories in 2020. We secured telehealth privileges (even if it was only temporary) and therapy assistants were given permission to permanently provide maintenance therapy. So, we know that we can win—but we have to dedicate more resources to advocacy and get better at organizing, focusing, and unifying our efforts.

We’ve only just embarked on the road to recovery, and we have a long way to go before we overcome all of the problems posed by COVID-19. However, I believe we’re about to enter an era of change, and if we’re willing to capitalize on it, we can emerge better, stronger, and more prepared for future crises. Are you ready to adapt for the future?