Founder Letter: Pandemic Outlook: What the Data is Telling Us About the Future of Rehab Therapy

The novel coronavirus took all of us by surprise. And while everyone around the world has been impacted to varying degrees, the healthcare industry—and specifically, the rehab therapy community—has been uniquely challenged during this time. While some states recognized us as essential workers from the start, others made it impossible for us to provide continuity of care to our patients, especially because prior to this, telehealth wasn’t widely available for rehab therapists to leverage. While all healthcare providers were adapting to new safety protocols and personal protective equipment (PPE) requirements, rehab therapists were also left trying to implement a brand-new service delivery model on the fly—with clear-as-mud billing guidelines—and attempting to gain buy-in from patients who were understandably distracted by serious concerns about their safety, health, and finances (concerns that we, of course, share). It’s been rough, to put it lightly.

One of the things I do when things get chaotic is turn to the data. Data grounds me; it brings me back to reality and helps me focus on what I can do to respond to the current situation. After all, numbers—specifically, numbers that paint a picture about where we have been—can show us where we’re heading. And that makes it much easier for us to figure out the best path forward. While there are still so, so many unknowns, here are a few things we do know (based on data we’ve assessed from our EMR, which serves more than 85,000 rehab therapy professionals across the entire US):

1. Patients need—and want—our services.

For a long time, rehab therapists have struggled to adopt a value proposition that clearly communicates the benefits of our care to patients, payers, and providers in other disciplines. It’s one of the main reasons we’ve historically struggled with less-than-adequate payment for our services. But despite all that—and even in the midst of a global pandemic with so much economic uncertainty—patients are still seeking out our care. 

At the lowest point, 16% of WebPT clinics weren’t seeing any patients all. But since then, things have trended up (for the most part), indicating that we—as an industry—have the potential to restabilize. So, while we’re still seeing fewer patients overall—in July, total patient volume was down 27.6% compared to pre-pandemic levels, and the average daily number of patients per therapist was down to 7.6 (from 8.8 pre-pandemic)—things are still improving, and the ratio of initial evaluations to total patient visits on a national scale has been holding steady at 10% for a while now. This is actually slightly higher than what we were seeing pre-COVID (8.8%). 

We’re still attracting new patients.

This gives me hope that we’re still attracting new patients who are beginning new care episodes—while still managing a fairly steady number of existing patients. And this is despite the fact that recent outbreaks have caused yet another round of shutdowns and further postponed elective surgeries in some harder-hit states.

2. Telehealth is here to stay.

Prior to the current situation, therapists were mostly prohibited from providing and getting paid for telehealth services, but we’ve witnessed a major about-face in the past few months. Today, most rehab therapists are able to provide and bill telehealth for most health plan beneficiaries. Even Medicare has granted therapists telehealth privileges. While it's possible that we’ll see some of this coverage rolled back at the end of the emergency period, it actually seems more likely that this will continue in some capacity.

And even if payers don’t stay on board, therapists have already established the value proposition for these services with patients, which means there may be opportunities to continue providing telehealth treatment on a cash-pay basis. In addition to empowering therapists to provide crucial treatment to patients from a safe distance, telehealth opens the door to a hybrid care model in which patients can easily access their providers between in-clinic sessions. It also represents a really wonderful opportunity for therapists to diversify their revenue streams, reduce churn, and recoup missed or cancelled appointments.

While almost all of our users’ patient visits were performed in-person before the pandemic, by mid-April, nearly 7% of visits were conducted via telehealth. Providers in some of the hardest-hit regions—like New York—were performing more telehealth sessions than in-person ones, with telehealth making up as much as 60% of total visits for some providers. From there, though, as states began easing some of their lockdown restrictions, telehealth visits steadily declined again. Still, for all of the reasons mentioned above, I expect that telehealth will continue to play an important role for therapists throughout the next decade and beyond—and rightly so. In order to ensure that happens given our industry’s unique practice care models, I encourage involvement with groups like The Alliance for Connected Care. A proactive approach to getting our voices heard early in the process will help us avoid a scenario in which we’re fighting tooth and nail to gain inclusion later on.

3. There may be more opportunities for mergers and acquisitions—as well as room to open up independent practices.

One of the biggest unknowns is whether the practices that suffered—and continue to suffer—the most are going to be able to recover enough to continue. In some cases, I believe the damage done may be too great. Remember the 16% of clinics who likely closed their doors—at least temporarily? It might be tough for those practices to bounce back, but it doesn’t necessarily mean they are out of the game just yet. After all, chaos often brings about clarity, and we may see our peers branching out, whether that means getting creative with their service offerings or rethinking what’s possible in a nontraditional merger or acquisition. 

We’ve yet to see where the pendulum will land.

Prior to COVID-19, the rehab industry was trending toward more consolidation. It’s not yet clear whether that trend will continue—or what it will look like if it does. We’ve already heard a lot of stories about practices entering into M&A deals that don’t require practice owners to take pennies for the practice, but instead give those owners the benefit of operational and/or payroll support until things get better. We’ve also seen a good number of providers who were let go from what seemed to be forever-stable corporate jobs heed the call to run their own businesses—on their own terms. While there likely aren’t too many folks opening new businesses just yet, I have a hunch that we’ll see a new wave of startup clinics when things truly stabilize. 

As WebPT CEO Nancy Ham shared on our last webinar, “It’s quite possible that the tumultuous nature of the past several months will increase individual providers’ desire for independence. After all, we just learned that the perceived security of working for a large organization may not be as sound as we thought.” In other words, if the entrepreneurial spirit is calling to you, now may be the time to explore that.

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4. Women may have a harder time recovering than men.

All signs looked promising that the industry—and the country—would stabilize this summer. But the dramatic rise in cases across numerous states put the brakes on things. We haven’t seen total visit numbers increase nearly as much as we would like—and the fact that elective surgeries in many states have been paused again means that it’s going to take the industry even longer than expected to recover. (For context, back in May, Definitive Healthcare estimated that it would take about seven months of working at full capacity to catch up on elective surgeries.)

Factor in prolonged school and daycare closures and stay-at-home orders, and it seems likely that women—many of whom are mothers and primary care givers—in the rehab industry will be disproportionately affected. This is especially important to consider because, as of 2018, women made up 68.5% of the US PT workforce. That means the entire rehab therapy industry may have taken a bigger blow than other medical professions with a more male-dominated workforce.

Within WebPT, we saw the average distinct weekly users drop to about 69% of pre-pandemic levels at the lowest point, demonstrating what we already knew: a lot of therapy professionals were laid off or furloughed during this time. But, these numbers are beginning to come back, which is promising. At the end of June, we were back to about 88%. 

5. We must advocate for the future we want.

It is abundantly clear that we, as an industry, must improve our advocacy efforts in order to achieve increased autonomy in care delivery (i.e., permanent access to telehealth treatment and payment privileges) and improved business preparedness training—before another crisis hits. It’s also still on us to once-and-for-all shut down Medicare’s looming 8% payment cut. Otherwise, we’ll be staring down a severe pay reduction on the heels of the current financial crisis—and that might finally be too much to bear. Consider this hypothetical: 

Let’s say your practice’s total revenue pre-pandemic was $100,000—and patient volume continues to be depressed next year. So, in 2021, if you’re seeing only 70% of the patients you once were—then your revenue would be down to $70,000. If half of those patients are Medicare beneficiaries, then you could see an additional 8% cut to half of that revenue, which leaves you with $67,200. While 8% might not seem like a lot, keep in mind that profit margins are already slim—and this is immediately following a very hard year. Most practices are going to need all the revenue they can get over the next several years to mitigate the damage that was done in 2020. 

To reverse this decision and prevent the cut from going into effect: 

• Contact Congress.
• Send a letter to your representatives.
• Reach out and collaborate with other providers.
• Encourage your patients to reach out to their representatives.
• Use social media to comment to CMS Administrator Seema Verma and your legislators.
• Support the Outpatient Therapy Modernization and Stabilization Act (H.R. 7154).

While we still have a long way to go before all rehab therapists are operating at capacity, I’m ultimately hopeful that we’ll be in a better position on the other side of this crisis—as long as we remember the lessons that have been offered to us. Where do you see the future of rehab therapy heading? I’d love to hear your predictions in the comment section below.