Founder Letter: It’s Time to Take Charge of Our Future (as Told at the 2025 Graham Sessions)
This moment in rehab therapy calls for solutions as much as conversation, along with a bigger tent.
WebPT Co-founder and Chief Clinical Officer Dr. Heidi Jannenga shares her takeaways from the 2025 Graham Sessions, including how PT can start looking for solutions.
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Although there was snow on the ground and 30-degree temperatures in Colorado Springs for this year’s Graham Sessions, hot topics and passionate “What I Believe” speeches kept everyone warm and engaged with the on-point industry themes—as did an enlightening discussion with industry legend Stanley Paris. There were many recycled topics, from declining insurance payments and our “broken education system” to professional advocacy and the lost art of manual therapy, since those issues are still plaguing our industry. But there was also new ground covered, from AI and its growing effect on how PTs practice to the evolution of the Graham Sessions meeting itself.
Speaking of the sessions, there were lots of mixed emotions throughout the two days of engaging conversations and debate—including joy, excitement, appreciation, and a little sadness—as Steve Anderson stepped down from his role as chief moderator. Steve passed the torch of leadership on to Sharon Dunn, PT, PhD and Keaton Ray, PT, DPT, OCS, the organizers who will lead the Graham Sessions into a new era. For those unfamiliar with the history, Steve Anderson, PT, Drew Bossen, PT, MBA, and Patrick Graham, PT, MBA, founded the Graham Sessions in 2007 when they realized that they needed an outlet for deeper conversation and idea sharing. They also wanted the opportunity to be controversial and disruptive, yet constructive and respectful without ruffling the feathers of protocol and formality found in the APTA House of Delegates—the only PT gathering of its kind at the time.
Since then, the annual GS conference has grown in notoriety, and while the Private Practice Section now funds it, it remains true to its founding charter in bringing the most important issues and topics in our industry to the table for discussion and debate. In the past, it's been emphasized that solutions to those issues weren’t the ultimate goal but rather the frank discourse of getting to the root causes of problems. However, having been to the Grahams for eight years now, I did sense a slight shift in the dialogue this year as the issues at hand have not fundamentally changed much over the years, and frankly, many have gotten worse—like payment, for example.
Don’t get me wrong; the discussions and presentations were provocative and noteworthy, but the “at the mic” discussion was less inquisitive and more sharing of solutions rooted in experiences that have worked for individuals from different settings and varying practice sizes across the country, which I found refreshing. The discourse at lunch and at the WebPT/ PT PAC happy hour was more about sharing what's working and not working as previously used methods had to change. I’d summarize this year’s meeting with what stuck in my mind and seemed to resonate with many others as well: “We know what the f-in’ problems are, and here’s what we are doing about it!”
Advocacy for increased payment IS advocacy for increased access to care.
The conference kicked off with a reminder for us all that, as PTs, we ARE the movement specialists, MSK experts, and high-value providers who can save healthcare costs. Unfortunately, our actions don’t match those beliefs when we accept low insurance payment contracts, shrink in the face of other providers’ challenges to our practice acts, or don’t fully advocate for ourselves with patients. A robust discussion on payer negotiation ensued, including these top tips:
- Never be done after asking once. “No” means “not right now” and is just an invitation to come back with different data and perhaps with some colleagues experiencing similar difficulties under the same contract agreement for payment.
- Never complain in meetings. Instead, come armed with solutions based on facts and data, such as network adequacy (#PTs/ area of population), average visits per plan of care, patient outcomes, and, of course, testimonials.
- Just like advocating on Capitol Hill, there can be power in numbers. While being vigilant about not violating collusion laws that prohibit competitors from working together to illegally restrict trade, PTs can still hold town halls to discuss patient value offered by PTs, what it costs to run a PT practice, and what payors are paying for PT services. Public relations can be another route to get the attention of patients and, in turn, payors.
If we want to shift the tide back in our favor, we’ve got to start doing some things that might make us uncomfortable.
Visits per episode of care are down for cash-pay patient visits.
As insurance payments have continued to decline, there has been a big movement toward providing cash-based services. We gripe about the decreasing number of visits that are allowed with insurance authorization for plans of care for our patients, and yet, data is showing that with cash-paying patients, not only are the number of visits per episode of care down, but the number of CPT codes charged per visits are down too. So what gives? Assuming the patient diagnosis is the same, are PTs just better at getting patients better when cash money is exchanged for services? Conversely, there was discussion about the decreased sentiment of our value as PTs and that we are afraid to charge too much or bill for everything we do because the patient might not want to pay. We must understand the economics of our businesses and believe that profit is more than just ok, it's good. I have been a staunch believer in conscious capitalism, in which there is a fundamental understanding that “profit can be used as a power for good,” and it was great to hear the dialogue move in this important direction. Profit allows us to grow and provide improved benefits for our employees- when clinics are successful, everyone wins—including the patients.
The front office has a role in advocacy.
Too often we get mired in the clinical aspects of all the things that therapists can do to not only advocate for our value but produce the best outcomes and provide the best patient experience. But running a PT practice is a team sport, and some of the key players are those who never put their hands on the patient: the front office and billers. As one speaker put it, “It is a form of advocacy to go through an appeal process and all of the efforts it takes to get the payments in. It becomes meaningful work when you know and can see how that money translates into running the business.” I learned that only 10% of denials are ever appealed - that seems appalling, especially when 50% are overturned with an appeal. As this article from the AMA lays out, 83 percent of Medicare Advantage prior auth denials are partially or fully overturned on appeal, which suggests that the claims are being denied simply because insurance companies know most providers don't have the stomach to fight it.
It’s tough for a single practice—especially a small one—to get concessions from payers. But it’s not just payers that we must build relationships with; key lawmakers in your state can be allies in helping to make changes to the practice act or help to reign in insurance companies—provided that they understand the importance and value you add to their constituency. That’s where groups like the APTA, both at the national level and state chapters, can be invaluable; you might not have time to reach out yourself every time, but by adding your support, the association leadership has that much more leverage for those conversations.
With a new administration in office, it's time for us to lean in hard on being proactive instead of reactive. We have an opportunity right now to double down on our ability as providers to drive long-term healthcare cost savings by reducing the need for surgery and other costlier treatment approaches. In today’s changing healthcare environment, we must take advantage of the uncertainty as an opportunity for disruption. This can only be done through organization, collaboration, and a united front as a profession on our priorities and what we can all get behind.
AI continues to make massive inroads into PT.
It wouldn’t be a conference in 2025 without at least some discussion of AI. Just like every other industry, AI has taken the PT industry by storm with the promise of improved efficiency and decreasing administrative burden. In the not-so-distant past, healthcare in general, including PT, has not been quick to adopt new technology. So it was surprising but refreshing to see a majority of hands go up in the room with the question about who has tried ChatGPT or Gemini. However, I did have some significant security concerns with some of the examples shared of how readily clinics were willing to share their data, including patient data, into large language models. Largely, though, people see AI now as what it’s meant to be, which is an assistant to handle the unpleasant chores of writing a note, finding the right code, reviewing charts, or finding the right words to use in writing an email or two.
So, what do PTs hope the future of AI looks like? There’s interest in AI being able to take on mundane, tedious, and repetitive tasks, like verifying patient benefits, handling prior authorization, or creating summaries of treatment to provide to patients. To continue on its current path of growth, AI must start to be even more useful to the PT in recognizing the patient better to predict outcomes, set goals, and optimize utilization of visits. Above all, it must remain affordable and connect to the EMR. Technology fatigue is real, and selection is now based mainly on price, alignment with decision-makers' values, and “doing what it says it's going to do.”
The evolution of AI in PT has the potential for some major disruption, but the one differentiator that we have as PTs—which, in my opinion, must remain a priority—is our willingness to put our hands on patients. Post-pandemic, manual therapy has taken a back seat to technology. With the changing landscape of healthcare, we may be one of the last providers who can boast the more intimate, hands-on approach that connects us as humans. I hope that our “secret sauce” does not get forgotten in this movement toward more technology utilization.
We have to keep evolving.
There was agreement in the room that our PT education system is not functioning optimally to meet the needs of the industry. The cost has become prohibitive and has lacked the continuous quality improvement needed to keep up with the changing healthcare landscape. There are things we have done well, like gaining more autonomy in practice, completing research to show the efficacy of our skills, and the renewed interest in pushing to be the primary care providers to MSK. However, with the eye-popping statistics of burnout and therapists leaving the profession, we may have lost sight of the characteristics that make a great physical therapist.
Culture and personality matter when choosing a candidate. Our PT program institutions must not let AI and other superfluous screening tactics supersede the importance of the interview process or the essay component during the selection process to enter a PT program. The “People First” mentality that we talk about as we develop the culture of our practices or clinical sites must be reflected in the academic selection process of our future PTs, as well as making sure we don’t allow our PT program instructors to lose sight of what’s current in patient care and the business aspects of the PT industry. A strong reminder was given that rules are necessary and in place for reasons, and we must abide by them—but we also have the ability to change the rules that no longer serve us. We can’t remain complacent and be afraid to do that. We must continue to evolve as healthcare and the needs of our patients change.
What’s next for the Graham Sessions?
With the changing of the GS guard, it was perfect timing to discuss the future of Graham Sessions and what it should look like going forward. I would argue that there is tremendous benefit from having a think tank-style industry event in which invitees can freely discuss, poke holes in, and offer up off-the-wall ideas or solutions to our industry's biggest problems.
A number of speakers cited the many ideas that were heard at previous GS meetings that were subsequently taken and implemented either as new business opportunities or within PT organizations for the betterment of their businesses. However, the critical issue remains that with so many specialties and areas of interest in our profession, we must narrow the field of critical issues plaguing the entire profession, not just those that affect private practice. We can benefit from this space to collectively come together for tough, honest conversations with a diverse set of people in the room (entrepreneurs, academics, PTAs, practice owners, researchers, and clinicians with varying levels of experience) who could provide input for the potential solutions to our industry’s biggest problems.
What I have admired about Steve’s leadership for all these years is the level of decorum and respect that was maintained even through emotional, heated debates. Unfortunately, we have gotten too territorial and gone away from our ability to challenge each other and walk away as friends and colleagues. “A painfully divided America can return to civil discourse only if people on all sides of the civic divide make themselves vulnerable to being challenged on their convictions, adopt the humility that they might be wrong, and respect the humanity of those who disagree with them,” was the message that scholars Cornel West, PhD, and Robert George, JD, DPhil, delivered to more than 4,200 medical professionals gathered at the American Association of Medical Colleges in 2022.
Thart quote rings true today and louder than ever in our society, and I believe that the Graham Sessions has allowed us to have a safe space for this type of banter to happen. However, as was painfully pointed out, the room in which the discussions are happening must be inclusive and represent a diverse set of people and ideas, not an echo chamber in which the same people attend each year to hear themselves speak. It’s a tough task, and there is merit in making sure decision-makers and other influential industry professionals who can make a difference are present. That said, there must also be room for new voices, contrarians, and historians to take part in order to gain a full 360-degree view of the topics at hand. We are in great hands with Sharon and Keaton taking the baton, and I look forward to the 2026 Graham Sessions. I hope to meet you there!
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