Real Talk: The Downside of Providing Wellness Services in Rehab Therapy

I’ll never forget my first car. I was 17, and I’d spent months saving up funds from my summer job. On the day of the big purchase, my mom insisted on accompanying me. I realize now that she had a hidden motive—props to my mom for her acting skills. I’d had my heart set on a sporty, black convertible with a manual transmission and more horsepower than I could handle. In fact, I was so set on the convertible that I hadn’t considered test-driving anything else. Before I signed on the dotted line, my mom off-handedly commented on a mid-sized SUV with four-wheel drive. (You could say it was built “like a rock.”) Long story short, I drove off the lot that day with the SUV. And when winter hit the upper Midwest that year, I had zero regrets about my decision. Between hitting patches of black ice and trekking to school on unplowed roads, I don’t think I would’ve made it through the winter in one piece without that SUV—and I doubt I could say the same about a sporty convertible. The day I bought that SUV, I also drove away with this life lesson: always weigh your options before making a major decision.

You might be wondering what this has to do with adding wellness services to your therapy practice. Well, you should never make a major financial decision—whether it’s purchasing a car or adding new ancillary services to your practice’s offerings—on impulse, and it’s always important to carefully consider your options. With that in mind, I examined the potential downside to offering wellness services in a physical therapy setting.

Therapists are healthcare providers, not technicians.

We’ve talked a lot about the perks of adding wellness services to your practice’s repertoire. Because of this, we know that cash-based services can be a great way to ensure steady revenue flow and increase patient engagement. But some folks argue that wellness services might be contributing to the physical therapy branding problem. In fact, during this year’s Graham Sessions, one attendee argued that when PTs provide wellness services, they are actually devaluing physical therapy as a profession, because they are straying away from therapists’ primary objective: restoring physical function. That got me thinking, are ancillary services partially responsible for the PT devaluation epidemic?

This argument could have some merit. All physical therapists have obtained at least a bachelor's degree, and a significant number have gone on to earn a master’s or doctorate—a number that will continue to grow. As educated healthcare providers, PTs have vast amounts of musculoskeletal expertise, and they’ve earned the right to be distinguished from professionals who only possess a certificate.

There’s a lot of research that speaks to this branding problem. In this survey from the University of Kansas, only 76% of respondents were aware that pain management is within the scope of physical therapy, and a mere 64% of survey-takers were aware that physical therapist address cardiopulmonary issues. Still, there isn’t a whole lot of evidence that suggests ancillary services are contributing to the industry’s devaluation problem, although it’s an argument that’s certainly worth exploring—especially considering that a significant portion of the general public seems to be unaware of the full PT scope.

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Keep an eye on the competition.

Don’t get me wrong, restoring function through movement-based therapy should always be at the heart of what every physical therapist does—it’s what PTs do best, after all. But as we mentioned in this month’s webinar, only 8% of neuromusculoskeletal patients seek out rehab therapy. This means therapists must stay competitive with doctors and surgeons who also provide services to potential therapy patients. And physicians aren’t your only competition. Like it or not, many potential patients also seek out massage therapy and chiropractic services, so offering those services in your practice could help you stay competitive with those professionals. Ultimately, if a demand for these services exists in your area, meeting that demand can boost your own marketability.

Conversely, if you’re concerned that adding wellness services could hurt your competitive edge by making you seem less “doctor-y,” keep in mind that many physicians offer ancillary services as well. In fact, research from Medical Economics found that 94% of medical practices offer some kind of ancillary service, so this certainly isn’t a trend that’s unique to rehab therapy.

Know your worth.

If we’re talking devaluation, it’s possible that the growing presence of ancillary services in clinical settings is more of a symptom than a cause. If that’s true, then what’s causing this issue? If you ask Dr. Jarod Carter, physical therapist and cash-based practice owner, he’ll likely tell you that the devaluation of therapy services stems from the provider mindset. In this article, Carter says many therapy providers have a hard time picturing patients paying for services out-of-pocket, which leads many therapists to believe their services aren’t worth the price of admission. As Carter puts it, “If we don’t view our services as highly valuable...and convey that value in everything we do, then our patients, the general public, and insurance companies/Medicare will not highly value us either.”

Don’t confuse “patients” for “customers.”

It’s hard to deny, though, that medical services come with a hefty price tag, which sometimes forces patients to prioritize other basic necessities over their own health. This is especially true for low-income individuals. During the Graham Sessions discussion mentioned above, another attendee brought up the point that there’s “danger in considering a patient a consumer” because consumers are always looking for ways to turn a nickel into a dime. Not only does this hurt patients’ health by leading them to not seek care when they should, but it also teaches patients that therapy services are a commodity, rather than a valuable care option. When therapists add wellness and fitness services to their menu of offerings, it could further propagate this notion. So in that sense, it might not exactly help with the often-discussed physical therapy branding problem.

Ancillary services might distract from a clinic’s brand.

Speaking of brand, if a practice does decide to add ancillary services, it’s important that those services align with the clinic’s individual brand. If the additional services don’t serve your target client base, you could end up losing money on marketing and supplies. As you start to think about which services you’d like to add, ask yourself what kind of clients you want to attract. If the clients you want are different from the clients you already have, be sure your brand and existing services cater to this new demographic. If you don’t know what your target audience is, be sure to research the demographic of your clinic’s surrounding area. For example, if your practice is located in an area with a large senior population, you’ll likely be better off adding wellness services that cater to health longevity and maintaining physical function.

There could be legal implications to adding non-therapy services.

The topic of wellness and fitness services may not have you thinking about malpractice suits, but rehab therapy providers should always be aware of the expectations that come with therapy licensure—even when those providers are rendering services that are secondary to their main function. According to this article from Gwen Simons, PT, Esq, if a patient becomes injured or experiences any other kind of medical episode, it’s the provider’s responsibility to administer aid to the best of his or her ability as defined by duty of care. In other words, if the therapist’s qualifications include the skills necessary to administer aid in an emergency situation or detect early risk factors for certain health issues, then he or she could be held legally accountable for failing to do so. This is especially true if the therapist uses his or her credentials to promote or market any wellness services. However, non-medical professionals—such as massage therapists and personal trainers—typically cannot be held liable if a patient becomes injured or experiences any other type of medical episode, as their qualifications do not encompass the appropriate training.

Cover your assets.

Even the most vigilant providers can be vulnerable to liability issues, but it’s possible to implement ancillary services in a way that keeps you—and your clinic—covered. To start, it’s important to establish a clear delineation between therapy services and ancillary services. In many cases, these services can be administered by non-therapists who have appropriate education and licensure. Additionally, if ancillary services are administered by a therapist, it’s important that the therapist avoid using that time to assess and administer therapy treatment to the participant. Also, make sure that these services are covered by your practice’s liability insurance. In some states, wellness and fitness programs are not considered part of the physical therapist’s scope of practice and thus, may not be included in liability coverage. So, be sure to consult your practice’s legal counsel before diving head-first into wellness services.

It’s easy to get swept up in all the pros of offering wellness services—higher patient retention, better marketability, and more reliable revenue, to name a few. But, remember the lesson passed down to me by my mom the day I bought my first car: big financial decisions should always come with heavy consideration. Otherwise, you leave your business vulnerable to road bumps that could put your practice’s crash rating to the test. So before you hop in the wellness driver’s seat, make sure you’re prepared for any potential twists and turns in the road ahead.