PTs Touch Down in Space City: Recapping CSM 2025

Better contracts require PTs to speak the language of business. 

In their opening session, Rick Gawenda, PT, and Kennedy Hawkins, MBA, JD, LLM, shared some hard and perhaps obvious truths about what insurance executives think about PTs, or physical therapy in general: that the services are overutilized, and that PTs are always asking for more money without any data to support their claims they deserve better pay. If PTs want to make their point to payers, they need to get into the minds of insurance company administrators, where both cost and data are kings and share price is the north star. 

Even though most PTs don’t bring the same business skills as C-suite insurance execs, that doesn’t mean they aren’t without tools to get the kinds of contracts they want and deserve. Gawenda stressed that practice owners need to read—really read—the contract they’re signing and not just look at the dollar figures. The contract language on things like covered versus non-covered services, credentialing, claim payment timelines, and even contract termination can make as much of an impact on your profitability as the rate you’re paid per service. 

That said, numbers are critical to getting the better rate you’re looking for, and if you want to make your case to insurance companies, you’re going to need those key performance indicators that demonstrate the value you’re providing for patients and, by extension, payers. You’ve also got to be aware of your place in the healthcare firmament in your area; know how many other PTs are in the area and what services you’re providing that others can’t or don’t, and understand the strength of your relationships with referring providers and your patients.

Most of all, PTs must be willing to ask for what they want specifically and often more than once, enter into tough negotiations, and walk away from bad contracts if necessary. As Heidi Jannenga discussed in her Graham Sessions recap, practices that can work together with others in their area to discuss questions or decision points about payer contracts will come out better than an individual approach that ends up a race to the bottom in terms of payment. 

Better marketing helps PTs speak a language patients understand.      

Of course, I couldn’t stay away from a marketing panel, and Scott McAfee, Pt, DPT, Arash Maghsoodi, PT, DPT, and Gene Shirokobrod, PT, DPT, delivered some great knowledge for PTs looking to up their marketing game. And it’s a timely message in this particular moment, as the ever-shifting insurance landscape has made it hard for patients to stay loyal while still staying in-network; undoubtedly, many PTs could speak to the patient who left for no other reason than the fact that their employer switched insurance carriers. To combat this and the other headwinds facing PT, practices and providers need to get better at explaining what they do in easy-to-understand terms, both with their online presence and in how they work with their patients.

We’ve said it on this blog many a time, but if your digital footprint online is lacking, you’re way behind your competition in 2025. Optimize your website to make sure you’re showing up to people searching for PT in your area—hopefully near the top of the results. Use real pictures of your team on the site, including working with patients, not stock images that you’re buying online. Start a blog to help increase that footprint and establish your expertise. And if you do nothing else, clearly and directly ask your happy patients to provide a review online; nothing will help drive business to your practice better than a stack of positive reviews on Google. 

You also need your messaging to resonate with patients. Explaining how you can solve pain points—in your case, quite literally—is effective messaging, provided that you can do so in a way that’s simple and makes it easy for patients to make a decision. Being able to tell an athlete that you can get them back to competing faster than any other method of recovery is a better pitch than listing out the services you’re offering and hoping they connect the dots and make an appointment.

Offering providers growth opportunities is a guard against burnout.  

Speaking of things we’ve discussed time and again, burnout remains an issue within physical therapy (albeit a slightly lesser one than in previous years). We all know the root causes; the question is, what can we do about it?

The answer may be to give providers the workplace environment they need—and a chance to branch out and develop skills beyond day-to-day treatment. Jaime Del Pallazzo, PT, DPT, F. Scott Feil, PT, DPT, EdD, Marla Ranieri, PT, DPT, and Emily Titus, PT, DPT, discussed how clinic leaders can cultivate practices that stem the tide of burnout that’s rolling through the profession. Today’s PTs are looking for a work environment that aligns with their culture and values, but they’re also looking to grow in their careers. In addition to offering a workplace where providers feel safe and respected, leaders can implement mentorship programs, training programs, and hybrid roles that allow clinicians to pursue their interests and grow their skills. If you have providers who are interested in working as an educator or researcher, for example, help them find those opportunities. If someone wants to spearhead a new wellness program at your practice, see how you can help them make it work. If a provider wants to take on RTM and telehealth as a way to find a better work-life balance, empower them to do so. While your immediate reaction might be to worry about the potential for lost productivity, you’ll gain far more from having a satisfied and engaged clinician producing excellent patient outcomes.   

Ultimately, the choice to embrace a workplace culture that allows providers to follow their passions plants a flag for the type of organization you want to be—and an organization that can boast of happy, skilled providers is one that will attract patients and clinicians alike. 

Offering hybrid care expands your reach and meets patient needs. 

Hybrid care remains a hot topic and will remain so for as long as we live in a world where in-person experiences take a backseat to convenience at every turn. As Tyler Cope, PT, DPT, ATC, Trevor Lentz, PT, PhD., and Kevin Carneiro laid out in their presentation, hybrid care where RTM and telehealth serve as tools at the provider’s disposal may be the path to not only better access to care but also finding the right level of care for each patient. The traditional model of PT, with frequent in-office visits, is bumping up against the realities of the daily grind many patients experience or the challenges of remote or immobile patients to drive to the clinic regularly. Remote care is one way to not only meet those changing needs but also provide an avenue for better data collection and more personalized care.

As any provider can attest, different patients have different needs, with some requiring less intense interventions. Remote care opens the door to new care models that feature either predominantly in-person care augmented by remote care for check-ins and monitoring or mostly remote care that has the patient coming into the office infrequently. Remote care gives providers the ability to assess each patient and figure out the right mix of in-person and virtual care. More active and health-informed patients could be better served by the use of more RTM and telehealth, whereas a patient who is more focused on passive treatment options, more likely to consider biomedical options, or isn’t especially tech-savvy might be better off with much more frequent in-person care.    

The key to making remote care work is still the provider’s interpersonal skills: their ability to build that strong rapport with patients so they’ll buy into remote care as an additive to their treatment and won’t feel as though they’ve been abandoned with less face-to-face time. Providers need to make both their expectations and what patients can expect clear from the start. 

Payment reform requires continued advocacy. 

Payment for PT services remains the elephant in the room in every presentation at any conference, or if you prefer, the black hole that draws every other topic toward it. So when it’s tackled head-on, you want to hear what the experts had to say. Kelly Sanders, PT, DPT, ATC, Wanda Evans, PT, DPT, MHS, and Justin Elliott offered a clear-eyed look at the payment problem, pointing out that while we’ve had some wins recently (the change to general supervision and POC certification requirements in the 2025 final rule), there’s still a lot of work to be done. 

Much of what ails PT payment today, at least as far as Medicare is concerned, dates back to the Balanced Budget Act of 1997 that stipulated the Medicare program needed to become budget neutral. Given that healthcare costs have gone up, providers have been the ones to take the hit to their bottom line, with PTs fairing worse than many other specialties. While the annual legislative relief for payment cuts is still important, we need actual reform to things like the Medicare Economic Index (MEI), MACRA and the QPP (including APMs), CPT code valuations, the RUC, MPPR, and the underlying requirement for budget neutrality.

Commercial payers certainly aren’t exempt from throwing up roadblocks, either. Any mention of prior authorization was met with a level of scorn usually reserved for our greatest movie villains, and talk of visit caps, documentation requirements, inconsistent coverage between payers, and complex coding similarly got listeners’ hackles up. 

The fight to tackle those problems is one that’s not going to be won overnight. In the meantime, though, providers can help themselves by not giving payers any reason to deny claims, making sure that their documentation shows progress for each patient, covers their functional status, supports the services billed for, and most of all, demonstrates why skilled intervention was necessary. Providers need to keep up to date with the latest evidence-based practices, and along the lines of what Gawenda and Kennedy discussed, they need to understand the language in each of their contracts with payers to make sure they’re getting everything to which they’re entitled.   

Payment reform requires collective action. 

One of the most compelling questions asked at CSM—at least from my vantage point—was posed during the session with Mike Horsfield, PT, MBA, Matt Hyland, PT, PhD, and Justin Elliott: who gets to shape the future of physical therapy? The answer isn’t so straightforward; while PTs are the ones driving clinical care and clinical innovation, ultimately, it’s payers who hold the purse strings. And while we can hope for those regulatory changes that will create a more sustainable financial future, it’s on PTs to adapt to the present reality. 

Fortunately, PTs aren’t without leverage in the fight. There’s more need for PT services than there are PTs to provide them at the moment, and the unacknowledged reality is that payers do need PTs in order to make money; after all, customers have some choice in plans, and one that doesn't offer PT is less valuable than alternatives that do. So what can PTs do to wield that power? They can start by working together. As a PT, you can join advocacy efforts for things like prior auth reform, fair co-pay legislation, and eliminating MPPR; the larger the constituency, the more likely legislators are to listen. You can also work with other practices in your area to try and further the profession as a whole without having to compromise on the basics of economic competition 

With all that in mind, the APTA has rolled out the State Payer Advocacy Resource Consortium (SPARC) to help deliver the tools, resources, and strategies that practices need to fight for better pay. 

Value-based care is coming, and it’s time to get ready. 

Discussing value-based care might seem like the boy who cried MIPS for some providers, but if you pay close enough attention, you can see how those initiatives are making steady progress. In their talk, Bryan Bourcier, PT, DPT, ATC, Thomas Reudiger, PT, DPT, DSc, and Brian Hull, PT, DPT, MBA, outlined why PTs need to define what value-based care is before payers create their own definition. At present, PT remains stuck in the early adopter phase of VBC; worse yet, they’re spending far too much time thinking about value in terms of lowering costs without proper consideration of quality.  

To start making strides into VBC, PTs need to overcome the cultural and operational barriers that are holding them back, whether that’s PTs’ resistance to change or their reliance on patient volume to combat decreasing payments. To make that happen, practices and the profession overall need leaders who can get buy-in from clinicians while being able to bridge the gap between the clinical and business factions of PT. Not unlike regular fee-for-service contracts,  practices considering entering VBC models need granular detail on patient outcomes and patient satisfaction, measured against the cost of providing that care and the revenue generated.  That means finding a way to classify their data, particularly their data on patient condition and care provided; while ICD-10 codes may seem like an obvious way to sort that information, there’s too much variance within coding for that to prove as accurate as needed. 

Where practices want to end up with VBC is a place where they can minimize the variance in patient outcomes for a given condition and thus be able to earn a strong return in a bundled/flat rate VBC contract with each patient. And, if done correctly, they can reach a place where they no longer have to battle with payers over using certain CPT codes, because the payment has already been determined. It may require some additional focus on efficiency and data collection, but it’s a path PTs may need to take if VBC continues to grow.

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Overall, the 50th edition of CSM was a great three days of education and connection, and I’m already looking forward to next year’s festivities in Mickey’s backyard.