What You Missed at Ascend 2023

This year’s Ascend was an extraordinary event. Not only was it the 10th anniversary of Ascend (which just so happens to coincide with the 15th birthday of WebPT this year), the two-day affair took place in Phoenix, Arizona, a city that both WebPT and so many WebPTers call home, myself included. Of course, milestones and locales alone are no guarantee of a great event—so it was a good thing that this year’s slate of speakers and panels brought their most thought-provoking insights with them to the valley.  

All in all, it was a whirlwind for those of us trying to chronicle the goings-on, with too many interesting sessions to choose from and but one humble writer available to document the proceedings. With that said, here’s what you missed at Ascend 2023. 

The Rehab Therapy Labor Shortage: A Brass Tacks Discussion on Changes Needed to Survive and Thrive

The first day’s keynote was a conversation between WebPT Co-Founder and Chief Clinical Officer Heidi Jannenga, PT, DPT, ATC, and panelists JeMe Cioppa-Mosca, PT, MBA, Senior Vice President at HSS, Josh Funk, DPT, Founder and CEO at Rehab 2 Perform, and Uzair Hammad, PT, DPT, NCS, of Orlando Health about the current staffing crisis plaguing the industry. The numbers paint a stark picture—a turnover rate of over 11% and burnout of over 36%, according to the 2023 State of Rehab Therapy report, plus 10,000 more rehab therapists leaving the profession than there are new grads to replace them from 2021 to 2022. Those numbers don’t have to shape the future of rehab therapy, though. 

The panelists had different perspectives on the problems based on their experiences. As a recent graduate, Hammad highlighted the barriers he’s seen and experienced since entering the profession, from PT’s brand problem and issues with the DPT curriculum to the prohibitive cost of that education and the incurred debt. Cioppa-Mosca pointed to the burnout related to COVID-19, the lack of diversity in the field, and the lack of brand awareness among high school students. Funk compared the challenges to the marketing funnel and the struggle to get students (and direct access patients) into the top of that funnel and expose them to what PT is like.     

When it comes to fixing those problems, leaders can implement a few tangible steps to try and turn the tide on the crisis. All panelists emphasized a need for greater employer transparency — both in setting realistic expectations and salary and promotion opportunities. Employees are also looking for employers willing to support their goals for professional growth.  

When it comes to finding the right people for your practice, Cioppa-Mosca and Funk highlighted the importance of culture in hiring. Clinic owners and leaders have to be intentional about their company culture, honing and reiterating their values until they’re embedded into the foundation of the business. Once you’ve identified the right people, you also need the right framework to help them get acclimated and ultimately succeed. Cioppa-Mosca notes that the onboarding process for HSS takes place over a year, with an upfront commitment to helping new employees grow in the HSS culture. 

Similarly, Funk emphasized the importance of getting PTs into your ecosystem to understand better what they’re about, whether that’s interns or prospective hires. He also stressed that long-term satisfaction is tied to continuous feedback loops with direct questions to gauge employees' feelings and transparency around benefits packages and paths to career growth.    

In-Network vs. Out-of-Network vs. Cash-Pay: A No-Holds-Barred Discussion About Hybrid Payment Models

The room was packed for our panel on hybrid payment models featuring John Wallace, Gwen Simons, and Brian Gallagher. It’s a complex topic with many nuances, making it challenging to offer hard and fast rules — that said, the panel offered some broad insights on navigating the world of cash-pay, wellness services, and going out-of-network—which, we should be clear, is not legal advice. (If you have thorny legal questions regarding your practice, it’s always a good idea to consult a healthcare lawyer.)    

• Every practice should be a hybrid practice. You should charge what you’re worth, especially when you have financial targets you need to meet, so don’t be afraid of cutting bad contracts as needed. Establish a self-pay policy, be aware of OON benefits for payers, and try to compete with other practices on quality instead of price.  
• You can offer general wellness services over the Internet, but you can run into trouble if you start treating pain, impairment, or dysfunction—in those instances, you might be providing PT services and could find yourself in hot water if you’re offering those services in a state where you’re not licensed.  
• Don’t try to disguise PT services as wellness just because PT services were denied by the insurer. If you get a denial from a payer, try to appeal—if that appeal is denied, that patient can pay out of pocket for those PT services with a payer agreement. 
• All payers within a practice must be either entirely in-network or out-of-network; you can’t separate services within the same tax ID and location based on status. To create separate hybrid entities, you must create new business entities and separate facilities.  

RTM Unplugged: Payer Updates, Data-Driven Trends, and Real-World Applications

The Remote Therapeutic Monitoring (RTM) panel featuring Heidi Jannenga, Kathleen Rosas, and Rick Gawenda highlighted changes in this emerging technology since last year’s presentation. In the past year, we’ve seen an increase in RTM adoption, as Rosas highlighted in WebPT’s data. Perhaps most surprising is that RTM is used most frequently with those between the ages of 65 and 80. This trend is partly because Medicare is a known reimburser for RTM services, but it also demonstrates that older patients are more adept with technology than is often (unfairly) assumed.

On the compliance side, Gawenda noted that CMS continues refining the RTM CPT codes, adding code 98978 to cover cognitive behavioral therapy and making the general supervision standards permanent in the 2024 proposed rule. They've also sought to address confusion around the use of RTM in certain instances; per the proposed rule, two separate providers can’t bill for RTM concurrently, and RTM services related to a surgery or procedure should not be billed separately. However, if the RTM services are unrelated to the diagnosis that led to said procedure or surgery, separate payments can be made. CMS is also clarifying that RTM codes can’t be billed when RPM services are being provided simultaneously.     

Finally, Gawneda reviewed the pros and cons of certain use cases for RTM in practice. For example, clinics making each provider responsible for their own RTM cases can facilitate better relationships between providers and patients, but this could burden clinicians with larger caseloads more than others. On the other hand, devoting PTAs or OTAs to RTM can make for better management of RTM patients but ultimately hinders the development of the therapeutic alliance. And offloading RTM to third parties eases the burden on your staff but is an added expense and a potential complication in integrating your workflows and EMR with a third party.  

Compliance Pulse: What You Need to Know About the Latest Updates in Rehab Therapy

For his second session of the day, Rick Gawenda covered some of the coming changes CMS offered in the 2023 Proposed Rule (many of which we highlighted in this blog). Here are a few of the key takeaways.

• CMS is proposing that PTs, OTs, and SLPs be added to the definition of suppliers as found in the Code of Federal Regulations (CFR).
• Currently, legislation that sets work geographic practice cost indexes (GCPIs) at 1.0 or greater is set to expire at the end of 2023, which means that some localities would see their work GCPIs drop below 1.0—reducing payment for providers in those states. 
• The 2024 Home Health Proposed Rule offered some positive news for rehab therapists in those settings, as CMS will begin to reimburse for lymphedema standard and fitted compression garments, provided that the patient has a diagnosis of lymphedema and that the garments are prescribed by a physician, physician assistant, nurse practitioner, or clinical nurse specialist.  
• The new Advance Beneficiary Notice of Non-Coverage (ABN) form went into effect on June 30; if the form you’re using doesn’t expire on January 1, 2026, you need to start using the updated form. 
• Thanks in part to advocacy efforts, UnitedHealthcare removed its requirement for physician orders and physician signatures for plans of care (POC) as of August 1. 
• Following in the steps of CMS, Aetna will institute CO and CQ modifiers for services provided by physical therapy assistants (PTA) and occupational therapy assistants (OTAs) beginning on December 1, which means the services will be paid at 85% of the standard rate. 

Audit your Managed Care Contracts

If you’ve ever groused about one of your payer contracts, the session with Connie Ziccarelli, Founder of Guidepost Consultants & Practice Management Specialists was squarely in your wheelhouse. The session emphasized that while there’s a lot that rehab therapists can’t control regarding their relationships with payers—hello, shrinking reimbursements—it’s important to gain a firm grasp on your payer contracts. Getting that understanding requires conducting periodic audits on those contracts and building a more productive dialogue with representatives from each payer to avoid unnecessary strife (although there will probably be some strife.)    

When you’re examining your payer contracts, you want to pay special attention to not only who the representative, liaison, or team that serves as a point of contact is, but also:

• The scope of services you’re being paid for under the contract and whether you’ve expanded your offerings since the contract was signed; 
• Which licensures are covered (PT, OT, SLP, or some combination of the three);
• What constitutes wellness services for that payer and whether they’re covered; and 
• Your responsibility to prove patient eligibility.

You probably want to get paid in full and on time. To do that, you want to know your payer’s reimbursement schedule and any time parameters for when you should bill and when you can expect payment. You also should understand when you can bill for deductibles and coinsurance and your responsibilities for collecting coordination of patient benefits paperwork.  

Part of getting paid and keeping payers happy(ish) is being able to respond to any records requests promptly with the information you’re obligated to have in your documentation. To that end, ensure you’re following the letter of your contract regarding record retention and availability—while not letting payers overstep the mark and demand more than they’re permitted to under those terms.   

Building that relationship with payer representatives is the most helpful step for managing payer contracts. You want to be someone who is not only helping solve a problem but also serves as an ambassador for rehab therapy.  

Big Takeaways from Ascend 2023

Of course, any Ascend will have its own themes that organically emerge from the scheduled sessions and the conversations people have throughout. This year, transformation and connection were the ideas that were woven throughout so many of the topics on hand. Of course, that was clearly on display in the opening remarks from WebPT CEO Ashley Glover as she laid out the company’s journey to PXM and the need for greater interoperability.   

Those themes were also present in the second day’s keynote speech from Elevation Project Founder Steven Tashjian. Tashjian detailed his time working with the U.S. Men’s National Team in preparing for the 2022 World Cup, describing how the newly-arrived staff sought to overcome past failures by reshaping the team’s culture and maximizing the players’ performance—in part by fostering greater collaboration with those players’ club teams to keep them healthy and playing at the highest level.   

While most attendees probably won’t find themselves working on the world stage, that doesn’t make the need for collaboration any less. Whether it was in discussions on interoperability in your technology solutions or discussions on recruiting, hiring, and retaining providers, it was clear that rehab therapy is going to need to be more connected on every level if it wants to adapt to the challenges of modern healthcare. 

Of course, those were just some of the many changes discussed. And while there was a healthy discussion on the pros and cons of topics like adopting hybrid practice models and cash-pay services, going out-of-network with providers, or adopting diagnostic or remote therapeutic monitoring into practices, there was little debate about the need (and the desire) for the profession to rapidly evolve to secure a stronger and more financially viable place within the healthcare landscape. 

That’s just a sampling of what you missed at Ascend if you couldn’t attend. Not to worry, though; Ascend 2024 will be upon us faster than you might think, with a new slate of topics and speakers ready to educate and energize audiences. Stay tuned for a future announcement on dates and locations so you can start planning!