The State of Rehab Therapy in 2023: Charting a Course Through Shifting Tides FAQ

Avast, readers! As it does every year, this edition of the State of Rehab Therapy report offered insights into the most thought-about and fretted-over topics in rehab therapy in 2023, including turnover and retention, burnout, student debt, salaries, and more. In fact, each report has enough compelling statistics and thought-provoking trends to dive into that it warrants its own webinar to break down the most significant findings. 

During this year’s webinar, “The State of Rehab Therapy in 2023: Charting a Course Through Shifting Tides,” host Heidi Jannenga, PT, DPT, ATC, Co-Founder and Chief Clinical Officer of WebPT, was joined by Dianne V. Jewell, PT, DPT, Ph.D., FAPTA, President and CEO of Sheltering Arms Corporation and Hospitals, and Richard Leaver, PT, CEO of Alliance Physical Therapy Partners to discuss these pressing industry challenges, and to pose potential solutions. As always, the webinar was filled from bow to stern with great insights and thoughtful questions—too many to get to in the allotted time. So we’ve gathered up the ones that fell overboard and answered them below.            

Challenges and Opportunities

What can rehab therapists do about the underlying issue of declining reimbursements?

This question was one of the most frequently asked during our webinar and was touched upon by our panel. That said, it’s worth reiterating, given the gravity of the topic for rehab therapy in 2023. First, providers should be checking their contacts to make sure they’re receiving the current rate; as pointed out during the webinar, payers have no reason to let clinicians know they’re paid less than what others might be. If you’re unhappy with the contracted rate, you can either try and renegotiate or go out-of-network with that payer. (If you do decide to renegotiate, our guide to payer contract negotiation will help you make your case for better reimbursement rates.)  

Industry-wide, fighting against shrinking payments will require advocacy with payers, elected representatives, and CMS. To that end, we’ve put together a template letter rehab therapists can use to voice their displeasure with the possible 3.3% payment cut in the latest proposed rule.   

Do you have any advice on implementing outcomes surveys? We find that survey fatigue is significant with our clients and referral sources.

Often, the best way to deal with pesky administrative requirements (like a functional outcome survey) is to discuss it upfront. Make sure patients know your clinic’s process regarding functional outcome surveys and why they’re important. Aside from the value of tracking outcomes data mentioned in the webinar, it also provides the patient a window into their progress—which can be highly motivating. That insight can also be a boon to the therapeutic alliance and building internal referral sources for the future.

Concerning dosing, some clinics administer functional outcomes at the initial evaluation, progress note, and discharge, while other clinics do them as often as every two weeks. Regardless of your choice, do what is best for your clinicians and patients and ensure all parties involved have transparency regarding outcomes survey expectations.

Looking beyond clinical roles, where can we make a change from the other side? Are there regulatory bodies or political groups we should look to?

Locally, the best place to start is often the state chapter for the APTA. Groups like the APTA of Arizona or Michigan regularly host events and are always looking for more help. These groups are also the first line of defense in collaborating and getting insights into your region’s insurance payments—or lack thereof. 

Beyond the local state chapters, student conclaves and educational institutions are another avenue to local advocacy. These organizations are often tied in with the APTA or similar national advocacy groups like the APTQI—both good options for driving change on a larger scale.  

Another good idea is to stay apprised of regulatory changes. We know these happen often, but some changes are scheduled. For instance, CMS’ final rule proposal comes out every July and is finalized sometime in the fall (usually October). Knowing what is coming and how it affects the profession is half the battle when advocating for change.

Staffing and Productivity

How does the burnout rate compare to the overall burnout rate in healthcare?

In total, 36% of our report’s survey respondents stated they are burnt out. While that number is high, burnout levels in rehab therapy in 2023 don’t seem to reach the levels of healthcare overall, according to recent research. One recent study published in the Journal of General Internal Medicine found that of the more than 40,000 participants across a multitude of roles and specialties who responded to burnout questions, 49.9% met the study’s criteria for burnout. Similarly, a study by the Mayo Clinic Proceedings found that 62.8% of surveyed physicians had at least one manifestation of burnout. 

That said, the studies cited above analyzed the mental and physical symptoms survey-takers provided in their surveys and applied them to their definition of burnout to arrive at their number of burnt-out clinicians. For the State of Rehab Therapy report, respondents self-reported whether they felt burnt out, with no additional questions on their physical or mental state. The burnout number could be higher if the standards used in the above studies were applied to the State of Rehab Therapy report.   

Do you have any advice on managing PTs doing more than three evals daily? Some therapists feel that they’re unable to do this, and it eventually becomes a provider retention problem.

Per our report, administrative burden and time to complete documentation surfaced as prime contributors to burnout among rehab therapy professionals. As any rehab therapist can tell you, the initial evaluation (IE) is often the most time-consuming aspect of documentation. These are further compounded by the intersection of primary authorizations and continuation of care after the IE. 

That said, performing more than three IEs in a work day—be that eight or twelve hours—will inevitably increase the burden placed on the evaluating therapist. Having a discussion with those therapists on the health of the business and the need to get patients in can assuage some of the concerns they might have about IEs. One potential solution might be offering paid documentation time whenever a therapist’s IE count exceeds two. In that instance, regular visits could be moved to an assistant’s schedule, or time could be made later in the week so that the evaluating therapist could catch up.

Thanks again to everyone who attended our webinar. If you missed it live, don’t worry—you can catch the replay at your convenience. And if you’re interested in more State of Rehab Therapy data, you can still download your copy of the report.   

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