Five Tips on Recruiting and Retaining Millennial Physical Therapists

Thinking about Your first physical therapy career move? My advice for recent physical therapy graduates.

By Thomas Janicky, PT, DPT

At this year’s Graham Sessions, Jamey Schrier spoke about fear being a fierce detractor from allowing us to realize our life goals. It is safe to say that everyone has experienced fear in their life whether it was minutes before the interview for your dream job or seconds before the starting gun of a big race. We often easily have the ability to overcome the fear of things we can touch, see, and hear. It is the fear of things that we cannot see, touch, hear, understand, or predict that can triumph over even the strongest among us. Fear of the unknown is a crusher of dreams and can often force us into making comfortable choices, which can lead to complacency and mediocrity. It can stifle the ability to be disruptive in our clinical practice and in a market that requires innovation and fresh ideas. Comfort puts us into the mindset of “this is how we have always done it;” it perpetuates the use of outdated treatment practices and thinking that there is a one-size-fits-all model in the way we deliver our services. History has shown us that innovation is bred through risk taking, learning from failures, and from those who have harnessed the nurturing guidance of mentors who instead of teaching us what to think, teach us how to think. So why is it that a very small percentage of the human population are innovators?

More and more of those who identify as millennial are seeking and craving opportunities to break the mold of the outdated “career ladder” and create new and interesting opportunities for growth within our workplaces. We are looking for different ways to define success and that often does not mean landing a comfortable 9 to 5 job. We are not interested in perpetuating an outdated system and instead we look to create better opportunities for ourselves, as well as the employees, associations, and consumers we belong to and work with. Those who understand this will describe this behavior as creative, bold, “outside the box,” courageous, and innovative. Those who do not understand this behavior will describe it as arrogant, entitled, defiant, disloyal, and reckless. I am describing the millennial physical therapist.

Today’s practice owners are frequently coming face to face with the millennial physical therapist. I think it is quite funny when practice owners approach me asking for advice on how to communicate with “my kind” as if we were delicate organisms being discovered for the first time. As a millennial myself, I want practice owners, educators, and leaders in the profession to fear us less by understanding us a little more. I want them to realize that they can harness the power of this “reckless and fear devoid” millennial with mutual benefit for their practice and the growth of said millennial. In the long run, this could in fact lead to the development of both individuals and ideas that lead to innovation that could benefit the professional association, private practice, and the profession as a whole. It is with that idea in mind I wanted to share five tips for hanging on to your millennial physical therapist.

1. Let the baby bird fly!
Much like the mother bird pushing her young ones out of the nest, do not be afraid to push us outside of our comfort zones and come to solutions on our own. Put the spoon down and see what happens, but avoid being harsh if we fail and instead discuss it and help us learn from it. Perhaps given your previous experience you hold the piece of the puzzle that can turn our failure into a genuine learning experience. We all want some form of mentorship, and your experience is extremely valuable to us. I am pretty sure this is not just a millennial thing; micromanaging can quickly frustrate anyone. If you treat your employees like the paranoid mother in the passenger seat of her teenager’s vehicle, your actions will get old quickly. I am not saying that we do not need guidance or assistance, but freedom to make decisions and learn from our mistakes creates learning experiences and avenues for growth for both parties. After all, you want to encourage your team members to learn to make decisions on their own.

2. We really, really like technology!
If you have yet to discover the power of technology you are missing out on a huge avenue for patient/client/employee engagement. With a large percentage of the population now owning a smartphone, it is a poor generalization to say we are the only ones “obsessed” with technology. The truth is we grew up with it and we understand it and that perplexes those who were not afforded the same luxury. Take advantage of this opportunity; allow your millennial physical therapist to get creative in this avenue. Patients/clients will usually jump on board if you can offer them something that saves them time. A study conducted by the analytics firm International Data Corporation concluded that on average smartphone users check their Facebook 14 times a day,1 imagine the marketing opportunities your tech savvy millennial can have for your clinic. Don’t hate it, embrace it.

3. If you are in the business of perpetuating the same old ideas, you probably will not hold on to your millennial physical therapist too long.
Do not take this statement the wrong way, of course there are guidelines to follow and systems in place, but do your best to hear us out. Outside the box thinking leads to innovation in practice, it inspires new ways of interacting with patients/clients as well as referral sources. I would encourage all practice owners to eliminate words such as “cannot” or “impossible” from their vocabulary when interacting with millennials. Hear us out, and encourage us to present our case. If something is lacking, maybe you have the missing piece. Frankly, a millennial that hears these words often enough will mostly likely seek opportunities elsewhere in search of someone who can at least entertain their ideas.

4. Get ready to dream big! Millennials often set lofty career goals.
It has been my experience that many professionals discourage new professionals from embarking into private practice, entrepreneurship, or creating different ways of selling what we do to the public, when having little if any practice experience. Innovation comes from taking risks and as millennials we are absolutely fine with that. Personally, I would rather fail doing what makes me happy than succeed in something that makes me miserable. We are not interested in perpetuating the ideas of the ones before use but creating new experiences and opportunities.

5. If you have a “career ladder” within your business with a ceiling and/or attic, we probably will not stick around long.
Millennials crave something to work toward, and a career opportunity with endless room for growth is most desirable. This path does not have to take the form of a ladder and it probably should be more flexible. Not all of us want to become managers or chief financial officers; we are seeing millennial physical therapists finding new opportunities and passions in things such as community outreach/education, research, marketing, and public relations. Do not be afraid to tap into the nonclinical skills and passions that your millennial physical therapist brings to the table. This may allow your business to explore opportunities that it has not found or had the resources to explore yet. These are great topics to discuss at the initial interview. Ask your millennial physical therapist what they are passionate about and how they plan to be innovative in their new workplace.

Embracing the unique characteristics of your millennial physical therapist can facilitate unique and exciting opportunities for your private practice. Taking the extra steps to understand your millennial physical therapist can help create an environment that will keep them engaged and excited about the future.

Reference

1. Levitas, D. (2013, March). Always Connected How Smartphones And Social Keep Us Engaged. Retrieved March 20, 2016, from www.nu.nl/files/IDC-Facebook Always Connected (1).pdf. Accessed March 2016.

Thomas Janicky, PT, DPT, is an outpatient physical therapist at Johns Hopkins Hospital in Baltimore, Maryland. He is also a member of the American Physical Therapy Association (APTA) Private Practice Section (PPS) editorial board. He can be reached at tjanicky@gmail.com and on twitter @TJ_Janicky.

The Best Person for the Job

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Create the right environment to keep your exceptional employees on board.

By Stephen Anderson, PT, DPT, and Lori Dillon, MPA

As private practice owners, we continuously navigate turbulent waters. Reimbursements and expenses fluctuate, regulations change, treatment approaches evolve, patient needs and demands grow. We rely on different resources to achieve success (at minimum, sanity and stability), the most significant being our valuable team members. Arguably there is nothing more important than skilled and loyal employees and partners.

We all know that sometimes employee turnover is positive. If you are seeking a culture change, dealing with a disgruntled underperformer, or your business needs evolve, you might intentionally devise a turnover plan to reach your ultimate goals. Most often, however, the turnover we experience is not in our control and has a devastating impact on our business. Much research has been done on the costs (direct and indirect) of employee turnover. Estimates are 1 to 12 months’ worth of an employee’s pay, depending on the role and experience spent to replace that person.1 Losing a good employee takes a toll on us and our business financially and emotionally. To avoid this, we try to proactively hire the right people.

The Right Seat on the Bus

Most of us have heard Jim Collins’s reference to getting the right people on the right seats on the bus2 in relation to great business practice—ensuring that the skills and experiences of our teammates align with their roles and our business needs. This is what makes recruiting so important—and time consuming. Though not foolproof, at our company, we have found that investing time and resources at this stage in the process reaps rewards. Ten years ago, we hired a dedicated recruiting specialist to facilitate this process. You may not have the resources for that, but there are other things you can do. Set aside time in your schedule to dedicate to these tasks, or delegate to a skilled teammate and ensure that they have time to focus on this work. Add hours and recruiting responsibilities to a current employee’s schedule—especially if it is someone you are mentoring to be a leader for your organization. Acknowledge when and how to use an outside recruiting company (perhaps for temporary coverage, or to maximize your exposure if you are in a rural area), but know that you and your teammates are the best spokespeople and relationship-builders for your business. You are poised more than anyone else to define the seats on your bus and attract the right people for them.

When it comes to interviews, do not rely on just one point of contact, especially for key positions.

  • Consider multiple meetings. Maybe start with a Skype call so that you can get a feel for each other’s personalities without the full investment of an in-person interview.
  • Have trusted team members interview candidates in addition to your interview.
  • Invite the candidate to shadow in the clinic for part of a day.
  • Use the interview process to observe and confirm behavioral patterns. Anyone can present a persona in one interview; it is more difficult to fabricate behavior over multiple engagements.

Get deeply curious about what drives your top candidates so that you can craft an enticing offer. Of course, pay and benefits are crucial to meet basic life needs. However, we know that our practices often run on thin margins and relative to other industries and settings, our base pay ranges will likely not be at the top of market scales. We have to get creative. At our company, we offer programs that attract the kind of motivated people we want to hire: a structured one-on-one mentoring program, Orthopedic Residency, and a 4-level Leadership Development Program designed to build leadership skills in every employee, at every level of our organization. We encourage all employees to develop a personal education plan, and we support their goals with continuing education dollars (sometimes even for learning endeavors not directly related to their role, but purely to enhance personal growth). We attract many entrepreneurial people to our company because of our equity ownership model, the opportunity for a motivated therapist to become a clinic and company owner one day. Your clinic may not be in a position to offer what we do but you will benefit from identifying what makes you unique. Figure out how to maximize those qualities for new hires. Think outside of the box and beyond the pay and benefits that your market competitors offer.

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Research has repeatedly shown that money is not a primary motivator for most people.3 The promise of camaraderie, support, trust, and respect in the work environment is what draws people in (and keeps them around). Take the time to demonstrate this to your top candidates. Connect with them beyond the interview process: send a thank you note following an interview, email links with resources that you think they might enjoy, offer to connect them with other people in your clinic (or even past employees) who can share personal stories and answer questions. If you have not seen Simon Sinek’s TED talk “How Great Leaders Inspire Action,”4 we highly recommend it. In it, he argues that people are motivated to take action—make a purchase, seek services, choose to work somewhere—not because of the details and data, but rather because of why the company exists. People want to be a part of something inspiring. Show them why you are great.

Whatever you do, do not hire out of desperation. We have all done it . . . and it never works out well. Waiting for that right person can pose short-term pains but almost always leads to far surpassing long-term gains. Good companies are picky. Hire slow and fire fast. If you weed out people who do not fit, that is good turnover. And the ones you end up hiring often turn out to be legacy-building teammates.

Keeping the Right People Engaged

After we have the right person hired, our work has only just begun. Avoiding negative turnover relies on strong leadership and fostering a positive clinic culture. Thanks to resources like Daniel Pink’s book Drive, we know that an ability to direct our own pathways, to learn and create, and to support and advance ourselves and those around us are profound human motivators.5 Likely these factors are at the core of why you got into private practice in the first place. The people who make your company great are those who seek a culture that allows them to have autonomy, achieve mastery of something, and live for a greater purpose. Give them opportunities to continuously have these things.

The best way to do this is through regular conversations. To really understand the needs of your team and truly support them in meeting those needs, you cannot rely only on an annual review. The best leaders dedicate time to these kinds of dialogues. Often what we discover in these talks not only helps us support an individual employee, but also uncovers other opportunities to celebrate or investigate in the clinic. Additionally, we know that millennials (the generation that many of us are hiring nowadays) want coaching, mentoring, and frequent feedback. We have found that even a few minutes of daily check-in and acknowledgment of a job well done can go a long way toward their satisfaction and loyalty.

Mentoring has become a buzzword within our profession. We believe that true mentorship is building skills, but more than that, it is about building leaders. Innovative companies recognize that successful leadership development for the future relies on the collaboration of diverse individuals who bring different perspectives, giving individuals ownership over their own development plans, and encouraging “vertical” versus “horizontal” development.6 Horizontal development is skill-building (to use a metaphor, it is filling a glass with water). Vertical development is supporting an individual through the stages of how they make sense of their world (transforming the shape of the glass of water entirely). Vertical development is when problem solving and complex thinking evolve. We know that the health care landscape is complex, and the future of our profession relies on innovators who will be able to work collectively to seek out, explore, and solve problems that may not even be on our current radar. Cultivating these skills in our teammates not only retains good people, but grows our profession. Our company encourages vertical development through investment in a yearlong development program for our directors. Annually, a new group of directors meets once per month with a facilitator to discuss and strategize challenges and opportunities in their roles. This program has not only grown participants’ skills, self-awareness, and confidence, but has also positively impacted our overall company culture. None of this is easy. It takes time and consistent work. It requires us as business leaders to do our own self-reflection and energy recharging. But if we can get these things right, those turbulent waters that we navigate on a regular basis will feel a lot more manageable.

References

1. www.forbes.com/sites/edwardlawler/2015/07/21/rethinking-employee-turnover/#7456f3db1496. Accessed April 2016.

2. Collins, J. Good to Great. www.jimcollins.com/books.html.

3. https://hbr.org/2013/04/does-money-really-affect-motiv. Accessed March 2016.

4. www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en. Accessed March 2016.

5. www.danpink.com/drive. Accessed March 2016.

6. http://insights.ccl.org/wp-content/uploads/2015/04/futureTrends.pdf. Accessed March 2016.

Steve Anderson, PT, DPT, is chief executive officer of Therapeutic Associates and past president of the Private Practice Section. He can be reached at sanderson@taiweb.com.

Lori Dillon, MPA, is director of professional development for Therapeutic Associates in Seattle, Washington, and can be reached at ldillon@taiweb.com.

Incentive Programs vs. Raises

Ways to retain and reward your staff.

IncentivesVsRaises
By Michael Vacon, PT

When I started out as a physical therapist 25 years ago, I was very excited to embark on a career that would allow me to help people . . . and maybe even make up to $50,000 a year. I remember looking at the back of the old PT Bulletin and seeing all those glamorous jobs offering those “huge” salaries and thinking that someday, if I worked really hard, I would get there. My first job paid me $28,500 a year and I had one of the highest paying jobs from my graduating class. Boy, have things changed in the last 25 years. Back then, $30,000 a year was a good salary and $150 a visit for reimbursement was pretty normal. There was only one insurance offering that I can remember that had a copay ($3), so we never even thought to collect it. Now the starting salary for a new graduate doctor of physical therapy is closer to $65,000 (depending on your market), the average reimbursement is hovering around the $80 to $90 a visit range, and the average copay is somewhere between $20 to $30.

With all these big changes in payment from insurance companies and increases in salary, have there been any big changes in the way physical therapists are being paid? Are employees still expecting to get a 2 to 5 percent salary increase every year, just for being a good employee? Can you afford those employee raises each year as other costs continue to increase for health insurance, rent, and supplies while your payment stagnates or decreases? Your largest expense every month is most likely your employee costs, so how do you keep that in check and not turn over your entire team every few years as they seek other employment?

Knowing there is a ceiling on what we can pay, what are some alternatives to just a straight salary? Does your practice offer incentives to your team to help challenge them? Have you “gamified” your practice? Do you have a profit sharing plan? Do you have clear accountabilities set up so your team knows what success is? Knowing how to design a plan that can motivate your team and keep your bottom line healthy can be an important tool in retaining key employees and maximizing your business.

Before opening my practice, I spent a number of years working for a large corporate physical therapy company. People were locked into specific salary tracks based on years of experience, and annual raises were tied directly to the score of your annual review. Every employee expected to get the highest available score on their review so they would get the largest annual raise. The culture rewarded them for having another full year of experience under their belt, but not much more. There is value in experience, but should years of experience be the only way to increase your salary and is it the only way we should be measuring our employees? If you look at the actual earning potential of a physical therapist, it does not necessarily vary based on years of experience. A new graduate could easily see the same number of visits over a year as a physical therapist with 10 to 15 years of experience and therefore bring in the same amount of revenue. Should they not be paid the same? That would be a tough pill to swallow for a number of practices and therapists. What about moving to a mode where you compensate on measurable performance metrics?

Imagine a salary structure where every physical therapist, regardless of experience, starts at a much lower base rate, but then is incentivized on the actual profitability of the facility and their contribution to that success. Clinical staff who are your better producers make more; people who are producing less make less. Simple, right? Direct profit sharing at its finest. Team Movement for Life has moved in this direction, and they have a large amount of success to show for it. Their president shared the details of their “out of the box” approach. Basically, they have a base salary generally in the mid $50,000 to low $60,000 per year range and in addition, they can earn a percentage of the clinic’s profit for each patient treated over an average of 12 patients per day. The bonus is calculated monthly and is paid in the following month. For them, it is all about transparency. The team knows what the bottom line is each month and is focused on making sure that the clinic remains profitable. If the clinic is successful and makes a profit then so do they.

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Does your clinical team know what the bottom line is in your office, or do they think there is an endless well of money to draw from? Do you share this information with them? Are you comfortable doing so? John Vacovec, PT, owner of Physical Therapy and Sports Rehab Inc., decided that transparency was important for his entire team. After trying a few different methods to incentivize his team, he decided to keep it simple and just have a profit sharing plan across the board. He knew what the bottom line was for his practice to be profitable, so he established a monthly gross receivables goal for his team to hit. If the office exceeds this number, they get a share of every dollar over the goal. This is not limited only to his clinical team either . . . all employees in his office are rewarded for accomplishing the goal. That gives him a dedicated team, focused on success. They know that every visit means something to the bottom line of the practice. In turn, you see peer-to-peer accountability: Cancellations and no-shows go down, patient satisfaction goes up, and everyone benefits.

Maybe transparency of your profit margin is not comfortable for you. In that case, designing a plan to focus your team on key business metrics might be a way to go. Many years ago I started an incentive plan based on the key metrics I used to gauge how my business is doing. On a weekly basis, I measure and share the number of visits, number of new patients, the cancellation rate, average visits per referral, and the units per visit charged. Looking at these numbers on a daily, weekly, monthly, and annual basis gives a good “dashboard” of the practice and also helps me to see if there are any anomalies that need to be addressed. I developed benchmarks for all these metrics and incentivized my clinical staff on achieving them. My goal was to educate my team on important business metrics without focusing on a bottom line. I assumed that having targets to shoot for would be enough to motivate people to “win” by hitting those targets. I could not have been more wrong. Having too many metrics just confused people and in some cases made them focus on areas that were not really that important to what my end goal was . . . to motivate them to help make the business successful. In the end, I scrapped that program and went with something much simpler: I had them focus only on average visits per day. I was able to get the clinical team focused on what actually was important to help the practice grow and keep the bottom line healthy, while allowing them to share in some profit.

In speaking with Sturdy McKee, PT, MPT, CEO, of San Francisco Sport and Spine Physical Therapy, I learned that his team went through a similar issue. When he and his business partners started to implement incentive programs to motivate employees for success, they made the “mistake” of thinking that their employees were just like them and that they would be driven by what drove them. Very quickly they found out that this was not the case. What they decided to do was retool their program and ask the employees how they wanted to be compensated while sticking to, and building, a culture of accountability. This led them to develop a program that focuses on a few key metrics as well as core values and accountabilities for their team. Every employee knows exactly what the expectations are, and they also have the opportunity for small salary increases three times per year if they are meeting the trifecta of metrics, accountabilities, and company core values. They feel so strongly about their program that it is published on their company web page under their Careers section. Instead of just creating a team focused solely on numbers, they are creating a team that shares a strong belief system, and they have truly implemented an alternative to the basic review structure to help reward their best employees.

Our profession will continue to face challenges of increasing expenses and decreasing payment. We will need to learn to do more with less. Finding alternatives to the way we pay our employees can help us reward our key people and help keep our practices thriving. These are just some of the many ways that you can try something different. Consider implementing a creative system in your practice today!

Michael Vacon, PT, is the managing partner of Blue Hills Sports & Spine Rehabilitation in Massachusetts, which is part of the Pinnacle Rehabilitation Network. He is a PPS member and also a member of the Impact magazine editorial board. He can reached at mvacon@bluehillspt.com.

Not a Cup of Coffee

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Strategies for fighting physical therapy commoditization.

By Rick Jung

I travel a lot. It is one of the most meaningful parts of my job. I love visiting therapists across the country and learning about the problems they need help solving.

When I am on the road, I sleep in hotels, eat food I do not normally eat, and wake up at different times. Despite the many things in flux, there is always one constant: a Starbucks cup of coffee.

No matter what state I am in, or what airport, I know that I can put down my $2.10 and get the exact same cup of coffee. It is a commodity; I will pay no more than $2.10 for a grande cream/no sugar, regardless of how many barista awards the person who served it has won. A strong cup of coffee is a strong cup of coffee.

After nearly three decades of working in health care, I have observed with great concern a similar commoditization of the physical therapy industry.

The PT Commodity Box

A commodity is a basic good or service that is interchangeable with other goods or services of the same type. The quality of a given commodity may differ slightly, but it is essentially uniform across producers.

Many referring physicians and payers view physical therapy the same way: as an easily repeatable service with little variance in value and, therefore, cost . . . like a cup of Starbucks coffee. Given this inherent uniformity, who would want to spend more than the lowest possible amount for it?

Signs of physical therapy commoditization are popping up everywhere: in reduced reimbursement rates, in the overemphasis on therapist productivity (instead of optimizing their time and taking burdensome administrative tasks off of their workload), and in the replacement of local physical therapy groups with national chains for managed care contracting.

While physical therapists have seen their incomes fall and their clout with insurers shrink, perhaps the biggest pitfall of physical therapy commoditization is the erosion of the patient/therapist relationship. For many physical therapists, that connection is the most treasured part of their profession.

Because insurers and employers pay the lowest possible price for a service that is perceived as a commodity, physical therapists are forced to maximize patient visits. That is a significant loss from the patient’s perspective, too, as getting them to complete their course of care depends largely on trust. But commoditization limits that face-to-face time, carving away at a patient’s comfort level and devaluing what services and counsel the therapist offers.

The stakes are high. Unless physical therapists distinguish their services on the quality front, they will be forced to compete in a commoditized market on price alone. This will inevitably lead to suboptimal care and the marginalization of the physical therapist as a key decision maker in overall population health management.

Physical Therapy as an Interchangeable Good: How Did it Come to This?

By definition, commoditization occurs when goods and services lose their differentiation across their supply base. The erasure of differences in physical therapy has been decades in the making. Two major historical events in the larger health care industry set the stage:

  1. Grouping Prospective Treatment into Homogeneous Units. Though it is a relatively new buzzword, the move toward greater commoditization started nearly 30 years ago when Medicare established its own fee schedule for Part A hospital services. Rather than continue paying hospitals based on their costs, Medicare created the diagnosis-related group (DRG) system in the mid-1980s and paid hospitals a flat rate for per DRG admission. In effect, the new model paid hospitals a predetermined, set rate based on the patient’s diagnosis. Over time, the ensuing cost cuts were devastating for small and medium-size hospitals, which had no choice but to consolidate. This consolidation expanded to all points along the continuum of care and gave way to commoditization, which is still going strong.
  2. Paying for Effort, Not Outcome. The arrival of DRGs in health care pricing was soon followed in the 1980s by Resource-Based Relative Value Scores (RBRVS), a system that determines how much money outpatient providers should be paid on a fee-for-service basis. One of the fundamental problems with RBRVS is that it determines payment based on the amount of effort expended, with no regard for whether that effort produces a favorable outcome. As a result, complex and costly interventions are often overused instead of effective, lower cost treatments like physical therapy. Today, RBRVS is the basis used by Medicare and by nearly all commercial payers to derive fee schedules.
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These two pillars of our modern health care system helped lay the groundwork for today’s reimbursement shifts and consolidations. In this health care environment, despite the Affordable Care Act, there is little correlation between price and quality. Payers and referring physicians perceive little differentiation among therapy services and thus cost—not value—becomes the driver in physical therapy utilization. In other words, all physical therapy visits are equal.

We know this is not the case. Low back pain is a perfect example, with the cost of treatment creating a major economic impact worldwide. In the United States, patients with musculoskeletal conditions incur total annual medical costs of approximately $77 billion.1 Numerous practice guidelines have been developed for patients with low back pain. Some approaches produce inarguably better outcomes and are more cost effective than others. Physical therapists should be at the center of making treatment recommendations for musculoskeletal conditions, not at the periphery as a second thought after surgery and other specialists.

But how effectively are physical therapists communicating the differences in their treatment value?

Fighting Back: The Power of Data

Historically, outpatient rehabilitation providers were not required to track or communicate therapy outcomes. As health reform transforms the industry, this is no longer the case. Payers are increasingly searching for value, and physical therapists are being required to demonstrate clinical effectiveness along with low costs to participate in many insurance plans.

Yet, while the ability to demonstrate outcomes is more important than ever, physical therapists must consider the following best practices for using this data successfully:

  1. Report on Functional Outcomes. Physical therapists have been largely set up to fail in defining their value. The communication system is traditionally set up to track medical problems as dictated by insurers, which often means that there is a code for relieving the effects of low back pain, but not a means for measuring it according to real-world function. The effectiveness of medical care is easier to measure than the effectiveness of physical therapy care. Diagnosis codes and procedure codes are a much more accurate descriptor of the problems treated by physicians, and of the procedures they perform. In our disease- and injury-centric medical system, physical therapists do not have a way to describe and classify their work in returning people to full function. To demonstrate effectiveness, physical therapists must standardize around proven outcomes instruments and performance-based patient tests that demonstrate true functional progress. This type of data has not been embraced by the physical therapy industry because it is not needed in a fee-for-service industry.
  2. Report Clinical and Financial Data. Private physical therapy practices typically keep financial and clinical data in separate silos that can only be analyzed through human interaction or complicated processing. These architectures are no longer defensible as the industry responds to federal quality reporting requirements. In order to rapidly analyze metrics across large population groups, develop evidence-based therapy guidelines, and better manage care for chronically ill patients, outpatient rehab providers must integrate clinical and financial information systems. The technology is out there to help therapists understand and communicate the clinical effectiveness and financial efficiency of the treatment they provide.

Redefining Physical Therapy in Population Health Management

Population health management uses data from across the health care continuum to improve quality of care while gaining efficiencies and reducing cost. Traditionally, health care has been rather disconnected across settings and providers from both an information technology and a process perspective. This makes it challenging to achieve coordinated care, often to the detriment of the patient.

Physical therapy can fight commoditization by integrating into tightly integrated networks that utilize outcomes and cost data. Armed with that invaluable data, physical therapists can become an appropriate point of entry in health care, and direct patients toward the most appropriate providers as necessary, such as outpatient clinics or urgent care centers, and be at the center of the continuum of care—not sidelined to the periphery as a commodity.

No effective payment system should treat everyone equally. I am the first to argue that low-quality and high-cost providers should be held accountable. In order to differentiate value and reverse the commoditization trend, physical therapists must show their own compelling value in vivid detail with clinical and financial data. Moving forward, we, as an industry, must take back our power.

Reference

1. Gaskin DJ, Richard P. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research Appendix C, The Economic Costs of Pain in the United States. www.ncbi.nlm.nih.gov/pmc/articles/PMC3843519. Accessed April 2016.

Rick Jung is chief executive officer and chairman of Clinicient. He has spent 25 years working in health care services and has extensive revenue cycle management expertise. He can be reached via Twitter at @RichardGJung.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.