An Optimistic Approach to the Future of Physical Therapy

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The author of this piece has requested anonymity.

A brief review of the annals of Impact yields hundreds of articles that lament the pending changes that will negatively affect the profession of physical therapy in the years to come. Writers share frustrations, pitch potential remedies, and commiserate with the reader in an attempt to reduce angst and offer hope. While the future is certainly harrowing, this article attempts to deftly sidestep naivety yet offer a slightly more optimistic view on what to expect for our profession.

DECLINING INSURANCE PAYMENT

Perhaps the greatest of future challenge on the stability of the private practice, reducing reimbursement for physical therapy services tops most lists as the largest stressor for practice owners and clinicians alike. Depending on a region’s saturation level, the accessibility of services, and the current contract status, a practice may experience utter frustration in attempts to negotiate contractual rates and therefore optimize payment for services. Whether providing care in a one on one model, offering specialty services like pelvic health or aquatics, or producing greater outcomes in fewer visits, most payers seem unaffected by these “stats” and are reluctant to negotiate rates with small players in the physical therapy space.

Ramifications of this frustration trickle down from owners to clinicians in the form of higher productivity expectations, increased scrutiny of billing charges, higher pressures on billing departments for recouping payment, and reduction in services to clients in the form of shorter treatment sessions or group therapy. It is a painful cycle that leaves all parties feeling vulnerable and underappreciated for the excellent care they provide.

The Optimistic Approach

Therapists who started their practice within the past 10-15 years are no strangers to payment reduction and have never experienced the glory days of yester-year where fighting for reimbursement wasn’t top of mind. A look around the industry reveals some creative ways that practice owners have adapted to reduced payment while continuing to optimize both the quality of care provided and their profit margin.

  • Review your scheduling practices. Are there ways to optimize the amount of treatment time for the contracts you serve? For example, if you have payers who pay on a per diem basis, consider shorter, more frequent sessions. If you have payers who pay on a time-based contract, optimize your sessions for units-billed by using a 40-minute session (3-4 units for the 8-minute rule, or 4-5 for AMA billing). This scenario ensures quality time with patients yet optimizes coding and billing.1
  • Audit your billing. What better way to optimize reimbursement then to coach your team to increase their value through proper coding that represents their high quality of service? Depending on the intent of their treatments, multiple codes can be used to capture care. Review your team’s use of CPT codes and determine if they are optimizing value. For example, if your therapists are using joint mobilizations to increase range of motion, educate them to bill Therapeutic Exercise rather than Manual Therapy, since improving range of motion is one of the key stipulations for use of code 97110.2
  • Investigate alternative, cash-based revenue streams. Depending on your market and business style, determine what other ways you can generate income. Is it by selling merchandise, wellness services, dry needling, or consulting? Today’s market is rife with ideas for complimentary cash services if you are not able or willing to move your practice to entirely cash-based services.

INCREASED ADMINISTRATIVE BURDEN

Spending extra time to accomplish the same task is arduous and exhausting for your staff, creates headache for your clinicians, and adds extra to-dos to your weekly audit list. Certainly, administrative burden is exactly that…burdensome. With more and more payers opting for authorization standards, the likelihood of a reduction in burden coming soon is unfavorable.

The Optimistic Approach

Administrative burden is primarily burdensome because of the time required to complete tasks and the high chance of error, however with a fresh review of your systems there is potential to improve the hardship.

  • Review how you complete authorizations and track direct access and ensure you have a cadence for timely processing. Create a checklist that can be reviewed weekly to prevent your team from missing necessary steps in completing authorizations and executing the conversations with patients about attaining referrals when necessary.
  • Reward your team members for a job well done. Consider a bonus structure or regular reward system when administrative tasks are completed in a timely manner without errors. This offers a chance to build morale around tasks that are typically draining.
  • Spread out the burden to multiple members of the team so that one person doesn’t feel all the weight of the mundane tasks.

This opportunity builds camaraderie and allows people the chance to vent with peers who understand their challenges.

BURNOUT

With the above stressors of increased productivity with reduced payout and increased administrative burden, it’s no wonder that our teams are experiencing higher rates of burnout than in previous years in healthcare.3 As in any area of life, management of stress and burnout is critical, and the workplace is no exception. Persistent burnout that remains unaddressed leads to lower work satisfaction, higher staff turnover, and a higher risk of other health-related issues.4

The Optimistic Approach

Stress is inevitable in all facets of life, and healthcare burnout, while unique, requires similar coping skills. Equipping your team with the resources necessary to mitigate stress and burnout will have a positive effect on other areas of their lives.

Consider sharing the following tools to enhance your team’s ability to optimize their mental health and resiliency.

  • Provide a paid block of time for mental decompression during their workday. Insist that this time be used for non-work-related activities like calling family, scrolling social media, taking a nap, or going for a walk.
  • Encourage stress-reducing behaviors both in and out of work. Take walking meetings to facilitate time outdoors while moving to boost endorphins. Consider participating in a meditation before the start of a team meeting. Remind your team to breathe deeply after delivering difficult news.
  • Share resources that explain stress and burnout like articles and podcasts. (bit.ly/3hkkjtX)

POLICY UNCERTAINTY

With the ever-changing political landscape, it is difficult to know what is coming down the pike regarding healthcare policy. Sometimes political action can result in restricted access for patients, reduced payments for providers, increased administrative requirements, and unfavorable tax scenarios for the business owner. It’s often easy to throw metaphorical hands in the air and claim to have no responsibility or power.

The Optimistic Approach

While seemingly a small player in a large pool of politicians, each American has a say in how policy unveils. Supporting like-minded legislators will foster the necessary change in the medical landscape to optimize for all private practices. APTA and APTA Private Practice provide many resources for improving your ability to get involved to make a difference on the policies that matter in your state, town, and country.

  • Host a legislator at your clinic so they can see the faces that their decisions affect. Share some talking points found on the APTA Private Practice website or your local APTA state chapter website. Be sure to leverage their visit for marketing purposes. (See right for more information)
  • Become an APTA Private Practice Key Contact and get to know your local legislator so that when major decisions are made, you can have a direct voice to the decision-maker. The time commitment is minimal and any expenses are often reimbursed by the PT-PAC.
  • Read. Stay abreast of the changes that affect your practice and educate your team and patients about how they will affect each of their lives. Having more people advocating for positive change can shift the needle in the direction of the profession.

It’s true. Private practice owners shouldn’t have to continually worry about the future of their beloved profession. We should be able to prioritize the things that matter most like providing excellent care and building exceptional teams that function well together. But in reality, there are challenges that will inevitably always be present. There are two ways to approach these challenges: with disdain, or with an optimistic approach which focuses on opportunities. Rather than lamenting, be a change-maker by encouraging yourself and others to continually seek a way to make a positive change, no matter the barriers.

References:

1Hughes M, Andrus B. “The 8-Minute Rule Showdown: Medicare vs. AMA.” WebPT. Published December 29, 2021. https://www.webpt.com/blog/the-8-minute-rule-showdown-medicare-vs-ama/

2Synovec MS, et al. 2022 CPT Professional, 4th edition. American Medical Association Press. 2021

3Weyrauch S. “Burnout Response for Leaders.” Impact Magazine. 2021;May:40-45

4De Hert S. “Burnout in Healthcare Workers: Prevelence, Impact, and Preventative Strategies.” Local Reg Anesth. 2020;13:171-183. Doi: 10.2147/LRA.SR240564

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

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