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Board Perspective: Navigating the Future of Private Practice

board members

Over the last year, we’ve all needed to escape to some degree. What do you do to unwind?

Ali: I reserve Wednesdays to get outside and usually
hike or ski with a group of amazing women.

Mike: My daughters and I
started working
out together in the clinic at night. Exercising, laughing, and reflecting on what is truly important is a great way
to end the day.

Stacey: Skiing, coaching softball,
family time. The pandemic has definitely forced me to slow down and enjoy everyday
things.

Kelly: Given the differences in
the past year versus a year
without a pandemic, the things I found escape in were the once labeled “little things”—being outside, exploring,
family dinners. I now cherish and find so much more gratitude in these things than pre-2020.

Amy: Long walks are a great way to
clear my mind. I love to
cook with my family, which often leads to a kitchen dance party.

With all the legislative and physical therapy practice changes that have occurred recently, our heads
are all still spinning a bit. Which ones do you expect to become permanent fixtures? Which ones will go
away?

Ali: I think we’ll see telehealth for physical therapists become permanent, but
it will take work on our part to get the legislative changes needed. I also think we’ll continue to see
employers being able to pay off student loan debt without it being taxable to the employee. Unfortunately, I
believe payment parity for telehealth will go away.

Mike: The 2% suspension
of sequestration will go away at some point in time. I am hopeful some of the telehealth provisions that make
access easier for patients will remain beyond the pandemic.

Stacey: I expect some form
of telehealth or electronic communication with clients to stick. I also feel a declining Medicare payment
environment will continue to stick, though I don’t agree with it.

Kelly: I am speaking
as an individual. I see many of the telehealth changes staying and finding their way into permanency
both at the state and federal level as well as the payer level; we are already seeing some of those
things occur. It is my sincere hope that, as practices, we will embrace this new digital medium of
practice and incorporate it into our care paths as the consumer will drive easier access to care.

Amy: I think that
telehealth will be an initiative we will continue to see evolve and change our profession. I don’t
believe it should or can replace our clinical care, but it will influence our future. I am looking
forward to social distancing going away.

If declining payment becomes a trend, how do you recommend practice owners go about creating healthy profit
levels?

Ali: Opt out of network for Medicare (still seeing medicare patients, but
at 115% of the fee schedule). The challenge here is that the patient receives the payment, and has to pay
the practitioner, which has its downside.

Add more fitness and prevention programs, with a transparent flow between that and the clinical services, and
a connection to other health care providers such as nutritionists, so patients see the value of having this
provided by a physical therapist.

Offer a cash-based payment system for those whose insurance has a high deductible or co-pay, or allows
the patient to get out from under third-party reviewers who restrict visits and put too much emphasis of
the treatment time on documenting tests, etc., take the therapist’s time away from actual treatment
trying to fight to get reimbursed or authorized visits. Make this very visible to one’s patient
population, with no apologies. It should not be an afterthought.

Kelly: Push into new areas, work directly with employers, stop taking
contracts that don’t cover your cost per visit, start working with other physical therapists in our areas.
There is plenty of business for every physical therapist out there, we only serve about 10% of the people
that could benefit from our services. We must spend our energies on forward looking items, not just how can
we squeak by with lower paying contracts. This is easy to type but not easy to do. We have some tough
decisions and a lot of work ahead but if we do it together, embrace the things we can do as physical
therapists and work to educate other healthcare providers, payers, employers (the real customer of payers)
and the consumer on how effective we are for both outcome and cost.

Amy: Practice owners need to be aware of their own KPIs and industry
benchmarks to help them manage and lead their practices.

Mike: Simplify and focus on what matters! Most practices
(including our own) have things that are 100% in our control that we don’t manage as effectively as we
should. In reviewing the PPS KPI data, the most profitable companies focus on the basics and execute
well. They make sure their therapists are taking care of the right amount of people (visits/FTE) and
are billing for what they do (timed units per visit). Small changes in these metrics move the
profitability needle dramatically.

What do you see as the biggest challenge to private practice physical therapists in the next five years?

Ali: Consolidation in the marketplace; partly due to low and disparate payment
pressure that will persist (for OP vs hospital and large organization payment that have better negotiation
power). Technology will bring more resources to the patient, that may replace some of what we typically do in
the office. The challenge will be for physical therapists to be the ones to own this space, versus losing it to
other types of practitioners and businesses.

Mike: Having to work harder (administrative burden) for less (declining
payment) will be an ongoing challenge. I’m encouraged by the collaborative conversations that are happening
across Sections of APTA and with outside parties who have a shared advocacy interest. There are several levers
we can pull in this area and coordinating them is essential. We must create a united national strategy if we are
going to change the trajectory on payment and administrative burden.

Stacey: The rising cost of physical therapy education is a serious concern.
There is a large gap developing between what physical therapists are paying for their education and payment for
our services through the third-party payer market. I worry about our ability to sustain this current model
without a drastic change. The only change that we, as a profession, can have some real control in, is the cost
of our educational process.

Kelly: Relevance. Our patient (consumer) is changing as well as the world
around us. We must change and evolve with their needs and wants. I believe we need to look forward as a
profession and realize that the digital era is here (has been for a long time), and we will no longer be able to
remain relevant if we don’t work to push outside of the four walls of our clinics. We will be replaced if we
don’t by other professions. I believe that physical therapists can single handedly help the US health care
system better manage many of the issues we sadly don’t manage well, starting with musculoskeletal care
management. We know that we are more effective, have better outcomes, are less invasive, and cost less than
other interventions in this realm, yet we remain behind. Imagine if we can “keep America moving” and not have
patients be limited by musculoskeletal issues. What impact could we have on chronic diseases like diabetes,
cardiopulmonary disease, obesity, etc.? Physical therapists are uniquely qualified to address movement
disorders. We have to come together, educate the consumer on what we do, meet them where they want care (in
clinic, home, work, online, etc.,) and do our jobs. The health of our nation is depending on it.

Amy: Payment has been and will continue to be a challenge for the private
practice physical therapist.

A lot of practice owners are concerned with the direction of payment for our services. What can we expect in
the future?

Ali: This is such a struggle. Unless we can get CMS to see the value of physical
therapy and pay for it appropriately, I think we are going to see low payment persist.

Mike: We must have a more coordinated and collaborative national strategy to
address Medicare payment and administrative burden if we want to see a different result. Each of us will have an
important role to play in the future, and we must not let the frustrations from the past take away our purpose or
our fight.

On a more optimistic note, the growing gap between hospital and private practice payment is looking like it is
transitioning from a frustration to an opportunity. Recent price transparency legislation is making it easier to
demonstrate our value proposition to self-insured employer groups. We are positioned perfectly for a
collaborative PT-driven solution that improves their bottom line and ours.

Stacey: In the third-party payer market, there is serious downward pressure in
payment. The strongest recommendation I would provide to every practice owner is to consider the contracts you are
signing. Accepting money from a third party means you have agreed to a contract. Is the contract fair for your
service model? What is the consequence of NOT signing the contract? Will you lose referrals, or may you possibly
keep the referrals? Manage a level of profit for your services. Understand your cost numbers very well to help you
make proper decisions for your practice.

Kelly: A tough road that requires a lot of advocacy and grit. We need to show
our value and work as a community of physical therapists to not be our worst enemy. We cannot have colleagues
accepting low payment, it’s just a race to the bottom. It is going to require that we work together and push outside
of comfort zones.

Amy: I wish I knew too! I believe that each owner can help these efforts by
understanding their own contracts and working to negotiate for fair payment. It is also each of our responsibility
to be involved in grassroots advocacy to help shape our future.

What adjustments can practice owners make now that will help them succeed in the future?

Ali: Look closely at their payment from each insurer and try to build up
referrals from the higher paying sources, to offset the low paying ones. Turn down contracts that do not provide
for any profit. Add cash-based services, either by hiring, contracting, or just renting space in the off hours,
to people such as yoga and pilates instructors, personal trainers, massage therapists, nutritionists, etc.

Mike: Invest in yourself! Find a group of people who care enough to ask
you the hard questions you don’t want to answer. Leadership is lonely. Having a group that is supportive,
understanding and will also hold you accountable is a wonderful gift that our Section offers. I’ve found the bar
at annual conference and Peer2Peer to be a great place to meet these people.

Stacey: There are many adjustments that are options. Each practice is so
unique in their location, clients, payers, relationships, etc. I think it is always wise to take the time to
step back when you can. If the environment is changing, it is important to be able to identify it. Then you need
to decide if you morph with the changes or if you start to find a new direction. There is a time to fight and
there is a time to just change course. Sometimes the line between the two is difficult to identify.

Kelly: Know your business. Know your costs, live within them, and only
accept business opportunities/contracts that cover those costs. Get out there and educate, educate, educate on
what we do as physical therapists, how we can help not only the individual but the entire health care system in
our country. Keep moving!

Amy: Never stop building your team. Keep fighting for our profession and the
patients we serve. Get involved at PPS, we are stronger together.