CSM 2023: Defining the value of PT (before someone does it for us)

After an eight-year hiatus from attending APTA’s Joint Section Meeting (CSM) — and suffering a freak cold in Michigan — I was excited to hop on a plane to sunny San Diego. But, after a three-hour weather delay and de-icing, I arrived in a rainy, windy city. Ever the optimist, I had heart that it could still beat the blizzard I left behind and I was about to mingle with the world’s largest gathering of neuromusculoskeletal experts. And thus, began my CSM 2023 experience.

After the first day of presentations, I began to see a theme emerge from the collection of speakers I listened to: We need to define what we value to the greater healthcare world. “Value” is not a new word to the healthcare lexicon, but in an era of declining reimbursement, PT staff shortages, and student debt, the idea of ​​bringing value to our profession extends beyond federal programs contained in value-based care (VBC). Is. )—it describes an ideal for being sustainable in the future.

How do we upgrade the PT industry?

At events like CSM, I love the panel discussions the most. Unlike traditional research or poster presentations – which are important in their own right – panel discussions provide an opportunity to hear from multiple perspectives on thought-provoking topics that excite the audience. And at a time when so many of us are focused on problems, these panel discussions offer a way forward and seek to create solutions – the first of which is to elevate our profession within a framework of our own set of values. Have to pick up

But, what exactly is our value?

I guess we can put some sort of spin on what we think or feel – there is value to us as a profession, but what is it to patients, payers or the population at large? In the CSM presentation, “Addressing the Value Puzzle in PT: Insights from Payers, Health Systems and Researchers,” the eclectic panel provided insight into why value has become such a hot-button term and why we should start caring about it years ago. (To be fair, WebPT has been banging this drum for a while now).

To help simplify the definition of value, the panel referenced a formula originally coined by Michael Porter, PhD: Value derives from results for dollars spent. Looking at this from a healthcare lens, you can see how this ties directly to VBC’s tenants. To this, the panelists explained how we are well-positioned in the greater healthcare community to influence outcomes for patients, payers, and regulators alike, but many outside our circles are unaware of this fact. And as I sat there listening to the speakers reflect on this topic, one thing stood out—if we don’t define our values, someone else will for us.

What does research tell us?

One of the panelists made a comment I think all outpatient orthopedic PTs would agree with: “PT should be able to serve 80-85% of spine-related dysfunction in patients.” And the research supports it – overwhelmingly. Another panelist noted that insurance companies love to predict and are afraid of unexpected costs. The fee-for-service (FFS) model is irreversibly tied to unpredictable costs because there is no determination of what a given cohort will cost at the end of an episode of care (EOC). With the wealth of data at our disposal, we can build predictive insights into the cost of our services and use informed decision making to guide clinical practice. Yet, we remain at the mercy of 90% of our problem, with patients continuing to see urgent care treatment first, resulting in unnecessary imaging, drug prescriptions, and even surgery. And thus, the cycle of overuse of FFS continues.

How do we effectively define and prove our value?

Physical therapy has a value proposition of delivering significantly better outcomes at less cost to patient and payer, but, so far, we have fallen advocating it. In the value puzzle presentation mentioned earlier, the late Congressman Tip O’Neill was quoted as saying, “All politics is local,” which the panelists took a step further to say, “All healthcare is local.” Every PT can do something to grab the closest seat—or bring their own—to the table with insurers and regulators to claim our value within the greater healthcare continuum.

Bringing value to patients through advanced technologies.

Remote Therapeutic Monitoring (RTM) has been a topic of discussion for the last one and a half years. Introduced in 2022, RTM fills a void that many physicians—myself included—have sought to close. Real results go beyond the walls of the clinic when patients adhere to their HEP, but getting this to patients can be a daunting task. Now, we can be reimbursed for time spent outside of a typical treatment session talking with patients on the phone, promoting home exercise adherence, or ensuring optimal tolerability for medical interventions. Perhaps no presentation was more attended than the one hosted by Rick Gawenda, PT, founder and president of Gawenda Seminars and Consulting, titled, “Understanding RTM as It Applies to Outpatient Physical Therapy.”

In this presentation, Gawenda discusses the benefits of RTM, including how it can help clinics generate new revenue, expand patient access, and improve patient outcomes. And given that regulators have already signaled VBCs as the future for healthcare, using RTMs can also provide PTs with a digital, data-driven method to demonstrate their value.

Digital MSK solutions like RTM are not a panacea though. Rather, we can use a variety of advanced techniques to improve our own practice models. Examples of this include:

Like it or not, advanced technologies will continue to enter the PT field as extensions of our current practice. If we acknowledge their value, we can combine this with hands-on care to positively impact more people and demonstrate our value to a wider audience.

Increase value by diversifying employee roles.

Last year, the World Health Organization estimated that 1.71 billion people globally have the condition of MSK. And in 2015, 124.1 million US adults reported having an MSK problem. With this vast pool of patients, there is unlimited potential to bring value to those affected by MSK dysfunction. Unfortunately, we have a short supply of PTs due to issues such as burnout, early retirement, and educational costs leading to a backlog of patients many practice owners are currently grappling with. Is there anything that can be done to remedy these conditions and give a new sense of value to the type of work that therapists do? Let’s start by diversifying our roles as physicians.

Some of the roles staff PTs may be well equipped to join are:

By breaking the traditional mold of being a physical therapist, we can begin to make the profession more sustainable for current and future PTs.

Cultivating value with the hybrid care model in PT practice.

Relying on insurance carriers as the sole source of revenue is not going to solve long-term value problems for PT practices. Thus, cash-based PT services have grown significantly over the last decade, proving that insurance is a sustainable revenue source outside of sports. To avoid alienating Medicare patients, many practices have opted for a hybrid approach, working both in- and out-of-network. But cash-based models aren’t the only hybrid care option available to PTs.

Direct-to-employer relationships are also becoming more substantial for PT practices. As outlined by the presenters for “Employers and Industrial Rehab: The Gateway to Direct Pay Revenue and New Patients,” PTs may want to bypass traditional insurance or worker’s compensation models entirely and go directly to employers. Are ready. This serves as a win-win (where are my office fans?) where employers can cut costs, employees are not trapped in the cycle of employee compensation, and PT practices can further diversify their revenue streams. Can – on their terms.

The presenters were quick to point out that PT should not limit itself to PT alone. They should pitch other services such as:

• capacity management,
• ergonomics assessment,
• Kalyan Clinic,
• early jobsite interventions (such as walk-arounds), and
• OSHA First Aid.

Whether through a cash-based PT or direct-to-employer model, hybridized care means finding value in more than one revenue stream.

Grow practices through staff retention.

Returning to the topic of staff shortages, staff retention is top of mind for most private practice owners. However, in our 2022 State of Rehab Therapy report, rehab therapy industry executives and clinic owners cited “managing employee happiness” as the biggest company challenge. So, we know that new ideas for how to boost morale and get employee buy-in are proving difficult for practice leaders, which this next presentation helped to address.

In “Entrepreneurship: Improving Employee Satisfaction and Retention Through an Innovative Model,” presenters revealed ways for employees to incorporate PT into their workplace beyond a one-time pay raise. This included a series of examples in which employers worked with their PTs to identify their own passions, merge them into practice and create additional revenue streams for both parties. Examples include role-playing therapists:

• Creating lifestyle or diet management subscription plans for new and former patients,
• leading the clinic’s retail sales and program, and
• Launching a program for breast cancer patients that provides them with supplies for lymphedema management and other related issues.

Engaging staff in intrapreneurship will only help the business grow together, increasing the clinic’s value within the community, which may ultimately have an impact on the profession. Furthermore, it will show our co-workers that they, too, are valued in a practice that places culture and personal development at the top of company principles. It may take a little creative thinking to find strategies that work for a given exercise, but the juice is certainly worth squeezing out.

Break away from silent thinking.

Years after I graduated from my manual therapy focused DPT program, I fell victim to the dogma that it was PT or bust. It took years and forceful conversations with other healthcare providers to see that staying within PT silos would inevitably reduce our value to the industry. In short, together we are stronger.

As Julie M. Fritz, PT, PhD, FAPTA noted in CSM, VBC is also about looking down beyond a patient’s EOC. How can we collaborate with other disciplines to improve patient experience and quality of life? By networking with primary care physicians, nurse practitioners, or physician assistants, PTs can show how we can share the load, improve patients’ lives, and enhance the value of the MSK care model that PTs pioneered. . Let’s move beyond siled thinking and commit to welcoming new perspectives as opportunities to advance our profession.

This year, I made a point of attending presentations and panel discussions that focused on enhancing practice management while simultaneously creating solutions to advance the PT profession. I came in with a sense of pride and urgency. There is pride for the fact that I can call myself a physical therapist, and an urgent need to define what that means to others outside of our circle. If we continue to bring this notion of value to the table, the problems facing our industry will fade away while we continue to thrive.

Any thoughts on CSM from this year, or maybe a burning question? Drop us a line in the comments section below.