A look at some of the challenges and opportunities for physical therapists amid today’s changing industry landscape.
By Melanie Hamilton-Basich
Overall, physical therapy is a good gig to have. It ranks number 10 among the top healthcare jobs in the United States according to U.S. News & World Report’s Best Jobs of 2022, and jobs for physical therapists are expected to grow by 21% between 2020 and 2030, according to the Bureau of Labor Statistics. But just like any profession, it’s by no means perfect, and it’s subject to multiple influences.
Physical therapy has gone through some major changes in recent years, with the COVID-19 pandemic affecting supply chains, staffing, and profitability. Now new trends are affecting the industry, and therefore the people who make up this profession. Economics and politics can get in the way of physical therapists’ focus on helping people. Issues such as staffing, reimbursement, mergers and acquisitions, and new technology can present challenges…but also opportunities.
Reimbursement Rates and Staffing
First, let’s take a look at some of the challenges facing physical therapy. Because of the structure of the United States healthcare system, insurance reimbursement rates and staffing are inextricably intertwined. Right now, because of reimbursement rates, it’s becoming more difficult for physical therapists and clinics to get ahead.
Mike Studer, PT, DPT, MHS, NCS, CEEAA, CWT, CSST, FAPTA, sees this as the number-one challenge facing physical therapy right now. He describes it as “the ever-encroaching lines of reducing therapy profit margins (reimbursement trends) with employee expectations due to academic debt and marketplace movement.”
Studer has been a physical therapist since 1991 and a private practice owner since 2005, so he’s seen this shift over time. If physical therapists can’t count on as much insurance reimbursement for their services, employers have more difficulty providing salaries that therapists expect and feel they need. So employee retention takes a hit.
Along the same lines, Karen Danchalski, PT, DPT, who practices in an outpatient orthopedic clinic and provides outpatient services in the home setting, is seeing the effects of recent changes regarding physical therapy assistants. A 15% Medicare payment cut was implemented Jan. 1, 2022, that applies when services are provided by a physical therapist assistant (or occupational therapy assistant) under Medicare Part B. “Because PTAs are going to be reimbursed at a lower rate than PTs, I know that my employer is reducing the number of PTAs providing service,” she says. This shift will likely continue to affect the way clinics approach staffing, possibly putting more burden on physical therapists.
While Danchalski is a physical therapist, not a PTA, she, too, feels the effects of concerns over staff pay and a clinic’s bottom line. At one of her jobs, most of her colleagues are part-time employees without benefits. She believes this is a result of small companies not being able to afford to offer health insurance to their employees. “This has caused schedules to be piecemeal with therapists working only a few hours in the evenings, or on a Saturday, or just a couple days a week,” she says. “I think this leads to difficulty retaining staff because there is not a strong commitment by either the therapist or the employer.”
Mergers and Acquisitions
As of late, larger companies have steadily been expanding by acquiring smaller physical therapy clinics, and it seems we can expect that trend to continue into 2023. Part of this is due to the staffing issues we’ve discussed.
With staff in high demand, many physical therapists motivated by changing economic conditions will take job opportunities elsewhere in the coming year, Studer predicts, with far-reaching effects. “As the housing market cools and the pandemic fades, families are going to be more inclined to make regional and cross-country moves—increasing the significance of this issue,” he believes. “This reduction in profit margin will be met with more mergers in the therapy industry. These are largely on hold due to matters of instability in the economy writ large. I foresee interest rates stabilizing and before the presidential election…transactions will happen.”
If all of this indeed comes to pass, even more clinic owners worried about their ability to make a profit and stay afloat will be tempted to sell to larger companies. Studer sees this as a related but separate challenge in the physical therapy industry today, which he refers to as “the sanctity of the small- to medium-size clinics and the temptation to sell.”
It’s up for debate what this trend means in the grand scheme of things, for both physical therapists and their clients. But Danchalski, who likewise sees acquisitions of smaller PT clinics as a growing trend, is not a fan. “I don’t think this is good for personal choice,” she says.
While physical therapists are certainly facing some challenges right now, many technologies trending in the industry provide opportunities to improve aspects of the job—benefiting therapists, clients, and clinics.
For instance, home exercise programs (HEPs) continue to gain traction with therapists and clients, as they help reinforce the movements learned during therapy sessions and can help promote adherence. HEPs are available as standalone products, and also come included as part of many comprehensive physical therapy software suites. “Electronic home exercise programs are really handy for therapists to quickly create and can be emailed to the patient,” Danchalski says. But she feels it’s important that patients only use them after learning the movements from their physical therapists, not as a substitute.
She has similar sentiments about consumer health apps. “There are tons of apps now for tracking exercises, performance, vitals, etc, that can be nice supplements to what patients learn in therapy,” Danchalski says. But as far as she is concerned, “Physical therapy is best experienced with direct-human-to-human contact and not human-to-screen.”
Virtual reality is a technology that fits a different mold, however. It blends a screen or headset with immersive interactivity, which a physical therapist facilitates in person with the client. Physical therapists already use it for vestibular rehab, assessing and improving gait and balance for those with various neurological conditions, and improving reaction time after injury, among other applications.
Studer anticipates that more clinics will purchase and adopt the technology in the near future, when “it becomes more affordable and clinics re-establish their confidence to invest larger [amounts of money] on technologies without direct ROI,” he says. “This is also strangled somewhat by non-profits and large entities experiencing a reduction in endowments and donations.”
While she hasn’t yet used virtual reality in therapy sessions with her clients, Danchalski looks forward to the opportunity. “I have tried it personally for video games and I think it is wild and awesome,” she says. “I would like to explore it more.”
Remote Therapeutic Monitoring
Digital communication has increased greatly since the COVID-19 pandemic throughout healthcare, and is here to stay, in various guises. This includes the development of remote therapeutic monitoring (RTM).
Telehealth is still in use by physical therapists, but not as much as it was during the height of the pandemic. Remote therapeutic monitoring can include telehealth appointments, but encompasses far more. In 2022, the Centers for Medicare & Medicaid Services (CMS) implemented four RTM CPT codes that relate to physical therapy. This allows outpatient therapists to bill for their time spent reviewing and monitoring patient data when patients are not in the clinic, including when using patient engagement technologies to communicate with patients.
This is just one reason Studer sees “the development, legislative, and market support for remote therapeutic monitoring” as major positive trends in physical therapy right now.
“I expect RTM to be significant as a direct effect, yet perhaps more significant in the indirect benefits, as this will bring an infusion to companies’ willingness to innovate remote technologies, remote service lines, and the like,” says Studer. “Also secondarily, the RTM could infuse more energy into the Physical Therapy Compact. These can help with innovation, entrepreneurship, and therapy models for retention of current employees, all being very important issues.” He also expects companies to build their patient engagement software around RTM to take full advantage of its benefits.
Other types of technologies that Studer foresees more physical therapy clinics adopting include those for cognitive and mental health, power training for older adults, and gamification of physical activity.
A Positive Outlook
Trends will come and go, and those who remain dedicated to their profession through it all will learn and grow from their experiences. As many of the aspects of physical therapy change, Studer is confident that physical therapists will adapt and thrive. “It is always worth noting the ways in which licensed PTs re-invent and innovate their careers into novel markets. This will continue for the foreseeable future,” he predicts. “Risk taking will be on the rise at about the same pace and timing with sales of PT-owned clinics and mergers.”
Studer expects to see many physical therapists who currently hold more traditional jobs in the profession transition into roles as coaches, ergonomic health experts, product designers, and consultants to large employers for wellness programs.
Danchalski is similarly optimistic. Regardless of what may happen, she has faith in the longevity of the physical therapy profession and the importance of the physical therapists at the core of it all. “Despite all the changes we are going through in this world with technology and what seems like the endless strive to make our work more efficient and productive, the one constant is that patients seem to always need us,” Danchalski says. “The healing touch of a therapist is worth more than what any piece of technology can provide.” PTP
Melanie Hamilton-Basich is the chief editor of Physical Therapy Products. For more information, contact [email protected].