PHOTO CAPTION: Clinics will most likely keep making use of the powerful software features that helped keep physical therapy patients feeling satisfied with their care despite the obstacles the COVID-19 pandemic posed.

Efficiencies were hiding in plain sight, and the pandemic helped clinics use them to their advantage.

Compiled by Physical Therapy Products Staff

It is common knowledge that viruses adapt, but the agility and speed with which PT clinics learned to adapt to the challenges of providing care during quarantine is something few could have envisioned. Yet, despite the obstacles the COVID-19 pandemic created in keeping physical therapy patients feeling satisfied with their care, resourceful managers used powerful software features to take patient engagement to a new level at a time when many clinics wondered whether they would stay in business.

The thinking behind these strategic shifts is chronicled by four subject matter experts for this Physical Therapy Products Q&A. The panel includes Sharif Zeid, business director, MWTherapy; Tannus Quatre, PT, MBA, vice president of sales for private practice, Net Health; Steven Presement, president, Practice Perfect EMR + The Wired Client; and Heidi Jannenga, PT, DPT, ATC, co-founder and chief clinical officer of WebPT.

How did the COVID-19 pandemic affect patient engagement strategies for most PT outpatient clinics, and how long are those changes likely to last?

Sharif Zeid: In our experience working with practices, it’s not so much that COVID-19 changed strategies but rather just made existing trends move a lot faster. Over the past several years, the push for more digital engagement, more patient self-service, the ability to do business over a patient portal had been growing in strength. COVID took that trend and expedited it substantially. In addition to pushing practices to do more, it also exposed that patients are comfortable doing a lot more digitally and do really value convenience. Those changes likely are definitely going to stick, and the trends will continue. Patients will continue to demand more convenience and more digital engagement, and practices will need to deliver to keep up with the emerging modern standard.

Tannus Quatre: Engagement over digital channels was imperative to maintaining the provider-to-patient relationship during the pandemic. Those therapy practices that were digital-enabled prior to, or during, the pandemic had a sizable advantage over their local competition. The definition of patient engagement during COVID-19 also expanded to include telehealth and patient portals, which are likely to continue within the definition moving forward.

Steven Presement: If there was an upside to COVID, it taught us all efficiency. We found that time spent with administrative staff in-clinic was handily replaced by texting and online forms, sent in advance of a visit. Our clinics used our Wired Client application to deliver COVID Screens Intake and Consent forms to patients, in advance of their appointment, which would normally have been completed sitting in the lobby of the clinic. Now this paperwork is completed in advance, before the patient even walks in the door, thus dramatically reducing the time taken by front desk at intake and potentially delaying appointment start times. Clinics and patients benefit from this new process, and I believe this is here to stay.

Heidi Jannenga: To say that the pandemic hit outpatient physical therapy hard is an understatement—yet the clinics that overcame the challenges of the past year with resilience and tenacity continue to inspire me. To better understand how COVID-19 affected outpatient physical therapy throughout the pandemic, WebPT published bi-weekly COVID-19 impact reports that tracked patient volume in rehab therapy clinics throughout the pandemic in each state. At the lowest point, 16% of WebPT clinics weren’t seeing any patients at all.

The pandemic accelerated the use of telehealth and remote treatment. What features and functions in your software product have been particularly important in helping clinics maintain effective patient engagement during a time when remote care has expanded?

Sharif Zeid: We moved quickly to integrate telehealth into our platform toward the beginning of the COVID-19 challenge. This allowed clinics to do virtual visits and, as time progressed, to offer a mixed strategy treating in-person when it was feasible and virtually when it wasn’t. MWTherapy has a dedicated patient engagement module, which only grew in popularity throughout COVID-19. We also have a number of time-honored engagement tools like a robust home exercise program and patient reminders.

Tannus Quatre: The Net Health Patient Portal is a core feature within our software and allows secure provider-to-patient communication, 24/7 access to patient health information, and previous/upcoming appointments, and serves as the hub for the delivery of online therapy including videoconferencing for telehealth visits. The use of Net Health’s patient engagement and digital marketing tools allows our customers to efficiently and effectively communicate revised hours of operation, sanitization protocols, and other information related to the delivery of safe care during the pandemic to the market at large via online business listings.

Steven Presement: Keeping the clinic top-of-mind to the patients is key to retention and compliance, which is why we built The Wired Client application and integrated it with Practice Perfect. Texting is a great way to engage clients without actually spending time to do so since automated campaigns can be set up to mimic “real” contact. Patients receive what seems to be a personalized text message, relevant to their situation, and they can reply. If they do reply, their clinician is notified immediately and can engage further, if required. The patient believes that the clinic reached out personally with little effort to do on the part of the clinic.

Heidi Jannenga: WebPT has several built-in solutions to help clinics maintain effective patient engagement for both in-person and remote care. On the appointment front, WebPT Scheduling offers a comprehensive scheduling solution that connects with patients’ records. This solution helps clinics maintain full schedules while reducing cancellations and no-shows. As part of the Scheduler, WebPT Virtual Visits offers live two-way video to conduct virtual therapy sessions with a Zoom for Healthcare integration that’s PIPEDA/PHIPA- and HIPAA-secure with 256-bit AES encryption. Additionally, WebPT is particularly equipped to help providers keep patients engaged with their care through a home exercise program (HEP). The WebPT HEP features video exercises, along with a wealth of patient-facing functionality.

What road map can clinics use to guide a patient engagement strategy from the ground up?

Sharif Zeid: Having an effective engagement strategy requires practices to really formulate a system from the ground up. The best way to build such a system and a strategy is by creating a patient experience road map. By this, we mean to sit down and really plot out a patient’s path before, during, and after their care with their practice. This would typically start with their initial referral and/or phone call to the practice, their intake, their care, their discharge and then ultimately post-discharge regimen. Once a practice has the road map drawn up, then one can start to think about how to engage with the patient at each of those steps on the journey and figure out what the right message is and how to deliver it to the patient.

Tannus Quatre: Use a multi-channel approach as patients like to engage with their providers through a variety of methods, including patient portal, email, text message, videoconferencing, and more. Go digital. Patient engagement without a strong digital foundation will be expensive and ineffective. Leverage sophisticated and specialized tools from rehab therapy-specific firms that understand best practices patient engagement workflow for therapists.

Steven Presement: Patient engagement should begin right from first point-of-contact. Patients should be able to register themselves from your website, book their first appointment online, receive a text message right away with their intake paperwork and consents/policies to engage them immediately. They should be texted a “thank you” after each visit, they should receive periodic surveys, they should be reminded if they have cancelled an appointment and not rebooked, they should certainly be texted if they have not lived up to their treatment plan, and finally, they should be texted post-discharge to check-in, ideally all automatically.

Heidi Jannenga: The company offers free and comprehensive resources on our blog as well as the Physical Therapists’ Guide to Patient Relationship Management to help clinics get started with patient engagement basics. What’s important to know is that no step toward building a patient engagement strategy is too small. According to research by WebPT, 20% of all physical therapy patients drop out of therapy within the first three visits, and 70% never complete their full course of care. Patient engagement strategies are instrumental to helping both PT clinics and PT patients thrive.

For clinics that already have a patient engagement strategy, how can they evaluate its effectiveness? And, for clinics that struggle to make patient engagement work, how does your company help practices overcome those struggles?

Sharif Zeid: Assessing any strategy or system is crucial to its continued evolution. Practices should evaluate their strategy for strengths and weaknesses. There are a number of ways to evaluate an engagement strategy. One method would be subjective; this would be primarily through the use of surveys or simply directly asking patients if they felt good about the communication and their experience with the practice before, during, and after their care. The other method would be objective, which would include reviewing data about patients’ utilization of communication (including things like email open rates, etc). The best assessment should include a combination of both methods. Practices that are experiencing success should look to build upon their strengths. Practices struggling should look to change their strategy (eg, timing, messaging) and then reassess and repeat until things get to where they should be.

Tannus Quatre: Choose which metrics you wish to measure. There is immense variability in the metrics, which may be relevant based on the systems and priorities of the practice. Once chosen, create a dashboard that is evaluated on a regular cadence to fully understand the effectiveness of the patient engagement plan. Set performance benchmarks for these metrics. If adoption rate of the patient portal is a key goal in your patient engagement strategy, set a target and monitor progress toward the benchmark. Perform a root cause analysis for achieving or missing the benchmark to know where to focus your improvement efforts. Evaluate your metrics, benchmarks, and performance regularly. Your measures and benchmarks are likely to require change over time, so don’t allow your efforts to become outdated in the fast-changing environment of patient engagement.

Steven Presement: Evaluating the effectiveness can be tricky if you don’t have any “pre-engagement” revenue numbers to compare. Are patients commenting on the engagement strategy? It wouldn’t hurt to ask patients if it’s too much, too little, if they enjoy them, etc. We have an application that ties directly into Practice Perfect EMR (or any other EMR, if they wish), which completely automates the engagement process with campaigns the clinic determines, including two-way texting.

Heidi Jannenga: The key to evaluating patient engagement comes down to a few metrics: patient loyalty, retention, and reputation. Each of these provides actionable insights into patient engagement effectiveness and opportunities to improve. Net Promoter Score (NPS) tracking is a great barometer to gauge patient loyalty. NPS tracks, on a scale of one to ten, how likely a patient would recommend a clinic to their friends or family. This measurement can help evaluate effectiveness whether or not the clinic has a formal patient engagement strategy.

Patient retention is a key indicator as well. As I mentioned previously, patient dropout is a pervasive problem in physical therapy. If clinics are seeing an increase in patient dropout, that should be a red flag that something isn’t working. Both retention and patient loyalty tie into reputation—which clinics can determine through a quick Google search. A successful patient engagement program should be generating positive online reviews and/or referrals to boost your online visibility and help you attract more patients. For those who are struggling with patient engagement, WebPT offers an end-to-end solution that automates NPS tracking, measures patient retention with key benchmark data, and helps clinics manage and market their online reputation. PTP