The COVID-19 pandemic hit the PT industry like a wrecking ball—and now clinics across the nation are beginning to pick up the pieces and learn how to treat patients in this new, virus-laden world. To help PTs navigate this new healthcare landscape, Heidi Jannenga, PT, DPT, ATC, WebPT Co-Founder and Chief Clinical Officer, and Nancy Ham, WebPT CEO hosted an hour-long webinar discussing the impact of the pandemic and strategies for reopening. We received so many questions during the live event—too many for our expert hosts to answer—that we compiled the most frequently-asked questions and answered them below. Don’t see the answer you’re looking for? Leave a comment at the bottom of the page and our team will help ya out.
- Financial Management
- Safety Protocols
- Mergers and Acquisitions
- Telehealth Services
- Marketing Strategies
Where can we trim expenses to make up for lost revenue?
Unfortunately, labor costs tend to be organizations’ highest expenditure, which may mean that—in order to stay afloat—you have to change how you staff and pay your employees. The next expense to consider is rent. If you haven’t already called your landlord to renegotiate the terms of your lease, do that immediately. In some cases, you may be able to pay less rent for a number of months and defer the increase until next year to give yourself some extra breathing room. Depending on how you envision your practice on the other side of this crisis, now may also be the time to reduce your operational footprint.
Beyond that, we recommend reviewing your expense register, reaching out to your vendors, and exploring more cost-effective product options. Further, reduce or minimize luxuries (e.g., travel or conference budgets) as much as possible. Some states are even adjusting their CEU requirements, so therapists have more opportunities to complete their courses online. This can significantly reduce the cost to attend a course and obtain credit.
Finally—in addition to looking for ways to trim expenses—we also suggest looking at ways to increase your revenue streams. Consider specializing in a new niche or offering alternative services (like dry needling or wellness services) to your patients.
How much cash should my clinic have in reserve?
A good rule of thumb is to have three months’ worth of cash on-hand to cover operating expenses (i.e., disaster reserves), and another three months on top of that. Accumulating that much money might sound intimidating, but it’s doable. Start by trimming expenses where you can, negotiating better deals with your landlord and vendors, and looking for additional revenue streams.
Should my clinic schedule more PTAs or techs since they’re less expensive than staff PTs?
Possibly yes—where it’s appropriate. PTAs and therapy techs play an essential role in patient treatment, but how you schedule them will depend on your payer mix. (Some payers, like Medicare, strictly limit how techs and/or PTAs can assist with treatment.) But, at the end of the day, initial evaluations, reevaluations, and a handful of critical treatments can only be furnished by PTs and OTs, so you need to schedule enough therapists to keep up your patient volume. Once your patient volume begins returning to normal levels, that might be a good time to start bringing assistants and tech back into the clinic.
How can we project revenue if our therapists do not complete their notes in a timely fashion?
Start by setting clear expectations with your staff members about completing their documentation in a timely manner. This is important for creating accurate revenue projections and ensuring that your practice is maximizing its cash flow—which is essential right now. In the meantime, you should still be able to implement the first revenue projection strategy that Jannenga and Ham discussed during the webinar: Simply multiply your weekly or monthly new patient volume by the average visits per new patient and average revenue per visit. That formula should help you project your revenue.
As a mobile PT (i.e., I come to you), is this a good time to boost my cash offerings?
That depends on your client base—who they are, what insurance carriers they use, and how likely they are to pay for a service out of pocket.
What should I do if a patient does not want to wear a mask during a PT visit?
To avoid this situation from the get-go, make a concerted effort to set expectations with your patients before they come to your clinic. If you have a mandatory mask policy, tell patients about it when they first call to make an appointment. When you send an appointment reminder, inform patients—yet again—that a mask is required inside the clinic. The day of the appointment, consider making yet another call to patients to remind them to wear a mask. Additionally, post your mandatory mask policy outside your clinic’s doors so patients see the reminder before they walk into the clinic. If a patient forgets to bring a mask but is willing to wear one, consider keeping some masks on hand that you can hand out as necessary.
At this point, if the patient is still unwilling to wear a mask, you have the right to turn them away in the name of maintaining a safe environment for your staff and other patients.
What should we do if a patient is under physician orders to not wear a mask? Should we excuse these patients from the mask requirement?
According to Veda Collmer, JD, OTR, WebPT’s Chief Compliance Officer, if a doctor orders a patient not to wear a mask, then the clinician should not enforce the mask requirement. As an alternative, providers may offer telehealth or isolated in-clinic services. According to Collmer, “If the clinic has capabilities to sequester the patient during his or her visit and the provider is wearing a mask, the risk of spreading infection is mitigated.” That may require “providing service in a private room or scheduling the patient when the clinic has a low volume of patients.”
Do you have any tips for cleaning small tools such as therabands, foam wedges, or other items with porous surfaces?
Per CDC guidelines, you should clean soft, porous surfaces by removing “visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces.” Once clean, “launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.” If you are unable to launder these items, the CDC recommends cleaning them with “products that are EPA-approved for use against the virus that causes COVID-19 and that are suitable for porous surfaces.” You can view the list of EPA-approved cleaning agents here.
Mergers and Acquisitions
We’re thinking about selling our practice, but we’re worried that we won’t get its full value in the current economy. But, with revenue down, we’re also worried about continuing to lose money. At what point are we better off selling for a lower price instead of waiting it out and continuing to lose revenue?
This really depends on your clinic’s cash reserves and its ability to weather the storm. But, it is important to note that selling your practice and continuing on as normal aren’t your only two options. More and more clinics are entering into alternative merger and acquisition relationships that don’t involve a full sale for pennies on the dollar. For instance, some companies are willing to step in and take on operating expenses (or temporarily pay staff), until revenue begins to pick up, putting both organizations in positions to prosper. Remember, there are good companies out there that want to forge mutually beneficial partnerships for years to come.
Would it be beneficial for us to enter into a partnership with a clinic in a different area or region that is less impacted by COVID-19?
Potentially, yes. Prior to the pandemic, many organizations preferred to merge with—and acquire—clinics inside specific, limited geographic regions. But now, there is budding interest in reaching into new spaces. For example, individuals and organizations that had a strong presence in urban areas are beginning to consider expanding into rural areas, which (generally speaking) have been less affected by COVID-19. There’s something to be said about finding strength in numbers—but make sure you pursue business opportunities and relationships that ensure balance. You must be able to support one another through the ebbs and flows.
Is this a good time to acquire the practice of a retiring practitioner that comes with referral resources and active patients? These are very uncertain times and I am not sure if it’s a good investment.
Ultimately, that depends on the state of your finances and the finances of the practice that you’re looking to acquire. However, if you believe that you found a good deal and a beneficial acquisition opportunity, then it may behoove you to strike while the iron is hot. Nancy Ham suggests working out an acquisition deal where you don’t have to pay the entire cost of the practice up-front. For example, you could potentially partner with the retiring practitioner and work with them side-by-side for a time before completely acquiring their business.
Do you think telehealth will remain a covered service for PTs, or do you expect that it will return to being largely non-covered in the future?
We think that telehealth is here to stay—at least, for a while. The most recent spike in COVID-19 cases indicates this crisis will probably not end any time soon, and CMS Administrator Seema Verma is talking openly about telehealth’s benefits for providers and beneficiaries. That said, we don’t want to sit on our laurels—we want to ensure that telehealth will become a permanent fixture in the PT industry. That’s why it’s so important that we participate in industry-wide telehealth advocacy efforts.
If insurance carriers stop paying for telehealth after the pandemic, how will this affect the hybrid therapy model?
It’s tough to say. If states allow therapists to continue providing telehealth after the pandemic (but insurance carriers stop paying for it), then the fate of the hybrid model lies in the hands of patients. If the patients in your community feel like telehealth is providing a lot of value, then they may be willing to pay for these services out of pocket. If that’s the case, your clinic could continue to provide telehealth on a cash-pay basis.
Is the payment rate for telehealth different than the payment rate for in-person services?
Sometimes. Prior to the pandemic, payers reimbursed telehealth services at a lower rate than in-person services. However, due to COVID-19, many payers (e.g., Medicare) are currently offering pay parity for telehealth and in-person services. Some states are even requiring pay parity (e.g., Arizona). Check with your PT state board, your individual payers, and your payer contracts to learn more about telehealth payment in your area.
Do I need to get credentialed with insurances for telehealth, specifically? If so, how do I accomplish this?
If you’re already credentialed with a payer, then you shouldn’t need additional credentialing to provide telehealth. However, we would still recommend reaching out to individual payers to determine their specific telehealth guidelines.
What is a good ratio of in-clinic visits to telehealth visits for each patient? For example, should we do one in-clinic visit per week and two visits via telehealth?
That entirely depends on the patient, the specifics of his or her condition, and the capacity and state of your clinic and team. Unfortunately, telehealth is largely uncharted territory for PTs, and there’s little guidance about telehealth best practices. With that in mind, this is an excellent opportunity to begin collecting data to identify trends and best practices for this new hybrid PT delivery model.
I work in a subacute setting and we have older clients who have limited access to smartphones or computers. How can they receive telehealth services?
Unfortunately, without access to—or comfort with—technology like smartphones, tablets, and computers, this population may not be best served via telehealth. However, older patients are beginning to ramp up their technology usage and improve their technological savvy. While your current set of patients may not be best served by telehealth, that could change in the near future.
Fewer patients feel comfortable attending therapy in our region, so competition has skyrocketed. What are some good strategies and tactics for out-marketing these competitors?
Make sure you understand and actively communicate your data-backed value proposition (i.e., why patients should seek your services, specifically), and consider offering new services that address the unique problems created by the pandemic (e.g., offering remote, PT-led exercise sessions to gym-goers).
Communicate with the patients you’ve seen in the past, and tell them about how your clinic is keeping patients safe—whether that’s by providing telehealth services, or by adopting rigorous infection control standards inside your clinic. Additionally, try reaching out to your old referral sources. Check in and see how they’re doing and—if they’re open—tell them that you’re open for business and that you’re operating with patient safety at top of mind.
And finally, make sure your public-facing information (e.g., your social pages and your website) communicate this same information. If patients are brave enough to venture into a PT clinic, they’ll likely want to know how you’re keeping them safe.
Other than offering and marketing telehealth visits, how can we make up revenue lost due to decreased patient volume?
Start by looking at your billing processes and ensure that you’re coding properly (e.g., correctly applying the 8-minute rule) and maximizing your time with patients. If you have PTAs or OTAs on staff, try strategically scheduling them in a way that allows your therapists to see more patients. Additionally, ensure that you’re collecting patient balances at the time of service—and make time to review and clear your outstanding accounts receivable.
This is also a great opportunity to get creative with your suite of services and find new ways to provide value to your patients—and community. For example, many gyms are closed, which means a PT-guided personal training visit could be a great service to offer to the community.
How can we get patients excited about telehealth?
A great way to get patients excited about telehealth is by talking about how it promotes accessibility, safety, and convenience. Telehealth is a great way to provide critical care to at-risk groups—or people who are in contact with someone in an at-risk group. Whatever the case, your patients can access care from the safety of their homes. Plus, telehealth therapy is convenient. Patients don’t have to worry about planning for a 20-minute commute to the clinic—they can sit down in their living room and join the videoconference within seconds.
Can we complete initial evaluations via telehealth?
Sometimes; it varies from state to state and from payer to payer. Reach out to your PT state board and check your state practice act to determine if you can legally provide initial evaluations over telehealth—and contact individual payers to determine if they cover remote evaluations.
Any idea how this is impacting the rehab therapy job market—particularly for new grads?
It’s difficult to say for certain—especially since the situation is continuously evolving. We imagine that, because of the recent increase in furloughs and layoffs, there are fewer job opportunities available for new graduates. That said, we’re not yet sure how this situation will play out over the next six months to a year. If seasoned therapists decide to explore early retirement, for instance, job opportunities for new grads might actually increase in number. But, of course, this is just speculation—and job markets are going to vary by region.
Are there any educational programs or training courses that focus exclusively on rehab therapy treatment for late effects of COVID-19?
Yes; the APTA Cardiopulmonary Section recently developed this video series, which offers clinical advice for treating post-COVID patients in the outpatient physical therapy setting. The APTA has also developed numerous educational resources and CEU courses for treating COVID-19 patients, which you can access in the APTA Learning Center.
How can I ensure employees who are on social media are not damaging my clinic’s reputation with their social activity?
If you don’t already have one, create a company social media policy that each employee signs at their date of hire. This policy should ask employees to represent only themselves when they post online—not the company—and it should discourage them from tagging or referencing the clinic where they work. Additionally, consider providing a staff outlet where your employees can speak in a safe environment (maybe through a bi-weekly video conference call). If your staff feels heard by management, they’re less likely to take to social media to air their grievances.
Still got some questions? Drop ‘em below and our team will do its best to find you some answers.
The post FAQ: PT After Crisis: Recovering, Reopening, and Refocusing on the Future appeared first on WebPT.
We’ve talked at length about nearly every aspect of telehealth as it relates to physical therapy: its advantages, its shortcomings, how to bill for it, how to launch and market it—the list goes on. However, there’s one angle we’ve yet to cover, and it’s perhaps the most important when it comes to the future of telehealth in rehab: the case for telehealth’s continued use and coverage in PT.
Why is this critical now? Because as we move closer to the end of the COVID-19 emergency period—and as more clinics reopen their doors to in-person treatment—telehealth’s role in physical therapy treatment becomes less concrete. Plus, Medicare and other payers have indicated that they may eventually discontinue the telehealth coverage they initiated in response to the pandemic. This would be a huge mistake for many reasons, and Bay State Physical Therapy—a therapist-founded, owned, and operated outpatient physical therapy practice with more than 60 clinic locations—has the data to prove it.
A Bit of Background
On March 23, Bay State PT officially launched its telehealth services, conducting routine patient visits through a contracted and HIPAA-compliant telehealth platform. The team’s goal with implementing telehealth was to maintain care access and ensure patient safety during the COVID-19 emergency period. In under three months, Bay State PT went from having delivered zero telehealth visits to 20,000.
Throughout the entire process, the team regularly gathered and reviewed patient feedback to ensure each clinic’s telehealth services aligned with patients’ evolving needs. This inspired Bay State PT to conduct a company-wide survey, in partnership with Northeastern University, to objectively measure telehealth patient satisfaction. (For more detailed analysis of this study, check out this report.)
The clinical outcomes Bay State PT has recorded over the past three months—in conjunction with the results from its patient satisfaction survey—turned the practice’s president and founder, Steven Windwer, DC, PT, from a self-admitted “telehealth skeptic” to a “true believer.” Perhaps more importantly, though, the data also presents an irrefutable case as to why telehealth should remain a permanent fixture in physical therapy.
Here are some of the most salient takeaways from Bay State PT’s data study:
Patients liked their telehealth experience.
Like Windwer, many therapy providers are leery of telehealth because physical therapy treatment often requires a hands-on approach. So, when introducing telehealth services to their patients, Bay State PT practitioners feared their Net Promoter Score® (NPS®)—a measure of customer satisfaction and loyalty—would take a significant hit. Much to their surprise, the opposite happened.
Patient loyalty and satisfaction scores remained high.
Prior to March 21, 2020, Bay State PT’s average NPS® score was 86.85. However, from March 23 to June 9, 2020 (when the practice began implementing its telehealth services), its average NPS® score rose to 91.25. Patient satisfaction survey results echoed this trend, with 95% of patients indicating that they were either “somewhat satisfied” or “very satisfied” with their telehealth experience. These numbers were nearly as high as Bay State PT’s in-clinic satisfaction scores, which typically average 98%.
What’s more, the clinic’s survey data show that older patients—who are often considered more technology-averse—were just as satisfied with telehealth as their younger counterparts. “We believe our older patient population, who are most at risk for the COVID virus, truly appreciated the speed at which we shifted to telehealth as well as the convenient access and surprisingly effective interaction with our therapists,” explains Windwer.
Many patients still find virtual care preferable to in-clinic visits.
Even though Bay State PT is upholding the CDC’s COVID-19 safety guidelines to a tee, many of the clinic’s patients (39%) are still uncomfortable returning to in-person appointments. By discontinuing telehealth coverage, Medicare and other payers would not only do a disservice to these patients, but also ignore an important shift in how patients want (and in some cases, need) to receive care. And isn’t that the point of value-based care—to provide a positive patient experience?
The flexibility telehealth affords is attractive to a wide variety of patients, such as:
- frequent travelers;
- those who are are sick with a contagious illness;
- patients who have trouble finding childcare;
- older patients with mobility issues; and
- patients with compromised immune systems.
By and large, extending telehealth privileges on a permanent basis—well beyond the end of the pandemic—would allow practices greater scheduling flexibility and support improved plan of care adherence.
Patients enjoyed greater care access.
It’s well-known that care continuity equates to better health outcomes, higher patient satisfaction rates, and lower healthcare costs. Thus, lapses in care can dramatically impact the ability to effectively treat patients via conservative therapies, which leads to poorer health outcomes and higher costs.
Patient no-show rates remain lower today than they were before the pandemic.
Although it has its limitations, telehealth gave Bay State PT a way to sustain many of its patients’ care plans from afar while stay-at-home orders were in place—and with inspiring results. The practice’s no-show rate after implementing telehealth dropped from 13% pre-COVID to 8% today. This was a clear indicator that telehealth services were a valuable and convenient option to patients.
“Given the ease and convenience of telehealth, it actually makes a ton of sense that patients would not cancel their appointments at the last minute,” says Windwer. “Furthermore, if something did come up for a patient, it’s very easy for our therapists to squeeze in the appointment at a more convenient time the same day.”
Patients realized downstream cost savings.
Delays in care affect more than just health outcomes—they often come with a higher overall price tag. When treating patients with low back pain, for example, episodic expenses decrease by 55% when these patients receive physical therapy within three days of onset versus 29 or more days after onset.
Patients reached their discharge goals sooner than they did before telehealth was an option.
In Bay State PT’s case, patients realized individual cost savings in shorter courses of care: patients were reaching discharge goals one visit sooner than they were pre-telehealth. That means one less visit payment.
And when patients experience uninterrupted care, they are more likely to achieve optimal outcomes quicker—which can help them avoid more expensive interventions like surgery down the road.
Telehealth prevents care disruptions that end up costing the entire healthcare system more in the long run.
All of that is to say that telehealth is not just a quick fix that has helped keep practices afloat and patients healthy during this unprecedented crisis—it truly is a sustainable alternative that allows patients to receive care when life prevents them from attending appointments in person. And it’s imperative that the physical therapy community advocate for continued telehealth coverage, as this will enable them to further diversify their services and strengthen the PT industry as a whole.
Take it from Windwer, the aforementioned “telehealth skeptic”: “Although COVID has brought many unforeseen hardships, it’s also brought with it a few bright lights. One of those is telehealth. I hope private payers and Medicare see the light as I have, and resolve to cover telehealth moving forward. If they have any skepticism, then I implore them to dig into the data. With so many lives lost during the pandemic, it would be a shame to lose this opportunity to improve access and lower the overall cost of care.”
Have more questions about applying telehealth in your practice? Wondering what you can do to advocate for its continued coverage in physical therapy? Let us know below and we’ll steer you in the right direction.
The post The Data-Backed Case for Continued PT Telehealth Coverage appeared first on WebPT.
Let me tell you a joke. Two humans walked into a bar. The third one ducked.
Which one are you?
The first two humans walked into the bar because they were not conscious of their surroundings. They were not aware of the dangers in front of them. Some of you may feel like you just walked into a bar due to the social tensions in America. You may feel like you don’t know what everyone’s arguing about, or why people are upset—or maybe you thought the situation wasn’t that bad. You may have even voiced your thoughts in a public space, only to be met by a negative response. You may have been “cancelled” by a family member, friend, or peer. That’s because the bar of social injustice is long and wide, and we are living in a historic moment where people are demanding its removal.
How will you engage in the fight for social justice?
Social justice requires equal access to privileges—like wealth or various opportunities—within a community or society. Without equal access to privileges, social injustices flourish until inequities appear everywhere—in education; housing; health care quality; distribution of wealth, violence, and policing; and other social staples in the world. But different opinions about social justice—what it is and how to achieve it—divide our country and our profession. The death of George Floyd and other recent events have forced us to enter a season of increased discussion and conflict around social injustices. We will have to make big decisions regardless of our individual stance. The decision to support or to not support the movement. The decision to engage conversations or not to engage.
If you choose to stay neutral, that decision will be judged by your peers, your friends, and the communities you serve—and often, neutrality is viewed as conscious, subconscious, or unconscious support of social injustice. You are the third human who ducked. You are aware enough to know that there is a problem, but you ducked the issue.
But you are a physical therapist, rehabilitation provider, or a business owner. You do not have the luxury of ducking, because you have entered into a healthcare partnership with your community—often with marginalized communities. Our industry works with communities that suffer the most from chronic disease and disability, and these mutualistic partnerships are extremely vulnerable during social crises. You have already recognized the bar—the problem—and you’re bound by an obligation to either ignore or help solve it.
How will you protect marginalized communities?
Patients who engage in a partnership with you will require a response to the current historic moment. In the absence of a response, whispers of social injustice and health inequity will wind through your clinic’s waiting rooms and staff areas, and in your satisfaction surveys and staff productivity and retention data.
We’ve seen the consequences of silence in academia. Silence breeds distrust. Distrust destroys the sense of community within and beyond the walls of your clinic. How will you protect your partnership with marginalized communities? How will you protect your most valuable asset—your connections and relationships with your patients and staff?
1. Acknowledge your risk areas.
Risk and risk management are a foundational part of the business experience, and risk related to social injustice requires you to have crucial conversations with your staff. You must honestly assess your organizational values and beliefs, and establish cultural norms that are agreed upon by all—not just your leadership team. New cultural norms that are determined by those in power are seldom effective when building a healthy work environment. Effectively setting new cultural norms requires collaboration and universal buy-in. But if you create that cohesive work community, then you will ensure the highest levels of operational continuity and team health and wellness—even during times of social crisis.
2. Know your community.
Start by asking yourself what you truly know about your staff. Can you identify their many layers based on the dimensions of the Loden and Rosener diversity wheel? What are your staff members’ pain points? How have they been (or how are they currently) marginalized? Make an effort to ask these questions, because unaddressed or ignored pain heightens during times of social crisis. This can be a risk or an opportunity for business owners and leaders. Have you expressed sympathy or empathy for your staff who are hurting?
Offer support for non-marginalized groups, too. During times of social crisis, there is often collective grief, pain, and loss. People hurt on all sides of the crisis—and therefore, everyone is vulnerable during a crisis. Have you also reflected on what your staff knows about you? If you asked your staff to state your values and beliefs about the current social crises, what would they say? Remember, you are part of the community, too—and you should express your voice and life experiences.
But, this is not the time to speak for anyone else. Speak as an individual and a fellow community member. It is not your responsibility to speak to another person’s experience. Instead, listen and respond with your personal truth—and lead through truth and vulnerability.
Seek more knowledge.
Think about your community more broadly. What do you know about the vulnerabilities of the communities you serve? Have you researched and identified the social vulnerabilities and health outcomes at your state, county, city, and zip code level? Consider the benefits of a community advisory council to determine the needs of your community and how you can meet them. Remember that many rehabilitation clinics are not located directly in the areas of greatest need, so you should seek advice from a diverse group of community members.
3. Prepare your response.
You must respond to these crises. Do not duck. Even if you do not support some actions that your community takes, you can acknowledge their pain. After all, everyone wants to be seen and heard. I often tell people that the truth is in the middle. However, the middle requires two opposing ends, and those ends must speak their truths. You cannot afford to not respond—and it’s not really a neutral option, either. Ducking the issue is still a response, and it tells people that you’re willing to ignore them or their lived experiences.
4. Prioritize transparency.
We all need honesty right now, but honesty is not meanness. When you speak your truth, be clear, but speak with kindness. Remember that clarity requires that you work on yourself—which means you must educate yourself on the issue, ask yourself why you believe what you believe, and challenge the story you tell yourself. We have all been marginalized at one time or another in our lives. We all know when we are being lied to—either directly or indirectly. Don’t waste your time or others’ time with a lie. The community deserves to know who you are and where you stand so they can make an informed decision about entering or remaining in a partnership with you. Speak your truth with love and kindness, and we can all try to grow together.
5. Stay true to your response.
Regardless of how you respond to the current social crises, take an action—something that aligns with your authentic response (and preferably something you can measure). For example, try:
- hosting staff focus groups to discuss your workplace culture;
- hosting community town hall meetings;
- analyzing your vendor relationships and finding opportunities to diversify; or
- inspecting your policies and procedures for biases against staff or customers.
Consider offering regular perspectives or impact reports to staff and the communities you serve. This effort will improve employee trust, satisfaction, and retention. You will also solidify your brand in the community.
It’s time to be courageous. Be the fourth person—the person who removes the bar of social injustices. Be the person who understands that injustice for one is injustice for all. If you are not ready for that conversation, consider this fact: the economic impact of health inequities (a social justice issue) annually costs taxpayers between $54 and $61 billion. As you review your accounts receivables, think about the potential benefits to your bottom line if customers had the resources to pay their co-pays and deductibles—or if payers could improve reimbursement rates. Correcting social injustices, regardless of your motivations, will affect everyone. Remember, a rising tide lifts all boats.
Are you ready to lift that bar out of the way?
In solidarity as a fellow human,
Lisa VanHoose, PT, PhD, MPH
Lisa VanHoose, PT, PhD, MPH, is the founder of the Ujima Institute and a Director of the Doctor of Physical Therapy program at the University of Louisiana Monroe. VanHoose is committed to reducing the healthcare equity gap for underserved communities (especially black communities) and is currently serving on the Health Disparities and Research subcommittee of the Louisiana COVID-19 Health Equity Task Force. She loves wrestling with complex questions and believes that all communities need access to healthcare providers who are empathetic, well-versed in cultural humility, and committed to providing high-quality care.
The post Responding to Social Crisis In Your Clinic and Community appeared first on WebPT.
Regardless of what you believe to be the societal and social implications of physical distancing, most people have—at least somewhat—adjusted to allowing for six feet of extra space between themselves and others. However, while it may be easy to scoot to one side of a wide sidewalk to let someone else pass by, social distancing in the clinic comes with a lot more challenges. Not only are patients probably not yet used to navigating a therapy environment in this manner, but the space itself also may not be totally conducive to allowing for such a wide berth. With all this in mind, here are five creative ways to promote social distancing in your clinic (adapted from this resource).
1. Have patients check in for their appointments outside of your office.
Depending on the size of your clinic, it may be a good idea to have your patients check in for their appointments—and wait—outside of your building. You could ask patients to call when they arrive, and then have a front-office staff member meet them outdoors to check them in, perform any necessary screening tests (e.g., a temp and symptom check), and collect any additional patient information. Then, you can call when you’re ready for them to come inside and start their appointment.
Digital intake forms can be incredibly helpful during this time, too, as you’ll already have patient demographic and insurance card information on file, which means you won’t need to collect documents during this encounter. On that note, touchless payment processing is also a huge convenience. (WebPT offers both; simply leave a comment at the bottom of this post if you’d like to learn more.)
2. Put marks on the ground to help patients visualize a six-foot distance.
Depending on your patients’ spatial reasoning ability, they may need some assistance visualizing—and maintaining—six feet of distance. For that reason, consider putting marks on the ground to indicate where patients can stand to, say, leave adequate space between themselves and the staff member who is collecting their payment, or another patient who is performing exercises in the same room.
Just remember that six feet of distance means six feet in all directions. I’ve seen way too many instances of marks that are six feet apart in one direction but only about two feet apart in the other.
3. Move exercise equipment and chairs to allow for extra room.
In addition to putting marks on the ground, consider removing some pieces of furniture and exercise equipment to allow for more spacing between the items that remain. More empty space means fewer opportunities for patients to crowd one another.
4. Stagger patient appointments.
While we know that you want to get your practice up to full capacity ASAP, you may need to stagger appointments in order to ensure that your patients—and staff members—feel safe coming in. While there is no magic algorithm for determining how many patients to have in the clinic at once—as so much of it depends on the space and layout of your office as well as how you transition patients through their sessions—we recommend starting off conservatively and adjusting as necessary based on how your patients use the space and how time consuming it is for your staff to properly clean all surfaces between appointments. You may find that you can have several patients in the clinic at the same time and simply alternate the order in which they move through your facility. For example, you may start some patients in the gym area with guided exercise while others start with manual therapy in the treatment area (rather than starting all patients in the treatment area).
5. Share policies in advance.
Regardless of the policies you decide to implement to help your patients and staff socially distance, be sure to communicate your intentions and expectations before patients arrive for their appointments. Doubling up on this communication may even be helpful. For example, have your front-office staff verbally share new processes with patients when confirming their appointments, and then follow up with an email containing clear written instructions for navigating the situation. If you expect patients to wear masks, for example, make that point clear—and it wouldn’t hurt to have extra masks on hand, because someone will almost certainly forget. Same goes if you decide to limit the number of people who can accompany a patient to an appointment. If family members aren’t welcome to come along—or even wait inside—it’s important to share this information before the patient and his or her family arrive.
Any time you introduce new processes, clear communication is paramount. So, before you implement any changes to promote social distancing in your clinic, be sure to loop in your team and give them the opportunity to ask questions and voice objections. The staff members who are interfacing directly with patients will likely have valuable insight to share about patient behavior and appointment flow.
On the subject of communication, you may also want to make it a point to share with patients how your team is handling safety precautions—for example, going through regular health screenings and washing hands and/or changing gloves between patients. Doing so may minimize patients’ anxiety about receiving hands-on treatment and exercising in a shared space.
The post 5 Creative Ways to Promote Social Distancing in Your Clinic appeared first on WebPT.
Integrating Picmonic for Nursing into the nursing program at Northeast Alabama Community College meant embracing change. Making big changes, like to how nursing educators interact with and teach their students, isn’t usually something people are eager to do. But as Magan Edwards, Nursing Faculty at Northeast Alabama Community College shares, it is more than worth […]
The post Bringing Picmonic to Northeast Alabama Community College’s Nursing Program appeared first on Picmonic.
In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) will offer flexibilities to clinicians who chose (or were mandated) to participate in MIPS during the 2020 performance year.
The Merit-Based Incentive Payment System (MIPS) is a Medicare payment program that rewards clinicians with financial incentives for improving the quality of care in their clinics—as per the standards of the program. Last year, 2019, was the first year that PTs, OTs, and SLPs could participate. While MIPS participation was optional for a large majority of rehab therapists, many chose to opt into the program in an effort to improve Medicare reimbursements for their clinics.
However, with the rapid spread of COVID-19 and its impact on the healthcare industry, CMS recognized that many MIPS participants may struggle to successfully report in 2020. So, on June 24, 2020, CMS announced that it would give 2020 MIPS participants some reporting flexibility.
Extreme and Uncontrollable Circumstances Application
CMS has opened up access to its Extreme and Uncontrollable Circumstances Application for MIPS participants. Through this application, participants (including individuals, groups, and virtual groups), can “request reweighting of one or more MIPS performance categories to 0%” due to hardship from extreme and uncontrollable circumstances—a pandemic, for example.
Essentially, what this means is that, upon application approval, reweighted categories will not contribute to a final MIPS score. So, because PTs, OTs, and SLPs are currently only eligible to participate in two of the four MIPS categories (quality and improvement activities), they could ask to reweight one or both of these categories.
CMS will review applications “on a case-by-case basis,” and the deadline to apply is December 31, 2020. Also, keep in mind that if you end up submitting performance data to CMS, it will void approved applications on a category-by-category basis.
How to Submit an Application
MIPS participants can submit an Extreme and Uncontrollable Circumstances Application through the QPP website (linked below) by following these instructions from CMS:
- Register for a HARP account (i.e., an account through the QPP) if you don’t have one.
- Sign in to the QPP website.
- Select “Exceptions Applications” in the navigation bar on the left side of the page.
- Select “Add New Exception.”
- Select “Extreme and Uncontrollable Circumstances Exception.”
- Complete and submit the application.
New COVID-19 Improvement Activity
For clinicians and groups that would like to continue participating in MIPS, CMS has added one new high-weighted improvement activity to the pool “to provide an opportunity for clinicians to receive credit in MIPS for the important work they are doing across the country.”
MIPS participants can receive credit for this activity in one of two ways:
- “A clinician may participate in a COVID clinical trial and have those data entered into a data platform for that study; or
- A clinician participating in the care of COVID-19 patients may submit clinical COVID-19 patient data to a clinical data registry for purposes of future study.”
Please note that while rehab therapists can theoretically report this activity, many will not meet the activity’s logistics criteria. Therapists who work in physician practices are the most likely candidates to be eligible to report this activity.
MIPS participation always comes with a degree of risk—and, all things considered, this might be a good time to assess how much risk your clinic can assume. Have questions about MIPS or the flexibility that CMS is offering? Feel free to leave a question below!
2020 has been one hell of a year. We kicked off the new year with a news cycle about fraught international tensions—followed shortly by all-encompassing coverage of the Australian bushfires. In February and early March, news about COVID-19 began picking up steam, and the economy started to feel the effects of the pandemic in April. Early May heralded the arrival of the murder hornets, and the month ended with the tragic death of George Floyd. June was defined by social unrest and the BLM movement (which still continues to this day), and it’s beginning to look like July will be the month of the sun-blocking Saharan dust cloud and the resurgence of COVID-19. (Then comes hurricane season and a presidential election!)
Needless to say, the American public has a lot on its mind, and I think it’s safe to assume that more than a few therapists (myself included) are struggling to stay present at work. It certainly doesn’t help that many providers are spending part of their day in front of a screen delivering remote care; telehealth has some wonderful benefits, but it distances us from the personal connection that we love.
So, what are therapists to do? How do we focus on treating patients when we’re consumed by everything that’s going on in the outside world?
Engage meaningfully with the people in your life.
Meaningful interpersonal connection is like a psychological balm. Studies show that strong social connections can help improve a person’s mental and emotional wellbeing. Unfortunately, with the country in various stages of lockdown, those all-too-important interpersonal connections are in short supply. That’s why we have to make a dedicated effort to connect with the people around us—in our personal lives and at work.
Video conferencing may not be the perfect way to connect with friends and family from a distance, but it’s better than nothing—and it’s definitely a step up from your run-of-the-mill phone call. So, schedule regular check-ins with your loved ones at a cadence that works for you (e.g., weekly or biweekly). If you live in the same city as those loved ones, try to plan safe meetups with one or two people at a time—like masked morning neighborhood walks (six feet apart, of course).
Connect with your coworkers.
If you don’t have many opportunities to connect with your family and friends (or if you just want more connection opportunities), you can forge meaningful relationships at work. This might be the perfect time to get to know your coworkers better. You don’t have to relegate yourselves to talking about patients or your commute—it’s far more rewarding on a personal level to talk about hobbies and recipes. Regular check-ins with clinic compadres (or comadres) who live alone or are new to the clinic can also go a long way to create camaraderie—and even build new friendships.
Create conversation boundaries.
We are being bombarded with bad (or less-than-ideal) news on a daily basis—so much so that there’s a name for it now: doomscrolling. Some people might process these stressors by talking about them, but others—maybe even you—might need a reprieve from the news sometimes. There’s no right or wrong way to process the latest current events, but you definitely need to establish some hard-and-fast conversation boundaries. Whether you decide you don’t want to talk about the news before your morning cup of coffee, or you want a personal media-blackout Friday, you’re well within your rights to kindly ask your social circles to respect your boundaries. Just be careful not to completely bury your head in the sand. The pandemic and BLM have both generated a lot of conversations about public health and diversity, and those discussions are worth having—even if you take a break now and then.
Prioritize your mental health.
Socially, we’ve progressed leaps and bounds when it comes to discussing mental health problems. But there’s still a stigma around mental illness that discourages many from seeking help or taking the steps they need to ensure their psychological well being. Luckily, there are some simple things you can do to help keep your mental health in tip-top shape.
Limit your news consumption.
This suggestion goes hand-in-hand with knowing when to set conversation boundaries with your peers. The reality of our modern digital world is that we have constant access to (and are constantly barraged with) news updates. It’s all too easy to become oversaturated with doom-and-gloom health forecasts and stories of violence and unrest. I don’t want to discourage anyone from staying up to date, but moderation is key. There’s a lot to be said for unplugging from all media (social included).
Try scheduling specific blocks of time where you catch up on the news for the day—maybe after dinner or once a week on Sundays. Do your best to seek information from reputable sources. Misinformation can cause unnecessary tension and stress for you and your peers.
Be kind to yourself.
I’m sure you’ve heard it 100 times by now, but these are unprecedented times, and we’re all trying to muddle our way through. You don’t have to continue functioning like the world is completely normal. If you’re not working at your full capacity, if you’ve had to withdraw from commitments, or if you’ve started replacing some of your home-cooked meals with take-out—that’s okay. We are all coping as best we can, and if you’ve found something that helps you relax (and it’s not harmful to yourself or others), then go for it. There’s no need to beat yourself up.
Part of being kind to yourself is staying active in any way you can. Gyms and other public recreation areas might be closed in some states (in Arizona, certainly), but we’re physical therapists. We’re masters of creating home gyms and adapting exercises to safely keep people active and moving. We should absolutely take advantage of that for ourselves—especially because so many therapists are providing more telehealth services, which limits the amount of activity they do at work.
Know when to seek help.
It’s hard to know when you need to seek additional mental health counseling, but there’s absolutely nothing wrong with doing so. As Mental Health America says here, “you don’t have to be in crisis to seek help.” In fact, it’s better to reach out to a mental health professional before your mental health deteriorates too much. Trained professionals can give you the tools you need to manage your stress and help you process the collective trauma that we’re all experiencing.
Set aside time to take action.
Another way to manage the all-consuming need to stay on top of the latest news is to set aside time in your personal and professional life to take action. When I feel like something is very wrong, I have a burning need to focus on it. That feeling of urgency only subsides when I take an action to fix what I perceive as wrong. Perhaps taking action in your professional and personal life will help quench that fire.
Find solutions to your worries.
Some of the latest major news stories (e.g., the pandemic and BLM movement) are bleeding into our professional lives because of the nature of what we do. We are healthcare professionals, so of course patient safety, public health, and care quality are all top of mind. So, in many cases, it’s actually very appropriate to bring up these current events in the workplace—and addressing them might actually help you take your mind off them.
Take the COVID-19 pandemic, for example. If you’re glued to the updates in your city—and you’re worried about contracting the virus or spreading it to your patients—then revisit your clinic’s infection control policies. You should always follow CDC best practices to ensure the safety of staff and patients. And if you discover an overlooked safety precaution, then bring it up to the clinic manager or director. Don’t sit in fear—take action. Try to fix the problem.
Or, let’s say the BLM movement and the drive for diversity and equality is eating at your every thought. Set aside some time to learn the National Culturally and Linguistically Appropriate Services (CLAS) Standards, and try to recognize and address any implicit biases in your clinic and/or treatment methods. Advocate for diversity, equity, and inclusion (DEI) in your clinic, and speak out against any policies that may inadvertently affect one group of patients more than another. Become an advocate for the people who need your help most, and know that you’re doing your part to aid in the movement.
Engage with your community.
Finally, if you have the time or resources to do so in your personal life, try to give back to your community and advocate for what you believe in. If you’re concerned about the pandemic, advocate for universal mask-wearing and speak out against rampant misinformation. If you feel comfortable doing so, you can volunteer at pop-up COVID-19 testing sites, or you can donate hygiene and sanitation supplies to homeless shelters and local non-profits. If you want to contribute to the BLM movement, continue learning and (again) speaking out against misinformation. Volunteer at local nonprofits (they have digital tasks, too!), sign petitions, support black-owned businesses, donate to humanitarian centers—the list goes on.
You can make a difference in your community, and sometimes being proactive can help you find a modicum of inner peace—which could help you focus on patient treatment.
I’m not going to say that these suggestions are a stressor cure-all, but forging genuine human connections and taking time to care for yourself and your community is a great place to start. We’re all in this together, and we will make it through the muck and the mire to a better day.
The post How to Focus on Treating Patients When it Feels Like the World is Falling Apart appeared first on WebPT.
In light of the ongoing civil unrest in the United States, I wanted to use this month’s Founder Letter as a way to engage with the physical therapy community—a group that includes peers, colleagues, and friends—about the topic of diversity. My hope is to spark meaningful, productive conversations surrounding racial disparity in rehab. As someone with a platform, I feel it is my duty—as well as my privilege—to promote and model a more equitable and inclusive environment for practice leaders, clinical staff, non-clinical staff, and patients alike.
I realize that in writing about this topic, I am inviting an opportunity for heated—and potentially uncomfortable—discourse. All it takes is a simple scroll through the comments beneath any recent article covering race and inequality to know that this topic incites strong reactions—both positive and negative. Still, I believe I have an obligation as a healthcare provider—and a business leader—to (1) think critically about issues surrounding systemic racism, (2) examine the ways it impacts patient health and access to care, and (3) discuss strategies to improve treatment delivery by promoting diversity, equity, and inclusion in the physical therapy industry. It is my hope that you will read this with an open heart and an open mind.
Inclusivity starts with the individual.
Fostering diversity and creating a more inclusive practice is not an overnight transition. And just like any massive undertaking, the work starts at home. As I mentioned before, I believe it is our moral imperative as physical therapists to do everything in our power to improve patient health and well being—and part of that is cultivating an environment of understanding, empathy, and inclusion. To accomplish this, PTs can start by making minor adjustments to their own interactions with patients and colleagues—something that is bound to create a ripple effect.
1. Seek learning opportunities on the causes and effects of systemic racism in healthcare and the physical therapy community.
One of the best things individual therapists can do to cultivate diversity and mitigate potential unconscious bias is to self-educate and listen. There are plenty of resources available to those who wish to learn—from books and research papers to podcasts and documentaries—and many are available online free of charge. It’s a massive topic, so if you’re not sure where to start, I’d suggest familiarizing yourself with definitions of words that are now commonplace (e.g., systemic racism, racist, anti-racist, etc.). It’s not enough to simply acknowledge that systemic racism exists in the PT community; we must also educate ourselves on why it exists in the first place. As you do your research, I encourage you to vary your sources and specifically seek out educational materials that come directly from voices in marginalized communities. A great example is Justice in June, which I am proud to say some WebPTers helped to make available to the public. As you start consuming information, share your findings with people who are open to thoughtful discussion. These types of conversations are just as beneficial for you as they are for the people to whom you speak.
I also recommend taking part in any formal educational opportunities available to you. Many educational institutions—including Yale, Columbia, and Harvard—are offering free online courses on the topics of race and diversity. And when you participate in PT industry conferences—online or in-person—make it a point to attend sessions focused on diversity in our profession. What better way to educate yourself than in a room full of your peers?
2. Be mindful of word choice when interacting with colleagues and patients.
Something we can all do right now is examine the language we use when communicating with—or referring to—individuals from minority groups. (For reference, this resource has a robust list of terms and guidelines for using inclusive language in the workplace.) Certain words or phrases—even when spoken without malicious intent—still communicate a sense of “otherness” to people of minority backgrounds. An example would be referring to an individual as your “______ patient” or “______ coworker,” wherein the blank is filled by that person’s ethnicity, skin color, sexual orientation, or religion—specifically, in cases where that descriptor is irrelevant to the conversation. Often, this reinforces embedded stereotypes, expectations, and the sense that society will always view that individual as a “______ person” instead of simply a person.
Furthermore, it’s important to maintain an open mind and a willingness to listen if you are ever corrected on your word choice—particularly if the person correcting you is from the community you referenced. Missteps are inevitable on the road to change, and terminologies can evolve over time. The important thing is that you’re open to learning.
3. Examine implicit bias and consider how it might impact your interactions with patients.
You’ve likely heard the term “implicit bias” before, but if not, here’s the quick definition: implicit biases are the unconscious beliefs every person has based on stereotypes and societal norms. You’ll note that I said every person—not just some people. For this reason, broaching the topic of implicit bias can be touchy. Most of us don’t want to think of ourselves as having biases—particularly when it comes to minorities or underserved communities. But unlike explicit bias, implicit bias isn’t a conscious choice. Rather, it’s the result of a lifetime of social conditioning that causes us to tie specific qualities to a given demographic. Having implicit biases doesn’t make someone a bad person—it’s simply part of the human condition. However, implicit biases can lead us to make unconscious assumptions about a person based solely on appearances. And as physical therapists, it’s critical that we understand how those assumptions can impact patient treatment. In 2003, the Institute of Medicine in Washington, DC, conducted a report on unconscious bias in healthcare settings that “concluded that unrecognized bias against members of a social group, such as racial or ethnic minorities, may affect communication or the care offered to those individuals.”
While some studies have implied a correlation between implicit bias and patient outcomes, it’s a topic that warrants further exploration. However, we do know that implicit biases can alter the way we communicate with each other—whether that be communication between PTs and patients or PTs and their colleagues.
Recognizing and deconditioning unconscious bias takes a concerted effort, but here are a few actions PTs can take to identify biases and address them:
- Taking Implicit Association Tests (IATs) and reflecting on potential biases.
- Making a list of scenarios that could potentially elicit bias.
- Thinking critically before reacting or responding when those scenarios arise.
- Connecting with populations that elicit bias.
- Avoiding categorizing individuals.
- Remaining humble and acknowledging implicit biases can exist without our knowledge.
Clinic leaders are the drivers for practice-wide culture shifts.
If you’re a leader in your practice, you have the means and the authority to shape the culture and values of your team. While each staff member is ultimately responsible for self-educating and addressing individual biases and behaviors, your leadership can have a major impact on your team’s journey toward prioritizing diversity and inclusivity. There may be bumps in the road, but if you create an environment of learning and self-reflection, you’ll eventually find yourself surrounded by a team that values those same goals.
If you’ve attended any WebPT webinars, you know I believe that achieving greatness in practice starts with education. That’s why WebPT has joined an organized nationwide effort to advance diversity, equity, and inclusion in the workplace: CEO Action. I strongly encourage you to consider joining this movement with us. It focuses on inclusion via the elimination of blind spots.
4. Consider the way implicit bias impacts your hiring decisions.
I mentioned before that unconscious bias can significantly impact how you communicate with your patients, but the importance of addressing biases doesn’t stop there. Implicit and similarity bias can also significantly affect employment practices. A 2016 study by the University of Toronto and Stanford University found that job applicants with anglicized names (i.e., caucasion-sounding names) were the most likely to receive a call back from potential employers. During the study, 25% of resumes for black applicants with caucasian-sounding names received a call back, while only 10% of applicants with traditionally black-sounding names received a call—despite both resumes being otherwise identical. For Asian applicants, 21% of resumes with anglicized names earned a call from the potential employer, while only 11.5% were contacted when their names indicated their ethnicity. Again, the education, credentials, and experience were identical on both versions of the resumes.
This isn’t to say that those employers or hiring managers were explicitly racially biased. In fact, the study had similar results when applications were specifically sent to employers who claimed to be pro-diversity and thus, actively sought applicants of color.
So, what does this mean? To me, it says that even the most well-intentioned employers are prone to unconscious racial bias. It also tells me that we must make a concerted effort to recognize, educate, and negate implicit bias in our recruitment practices. This starts with scrutinizing current hiring practices and ideally, enacting a blind recruitment process—meaning demographic information that may imply an applicant’s race, gender, age, or economic class is removed from resumes before they reach your desk.
Additionally, practices can regularly check their screening processes for discrimination by weighing the percentage of minority applicants against the percentage of those applicants who made the initial cut.
5. Foster an environment that encourages accountability, empathy, and growth.
Let’s face it: discussions around race and inequality are often uncomfortable. I think in most cases, our knee-jerk reaction is to reject racism and any role we might play in it, because of course we don’t want to think of ourselves as racist. These discussions challenge our sense of self, and they ask us to question our own actions—even the unconscious ones. They also force us to re-examine seemingly innocuous tendencies and beliefs we’ve held our entire lives.
Whether the topic is race, religion, or politics, finding yourself in a situation where you’re asked to question a deeply-held belief is like asking your arm to bend in the opposite direction. So, it stands to reason that an individual’s initial reaction to such situations may not be a receptive one. However, with a little patience and encouragement, people often change their minds. So, if you find yourself interacting with someone who doesn’t immediately “get it,” it’s okay. But more importantly, you should promote an environment of learning that allows these individuals to come back later if they’ve had a change of heart—without fear of ridicule or belittlement.
The entire physical therapy profession has a part to play.
This is one of those potential knee-jerk moments, but I hope you’ll keep an open mind to what you’re about to read: nearly every modern system in the United States has been impacted by racial inequity in some way, and unfortunately, health care—including physical therapy—is no exception. I won’t delve too deep into the roots of this disparity—there are many—but I encourage you to do your own research on the subject, as I believe it can help us come up with ways to better address it.
6. Consider the social determinants of health and how diversifying the profession can improve outcomes.
Historical data on the number of black providers in the United States sheds a harsh light on the very real racial disparity across all areas of health care. Around the year 1900, about 2% of medical professionals were black—a number that did not budge until the 1980s, despite the growing black population in the country. Today, about 5% of physicians in the US self-identify as black, according to the Association of American Medical Colleges. Compare that to the 13.4% of Americans who identify as black, and the disparity is easy to see.
With that historical data in mind, let’s shift the focus back to PT. In 2019, WebPT conducted our third-annual State of Rehab Therapy industry survey. Of the 6,000 individuals who responded to our survey—including occupational therapists and speech-language pathologists—a mere 2.2% self-identified as black or African-American. That’s nearly identical to the percentage of black medical doctors who practiced during the era of Jim Crow and segregation. This number aligns with the APTA’s most recent demographic analysis of its member population: as of 2017, only 1.5% of APTA members identified themselves as black or African American.
The black community is not the only one that experiences disparity. Our 2019 industry survey found that 4% of rehab therapy professionals identify as Hispanic or Latino, while the APTA reported that a mere 2.5% of its members identify the same way. However, 2019 US census data tells us that Hispanic and Latino individuals make up about 18.5% of the population.
The Impact on Physical Therapy Treatment
You might be wondering about the implications of this data when it comes to treating patients. After all, a talented PT can provide excellent care to any individual regardless of the patient’s race or ethnicity, right? While that may be true, a lack of diversity can often impede patients from seeking care in the first place. A recent study from the National Bureau of Economic Research found that black men seen by black doctors agreed to undergo more preventive services—as well as more invasive treatments—than those seen by non-black doctors, an effect that was said to be “driven by better communication and more trust.”
This revelation is especially prudent for physical therapists. Quality health care—and physical therapy, in particular—is driven by human connection, and patients can more easily connect with providers when their relationship is built on mutual understanding and trust. Conversely, if patients don’t trust their providers or feel misunderstood by them, it gives those patients a reason to not return for care—or to not seek it at all. And considering that only 10% of patients who could benefit from physical therapy actually receive it, this is a missed opportunity to solve the so-called “90% problem.” But more importantly, health outcomes and life expectancy are significantly lower for people of color compared to the white population, and we should be striving toward any solution that can help mitigate that trend.
7. Press universities to consider a holistic admissions approach that supports a diverse student population.
As we face these discouraging numbers, we must ask ourselves why there is such a massive disparity between the number of white PTs and the number of PTs of color; then, we must come up with ways to address that disparity. To me, one very obvious place to start is with PT education.
In 2018, faculty from the University of Colorado’s School of Medicine hosted a session at the APTA’s Combined Sessions Meeting (CSM) that addressed this very issue. During the session, the presenters discussed their experience with restructuring the admissions processes for DPT programs in order to cultivate a more diverse workforce. The speakers presented findings they collected after employing tools in their own admission process that:
- accounted for both cognitive and non-cognitive factors, and
- fostered a more holistic approach to admission selections.
They noted that an applicant’s test-taking ability or cumulative GPA was not necessarily an accurate representation of the kind of PT he or she would become. (They did, however, note that academic performance in math and sciences is highly valuable when assessing an applicant’s potential for success as a physical therapist.) So, in addition to test scores and GPA, the admissions staff also considered non-cognitive assessment methods such as emotional intelligence and grit score.
Recruitment efforts should start as early as possible.
This session spurred a lot of discussion around the need for a more diverse applicant pool. One commenter—a faculty member at Northern Illinois University—mentioned that it’s hard for diversity initiatives to be successful when you’re pulling from the same pool every year. She recommended working with local professional chapters to assist in recruitment efforts. Another commenter from the University of Arkansas said we must get adolescents in the PT pipeline from the moment they become interested in health care (as early as high school, middle school, or even elementary school). Far too often, when high school students speak with guidance counselors about a career in health care, those students are funneled into a physician path—unless they specifically express an interest in PT.
The presenters also noted the need for inclusivity across all stages of the PT career, not just during the school admissions process. According to Lara Canham, a faculty member from the University of Colorado, “[Diversity] can’t be a program-level effort. It needs to be a national effort; a societal effort, if we want to see change.”
8. Support PT-led, minority-focused organizations.
Still, once we have greater diversity in the PT education system, we must continue supporting these clinicians beyond graduation day by ensuring they have equal opportunities for success. Diversity can be metrics-driven and measured, but inclusion is a choice. I believe one very important component of ensuring continued success is to endorse and advocate for organizations that support these future PTs. Two organizations that come to mind are the National Association of Black Physical Therapists, Inc. and PT Proud, an advocacy group supporting patients and providers in the LGBTQ+ community. By reaching out to these groups, we can learn how to be better leaders, better colleagues, and better PTs—as well as better allies.
This is not a PT-specific issue.
As we discuss ways to cultivate inclusivity with our patients and within our practices and profession, we cannot forget about our healthcare peers outside of physical therapy. As PTs, we must hold ourselves accountable for the systemic effect of inequality within not only our own profession, but also the healthcare industry at large. After all, as we strive to work with physicians and other rehab therapists as part of integrated care teams, we must first be the change we wish to see.
9. Support efforts for inclusivity in physician education practices.
Just as we should push for greater inclusivity in physical therapy education, the entire medical community could benefit from re-examining their education practices. I believe medical programs—as well as other healthcare professional programs—should consider ways they can foster diversity during the admissions process.
That said, simply leveling the playing field isn’t enough. Historically, people of color have had less access to higher education, which is part of a much larger issue within our society. For that reason, universities must find opportunities to reach adolescents within these communities and provide pathways to students who wish to pursue healthcare careers.
Diversity efforts must also extend to the academic awards process.
With that in mind, the acceptance rate for medical students from minority communities isn’t the only area of higher education that warrants further review. In 2017, a collaborative study examined the admittance rate of medical students to one of the most prestigious medical honor societies. Upon review, black and Asian applicants were far less likely to be admitted than white applicants. Considering the impact such awards have on future employment and grant funding opportunities, this disparity could end up putting minority students at a disadvantage.
10. Push for inclusivity in the way our technology and systems are built.
As a PT in technology, I would be remiss to overlook the role tech systems can play in fostering greater inclusivity in health care. A challenge that many who use EMRs and EHRs run into—and one that has been brought to my attention personally—is the lack of gender-inclusive terminology in electronic patient charts. While changing gender terms seems like an easy back-end fix, the lack of cohesion among various EMR/EHR products and other platforms (e.g., billing software) means adding more nuanced gender options creates an interoperability dilemma. Namely, if the payer recipient is not also updated with those same terms, it could lead to incomplete data transmission and denied claims. Correcting this issue at scale will require cooperation and a united commitment to diversity across the entire health IT community—not just one or two companies. However, the WebPT team is currently testing ways to make this change within our platform—an effort we hope will lead the charge for transformation within the industry at large.
2020 has been a year for the books, and I don’t think it’s controversial to say that we’re witnessing history in the making. The message behind the Black Lives Matter movement—and the voices spreading that message—has forced every community to think critically about their role in systemic racism and the actions they can take to create lasting, meaningful change. Granted, that change won’t happen overnight; we have a lot of work to do with ourselves, our businesses, and our communities. But as long as we listen, maintain empathy, and stand in solidarity with those who speak out against inequality and injustice, I believe we will see a better tomorrow—for everyone.
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Are you an entrepreneur looking for support with your business model during COVID-19? Attend the next 2-Day Pivot Camp on July 23rd-24th for guidance on how to rapidly iterate your product or service, reach new customers, and explore additional revenue streams.
In the age of COVID-19, entrepreneurs just may be the key to promoting and encouraging community recovery. That being said, the majority of the conversation around how to help entrepreneurs revolves around loans and grants, even though entrepreneurs need a lot more help than just monetary resources. While these are definitely important aspects of entrepreneurship, we wanted to find out what else is on the minds of entrepreneurs during these trying times.
With that in mind, SEED SPOT paired up with researchers at the University of Delaware to speak with entrepreneurs about their experiences dealing with this crisis. By talking to several SEED SPOT alumni, we learned some inspiring insights that are too good not to share.
Resilience is at the Forefront
One of the most motivating aspects of the conversations was that these entrepreneurs were even more passionate about their business and their impact than before, a testament to their strength and tenacity. Rather than let the negative news around the world bring them down, they are focusing their energy positively on how their social-impact businesses will make a difference globally. Though entrepreneurs are definitely facing added and different stress, entrepreneurship 101 teaches that it’s possible to turn every negative into an opportunity.
The New Networking Strategy
Another fascinating way that SEED SPOT alum are adapting to their situations is by using technological tools to stay connected and continue to grow. Resources like Zoom and social media have helped maintain relationships and connections, and virtual webinars and classes have been helpful as well to stay motivated. It’s not always as easy to network and build a relationship with somebody virtually, but technology makes it feasible and they are thankful for that.
Forging Routines of Connection and Care
There’s also a silver lining in all of this. Many entrepreneurs are reporting that they are having more time for self care as a result of being cooped up in the house all day. “[I’m] Doing a better job of following up with people I haven’t talked to in a couple months or even a year just to see how they’re doing. I hope after all this is done, that doesn’t go away”, reports one entrepreneur.
Deep Diving into Fundamentals
Lastly, SEED SPOT alumni entrepreneurs also had some advice to share with other leaders trying to make sense of everything happening in the world. One of the most consistent pieces of advice was to take this time to better understand your product and your market, and really dive deep during this down time to learn all the ins and outs about your business and your market position. They also stressed the importance of staying positive, and reminding yourself that this difficult period won’t last forever. Good things come out of difficult circumstances, and COVID-19 is no exception.
Thank you to the SEED SPOT alumni who agreed to speak with us, and thank you to the researchers at the University of Delaware for your assistance in this project! Together, we are stronger.
If you are an entrepreneur who can relate to the challenges that these alumni have faced, and you want to make a pivot with your business, then SEED SPOT’s virtual 2-Day Pivot Camp is for you. Sign up today to reserve your spot at the upcoming 2-Day Pivot Camp from July 23rd-24th.
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