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Why PTs Must Embrace Change — and How They Can Do It

By May 24, 2017 August 26th, 2019 No Comments

Our chief clinical officer Anang Chokshi, DPT, recently shared his thoughts about why physical therapists should embrace change on WebPT, a leading physical therapy solution provider site. Here is a repost of his WebPT blog in case you missed it:

As the chief clinical officer and lead physical therapist for a digital healthcare company, I have the privilege of regularly speaking to my fellow PTs regarding the trends in physical therapy and overarching healthcare changes that impact our profession most. While it’s always a pleasure to talk shop with my peers, I will attest that many of these conversations leave me a bit concerned.

As the healthcare industry reshapes its infrastructure to pave the way for more collaborative, affordable, and standardized medicine, healthcare providers are evolving in an effort to get ahead—by way of digital technology, cognitive assistants, or practice management changes. And they are doing so quickly—with the exception of PTs. In other words, there’s a huge adaptation lag within our profession. In fact, there seems to be a strong, unyielding resistance to it—due to fear of either losing autonomy or being replaced. But, I believe this is the wrong mindset to have. If anything, I’d argue that we’ve reached a point at which we must:

  • Become even more receptive to change,
  • Rethink the status quo, and
  • Redefine our approach within a more coordinated, increasingly digital healthcare environment.

Go beyond “hands-on.”

Traditionally, our profession has been defined by our manual therapy and biomechanical expertise. Our hands-on approach to assessing and treating an individual’s functional performance sets us apart from everyone else in the healthcare community. But considering the current, highly transformative healthcare environment, I believe our value actually far exceeds what we can do with our hands during a one-hour visit. Instead, I believe our future success hinges on our willingness to use meaningful data to enhance our clinical decision-making skills and effectively manage our patients when they are not in our presence.

The idea of treating a patient “globally” forms the very core of our profession. But, let me ask you this: when patients are home, can you quickly and objectively determine whether the activities they are engaging in are making them better or worse? Are you able to develop a concrete understanding of a patient’s condition—and the potential factors that may affect that condition—when he or she is at home? Or, are you forced to treat the condition based on what you see in person and what the patient tells you at that moment in time? When you give a patient a home program of four to five exercises, how do you know he or she is really doing it? More than that, how do you know the patient is doing the exercises correctly? Could he or she potentially do more? Does he or she need additional in-person attention? It’s tough to know.

What we know very well is that our expertise in rehabilitation has a dramatic impact on our patients’ quality of life. As studies prove, their success depends on both our intervention and their adherence to the in-home regimens we provide. But, we have to concede—or at least bring into question—the possibility that our impact is significantly less powerful when the patient finishes an in-person visit and goes home.

Look at it in the context of a week. For a typical PT prescription, the patient will only receive our intervention for two to three hours of the 168 hours in that week. That’s only 2% of the time in a week, which begs the question: what is our impact during the 98% of the time the patient is not under our supervision—when he or she has only a paper handout of exercises? Can we quantify that progress? Can we prove with objective certainty that he or she has been adhering to our plan? Is it feasible that a patient’s recovery from knee replacement surgery, for example, was more of a result of him or her simply doing more around the house (thus exceeding our exercise prescription)?

Chances are, we don’t know. It’s very difficult to make such assertions with certainty, as we’ve traditionally never had true insight into what the patient is doing or not doing in between PT appointments. When patients are recovering, they are without our supervision most of the time. And yet, they are still expected to adhere to our home exercise prescriptions. Perhaps this is what makes it difficult for referring providers and insurance companies to determine the true impact of our intervention. Our clinical effectiveness is currently only measured by the in-person visits we conduct.

Now, I am in no way implying that we have limited impact. Our skills in musculoskeletal rehabilitation are second to none. But, imagine what we could achieve if we increased our influence on the patient and took our intervention beyond the four walls of the clinic. We could maximize the efficiency of our practice and even get patients better, faster. We could potentially figure out which patients were having more difficulty at home—and then bring them in sooner for additional intervention. Maybe we could objectively identify our most compliant patients. If they perform well without complications, maybe we could give them more exercises and let them remain at home while we remotely track their progress.

Now, I’m guessing the previous sentence led you to form a rather critical opinion as to the legitimacy of this idea. We all know the elephant in the room: most PTs and private practice owners are paid via fee-for-service. And who would dare consider the idea of decreasing the amount of time patients see us in person? Furthermore, we pride ourselves on quality—and we rely on the human touch to provide it. But, let’s look at this under a different light. First, regarding quality, we have to admit the manner in which we perceive it can vary widely from PT to PT. Second, keep in mind that reimbursements are decreasing as hospitals, government agencies, payers, and doctors pay closer attention to where patients go in the post-acute setting. Not to mention, the utilization of this setting is becoming increasingly dependent on cost, measurable outcomes, and standardized practices that can easily be understood by the referring party.

If this is the case, then we have to start developing new ways to manage a patient population more efficiently while simultaneously delivering results that are both meaningful for patients and measurable for the rest of the healthcare community. Technology can help us achieve that.

By Anang Chokshi, PT, DPT, OCS, SCS