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The Value of Physical Therapy: What, Exactly, is it?

by Dustin Passigli, PT, DPT, MA, CES, PES

young-woman-doctor-older-man-patient-smiling

Here at NGPT, it is our duty to provide you with updated content that expands your knowledge base, and continues to be a source for personal development.

First and foremost in this mission is the ability to provide content that you, our loyal readers, deem as valuable. The value of physical therapy can be looked at in so many different ways, such as patient/client function, reduced pain, increased profits, quality of life, economic costs, time, effort, etc. The content in this article will provide you with a method to understand what "value" is and how to use it to improve your practice both in and out of the clinic.

Newly minted physical therapists can consume this information and, hopefully, use it primarily to benefit their patients/clients. However, this information can also directly benefit physical therapists themselves. If therapists understand how to provide value for their services, improved patient outcomes and retention rates will follow.

How do you define this abstract term in a way that either a clinic owner, staff physical therapist or any other healthcare professional can understand and use in their practice?

"Value" as defined by the modern healthcare system

In overall terms, leaders in the healthcare field around the world are under a ton of pressure to keep healthcare costs at a minimum.

Many healthcare systems are investing in what they call "healthcare value," which, in simple terms, is the amount of positive healthcare outcomes per dollar spent. (1) This has had a dramatic effect, especially when it deals with health insurance reimbursement for services rendered. Instead of looking at services based on cost, third party payers are looking at how services are valued.

Here's where I think this idea falls short.

  • No single outcome captures the results of care for a particular medical condition.
  • Care for a medical condition (or a patient population) usually involves multiple specialties and numerous interventions.
  • Value for the patient is created by providers' combined efforts over the full cycle of care.
  • The benefits of any one intervention for ultimate outcomes will depend on the effectiveness of other interventions throughout the care cycle. (2) 

Multiple co-morbidities can complicate the picture; they elucidate the importance of not only practitioners being able to treat multiple conditions but looking at the patient outcomes and costs of treating said individuals over the long term. This would be the only true way to organize a wide vista picture of the person and their overall cost on the system.

The value of physical therapy cannot be measured.

The evolution of healthcare technology, along with advances in modern medicine, have created a highly volatile situation in regards to patient/client expectations.

Complicating the situation in some way, the prevalence of the internet has also changed the way a patient can consume knowledge. For example, one can just go to google and search "knee pain" and they are forwarded to a website, such as webMD, where they can self diagnose in an instant.

Now, I am not for the dissolve of this website (or any others), but healthcare providers need to understand that patients/clients' expectations usually dictate whether they find value in a particular service.

Additionally, while modern medicine has been improving in many ways, it has not been able to keep up with patients' expectations.

So, what do physical therapists have over the staunch practices of most allopathic medical practitioners?

The answer is ATTITUDE!!!! (2)

On average, a physical therapist will spend more time with a patient/client than most other practitioners would. This affords us a lot in regards to providing physical therapy value via our interpersonal relations.

Patients are people, first and foremost. The system does have its way in investing more into the scientific method than in time spent interacting with people. Our very own Michael Curtis wrote a great article on the invaluable services we provide and how to promote the profession here.

In my opinion, the most important instance where a PT can demonstrate the value of physical therapy is during the initial evaluation. 

Looking at the initial evaluation as the "patient catcher"

Physical therapy school taught us that the initial evaluation is essential in regards to both patient care and practitioner autonomy.

The initial evaluation is the exact time and place where the clinician needs to prove the value physical therapy can provide. The truth is, often you only have one shot to get your value proposition across to new patients.

Now, most of you will groan at the fact that, while you believed that graduating was enough to provide you with the skills to keep a full patient caseload, you're sorely wrong. This is the point at which you learn how to sell yourself and your services.

Understanding your patients' goals right from day one, and helping to educate them on the steps that will be needed to reach them, should be at the forefront of your mind. (3) It is very similar to going on a first date; one has to outline certain attributes in order to attract and retain that persons company.

Most likely at this juncture, you are not the first clinician the patient has seen. The healthcare system can become an exhaustive loop of paperwork, red tape, and bureaucracy. These individuals are in pain and need your help.

This is where PTs who are not spurned by the system and target numbers do so well. They can listen, comprehend, and empathize with the patient. They thrive under new interactions. They can befriend even the most bombastic of an individual. They are detail oriented and are able to adapt to different patient learning styles.

Here are a few pointers to adhere to during the initial appointment:

  • Make sure to repeat what the patient has said to confirm you are present.
  • Absolutely do not have your back turned to the patient. Look into the patient's eyes and try to observe the inner strife that may be swirling.
  • Provide a written printout or digital access to a list of Frequently Asked Questions (FAQs) or resource database because most of the time patients tend to forget questions they might have had previously.
  • Show interest in the patient's story. Be respectful and most of all do not interrupt the patient when they are speaking.
  • This is also the time that you can feel out their responsiveness to touch. Different cultures have different viewpoints in this regard and it's important to approach carefully not to invade someone's personal boundaries.
  • By and large, patients should be able to leave your clinic with a substantial understanding how you’re working to help them improve their health.
  • Provide not only auditory information regarding the patient's home exercise program (HEP) but also provide them with visual material whether that be in written, picture, or video format.
  • This should also be the time that the clinician emphasize treatment modalities or other services that the clinic can provide that are unique.

A unique value proposition

At the end of the day, whether you want to become a clinic owner, manager/director, involved in profit sharing, or want to continue being a staff therapist; the private setting should be looked at as a business in the realm of client relations and marketing. Your success depends on the value that your clients see in your business. A common business adage is “Price is what you pay, value is what you get.” In order to be successful, you first need to identify your particular value, and then you need to properly convey your value to current and potential clients.

Motivation = Perceived Benefit - Perceived Cost

Clients/patients will more likely continue physical therapy at your clinic if they perceive the benefits to outweigh the costs of each session. More than ever, clients want relationships they can trust...relationships that add value to their lives. Your UVP defines the intrinsic worth of the service you offer your clients, and defines what they will get for their money.

This area of marketing should be the main focus and delves into what only you or your clinic alone can provide to the patient. The hard part is determining what these unique services are, how to market them, and how to differentiate which population needs different services that they deem unique. As in research, marketing yourself requires surveys, questionnaires, and other statistical tests. This is useful in determining which benefits you provide are perceived to the most important to your clients/patients. (5) 

Social media presence

The social media boom, which seems to have no decline in sight, can be an important tool in one's arsenal to show value in services provided. This medium allows the physical therapist and/or clinic owner to reach a larger audience more quickly than the old guard of print media. It’s an incredibly effective method of gaining better company branding.

Plus, social media is easily one of the most affordable online marketing strategies, and allows you to share content, photos and videos quickly and easily. These forms of media will engage with your customers and fans, which will then, in turn, increase your web traffic, online and presence and sales. Video/audio plays an important role in this manner because on average our society learns more effectively with visual/audio aids. (8)

The value of social media marketing in physical therapy

Social media marketing can help your practice by providing you with various benefits, such as:

  • Better company brand recognition
  • Increase the public’s awareness about the services and treatments you offer
  • Interact, socialize and build a stronger relationship with your patients
  • Gain new patients while also retaining existing ones
  • Provide excellent customer service in an effective way

Our very own co-founder of NewGradPhysicalTherapy, Brett Kestenbaum, was just at the APTA's CSM talking about the importance of social media in physical therapy. #SocialPT!

Social media marketing strategies for physical therapists

Every social media profile for your business or clinic should have:

Social media platform

Picking the platform can be just as important as even beginning to initiate an online campaign. Each platform, such as Facebook, Twitter, Instagram, and LinkedIn, to name a few, have certain pros and cons to their outreach and formulation of media you can post.

Facebook likes longer statuses, Twitter is short and sweet, and LinkedIn is largely for professional use. But in general, you should post educational articles, clinic news, and patient success stories (with written permission from the patient), wherever you post. Your goal is for people to share your content, which leads others to like your page, visit your website, and call in for more information. Everything you post should link back to your website to ensure the content is attributed to your practice and that people know you are the experts to see for PT. Whatever the platform you use (most likely all of them if you can maintain a presence), its about building relationships.

Building relationships

Your job is to build trusting and loyal relationships on the social media sites by being friendly, sharing great content, helping people, and earning their trust. Just like in the real world, social media followers will relate to a name and reputation that they can trust. All of this hard work will build a positive image around your practice’s name and will soon convert into more business. Most people who come to view social media posts are not looking for hard sells from companies or clinics. They are looking for knowledge and to understand how they can help themselves get better. Be a friendly guide that provides information in a cloud of sincerity. (8)

Sharing your own branded content should come naturally. It’s the other two thirds that may be a challenge. (9)

Invaluable Importance of Support Staff

As anybody who has ever visited a private healthcare practitioner's office knows, there are other staff members present who are part of the healthcare experience. These may include office managers, billing managers, receptionists, custodial services, PT aides, PT assistants, students, and volunteers. There will inevitably be times where these individuals will interact with your patient/client. It is of utmost importance that a clinic owner or director who participates in hiring understands that strategic hiring plays a key role in the success of the practice.

Billing 

This is especially important in regards to the process of billing. Difficulties with communication between the clinician and the billing team can prove disastrous if there are any HIPAA violations. Violations can cost "up to $50,000" according to Monster.com. 10 Furthermore, errors in filing claims, misinformation, and lost data can lead to delays or even no reimbursement for attended sessions. Additionally, it's essential that the billing staff hired is aggressive enough to collect and enforce co-pays or self-pay amounts before or after every session.  When you get it all on paper, you’ll realize it’s a pretty substantial list of responsibilities. Lots of people include “ability to multi-task” on their job applications. For this position, you want to make sure the candidate truly lives up to that qualification.

Front Desk/Reception Staff

Most of the time, the front desk staff are the first personnel to interact with the potential client. This is why it is of utmost importance to bring on staff or educate current positions on the importance of communication, time management, commitment, and goal making.

Timeliness is also a huge factor in regards to office staff responding to potential clients. These individuals might be in a hurry to get excellent treatment because they are in pain. It is essential that front desk staff respond to messages or voicemails as soon as possible. The front desk staff member should be motivated to ease the transition of the client onto the physical therapist's schedule.

Speaking of position descriptions, put a lot of time and thought into your job listings. As Monster explains, “when the pressure is on to open the doors to your new practice or replace a soon-to-depart receptionist or scheduler, you’ll be tempted to rush.” Don’t go that route.

You have good reasons (like everything listed above and then some) to avoid the "need a warm body" temptation and hire the right candidate.

That starts with crafting an honest, detailed, well-written job announcement. (10) Remember that grade-A candidates are always in high demand, so pay competitively. It might be tempting, but don’t get someone to work for lower hourly wages to simply answer phones and do intake. With a more skilled front office team member, you can shift responsibilities to increase efficiency. (10)

In Summary

Physical therapists provide such an important role in improving function, decreasing pain, and increasing quality of life.  These benefits alone should be the reason an individual comes to your clinic.

But it really isn't that simple.

Although research shows that physical therapy is effective in treating a variety of musculoskeletal disorders, many individuals drop out of treatment prematurely. Moreover, factors associated with premature treatment dropout remain unclear; systematic research on physical therapy treatment retention is scant, and available findings are inconsistent and statistics show this problem.

Given the wide variance in research studies reporting treatment retention statistics, it comes to no surprise that rates of completing physical therapy have ranged from 45.5% to 100%. (11) We, as physical therapists, need to change this view. Patient/client perception is powerful and staunch in some individuals, but it can be changed. For human beings, it holds that satisfaction equals perception minus expectation – small, unexpected rewards can have disproportionate effects. NGPT hopes that this article provides the reader with help in changing the patient/client perception.

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References

  1. Ubel PA. Value Promotion in Health Care: The Importance of Symmetry. JAMA.2016;315(2):133-134. doi:10.1001/jama.2015.18159
  2. Porter ME. What is Value in Healthcare?. N Engl J Med. 2010; 363:2477-2481. doi: 10.1056/NEJMp1011024
  3. Hebert S. The Importance of Patient Retention. <http://blog.strivelabs.com/2014/11/24/importance-of-        patient-retention/> Accessed Jan. 14, 2017.
  4. http://www.pictaram.com/media/1266852395423745187_2321056392
  5. https://www.widerfunnel.com/how-to-create-an-awesome-value-proposition/
  6. Dmitry D, DeWayne P, Haresh K, Jeffrey H, John Z. Evidence, Quality, and Waste: Solving the Value Equation in Neonatology. Pediatrics Feb 2016, peds.2015-0312; DOI:10.1542/peds.2015-0312
  7. http://www.forbes.com/sites/sachinjain/2016/04/13/what-is-value-in-health-care-really-six-principles-from-organizations-bringing-value-to-patients/#370deb656a26
  8. Straight D. "How to use social media for your physical therapy practice".  <http://e-rehab.com/2014/02/14/how-to-use-social-media-for-your-physical-therapy-practice/> accessed. Feb. 2017. Online.
  9. Milbrath S. "Are you following the social media rule of thirds?". <https://blog.hootsuite.com/social-media-rule-of-thirds/> accessed online. Feb. 2017.
  10. Rossheim J. "How to hire office staff for a medical or dental practice". <http://hiring.monster.com/hr/hr-best-practices/recruiting-hiring-advice/acquiring-job-candidates/how-to-hire-office-staff.aspx> accessed online. Feb 2017.
  11. Lysack, C., Dama, M., Neufield, S., & Andreassi, E. (2005). Compliance and satisfaction with
    home exercise. Journal of Allied Health, 34, 76-82.

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