When thoughtfully implemented, the impact of digital MSK tools and services can positively impact rehab therapy practices in significant ways. As outlined previously in this series, not only do patients want and expect to engage digitally, but such programs can lead to improved patient compliance and outcomes. They can also open the door to new patient populations and revenue streams for a clinic.
Does this mean every rehab therapy practice owner and operator should start stockpiling the latest tools for telehealth, remote therapeutic monitoring (RTM), patient portals, etc.? Not necessarily, says outpatient rehab therapy experts like David McMullan, PT, Director of Enterprise Therapy Solutions with Net Health.
According to McMullan, investing time, money, and resources into digital tools requires a thoughtful process that considers the needs and demands of all parties involved: patients, clinicians, administrative staff, and payers.
“Just don’t go buy the shiny new object,” he said. “You don’t go sign, say, with the first person who says they do RTM, and then shove it down [the staff’s] throat. This requires lots of consideration, so just be thoughtful about it. What does it mean to your practice? How is it going to impact the front office, the back office … what’s the clinical impact? You should have answers to these and other questions before moving forward.”
In this spirit, Net Health rehab therapy experts offer the following 10-point checklist each rehab therapy owner and operator should consider prior to investing in digital MSK. Not only will reviewing each of these points help determine which programs may provide the greatest impact, but doing so can also help identify potential hurdles operators and clinicians may encounter when implementing digital solutions and tools.
1. Know Your ‘Why’
This is an overarching question that deserves thorough consideration. Yes, the ways digital tools and services can positively impact rehab therapy have been well-documented, but more subjective, practice-specific reasons should be considered.
What is the goal of the specific digital care and/or engagement effort? What challenges do operators and clinicians hope to overcome by establishing a digital presence? How will the success or failure of these programs be measured? How will these efforts lead to revenue growth?
Payer reimbursement is a powerful incentive for outpatient rehab therapists and their managers to implement telehealth and RTM programs. If this is your “why,” keep in mind that not all reimbursable services, such as RTM, operate so smoothly.
Wherever payers are involved, compliance-based rules and regulations will dictate what services clinics can provide, how they’re provided, and how they’re billed. These rules can increase administrative time and drastically alter the workflow of a practice.
That’s not to say services such as RTM aren’t worth pursuing. When just starting, however, keep in mind why payers are willing to offer these reimbursements — because RTM services improve patient compliance, which lowers drop-off rates and improves patient outcomes. Each one of these benefits can also directly impact revenue growth.
“Always start processes like this with, ‘Why are you doing it?’” McMullan said. “You need to be a prudent buyer, for one, but you also have an obligation to make sure your staff understands your ‘why,’ as well.”
2. Analyze Your Patient Population
While patients who appreciate and benefit from digital MSK services span a wide demographic, some groups of patients better fit the mold of those most eager to take an active and engaging role in their wellness. Clinics that service more of these types of healthcare consumers are likely to find more success when rolling out digital tools and services.
These patient types include younger people, active and athletic adults, busy professionals, and those whose payers incentivize utilizing rehab therapy first for musculoskeletal ailments. It may also include many older patients as Medicare reimburses for both telehealth and RTM services.
Also, look beyond current patients to groups and organizations that might see value in partnering with a digitally capable rehab therapy clinic. This may include local businesses, school systems, or large employers that find value in employee wellness and healthcare cost-saving initiatives.
And of course, if an increasing number of current patients are asking for telehealth options or ways to connect between visits, this indicates digital MSK may be well-received.
3. Know Your Practice’s Self-Discharge Rate
Patient self-discharge rates, also known as the patient drop-off rates, indicate that patients simply aren’t understanding the value of rehab therapy. This can be self-inflicting (i.e., they weren’t completing their home exercises) or can be caused by a lack of understanding about their plans of care. Patients may also self-discharge due to personal or transportation issues related to their appointments.
Regardless of the reasons, a high self-discharge rate can indicate a practice may benefit from the flexibility offered by digital MSK tools and services. According to Doug Cundiff, Vice President of Therapy Solutions at Net Health, clinics that implement digital tools can offer patients a variety of options for completing their plans of care apart from all in-person visits.
“We know statistically across the country, it’s a very low percentage of patients that complete that plan of care,” Cundiff said. “Instead of requiring two or three visits a week, if you can start to wean them to once a week or once every other week, and still regularly check in with them digitally, we can help patients ensure that they get to the end goal that we set together, and they don’t self-discharge. And ultimately, we’re going to get that optimal patient outcome.”
4. Review Home Exercise Program Success Rates
Home exercise program (HEP) compliance is one of the key indicators for rehab therapy patient success. Yet, up to 70 percent of patients remain non-compliant with their HEPs, which can negatively impact physical function and long-term health.1
This can snowball into additional factors that may affect a rehab therapy practice’s bottom line: patient drop-offs, negative patient experiences, and over time, a loss of referral sources.
When patient HEP compliance is problematic, digital MSK tools can help. RTM programs, for example, enable therapists to track patient exercises and check in on progress. When patients experience pain or have concerns about exercises, direct messaging further allows them to connect with clinicians to alter the program so it’s safer and more effective.
And, if larger pain or injury-related issues emerge, telehealth offers a way for therapists and patients to connect more immediately and directly to triage new symptoms.
“At the end of the day, if they’re a super compliant patient, they’re going to have great outcomes,” McMullan said. “That’s great for your business. They’ll come back to you, they’ll refer their friends to you. So, it has a big revenue impact.”
5. Research and Understand Your Real Cancel/No-Show Rates
Unfortunately, no-shows and cancelations are just part of the outpatient rehab therapy business. Yet, while they’re difficult to fully avoid, McMullan said no-show/cancelation rates should top out between 10% to 12%.
Clinics with rates that are consistently higher than this, he added, may consider offering telehealth options and perhaps brief virtual check-ins between appointments to keep patients active within their plans of care. With virtual appointment and check-in options in their back pockets, front-office schedulers have the tools to preserve more patients who intend to cancel.
The numbers, however, only tell part of the story. It can also be beneficial to know why patients cancel or fail to show up for appointments. While this can take some legwork, one’s findings can shine additional light on the potential for digital services.
For example, if one’s cancelation rate is just 8%, but more than half of those cancelations were due to inconvenience (i.e., transportation issues, bad weather, personal or professional conflicts, etc.), this indicates that offering digital appointment options may put a significant dent in missed visits.
6. Evaluate Your Potential for “PT-First” Patients
Ever since state jurisdictions began removing physician referral mandates for physical therapy, a top goal of outpatient rehab therapists has been to attract more direct-access patients who seek physical therapy first for musculoskeletal pain and injury assessments.
With digital MSK tools and services, outpatient practices looking to diversify and rely less on their referral sources can establish and promote what’s called a “digital front door.” This enables people who experience musculoskeletal pain or injury to virtually visit a rehab therapist for advice before considering more expensive and potentially invasive testing.
While not all PT-first patients will require long treatment plans, simply having the opportunity to interact with and provide value for new potential patients can be a first step in developing brand allegiance and trust.
“Say someone is out jogging one morning and they start feeling pain around their kneecap,” said Tannus Quatre, PT, MBA, Senior Vice President and Chief Business Development Officer with Net Health Therapy. “Instead of scheduling a doctor’s visit or heading into immediate care, this person could quickly meet with a physical therapist on a telehealth visit [for] a pain assessment. That’s a valuable service. You can charge for it, sure, but the real value is that you’re driving awareness and possibly getting a new patient all because you were easy to connect with.”
7. Track Your New-Patient Wait Times
Always try to schedule new patients for an initial appointment within 24 to 48 hours of their initial call or message. This is a common rule of thumb throughout the outpatient rehab therapy profession as longer wait times can cause patients to seek care elsewhere, even if they scheduled with the first clinic they spoke with.
Unfortunately, this can be a difficult rule to maintain, especially in areas with fewer rehab therapy options. Staffing shortages can also affect new patient wait times.
If or when this becomes a problem, which can lead to high no-show rates, digital MSK can help. Tools like telehealth can help bridge patient wait times, preventing them from searching for more immediate assessments and treatments. Rather than having to reserve a 45- or 60-minute block for a new patient visit, clinics can offer shorter initial telehealth screenings with a shorter wait – appointments that can lead to longer in-person sessions later.
8. Consider Staff Benefits, Readiness, and Buy-In
A practice can invest in the very best digital MSK tools available on the market. Yet, if its clinical staff hasn’t fully bought into this transformation toward digital and hybrid care, the operator’s efforts will be all for naught.
That’s why this question about staff readiness is critical, as are the multiple discussions that must take place to assess the overall enthusiasm, concern, and potential skepticism around digital MSK.
“There are some that are going to have no problem doing hybrid or virtual interactions with the patient, and there will be others that will say, ‘No, no, no, no … I’m all hands-on,” McMullan said. “Well, that’s fine. You need to figure that out.”
Transparency is essential throughout these discussions. Not only must staff members be able to express concerns as well as ideas around the tools and services being considered, but owners and operators must be clear about why (and how) such solutions are being implemented.
It’s paramount that all staff members, whether or not they ultimately buy into digital tools programs, understand the “why” behind these efforts. That’s because the entire staff must be on the same page when articulating the value of these services to patients.
9. Evaluate the Integration Capabilities of Your EHR
For a wide range of reasons (i.e., documentation, billing, coding, scheduling, etc.), it’s important that digital MSK solutions can seamlessly integrate with a practice’s EHR software. Ensuring this before investing is critical.
Doing this requires a conversation with one’s digital MSK and EHR vendors. According to McMullan, it’s not uncommon for a digital solutions vendor to claim their product integrates with specific EHRs when, in reality, the integration is complicated, unstable, and limiting when it comes to usability.
When exploring possible digital MSK solutions, McMullan suggests operators start by speaking with the EHR vendors, especially if they’re happy with the vendor’s software and service. The EHR representative can possibly provide a list of digital MSK solutions that most seamlessly integrate with their system.
“I think it’s important to have strategic conversations with your vendors, which I don’t think enough practices do,” he said. “It’s great to jump on into something that’s really cool, and it may look great and have a great ROI. But, if the integration’s poor, you’re now creating more administrative burden, more frustration, and lower staff morale during a time when staff retention is critical.”
10. Assess Your Operation’s Physical and Digital Infrastructure
In some ways, investing in digital MSK technology is the easy part. Neatly integrating this new solution into an existing clinical structure can be challenging. The willingness and ability of ownership and management to invest in this effort is an essential part of investing in digital MSK.
For example, how is the clinic set up to accommodate both in-person and virtual patients? Is there a room or corner space dedicated to online appointments, and how is it equipped and furnished?
Technologically, does the clinic’s Wi-Fi plan offer enough bandwidth to handle multiple video streams? What equipment is needed to ensure the cleanest audio and video connections? What will clinicians use for documentation, and do all systems integrate seamlessly with the practice’s EHR?
As stated above, practice operators should meet with EHR providers and potential digital MSK vendors to develop the fullest possible picture of integration and infrastructure needs. Operators should also include a trusted IT professional within these discussions — someone who represents the practice, understands its vision, and speaks the language of tech.
Potential Pitfalls When Implementing Digital MSK
Once you decide if digital MSK is right for your practice, care should be taken during implementation. Two common mistakes made during the digital MSK planning, implementation, and adoption process include:
Assuming a Smooth Staff Buy-In Process
As discussed earlier, staff buy-in can truly make or break the success of a digital MSK program. Without staff buy-in, clinicians will be unwilling or unable to fully relay the value of such programs to patients.
Because digital services are evolving and being adopted at such a high rate today, however, it may be tempting for an operator to move forward with virtual programs and services assuming the clinical staff will fall in line.
This would be a mistake.
Depending on the size of a clinic’s staff, it’s likely one or two clinicians will want to continue seeing in-person patients only. This is expected, and there is nothing wrong with this. Every clinician brings his or her own sets of skills and specialties to the table, after all.
Yet, even these clinicians are likely to encounter patients who would be better served via a hybrid model of care. They must be able to identify these patients and willingly pass them on to a more digitally savvy cohort at your clinic to retain the patient.
In addition, as in-person and virtual care require different approaches, staff must be trained in telehealth and other services for the tools and services to work properly.
Moving Forward Too Quickly
Starting a new digital MSK effort isn’t like flipping a switch, nor should it be treated as such. Even after all solutions and processes are implemented, McMullan says it’s critical clinics roll out digital MSK as a pilot program before making it publicly available.
“The pilot is really to kind of run some water down the pipes and show how successfully the program works in the real world,” he said. “How do we make this work most effectively within our organization? What things can we be doing better, and what aspects of the program are weak and must be changed to be successful?”
As new programs tighten up and patients start responding positively to the services, clinicians and other staff members may begin to visualize similar successes for their own patients, leading to greater buy-in.
It’s worth noting that the best pilot programs are ones that are narrowly focused on an individual program, service, or solution. Clinics new to the digital MSK space should consider factors related to patient needs, clinician adoption and buy-in, and EHR integration to determine which programs to focus on.
Do not try to roll out several programs at once as this creates greater difficulty and confusion.
“Change is difficult, but it’s not an immediate switchover to this technology,” Cundiff said. “It’s a migration to and an inclusion of it in your practice. If you approach your education and continued advancement in this area in that manner, I think there’s a lot of potential for therapy to win this market share [over MSK service providers outside of rehab therapy] in the digital space.”
SOURCES:
1 BMC Musculoskeletal Disorders, “Development and Validation of the General Rehabilitation Adherence Scale (GRAS) in Patients Attending Physical Therapy Clinics for Musculoskeletal Disorders,” Feb. 1, 2020
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