Changes to Look for in the Physical Therapy Industry in 2020

Physical therapy continues to be a growing field with a positive outlook as a career path. It is a $30 billion industry with a projected 30% job growth over the next 10 years. This expansion is due to an increase in sedentary lifestyles, an aging population, steady growth in employment and early specialization in sports. 

Steady in revenue growth since 2007,  this market is projected to reach $45.7 billion by 2023 if it continues to follow the average annual pace of 6.2% The physical therapy market is expected to continue to flourish, but there will be new innovations and technology in physical therapy that may disrupt the industry as we know it.

The physical therapy industry in 2020 will involve many different and exciting aspects, but some of the most intriguing include the following: 

• Continued use of merit based incentive payment systems (MIPS)
• Merging of existing healthcare organizations 
• Using technology to increase referrals
• Increasing the number of both in and out of network providers
• Changes to home health care through Patient-Driven Groupings Model (PDGM)
• Telehealth service use will be on the rise as part of initial evaluation and the overall therapy plan
• Physical Therapy Assistants will have lower reimbursement rates
• More clinics may choose to go out of network or implement support of cash-based services

Read on to find out more about each of these aspects in detail. 

MIPS (Merit based incentive Payment System) for Physical Therapy Billing

2020 marks the second year that MIPS for physical therapy is a relevant topic. In 2019, PTs became eligible to enroll in this program, and 2020 promises to continue the use and expansion of it.

So what is MIPS physical therapy? MIPS physical therapy in 2020 refers to a payment adjustment system that’s based on quality data. It is one of the new innovations in physical therapy that is set to be a replacement for PQRS data reporting, and its goal is to decrease the cost of care while increasing the quality.

The MIPS physical therapy payment adjustment score is measured on a per-provider basis according to 4 pieces of criteria:

• Quality (to replace PQRS)
• Improvement Activities
• Advancing Care Information
• Cost

Your score according to the MIPS for physical therapy translates to the payment adjustment applied to your Medicare B payments two years later. Now, when it comes to MIPS physical therapy in 2020, individuals and clinics may be eligible for participation.

Merging Healthcare Organizations Continue to Define the Landscape

In 2017, the healthcare market was highly fragmented and competitive with the largest 50 competitors comprising less than 25% of the market. Two years later, hospital mergers and acquisition trends still show  a huge uptick with $2.5 trillion in total deals made in the first half of 2018 and more continuing into 2019, with 46 total announced actions by the second quarter of the year. 

Healthcare mergers and acquisitions trends continue to be one of the biggest changes to keep a lookout for in this field. Large corporations will continue buying up small mom and pops and hospital systems will start to take over the market. For instance, Kohlberg Kravis Roberts & Co. (KKR) bought Envision Healthcare Corporation for $9.9 billion in one of the largest examples of merging healthcare organizations.

It is expected that 2020 will see even more high-level private equity acquisitions. Overall, hospital mergers and acquisition trends will continue to be the focus of the year as more major players emerge on the scene to buy up privately-owned healthcare organizations and bring them into their already established networks.

Technology Changes Will Transform Physical Therapy Referral Source

Due to hospitals and doctors having more ownership in physical therapy billing and practices, independent physical therapy practices will find it harder to rely on physicians as their primary referral sources. Hospitals and doctors will want to keep patients within their network and will be less likely to refer out.

For this reason, private owned practices will need to look for different ways to obtain referral sources and will have to rely on new innovations in physical therapy to help attract patients. Direct access, social media marketing and digital patient engagement tools (such as BetterPT) all represent technology changes in physical therapy that can help maintain or increase their patient caseload.

Increased Out of Network Providers Affect Physical Therapy Reimbursement Trends

As healthcare continues to reform through government mandates and marketplace pressure,  the industry continues to see lower reimbursement rates and stricter Medicare guidelines for physical therapy billing. This will cause private practices to shift gears toward being considered an out-of-network provider and could result in Medicare changes for physical therapy in 2020 as more people turn to other options when seeking care.

This means that clinics will have the main relationships with their patients, not insurance carriers. In terms of physical therapy insurance reimbursement, this becomes pricier for the patient, as they have to pay the physical therapy clinics directly for their services and then be partially reimbursed from their insurance provider or rely on their Health Care Flexible Spending Account (HCFSA) to fund.

Corporately run physical therapy practices will be able to maintain in-network benefits with their physical therapy billing due to leveraging their sheer volume of patients and clinics. However, small mom and pop shops will not be able to survive with this model for physical therapy insurance reimbursement and will look towards becoming part of a physical therapy network such as PTPN.

Advanced APMs Expand Upon Medicare Guidelines for Physical Therapy Billing

Under Medicare Access and CHIP Reauthorization Act (MACRA), Advanced APMs (alternative payment models) and MIPS for physical therapy were both established as quality payment program options. Like MIPS physical therapy, Advanced APMs are scored based on a series of quality-based criteria and help to determine Medicare guidelines for physical therapy billing.

The Advanced APM physical therapy Medicare guidelines differ from MIPS, however, in that providers take on additional risks in order to earn higher incentive payments. Based on patient outcomes, this incentive towards physical therapy insurance reimbursement is calculated and administered as necessary.

In conjunction with MIPS physical therapy in 2020, Advanced APMs will be a major part of physical therapy reimbursement trends that transform physical therapy billing. In both forms of quality-based care, the emphasis is placed on affordability and effectiveness of care. This could then help to shape physical therapy Medicare guidelines well into the future, providing additional benefits and changes for everyone involved.

Increased Patient Engagement Tools Will Spark New Innovations in Physical Therapy

Patient engagement is consistently a hot topic throughout the healthcare world. Technology changes in physical therapy geared toward this goal will continue to make their way into the market, no matter what other changes are imposed, too. In an effort to keep patients connected to clinics and ensure that they will return for their next visit, physical therapy practices must create meaningful relationships with their patients and keep them connected to the clinic even when they are not physically in the building. Keeping up with new innovations in physical therapy (like working with betterPT) will improve the patient experience and also improve patient satisfaction.

Industry shifts and technology changes in physical therapy provision are certain as we move forward into 2020.From the rise of MIPS physical therapy to merging healthcare organizations, new innovations in physical therapy are imminent. 

While they may bring unwelcome difficulties and many changes, embracing these changes as a patient and as a clinic will help keep everyone connected. Physical therapy providers should focus on ways that they can deepen their relationship with patients as well as revamp their marketing strategies to help get patients in the door faster and to keep them there.

Three goals for patients include: 

 Having better access to healthcare

Be able to obtain increased knowledge about where to go for this care

Havemore autonomy to choose a clinic that best fits their needs. 

The BetterPT website and BetterPT mobile app are here to help! This is a mobile and web-based platform that brings patients and physical therapists together with seamless scheduling, booking and in-app communication with top clinics and facilities.

Don’t let the physical therapy industry change without you – start getting BETTER in 2020!