Changes to Look for in the Physical Therapy Industry in 2019
Physical therapy continues to be a growing field with a positive outlook as a career path. It is a $30 billion industry with a 30% job growth over the next 10 years. This expansion is due to an increase in sedentary lifestyles, aging population, growth in employment and early specialization in sports.
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.
MIPS (Merit based incentive Payment System) for Physical Therapy Billing
2019 marks the first year that MIPS for physical therapy becomes a relevant topic. It is in this year that PTs are finally eligible to enroll in the program.
So what is MIPS physical therapy? MIPS physical therapy in 2019 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 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
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 2019, individuals and clinics may be eligible for participation.
Merging Healthcare Organizations Continue to Define the Landscape
In 2017, the market was highly fragmented and competitive with the largest 50 competitors comprising less than 25% of the market. A year later, hospital mergers and acquisition trends showed a huge uptick with $2.5 trillion in total deals made in the first half of 2018.
Healthcare mergers and acquisitions trends clearly continue to be one of the biggest changes to keep a lookout for. Big 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 2019 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.
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.
Therefore, 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. 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
Healthcare reform is on the horizon with the industry continuing to see lower reimbursement rates and stricter Medicare guidelines for physical therapy billing. This will cause private practices to shift gears towards being an out-of-network provider and could result in Medicare changes for physical therapy in 2019 as more people turn to other options.
This means that clinics will have a relationship with their patients, not insurance carriers. In terms of physical therapy insurance reimbursement, this becomes pricier for the patient, as the patient has to pay the physical therapy clinics directly for their services and then be partially reimbursed from their insurance provider.
Corporately run physical therapy practices will be able to maintain in-network benefits with their physical therapy billing due to leveraging out 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 physical therapy networks such as PTPN to be a part of.
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.
In conjunction with MIPS physical therapy in 2019, 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 shape physical therapy Medicare guidelines well into the future.
Increased Patient Engagement Tools Will Spark New Innovations in Physical Therapy
Patient engagement is a hot topic throughout the healthcare world and technology changes in physical therapy geared toward this goal will continue to make their way into the market. 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 at the clinic. Keeping up with new innovations in physical therapy (such as betterPT) will improve the patient experience and improve patient satisfaction.
Industry shifts and technology changes in physical therapy are certain as we move forward into 2019 From the rise of MIPS physical therapy to merging healthcare organizations, new innovations in physical therapy are clearly happening. While they may bring unwelcome difficulties and change, embracing these changes as a patient and as a clinic will help keep everyone stay connected. Physical therapy providers should focus on ways that they can deepen their relationship with patients and revamp their marketing strategies to help get patients in the door quicker and to stay in the door.
The goal is for patients to have better access to healthcare, better knowledge about where to go and more autonomy to choose a clinic that best fits their needs. The BetterPT website and BetterPT mobile app are here to help! It 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 2019!