Why do PTs feel like they're being forced to see patients at a loss?

Recently, I've seen a few articles and social media posts in the physical therapy world discussing the downward pricing pressure (declining reimbursement rates) even while some payers (UHC often is the target here) report profits in the billions of dollars per quarter. And, at first sight, you can totally appreciate where these clinicians and writers are coming from. I mean, why cut payments to providers when your organization is raking in record profits? As many clinicians and practice owners put it: they feel forced to see these patients at a loss because of the declining reimbursement rates.

Now, the reason for declining rates may vary on paper, but it really comes down to two things: 1) incentives and 2) the reimbursement model for healthcare in the US. And both of those things are tied together. I dedicated a whole chapter in my book about the problems with a fee-for-service model in healthcare, but here are the basics: when clinicians get paid for their time (or the codes they bill), they're incentivized to bill as much as possible, in as little time as possible. Payers, on the other hand, only have two levers to pull to cut costs: 1) deny services altogether (or gait them with authorizations and the like) or 2) pay less for those services. That means that it's only natural that, under that environment, payers will place barriers to the service (preauthorizations, etc.) and reduce their fee schedule (the amount they pay clinicians for those services). And that's why PTs feel the squeeze, or the downward pricing pressure, affecting their practices.

But here's one thing that we rarely talk about when it comes to insurance and reimbursement rates: who's forcing us to see these patients at a loss? I mean, UHC isn't storming clinics and coercing them into signing provider contracts. The truth is that contracting is a choice, a choice that many clinics and practices are making. In this episode, I break down the reasons why practices may consider contracting with a payer. The pros and cons of being "in-network" providers. And how to combat some of the downward pricing pressure in healthcare.

What we cover in this Episode:

-Understanding fee for service reimbursement models
-Why patients still get surprise bills because of the lack of transparency
-How clinicians come to the decision to sign contracts with payers
-The levers that payers have to control costs and profits
-Why value-based care can be difficult for smaller, independent practices
-How value-based care aligns with incentives
-Making the decision to stay in or leave a payer network
-Why we need to think more deeply about the value our treatments and services bring

Full episode note: https://rehabupracticesolutions.com/better-outcomes-152

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Are there times when saying goodbye to team members is the right thing to do?

"I would be a bad boss if I told you to stay here. As much as we love having you on the team, you need to do what's best for you and your family." Over the last few months, I've found myself saying this a couple of different times to team members who were in a place where they felt that a change was necessary. Saying goodbye to team members can be hard. Either for personal reasons or professional reasons.

It's easy to become defensive, or take it personally when a team member approaches you about potentially leaving the team.

Was it something I did as a leader?

What am I doing wrong that they don't want to stay?

Of course, you can explore those questions if you're experiencing a great deal of turnover. But, typically, if it's you, those team members will just leave. There's no discussion; simply a notification: "This is officially my resignation notice". But, if you find yourself in a situation where a team member approaches you about potentially leaving, and you end up in a conversation about priorities, life goals, and continued fit, then I'd venture to say that you're doing just fine as a leader.

I remember approaching a boss several years ago and the conversation basically went like this: "I've been offered this position in an academic program, full benefits, retirement, the works. The problem is, I really love the team here and the work we're doing is meaningful." I'll never forget what my boss said to me: "Rafi, I'm not saying this because I want you gone, but you'd be foolish not to seriously consider the offer." We then had a real discussion about my life priorities, career goals, and how this team fit into that list. Now, I went on to stay with that team until our consulting project was over, but the lesson from that conversation has stuck with me since then. I'm still learning this and working on it myself, but I have come to believe that being a "good leader" is essentially the same as "being a good person". And that starts with looking out for the best interest of those on your team...even if that means that they end up leaving the team for other opportunities or roles. Not every boss I've ever had would have had that conversation with me. But, I'm forever grateful that I've been blessed to have learned from some great leaders over my career who modeled this style of people-first leadership...

I read in a book once that your clients won't remember you in 20 years, but the people who will remember you are the people you worked with, and especially the people you managed or led. If you want to have a real impact in your industry, perhaps a way to do that is by being a good leader to your team, and letting them spread their wings and hopefully they'll create positive waves wherever they end up.

What we cover in this Episode:

• Building a strong work culture that promotes conversations rather than notifications
• Challenges in recruiting and retaining healthcare team members
• How these conversations are different than letting a team member go due to performance issues
• Looking at saying goodbye to team members as a way to continue to build a strong work culture
• Leading in a human way
• A bit of my backstory and career history

Full episode note: https://rehabupracticesolutions.com/better-outcomes-151

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Do people really understand their healthcare bill?

I talk about this all the time on the show, but healthcare is one of the only areas of the economy where the distribution of information is extremely one-sided. What do I mean? I mean that, for the most part, patients receiving care may have a general idea about how much their care will cost, but very few actually have a specific dollar figure upon which to base their decisions. On top of that, unless they are healthcare-trained professionals, they also lack a complete understanding of the treatment options, potential outcomes, and the like. The same holds true for their healthcare bill.

For the most part, people have a general idea of what they need to pay for healthcare services. The problems start to appear when insurance denies claims or treatments require preauthorizations or the like. The resulting bill often comes as a surprise, and can in many cases be rather large. In fact, surprise medical bills have become such a large issue, that the No Surprises Act of 2022 was enacted to try and counter the trend.

This week, I sit down with Frank Lobb, author of The Big Lie in my Healthcare Bill: Why I Don't Owe What My Insurer Fails to Pay". In this book, Frank tackles the topic of insurance denials leading to surprise medical bills.

What we cover in this Episode:

-Who actually pays in healthcare
-How healthcare bills result in true financial burden for patients across the country
-How Insurers structure contracts with providers
-The challenges that come from big healthcare & the push for efficiency
-The Value that Insurers State that they Bring to the Market
-Frank's story of Insurance Denials and Being Unable to Pay out of Pocket for Treatment
-How an Engineer Came to Write a Book About Healthcare Bills

Full episode note: https://rehabupracticesolutions.com/better-outcomes-150

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

How do you set up an RTM Program that's actually profitable in an outpatient clinic?

Well, it's been 3 years since remote therapeutic monitoring, or RTM codes, were introduced by CMS to allow clinicians to monitor patients outside of the clinic. Many clinics rushed to implement RTM Programs in the months following these new codes going live. And many clinics stopped delivering RTM services almost as quickly as they started. But why?

The main reason many of these RTM Programs failed stems from the fact that many were thrown together as "add-ons" to treatment rather than a legitimate program. As a result, clinicians tasked with implementing RTM lacked processes and an understanding of the reasoning behind implementing RTM in the first place. Even now, when I talk with RTM platforms and practice owners, I hear the same thing: Initial sign-ups and patient enrollment were high, then trickled off, and are now almost nonexistent.

So, this week, I sit down with a previous guest, Matt Juke, CPT, to talk about how to set up and implement an RTM program that is not only sustainable, but profitable for the clinic and a value add for patients.

What we cover in this Episode:

-The benefits of RTM Programs in outpatient therapy clinics
-Challenges of implementing & billing for RTM Programs
-The importance of understanding workflows for RTM
-How to select a platform for RTM
-Communicating the value of RTM to all stakeholders

Full episode note: https://rehabupracticesolutions.com/better-outcomes-149

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Can AI Healthcare Phone Services Increase Patient Access & Improve Engagement?

You know what frustrates many patients (including yours truly)? Phone trees. "Press one to select scheduling" (Presses 1) "By pressing 1 you have indicated that you would like to connect to scheduling. Is this correct? Press 1 to confirm or 2 to cancel". It drives many patients to hand up the phone, drop off the schedule, or go find another healthcare provider. But what if there was a way that automated phone messages could increase access, patient engagement, and experience? Enter an AI Healthcare Phone Service.

If implemented well, AI has the ability to greatly increase practice efficiency and allow clinicians to actually spend more time delivering care. The same holds true for the administrative process of care. Healthcare workers, including office managers and patient access personnel who manage scheduling, struggle with the overwhelm of more phone calls and requests than they can manage. And, despite the fact that many healthcare providers offer an online patient portal, only around 30% of patients actually use those portals. Patients still want to talk on the phone with their providers. So, this week, I speak with Ada Andruszkiewicz from Talking.ai about how implementing AI into processor care can actually increase patient access and improve human connection in healthcare.

What we cover in this Episode:

-The winding road from tech development to the healthcare SaaS market
-Burnout in Healthcare
-Understanding Value in Healthcare Technology
-Challenges in running independent healthcare practices
-How implementing technology can actually increase human connection in -healthcare
-Thoughtful implementation of Artificial Intelligence in healthcare
-Deploying an AI Healthcare Phone Service in a practice

Full episode note: https://rehabupracticesolutions.com/better-outcomes-148

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Is Value-Based Care Too Much for Independent Healthcare Practices?

I've talked about the consolidation in the healthcare market before. I recently sat down with the folks at StrataPT to talk about PE firms buying up healthcare practices and how small, independent healthcare practices are beginning to feel the pressure. But one thing I haven't discussed on the show is what exactly has caused the consolidation in healthcare (big players buying up little players). Over the years, many independent healthcare practices have been purchased by either private equity firms or health systems/hospitals. But why?

Part of the drive for this consolidation stems from economies of scale. Big healthcare systems and hospitals leverage their size to combat rising overhead costs, declining reimbursement, and even compliance and the ability to participate in alternative payment models. That last one is an interesting take that I hadn't considered before. But, over the holidays I read an article entitled Value-Based Payment and Vanishing Small Independent Practices. In this article, the authors argue that one driving factor for the consolidation in the healthcare market stems from the fact that value-based payment models require a lot of administrative work & data management that independent healthcare practices struggle to manage. So, this week, I take a dive into this idea and discuss some ways that independent healthcare practices can maintain viability in the world of big healthcare.

What we cover in this Episode:

-Understanding how Big Healthcare benefits from value-based payment models
-How economies of scale help improve data exchange and combat decreasing reimbursement in healthcare
-Understanding Value in Healthcare
-Challenges in running independent healthcare practices
-Independent Healthcare practice as a business
-Some strategies that independent healthcare practices can employ to remain competitive
-How to create an effective healthcare positioning strategy to thrive in the current healthcare landscape

Full episode note: https://rehabupracticesolutions.com/better-outcomes-147

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

What is Healthcare Positioning?

When I talk to clients about Healthcare Positioning, the first question to address is “What is positioning?” And that’s a fair question. I usually tell people that positioning involves communicating the value you/your company creates for your customers/clients in a way that differentiates you from competitors and builds perceived credibility & authority to your ideal target market. This week on the podcast, I take a deep dive into the idea of healthcare positioning strategy. I discuss how to develop an effective positioning, some challenges and pitfalls that many of my clients have fallen victim to, and some thoughts around the nuances of positioning in healthcare vs. other industries.

What we cover in this Episode:

-Define healthcare positioning strategy
-Marketing strategies that work in healthcare
-Communicating Value in Healthcare
-The goals of healthcare positioning
-Identifying your target market in healthcare
-Using healthcare positioning to make strategic business decisions
-How to create an effective healthcare positioning strategy

Full episode note: https://rehabupracticesolutions.com/better-outcomes-146

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

A year in review: Healthcare in 2024

It seems like only yesterday that I was planning for 2024. Scheduling out projects for the year, booking speaking engagements, and lining up interviews for the podcast were in full swing. Then, in the blink of an eye, we arrive at the end of 2024. And what a year it has been. From cyberattacks to breaking healthcare innovations, 2024 has had its share of big news stories. So, this week, I take the time to do a "2024 Year in Review: Healthcare".

What we cover in this Episode:

-The Change Healthcare Cyberattack and it's downstream effects
-The Expansion of & Breakthroughs in Artificial Intelligence in Healthcare
-Hospital and Healthcare Closures and Financial Troubles
-Remote Patient Monitoring and Telehealth & Virtual Healthcare
-Anti-Trust issues and litigation in Healthcare Tech
-Health Equity comes to the forefront of healthcare policy discussions
-Integration & Interoperability in Healthcare Tech
-Leadership in healthcare amidst tragedy and turmoil
-Healthcare policy shifts and the future political landscape for healthcare in the US

Full show notes: https://rehabupracticesolutions.com/better-outcomes-145

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!