Episode 8

The Biggest Issues Facing Physical Therapy Practices Today

CEO of the American Physical Therapy Association, Justin Moore, gives us some insight into the broad issues facing physical therapy practices today. Some of what we talk about: The issue with static pay How a higher demand for physical therapy is driving our workforce shortage How artificial intelligence is affecting the T&R space
Published on 06/30/2023
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Episode Transcript

Scott Rongo (01:40.150)

Hey, good morning, good afternoon and good evening and welcome to the Therapy Matters podcast, your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Scott Rongo, and today we have a very special guest in Justin Moore, the CEO of American Physical Therapy Association, also known as APTA. Justin, thanks for joining us today.

 

Justin D Moore (01:59.794)

Thank you, Scott. Privilege to be with you and I look forward to our conversation this morning, this afternoon or this evening.

 

Scott Rongo (02:06.254)

Absolutely. So Justin, you’re not new to the space or the industry. Perhaps let’s get started with maybe just giving a little bit of guidance and background on yourself for our audience.

 

Justin D Moore (02:20.198)

Yeah, well thanks. As you said, I’m Justin Moore. I’m the CEO of the American Physical Therapy Association, but I’m a physical therapist by background and have been at APTA for the last 24 years. So very early on in my career, I got the opportunity to come to APTA to work on public policy issues, and specifically the physical therapist profession’s efforts to protect manipulation as a part of our scope of practice. So that’s what brought me to APTA.

 

I’ve spent my career here and presently have been the CEO for the last seven years.

 

Scott Rongo (04:42.862)

So Justin, there, again, Justin, so you have a bit of a unique lens, right? You practice, but then you also have the lens of being able to see across the country what’s happening in the space and interact with your PTs again across the country. Be curious, what are the three key things that you know, come across your desk that you’re hearing in the space that we need to make sure we are mindful of as we move forward.

 

Justin D Moore (05:17.466)

Yeah, it’s definitely a unique vantage point from where I sit. And the three things that I think that we see that are really the challenges or opportunities for this profession are, first and foremost, payment. We have been in a static payment environment for a number of years. And so how do we really reflect the value that physical therapists provide and be paid fairly and appropriately? And so with payment being static, we definitely need to find efforts to get increased value, increased payment.

 

for our providers, for our practices. That’s also combined with increasing administrative burden. And so the cost of delivering care has gone up at a faster rate than our payment rates have. So how do we also attack that side of the equation and really start to look at how do we lower overall costs of care delivery as well? So it’s a two-prong attack on the payment front. How do we raise revenue, lower expenses so that we have a vibrant business community,

 

practice community to support the impact physical therapists can make. So that’s the first, that’s always priority one. The other two issues are workforce. That does have some relationship to the cost of care, but we are at a little bit of post pandemic labor crisis. And we’ve seen a high number of individuals leave the profession. We’ve seen a reduction in hours. And we’ve seen that really challenges practices.

 

to having the workforce they need to serve the demand our profession is driving. And so it’s a great victory for the profession. We’re seeing more people seek our care. Now we need to have an adequate workforce to be able to meet those patient needs, whether it’s long COVID, pain medication, an alternative to pain medications. How do we really have a robust and prosperous workforce? And then the third, which is sort of a new area is

 

the emergence of technology in the profession. So how are our practitioners really using what’s becoming more portable, more mobile, more accessible technology? And that’s seen through remote therapeutic monitoring, that’s seen through the digital platforms that are coming on the market, that’s seen the use of electronic health records that can provide insights and data and practice parameters. There’s just a lot converging

 

Scott Rongo (07:11.950)

the emergence of technology.

 

Scott Rongo (07:39.426)

a lot emerging on the technology.

 

Justin D Moore (07:40.630)

on the technology side of how does that really help our practitioners, everything from practice management and be more efficient on that cost side to how do they get insights to help improve and do continuous quality improvement practices. So those are the three things that we see from all vantage points, whether we’re talking to industry, practice owners, individual clinicians, students, they always come together for those three sort of key themes of payment, workforce and innovation.

 

Scott Rongo (08:08.638)

Yeah, and to your point about one and two, my suspicion is even on the third one, you can kind of, they all are intertwined, right? On how they work together and how the providers kind of are impacted by the technology, by cost, by reimbursement, and the workforce certainly is again, impacted across the board, whether it’s a PT or front office staff or back office staff.

 

So my, you know, my, my sense is we could probably go, you know, a good few hours on each of these topics, um, which we clearly won’t have time for today, but hopefully we’ll be able to have some follow-up, maybe conversations with, with folks around these, but let’s start with, you know, rising costs and you know, reimbursements down, you know, from your vantage point, you know, how can organizations best manage this? I mean, this is, it’s a challenging thing.

 

Justin D Moore (08:37.938)

Yeah, absolutely.

 

Scott Rongo (09:04.782)

across the board, right? Regardless of the size of your practice, but what kind of guidance would you give to organizations out there to help manage this and control this?

 

Justin D Moore (09:16.370)

Probably my two biggest pieces of advice are diversification. One of the great things that has happened in this profession is that we are recognized by insurance companies, whether that’s Medicare on the federal level or most the commercial payers or even state-based plans. So physical therapy has really achieved a lot by being recognized by those payers, but it’s also created a little bit of dependency on that model. So diversification of revenue sources is critical for practices.

 

and clinicians from that standpoint. And the data we know that is we are really insurance dependent and insurance directed. And that has been good for the profession at a macro level, but is also some of the pressures we’re feeling with lowering rates, increasing administrative burden. So we really look for practitioners to look to go direct to consumer, look to diversify, add new services, add new product lines.

 

Scott Rongo (10:09.684)

Mm.

 

Justin D Moore (10:14.710)

We need to have a more diverse set of offerings to help drive revenues into our practice. So that’s the first thing that really stands out to me for advice. And then we have to empower consumers. One of the things, those consumers are the people who are working with their employer and purchasing that insurers. So we have to be able to talk directly to consumers and really help them be our advocate on getting their insurance to cover physical therapy and to cover it adequately. So on the practice side, I always argue for, greater diversification, seeking new revenue sources, but also then empowering who is your best PR, your patients. We know that from consumer data, that the patients who receive good quality care become our best ambassadors and our best advocates. So how do we make sure that they’re talking to their insurance company because they’re going to have as much impact. as all of us are, and we’re going to continue to do it from an association standpoint, but that surround sound is what’s going to get their attention. consumer driven healthcare, right? I mean, I can tell you as a PT patient and as having a child that has needed PT, I think that is so critical in being able to know and be able to have access to be able to get the care that is needed for sure. 

 

Scott

So now if you put your APTA hat on, right? Are there things that… the organization are doing to help try to drive reimbursements on behalf of the industry.

 

Justin D Moore (11:53.166)

Yeah, yeah, a couple things is probably what we do the most of is advocacy. And that’s both at the federal and in collaboration with our state chapters at the state level. So the issues were that are sort of top of the agenda this year are increasing Medicare payment rates. We are in a death spiral of the Medicare physician fee schedule. Every year that comes out about July 1st. It’s because of a payment policy that.

 

incentivizes primary care, we get a cut. And so each year we fight that cut and try to address so that we can keep payment at least adequate. And so that’s our first priority is making sure that Medicare physician fee schedule cut is not fully implemented. So we want to delay it, diminish it, and that’s an annual process. And so a lot of our advocates that listen to these podcasts will know that that’s, they really are the

 

the ground troop of making sure that Congress hears that we need to address that because those cuts are unsustainable. At the same time, we’re trying to pass legislation that would take that policy off the books and replace it with an annual Medicare economic inflationary index so that we’re not fighting this diminishing the cuts. We’re fighting, you know, we get a stable payment environment so we can seek long-term reforms. So that’s really, and the reason Medicare is so important, is because a lot of private pays and commercial pays use that as their benchmark or their reference point. So if you see a cut in Medicare downstream the Aetna’s, Blue Cross’s, all the other payers sort of follow that over a course of time. And so it doesn’t affect the wide swath of patients that physical therapists serve, but it does set a standard or a benchmark on which payment is referenced.

 

Scott Rongo (13:32.261)

Mm-hmm. Falsuit.

 

Justin D Moore (13:46.674)

or compared to. So that’s our first. We’re also attacking the administrative burden side that you saw on the front end and prior authorizations, the big one, our data at APTA shows that prior authorizations adding anywhere from eight to 10 minutes per patient visit. As we know in physical therapy, as whether our payment system is time based, that is non billable time. And so that’s a that’s a somebody could be getting

 

Scott Rongo (13:56.057)

Hmm.

 

Justin D Moore (14:14.598)

when somebody is actually in the back office filling out paperwork. So if we, so prior authorization is the administrative burden we’re most focused on right now. And we’re doing that both at the federal level working at Medicare Advantage plans, but also having great success at the state of working directly with local payers and getting state legislators involved in this issue as well. And you know, attacking prior authorization.

 

Scott Rongo (14:17.090)

Somebody is actually in the back office.

 

Justin D Moore (14:41.666)

is going to be our focus when we go out to state legislative conferences this summer. So we were running ads, education seminars to really how can policymakers help us address this hidden cost in health care. It’s really just driving up costs for the patient without any care being delivered.

 

Scott Rongo (14:59.088)

and just a lot of state-legislative companies running ads, education seminars, but really how can policymakers help us address this hidden cost of health, and really just driving up the cost for the patients and outpatients of care vehicles? Eight minutes a patient is gonna add up very, very quickly, right? Very, very quickly. That’s good stuff. So let’s maybe shift our conversation to the workforce.

 

Justin D Moore (15:04.175)

Yeah, absolutely.

 

Scott Rongo (15:13.293)

workforce shortage.

 

Scott Rongo (15:18.082)

Is this driven by the COVID pandemic? What do you think the root cause of this is? Is it people are looking at it saying, hey, there are income potentials or challenges rather downstream. What do you think the cause is?

 

Justin D Moore (15:36.142)

Yeah, it’s all the above. So workforce is as close to payment as a major challenge that we’ve seen. And I personally think we’re sort of in a labor crisis. And the reason is the pandemic did have an impact. During the pandemic, we did see PT’s furloughed, laid off, and did they return to work? As the pandemic recovered, we’re still gathering data on that, but there is an indication that we did lose a portion of our workforce.

 

over the 40 months of the public health emergency, which ironically ends today. So the public health emergency ends today and we’ve been in that for 40 months. But we did see an impact, whether it was lost revenue, lost hours. We also see an increasing trend of individuals seeking less full-time employment. And so part-time employment is becoming a new trend in the workforce.

 

Scott Rongo (16:11.198)

Yeah, that’s right.

 

Justin D Moore (16:33.486)

So working 30 hours versus the full 40 hours, which obviously has a macro impact on the total available clinical workforce. And so that’s going on in that dynamic. So that leaving the workforce, big issue through the pandemic, different practice patterns from our clinicians of part-time or wanting to do gig economy in addition to a full-time employer. All those are having an impact of a very…

 

Justin D Moore (17:03.430)

very dynamic workforce and a very mobile workforce. We also have some good news stories on the workforce side. And partially those two good news stories as the demand for services is increasing. And so practices are seeing more people seek their care. We’re seeing more career opportunities for physical therapists, both good news stories. But when you start to pull PTs out of the clinical workforce, that is a challenge to the available

 

Scott Rongo (17:06.871)

Hmm.

 

Scott Rongo (17:16.088)

Mm-hmm.

 

Justin D Moore (17:32.434)

the available portion of the workforce to see patients. So we’re seeing growing number of clinicians choose non-clinical practice environments. I’m an example of one. We have PTs that are CEOs of major hospitals. We have new competition in the market for positions. The digital platforms that we talked about in innovation are employing physical therapists. And so those are pulling more competition in the available jobs for physical therapists, which at a macro 30,000 feet level is very exciting for the profession.

 

Scott Rongo (17:53.669)

It’s a concern, more competition in the available time.

 

Justin D Moore (18:02.502)

But at a daily level, it is challenging the available workforce on site in clinics, in practices, providing patient care. The last thing I’ll say on the workforce is, you know, PT should be proud of how they’ve invested and sustained a viable pipeline. Our profession has grown very rapidly. We’re now the fifth largest profession in health care. We’re producing. We’ve doubled our workforce in just over a decade.

 

Scott Rongo (18:24.802)

largest profession in healthcare. We’re producing, we’ve doubled our workforce in just over a decade. So we’re now graduating about 12,500 new physical therapists annually. May is a big month. About 60% of all those graduates graduate this month. We’ll start to take their MPTE and be available to the workforce August and December, the next two cycles that we see on that work.

 

Justin D Moore (18:32.402)

So we’re now graduating about 12,500 new physical therapists annually. May is a big month. About 60% of all those graduates graduate this month. We’ll start to take their NPTE and be available to the workforce, August and December, the next two cycles that we see on that workforce. And so we should be proud of that pipeline and that production. We need to also match that with how do we retain our workforce and how do we create healthy practice environments.

 

Scott Rongo (18:51.434)

And so we should be proud of that pipeline and that production. We need to also match that with how do we retain our workforce and how do we create healthy, fast environments where people see a career in physical therapy and really support our clinics, clinical workforce at a high level. And we’re seeing that at…

 

Justin D Moore (19:00.658)

where people see a career in physical therapy and we really support our clinical workforce at a high level. And we’re seeing that across healthcare. How do we prevent burnout? How do we build resiliency? How do we keep a fit and well practice community so that we can meet that ultimate mission of serving patients and improving the health of society?

 

Scott Rongo (19:25.798)

Yeah, that’s great. And this recording is taking place on May 11. So to your point about the pandemic, quote unquote, ending today is in reference to that. And I’d also say congratulations to all those graduates that are going to be happening over the next couple of weeks. So that’s great news. The third thing that you mentioned is technology. And you referenced

 

a lot of different things, right? There’s EMRPM software, there’s, there’s remote therapy monitoring that obviously is taking hold and changing the landscape. I’d be curious as to one bit of technology though, that I don’t know if, if you and the APTA has given much thought to it, but there’s a lot of talk around AI, not just in the PT space, but just, you know, across the board, right? You can’t turn on,

 

Scott Rongo (20:21.118)

a news channel and not have some kind of story around how AI is penetrating and impacting all sorts of industries. Just kind of curious as to what you’re hearing out there, if there’s technologies on the horizon with AI in particular that you think are going to start having an impact or not just technologies, but how AI might have an impact on the space in general.

 

Justin D Moore (20:47.706)

Yeah, it’s a great question because I think I’ve heard more about AI in the last two weeks. I mean, I knew I was out there, but it is gone from being a curiosity to an all-consuming thought. And we look at it at APTA at two levels. And the first, and I’ll spend very little time on this, but the first is how does it affect our role as an association supporting individual members who are seeking our knowledge, our resources?

 

Scott Rongo (20:58.350)

Mm-hmm. Yeah.

 

Justin D Moore (21:17.214)

And we know we’re going to have major business disruption due to AI. And so a great example of that is we’re in the certification business. We’re, you know, especially certification and what are the ways to maintain the integrity of that process when AI, you know, is starting to be very, very proficient in, you know, helping people with applications and scientific publications, you know, how does AI challenge the journal world where people can ask, you know, chat GPT.

 

What’s the latest ways to treat blowback pain and get results versus doing the evidence-based research? So we’re looking at it from that standpoint already from a APT as an association supporting the individual physical therapist. But I think more important in your point is it’s gonna disrupt practice. And I think it’s probably gonna be on two levels is how does AI get deployed on the practice management standpoints? So can it add efficiencies to practice? Can it provide predictive analytics?

 

Scott Rongo (22:00.046)

I think more important than your point is, it’s gonna disrupt the practice. And I think it’s probably gonna be on two levels is, how does AI get deployed on the practice management? So can it add efficiency? So,

 

Justin D Moore (22:16.634)

and they help you understand trends patterns at a higher level. And will reduce some of the administrative burdens we see. So there could be some pluses on that. So we need to, we’re digging into that and what’s the role of AI as it matures to really helping us be doing what we all sought to do was to spend time with patients. So the other thing it’s gonna, on that side is how’s it gonna be utilized by consumers?

 

Scott Rongo (22:34.558)

what we all thought to do.

 

Justin D Moore (22:45.110)

How are they gonna use to seek our care or to augment our care? And then how’s it gonna assist in practice delivery? And all those things really come together to really challenge us as a profession to see how are we going to set the right ground rules, guard rails around the use of AI in PT practice? And I think AI is sort of where Telehealth was 25 years ago.

 

Scott Rongo (23:02.798)

saying how are we going to set the right ground rules, guardrails around things of AI in the ground. And I think AI is sort of where telehealth was 25 years ago. When we were sitting there saying, oh, there’s a new way of providing patient care over telecommunication.

 

Justin D Moore (23:13.490)

when we were sitting there saying, oh, there’s this new way of providing patient care over telecommunications. What are the parameters? What are the guidelines? And it took 25 years for telehealth to sort of mature, and it matured in about three days once everybody had to do it. And I think in AI, it’s gonna happen faster. I think we’re gonna have to be quicker to the guardrails, quicker to the adoption and adherence, because we’re not gonna have 25 years like we did with telehealth. We’re gonna have 25 months.

 

Scott Rongo (23:23.914)

And it took 25 years for telehealth to sort of matured and matured in about three days once everybody had to. And then AI and AI.

 

Scott Rongo (23:34.367)

Yeah.

 

Justin D Moore (23:43.086)

Maybe. And so I think we have to be, and our board’s having a lot of conversations about this of really what do we need to do with the PT community at a little, at the base level of education and literacy? What is AI? What are the different things that are going on in the profession in AI to best practice? And that’s the spectrum that we would look at it from is everything from basic literacy on AI to best practice on use of AI and patient care and practice management.

 

and association business.

 

Scott Rongo (24:14.787)

Yeah, and I agree. There’s no way there’s 25 years and I think 25 months is questionable too at this point, right? It is coming and coming quickly across the board. So just I think.

 

Justin D Moore (24:22.483)

Exactly.

 

Justin D Moore (24:26.822)

Yeah, there was just an article in, I think it was the British Medical Journal about the use of AI in healthcare. And so you’re already starting to see scholarly publications, which are not known as the most efficient processes, talk about AI. And so if they’re already embracing it and talking about it, the practice community has got to be adopting it and understanding it at a very high level.

 

Scott Rongo (24:38.830)

Hmm.

 

Scott Rongo (24:46.510)

Mm-hmm.

 

Scott Rongo (24:52.362)

Yeah, yeah, totally, totally agree on that. So Justin, I think we’re about out of time, but I would love for you to maybe just talk to the audience for those listening that are either currently involved with APTA, maybe, you know, how they can be more involved. And for somebody that’s listening, maybe that’s not involved with APTA that would like to get involved. How can they how can they get involved with the organization?

 

Justin D Moore (25:20.018)

Well, first and foremost, APTA is the sum of its members and it is a member-driven organization. So getting involved, being engaged in your professional association is, you know, not a sort of a transaction. It is a commitment to advancing your profession. So I’d highly encourage all PTs out there to be part of this community, part of this organization, because not only do we need you for our voice, for our impact,

 

We do need a collective organization advancing this profession, addressing issues like what are the parameters of AI? What are the new payment models? And we’re the implementers here on the staff side, and we need the ideas and the innovation coming from the profession. So we highly encourage anyone that’s listening to this podcast. If you’re a member, first of all, thank you, because you are what make us go.

 

And then if you’re not a member, I consider joining this community because people who are involved will tell you, you get more out of it the more you put in it. And so we always hear, oh, it’s expensive or I don’t see value, help us create that value. And I guarantee you, if you get involved, you start participating, attending conferences, you will get more value out of it than you’ll ever experience, whether that’s networking, connecting to other people that are gonna help you be your best self.

 

Scott Rongo (26:25.870)

Mm-hmm.

 

Scott Rongo (26:33.001)

And I might.

 

Justin D Moore (26:46.102)

But that’s sort of what associations are. It’s bringing the community together, you know, centralizing those resources to do advocacy, PR, and those different activities to advance the profession. And our goal at the end of the day is that every physical therapist can practice at the top of their license and has the economic opportunities to practice where, when, and how they want. And that’s what we’re all about. And so be part of this community.

 

Scott Rongo (27:12.815)

Yeah, what’s the old saying? You get out what you put in, right? So, yeah.

 

Justin D Moore (27:16.026)

Yeah, absolutely. We always, I always laugh when we have our top awards of the big, the physical therapists that have, lifetime achievement awards essentially, whether that’s fellowships or the McMillan lecture, they almost all say, I got way more out of it than I ever put into it. And these are the top of the top. And so, it’s sort of the Sammy Sosa line, physical therapy has been very, very good to me. So that’s what you hear from that standpoint.

 

Scott Rongo (27:45.130)

Very good. Well, Justin, very much enjoyed the conversation and appreciate you taking the time out here today and to have it with me. And to our audience, thanks for tuning in to the therapy matters podcast, your one stop resource for expert insights and advice on everything therapy and rehab. We look forward to seeing you on the next episode. Take care and have a great day.

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