3 Biggest Frustrations (and Coping Strategies) of Physical Therapy Clinic Owners

In a recent survey we asked 82 physical therapy clinic owners and managers about the hardest or most frustrating part of running their clinic.

#1 – Dealing with Insurance Companies

It wasn’t even close. Dealing with insurance companies was cited as the hardest or most frustrating part of running a PT clinic by the largest number of respondents. The comments were divided into two main areas of complaint:

  1. Large amount of required paperwork / documentation; and
  2. Keeping track and complying with the constantly changing requirements.

Some representative quotes include the following:

  • “What used to be a profession of hands-on, skilled techniques, using the knowledge gained through evidence-based science and a clinician’s experience and expertise, is now a profession of appeasing insurance companies with ridiculous amounts of paperwork.”
  • “I think I am not different than most therapists and paper work has always been the worst part of PT. Seems like we spend more and more time doing computer work, re evals, PN and reverts.”
  • “Definitely documentation for me! It’s tedious, repetitive, and requires me to sit in front of a screen, which are all the opposite of PT in my mind.”
  • “Easily the ability to control the paperwork after hours. Working is a joy… the part that takes that away is the unbelievable amount of paperwork.”
  • “By far dealing with multiple insurance companies and trying to get patients coverage. It’s an uphill battle sometimes.”
  • “I think the hardest part about being a physical therapy office manager/administrator is keeping up with certain insurance companies and their ever changing requests to remain in network.”
  • “Dealing with the administrative items with insurance companies, getting the authorizations, getting the insurance companies to correct their mistakes with payments or lack of payments due to their errors.”
  • “Dealing with insurance authorizations. There are so many different online forms, many that are not user-friendly and I am constantly doing double paperwork.”

#2 – Not having enough time for patient care and work-life balance

The second most common complaint cited by clinic owners / managers is difficulty finding enough time for quality patient care, working long hours and working through breaks. This appears to be closely related to the documentation overload placed on physical therapists.

Some representative quotes include:

  • “I find the hardest thing is having enough time to give the patients what they need, demands on time include documentation, marketing, supervising staff, insurance issues and productivity demands.”
  • “Time management to accurately document what you’ve done on a patient to get properly reimbursed. The curse of documentation is that it interferes with the old paradigm of one to one care.”
  • “Patient care and the resulting paperwork push beyond the 8 hour work day. I am oftentimes writing notes on ‘home’ time.”

#3 – Low reimbursement

Our previous physical therapy industry research based on reports from large, publicly-traded physical therapy companies (U.S. Physical Therapy and Select Medical) suggested that average industry reimbursement rates per visit are currently in the $100-$110 range. However, we have received reports of significantly lower commercial insurance reimbursement from smaller clinics in certain geographies, for example, $70 per visit in Washington D.C. area, and $90 per visit in the Boston, Massachusetts area.

Some representative quotes concerning the low (and declining) reimbursement rates include the following:

  • “I would say my biggest challenge of being a PT would be the reimbursement rates. We aren’t being paid fairly for our services when out of every doctoring profession we spend the most time with our patients.”
  • “Reimbursement is probably the biggest challenge we face. We see a high level of workers compensation and we generally have more problems with them reimbursing than with commercial insurances.”
  • “Poor reimbursement rates for our services that are often highly skilled. Massage therapy pays out more than manual. Who decided that?”
  • “The most frustrating thing for me is negotiating payer contracts and being met with low offers as reimbursement continues to decline.”

Coping strategies

Clinic owners and managers are pursuing some of the following coping strategies to deal with the issues listed above.

1) Taking the time to find a great billing service (for smaller clinics), or bringing billing in-house for larger and multi-location clinics:

  • “I finally found a billing service with whom I have a successful working relationship. It took me 4 years to find them. Initially, getting paid timely was my greatest concern, but now that I have a great billing service, that’s not such an issue.”
  • “Bringing billing in-house was one of the smartest things we ever did…third party billing is a complete nightmare when you are trying to get answers about difficult claims and don’t have direct contact with the person or persons reviewing and handling the claims.”

2) Creating special cash-pay programs or becoming a fully cash-based practice

  • “Reimbursement is certainly one of the biggest issues facing PTs currently, and truthfully it has been problematic for a long time. I’ve known several therapists to choose the cash-based route due to the time and cost required to coordinate with insurance companies.”
  • “Being a cash-based practice I do not have to worry about insurance reading my documentation.”
  • “Our approach is finding the right folks who are willing to pay for high quality care instead of being a product in a mill.”

3) Being very deliberate and disciplined about taking breaks and maintaining a work-life balance

  • “I am more sane, refreshed, energized, resourceful and knowledgeable by actually taking an hour for lunch and another hour break later in my day. And taking Fridays off for admin time or for play time has been helpful. Otherwise, I work 8-6, sometimes until 7, 4 days a week.”

There is one additional strategy for coping with documentation that some clinics (our clients) are using. These successful clinics use a special software tool (as a complement to their Electronic Medical Record) to let patients generate the documentation needed for reimbursement.

It’s a win-win: patients feel more engaged in their care and therapists spend less time on the hated paperwork and more time doing what they love (taking care of patients and going home earlier to their families).

If you would like to learn more about this tool, please email us at: ab@jakaricare.com

(c) 2018. Jakari Care, Inc.

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