November 14, 2025 • 50 mins
On this episode of Agile&Me, host Richard Leaver is joined by Nick Patel, Executive Director of the Alliance for Physical Therapy Quality and Innovation (APTQI), to discuss the evolving landscape of advocacy in physical therapy. Nick shares insights from his eight years of leadership at APTQI, the challenges faced by the industry, and the strides made toward creating a stronger, unified voice for the profession.
To learn more about us, visit our website at https://www.allianceptp.com/
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Alliance Physical Ther (00:02):
Alliance Physical Therapy Partners in
Agile Virtual Physical Therapyprobably present Agile and Me, a
physical therapy leadershippodcast deviced to help emerging
and experienced therapy leaderslearn more about various topics
relevant to outpatient therapyservices.
Richard Leaver (00:19):
Welcome back to Agile and Me, a PT Physical
Therapy Leadership Podcastseries.
And I'm excited, again, in mymonotone British voice, to
welcome back Nick Patan.
Nick was last with me in 2001on this podcast.
So welcome, Nick.
Nick Patel (00:36):
21, I think.
But yeah, well, I'm excited.
Yes.
Appreciate being back on.
Richard Leaver (00:44):
Time flies in the Career.
So today I wanted to kind ofregroup and talk a bit about
advocacy, APTQI, and reallywhat's going on.
And but before we do that,Nick, can you perhaps introduce
yourself to our listeners?
Nick Patel (01:02):
Yeah, absolutely.
So, you know, I am theexecutive director of our group,
the Alliance for PhysicalTherapy, Quality and Innovation.
It's a it's a mouthful, but II've been in the fortunate
position to be the executivedirector for about eight years
now.
I'm a physical therapistmyself.
Almost all of my career hasbeen in the outpatient or
office-based setting.
(01:22):
One of the things that I havereally dedicated a good chunk of
my career to has beenadvocating for better policies
for therapists, because aswonderful as our profession is
and as great it is to see howthe things that we do are able
to impact people in such ameaningful way, the more you
(01:44):
treat, or the at least the moreI treated, the more I realized
that, man, this is a there's alot of artificial barriers,
man-made barriers that we haveput in place over time that just
make delivering care reallyfrustrating.
And so that frustration for meled me to a slightly different
path, which is, you know,finding ways to advocate and
(02:04):
influence and, you know,ultimately make changes for the
better.
Richard Leaver (02:09):
Yeah, first and foremost, thank you for your
work.
You know, you definitely are uha thought leader within
outpatient therapy as itpertains to advocacy and really
promoting the profession.
And without you, we would notbe where we are today.
And I'm sure that yourinfluence will continue to
(02:29):
really pay dividends to theentire profession.
So thank you.
I appreciate that.
So rather than just talkingabout the concept of advocacy
per se, which we did on our lastpodcast, I I think perhaps what
might be helpful is to talk alittle bit more about the APTQI,
(02:50):
because since we spoke in 21,it really has morphed into
something that is much biggernow, and I believe actually a
much larger, more powerful voiceas well.
So perhaps if you could justtalk a little bit about that
first.
Nick Patel (03:09):
Yeah, it's certainly been a tremendous journey for
the group.
We are in some ways bigger thanI ever imagined, but in other
ways, I think that the growthhas sort of led me to understand
that there's a whole world outthere of organizations and
leaders who really want to gettheir hands dirty in advocacy.
And that has actually beengreat.
(03:31):
So where we are with APTGIright now is we initially
started as you know aprovider-centric group where all
the members were operators thathad multiple hundred clinics
and multiple states, and and andthat was and that was great.
Over time, we started to say,you know, we would get interest
from other members like yourselfthat would say, you know, we
(03:52):
want to join.
And and we're smoking, we're abit smaller.
We're not in, you know, 28states and blah, blah, blah, but
we like what you're doing andwe want to help.
And, you know, we're we'rewilling to join.
And so we created a anothermembership class, and that class
has been just explosive forgrowth.
More people coming than than Iever thought possible.
I at first I thought, well,sure, let's let's open up
(04:14):
another one, but I doubt anyonecomes.
And of course, I was provedwrong time and time again.
And then we did this sort ofthird membership class where we
were approached by you knowcompanies that maybe weren't
providing physical therapy, butall of the products, the
services they did were were usedby therapists.
So however the therapyprofession goes, so did their
business.
They just didn't happen to beproviders.
(04:36):
Maybe they ran an EMR company,maybe they sold DME, maybe they
had a technological platform fortherapists to use.
And sure enough, same thinghappened.
We opened up the doors to that,and we had great interest from
folks coming in on that way.
So where we stand now is, youknow, the Alliance has over 30
companies, whether you're, youknow, multi-state, over a
(04:58):
thousand clinics, maybe you're avery regional, 20 to 50
clinics, or maybe you have aplatform for therapists to use.
You're all under the umbrellaof you know trying to do good
for the profession.
And the thing that has neverchanged, regardless of how many
people we've brought in or howbig we have gotten, is something
that I think is really unique,which is uh we we are home to
(05:20):
people who compete every day ofthe week on sometimes on the
same street corner of the samestate every day.
However, when we meet, all ofthat is checked at the door.
And egos and and pettinessdon't really exist when we meet.
And it's all about what we cando for the profession.
Because whatever we can dopositively for the profession is
gonna help me, you, andeverybody else.
(05:41):
It'll be good for all of us.
And I think that I again I liketo think that that happens on
the industries, but I just don'tknow if it does, if it does.
I I make this joke all thetime, but you know, I don't know
if the CEOs from McDonald's andBurger King and Taco Bell meet
every month to talk about likewhat they can do to make food
better.
And my my feeling is they don'tbecause their food is awful for
(06:02):
you, but you know, that's notwhat happens in therapy.
We are we are we're we're doingit monthly.
I mean, you know, and and andyou're there and and you've seen
it, but and and all we we don'ttalk about, well, my company
needs this, and this guy'sbothering me, and we're
competing here.
It's none of that.
And so we've just been able tocontinue with this culture from
the beginning of ego's checkedout the door, and we're all
(06:24):
gonna try to help.
And I think it's made theoperators of these companies go
from competitors to stillcompetitors, but actually
friends and networking and beingable to lean on each other
because no one else knows yourjob better than the person who
has a similar job to you atanother company.
And I think it's made a madefor a nice camaraderie.
And because of that, I thinkthey were we're able to maybe
(06:45):
get make movement and get somethings done, which is the
ultimate goal, because we areable to sort of come together in
that fashion.
Richard Leaver (06:52):
Yes, it's still a very fragmented industry, I
think.
You know, healthcare generally,but outpatient therapy, even
with the consolidation that'soccurred over the last 10, 15
years.
And you know, for me, advocacy,there's really two points.
One is the message.
You have to have a goodmessage, but then there has to
be power in numbers and strengthin voice.
(07:13):
And what has amazed me in thelast five years, particularly,
is that voice seems to be atleast being heard.
Because when we last spoke in21, I think I think we we
questioned to a certain extent,certainly looking back at that
(07:34):
point, that the the voice wasvery weak.
But you know what I've myperception in the last,
particularly in the last coupleof years, as as APT QI has
grown, and also to be fair, asAPTA has morphed and evolved
from an outpatient perspective,I I feel that there is now a
(07:56):
voice uh and proper advocacyoccurring.
Would you agree with that?
Or do you think there's just Iwas ignorant to it in the past?
Nick Patel (08:05):
No, I think you know you hit the nail on the head
because I mean, whether it wasfour years ago or 14 years ago,
I think therapists had a agroup, not not really, you know,
the the fault of any oneparticular individual, one
particular organization, but asa group, as a profession, a bit
of a passivity to us when itcame to advocacy.
And and that voice was wasquite diminished because it was
(08:28):
maybe just a handful of peoplewho are who are participating.
And you really can't get veryfar with with just a handful of
folks.
And one of the things that Ithink is much better about the
industry now is that there's somany more ways for folks to to
to advocate.
I think APTA does a tremendousjob with you know with their
(08:49):
efforts.
And I and I and I think it'samazing what they're able to do
with since I've been a therapistfor 25 years, they represent
about like 25% of theprofession, 20%, it's it's
almost athletic it vacillates inbetween a certain range.
It's always been about aquarter since I think I've uh I
graduated.
And they're able to get so farwith that.
And in my mind, and it butunfortunately that number
(09:11):
doesn't change much.
And I know that they wanted tochange and I'd love it to
change, but you know, if youhave a 20-year track record of
that number staying in a similarrange, how do we get the other
75% involved?
Right.
And so, you know, if if allthings are equal, that probably
means 75% of Alliance physicaltherapy partner employees are
probably not members.
That means 75% of the othercompanies' employees are
(09:33):
probably not members.
But if we can create an avenuefor them to advocate, you know,
and combine them with the folkswho maybe already are doing some
things, then that that's gottabe helpful for us because it's
one thing to have a louder voiceby having more people.
But one of the other thingsthat I've learned is there's
sort of like a value to being inthe public consciousness and
(09:53):
the public discourse.
And I cannot tell you, and I'mhopefully I'm hoping it's better
now, but as a 20-something, youknow, early career person, I
can't tell you how many times Ihad to explain to somebody when
they said, What do you do?
And I would say, I'm a physicaltherapist, and they'd say,
Well, what is that?
Or is that they would saysomething like, Oh, I know what
that is.
That's kind of like achiropractor, right?
(10:15):
Or you're kind of like amassage therapist.
Or they didn't have a like areally solid view.
We weren't in the publicconscious.
You probably just went to onewhen you got hurt, but I, you
know, knock on wood, I've neverhad cancer, but I know what an
oncologist is.
You know, I mean, like weshould just be at a certain
level, people understand whatwhat we are and who we, you
know, who we are and what we do.
(10:36):
And I don't think it was therefor a very long time.
And then so naturally, whendecisions are made and policies
are created, who's going to bethinking, well, how's this gonna
affect a therapist if theydon't even know what we do?
What what what we're trying toaccomplish here?
And if you and if you answerthe question with, you know, I'm
a movement expert or I try tohandle musculoskeletal problems,
(10:58):
I don't think the publicunderstood what that meant,
even.
You know, again, it makes senseto me, it makes sense to you,
it makes sense to people who arelistening.
But the average person outthere, the the ways we've done
we have tried to defineourselves don't quite make sense
in the public realm.
And I think that's somethingthat as you get more voices
helps.
But we've tried to do thingswhere we get, you know, we try
to get more articles just placedin papers about what it is that
(11:19):
we do because people actuallystill read papers.
We try to get in news stories,you know, and we're because
people will watch it.
We try to create betterhandouts and better one pagers
and create better messagingaround what does it mean to be a
movement specialist and and notusing fancy words and not using
words that only other PTsunderstand, but you know, being
able to articulate it in a waythat the public will understand
(11:40):
it.
Because I think that is a hugepart.
When you talk about cutting,you know, I I I make this
reference all the time, but youtalk about cutting cardiac care.
People think, oh my God, whatare we gonna do with all the
people with heart attacks?
And you think about cutting,you know, oncology, people say,
what about the poor people withcancer?
When you talk about cuttingtherapy, no one understands what
that really means because theydon't know what it is that we
(12:01):
do.
If I could go back in time, Iwould just make us all
philologists by title.
Because I then someone willsay, Well, go cut therapy
because people are gonna falleverywhere, and that's a bad
thing.
Because then at least we'rewe're we're we're tied to
something.
And I think one of the, youknow, it's a challenge and it's
not nearly of our doing, but wetreat patients across such a
large spectrum, not only in onesetting, but then think of all
(12:22):
the settings that we work in.
So from the hospital to theschool to the outpatient
facility to in someone's home,but then for musculoskeletal
ages, for host neurologicaldisorders, for you know,
headaches, for developmentalproblems.
We just do so many differentthings, but all with the same
degree.
It's very hard for someone tothink about well, if we cut
therapy, then this is going tobe a problem.
(12:43):
So we have to get that outthere as well.
And I think that that's helpfulfor the profession to
understand to get that out therein ways that the general public
can understand.
But also if you're apolicymaker in in Washington,
DC, you have to know whattherapy does.
And and it's not up to anyoneelse to define it.
If we allow other people todefine it, it'll be not what we
want it to be.
(13:04):
So that you know, that thatshould be our job.
And I think that's one of thethings that we've tried very
hard to start turning thatconversation.
No one can do it in a day, noone can do it at night.
It takes some time, but I thinkwe're working on it.
And I think that that'ssomething where it's a little
bit different than tellingsomeone, write a letter and you
know, and you'll change theworld.
But I think it's giving peopleother constructive avenues to
(13:24):
make the profession better, Ithink is receptive.
Alliance Physical Therapy Pa (13:28):
At Alliance, we believe that
partnership means creatingsomething greater than the sum
of its parts.
Our focus is finding physicaltherapy practices with a strong
culture and thriving community,and providing them with
additional tools, resources, andexpertise to take their
practice to the next level.
To learn more about joining ournationwide community of
(13:48):
outpatient physical therapypractices, visit our website at
allianceptp.com.
Richard Leaver (13:56):
Before we look forwards about advocacy
generally, I'd love to perhapstouch upon some of the hot
topics at the current time thatare affecting outpatient therapy
and how advocacy is occurringthrough various entities,
mediums.
So we one of the things that isuh definitely of significance
(14:22):
is the SAFE Act and the impact,potential impact that can have
on therapy generally.
Would you be able to verybriefly explain what the SAFE
Act has is, but moreimportantly, perhaps, what the
the reasons are behind how howand why it is so important?
Nick Patel (14:44):
Yeah, absolutely.
So the the Safe Act in anutshell is a is a bill in
Congress right now that, ifenacted, would allow for a
Medicare beneficiary who hasfallen in the last year to
receive a no-cost, so so free tothem, a no-cost visit with a
physical occupational therapistfor an annual fall risk
(15:08):
assessment.
So that that's not a screen,that is not a let's do a time
get up and go.
That is a come see me, I'llspend 45 minutes, an hour with
you, I will test your strength,your balance, do a home
assessment, you know, talk aboutwhatever, you know, it is
that's bothering you when youwhen you walk or when you're
trying to transfer, all thatstuff.
And and and I can do all thatwith that person before,
(15:29):
hopefully before they hurtthemselves the next time around.
And it'll encourage them tocome in by saying, you won't
have to pay for this.
And the the reasoning behind itis has multiple, there's
there's multiple reasons we wedecided to pursue this.
The first one is the the theproblem of falls is huge in our
country.
So the medical cost for fallslast last year was about $50
(15:54):
billion.
And 75% of that was born byMedicare and Medicaid.
That and that number is on avery steep curve and
exponentially goes higher.
By the end of this decade, ifnothing changes, we will spend a
hundred million dollars, ahundred billion with a B dollars
on Falls.
And again, 75% of that willlikely be Medicare and Medicaid.
So those are tax dollars, thoseare money, you know, that
(16:17):
that's money that that's beingtaken out of the treasury to pay
those claims.
We we have to stop.
We have to put a dent in thatcurve.
These are people who are oneday ambulatory, living by
themselves, independent, andafter a post-fall, you know,
frig, you know, put aside thethis the hip replacement or
whatever that they have to havegot done afterwards, but now
(16:37):
they're never allowed to livealone again.
They're not allowed to age inplace anymore.
They're their life, their lifebecomes over.
And then if they have to livewith a with a family member,
someone's staying home with momthen.
So now you've taken somebodyout of the workforce.
Now you've taken somebody outof, you know, out of their
contribution to society.
So falls have a huge problem,or falls create a huge problem
(16:59):
for Medicare spend.
They also create a huge problemfor society.
So I'm addressing, we're tryingto address a problem.
Two, it's trying to highlightthat physical therapy can help
with this problem.
So again, there's thatconnection in that in that
public awareness of we can helpwith a very serious danger to
our citizens.
And then the third is a littlemore, you know, you have to dive
(17:20):
into it a little bit to see it,but there's a couple things
that I that we really wanted toaccomplish with the Safe Act.
So one was if we need to startseeing seeing therapy as
something that people can accessbefore you actually get
injured.
You know, and we've talkedabout PT should be primary care
or PT for the MSK space and allthat kind of stuff.
We need to start somewherethough.
I'd love to say let's juststart it tomorrow and everyone
(17:42):
just starts.
It doesn't work that way.
But this is, I think, is a goodway for us to start to start
having that conversation andthat we're not always in there
after you've had surgery.
And what better way to do itthan by saying, let's create a
benefit for people, not thetherapist.
This is a benefit for peopleand for seniors, senior citizens
to have.
(18:02):
And I think you'll get muchbetter buy-in from getting
seniors on your side becauseit's very hard for a senior to
say, I really believe thattherapy payment should be more.
It's not their payment, it'sour payment, right?
And they may love us and andand and really value what we do,
but you know, they don't wantto get caught in, well, I like
my family practice physician aswell.
(18:22):
I don't want him to have to cutfor you to get like it's stuff
that they don't really want towade into.
But it for them to say, I get ano-cost foul risk assessment
once a year on the par withbeing able to get a colonoscopy
once a year for no cost, or myblood work done once a year for
no cost, but falls are just asdeadly to me as maybe
potentially diabetes or coloncancer.
I think those are the thingsthat, again, elevate our
profession a little bit.
(18:43):
It's good for our patients andit allows us to tap into an army
of grassroots on the patientside that typically a lot of our
causes and a lot of ouradvocacy efforts haven't been
able, haven't been things thatwe can get patients really riled
up about.
And so one of the things Ireally like that we did with
Safe Act was we went to patientgroups and took them this bill.
And AARP has come out andpublicly supported this bill,
(19:05):
the Gerontological Society ofAmerica, Families USA.
These are all patient-centricgroups that have publicly said,
yes, we support this idea andthis bill.
And I don't think that reallyhappens with the bill that says
pay therapist more, but I thinkit does with this.
So that's probably along-winded answer to why we
decided to attack this path.
But I think it kind of itaccomplishes a lot of goals for
(19:26):
us at the same time.
Richard Leaver (19:28):
And there are no losers with this, say factors
there, because you know,obviously, patients hopefully
full prevention or fullmanagement, and the cost, as you
say, is is obscene and and forincidence is really high.
And we talk about incidents ofheart attack or cancer or or
multiple other things, but butthe number of people that fall
(19:49):
is is massive, with withobviously uh you know multiple
implications associated withthat.
But there is a uh carefullycalculated financial saving for
everybody with this.
So it's a no-brainer uh in myperspective, yes.
Nick Patel (20:09):
Yeah, you're absolutely right.
So we actually included a smallprovision in the bill that said
that if this bill is enacted,Congress should get a report
from CMS or HHS saying how manypeople fell who got the physical
therapy assessment and how manypeople fell who didn't get one.
And then if the group that gotthe assessment falls less and
has less incurring of expensesbecause of less ER visits and
(20:33):
you know, surgeries and thingslike that, and potentially
removing the need for opioidsfor them as well.
What Congress can do with thatis say, oh, wait a minute.
For the first time, they'lllook at something and say,
here's a therapy invention thatnever existed before.
And when we put it in place, wesaved money.
And because we're willing toactually write that into the
bill, like go ahead and measureit.
We're confident in what it willshow.
(20:54):
Go ahead and measure it.
I think that that that thatlends people to think that,
well, what can we go, what cango wrong here?
Because let's let's go for it.
Let's try it.
And that's I think why whetheryou're super fiscally
conservative or you're, youknow, you're you're you're super
liberal, there's people on allends of the spectrum who are who
are sponsoring and supportingthis bill because I think it
just does have that, it's sobipartisan, it's almost
(21:16):
nonpartisan.
Like it like really doesn'tseem to make sense to be against
it.
So I think that that'ssomething that's that's going in
our favor.
And again, it's it's it's oneof those things that we get only
by really trying to address apublic health issue as opposed
to like a personal, like, I justwant to make life better for a
PT for type of issue.
Richard Leaver (21:33):
Yeah, one last issue.
I always say that we have to,as a profession, we have to
demonstrate value.
And this is probably the firsttime that I know of where one
only we demonstrate value, it'sactually going to be measured in
a very methodical manner so wecan then go and reinforce the
(21:55):
fact that we will save overallcost.
Nick Patel (22:00):
Yes.
And and that's one of thefrustrations I have, you know,
when I as I go through policy asa therapist.
You know, I know everytherapist out there knows that
we save the system money.
Uh inevitably, you will treat apatient who gets to bypass
surgery because of theirinteraction with you, or doesn't
need some injections, or hasnow not needed to get three MRIs
(22:21):
for the same issue, likewhatever it happens to be.
That saves the system money.
Everything that we do right nowthat saves money gets rolled
into the baseline.
And by that I mean we don't getcredit for any of it.
Um, I think we all know that ifyou just remove therapy as an
option in the MSK treatmentpathways, we would spend more
money on all the treatment forMSK.
(22:42):
But it's hard for me toquantify that.
It's hard for me to show thatthrough claims analysis right
now.
How so if I create an entirelynew physical therapy benefit
that's never existed in thesystem before and say, let's
just measure that, we will beable to, if there are savings,
which I'm confident there willbe, we would be able to
attribute all those savings tospecifically therapy spent.
And then the next time we tryto get cut, or the next time
(23:04):
they try to propose, let's let,let's, let's see what happens if
we cut therapy, we'll be ableto point to, well, you know
what, we actually do save moneyon this very high dollar risk
issue.
If you have less therapists inthe market, this will actually
end up costing you more.
I can't really do that becauseright now, because all of our
savings are sort of just used byother folks and and and
absorbed into the system.
And we need to highlight and beable to break it out.
Richard Leaver (23:27):
So talking about money, obviously the other
topic that is reoccurring everyyear when it comes to advocacy
and therapy is the Medicarerules.
Kind of said in a deflatedvoice as well, I'm afraid.
The 2026 Medicare proposed rulecame out, I think, a couple of
(23:48):
weeks ago now.
I think.
You know, we're at we seem tobe on a conveyor belt and of you
know rate cuts and challengesto outpatient therapy from a
reimbursement perspective.
Specific to Medicare, and thenperhaps we can open up the kind
of the conversation to perhapsother payers, but specific to
(24:10):
Medicare, are we still on thisconveyor?
What's is the conveyor justchugging along or continue to
chug along for years to comewhere it's kind of a a death by
a thousand paper cuts of youknow one percent, two percent,
three percent?
Or is there light at the end ofthe tunnel?
So perhaps if we can justperhaps talk about 26 and then
(24:33):
perhaps expand the conversationto to a crystal ball and what's
going on from an advocacyperspective and legislative
perspective that we can cutsthink about going forwards.
Nick Patel (24:45):
Yeah, so I'm sure as your listeners all know, you
know, for the last five years,you know, we have been on this,
you know, cut, and then maybewe'll get cut a little bit less,
and then, you know, but it'sstill a cut, and then we have to
absorb a little bit more thannext year.
And if you accumulateeverything from 2020 to about
2025, the therapy cut on theMedicare physician fee schedule
(25:09):
has been almost 11% now thatit's all in and you know that
it's sort of stopped phasing.
One good thing is so as westand here, it's the end of
July, we have the proposed rulefor Medicare for what the 2026
rates will be.
They'll be slightly higher thanthan 25 rates, not anywhere
near the 11% that we have givenup in in the last five years.
(25:30):
But I think from one aspect ofthe conveyor belt, we I think
we're done with that sort of youknow massive devaluation that
we had to absorb over the lastfive years.
However, having said that,we'll see what gets finalized.
You know, the things won't getfinalized till November, and we
won't know the exact rates tillthen.
But what I have learned and theconclusions that I'm coming to
(25:52):
recently when it comes toMedicare fee schedule is if you
look at how the Medicare feeschedule calculates payments, it
rewards certain things.
Any payment system has inputsand any payment system rewards
or weights certain things higherand lower than others.
One of the things about, orjust two things about the fee
(26:13):
schedule that you have to keepin mind.
One, it is a budget neutralpie, which means anytime they
increase a particular code,there has to be a corresponding
decrease somewhere else becausethe the the entire amount of
money in the fee schedule has toremain roughly the same.
You can expand a little bitwithout offsets, but you you
basically have to give when youget whenever you get in one
(26:34):
place or another.
So most people don't understandthat.
So there's always littlethere's always little kind of
shifts just owing to the budgetneutrality.
But think about this.
Every time they create newcodes and interject them in the
fee schedule, the amount ofmoney for the fee schedule does
not change.
So these neat new codes have tobe valued and have prices
(26:55):
attached to them.
And then if they do, they thenthat means other things have to
go down.
And if you think about the youknow progression of technology
and care, new codes are comingin all the time.
And especially, you know, maybeyou went from the 90s to you
know mid 2010s where the codesdidn't change much.
But now you've got things, youknow, even for therapists like
(27:18):
remote monitoring, but for otherphysicians, telehealth type
codes and technology assistedcodes and caregiving, like there
are all these types of thingsthat are happening across all
the different professions thatare causing rebalancing of the
fee schedule, whether there'snew money in it or not.
The second thing you have tounderstand is what gets
weighted.
And here's where I have somefrustration a bit with being in
(27:39):
the fee schedule.
A good chunk of the weightingof what you get paid is how
expensive your equipment is todeliver your care.
And, you know, if I ask, youknow, you, Richard, like how
many of your Alliance PTVclinics have a single machine
that it costs $100,000?
My guess is that you probablydon't have any pieces of
(28:02):
equipment in a single clinicthat costs $100,000.
But that's who we competeagainst.
We compete against physicianswho are having to buy $100,000
pieces of equipment or $50,000machines or what have you.
And ours just do not cost thatmuch.
And and and then what willhappen is that three or years
(28:22):
later, there's a new machinethat's invented and it costs
even more.
And they have every incentiveto buy it because then that
actually becomes the increasedweighting for them to put that
in there.
The second thing that can helpdrive your payment is what the
risk is of the treatments thatyou do.
So, in other words, if if thetreatment by nature is risky and
(28:43):
has like higher malpractice,you know, threat attached to it,
you get paid more as wellbecause it's a risky treatment.
Well, again, therapists don'tget sued, again, knock on wood,
but we don't get sued veryoften.
The things we do are safe.
The things we do are aretypically don't require patients
to have a large risk for thethings that we do.
There's not there's not muchdownside there.
(29:04):
So if we're in a system wherethe to in order to get ahead,
you should have really expensiveequipment or do really
potentially dangerous things,and then you're gonna see some
nice increases.
And neither one of those,either now or probably never
will apply to us, are we in asystem that we can never really
win in?
And to your point, are we in aare we on this conveyor belt
(29:26):
that you know if every if everydollar that is new spend has to
come in, has to be offset bysomething else, and we really
don't have an increase in ourequipment and we don't want to
have an increase in allmalpractice, where does that
leave us when these new codes orthese shifting has to happen?
I think it leaves us on theplate to get cut more often.
And I think that's whathappens.
It's my it's my two cents.
(29:46):
I I I can't calculate it outfor you and show you the effect
that that's you know, uh thatit's had.
But I think as I look at if Ias I think about you know 26 and
beyond, I think it's time fortherapy to come up with a game
plan.
For how to get paid as aprovider that uses low-cost
equipment, that does treatmentsthat are not necessarily risky
(30:08):
for the patient and carry andcarry large amount practice
expense?
Is there a way for that personto get paid in a way that is
commensurate with what the valuethat they're providing, but
also is at the level ofrewarding the education and the
knowledge that somebody has toput in there?
You know, when you're in thephysician fee schedule, I hear
this all the time.
I am a DPT and I went to schoolfor seven years and I get paid
(30:29):
this, but you're in a feeschedule with other everyone
else in that fee schedule hasgone to school for seven, eight
years.
And so we we don't really winon that argument where the with
the differentiators are theequipment and the malpractice
and things like that.
And that's where we tend totend to lose.
So that's how that's kind ofhow I see our future is maybe
our future becomes brighter ifwe stop banging our head up
(30:50):
against the wall in a systemthat doesn't reward low-cost
providers to have high qualitybut low cost, that's not
necessarily what the feeschedule rewards.
And I don't think I'm gonna beable to change the entire fee
schedule.
Maybe I just gotta figure out away for a therapist to get paid
differently.
Richard Leaver (31:06):
Yeah, it's it's a pretty messed up system, isn't
it?
Where if you provide high cost,high-risk service, you get
rewarded for that.
Whereas in reality, why wouldyou want a reward for that?
Wouldn't you one rather, asociety, rather have low-risk,
low-cost service?
(31:26):
But anyway, we can debate that.
Nick Patel (31:28):
So that's why you'll never find a physician that
says no to let me buy an evenmore expensive piece of
equipment because they'll endthat's how they actually get
high-increased reimbursement.
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Richard Leaver (32:17):
I suppose the opportunity, I suppose we could
just pay $100,000 for atreadmill and just say we're
having cost.
Yeah.
I'm not advocating oursuppliers listen to that and in
the case.
Yeah, please don't.
Nick Patel (32:30):
But yeah, I mean that's that's that's in a
nutshell, it's sort of whatwe're up against.
Richard Leaver (32:34):
And then you you mentioned the kind of the 11%
cut.
That's an actual real cost,isn't it?
But relative cut to Medicareover an extended period of time,
I've heard different numbers.
But you know, when you takeinflation into account as well
over an extended period, I thinkour relative cut has been when
I I again correct me if I'mwrong.
(32:54):
I I've heard the idea is forapproximately a 30% cut over the
last five, ten years.
And I don't know what numberthat's kind of thrown out and
used and you've heard, but itit's a significant cut, isn't
it, compared to well compared toany anyone really, for anyone.
Nick Patel (33:12):
Yeah, you're you're exactly right.
So, you know, the governmentpublishes a number, it's called
the you know, MEI.
It's the index that sort ofmeasures the amount of inflation
from medical costs and medicalcare.
Almost every other setting getsan MEI or a COLA cost of living
adjustment upward every year.
So for five years, the feeschedule, not just therapists,
(33:32):
but everyone in that feeschedule were not allowed to get
any inflation adjustment.
When that was originallypassed, it was sort of as a
trade for getting out of the SGRproblem, which what we all some
of us remember was was a hugeproblem.
And at the time, inflation wasvery minimal.
And so, you know, if you goback all the way to 18 and 19,
(33:53):
inflation was not something thatwas a that was a concern for a
lot of folks.
And unfortunately, people havea tendency to think whatever
things are now is what they'llbe like forever.
And I as you as you well know,things that inflation did not
just stay at that level.
It had been that low for for agood number of years, but it
eventually caught up to us andit spiked and it's here to stay.
(34:14):
And some of these priceincreases have been sticky, and
they show up not just in youknow things like your equipment
and and maybe your rent, butit's the salaries.
I mean, you know, it's it'sit's it's the compensation for
our workforce because I can makedo without a certain piece of
equipment, but the one thing Ican never out make do without is
the therapist.
And and again, you have someonewho's spent a lot of time in
(34:36):
school and and getting theirtraining and and and they care a
lot and they coming out.
I don't think it's a I don'tthink it was a coincidence that
in the midst of all of this, anduh and and during COVID, I know
it was a very tough time forevery healthcare provider, but
therapists lost 20,000 workersout of the workforce.
That's the equivalent of twoyears worth of new grads.
And and it wasn't like theywere just gonna go on the
(34:58):
sidelines and wait for COVID tokind of flesh out they'll
they're gonna come back.
These are folks who are likenever coming back.
They have no intention ofre-entering the workforce, even
though COVID has worked itselfout.
So it was that that's why I sayI don't think it's solely
attributed to COVID because theydidn't come back when COVID
kind of resolved itself.
And and that's the issue, Ithink, partly is they found
other things to do forcompensation.
(35:18):
Then why would I go back tobeing a therapist?
Uh I have found other thingsthat keep up with inflation that
allow me better upward mobilitywith my salaries.
And that's not just a Medicarething, and I don't want to put
it solely at their feet becauseI think we have a problem with
payment off Medicare, MedicareAdvantage, or commercial payers,
you know, you name it, it'sacross the board.
But that's what inflation alsohurts us as well.
(35:39):
So it's not just that one-timepurchase of a piece of equipment
or that you know, one-timelease renegotiation.
We pay our we pay our peopleevery every week, every two
weeks.
And we have to keep up withthat.
And and and you know, hiringnew people every year with
higher salary expectations thanwere than they had, you know,
two years ago.
It's a difficult thing tomanage.
(36:00):
And and again, we have to havea plan for that.
And and and we have to navigatethat because there's one thing
right now that that I've seen isI think that 20,000 workers out
of the workforce, plus the factthat I think people do use
therapy more now, is we don'thave a volume clinic in most of
our clinics.
People are coming in.
We don't have people to seethem, you know, and then and and
(36:23):
we don't get paid well enoughon the people that we do see to
justify bringing in more staffthat that that can help.
And that's where the, you know,that's where the the real bane
of our private practice ownersright now.
Richard Leaver (36:35):
Yes.
I'm grateful the fact that I Ibelieve our advocacy is being
heard and gaining some tractionfor for multiple reasons.
But one of the reasons whichyou've just highlighted is the
fact that we as a provider arestruggling to be able to provide
(37:02):
any services for certaincomponents of the community as a
result of a lack of providersin in a lot of drop or
geographical locations, areduction in number of people
applying for therapy school,relative reductions in pay over
(37:23):
extended period of time.
So uh it it's evident when youtalk to uh APTQI members and and
in the broader outpatienttherapy world that we have to uh
change not only changeinternally and how perhaps how
(37:44):
we treat and how we managepatients, but the the
reimbursement uh issue is uhbecoming or has become, I think,
critical.
And uh ultimately it is the uhpeople who require our care that
suffer by not being able to getthe amount amount or even not
(38:05):
be able to get care.
So looking forwards, you know,from an advocacy perspective,
what do you think what what'swhat's uh is perhaps being done,
but more importantly is whatcan listeners, what can
clinicians do, what can peoplesupporting our profession do
now?
Because I I think we're on, Idon't mean to necessarily be
(38:30):
melodramatic here, but I thinkwe're on pretty shaky ground,
and we have to to get a footing.
And if we don't, then I'm I'm alittle concerned that we won't
be able to continue to see paythe patients as the we have this
aging population, et cetera,and increasing demand.
(38:51):
So so what can we do from anadvocate be advocacy
perspective?
Nick Patel (38:56):
Yeah, I'm gonna throw out a couple things that
might be a little bit different.
This is usually the space whereyou may hear somebody say,
write your congressman, make aphone call, or or donate to a
PAC.
I I feel like those pieces ofadvice are they're all great, by
the way.
I don't think you're tellinganybody anything they didn't
already know.
So if you'll indulge me, I wantto I'll say, I'll say it for
(39:17):
the sake of saying it.
Those things are all important.
However, let me let me maybeattack it a slightly different
way to maybe see if we can getbetter results.
One is you want to write yourcongressman, call them, that's
fine.
But think of it this way (39:28):
do you have a relationship with the
your elected official's office?
And by that I mean, have youever just gone by their office?
I don't even doesn't have to bethe DC one.
Every elected official has alocal office in the district.
Go by there and say, My name'sRichard.
I'm a business owner in thisdistrict, at my clinics down the
street, what have you.
(39:49):
This is my business card.
I'm a physical therapist.
I'd like to be a resource foryou guys to talk about anything
as relates to healthcare.
If you ever want to know howsomething that you're deciding
on as it relates to healthcareaffects us in in the city or in
the district, call me up.
Or would you like to hear someexamples of what I'm dealing
(40:09):
with right now?
That sounds really simple, butit doesn't happen.
And it if you think about this,there's 535 elected members of
Congress, right?
If that happened 500 times inevery in every district, I think
we'd be getting a little bitdifferent.
I just, it just right now, itdoesn't.
It's it, you know, advocacy isa one time a year, let's all go
(40:31):
to the hill, let's make arounds, and then we'll come back
home.
And the other 364 days are justgriping about how things really
don't work well for us.
What I'm saying is go locally,become that person, go there
multiple times.
Advocacy is not a one time ayear thing.
You know, if you want to getpaid every day for your
services, advocate every day foryour services.
If you want to, if you want tomake your payments every month,
(40:52):
advocate every month.
So I mean you go there and youmake relationships because guess
what?
The guy who's working there wholoves you and thinks you're
great and wants to form arelationship with you where you
have this great, greatunderstanding, will be promoted
and out of that, and then yougot another one, you got to
start again.
And that's what you do.
And you keep going back becausethere is a lot of movement with
those jobs.
So create a relationship withthem.
It's not that hard.
(41:13):
I tell therapists all the time,we every therapist I know that
worth their salt has this hasthis innate superpower where you
meet someone who is a completestranger to you, and within five
minutes, they are taking offtheir shirt and pointing to
where it hurts.
They are in you can makesomeone incredibly comfortable
with you who's a completestranger.
If you cannot walk into thatoffice and say, I'd like to talk
(41:35):
to you about physical therapyand what it means and how these
things affect us and myemployees and my patients, if
you don't feel comfortable doingthat, I don't know what to tell
you.
You can do something infinitelyharder than that every day,
sometimes 12, 15 times a day.
Can you not really do that?
I don't believe it.
I refuse to believe that we'renot good at that.
You don't need training, andyou don't need you know a whole
(41:57):
lot of guidance and mentoring.
You probably do it tomorrow ifyou really want to.
So that's one thing, createthat relationship.
Second thing, if you're abusiness owner, I'm not gonna
tell you what to do with yourbusiness, but maybe my advice
would be think twice when youget that contract and the rate
on it is so far below what yourcost is to provide that service.
(42:18):
And I would just say thinkthink think twice about you know
signing that.
You know, again, I everyoneneeds to do what what they need
to, but I think there'ssomething to be said for every
rate that someone complainsabout is a rate that someone
signed, though.
So, you know, that that wouldit's definitely not our it's
definitely I'm not saying it'sour fault.
(42:39):
Like it's the if the insurancecompany is setting a rate,
that's what they're doing, andthey're doing what they think is
best.
I'm saying maybe you should dowhat you think is best for for
you.
And at a time when volumedoesn't seem to be an issue
because we are having moreboomers and we are having more
people coming to our clinics,uh, just double, just take a
second to look back.
It it is a form of advocacy tosay, I, Richard, believe I am
(43:03):
worth way more than $65 a visit.
You are advocating for yourselfor your your therapist to say
that this is not a fair pricefor what I do.
It does not reflect the valueof what I provide.
And I know that it could be adifficult thing to lose some
patients if if you have to.
I understand all that, andthose are parts of the equation
(43:25):
that are not easy.
But my request is if you're asyou're thinking about advocacy,
think about it whenever thatnext renewal comes.
The last thing is probablysomething, again, it it may be a
little bit, you know, out ofout of left field, but again,
there is voice, there, there isthere is strength in numbers.
So, you know, it's whatAlliance did.
You don't if if you don't likeABTQI, try to get involved with
(43:50):
APTA.
If you don't like APTA, findanother NARA, like whatever it
happens to be.
I think so many of our of ourfolks say, I don't want to
advocate because I don't likethis association.
I don't know, and it may be allvalid.
Maybe you don't like thedecisions they made, maybe you
don't like the people there.
I it's fine, whatever.
But then just find somewhereelse to join in and amplify your
(44:13):
voice.
I think right now there aremore options for the therapist
out there to join withlike-minded people than ever.
So it's okay if you don't likeour group.
That's that's fine.
If if you know, if you're an OTand feel like APTA has nothing
for you, how about AOTA?
Look at them, whatever ithappens to be.
But I feel like there's moreavenues today than ever.
And there's less excuse for youto say, I'm gonna tune out and
(44:37):
not lend my voice to a largergroup because I have maybe some
philosophical differences withthat group.
Valid, fair.
I'm not gonna argue with you ifthat's the case.
But then there's got to besomebody else, you know, that
that does.
Seek those people out, whetherit's a conference or meetings or
whatever.
Something tells me you'll beable to find someone that you
say, yeah, I think this is thisis worth merging my voice into.
(44:57):
Because we cannot sit back andsay, Well, I don't like that
group, so I'm kind of notgetting involved.
Find another one.
Richard Leaver (45:04):
Yes.
And then yeah, the world ofsocial media as well.
There's there's it's very easyto put one's voice behind
advocacy.
And it amazes me how muchtraction certain very simple
media social media posts canget.
And they can get picked up veryeasily by multiple groups,
(45:25):
multiple individuals.
So I think that's anothermethod that if we get suff
sufficient numbers that areproactive in that can be
extremely powerful.
You know, I'd love to see somesome PT influencers focused on
on the advocacy component.
I don't see any or hear ofthose, but but there's
(45:48):
absolutely no reason why thereshouldn't be those people,
should there?
Nick Patel (45:52):
Yeah, no, exactly.
And and if you think about thenumbers, I mean it's one of
these things, it's it's almostit's it's like a it's a great
trick that's been played ontherapists.
And I I see this happen a lotwhen I talk to folks, and they
always say, Well, we're sosmall, we're always gonna get
picked on.
Or we're always the little guy.
We're like, we're always a veryfraction of a fraction, and
blah, blah.
There are hundreds of thousandsof therapists in this country,
(46:16):
right?
Granted, some of them aren'tfull-time, and I understand that
that that's an inflated numberfor a lot of reasons.
But my point is, there's moreof us than a lot of other
professions.
There's more of us than a tonof other professions that get a
lot of what they want, whetherit's in Congress or for private
payers or whatever.
But sort of, I almost thinklike I almost feel like someone
(46:38):
has been sold a bill of goods tobe told we're just too small
and we really can't get anythingdone.
If we band together and createsome volume behind our voices,
we can actually get quite a lotdone.
Because if if every professionspoke with 100% of their
licensees, we wouldn't be nearthe bottom.
We would be not even in themiddle.
(46:58):
We'd be closer to the, youknow, the top quartile.
You know, there's way more ofus than chiropractors.
There's way more of us than, Imean, a lot of other people that
would probably surprise youbecause there's just a ton of
therapists out there.
But yes, we all have differentwork in a lot of different
settings and we work in a lot ofdifferent, you know, practice
specialty areas.
But my point is we're notsmall.
And don't let anyone tell youwe're small.
(47:20):
And don't let anyone tell youthat we're just a fraction of a
fraction or a fraction, and wedie.
And so therefore, what's thepoint of trying to advocate?
Because we'll never get what wewant.
If everyone spoke up or foundfound a place they felt
comfortable to speak up, I wishit was with us or with APTA or
but it could be with anyone,doesn't matter.
We will actually get a littlebit further.
Stop believing in that becauseI don't think it's true.
It will it the numbers don'tthe numbers say it's not true.
Richard Leaver (47:43):
Time's always against us with these
conversations.
Uh it's been great.
Any final thoughts, words ofwisdom, perhaps to our
listeners?
And then also if we've talked alot about the APTQI, how would
somebody learn more about thatgroup as well?
Nick Patel (48:02):
Yeah, if you know, if you're a provider and you
have, you know, you have someclinics and in and you're and
you want to learn more, youabsolutely can go to our website
to learn more, aptqi.com.
Or you can email me.
It's npatel@ aptqi.com.
I'm I, you know, I respond toas many emails as I can
directly.
The last thing I I I leaveanyone with is don't don't
(48:27):
despair.
And I and I because it can be adark time to be a therapist and
practice owner right now,whether you're a staff therapist
or you're in charge of you knowmultiple clinics, the five
years that you just went throughwere probably quite difficult.
And you may feel like you havea bunch of train marks down your
back and and and and it'svalid.
For those of us who are alittle bit older, I can only say
(48:47):
1999 and 2000, 2001 were verysimilar.
If if if if you're my age, andthere was a time where we
thought therapy would never getbetter.
And it was very difficult.
And you couldn't find a job andyou couldn't get reimbursed,
and it was it was it didn't seemlike there was much of a
future, but there was.
And and and actually things itended up leading to a quite of a
(49:09):
boom time for therapy.
I truly believe sometimesthings are quite things,
sometimes are just about to bethe brightest right when you
feel like things are the darkestand can't get any better.
Um, so don't give up on theprofession or don't give up on
on what you're doing if you areadvocating, because typically,
whenever we are pushed upagainst the wall, things start
(49:31):
to get better because we as aprofession start to fight a
little bit more.
But also, you know, thependulum can only swing so far
in one direction before it hasto start swinging in the other.
And you don't want to miss thatride.
If you've hung in here forthose five years, you don't want
to miss the ride going back theother way, is is is sort of
what I've been trying to tellpeople.
Richard Leaver (49:48):
That's remarkable wisdom.
So thank you, Nick.
And some from somebody who'sonly 25 years old as well.
Nick Patel (49:55):
So Yeah.
Yeah.
I just read about 2000 inhistory books, Richard.
Richard Leaver (49:59):
I was like, Well, again, thank you.
Thank you so much for what youdo, Nick, and thank you so much
for what you know APTA does,APTQI, and and the other groups
that advocate for therapybecause we'd be in a much
different place if we didn'thave all of you.
So I appreciate you and andeverything that that
(50:21):
profession's doing to help driveus forward.
So appreciate it.
Nick Patel (50:25):
Appreciate you having me.
Alliance Physical Therapy (50:27):
This podcast was brought to you by
Alliance Physical TherapyPartners.
Want more expertise andinformation?
Visit our website atallianceptp.com and follow us on
social media.
You can find links below in thedescription.
As always, thank you forlistening.
Alliance Physical Therapy Partners in
Agile Virtual Physical Therapyprobably present Agile and Me, a
physical therapy leadershippodcast deviced to help emerging
and experienced therapy leaderslearn more about various topics
relevant to outpatient therapyservices.
Richard Leaver (00:19):
Welcome back to Agile and Me, a PT Physical
Therapy Leadership Podcastseries.
And I'm excited, again, in mymonotone British voice, to
welcome back Nick Patan.
Nick was last with me in 2001on this podcast.
So welcome, Nick.
Nick Patel (00:36):
21, I think.
But yeah, well, I'm excited.
Yes.
Appreciate being back on.
Richard Leaver (00:44):
Time flies in the Career.
So today I wanted to kind ofregroup and talk a bit about
advocacy, APTQI, and reallywhat's going on.
And but before we do that,Nick, can you perhaps introduce
yourself to our listeners?
Nick Patel (01:02):
Yeah, absolutely.
So, you know, I am theexecutive director of our group,
the Alliance for PhysicalTherapy, Quality and Innovation.
It's a it's a mouthful, but II've been in the fortunate
position to be the executivedirector for about eight years
now.
I'm a physical therapistmyself.
Almost all of my career hasbeen in the outpatient or
office-based setting.
(01:22):
One of the things that I havereally dedicated a good chunk of
my career to has beenadvocating for better policies
for therapists, because aswonderful as our profession is
and as great it is to see howthe things that we do are able
to impact people in such ameaningful way, the more you
(01:44):
treat, or the at least the moreI treated, the more I realized
that, man, this is a there's alot of artificial barriers,
man-made barriers that we haveput in place over time that just
make delivering care reallyfrustrating.
And so that frustration for meled me to a slightly different
path, which is, you know,finding ways to advocate and
(02:04):
influence and, you know,ultimately make changes for the
better.
Richard Leaver (02:09):
Yeah, first and foremost, thank you for your
work.
You know, you definitely are uha thought leader within
outpatient therapy as itpertains to advocacy and really
promoting the profession.
And without you, we would notbe where we are today.
And I'm sure that yourinfluence will continue to
(02:29):
really pay dividends to theentire profession.
So thank you.
I appreciate that.
So rather than just talkingabout the concept of advocacy
per se, which we did on our lastpodcast, I I think perhaps what
might be helpful is to talk alittle bit more about the APTQI,
(02:50):
because since we spoke in 21,it really has morphed into
something that is much biggernow, and I believe actually a
much larger, more powerful voiceas well.
So perhaps if you could justtalk a little bit about that
first.
Nick Patel (03:09):
Yeah, it's certainly been a tremendous journey for
the group.
We are in some ways bigger thanI ever imagined, but in other
ways, I think that the growthhas sort of led me to understand
that there's a whole world outthere of organizations and
leaders who really want to gettheir hands dirty in advocacy.
And that has actually beengreat.
(03:31):
So where we are with APTGIright now is we initially
started as you know aprovider-centric group where all
the members were operators thathad multiple hundred clinics
and multiple states, and and andthat was and that was great.
Over time, we started to say,you know, we would get interest
from other members like yourselfthat would say, you know, we
(03:52):
want to join.
And and we're smoking, we're abit smaller.
We're not in, you know, 28states and blah, blah, blah, but
we like what you're doing andwe want to help.
And, you know, we're we'rewilling to join.
And so we created a anothermembership class, and that class
has been just explosive forgrowth.
More people coming than than Iever thought possible.
I at first I thought, well,sure, let's let's open up
(04:14):
another one, but I doubt anyonecomes.
And of course, I was provedwrong time and time again.
And then we did this sort ofthird membership class where we
were approached by you knowcompanies that maybe weren't
providing physical therapy, butall of the products, the
services they did were were usedby therapists.
So however the therapyprofession goes, so did their
business.
They just didn't happen to beproviders.
(04:36):
Maybe they ran an EMR company,maybe they sold DME, maybe they
had a technological platform fortherapists to use.
And sure enough, same thinghappened.
We opened up the doors to that,and we had great interest from
folks coming in on that way.
So where we stand now is, youknow, the Alliance has over 30
companies, whether you're, youknow, multi-state, over a
(04:58):
thousand clinics, maybe you're avery regional, 20 to 50
clinics, or maybe you have aplatform for therapists to use.
You're all under the umbrellaof you know trying to do good
for the profession.
And the thing that has neverchanged, regardless of how many
people we've brought in or howbig we have gotten, is something
that I think is really unique,which is uh we we are home to
(05:20):
people who compete every day ofthe week on sometimes on the
same street corner of the samestate every day.
However, when we meet, all ofthat is checked at the door.
And egos and and pettinessdon't really exist when we meet.
And it's all about what we cando for the profession.
Because whatever we can dopositively for the profession is
gonna help me, you, andeverybody else.
(05:41):
It'll be good for all of us.
And I think that I again I liketo think that that happens on
the industries, but I just don'tknow if it does, if it does.
I I make this joke all thetime, but you know, I don't know
if the CEOs from McDonald's andBurger King and Taco Bell meet
every month to talk about likewhat they can do to make food
better.
And my my feeling is they don'tbecause their food is awful for
(06:02):
you, but you know, that's notwhat happens in therapy.
We are we are we're we're doingit monthly.
I mean, you know, and and andyou're there and and you've seen
it, but and and all we we don'ttalk about, well, my company
needs this, and this guy'sbothering me, and we're
competing here.
It's none of that.
And so we've just been able tocontinue with this culture from
the beginning of ego's checkedout the door, and we're all
(06:24):
gonna try to help.
And I think it's made theoperators of these companies go
from competitors to stillcompetitors, but actually
friends and networking and beingable to lean on each other
because no one else knows yourjob better than the person who
has a similar job to you atanother company.
And I think it's made a madefor a nice camaraderie.
And because of that, I thinkthey were we're able to maybe
(06:45):
get make movement and get somethings done, which is the
ultimate goal, because we areable to sort of come together in
that fashion.
Richard Leaver (06:52):
Yes, it's still a very fragmented industry, I
think.
You know, healthcare generally,but outpatient therapy, even
with the consolidation that'soccurred over the last 10, 15
years.
And you know, for me, advocacy,there's really two points.
One is the message.
You have to have a goodmessage, but then there has to
be power in numbers and strengthin voice.
(07:13):
And what has amazed me in thelast five years, particularly,
is that voice seems to be atleast being heard.
Because when we last spoke in21, I think I think we we
questioned to a certain extent,certainly looking back at that
(07:34):
point, that the the voice wasvery weak.
But you know what I've myperception in the last,
particularly in the last coupleof years, as as APT QI has
grown, and also to be fair, asAPTA has morphed and evolved
from an outpatient perspective,I I feel that there is now a
(07:56):
voice uh and proper advocacyoccurring.
Would you agree with that?
Or do you think there's just Iwas ignorant to it in the past?
Nick Patel (08:05):
No, I think you know you hit the nail on the head
because I mean, whether it wasfour years ago or 14 years ago,
I think therapists had a agroup, not not really, you know,
the the fault of any oneparticular individual, one
particular organization, but asa group, as a profession, a bit
of a passivity to us when itcame to advocacy.
And and that voice was wasquite diminished because it was
(08:28):
maybe just a handful of peoplewho are who are participating.
And you really can't get veryfar with with just a handful of
folks.
And one of the things that Ithink is much better about the
industry now is that there's somany more ways for folks to to
to advocate.
I think APTA does a tremendousjob with you know with their
(08:49):
efforts.
And I and I and I think it'samazing what they're able to do
with since I've been a therapistfor 25 years, they represent
about like 25% of theprofession, 20%, it's it's
almost athletic it vacillates inbetween a certain range.
It's always been about aquarter since I think I've uh I
graduated.
And they're able to get so farwith that.
And in my mind, and it butunfortunately that number
(09:11):
doesn't change much.
And I know that they wanted tochange and I'd love it to
change, but you know, if youhave a 20-year track record of
that number staying in a similarrange, how do we get the other
75% involved?
Right.
And so, you know, if if allthings are equal, that probably
means 75% of Alliance physicaltherapy partner employees are
probably not members.
That means 75% of the othercompanies' employees are
(09:33):
probably not members.
But if we can create an avenuefor them to advocate, you know,
and combine them with the folkswho maybe already are doing some
things, then that that's gottabe helpful for us because it's
one thing to have a louder voiceby having more people.
But one of the other thingsthat I've learned is there's
sort of like a value to being inthe public consciousness and
(09:53):
the public discourse.
And I cannot tell you, and I'mhopefully I'm hoping it's better
now, but as a 20-something, youknow, early career person, I
can't tell you how many times Ihad to explain to somebody when
they said, What do you do?
And I would say, I'm a physicaltherapist, and they'd say,
Well, what is that?
Or is that they would saysomething like, Oh, I know what
that is.
That's kind of like achiropractor, right?
(10:15):
Or you're kind of like amassage therapist.
Or they didn't have a like areally solid view.
We weren't in the publicconscious.
You probably just went to onewhen you got hurt, but I, you
know, knock on wood, I've neverhad cancer, but I know what an
oncologist is.
You know, I mean, like weshould just be at a certain
level, people understand whatwhat we are and who we, you
know, who we are and what we do.
(10:36):
And I don't think it was therefor a very long time.
And then so naturally, whendecisions are made and policies
are created, who's going to bethinking, well, how's this gonna
affect a therapist if theydon't even know what we do?
What what what we're trying toaccomplish here?
And if you and if you answerthe question with, you know, I'm
a movement expert or I try tohandle musculoskeletal problems,
(10:58):
I don't think the publicunderstood what that meant,
even.
You know, again, it makes senseto me, it makes sense to you,
it makes sense to people who arelistening.
But the average person outthere, the the ways we've done
we have tried to defineourselves don't quite make sense
in the public realm.
And I think that's somethingthat as you get more voices
helps.
But we've tried to do thingswhere we get, you know, we try
to get more articles just placedin papers about what it is that
(11:19):
we do because people actuallystill read papers.
We try to get in news stories,you know, and we're because
people will watch it.
We try to create betterhandouts and better one pagers
and create better messagingaround what does it mean to be a
movement specialist and and notusing fancy words and not using
words that only other PTsunderstand, but you know, being
able to articulate it in a waythat the public will understand
(11:40):
it.
Because I think that is a hugepart.
When you talk about cutting,you know, I I I make this
reference all the time, but youtalk about cutting cardiac care.
People think, oh my God, whatare we gonna do with all the
people with heart attacks?
And you think about cutting,you know, oncology, people say,
what about the poor people withcancer?
When you talk about cuttingtherapy, no one understands what
that really means because theydon't know what it is that we
(12:01):
do.
If I could go back in time, Iwould just make us all
philologists by title.
Because I then someone willsay, Well, go cut therapy
because people are gonna falleverywhere, and that's a bad
thing.
Because then at least we'rewe're we're we're tied to
something.
And I think one of the, youknow, it's a challenge and it's
not nearly of our doing, but wetreat patients across such a
large spectrum, not only in onesetting, but then think of all
(12:22):
the settings that we work in.
So from the hospital to theschool to the outpatient
facility to in someone's home,but then for musculoskeletal
ages, for host neurologicaldisorders, for you know,
headaches, for developmentalproblems.
We just do so many differentthings, but all with the same
degree.
It's very hard for someone tothink about well, if we cut
therapy, then this is going tobe a problem.
(12:43):
So we have to get that outthere as well.
And I think that that's helpfulfor the profession to
understand to get that out therein ways that the general public
can understand.
But also if you're apolicymaker in in Washington,
DC, you have to know whattherapy does.
And and it's not up to anyoneelse to define it.
If we allow other people todefine it, it'll be not what we
want it to be.
(13:04):
So that you know, that thatshould be our job.
And I think that's one of thethings that we've tried very
hard to start turning thatconversation.
No one can do it in a day, noone can do it at night.
It takes some time, but I thinkwe're working on it.
And I think that that'ssomething where it's a little
bit different than tellingsomeone, write a letter and you
know, and you'll change theworld.
But I think it's giving peopleother constructive avenues to
(13:24):
make the profession better, Ithink is receptive.
Alliance Physical Therapy Pa (13:28):
At Alliance, we believe that
partnership means creatingsomething greater than the sum
of its parts.
Our focus is finding physicaltherapy practices with a strong
culture and thriving community,and providing them with
additional tools, resources, andexpertise to take their
practice to the next level.
To learn more about joining ournationwide community of
(13:48):
outpatient physical therapypractices, visit our website at
allianceptp.com.
Richard Leaver (13:56):
Before we look forwards about advocacy
generally, I'd love to perhapstouch upon some of the hot
topics at the current time thatare affecting outpatient therapy
and how advocacy is occurringthrough various entities,
mediums.
So we one of the things that isuh definitely of significance
(14:22):
is the SAFE Act and the impact,potential impact that can have
on therapy generally.
Would you be able to verybriefly explain what the SAFE
Act has is, but moreimportantly, perhaps, what the
the reasons are behind how howand why it is so important?
Nick Patel (14:44):
Yeah, absolutely.
So the the Safe Act in anutshell is a is a bill in
Congress right now that, ifenacted, would allow for a
Medicare beneficiary who hasfallen in the last year to
receive a no-cost, so so free tothem, a no-cost visit with a
physical occupational therapistfor an annual fall risk
(15:08):
assessment.
So that that's not a screen,that is not a let's do a time
get up and go.
That is a come see me, I'llspend 45 minutes, an hour with
you, I will test your strength,your balance, do a home
assessment, you know, talk aboutwhatever, you know, it is
that's bothering you when youwhen you walk or when you're
trying to transfer, all thatstuff.
And and and I can do all thatwith that person before,
(15:29):
hopefully before they hurtthemselves the next time around.
And it'll encourage them tocome in by saying, you won't
have to pay for this.
And the the reasoning behind itis has multiple, there's
there's multiple reasons we wedecided to pursue this.
The first one is the the theproblem of falls is huge in our
country.
So the medical cost for fallslast last year was about $50
(15:54):
billion.
And 75% of that was born byMedicare and Medicaid.
That and that number is on avery steep curve and
exponentially goes higher.
By the end of this decade, ifnothing changes, we will spend a
hundred million dollars, ahundred billion with a B dollars
on Falls.
And again, 75% of that willlikely be Medicare and Medicaid.
So those are tax dollars, thoseare money, you know, that
(16:17):
that's money that that's beingtaken out of the treasury to pay
those claims.
We we have to stop.
We have to put a dent in thatcurve.
These are people who are oneday ambulatory, living by
themselves, independent, andafter a post-fall, you know,
frig, you know, put aside thethis the hip replacement or
whatever that they have to havegot done afterwards, but now
(16:37):
they're never allowed to livealone again.
They're not allowed to age inplace anymore.
They're their life, their lifebecomes over.
And then if they have to livewith a with a family member,
someone's staying home with momthen.
So now you've taken somebodyout of the workforce.
Now you've taken somebody outof, you know, out of their
contribution to society.
So falls have a huge problem,or falls create a huge problem
(16:59):
for Medicare spend.
They also create a huge problemfor society.
So I'm addressing, we're tryingto address a problem.
Two, it's trying to highlightthat physical therapy can help
with this problem.
So again, there's thatconnection in that in that
public awareness of we can helpwith a very serious danger to
our citizens.
And then the third is a littlemore, you know, you have to dive
(17:20):
into it a little bit to see it,but there's a couple things
that I that we really wanted toaccomplish with the Safe Act.
So one was if we need to startseeing seeing therapy as
something that people can accessbefore you actually get
injured.
You know, and we've talkedabout PT should be primary care
or PT for the MSK space and allthat kind of stuff.
We need to start somewherethough.
I'd love to say let's juststart it tomorrow and everyone
(17:42):
just starts.
It doesn't work that way.
But this is, I think, is a goodway for us to start to start
having that conversation andthat we're not always in there
after you've had surgery.
And what better way to do itthan by saying, let's create a
benefit for people, not thetherapist.
This is a benefit for peopleand for seniors, senior citizens
to have.
(18:02):
And I think you'll get muchbetter buy-in from getting
seniors on your side becauseit's very hard for a senior to
say, I really believe thattherapy payment should be more.
It's not their payment, it'sour payment, right?
And they may love us and andand and really value what we do,
but you know, they don't wantto get caught in, well, I like
my family practice physician aswell.
(18:22):
I don't want him to have to cutfor you to get like it's stuff
that they don't really want towade into.
But it for them to say, I get ano-cost foul risk assessment
once a year on the par withbeing able to get a colonoscopy
once a year for no cost, or myblood work done once a year for
no cost, but falls are just asdeadly to me as maybe
potentially diabetes or coloncancer.
I think those are the thingsthat, again, elevate our
profession a little bit.
(18:43):
It's good for our patients andit allows us to tap into an army
of grassroots on the patientside that typically a lot of our
causes and a lot of ouradvocacy efforts haven't been
able, haven't been things thatwe can get patients really riled
up about.
And so one of the things Ireally like that we did with
Safe Act was we went to patientgroups and took them this bill.
And AARP has come out andpublicly supported this bill,
(19:05):
the Gerontological Society ofAmerica, Families USA.
These are all patient-centricgroups that have publicly said,
yes, we support this idea andthis bill.
And I don't think that reallyhappens with the bill that says
pay therapist more, but I thinkit does with this.
So that's probably along-winded answer to why we
decided to attack this path.
But I think it kind of itaccomplishes a lot of goals for
(19:26):
us at the same time.
Richard Leaver (19:28):
And there are no losers with this, say factors
there, because you know,obviously, patients hopefully
full prevention or fullmanagement, and the cost, as you
say, is is obscene and and forincidence is really high.
And we talk about incidents ofheart attack or cancer or or
multiple other things, but butthe number of people that fall
(19:49):
is is massive, with withobviously uh you know multiple
implications associated withthat.
But there is a uh carefullycalculated financial saving for
everybody with this.
So it's a no-brainer uh in myperspective, yes.
Nick Patel (20:09):
Yeah, you're absolutely right.
So we actually included a smallprovision in the bill that said
that if this bill is enacted,Congress should get a report
from CMS or HHS saying how manypeople fell who got the physical
therapy assessment and how manypeople fell who didn't get one.
And then if the group that gotthe assessment falls less and
has less incurring of expensesbecause of less ER visits and
(20:33):
you know, surgeries and thingslike that, and potentially
removing the need for opioidsfor them as well.
What Congress can do with thatis say, oh, wait a minute.
For the first time, they'lllook at something and say,
here's a therapy invention thatnever existed before.
And when we put it in place, wesaved money.
And because we're willing toactually write that into the
bill, like go ahead and measureit.
We're confident in what it willshow.
(20:54):
Go ahead and measure it.
I think that that that thatlends people to think that,
well, what can we go, what cango wrong here?
Because let's let's go for it.
Let's try it.
And that's I think why whetheryou're super fiscally
conservative or you're, youknow, you're you're you're super
liberal, there's people on allends of the spectrum who are who
are sponsoring and supportingthis bill because I think it
just does have that, it's sobipartisan, it's almost
(21:16):
nonpartisan.
Like it like really doesn'tseem to make sense to be against
it.
So I think that that'ssomething that's that's going in
our favor.
And again, it's it's it's oneof those things that we get only
by really trying to address apublic health issue as opposed
to like a personal, like, I justwant to make life better for a
PT for type of issue.
Richard Leaver (21:33):
Yeah, one last issue.
I always say that we have to,as a profession, we have to
demonstrate value.
And this is probably the firsttime that I know of where one
only we demonstrate value, it'sactually going to be measured in
a very methodical manner so wecan then go and reinforce the
(21:55):
fact that we will save overallcost.
Nick Patel (22:00):
Yes.
And and that's one of thefrustrations I have, you know,
when I as I go through policy asa therapist.
You know, I know everytherapist out there knows that
we save the system money.
Uh inevitably, you will treat apatient who gets to bypass
surgery because of theirinteraction with you, or doesn't
need some injections, or hasnow not needed to get three MRIs
(22:21):
for the same issue, likewhatever it happens to be.
That saves the system money.
Everything that we do right nowthat saves money gets rolled
into the baseline.
And by that I mean we don't getcredit for any of it.
Um, I think we all know that ifyou just remove therapy as an
option in the MSK treatmentpathways, we would spend more
money on all the treatment forMSK.
(22:42):
But it's hard for me toquantify that.
It's hard for me to show thatthrough claims analysis right
now.
How so if I create an entirelynew physical therapy benefit
that's never existed in thesystem before and say, let's
just measure that, we will beable to, if there are savings,
which I'm confident there willbe, we would be able to
attribute all those savings tospecifically therapy spent.
And then the next time we tryto get cut, or the next time
(23:04):
they try to propose, let's let,let's, let's see what happens if
we cut therapy, we'll be ableto point to, well, you know
what, we actually do save moneyon this very high dollar risk
issue.
If you have less therapists inthe market, this will actually
end up costing you more.
I can't really do that becauseright now, because all of our
savings are sort of just used byother folks and and and
absorbed into the system.
And we need to highlight and beable to break it out.
Richard Leaver (23:27):
So talking about money, obviously the other
topic that is reoccurring everyyear when it comes to advocacy
and therapy is the Medicarerules.
Kind of said in a deflatedvoice as well, I'm afraid.
The 2026 Medicare proposed rulecame out, I think, a couple of
(23:48):
weeks ago now.
I think.
You know, we're at we seem tobe on a conveyor belt and of you
know rate cuts and challengesto outpatient therapy from a
reimbursement perspective.
Specific to Medicare, and thenperhaps we can open up the kind
of the conversation to perhapsother payers, but specific to
(24:10):
Medicare, are we still on thisconveyor?
What's is the conveyor justchugging along or continue to
chug along for years to comewhere it's kind of a a death by
a thousand paper cuts of youknow one percent, two percent,
three percent?
Or is there light at the end ofthe tunnel?
So perhaps if we can justperhaps talk about 26 and then
(24:33):
perhaps expand the conversationto to a crystal ball and what's
going on from an advocacyperspective and legislative
perspective that we can cutsthink about going forwards.
Nick Patel (24:45):
Yeah, so I'm sure as your listeners all know, you
know, for the last five years,you know, we have been on this,
you know, cut, and then maybewe'll get cut a little bit less,
and then, you know, but it'sstill a cut, and then we have to
absorb a little bit more thannext year.
And if you accumulateeverything from 2020 to about
2025, the therapy cut on theMedicare physician fee schedule
(25:09):
has been almost 11% now thatit's all in and you know that
it's sort of stopped phasing.
One good thing is so as westand here, it's the end of
July, we have the proposed rulefor Medicare for what the 2026
rates will be.
They'll be slightly higher thanthan 25 rates, not anywhere
near the 11% that we have givenup in in the last five years.
(25:30):
But I think from one aspect ofthe conveyor belt, we I think
we're done with that sort of youknow massive devaluation that
we had to absorb over the lastfive years.
However, having said that,we'll see what gets finalized.
You know, the things won't getfinalized till November, and we
won't know the exact rates tillthen.
But what I have learned and theconclusions that I'm coming to
(25:52):
recently when it comes toMedicare fee schedule is if you
look at how the Medicare feeschedule calculates payments, it
rewards certain things.
Any payment system has inputsand any payment system rewards
or weights certain things higherand lower than others.
One of the things about, orjust two things about the fee
(26:13):
schedule that you have to keepin mind.
One, it is a budget neutralpie, which means anytime they
increase a particular code,there has to be a corresponding
decrease somewhere else becausethe the the entire amount of
money in the fee schedule has toremain roughly the same.
You can expand a little bitwithout offsets, but you you
basically have to give when youget whenever you get in one
(26:34):
place or another.
So most people don't understandthat.
So there's always littlethere's always little kind of
shifts just owing to the budgetneutrality.
But think about this.
Every time they create newcodes and interject them in the
fee schedule, the amount ofmoney for the fee schedule does
not change.
So these neat new codes have tobe valued and have prices
(26:55):
attached to them.
And then if they do, they thenthat means other things have to
go down.
And if you think about the youknow progression of technology
and care, new codes are comingin all the time.
And especially, you know, maybeyou went from the 90s to you
know mid 2010s where the codesdidn't change much.
But now you've got things, youknow, even for therapists like
(27:18):
remote monitoring, but for otherphysicians, telehealth type
codes and technology assistedcodes and caregiving, like there
are all these types of thingsthat are happening across all
the different professions thatare causing rebalancing of the
fee schedule, whether there'snew money in it or not.
The second thing you have tounderstand is what gets
weighted.
And here's where I have somefrustration a bit with being in
(27:39):
the fee schedule.
A good chunk of the weightingof what you get paid is how
expensive your equipment is todeliver your care.
And, you know, if I ask, youknow, you, Richard, like how
many of your Alliance PTVclinics have a single machine
that it costs $100,000?
My guess is that you probablydon't have any pieces of
(28:02):
equipment in a single clinicthat costs $100,000.
But that's who we competeagainst.
We compete against physicianswho are having to buy $100,000
pieces of equipment or $50,000machines or what have you.
And ours just do not cost thatmuch.
And and and then what willhappen is that three or years
(28:22):
later, there's a new machinethat's invented and it costs
even more.
And they have every incentiveto buy it because then that
actually becomes the increasedweighting for them to put that
in there.
The second thing that can helpdrive your payment is what the
risk is of the treatments thatyou do.
So, in other words, if if thetreatment by nature is risky and
(28:43):
has like higher malpractice,you know, threat attached to it,
you get paid more as wellbecause it's a risky treatment.
Well, again, therapists don'tget sued, again, knock on wood,
but we don't get sued veryoften.
The things we do are safe.
The things we do are aretypically don't require patients
to have a large risk for thethings that we do.
There's not there's not muchdownside there.
(29:04):
So if we're in a system wherethe to in order to get ahead,
you should have really expensiveequipment or do really
potentially dangerous things,and then you're gonna see some
nice increases.
And neither one of those,either now or probably never
will apply to us, are we in asystem that we can never really
win in?
And to your point, are we in aare we on this conveyor belt
(29:26):
that you know if every if everydollar that is new spend has to
come in, has to be offset bysomething else, and we really
don't have an increase in ourequipment and we don't want to
have an increase in allmalpractice, where does that
leave us when these new codes orthese shifting has to happen?
I think it leaves us on theplate to get cut more often.
And I think that's whathappens.
It's my it's my two cents.
(29:46):
I I I can't calculate it outfor you and show you the effect
that that's you know, uh thatit's had.
But I think as I look at if Ias I think about you know 26 and
beyond, I think it's time fortherapy to come up with a game
plan.
For how to get paid as aprovider that uses low-cost
equipment, that does treatmentsthat are not necessarily risky
(30:08):
for the patient and carry andcarry large amount practice
expense?
Is there a way for that personto get paid in a way that is
commensurate with what the valuethat they're providing, but
also is at the level ofrewarding the education and the
knowledge that somebody has toput in there?
You know, when you're in thephysician fee schedule, I hear
this all the time.
I am a DPT and I went to schoolfor seven years and I get paid
(30:29):
this, but you're in a feeschedule with other everyone
else in that fee schedule hasgone to school for seven, eight
years.
And so we we don't really winon that argument where the with
the differentiators are theequipment and the malpractice
and things like that.
And that's where we tend totend to lose.
So that's how that's kind ofhow I see our future is maybe
our future becomes brighter ifwe stop banging our head up
(30:50):
against the wall in a systemthat doesn't reward low-cost
providers to have high qualitybut low cost, that's not
necessarily what the feeschedule rewards.
And I don't think I'm gonna beable to change the entire fee
schedule.
Maybe I just gotta figure out away for a therapist to get paid
differently.
Richard Leaver (31:06):
Yeah, it's it's a pretty messed up system, isn't
it?
Where if you provide high cost,high-risk service, you get
rewarded for that.
Whereas in reality, why wouldyou want a reward for that?
Wouldn't you one rather, asociety, rather have low-risk,
low-cost service?
(31:26):
But anyway, we can debate that.
Nick Patel (31:28):
So that's why you'll never find a physician that
says no to let me buy an evenmore expensive piece of
equipment because they'll endthat's how they actually get
high-increased reimbursement.
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Richard Leaver (32:17):
I suppose the opportunity, I suppose we could
just pay $100,000 for atreadmill and just say we're
having cost.
Yeah.
I'm not advocating oursuppliers listen to that and in
the case.
Yeah, please don't.
Nick Patel (32:30):
But yeah, I mean that's that's that's in a
nutshell, it's sort of whatwe're up against.
Richard Leaver (32:34):
And then you you mentioned the kind of the 11%
cut.
That's an actual real cost,isn't it?
But relative cut to Medicareover an extended period of time,
I've heard different numbers.
But you know, when you takeinflation into account as well
over an extended period, I thinkour relative cut has been when
I I again correct me if I'mwrong.
(32:54):
I I've heard the idea is forapproximately a 30% cut over the
last five, ten years.
And I don't know what numberthat's kind of thrown out and
used and you've heard, but itit's a significant cut, isn't
it, compared to well compared toany anyone really, for anyone.
Nick Patel (33:12):
Yeah, you're you're exactly right.
So, you know, the governmentpublishes a number, it's called
the you know, MEI.
It's the index that sort ofmeasures the amount of inflation
from medical costs and medicalcare.
Almost every other setting getsan MEI or a COLA cost of living
adjustment upward every year.
So for five years, the feeschedule, not just therapists,
(33:32):
but everyone in that feeschedule were not allowed to get
any inflation adjustment.
When that was originallypassed, it was sort of as a
trade for getting out of the SGRproblem, which what we all some
of us remember was was a hugeproblem.
And at the time, inflation wasvery minimal.
And so, you know, if you goback all the way to 18 and 19,
(33:53):
inflation was not something thatwas a that was a concern for a
lot of folks.
And unfortunately, people havea tendency to think whatever
things are now is what they'llbe like forever.
And I as you as you well know,things that inflation did not
just stay at that level.
It had been that low for for agood number of years, but it
eventually caught up to us andit spiked and it's here to stay.
(34:14):
And some of these priceincreases have been sticky, and
they show up not just in youknow things like your equipment
and and maybe your rent, butit's the salaries.
I mean, you know, it's it'sit's it's the compensation for
our workforce because I can makedo without a certain piece of
equipment, but the one thing Ican never out make do without is
the therapist.
And and again, you have someonewho's spent a lot of time in
(34:36):
school and and getting theirtraining and and and they care a
lot and they coming out.
I don't think it's a I don'tthink it was a coincidence that
in the midst of all of this, anduh and and during COVID, I know
it was a very tough time forevery healthcare provider, but
therapists lost 20,000 workersout of the workforce.
That's the equivalent of twoyears worth of new grads.
And and it wasn't like theywere just gonna go on the
(34:58):
sidelines and wait for COVID tokind of flesh out they'll
they're gonna come back.
These are folks who are likenever coming back.
They have no intention ofre-entering the workforce, even
though COVID has worked itselfout.
So it was that that's why I sayI don't think it's solely
attributed to COVID because theydidn't come back when COVID
kind of resolved itself.
And and that's the issue, Ithink, partly is they found
other things to do forcompensation.
(35:18):
Then why would I go back tobeing a therapist?
Uh I have found other thingsthat keep up with inflation that
allow me better upward mobilitywith my salaries.
And that's not just a Medicarething, and I don't want to put
it solely at their feet becauseI think we have a problem with
payment off Medicare, MedicareAdvantage, or commercial payers,
you know, you name it, it'sacross the board.
But that's what inflation alsohurts us as well.
(35:39):
So it's not just that one-timepurchase of a piece of equipment
or that you know, one-timelease renegotiation.
We pay our we pay our peopleevery every week, every two
weeks.
And we have to keep up withthat.
And and and you know, hiringnew people every year with
higher salary expectations thanwere than they had, you know,
two years ago.
It's a difficult thing tomanage.
(36:00):
And and again, we have to havea plan for that.
And and and we have to navigatethat because there's one thing
right now that that I've seen isI think that 20,000 workers out
of the workforce, plus the factthat I think people do use
therapy more now, is we don'thave a volume clinic in most of
our clinics.
People are coming in.
We don't have people to seethem, you know, and then and and
(36:23):
we don't get paid well enoughon the people that we do see to
justify bringing in more staffthat that that can help.
And that's where the, you know,that's where the the real bane
of our private practice ownersright now.
Richard Leaver (36:35):
Yes.
I'm grateful the fact that I Ibelieve our advocacy is being
heard and gaining some tractionfor for multiple reasons.
But one of the reasons whichyou've just highlighted is the
fact that we as a provider arestruggling to be able to provide
(37:02):
any services for certaincomponents of the community as a
result of a lack of providersin in a lot of drop or
geographical locations, areduction in number of people
applying for therapy school,relative reductions in pay over
(37:23):
extended period of time.
So uh it it's evident when youtalk to uh APTQI members and and
in the broader outpatienttherapy world that we have to uh
change not only changeinternally and how perhaps how
(37:44):
we treat and how we managepatients, but the the
reimbursement uh issue is uhbecoming or has become, I think,
critical.
And uh ultimately it is the uhpeople who require our care that
suffer by not being able to getthe amount amount or even not
(38:05):
be able to get care.
So looking forwards, you know,from an advocacy perspective,
what do you think what what'swhat's uh is perhaps being done,
but more importantly is whatcan listeners, what can
clinicians do, what can peoplesupporting our profession do
now?
Because I I think we're on, Idon't mean to necessarily be
(38:30):
melodramatic here, but I thinkwe're on pretty shaky ground,
and we have to to get a footing.
And if we don't, then I'm I'm alittle concerned that we won't
be able to continue to see paythe patients as the we have this
aging population, et cetera,and increasing demand.
(38:51):
So so what can we do from anadvocate be advocacy
perspective?
Nick Patel (38:56):
Yeah, I'm gonna throw out a couple things that
might be a little bit different.
This is usually the space whereyou may hear somebody say,
write your congressman, make aphone call, or or donate to a
PAC.
I I feel like those pieces ofadvice are they're all great, by
the way.
I don't think you're tellinganybody anything they didn't
already know.
So if you'll indulge me, I wantto I'll say, I'll say it for
(39:17):
the sake of saying it.
Those things are all important.
However, let me let me maybeattack it a slightly different
way to maybe see if we can getbetter results.
One is you want to write yourcongressman, call them, that's
fine.
But think of it this way (39:28):
do you have a relationship with the
your elected official's office?
And by that I mean, have youever just gone by their office?
I don't even doesn't have to bethe DC one.
Every elected official has alocal office in the district.
Go by there and say, My name'sRichard.
I'm a business owner in thisdistrict, at my clinics down the
street, what have you.
(39:49):
This is my business card.
I'm a physical therapist.
I'd like to be a resource foryou guys to talk about anything
as relates to healthcare.
If you ever want to know howsomething that you're deciding
on as it relates to healthcareaffects us in in the city or in
the district, call me up.
Or would you like to hear someexamples of what I'm dealing
(40:09):
with right now?
That sounds really simple, butit doesn't happen.
And it if you think about this,there's 535 elected members of
Congress, right?
If that happened 500 times inevery in every district, I think
we'd be getting a little bitdifferent.
I just, it just right now, itdoesn't.
It's it, you know, advocacy isa one time a year, let's all go
(40:31):
to the hill, let's make arounds, and then we'll come back
home.
And the other 364 days are justgriping about how things really
don't work well for us.
What I'm saying is go locally,become that person, go there
multiple times.
Advocacy is not a one time ayear thing.
You know, if you want to getpaid every day for your
services, advocate every day foryour services.
If you want to, if you want tomake your payments every month,
(40:52):
advocate every month.
So I mean you go there and youmake relationships because guess
what?
The guy who's working there wholoves you and thinks you're
great and wants to form arelationship with you where you
have this great, greatunderstanding, will be promoted
and out of that, and then yougot another one, you got to
start again.
And that's what you do.
And you keep going back becausethere is a lot of movement with
those jobs.
So create a relationship withthem.
It's not that hard.
(41:13):
I tell therapists all the time,we every therapist I know that
worth their salt has this hasthis innate superpower where you
meet someone who is a completestranger to you, and within five
minutes, they are taking offtheir shirt and pointing to
where it hurts.
They are in you can makesomeone incredibly comfortable
with you who's a completestranger.
If you cannot walk into thatoffice and say, I'd like to talk
(41:35):
to you about physical therapyand what it means and how these
things affect us and myemployees and my patients, if
you don't feel comfortable doingthat, I don't know what to tell
you.
You can do something infinitelyharder than that every day,
sometimes 12, 15 times a day.
Can you not really do that?
I don't believe it.
I refuse to believe that we'renot good at that.
You don't need training, andyou don't need you know a whole
(41:57):
lot of guidance and mentoring.
You probably do it tomorrow ifyou really want to.
So that's one thing, createthat relationship.
Second thing, if you're abusiness owner, I'm not gonna
tell you what to do with yourbusiness, but maybe my advice
would be think twice when youget that contract and the rate
on it is so far below what yourcost is to provide that service.
(42:18):
And I would just say thinkthink think twice about you know
signing that.
You know, again, I everyoneneeds to do what what they need
to, but I think there'ssomething to be said for every
rate that someone complainsabout is a rate that someone
signed, though.
So, you know, that that wouldit's definitely not our it's
definitely I'm not saying it'sour fault.
(42:39):
Like it's the if the insurancecompany is setting a rate,
that's what they're doing, andthey're doing what they think is
best.
I'm saying maybe you should dowhat you think is best for for
you.
And at a time when volumedoesn't seem to be an issue
because we are having moreboomers and we are having more
people coming to our clinics,uh, just double, just take a
second to look back.
It it is a form of advocacy tosay, I, Richard, believe I am
(43:03):
worth way more than $65 a visit.
You are advocating for yourselfor your your therapist to say
that this is not a fair pricefor what I do.
It does not reflect the valueof what I provide.
And I know that it could be adifficult thing to lose some
patients if if you have to.
I understand all that, andthose are parts of the equation
(43:25):
that are not easy.
But my request is if you're asyou're thinking about advocacy,
think about it whenever thatnext renewal comes.
The last thing is probablysomething, again, it it may be a
little bit, you know, out ofout of left field, but again,
there is voice, there, there isthere is strength in numbers.
So, you know, it's whatAlliance did.
You don't if if you don't likeABTQI, try to get involved with
(43:50):
APTA.
If you don't like APTA, findanother NARA, like whatever it
happens to be.
I think so many of our of ourfolks say, I don't want to
advocate because I don't likethis association.
I don't know, and it may be allvalid.
Maybe you don't like thedecisions they made, maybe you
don't like the people there.
I it's fine, whatever.
But then just find somewhereelse to join in and amplify your
(44:13):
voice.
I think right now there aremore options for the therapist
out there to join withlike-minded people than ever.
So it's okay if you don't likeour group.
That's that's fine.
If if you know, if you're an OTand feel like APTA has nothing
for you, how about AOTA?
Look at them, whatever ithappens to be.
But I feel like there's moreavenues today than ever.
And there's less excuse for youto say, I'm gonna tune out and
(44:37):
not lend my voice to a largergroup because I have maybe some
philosophical differences withthat group.
Valid, fair.
I'm not gonna argue with you ifthat's the case.
But then there's got to besomebody else, you know, that
that does.
Seek those people out, whetherit's a conference or meetings or
whatever.
Something tells me you'll beable to find someone that you
say, yeah, I think this is thisis worth merging my voice into.
(44:57):
Because we cannot sit back andsay, Well, I don't like that
group, so I'm kind of notgetting involved.
Find another one.
Richard Leaver (45:04):
Yes.
And then yeah, the world ofsocial media as well.
There's there's it's very easyto put one's voice behind
advocacy.
And it amazes me how muchtraction certain very simple
media social media posts canget.
And they can get picked up veryeasily by multiple groups,
(45:25):
multiple individuals.
So I think that's anothermethod that if we get suff
sufficient numbers that areproactive in that can be
extremely powerful.
You know, I'd love to see somesome PT influencers focused on
on the advocacy component.
I don't see any or hear ofthose, but but there's
(45:48):
absolutely no reason why thereshouldn't be those people,
should there?
Nick Patel (45:52):
Yeah, no, exactly.
And and if you think about thenumbers, I mean it's one of
these things, it's it's almostit's it's like a it's a great
trick that's been played ontherapists.
And I I see this happen a lotwhen I talk to folks, and they
always say, Well, we're sosmall, we're always gonna get
picked on.
Or we're always the little guy.
We're like, we're always a veryfraction of a fraction, and
blah, blah.
There are hundreds of thousandsof therapists in this country,
(46:16):
right?
Granted, some of them aren'tfull-time, and I understand that
that that's an inflated numberfor a lot of reasons.
But my point is, there's moreof us than a lot of other
professions.
There's more of us than a tonof other professions that get a
lot of what they want, whetherit's in Congress or for private
payers or whatever.
But sort of, I almost thinklike I almost feel like someone
(46:38):
has been sold a bill of goods tobe told we're just too small
and we really can't get anythingdone.
If we band together and createsome volume behind our voices,
we can actually get quite a lotdone.
Because if if every professionspoke with 100% of their
licensees, we wouldn't be nearthe bottom.
We would be not even in themiddle.
(46:58):
We'd be closer to the, youknow, the top quartile.
You know, there's way more ofus than chiropractors.
There's way more of us than, Imean, a lot of other people that
would probably surprise youbecause there's just a ton of
therapists out there.
But yes, we all have differentwork in a lot of different
settings and we work in a lot ofdifferent, you know, practice
specialty areas.
But my point is we're notsmall.
And don't let anyone tell youwe're small.
(47:20):
And don't let anyone tell youthat we're just a fraction of a
fraction or a fraction, and wedie.
And so therefore, what's thepoint of trying to advocate?
Because we'll never get what wewant.
If everyone spoke up or foundfound a place they felt
comfortable to speak up, I wishit was with us or with APTA or
but it could be with anyone,doesn't matter.
We will actually get a littlebit further.
Stop believing in that becauseI don't think it's true.
It will it the numbers don'tthe numbers say it's not true.
Richard Leaver (47:43):
Time's always against us with these
conversations.
Uh it's been great.
Any final thoughts, words ofwisdom, perhaps to our
listeners?
And then also if we've talked alot about the APTQI, how would
somebody learn more about thatgroup as well?
Nick Patel (48:02):
Yeah, if you know, if you're a provider and you
have, you know, you have someclinics and in and you're and
you want to learn more, youabsolutely can go to our website
to learn more, aptqi.com.
Or you can email me.
It's npatel@ aptqi.com.
I'm I, you know, I respond toas many emails as I can
directly.
The last thing I I I leaveanyone with is don't don't
(48:27):
despair.
And I and I because it can be adark time to be a therapist and
practice owner right now,whether you're a staff therapist
or you're in charge of you knowmultiple clinics, the five
years that you just went throughwere probably quite difficult.
And you may feel like you havea bunch of train marks down your
back and and and and it'svalid.
For those of us who are alittle bit older, I can only say
(48:47):
1999 and 2000, 2001 were verysimilar.
If if if if you're my age, andthere was a time where we
thought therapy would never getbetter.
And it was very difficult.
And you couldn't find a job andyou couldn't get reimbursed,
and it was it was it didn't seemlike there was much of a
future, but there was.
And and and actually things itended up leading to a quite of a
(49:09):
boom time for therapy.
I truly believe sometimesthings are quite things,
sometimes are just about to bethe brightest right when you
feel like things are the darkestand can't get any better.
Um, so don't give up on theprofession or don't give up on
on what you're doing if you areadvocating, because typically,
whenever we are pushed upagainst the wall, things start
(49:31):
to get better because we as aprofession start to fight a
little bit more.
But also, you know, thependulum can only swing so far
in one direction before it hasto start swinging in the other.
And you don't want to miss thatride.
If you've hung in here forthose five years, you don't want
to miss the ride going back theother way, is is is sort of
what I've been trying to tellpeople.
Richard Leaver (49:48):
That's remarkable wisdom.
So thank you, Nick.
And some from somebody who'sonly 25 years old as well.
Nick Patel (49:55):
So Yeah.
Yeah.
I just read about 2000 inhistory books, Richard.
Richard Leaver (49:59):
I was like, Well, again, thank you.
Thank you so much for what youdo, Nick, and thank you so much
for what you know APTA does,APTQI, and and the other groups
that advocate for therapybecause we'd be in a much
different place if we didn'thave all of you.
So I appreciate you and andeverything that that
(50:21):
profession's doing to help driveus forward.
So appreciate it.
Nick Patel (50:25):
Appreciate you having me.
Alliance Physical Therapy (50:27):
This podcast was brought to you by
Alliance Physical TherapyPartners.
Want more expertise andinformation?
Visit our website atallianceptp.com and follow us on
social media.
You can find links below in thedescription.
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