Therapy Services
Engage Magazine Fall 2020 General Interest

The Future of Therapy Services

by Keith Carson, Director of Partnerships, Therapy Specialists

Keith Carson, Therapy SpecialistsThe future is an interesting thing when you think about it. There are aspects of the future we can predict with a high degree of certainty. For example, the sun will come up tomorrow, or, as the saying goes, “Time marches on.” The future comes like a series of waves that invariably arrive on shore with the consistent rhythm of a pendulum. However, there are other aspects of the future that are entirely unpredictable. The rogue wave that comes out of nowhere and swallows up whatever it finds.

In therapy services, we have seen for some time the invariable waves of virtual visits, the Baby Boomer bell curve and their ambition to maintain their quality of life for as long as possible, as well as the economic pressure trickling down to patients and providers from a healthcare system that is far from perfect. Then without much warning, a rogue wave arrived — COVID-19, which in many ways has served to simply accelerate the arrival of the future we could already see was coming.


COVID-19 has undoubtedly accelerated the use of telehealth for rehabilitation services. Throughout the pandemic, CMS has taken the lead in ensuring more access for patients to healthcare services through virtual visits. For many therapy providers, telehealth was a life preserver that kept them and their patients afloat during the first few months of the pandemic.  At Therapy Specialists, for example, we went from doing zero virtual visits per month in March to over 500 virtual visits in September.  Telehealth has also enabled us and other therapy companies to provide more specialized services to our patients.  We can now ask a therapist that lives in Stockton, Calif. with a certification in a specific treatment modality to treat a patient suffering from Parkinson’s disease in San Diego, Calif. Although telehealth is becoming more mainstream, it remains unclear as to whether Medicare and other insurance companies will continue to reimburse therapy providers for these services in the future. Right now CMS is seeking comments on their 2021 Proposed Rule on whether certain therapy codes should be added permanently to the list of acceptable telehealth services  We remain hopeful that they will not restrict the access to these services in the future.


Another significant issue for the future of therapy services is the economic pressure that is trickling down from Medicare to rehab providers. Most agree that Medicare needs to reduce costs, maintain outcomes and improve the overall health and well-being their patient population. But the economic backdrop to these efforts in therapy services are that therapists remain in high demand, and as a result are able to request more compensation for their services than they have in the past. Higher salaries for therapists mean increased cost for therapy providers, and therefore, can lead to increased costs for skilled nursing facilities. In the most recent proposed rule, CMS included a 7 to 9 percent cut for physical, occupational and speech therapy services across the board. Although many therapy associations are aggressively advocating against these cuts, a basic understanding of economics will tell you that something will have to give in the future. The silver lining for therapy providers is that patients will continue to need therapy services, and our therapists will continue to be an essential part of the healthcare system. But we will need to continue to innovate in order to deliver these services and maintain patient outcomes in the midst of these economic pressures.


The need for physical, occupational, and speech therapy services is going to dramatically increase in the upcoming months — and probably years. One primary reason is because our healthcare system, understandably so, has been acutely focused on mitigating the impact of COVID-19 over the last nine months — and will continue to be focused on it over the next nine months. Amid the pandemic, lying in wait has been the muscle strains and sprains, chronic pain, and deconditioning that has gone unaddressed with most older adults. You might remember that at the beginning of the pandemic many “essential” healthcare workers were furloughed in large part because doctors stopped treating patients and surgeons stopped doing surgery. Think about the potential impact on a resident in your community who recently had surgery and been prescribed therapy services twice a week, but was unable to receive those services because of the pandemic. COVID-19 has decreased the amount of therapy being provided, and as a result new problems have arisen, new injuries have surfaced, and new conditions have revealed themselves. So, as we continue to try to suppress COVID-19 we will see an influx of patients coming back to therapy because their issues have been exacerbated. This will certainly continue in the upcoming months, and likely extend into the next few years.

Although the waves of the future will present some challenges for our profession, they will also bring about opportunities for patients and providers alike. The challenges we face have only served to remind me of the invaluable role the physical, occupational, and speech therapist plays during this season in helping people recover from their injuries and keep moving. They are essential workers to the fullest extent of the word and will play an increasingly important role in our healthcare system both now and into the future.