The 2019 survey results are in…
If you’re on the email list, you received the report of the survey we recently completed on outpatient OT & PT clinics. (Fill out the form below if you’d like to receive future updates). This survey asked 10 questions about the clinic demographics, service population, volume, and trends regarding patient engagement, retention, and engagement. If you want to see the full report, you can download it here.
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This survey was completed in the latter part of 2019 and provides some insight into trends in the outpatient OT/PT world. Besides providing some demographic data (most common diagnoses, clinic size, etc.), this survey provides some interesting data around patient patient retention (course of care & clinic retention), third-party denials, and varying referral sources. I hope you find the information interesting, insightful and useful in helping you improve operations at your clinic, rehab department, or organization. You can download the full report here.
Below are the questions with initial responses:
Question 1: Population or age demographic of the patients you treat daily
Far and away, adult populations take the prize as the most common populations being treated in outpatient OT & PT clinics, according to this survey. Of that group, neurological diagnoses (CVA, TBI, etc.) lead the pack, with orthopedics and workman’s comp shortly behind.
These seems pretty consistent with my experience working with outpatient clinic owners and managers.
- Adult Orthopedics: 60%
- Geriatrics (Wellness & Fall Prevention): 13.3%
- Geriatrics (Dementia & Neurocognitive Decline): 6.7%
- Adult/Adolescent Sports Medicine: 33.3%
- Workman’s Comp: 46.7%
- Pediatrics: 13.3%
- Adult Neurological Diagnosis (TBI, CVA, etc.): 73.3%
- Other: 6.7%
What does this tell us about the outpatient OT/PT space? Well, for one, it shows possible opportunities to either expand existing services or to create new offerings to serve various demographics.
Question 2: On average, how long do you typically see each patient over the course of treatment?
- 2-4 Weeks: 6.7%
- 4-8 Weeks: 46.7%
- 8-12 Weeks: 33.3%
- 16+ Weeks: 13.3%
The responses to this question may not come to a surprise to anyone who works —or has worked— in outpatient PT or OT clinic settings. This is most often driven by third-party payers (more on that later on in the report), rehab or post-surgical protocols, and standard convention (or common practice). Typically an outpatient OT or PT treatment program lasts between 4 and 12 weeks, depending on the injury/diagnosis, rehab potential, patient factors etc.
It’s important to be aware of this information for two reasons: 1) It gives you an idea of the importance of developing strong therapeutic relationships. 2) It gives you a reference point for normative treatment lengths. This doesn’t mean that you should always schedule a patient for “4-6 weeks” of treatment, but it can act as a guide.
Question 3: On average, how many times per week do you see your patients over the course of treatment?
- 1 Time per Week: 13.3%
- 2 Times per Week: 73.3%
- 3 Times per Week: 13.3%
Again, the responses to this question didn’t reveal any surprising insights. By far, two times per week garnered the most responses. Again, anyone who has worked in the outpatient therapy world for a while typically schedules patients for a couple of times per week.
Two thoughts come to mind when I consider the last couple of questions (#2 & #3). The first was mentioned above, and that is the opportunity we, as outpatient therapy clinicians have in seeing patients frequently over a course of time. Again, this provides great opportunity for outpatient OT & PT clinicians to develop strong therapeutic relationships with their patients, and then use those relationships to affect real change in their patients’ lives.
The second thought I have may seem at odds the idea that frequent treatment sessions provides a great opportunity and strength. Let me posit one question: Is it necessary to see every patient multiple times per week?
Why am I asking this question? Because the danger here, when you have the majority of clinicians or clinics scheduling a certain way, is that patients may be getting scheduled for more treatment than is necessary. This may not be a result of the clinic or clinician being incompetent or nefarious. It simply happens because “that’s the way we schedule all our patients”.
Question 4: How many patients are seen in your clinic each week?
- 40-100: 21.4%
- 101-200: 42.9%
- 201-450: 21.4%
- 451-600: 7.1%
- 600+: 7.1%
The answer for this question depend and relate to the answers from question #5. It should seem pretty intuitive that the more clinicians work in a clinic, the more patients get seen in a given week. No surprise there, right?
What is interesting is that 42.9% of clinics see between 101-200 patients per week. That means that they’re seeing an average of 600 patients every month; or at least scheduling 600 appointments.
What does this number mean? Well, let’s say each clinic gets an average of $112.50 per appointment. We arrive at that number based of of the often cited cost per outpatient therapy visit as being between $75-150 ($112.50 is the average between those). Working from those numbers, that would make monthly expected revenue around $67,500 per month ($112.50×600).
Now, let’s say that you’ve got a patient retention problem of around a 20% drop-off rate. That would cost you roughly $13,500 per month; or $162,000 per year!
Question 5: How many clinicians work and treat in your clinic?
- 1: 6.7%
- 2-5: 13.3%
- 5-10: 40.0%
- 10-20: 6.7%
- 20+: 33.3%
The spread of responses to this question interests me a bit. On the one hand, you have 40.0% of responding clinics having between 5-10 treating clinicians. This number is pretty consistent for most private outpatient therapy clinics I’ve seen and worked with.
But what’s more interesting is that 33.3% of clinics surveyed reported that they have 20+ clinicians working and treating in their clinics. That makes me think that these clinics are either attached to or part of a hospital system, or that they use a lot of PRN staff.
However, whether you’ve got 5 or 25 clinicians treating in your clinic, one thing is certain: you need to be intentional about creating the culture of your clinic or organization.
Is culture really that important in healthcare organizations?
In a word: YES!
Great organizations center around one thing: people. The people who work for that organization and the people who buy from that organization both play a role. Directors, supervisors, and staff members make decisions that directly impacts the culture of that organizations.
Question 6: What are your largest 2 sources of new patients?
- Physician Practices (Surgery, neurology, etc): 80.0%
- Hospital Referrals: 33.3%
- Primary Care Providers: 53.3%
- Ancillary Medical Professionals (Chiropractor, other allied health specialities, etc.): 0.0%
- Workman’s Comp: 6.7%
- Direct Access Patients (through insurance): 0.0%
- Private Pay & Self-Referrals: 6.7%
- Schools: 6.7%
- Returning Patients: 6.7%
- Other: 6.7%
I always like hearing about where clinics receive the majority of their referrals. It provides great insight about their priorities, focus, and innovative thought. What’s not so surpising is where most clinics surveyed reported receiving new referrals. Physician groups and primary care providers make up the majority of the responses.
This is reason why many clinic owners and managers see “developing strong physician relationships” as they key to keeping caseload up. And, in some ways, this can be true. If you develop a good relationship with a physician group, it can provide you a steady stream of referrals. There is one big weakness to this strategy, though.
You’re relying on someone else to make sure the referrals come your way. Worse, yet, you’re often relying on someone like the clinic manager or administrative assistant to get those referrals. And when they end up moving on or getting promoted, you’re out of luck.
Question 7: As a percentage, how many patients do you think complete their course of care in your clinic? (ex: stop coming because they met their goals rather than running out of visits, self-discharges, etc.)
- 20-30%: 6.7%
- 30-40%: 13.3%
- 40-50%: 6.7%
- 50-60%: 40.0%
- 60-70%: 6.7%
- 70-80%: 20.0%
- 90-100%: 6.7%
To be honest, this was the main question I wanted to answer when I set out to do the survey. I wanted to know how many patients actually completed their plan of care and I wanted to know what factors influenced completion rates.
Now, I’ve cited a research article reporting that around 14% of physical therapy patients will not show up to their follow-up appointments after the initial appointment . Some numbers even suggest that 20-30% won’t show up to their third appointment, and up to 70% will not complete their plan of care at all.
Those first few numbers seemed accurate with what I’ve seen in my work in the outpatient OT/PT world, but the 70% attrition rate seemed a little high. Now, this survey did not have nearly as many respondents as the one referenced in the article, so it may not be as accurate of a number.
However, the results of this survey show that closer to 40-50% of patients do not complete their course of care in the PT & OT clinics that responded. But that’s still a huge number.
 Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220–228. doi:10.1016/j.math.2009.12.004
Question 8: What do you think are the top 3 reasons why a patient might not complete their plan of care in your clinic?
- Negative Experience with the Clinic: 20.0%
- Issues with Communication Styles: 6.7%
- Unrealistic Expectations for Treatment: 40.0%
- Not Enough 1:1 Time with the Treating Clinician: 20.0%
- Insurance Limits &/or Denials: 73.3%
- Cost of Treatment: 40.0%
- Time Commitment & Scheduling Difficulties: 53.3%
- Travel or Transportation Issues: 20.0%
- Doctors Order to Cease Treatment: 0.0%
- Complications or Comorbidities: 13.3%
- Moving out of Town/State, etc.: 6.7%
Why do patient’s not complete their plan of care? According to the clinics who responded to this survey, the number one reason was insurance limits and/or denials (73.3%), followed by scheduling difficulties, time commitment, cost of treatment & unrealistic expectations.
Now let’s set the insurance denials or limits off to the side. While you can make the argument that this whole problem would go away (and more patients would complete their course of care) if you simply went out of network or cash-based, that’s hard step to take. On top of that, the next three reasons (time, cost, and expectations) need to be addressed before you consider leaving the insurance world behind. That’s because those three issues revolve around your ability to effectively communicate the value of the services you provide.
Now, for decades, clinics and clinicians have relied on being “in network” to avoid having to talk about value. And, in reality, they didn’t have to. Patients simply went where their doctor sent them. But, as mentioned above, patients are beginning to be more picky about which provider they go to for therapy.
Rising healthcare costs (deductibles, coinsurance, etc.) combined with the access of the internet means that patients now have a choice in who they see. And they’re beginning to use it. This change means you have to be able to effectively communicate the value you bring to the table.
Question 9: As a percentage, how many patients come back to your clinic for treatment for another issue? (ex: someone treated for a shoulder now returns for treatment of their wrist)
- 10-20%: 26.7%
- 20-30%: 20.0%
- 30-40%: 13.3%
- 40-50%: 20.0%
- 50-60%: 6.7%
- 60-70%: 6.7%
- 80-90%: 6.7%
There are two types of patient retentions. Course of Care Retention, is addressed by the previous two questions. It represents the number of patients who complete a course of treatment.
This question addresses Clinic Retention, or the number of patients that complete a plan of care and then come back when another issue arises. This can be harder to track, but it is worth it to better understand how to get “return customers” into your clinic.
What is common about patients who return to your clinics for new courses of treatment?
They are often your biggest fans, telling everyone they know about how great you are and how much you helped them. If they were referred to your clinic by a PCP or Specialist, they likely have told that doctor about their experience with your clinic. This can lead to that referral source feeling confident in referring more patients to your clinic.
Question 10: As a percentage, how many patients tell you they have heard about you, looked you up online, or got recommendations from friends/family before coming in for their first appointment?
- 0-10%: 6.7%
- 10-20%: 13.3%
- 20-30%: 26.7%
- 30-40%: 20.0%
- 40-50%: 6.7%
- 60-70%: 13.3%
- 70-80%: 6.7%
- 90-100%: 6.7%
The numbers were all over the place for this question, but the average was somewhere between 20-40% of patients either had heard about the clinics, got recommendations, or searched them online before their first appointment.
This highlights what I mentioned earlier: patients are beginning to act more like consumers. They’re doing some research (aka Google), asking friends and acquaintances, and maybe even checking out a site like healthgrades.com.
Ultimately, you need to make sure that you’re managing your reputation, both online and in the local community to make sure that prospective patients hear good things about you. One of the best ways to do this is to make sure you’re taking care of the patients you’re already seeing.
If you’d like to read the report in full, check it out here.
How do these results compare with what you’ve seen in your clinic or organization? Share your thoughts in the comments below!
For more informational reads, check out our Insights Page to see all the articles we’ve published to date. Click here to head over to our resources section and check out our variety of clinical and professional resources aimed at increasing your knowledge and skills. If you’d like to make some changes in your clinic or health center, and would like some help, check out our consulting and advisement services or contact us to see how we can help you break out of the norm and provide a truly impactful patient experience.
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