Dana Strauss (00:00) Hey everybody, welcome back to Future Proof PT. In today's provocative conversation, we cover some newsworthy policy topics and how they relate to what we hope is the evolving identity of physical therapy as a profession and physical therapists as healthcare professionals. Alex and I are bringing on our next guest, Jerry Durham to liven things up. We challenged the status quo and we're questioning whether PTs are truly functioning as healthcare professionals.

or merely, as you'll hear more about, quote, flipping burgers in an operationalized system. We explore the critical distinctions between being a physical therapist operator and what is sometimes considered the modality of PT versus the expertise of the physical therapist professional and why these differences matter now more than ever.

We get kind of heated in the discussion when we start talking about patient journeys, drop off rates, and who should truly be responsible for these crucial aspects of patient care. You'll hear from us the passionate arguments for why PTs need to quote, look up from their silos and understand the broader healthcare ecosystem, including of course, value-based care models and alternative payment structures.

We're not holding back on our criticism of the profession while simultaneously advocating for its enormous untapped potential. Our conversation is also touching on everything from leveraging technology and measurement systems to building stronger relationships with primary care physicians and physician specialists. There's a palpable sense of urgency throughout.

As I mentioned, you can feel the static in the air as healthcare transforms around us. So more about that. We also begin discussing what I found when I started going through the 2026 physician fee schedule proposed rule. CMS decided to shake things up and begin reweighting work RVUs that have favored non-time-based professionals. And they also adjusted practice expense RVUs, which

is shifting reimbursement away from hospital-owned provider practices or what's considered facility providers. Some of you may know there's also an increase in the conversion factor this year. was the headline. Most of that's being funded for one year by the One Big Beautiful Bill Act. There's excitement about this conversion factor increase when I look online, but therapists, please look a level deeper.

CMS is proposing to increase the work RVU weights of codes used by time-based providers. So think primary care physicians, nurse practitioners, physician assistants, and the behavioral health providers. So those changes are going to increase reimbursement by between 5 and 9 percent depending on the specialty. So that's

the weight of the three RVUs types combined.

But PT's and OT's, they also use time-based codes. However, they're seeing a drop of minus 1 % for providers whose practice is not owned by a hospital health system. So that's even with the higher conversion factor and positive news on the RTM codes that therapists use.

Because conversion factor is multiplied by three types of RVUs or relative value units, as well as the geographic adjustment, that's what actually impacts total reimbursement. And again, unlike our primary care and behavioral health colleagues, the improvement in the value of our time-based codes did not go up.

I encourage you all to check out table 92 in the 2026 physician fee schedule proposed rule to take a look at this in more detail. So whether you are a practicing clinician, a clinic owner or a student, this episode will challenge you to think differently about your role in healthcare and also maybe even a little bit about how policy impacts healthcare. I hope it'll peak your interest in health policy further.

I think you're gonna find the energy and conviction in this discussion might just be the catalyst you need to redefine your professional identity and secure your place in the future of healthcare. Hope you enjoy episode 15.

Dana Strauss (04:27) you can just feel it. It's like a static in the air. Things are changing. So I hope therapists can galvanize and, you know, really take advantage of this.

Jerry Durham (04:27) yeah, right.

I think they will, you know,

I think, you know what I think? I think people have been doing a good job getting the word out that the need, not just this was coming, the need to pay attention and the need to look at this. And I did a podcast yesterday,

Almost an hour, I mean, we talked all straight up business PT side and we kept bringing all this stuff up, all this stuff up, all this stuff up. And it just, and we talked about, you know, just from a business perspective of what you've been doing versus what you can do in the future. the last thing I'll say here is you don't have to blow everything up to do this. And we talked about ways to implement and it's not like you got to go out and create something new. You just start, you know, you just create this new space.

to start doing this stuff in the business and then grow into it and let it be successful and then you're investing, investing, investing. So yeah, so I'm excited. I think there's huge upside for our profession and the people we serve.

Alex Bendersky (05:24) Do you think we have the infrastructure? 100 % there.