Trends Shaping the Future of Ambulatory Rehabilitation

Michael Schmidt is a healthcare leader with over 20 years of experience. He is currently the director of ambulatory rehabilitation at Duke University Health System, where he oversees the clinical operations of over 250 rehabilitation professionals in 28+ ambulatory clinic settings. He is also the director of residency and fellowship programming for Duke University Hospital System, overseeing 11 residency and fellowship programs accredited by the American Physical Therapy Association and the American Occupational Therapy Association.

Please tell our readers about the journey you have had in the industry and what are some of the key roles and responsibilities that you have daily.

Originally from a small town in Michigan, I pursued my education in physical therapy at Duke University in North Carolina, where I subsequently completed a residency and fellowship program in orthopedics. Over the years, my role has evolved from being a clinician and educator for students, residents, and fellows to taking on additional responsibilities as an assistant manager.

“Our focus has been on reducing the growing number of denials, not by merely increasing patient volume to improve our financial situation, but rather by supporting our team and exploring modifications to enhance our financial outlook.”

About a year and a half ago, I was promoted to Director of Rehab Services. In this capacity, I oversee all ambulatory clinic locations and our pediatric team. On a day-to-day basis, my responsibilities are diverse and dynamic. This includes visiting clinics, engaging with our team, meeting with various stakeholders across our healthcare organization, and addressing patient concerns. Additionally, a significant part of my role involves program development, collaborating with stakeholders such as program managers, finance, compliance, and risk management within the healthcare system. The nature of my work ensures that each day presents unique challenges and opportunities.

What are some of the recent trends and challenges impacting the industry lately?

One of the prominent trends we've observed is the significant growth we've experienced in our market area. This surge is attributed to a considerable number of people relocating to our region. Consequently, our clinics have seen a notable increase in patient volumes. The foremost challenge we currently face revolves around ensuring access to care, given the substantial influx of patients. Meeting the demand has become a daunting task.

Moreover, within the realm of rehabilitation, a persistent challenge lies in reimbursement. Over the years, we've witnessed a continual decline in reimbursement rates. Despite this, we've found it necessary to augment the salaries of our teams to stay competitive in the job market. This has resulted in a scenario where we are expending more while generating less revenue—an equation that poses inherent difficulties. To retain a skilled and motivated workforce, we have prioritized compensating our teams adequately, but the ongoing issue of diminishing reimbursement rates remains a significant hurdle for us to navigate.

As a leader, how have you adjusted your approach or strategy to address and overcome these challenges?

In response to the challenges we've faced, especially in terms of billing practices and denial reporting due to insurance restrictions, we've undertaken significant efforts.Our focus has been on reducing the growing number of denials, not by merely increasing patient volume to improve our financial situation, but rather by supporting our team and exploring modifications to enhance our financial outlook. Additionally, we've recognized shifts in the workforce landscape, with a greater emphasis on work-life balance and modified schedules to meet individual needs. This includes an increase in employees adopting alternative schedules, such as four 10-hour shifts or reduced weekly hours, reflecting the changing dynamics in our workforce over the past decade.

How do you envision the future of the space?

We've been exploring various emerging developments, including the adoption of new therapeutic monitoring codes. These codes facilitate the connection with patients and assist in monitoring their health at home. This approach allows for the modification of patient programs within these code categories, presenting a departure from traditional practices. I anticipate significant growth in this area. Additionally, some regions are encountering frustration with insurance carriers and their limited reimbursement. As a response, there's a noticeable trend towards cash-based service offerings for various programs, which I foresee experiencing further expansion. Many of our private practice counterparts in the region have shifted away from insurance, opting for a cash-based model to ensure viability within the marketplace.

What are some of the project initiatives that you are a part of?

One significant project initiative I've been involved in is centered around enhancing the customer experience, particularly by leveraging technology to improve access. A key pilot initiative we've undertaken is known as direct scheduling. This entails empowering patients to have control over their scheduling through various devices such as iPhones or computers. They can effortlessly schedule or cancel appointments at their convenience, moving away from the traditional telephone-based appointment system. Initially implemented for return visits, we are now extending this initiative to cover new evaluations as well. This allows any patient seeking rehabilitation services to conveniently schedule appointments with us online.

What would be your piece of advice to your fellow peers?

My primary advice to my fellow peers would be to prioritize and concentrate on your teams and individuals. Valuable insights often arise from the clinicians working in our clinics daily, identifying problems that can be addressed. By emphasizing our focus on people, we not only enhance their support but also witness improvements in financial aspects, productivity, and other metrics. Spending time with and supporting your people will yield positive long-term outcomes.