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The Biggest Challenges Facing Today’s PT Practices, and How to Overcome Them

Challenges facing PT clinics today

Improving the lives of patients doesn’t always come easy. For physical therapy teams and other outpatient rehab specialists, the struggles are many. In following this industry so closely and talking with practices around the country about their evolving needs, we’ve seen how the challenges are getting more complex and in some cases difficult to overcome, especially in today’s market.

Based on our research, the following are the top challenges that today’s PT businesses are facing in managing and scaling their practice – with some insight on how your team might address each issue. If you’re running or working at a practice and can relate to any of these, just know that you’re not alone, and the community will continue to work together in facing the challenges of today and tomorrow.

1. Hiring qualified providers (and also, retaining them)

Over the past year, staffing challenges were easily the most common struggle we heard about, and teams are experiencing the problem from a number of angles.

According to our research, a majority of clinics felt that the hiring market was tougher this past year than it was the previous year. Finding the best fit for the job can take months in many cases, and this has a domino effect into:

  • Scheduling issues and headaches
  • Not being able to keep up with new patients
  • Hindering the patient experience for active cases
  • Provider and staff burnout

A major thread between this and our next challenge: rising operational costs and declining reimbursement rates that make it difficult for clinics to pay competitive wages. In many cases, therapists wages are staying the same while costs continue to climb – making it hard for providers to keep up with the increasing cost of living and, therefore, making otherwise amazing clinic jobs not appealing for qualified candidates. This can also make it difficult for practices to retain awesome staff after they’re hired, who may leave for better-paying jobs if a clinic can’t afford to meet their needs.

Overcoming this

Filling your open roles (and keeping them filled) starts at a foundational level: With strong leadership, a supportive work environment, and giving staff the tools they will need to succeed and thrive. Even with all that, how you approach the hiring search at every stage will play a significant role. In response to these universal hiring struggles, we’ve been putting out a number of articles that touch on different parts of the staffing puzzle. Check out any of these hiring-related blog posts to (hopefully) help you and your team find 

And if you know a PT, PTA, biller, or front staffer that is looking for a job opportunity, you can share our LinkedIn and Facebook pages, where we’ve been posting weekly round-ups of open positions at clinics that use Prompt. So they’ll know these practices are ahead of the game. 💁

2. Declining reimbursement rates (while costs are surging)

The elephant in the room for a lot of physical, occupational, and speech therapists is the continued cutting of reimbursement rates in the U.S. The downward trend of insurance reimbursements, as inflation continues to rise year over year, has become such a prevalent issue that the community has called on Congress to intervene – especially regarding Medicare rates and access to care for seniors.

Paired with the staffing shortages, and in many ways related, it is a perfect storm for clinics when it comes to sustainable profit margins – not just to scale a practice, but keep it running with a full staff and delivering the level of care that patients require. And if patients who need care can’t afford the out-of-pocket expenses for treatment, they often have to choose between going into debt for treatment or skipping out on their recommended outpatient rehab.

Overcoming this

Without a clear path to structural change from insurance providers, many practices this year will have to find their own personal ways to reduce costs, generate more revenue, and optimize their reimbursements however possible. 

Work with your team to understand profits and losses, where your budgets are going, and what expenses are fixed vs. variable and have room for improvement. Hold all your numbers against well-informed KPIs so you can take proactive measures in your spend rather than just reactive, and forecast what you’ll need to hit to scale vs. just to break even. And as best you can, monitor for and identify gaps in your collections for each case so you can go after what you should be owed, whether that’s from patient balances or discrepancies with your insurance payers.

The software you’re using does matter. Despite the steadily declining rates in the industry, our customer research shows that Prompt users increased overall revenue in 2023 by an average of 39.3%. Making the most of Prompt’s features can improve margins in a number of ways:

  • Filling empty appointment slots on your calendar
  • Preventing unnecessary losses
  • Providing real-time, trustworthy reports that help you manage objectively
  • Enabling the front office to support more therapists
  • Enabling the back office to support more therapists

Also, one of the biggest benefits of Prompt we hear about from practice owners is the in-depth reporting that gives a clear view of clinic performance from every angle. This allows Prompt clinics to better understand their efficiency, what’s working, and what’s not – so they can make data-based decisions. The more opportunities that practices find to lower expenses, the bigger their profit margins will be.

3. Attracting new patients

Outpatient rehab treatment is, unfortunately, considered “optional” care for even those patients that need it most, and this is sometimes enabled by the limited education around it in general healthcare, a lack of proper referrals from doctors during the diagnosis phase, and how much (or little) insurance can support it. 

In reality, the need for physical therapy has never been higher, but many clinics report that it’s difficult to attract patients or bring back patients who dropped off along their care journey. And at a time when reimbursements are in steady decline (see previous section), it’s “burning the candle at both ends” for practices trying to market PT, occupational, and speech therapy. The challenge of attracting the right new patients is even larger for clinics with specializations who are seeking a very particular patient profile.

Overcoming this

The quest for new patients will be different for each business, but there are some common strategies that can play a role, covered in the following articles:

Along with that, the right software at your practice can help you market your practice, engage with your community, and create the most memorable and beneficial patient experience possible at every stage. Prompt has been proven to generate more positive word-of-mouth for clinics (ex. Prompt Plus users generated 22 new Google Reviews per month last year) and simplify the customer journey, from digital intake to home exercise projects and everything in between. Prompt providers also spend less time documenting and more time building relationships with their patients and making their visits truly count. This can create raving fans that stick around and share your clinic with others.

4. Documentation

At the provider level, tedious documentation is and has always been a “common enemy” that unites outpatient rehab experts. The struggle remains one of the top things we hear about, whether in demo calls with potential customers or across the web in PT forums and testimonials. Too often, therapists have to come in early or stay late to complete their notes with all the necessary details for claims. And the compounding effect of this daily time drain makes documentation one of the leading contributors to PT burnout across the industry.

Overcoming this

It’s somewhat impressive that, as the industry evolves each year, this remains such a thorn in the side of therapists. Complex and ever-changing rules from insurance payers are certainly one major piece of it. Better education and preparedness for these across your staff can improve efficiency with compliant documentation. This might entail compliance training for your staff and any new hires that you bring on. Also, help instill the mentality that good notes are not always the same as lengthy notes – over-documenting is a very common habit in PT that wastes precious time and contributes to burnout while, in many cases, not actually taking down the right info in the right way. Templating your note-taking process can go a long way.

Another piece is that many clinics are using outdated legacy software that hinders their productivity, takes time away from patients, and also contributes to burnout rather than helping prevent it. From day one at Prompt, modernizing and streamlining documentation has been one of our North Stars. How we help eliminate these stresses is one of the outcomes we hear most about in customer case studies, online reviews, unsolicited comments on social media, and more. And this year we released even more features based on all the feedback we hear that are designed to improve documentation efficiency and outcomes, such as AI-enabled note-taking shortcuts that help reduce claim denials.

The bottom line is: Providers shouldn’t be taking documentation home with them, or spending so much time on repetitive notes that they take focus away from the patient. This common industry challenge can perhaps be most directly addressed by leveraging modern technology at your practice and training your staff to get the most out of these tools.

5. Billing inefficiencies

The daily routines of PT billing teams can be equally tedious, due to complicated insurance rules and “companies with ever-changing authorization processes.” Not only do insurance providers update their verification requirements all the time – making it an uphill battle to bill with 100% accuracy in all cases – but many billers are also learning on the job due to juggling many responsibilities at small practices. And improper billing can result in a long list of side effects, from a poor patient experience, to missing out on some crucial financial return for the practice, to creating legal risk for the business. It’s a unique challenge that was on top of mind for practice teams this year. 

Overcoming this

For most growing clinics, it’s important to ask if you should bring billing in-house or if it’s worth the investment to hire a third party, to most effectively handle these responsibilities and minimize stress on your team. You might consider a billing consultant to help assess your clinic’s needs and determine the best path forward with respect to your in-house experience, business size, structure, and budget. If you decide to keep billing in-house, training and continued education on best practices will be essential.

Some helpful considerations for in-house billing experts include looking at A/R and testing different ways to accelerate your clean claims posting process, so that your team focuses first on claims that need attention (i.e. those that might be denied). Your practice should also make it as easy as possible to collect payments and have them quickly reflected in accounting logs, so that you have a clear and up-to-date picture of what’s paid and owed. Sooner is always better with submitting claims – while always ensuring they’re accurate and compliant – to expedite your revenue cycle and avoid unwelcome surprises at the end of each month.

For these reasons and more, billing in-house warrants the best possible tools for the job. The complexities of outpatient rehab billing are only poised to grow, and for the sake of those employees, your patients, and your business as a whole, having a platform that can keep up is an increasingly crucial investment that will address several of your biggest challenges at once. Using a solution like Prompt can go a long way in making things easier and more accurate, and emerging AI capabilities are changing how billers do their jobs in real time. An advanced, all-in-one EMR like Prompt can even empower team members with no prior billing knowledge to handle these tasks, and get your clinic paid accurately and in record time.

If you do decide on a third-party biller for your practice, they will likely charge less if you use Prompt because they’ll be able to process your claims more efficiently. So factor all of this into your billing discussions and how the right tools at your practice will go far, however you approach these particular challenges.


The outpatient rehab industry is in the middle of a particularly transformative time, with some growing pains hitting even the most seasoned professionals out there. Prompt is doing everything in its power to be a trusted partner in the fight. Last year we helped thousands of practices offset these industry headwinds to not only survive but see massive growth in visits and profitability, and we’re going to continue to do that. We believe in a bright future for this industry and are dedicated to not only providing the best tools to overcome these challenges, but steering positive change in the industry as a whole. Our team would love to hear about the hurdles you and your team are facing at your practice, and work together to help you face them head-on.

Prompt Staff

Prompt Therapy Solutions builds practice management software for physical therapy clinics ranging from single provider practices and startups, to large enterprise organizations.

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