Covid impact

Outpatient Rehab COVID-19 Impact: Trends and Stats

How has COVID-19 impacted outpatient rehabilitation? How badly were treatment rates impacted? Are we recovering? Where does our industry stand with telehealth?

Systems 4PT specializes in outpatient rehabilitation. Based on our nationwide experience, here is the analysis:

Treatment Volume:

Like every aspect of life, patient treatment volume was significantly impacted by COVID-19. Thinking back to March 2020 (doesn’t that feel like years ago!), the outbreak was high in Washington State, New York City, and other isolated spots. While COVID-19’s impact felt “regional” and “just beginning”, nationwide patient treatment rates declined by 30% in March. A void of information about telehealth aggravated the depressed treatment rate. While Systems 4PT practices were documenting and billing telehealth as of March 24th, most outpatient rehabs didn’t start until mid-April.

April was the low point, as outpatient rehab patient treatments were only 36% of normal. Practices were facing a crushing 64% decline in patient visits. Anticipating the devasting impact on cash flow, Systems 4PT provided revenue modeling tools in March, enabling practice owners to forecast various hands-on vs. telehealth treatment rates. Likewise, Systems 4PT provided real-time instruction on the Payroll Protection Program. Our practices began applying for PPP on April 4th; most had applied by April 8th, with the desperately needed funding arriving as early as April 29th.

Telehealth aggravated everything. The industry was awash with contradictory webinars and chat rooms overflowing with incorrect advice. The message to therapists from most EMRs was, “Telehealth is on you.” Provided with little more than custom coding fields, therapists were suddenly expected to master a chaotic new billing environment (as if navigating a pandemic and economic collapse wasn’t enough).

In the face of crashing patient visits. The last thing practices needed was skyrocketing telehealth rejections.

From the start (March 24th), Systems4PT notified our practices that their job was to focus on their families, patients, employees, and treatment volume. “You sign the telehealth claims, and Systems4PT will add all the custom coding. It’s our job to get telehealth claims paid.”

As practices increasingly relied on telehealth, patient visits improved from only 36% of normal in April to 41% in May. Not great, but outpatient rehab began its journey toward recovery. May’s improvements were certainly bolstered by the April 30th announcement that, finally, Medicare would cover telehealth. As before, Systems 4PT updated our Medicare protocols advising practice owners, “Your job is to treat the patient. Our job is to get the telehealth claims paid”. As Medicare began funding telehealth payments at the end of May, the desperately needed cash flow for the month was consistent with volume-adjusted expectations.

The trend in June is very optimistic. Patient treatment volume is 58% of normal and is continuing to build. Finally, COVID-19 impacts treatment volume less than half of normal patient volume. Telehealth treatments and payments are (dare we say) routine and predictable. (At least for Systems 4PT practices.)

From here, outpatient rehab’s patient treatment rate will continue to improve toward normal. However, whether treatment rates will return to 100% in 2020 is unclear. We encourage practice owners to continue their monthly cash flow modeling for the remainder of the year.

Other COVID-19 Related Trends:

Because of PPP, many practices have been fully staffed since April. Since patient visits have been less than half of normal, practices have increased their focus on “constant improvement.”

EMR and billing have been at the top of the list. Practice owners who were not thrilled with their EMR/billing before the pandemic found themselves double-frustrated with the lack of telehealth support from their EMR. These practices use the time gained from the short-term decline in treatment rates to find more effective billing technology.

Since treatment volume is lower than usual, it’s the perfect time to change EMR/billing software because there is less data to convert and more time. Often, practice owners assign therapists to research EMR while not treating. Researching EMRs online is easier than ever, as most EMRs offer video demos that allow for an assessment of options while remaining anonymous, with zero sales pressure.


It’s an “inch by inch” slog as outpatient rehab fights to return to normal treatment levels. The good news: Regarding treatment volume, the worst is past, and improvements are happening. Practices still being told, “Telehealth is on you,” are taking action as they insist upon working with a more trustworthy EMR/billing partner.

Finally, there is absolutely no room for complacency. We can never give in to fatigue as it relates to mitigating the risk of infection with COVID-19. As America “opens up” every day, we learn more about how to return to a more normal place while at the same time staying safe. No doubt, this is the #1 most important focus.

Systems4PT will update you again as we migrate through COVID-19 together.

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