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  • Episode 32: The Physical Therapist, The Big Cycle, and The Age of AI

    Episode 32: The Physical Therapist, The Big Cycle, and The Age of AI
    2026/07/04
    Plus, Ray Dalio's framework for how systems break, applied to the profession's financial reckoning and its AI future(note: this episode was published before the CMS 2027 Physician Fee Schedule Proposed Rule was published)Is physical therapy heading toward its own financial reckoning?In Episode 32, Dana and Alex run MSK care through the same systems logic Ray Dalio uses to explain how countries go broke. Here's what you'll hear:How physical therapy goes broke. Large systems are already taking write-offs and defaulting as payers stop feeding operations that don't return what they promised. Alex makes the case that these are the first signs of a two-to-three year restructuring, and that it's predictable if you know the cycle.Your evaluation pays $90. Your treatment pays $30. The system is already telling you where your value is. We get into why that gap exists and what it should change about how you design your day, your team, and your top-of-license time.Your patients are already grading your plan of care with ChatGPT. A time-constrained patient can drop their symptoms and your plan into AI and ask "is this any good?" in thirty seconds. We talk through what that means for how defensible your plans need to be, starting now.The money is moving to primary care (even in fee-for-service), and PT is sitting in the specialty bucket. Advanced Primary Care Management codes, capitation tests in ACO models, and a closed-system reality where dollars flowing to primary care flow away from the rest of us. Dana lays out a four-to-six year forecast and why PTs need to fight into that definition before it hardens.Your discharges might be creating your own return visits. Tissue remodels over months and years. An episode of care runs days and weeks. We unpack that mismatch and why treating to symptom relief (often with unnecessarily high visit frequency) keeps sending patients back through the door.AI is safer than your intuition wants to believe. Iatrogenesis is one of the largest preventable costs in medicine. Bring in the Waymo that has never had a fatality, add the difference between training and tuning these models, and you get a real role for clinicians as the people who tune them.The optimistic close. Done right, AI plus interoperability finally plugs PT into the rest of the medical system and makes the work more individualized, more rewarding, and more visible. Or you can keep your paper charts and your goniometer.Chapters:00:10 Introduction to Payment Stressors in Healthcare01:43 The Evolution of Physical Therapy and Payment Reform05:30 The Impact of AI on Healthcare Delivery09:53 Revolution vs. Evolution in Healthcare Systems14:01 The Future of Payment Models and AI Integration19:30 AI's Role in Healthcare Precision and Transparency21:05 Access Challenges in Urban vs. Rural Healthcare22:52 Understanding Access Problems in Healthcare25:02 AI's Impact on Healthcare Access26:51 Network Adequacy and AI's Potential29:08 AI Safety and Bias in Healthcare31:16 The Future of Physical Therapy with AI33:48 Embracing Change in Healthcare DeliveryFind the full transcript here.Referenced in the episode:Dr. Chad CookDr. Trevor LentzRay Dalio's booksCMS Physician Fee Schedule home pageMedicare Shared Savings ProgramACO REACH ModelLEAD ModelACCESS ModelACCESS Model: landing page for referring and co-managing clinicians (including PTs and OTs)Advanced Primary Care Management services and codes under the Physical Fee ScheduleDuke research finding removing financial barriers to physical therapy led to more evidence-based care and cut unnecessary healthcare utilization."Healthcare Dive's" coverage of the Hinge Health IPOWaymo's March 2026 landing page covering their safety dataAbout the show: Future Proof PT is a podcast for physical therapists, physical therapists assistants, and others who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.Hosts: Alex Bendersky and Dana StraussWant information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.
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    36 分
  • Episode 31: Physical Therapy is the Swiss Army Knife Profession

    Episode 31: Physical Therapy is the Swiss Army Knife Profession
    2026/05/25
    Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing insteadA VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out."Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field.What we cover:Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary careWhere tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually doHow the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectoryWhy social media arguments about exercise intensity and volume miss the point, and what behavior change should look like insteadPlus three threads that emerged outside the five-things framework:The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expectWhat top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuseThe phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change"Dr. Cook shares some uncomfortable numbers that we need to face to address.-75% of PT referrals never initiate,-30% drop off after the first visit,-and MSK patient outcomes have actually gotten worse over the last two decadesPlus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in.Chapters00:00 Introduction to Dr. Chad Cook02:56 The Identity Crisis in Physical Therapy05:47 The Role of Physical Therapists in Primary Care08:33 The Precision Paradox in Treatment10:51 The Emotional Aspect of Diagnosis13:29 The Transition to Self-Management15:41 The Impact of Digital Health Solutions18:20 The Future of Physical Therapy28:45 Navigating Uncertainty in Healthcare30:45 The Digital Transformation of Health Systems32:08 The Role of AI in Patient Care36:51 Understanding Patient Recovery Trajectories39:36 The Importance of Prognosis in Therapy46:04 Redefining Exercise and Patient Engagement50:48 The Power of Touch in Therapy55:22 Negotiating Behavioral Change in Healthcare59:09 The Future of Physical TherapyFind the full transcript here.Related: Episode 30 with Dr. Trevor LentzAbout our Guest:Dr. Chad Cook is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries.Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: Many Paths to Recovery: The Case for Treatment Pluralism.About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.Hosts: Alex Bendersky and Dana StraussWant information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.
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    1 時間 1 分
  • Episode 30: One Bad Experience with PT Loses Patients Forever with Dr. Trevor Lentz, PT, PhD, MPH

    Episode 30: One Bad Experience with PT Loses Patients Forever with Dr. Trevor Lentz, PT, PhD, MPH
    2026/05/02
    And the active ingredients in PT often aren't even physical"We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor LentzDr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value.In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession.The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume.What you'll hear:Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.The challenge of fostering critical thinking and comfort with uncertainty in clinical education.Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.How Duke's Joint Health Program built a longitudinal care model before the payment model existed.Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.The AIM-Back trial and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care.Find the complete transcript and outline here.Chapters:00:00 Introduction00:23 Trevor's background and path to research03:00 Day-to-day at Duke03:54 Inductive vs. deductive reasoning in clinical practice05:39 The No-Copay Revolution study09:30 Horizontal vs. vertical value and the time-horizon problem12:44 Rethinking incentives and longitudinal care17:28 Why one bad PT experience ends the relationship forever20:53 The identity crisis and language problem26:57 Phenotyping and tiered, personalized care39:32 The Pain Navigator program and AIMBAC trial46:23 Navigators in the commercial space48:14 Closing: the whole-person argumentAbout the guest:Trevor Lentz, PT, PhD, MPH is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care.About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.Hosts: Alex Bendersky and Dana StraussWant information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."Follow Dana Strauss on Linked In.Follow Alex Bendersky on Linked In.Subscribe to the Future Proof PT Linked In page.Subscribe to the Future Proof PT YouTube Channel.Subscribe to our newsletter and email list.Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.
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    51 分
  • Episode 29: Build a PT and OT Clinic Where Therapists Want to Work

    Episode 29: Build a PT and OT Clinic Where Therapists Want to Work
    2026/04/18
    Why content follows culture, and practical actions clinic owners can implement within the next 3 months.


    Find the full episode transcript here.


    Posting more isn’t a growth strategy. Kylie Williams joins us to break down why “marketing to patients” on social media is getting harder, and why the clinics that win are the ones building culture that therapists actually want to be part of. We talk retention, autonomy, flexibility, benefits that matter, and a simple “side quest” approach to content that does not derail clinical excellence.


    Kylie is a healthcare professional with 8+ years of experience in physical therapy as a PTA. Now in a non-clinical role, she focuses on industry market analysis and storytelling to help private practices grow, adapt, and stay strong in a change healthcare landscape.


    Key Topics:


    -Social media's impact on private practice growth

    -Creating a strong clinic culture to reduce turnover

    -Innovative marketing strategies for healthcare providers


    Chapters:


    00:00 Introduction to Kylie Williams

    01:36 The Importance of Culture in Physical Therapy

    05:05 Defining and Building a Positive Work Culture

    09:29 Targeting the Right Audience for Recruitment

    18:15 First Principles for Engaging New Clinicians

    23:07 The Impact of Social Media on Attention Spans

    23:40 Balancing Attention and Depth in Learning

    25:20 Navigating the Attention Economy

    26:10 Attracting Talent in a Digital Age

    27:04 Creating Value in Social Media Content

    28:27 The Challenge of Teaching Value in Social Media

    30:18 Connecting Social Media to Business Success

    32:12 Investing in Marketing Education for Therapists

    34:03 Finding Balance in Clinical and Promotional Roles

    37:15 The Role of Influencers in Modern Careers

    39:07 Empowering Clinicians to Pursue Side Projects

    40:47 The Importance of Agency in Clinical Roles

    42:36 Shifting Paradigms in Therapy Business Models

    44:40 Embracing Creativity and Optimism in Therapy


    Want information on PT and OT reimbursement and opportunities in policy and advocacy?

    Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."


    Follow Dana Strauss on Linked In.

    Follow Alex Bendersky on Linked In.


    Subscribe to the Future Proof PT Linked In page.

    Subscribe to the Future Proof PT YouTube Channel.

    Subscribe to our newsletter and email list for exclusive content.


    Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.
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    47 分
  • Episode 28: Skin in the Game: How PT Wins in the ACCESS Model

    Episode 28: Skin in the Game: How PT Wins in the ACCESS Model
    2026/03/27
    How RVUs (Not the Conversion Factor) Quietly Squeeze PT and OT and the Practical Blueprint to Shift From "Minutes" to ACO-Ready Value


    (read the full transcript here)


    In this episode, Alex and Dana discuss the CMMI ACCESS Model and what it could unlock for MSK care inside ACOs. They debate digital enablement reality and explain how aligned incentives can reshape referral pathways. They make a direct case the that the physical therapy profession's future depends on understanding payment mechanics.


    A core theme of this episode is that if PT stays positioned as specialty care based on "treatment minutes" as the primary service, it will keep losing in a system shifting relative value units (RVUs) toward primary care and behavioral health. If PT repositions around evaluation-driven expertise and ACO partnership, the profession can move from survival to influence.


    Here's what else you'll learn:


    • Why the ACCESS Model payments are intentionally low, and why that is not the point.
    • How ACOs think about total cost of care and why MSK spend is hard for primary care to manage.
    • What “aligned incentives” can look like in a PCP + ACO + ACCESS org + PT partnership.
    • Why engagement is often 3–5% for digital MSK programs, and what that means in context.
    • A practical “go do this tomorrow” play for clinics: identify local ACO participants and pursue Preferred Provider relationships.
    • The RVU basics most therapists never learned, and why it changes your advocacy strategy.
    • Why PTs should prioritize evaluation, differential diagnosis, and plan-setting, with PTAs executing more follow-up care.
    • How waitlists and access challenges become non-starters if PT wants to play in ACO-aligned care.
    • A potential new productivity mindset: RVU-based expectations instead of “visits per week.”


    Want more information on PT and OT reimbursement and opportunities in policy and advocacy?

    Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."


    Follow Dana Strauss on Linked In.

    Follow Alex Bendersky on Linked In.


    Subscribe to the Future Proof PT Linked In page.

    Subscribe to the Future Proof PT YouTube Channel.

    Subscribe to our newsletter and email list for exclusive content.


    Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.
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    1 時間 4 分
  • Episode 27: The $900 Billion Problem | Can AI Actually Fix Musculoskeletal Care?

    Episode 27: The $900 Billion Problem | Can AI Actually Fix Musculoskeletal Care?
    2026/03/14
    A reality-check on what works today, what is hype, and what must improve before digital-first MSK care earns trust


    We sit down today with Sergei Polevikov (FixHealth.ai, Well.AI / Chart2Chart) for a reality-check conversation on what AI in healthcare actually is, where it genuinely helps today, and where the hype can cause harm.


    Sergei breaks down AI’s evolution from early machine learning to modern transformer models, then moves from definitions into the real stakes: transparency, validation, and workflow fit. Then we discuss with him the risk of overpromising in musculoskeletal care.


    The conversation zooms in on a massive, under-discussed shift: Medicare’s growing interest in digitally enabled care models that can substitute for traditional services, and what that could mean for PTs, patients, and outcomes. Sergei explains why digital-first triage is likely the future, while also outlining the biggest watch-outs right now, including hallucinations, automation bias, incomplete data, and the lack of real-time interoperability that healthcare needs most.


    We also cover a PT and OT relevant rubric for separating hype from real clinical value: does the tool augment PT judgment and continuity of care, or is it being positioned (and reimbursed) to substitute for PT, especially in emerging Medicare digital-first models?


    Takeaways from the episode should help outline what to pressure-test before adoption or referral: safety guardrails and hallucination risk, transparency and validation in real-world MSK populations, EHR/workflow fit (not “more clicks”), and whether the vendor’s incentives align with outcomes vs. billing.


    Clinicians are concerned about AI "replacing clinicians tomorrow," but that's not reality and it distracts from the real issue. The biggest threat is poorly governed digital care pathways that can bypass PT and OT, fragment care, and dilute instead of improve accountability unless the evidence and oversight are truly there.



    Follow Dana Strauss on Linked In.

    Follow Alex Bendersky on Linked In.


    Subscribe to the Future Proof PT Linked In page.

    Subscribe to the Future Proof PT YouTube Channel.

    Subscribe to our newsletter and email list for exclusive content.
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    47 分
  • Episode 26: The PT Identity Project | The Problems Causing PTs Patients, Pay, and Progress

    Episode 26: The PT Identity Project | The Problems Causing PTs Patients, Pay, and Progress
    2026/02/20

    We are tackling physical therapy's brand crisis head-on. From pop culture portrayals (yes, we're talking about that "Land Man" stripper scene) to CMS policy that treats PT as "substitute spend" for MSK digital health solutions, the evidence is clear: we have a public perception problem.


    We explore why professional identity matters, how specialization creates internal dissonance, and why evidence-based practice sometimes conflicts with how we want to be perceived. We talk about the importance of communicating our actual skill set, and why we need to stop being terrible at telling people what we do and why it matters.


    Why this matters right now:


    Value-based care and episode/bundled payment models are framed as the future: fewer visits, higher impact per encounter. But remaining the PT who serves as the primary provider for managing their patients' longitudinal spend. In those models, PTs “win” by preventing downstream costs (imaging, opioids, injections, surgery, prolonged disability). But that only works if we can show it.


    Key topics: professional branding, healthcare policy, payment models, public perception, advocacy, and the path forward for elevating the profession.


    Mentioned in the episode:


    Nassim Taleb | "Skin in the Game" Hidden Asymmetries in Daily Life


    Episode Quality Improvement Plan (EQIP)


    ACCESS Model


    ACCESS Technical FAQs
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    33 分
  • Episode 25 | Pain Science, Manual Therapy, and the Economics of PT with Paul Ingraham

    Episode 25 | Pain Science, Manual Therapy, and the Economics of PT with Paul Ingraham
    2026/01/26
    Explore the intersection of evidence-based practice, healthcare economics, and pseudoscience in rehab, plus practical strategies for clinicians who want to do better without going brokeIs your physical therapy practice built on evidence, or just what pays? In this episode, we sit down with Paul Ingraham, science writer and founder of painscience.com, to challenge the line between evidence-based practice and pseudoscience in rehab. We explore why manual therapy needs a serious reframe, how economic pressures push clinicians toward uncertain treatments, and whether honest patient communication can coexist with running a profitable practice. Paul doesn't hold back: he argues that most PTs operate in a gray zone where research is weak, outcomes are unpredictable, and informed consent is virtually nonexistent. You might not agree with everything he says—but you'll hopefully question what you do and why you do it. Maybe you'll look into the scientific evidence behind your current common care plans.Topics include:Evidence-based practice vs. pseudoscience: where's the line? Why manual therapy should be reframed as an experimental intervention in many casesThe role of informed consent in uncertain treatments (not unlike what we hope physicians do when prescribing a treatment plan whose results are uncertain)How value-based care incentives better outcomes and discourages pseudoscienceThe economics of PT: balancing integrity with incomeWhy strength training and exercise therapy are still key ingredients in PT treatment plansTeaching intellectual humility and critical thinking in healthcare educationPractical strategies for clinicians who want to practice honestly without going brokePaul Ingraham is a Vancouver science writer and a former Registered Massage Therapist, a profession he left in 2010 over concerns about its pseudoscientific nonsense. Since then, he has been publishing PainScience.com full-time, a website about the science of pain and injury, known for its rich footnotes and anti-quackery activism. The site offers hundreds of articles and ten books, all based on a huge bibliography. Paul was an active amateur athlete for decades, especially in ultimate (the Frisbee sport), but has now retired from competitive intensity and “just” does a lot of running and cycling, despite grappling with his own chronic pain/illness problems since 2015.Here's where you can find Paul! https://www.painscience.com/subscribe [free newsletter]https://www.painscience.com/ebookshttps://www.facebook.com/painsciencehttps://www.threads.net/@painscihttps://bsky.app/profile/painsci.bsky.socialhttps://x.com/painsciSign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy.Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians.Subscribe to our YouTube Channel
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    1 時間 12 分