Chris Hoekstra watched PT's AI panic flip in twelve months at the same annual meeting, and he explains what that reversal says about how this profession actually changes.

Chris has been a PT for about 25 years. He also holds a PhD in clinical informatics, teaches organizational behavior at Oregon Health & Science University, and leads clinical transformation work at Therapeutic Associates. He calls himself a sociotechnologist, and that turned out to be the right word for this conversation.

We got into why PT has been slow to adopt technology, why most therapists can't tell you what an RVU is when every physician can, the difference between quality and value, and what Chris thinks leadership actually requires. He also tells the story of a quality dashboard rollout that made therapists call in sick.

What we cover:

→ Why the HITECH Act money went to medicine and PT paid its own way → The four levers that decide whether anybody changes anything → The gap between the scope therapists have and the codes they can bill → Quality and value, and why treating them as the same word keeps us stuck → What $800 a day buys in a skilled nursing facility → Why a quality number feels like a verdict on your character → What CMS is signaling in this year's requests for information → The three ingredients that put a clinician in flow

Chapters:

00:00 Meet Chris Hoekstra

02:15 Why PT lagged on technology

04:05 What actually forces change

07:13 When patients start acting like consumers

10:29 The four levers behind every decision

12:45 The scope we have and the codes we don't

15:41 "I want an hour with my patients"

16:55 Quality and value are not the same

19:16 $800 a day to walk down the hall

22:09 The patient who wants the ultrasound

24:34 The 10 percent echo chamber

25:30 A failure of leadership

29:26 They have to feel it

31:12 Confident humility and one percent better

32:26 Every physician knows what an RVU is

35:06 AI, second brains, and what it's for

37:45 When AI alone outperformed the doctor

38:28 From boogeyman to ChatGPT in one year

41:56 The dashboard that made PTs call in sick

43:46 What quality even means anymore

46:06 What CMS is signaling in the RFIs

48:31 PT as prevention

50:40 Part of the primary care team

53:29 The recipe for flow

54:36 What every PT should understand

A few quotes from Chris during in this episode. Listen for them:

"I had more than one PT, the first day we rolled it out, call in sick, because they thought maybe they would be the lowest performing person on that dashboard. That's the amount of fear we have with people when you start to show these."

"Historically we've dumbed down PT to say it's visits plus units."

"We went from one year boogeyman to the next year put everything in ChatGPT. It just takes a couple of people getting a good outcome from it. And we're lemmings, so we're gonna follow."

"We teach our PTs to look at the efficacy of their care in a frame of one, always. What we rarely do is roll those up into populations to say, how am I doing en masse?"

"Be confident, but first be humble. Every day step into it saying, I'm not where I need to be. And if I am, I should probably retire."

"MIPS has been a travesty in many respects, with an overfocus on process measures that actually don't change care. Everyone's gonna game the system when you throw money at it."

Find the full transcript and Chris' bio here.

Follow Chris on Linked In here.

Hosts: Alex Bendersky and Dana Strauss

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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 and Therapy and Value-Based Care Models.