CMS released the final 2027 Medicare Physician Fee Schedule on November 4, and the main number is bad news. For most clinicians the conversion factor drops about 2.3%, which is a bigger cut than the agency proposed in July. When APTA looked at the July proposal, it thought physical therapy codes might still come out a little ahead. The final cut is steeper, so whatever cushion PT had is probably smaller now.
Nobody in Lima can change the fee schedule. What you can change is how many visits you lose after a patient has already started. You know the type: they come in for the evaluation, book two follow-ups, and then just stop showing up.
Dropouts are a tracking problem
A 2025 study in Musculoskeletal Science and Practice interviewed Midwestern patients about why they skipped visits or quit after their first PT evaluation. Some said they felt better enough to stop. Some thought they could keep going on their own. Those are normal human reasons, and a phone call at the right time can address both. Feeling better at visit three doesn't mean the patient is done, and a therapist can tell them that.
The hard part is knowing who to call. Your EMR has the schedule and the notes. But it's bad at one simple front-desk question: which patients have an open plan of care, no visit booked, and haven't been in for eight days? Without an answer, follow-up depends on someone remembering. And that's the first thing to slip when the waiting room is full.
What a custom CRM looks like in a PT clinic
Off-the-shelf CRMs are built for sales, so they track leads and deals. A clinic tracks episodes of care. A custom CRM is built around the way your clinic actually works, and building one produces three things.
The first is the CRM spec. We sit down with your front desk and one therapist and write out the real workflow. What happens after an eval? Who calls a no-show, and how soon? What counts as discharged at your clinic? When does a referring doctor expect an update?
The second is the data model. This is where the PT-specific details live:
- Patient, linked to one or more episodes of care
- Episode: diagnosis, start date, visits prescribed, visits completed, payer, authorization end date
- Referral source, so you can see which doctors' offices send patients who finish their care
- Follow-up task, created automatically when something happens
The third is the build plan: a rollout in phases that starts with one automation that pays for itself before anything fancier gets added.
The first automation to build
When a visit is marked as a no-show, or cancelled without a new booking, the CRM checks that patient's episode. If visits are left and nothing is scheduled, it creates a same-day call task for the front desk. The task shows the patient, their therapist, how many visits are left, and when the authorization ends, all on one screen. If nobody makes the call within 48 hours, the task goes to the treating therapist.
When a patient is discharged, the CRM schedules one check-in call about 30 days later. That call catches the people whose "I'm fine" didn't last. It's also a natural time to ask for a review.
A careful builder gets two more things right. First, this system holds protected health information. Every tool in the chain needs a signed business associate agreement, and texts to patients should say "please call us" and nothing about their diagnosis. Second, tasks are created when a visit's status changes, not by a timer that checks over and over. That keeps the system cheap to run and quiet when nothing is happening.
How will you know it works? Not because we tell you. Before launch, pull two numbers from your own EMR for the past three months: plan-of-care completion rate, and visits attended per new evaluation. Pull the same numbers for the three months after launch. If they don't improve, the build plan changes.
Medicare rates drop again in January. For a Lima clinic, finishing the plans of care you've already started is the cheapest revenue there is. If you'd like to see your own workflow written up as a spec, Paglow Automations can map it out with you in one meeting.
Sources
- CMS issues CY 2027 physician fee schedule final rule — American Hospital Association
- Medicare's final 2027 fee schedule cuts physician pay more than proposed but softens the same-day visit penalty — Medical Economics
- Proposed 2027 Medicare Physician Fee Schedule: What PTs Need to Know, Part 1 — American Physical Therapy Association
- Why patients skip or drop out after the initial physical therapy evaluation (Musculoskeletal Science and Practice, 2025) — Duke University Scholars
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