Decision Fatigue in Rehab (RTS Newsletter #5)

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First, a laugh 🤣 

Community Spotlight: Matthew Blye, Sr. Director of Provider Relations 🚀

RTS: Clinician burnout is rampant in rehab. Do you have any advice for clinicians looking to improve the quality of their work and life?

Matthew: The healthcare system faces significant challenges, often limiting access to effective, patient-centered care. Physical therapists are highly skilled professionals who have the potential to greatly enhance patients' quality of life and reduce their need for costly medical services. Luna addresses these issues by empowering physical therapists with greater autonomy, enabling them to focus on delivering exceptional care directly to patients in their homes. By minimizing administrative burdens through streamlined technology, Luna allows therapists to practice on their own terms, fostering a model that prioritizes both provider well-being and patient outcomes.

RTS: What innovative technology or approach have you or the clinicians you work with implemented recently, and how has it improved patient outcomes or your clinical workflow?

Matthew: I am genuinely excited about the technology that enables a more standardized, evidence-based approach to delivering care in the home setting. By harnessing data analytics, we can now suggest personalized care plans and recommend targeted clinical interventions, making it possible to drive more consistent, measurable outcomes. These insights enhance patient care and allow us to identify causal relationships in treatment effectiveness, leading to continuous improvements in quality and efficiency. This data-driven approach empowers providers to deliver high-impact care that adapts to each patient’s needs, bringing precision and accountability to home-based healthcare.

RTS: Is there a particular area of rehab therapy where you think technology could make a significant impact?

Matthew: AI-supported documentation and advanced biofeedback technology can transform patient care by reducing variability in treatment pathways and supporting more informed clinical decision-making. AI-driven documentation can streamline the recording and analysis of patient data, ensuring consistency and freeing providers to focus more on direct care. Meanwhile, functional biofeedback technology allows for real-time tracking of patient progress and responses, offering critical insights that enable providers to adjust care plans proactively. Together, these technologies provide a robust foundation for standardized, personalized care that aligns closely with evidence-based practices—ultimately leading to better outcomes and greater efficiency across the healthcare system.

RTS: What advice would you give to other therapists who want to integrate more technology into their practice?

Matthew: To therapists considering integrating technology into their practice, I would strongly encourage them not to shy away from it but to embrace the advancements explicitly developed to support and elevate the care they provide. Today’s technology enhances therapists' skills and interventions, offering tools to improve patient outcomes and make a tangible difference in day-to-day practice. Moreover, technology can streamline essential administrative functions—billing, scheduling, documentation—freeing therapists to dedicate more time to hands-on patient care. Additionally, leveraging technology can reduce overhead costs, creating efficiencies that make it easier to grow a practice sustainably and increase profitability. Embracing these innovations allows therapists not only to deliver exceptional care but also to build a thriving business that can serve more patients and create a lasting impact.

RTS: Why are you excited about the Rehab Tech Stack newsletter and community?

Matthew: I am eager to explore how other companies are leveraging technology to create a healthcare experience that benefits patients, empowers providers, and simultaneously reduces costs. Learning about innovative approaches in healthcare technology offers valuable insights into ways we can enhance patient outcomes, streamline provider workflows, and improve access to care—all while containing expenses. I’m particularly interested in understanding how advancements in digital tools and data analytics are shaping more efficient, patient-centered models that support sustainable, high-quality care for all.

World of Rehab 🌐

• [Speech] TriWest Healthcare Alliance will replace Health Net Federal Services as the TRICARE West region contractor starting January 1, 2025, requiring providers to re-enroll even if currently enrolled with Health Net, while also expanding to include six additional states from TRICARE East and implementing significant rate reductions that have prompted the creation of a template letter for providers to express their concerns.

• [Physical] Blue Cross Blue Shield Association has reached a $2.8 billion antitrust settlement that includes significant operational reforms to its BlueCard Program, with changes that will benefit healthcare providers through improved prior authorization processes, new value-based contract options, and streamlined claims processing across all 33 member companies.

• [Occupational] Therapists at Penn State Hershey Medical Center have incorporated "forest bathing" and other outdoor activities (like visiting farmers' markets and community gardens) into their treatment of patients with eating disorders, finding that these nature-based interventions help reduce anxiety, increase food exposure, and improve overall treatment outcomes.

• [General Rehab] Zia Sherrell, MPH writes about the relationship between Ehlers-Danlos syndrome (EDS), a genetic connective tissue disorder, and postural orthostatic tachycardia syndrome (POTS), a condition affecting heart rate upon standing, noting that about 80% of EDS patients also have POTS due to how EDS affects blood vessels and blood flow regulation.

Indie’s Insights: Decision Fatigue Is Real💡

While everyone obsesses over buzzwords like “AI” and “Robotics,” it's important to remember the purpose of the technology. It’s more nuanced than people think.

People are ultimately interested in these technologies' output, not the technologies themselves. This output can be quantifiable, such as reimbursement rates or time saved, or more subjective, but no less important.

Another more subjective example I’ve discussed with other clinicians is decision fatigue, which clinicians face daily. The amount of decisions at any given moment can be exhausting. You know you’ve reached maximum fatigue when your mental performance hits 99% after the millionth clinical decision of the day.

Defining Decision Fatigue

It's not just about being tired - it's a measurable deterioration in decision quality that occurs when clinicians face prolonged periods of choice-making. As mental resources deplete, providers either make impulsive decisions or avoid them altogether, seeking cognitive shortcuts that can compromise patient care.

The Impact of Decision Fatigue

Research from "Decision Fatigue in Emergency Medicine" reveals that physician burnout rates related to decision fatigue range from 25-78%, with documented impacts on healthcare costs through extended hospital stays and additional interventions.

Moorhouse's 2020 study "Decision fatigue: less is more when making choices with patients" found that clinicians experiencing decision fatigue tend toward more conservative management plans and often choose paths of least resistance, such as prescribing unnecessary antibiotics.

The implications extend beyond individual patient encounters - this cognitive drain creates a ripple effect through our healthcare system, impacting everything from care quality to cost efficiency.

Decisions that Cause Fatigue

The list of decisions is exhaustive, spanning treatment, load management, prescription, and documentation. Here are a few examples:

• Treatment Planning Decisions

  • Determining appropriate exercise progression/regression

  • Modifying manual therapy techniques based on patient response

  • Adjusting treatment frequency and duration

  • Choosing between different therapeutic approaches (manual vs. exercise vs. modalities)

• Patient Load Management

  • Prioritizing patients based on acuity and progress

  • Determining appropriate discharge timing

  • Managing group therapy composition

  • Balancing one-on-one time versus supervised exercise

• Exercise Prescription

  • Selecting appropriate resistance levels

  • Determining sets, reps, and rest periods

  • Choosing between treatment modalities

  • Modifying exercises for equipment availability

• Documentation Decisions

  • Selecting appropriate functional outcome measures

  • Determining progress toward goals

  • Justifying continued skilled care

  • Coding for complexity and time

Several emerging technologies aim to reduce clinicians' cognitive burden rather than adding to it:

• Smart documentation leverages voice dictation and automated templates to streamline paperwork. 78% of clinicians report expedited note-taking.

• Workflow optimization technology intelligently groups similar patients and prioritizes tasks.

• Data synthesis tools automatically summarize lab results and visualize trends across systems.

• Clinical decision support tools provide evidence-based order sets and automated alerts without disrupting workflow. Studies show improvements in safety, efficiency, and cost savings.

• Communication platforms standardize messaging and automate patient education.

Looking Ahead

As we build the next generation of healthcare technology, success metrics should include clinical outcomes and the overall quality of life for clinicians.

The solution isn't necessarily adding more tools that further tax mental bandwidth but finding ways to reduce the cognitive load altogether.

The key is that these technologies handle routine cognitive tasks, letting clinicians focus their mental energy on complex clinical reasoning and patient care. For example, instead of manually checking drug interactions or insurance coverage, automated systems can flag issues proactively, preserving the clinician's decision-making capacity for critical care choices.

Think outputs, not buzzwords.

See you in two weeks,

Eddie

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