• Home
  • 2015-02-February

The Catch 22 of Health Care Reform

Can private practices meet obligations under compliance and reporting requirements and still turn a profit?

By Dan Alloway

Everyone is asking this question. The new normal for physical therapists is that every time Medicare adds another rule you are forced to spend yet more time coding, checking boxes, and defending your methods of care. If that is not bad enough, the pace of these new rules seems to be accelerating.

Let’s begin with the obvious problem: Increasingly, therapists’ attention and time are dedicated to writing books for payers instead of restoring the patient’s functional deficit(s). This tilts the practice economics dangerously into the negative. Practice costs are steadily increasing as payers chip away at reimbursements, while therapist production per treatment hour is declining because of the arduous and complex documentation requirements. Meanwhile, the payers are using their computers to see if you are following those requirements. They are checking your coding and how your patients are progressing. They are tracking your outcomes. You find yourself a Catch 22—you cannot spend less time treating your patients, but you still have to find a way to document all those treatments. It probably seems like the only answer is to work at night and on the weekends, which is what you are doing.

But there is a better way out of that box: technology. Use the technology available to you. At this point, the common response is is “We are using technology!” Or “We are documenting on computers!” Yes, you are using a computer, but you are using it as a “virtual typewriter” instead of using it as an analytical tool that is capable of substantially reducing documentation time? If computers can fly airplanes and drones, we can certainly, automate G-codes, physician quality reporting system (PQRS) coding, and treatment documentation that will allow you to return to patient care, which can never be automated.

These technologies are not available everywhere, but with a little research you can find systems that will reduce therapist touch time for G-code and PQRS reporting to 30 seconds and compose your notes in the blink of an eye.

So, if this prescription for success is obvious, why is the theme of this month’s Impact magazine: “Can private practices meet obligations under compliance and reporting requirements and still turn a profit?” Why isn’t this month’s theme, “Technology and the golden era of outpatient rehabilitation?” Why have we not made that jump? There are two answers to that question.

First, technology is difficult and expensive. Many EMR companies do not have the financial strength required to play at this level. The development and testing time are extensive.

Second, a concern that technology encroaches on the therapist’s clinical judgment exists—such as “physical therapy documentation should be hard. If it were easy, anyone could do it.”

Sadly, these types of comments are coming from some of the leaders in our industry. They do not seem to understand that we need to automate the mechanics of documentation, so that therapists can cure their patients. They don’t understand that technology does not threaten clinical judgment, it enhances it.

Computers accumulate and analyze data and then organizes that data, saving a physical therapist hours of work. Forward-thinking doctors in hospitals, such as the Mayo Clinic, are all over this new approach. They understand that there is no way to fulfill their mission without maximizing the use of technology. They understand that technology is used to identify and organize evidence. They also understand that technology is used to present medical professionals with evidence-based scenarios, enabling significantly more complex analyses than are possible any other way.

As outpatient rehabilitation embraces technology instead of dropdowns with checklists, we will alleviate the burdens of complex payer reporting requirements and usher in a new era of technology-driven, evidence-based capabilities—enabling significant gains in both treatment efficiency and patient outcomes.

Dan Alloway is vice president of Development Systems4PT. He can be reached at DCA@Systems4PT.com.

Expert Advice

Creating more profitable private physical therapy practices.

By Steve Takle, BA (Hons), MA

While there are most likely as many motivations for entering the physical therapy industry as there are therapists, the majority are inspired to complete their training to provide care for others. Whether this comes from an interest in the science and technology behind modern physical therapy practices or simply an altruistic intent to do good, it seems that most privately-owned physical therapy businesses are therapy first and business second.

However, that does not mean that “business” is a dirty word. It just means that practice owners tend to be therapists, rather than entrepreneurs. It is a mindset that is practically the default of nearly all academic institutions, where the business element of owning or managing a private practice is largely disregarded.

It is this mindset that physical therapists take into their professional career. As a result, many private practices lack the tools, knowledge, and ability to maximize the potential of their businesses. Paths to this information can be costly, time consuming, and off-putting with hard-nosed business advice, which seems a world away from providing the care that inspired a person to become a physical therapist in the first place.

It was precisely with this in mind that the first COPA Practice Growth was held in London, England, in 2013. The exhibition and conference was specifically designed to offer chiropractors, osteopaths, and physical therapists industry-specific business advice and insight, along with the latest rehabilitation research and products in the sector. The event was an instant hit with the European profession and doubled in size for 2014 to become Europe’s largest medical rehabilitation exposition. This year the event will be held March 4 and 5 at the Javits Center in New York.

COPA Practice Growth is designed for the private practice owner and is a business services expo specifically created to help successfully grow the practice and skills of the practitioner. The event aims to enable you and your business to grow, providing rehabilitation practitioners with expert advice, guidance and inspiration from experienced, successful sources. You will gain the knowledge you need to propel yourself and your practice to the next level.

These seminar sessions cover the most important developments facing rehabilitation therapy, with speakers ranging from leaders in medical to business experts and professionals—confirmed to speak are Henry Hoffman, Co-founder of Saebo and Dr. William Pawluck, electromagnetic field expert.

COPA Practice Growth is committed to providing advice and education to aid your professional development. Attending the exhibition and conference will contribute toward your continuing education units.

COPA Practice Growth will coincide with Neurological Rehabilitation Therapy & Technology, Elite Sports Therapy & Medical Rehabiltation; and Animal Rehabilitation Expositions.

To register for a free ticket to the expo, visit www.copaexpo.com

Steve Takle, BA, MA, is a freelance copywriter and editorial consultant in Bristol, England. He can be reached at hello@stevetakle.com.

What the Future Holds

By Terry C. Brown, PT, DPT

When I was growing up, 2015 was the future, not like a few years into the future, but like the Jetson’s future. (Those of you too young to have experienced The Jetsons, Google it). Flying cars, food in pellets, and robot servants were predicted. Well, the future has arrived and I don’t know about you, but I’m still driving on the road, eating real food, and serving myself. Some predictions for the future are just that—predications.

Sound Sleep


How can your private practice highlight National Sleep Awareness Month?

By Don Levine, PT, DPT, FAFS

The marketing and PR Committee looks ahead to March to see where our efforts might coincide with some of the national events or causes on our calendar. In past years, we have highlighted issues such as brain injuries, March Madness, and the start of Little League baseball and softball. This year, we will focus on a topic that affects not only your current and potential patients, but also your employees and co-workers. March is National Sleep Awareness Month, a topic that impacts individuals on many levels.

We all know how we feel when we do not get enough sleep—but what are the benefits for getting a good night’s sleep?

Just the Facts

What happens when we sleep?1
  • Our blood pressure drops.
  • Muscles relax and receive more blood flow.
  • Tissue growth and repair occurs.
  • Hormones are released (such as growth hormone).
  • Energy is provided to the brain and the body.
What happens when we do not get enough sleep?2
  • Accidents occur: The National Highway Traffic Safety Administration estimates that fatigue is a cause in 100,000 auto crashes and 1,550 crash-related deaths a year in the U.S. The problem is greatest among people under 25 years old.
  • Sleep loss impedes cognitive function: Lack of sleep impairs attention, alertness, concentration, reasoning, and problem solving.
  • Lack of sleep is linked to depression.
  • Loss of sleep can lead to weight gain: Recent research has focused on the link between sleep and the peptides that regulate appetite. “Ghrelin stimulates hunger and leptin signals satiety to the brain and suppresses appetite.”
  • Shortened sleep time is associated with decreases in leptin and elevations in ghrelin. Not only does sleep loss appear to stimulate appetite, but it also stimulates cravings for high-fat, high-carbohydrate foods.
  • Sleep deprivation can lead to serious health issues. Chronic sleep loss can put you at risk for: Heart disease, heart attack, heart failure, irregular heart beat, high blood pressure, stroke, diabetes.

Chronic sleep deprivation can also jeopardize your patients’ ability to heal. Just one night of less than six hours of sleep negatively affects the expression of more than 700 genes the next day. This leads to weakened immunity, increased inflammation, and decreased cell repair.3

Sleep facts and teens
The Better Health Channel says the typical teenage brain wants to go to bed late and sleep late the following morning. Work on adjusting your body clock and check out these tips:4

  • Choose a relaxing bedtime routine, for example, have a hot bath before bed.
  • Avoid loud music, homework, computer games for about an hour prior to bedtime.
  • Start your bedtime routine a little earlier than usual (for example, 10 minutes).
  • Avoid staying up late on weekends.

Sleepfoundation.org offers teens some other tips:

  • Make your room a sleep haven. Keep it cool, quiet, and dark.
  • Do not eat, drink, or exercise within a few hours of your bedtime.1

Provide information in multiple formats, such as on a company Facebook page, newsletter, and website. Leave facts up in your staff break room.

Hold lectures for coaches, parents, and athletes. The links below offer free information that is easy to share with your community.

Looking at the statistics and suggestions above, it is obvious that sleep deprivation is an epidemic. From improved healing rates to improved performance and mental acuity, helping our patients, staff, and co-workers understand the importance of a good night’s sleep is beneficial to all. While we make note of this for the month of March, physical therapists should spend time every month of the year discussing the benefits of sleep with our patients.

The Marketing and PR Committee hopes that these ideas will help you promote your practice and engage your community. We would love to hear about your successes. We can all spread the message about the benefits of physical therapy—as well as a good night’s sleep.

Share your events in the Marketing section on the PPS Message Board at www.ppsapta.org.


1. National Sleep Foundation. Website www.sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep. Accessed December 2014.

2. WebMD. Website www.webmd.com/sleep-disorders/excessive-sleepiness-10/10-results-sleep-loss?page=1. Accessed December 2014.

3. Psychology Today. Website www.psychologytoday.com/blog/the-healing-factor/201303/the-healing-significance-sleep. Accessed December 2014

4. Better Health. Website www.betterhealth.vic.gov.au/bhcv2/bharticles.nsf/pages/Teenagers_sleep. Accessed December 2014.


Don Levine, PT, DPT, FAFS, is chair of the marketing and PR committee and co-owner of Olympic Physical Therapy with five locations in Rhode Island. He can be reached at dlevine@olympicpt-ri.com.

New Relationships


A great time to partner in health care.

By Sean McEnroe, PT, SCS

The U.S. national debt is over 100 percent of Gross National Product (GDP)!
Health care has grown to more than 17 percent of GDP!
ICD-10, Functional Measures, Multiple Procedure Payment Reduction (MPPR)

Whatever your worry or concern, today is a great day to be in health care. This month’s Impact magazine is dedicated to heady topics including compliance, reporting, and the struggle for profitability. Even so, today’s evolving health care marketplace offers us the greatest opportunity to effect change and build the business we desire—if we are willing to explore the new models of delivery.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.