Luck of the Draw? No, Not Really!

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By Terry C. Brown, PT, DPT

One of the single greatest resources that can make our practices go from good to great is having a dedicated staff that believes in the practice and are with us for the long haul. Every practice owner knows that the people with whom they surround themselves play heavily into the practice’s success or failure.

Most of us are people persons and we can get someone in the door. We understand the need for a competitive salary structure and benefits. We are good at getting them on board, then spending time and money training and molding them into productive team members.

However, how many of us have a comprehensive retention program? Being good at getting folks in the door has nothing to do with keeping them as a longtime faithful employee. Why is this? I think many of us have a misconception about what factors matter for retention. Most of us built our businesses believing that salary, benefits, and incentives would keep our employees satisfied . . . when in reality the drivers go deeper into the human psyche to the actions and attitudes that make employees feel successful, secure, and appreciated.

As private practice owners, we must strive to engage all employees to feel as if they have ownership in the practice. We need to treat them as partners in our endeavor and ensure we meet their needs. I believe there are some core areas that we could all look at to make our employees feel like owners.

First and foremost, remember that communication is a two-way street. Listening and communicating your vision are equally important. Structure your communication to inform, emphasize, and reaffirm to employees that their workplace contributions have an impact. Properly done, communication with your staff will provide you with the insights you need not only to run your business better but also to know how your employees feel about working for your business. Employees need the chance to be heard and recognized.

Empower your employees to do their best. This requires having measurable objectives for each employee and providing steady feedback to them. Studies confirm that people have a deep desire to feel they are succeeding and that their talents and capabilities are being used in a way that makes a difference to the business. When people sense their actions are fulfilling this desire, they begin to develop a sense of belonging and a feeling that your company is their company.

Next is putting your company in a position of competitive advantage. Set yourself apart from the competition. People want to work for a winner. Be active in your community and engage your employees in those activities you support. Build loyalty by earning trust, respect, and commitment from your employees as they work along with you in volunteer efforts to better your community.

We as private practice owners should provide the place for young entrepreneurs to come and build a home that provides them with opportunity for success in the way that each of them defines it. I hope this issue of Impact helps you develop your staff as a competitive core of “business owners” that are providing top care in your community for years to come.

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Staff Recruitment and Retention

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By Allyson Pahmer

In a white paper released in January of this year, the Bureau of Labor Statistics (BLS) investigated the difference in labor market activity—job openings, new hires, and separations—among 20 different industries and found that health care was one of a handful of industries where job availability far exceeded the number of new hires. Not only was that true for the reported, actual data they studied, but BLS also projects 5 million new jobs in health care between 2012 and 2022 and forecasts the compound annual rate of change—that is, the calculation of job openings, hires, churn, and fill rates—at 2.6 percent, the highest of all industries, tied only with construction.1

It is probably not news to any of us that the aging of the U.S. population will result in an increased need for health care workers to care for these seniors, as well as the need to replace those health care workers who are “aging out” of the workplace themselves. Physical therapists will be called on to assist this population with rehabilitation and wellness services in numbers and volumes we have never seen, and today’s physical therapy students are likely looking at a healthy employment future. 

But the availability of health care employment opportunities tells only one side of the story. I have heard from many Private Practice Section (PPS) members how difficult it is to find qualified, dedicated workers for their clinics and businesses. Survey information collected at this year’s PPS Annual Conference only reinforces these anecdotes. When asked, “What problems or issues would you like PPS educational programs to address?”, write-in responses included “recruiting the right staff,” “managing across generations,” and “cultivating a service-oriented workforce.” Nearly half of the 114 submissions the Annual Conference Program Work Group looked at fell into the human resources and practice management categories (although I will admit that this collection of submissions skewed much more to practice management than to HR, about 5 to 1). 

For those of you seeking assistance in this area, you have come to the right issue of Impact. And if you are looking for help from past issues, the Human Resources Compendium of Impact articles is a resource you must have on your shelf. The Compendium offers a concise resource for topics ranging from recruiting and hiring to mentoring, from compensation to equity arrangements, from communication skills to leadership development, and much more. 

Do not overlook the other resources your Section has to offer year round. Programming at past Annual Conferences is archived on the PPS website, as are some of our past webinars like “Independent Contractors vs Employees: What You Need to Know,” “10 Secrets to an Effective Performance Review,” “Retaining Key Personnel through Deferred Compensation Strategies,” and “Riding the Waves Without Getting Wet: How to Introduce and Manage Change in Your Practice to Get Better Results.” 

As we look ahead to this year’s Annual Conference in Las Vegas, October 19-22, think about sending your office staff to participate in the Administrator’s Certificate program. This 3-day, 13-hour curriculum is designed for the non–physical therapists on your payroll and is a complete immersion into marketing and customer service, human resources, business operations, legal compliance, financial management, and billing and coding. 

Finally, the granddaddy of PPS guidance, “Private Practice: The How-To Manual,” delivers on its promise to be a concise guide for physical therapists who are considering opening a private practice—and, I would add, for those who already have their own practice and could use a little help with, say, writing a business plan or revenue cycle management. The section on “Managing Human Resources” is an invaluable resource in payroll, credentialing requirements for insurance, recruiting, hiring, onboarding, employment policies and procedures, insurance and other benefits, compensation, and retention.

We hope these and other PPS resources help you build the best, most committed, and loyal staff you can. If we are missing something, please do not hesitate to let us know. 

1. “Which industries need workers? Exploring differences in labor market activity,” Bureau of Labor Statistics, January 2016. www.bls.gov/opub/mlr/2016/article/which-industries-need-workers-exploring-differences-in-labor-market-activity.htm. Accessed March 2016.

Allyson Palmer
Executive Director, PPS

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Good to Great

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By Jim Collins | Reviewed by John Lowe, PT

What distinguishes an enormously successful company from the rest? Is it the result of having driven, larger-than-life leadership? Or is it just a matter of being in the right place at the right time?

Jim Collins and his group researched a number of business organizations in an attempt to identify common elements in businesses that have outperformed their peers. Many of the companies researched went from doing fairly well to the next level. Others were underperforming and turned the corner to producing outstanding results.

Collins and his group identified the following features found in the business organizations they researched:

  1. Realizing that being good can be a barrier to becoming great.
  2. Traits of leaders who have built great organizations.
  3. First who then what: Getting the right people on the bus (and the wrong people off).
  4. Confronting the brutal facts of their current reality.
  5. The Hedgehog Concept: understanding what their organization can excel at and what it cannot excel at.
  6. Creating a culture of discipline.
  7. Applying technology in a carefully selected manner.

This book was published in 2001, and it is interesting to look at the current state of some companies surveyed. Circuit City, for example, turned the corner in the early 1980s and over the next 15 years outperformed the general stock market more than 18 times. They pioneered the consumer electronics superstore; however, the company no longer exists as an independent entity. Wells Fargo, on the other hand, is still alive and thriving. Did Circuit City somehow lose direction, abandon its core principles, and fail to adapt to changes in the appliance and electronics retail industry?

The features that were found in successful organizations are easily understood and may be applied to any type of business. Good to Great is written for business people and therefore may be an excellent resource for physical therapists who own and manage businesses and are looking for ways to stand out from their competition and otherwise take their practice to the next level.

*This book was last reviewed for Impact in 2009. Lowe,-John

John Lowe, PT, MPT, is currently employed by WorkWell Prevention and Care and has been a member of the American Physical Therapy Association’s Occupational Health Special Interest Group board for 6 years. He can be reached at john.lowe@workwellpc.com.

Because They Cannot Say No

No!
By Tannus Quatre, PT, MBA

My dad always taught me not to take “no” for an answer. It has served me well both personally and in business.

While I am pretty sure the message Dad was trying to get across was to assert myself, there is a slight twist on this lesson that works well when selling your services: Do not let “no” be an answer.

When selling, many people are essentially asking the question, “Will you buy this from me?” A question that starts with the word “will” has two possible final destinations: “yes” or “no.”

That is not good enough. We do not want “no” as an answer. A good salesperson works hard to ensure the answers are all just different shades of “yes.”

Sounds great, but how does this all work? Here are a few tips that work to keep “no” out of the vocabulary for your customers.

Ditch the words “will” and “would.” When attempting to close a deal (schedule a patient, solicit a referral), never use the words “will” and “would.” Questions starting with these words can end in “no.” Starting your questions with words such as “when” and “how” provide options that do not facilitate “no” as an answer.

Do: “When is your next availability?”

Do Not: “Would you like to schedule your next appointment now?”

Use your watch, not theirs. Oftentimes, getting to “yes” takes several tries. As many will attest, a single lunch with a physician group does not by itself open the floodgates to new referrals. When a “yes” is not achieved, make sure that follow-up plans are directed by you, not them. If you did not get what you want, schedule a follow-up on your timeline and get agreement on your follow-up plan.

Do: “Thanks for your time today, I’ll plan to follow up with you in a couple weeks to check back in.”

Do Not: “Thanks, well just let me know if you want to follow up on this at a later time.”

Change the subject. If you do not see the answer you are looking for on the horizon, do not force the issue. Changing the subject will still give you the opportunity to leave a good impression and to work on getting to “yes” at a later time.

Do: “OK, enough about physical therapy for now . . . you said you had kids, where do they go to school?”

Do Not: “OK, it does not sound like you are ready for physical therapy right now. Let me know if you change your mind.”

Always leave an opening. Unless you have determined that you no longer want the business from your customer, never, ever, ever, let the conversation resolve with a final “no.” There is always the potential to earn the business at a later time, and leaving an opening to a future conversation can be key to landing good business down the road.

Do: “OK, it looks like you are all set for now but listen, I am going to stay in touch with you, and please make sure to reach out if your needs change before we talk again.

Do Not: “OK, well I am sorry I cannot serve you right now. I appreciate your time.”

“No” is a dirty word in sales, and it can unwittingly harm those who need our services. We have to be assertive. So, do not take “no” for an answer . . . better yet, do not let “no” be an answer.

tannus_quatre Tannus Quatre, PT, MBA, lives at the intersection of physical therapy and entrepreneurship, spending his time helping physical therapists build and operate successful practices through his company, Vantage Clinical Solutions. He specializes in marketing, finance, and business planning, and authors and speaks regularly for the APTA and PPS. He can be reached at tannus@vantageclinicalsolutions.com.

Goodwill Hunting

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Mergers and acquisitions compliance.

By Nancy J. Beckley, MS, MBA, CHC

The mergers and acquisitions frenzy: It is likely to hit your market, or about to hit your market. At the Private Practice Section (PPS) annual meeting 18 months ago, two major market acquisitions were announced, which lit up conversations in the exhibit hall for the duration of the conference. Practice owners are accustomed to looking at exit strategies or succession plans unique to their practice; however, now practice owners have to take notice of major therapy companies migrating around the country and immersing themselves into new, untapped markets as well as penetrating deeper into existing markets.

An exit strategy that a practice owner may be contemplating on a 10-year horizon may have to be moved up before the market is gobbled up. We are now facing market factors affecting the therapy landscape locally, regionally, and nationally—including accountable care organizations (ACOs), Medicare’s Comprehensive Care for Replacement of Joint that just rolled out in 67 markets, Medicare reimbursement penalties for Physician Quality Reporting System (PQRS) reporting deficiencies, and the Office of Inspector General (OIG) Work Plan’s continued inclusion of physical therapists in private practice. Not to mention physician offices with therapy, and hospitals gobbling up physician practices.

A recent presentation to physical therapists and practice owners by Paul Martin provided context to the heat being generated in the hot outpatient therapy market1:

  • Outpatient therapy is a $29.6 plus billion industry with strong growth prospects.
  • There is relatively stable reimbursement compared with other health care sectors.
  • The outpatient therapy market is fragmented, even with the presence of large companies owning over 500 plus clinics.
  • The population is aging.
  • Outpatient therapy business is “scalable” and not hard to grow once in a market area.
  • There are relatively few barriers to entry into the outpatient therapy market.
  • The de novo cost to build new clinics is minimal.
  • There are three to five regional therapy companies in each state.
  • Performance factors of the publicly traded therapy companies provide a positive outlook.
  • The “invasion” of private equity has fueled growth; it seems everyone wants in on the action generated by the prospects of positive returns with an investment in outpatient therapy.

And according to Martin, “The private equity groups studied all the above dynamics, and the battle for outpatient therapy market share began.”

What should a practice do? Whether your practice is simply formulating a succession plan or an exit strategy, or is on the market, open to the opportunity for a sale, or a reluctant seller, compliance should figure in your practice plan now and in the future. What? In the middle of this article on hot revenue prospects in the outpatient physical therapy market, we are discussing compliance? Yes, indeed we are! Maybe you were thinking that only if you are seeking to sell, or find yourself a reluctant seller due to market conditions, a compliance program is in order. For all practices an effective compliance program will potentially assist in mitigating problems—and that could be anything from having an excluded provider on your roster, inappropriate use of provider numbers, lack of proper supervision for physical therapist assistants, documentation errors, or the mother lode of coding and billing errors. You are probably wondering what this has to do then with selling a practice? Or mergers and acquisitions? Is it not the case that potential buyers are looking at my practice in terms of revenue and other metrics such as units per visit, visits per referrals, and associated costs and the like? Maybe you are working with a business broker or legal firm representing your practice to develop a business portfolio and practice profile to shop around to potential buyers. A potential buyer or investor in your practice will be interested in risk that may accrue over the future horizon related to the civil and criminal statutory lookback period for violations of the major health care laws including the False Claims Act, Anti-Kickback Statute, Civil Monetary Penalties laws, Exclusion Authorities, and the Stark law. In a stock purchase the buyer is buying your past acts, which can be discovered long after the closing, with the buyer on the hook for potential paybacks, fines, and penalties.

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While this is not intended as a primer on health care laws, suffice it to say that an understanding may prevent violations including improper use of the group therapy code payments to physicians for referrals that are presented as “medical directorships.”

All that notwithstanding, in today’s market there is value in compliance even if it is seemingly intangible. Compliance does not produce revenue, but it presents an opportunity for goodwill on your financials. As with all goodwill valuations, compliance goodwill may not be as clear a valuation as a revenue run based on patient referrals, but rather signals commitment to a program that is designed to detect, correct, and prevent compliance problems. The operative definition, of course, implies an effective compliance program.

So where to start building compliance goodwill? Implementing a scalable compliance program based on a compliance plan following the OIG Compliance Program for Individual and Small Group Physician Practices is the perfect place to start.2 A couple of takeaway recommendations to elevate your compliance program should include, but not be limited to3:

  1. Complete a practice risk assessment in which you actively seek to identify issues to be addressed by your compliance program.
  2. Develop and scale a compliance plan that identifies your company’s code of conduct, compliance program guide, and relevant policies and procedures.
  3. Have your employees, contractors, board members, and owners attest to their understanding of and obligations under your compliance program.
  4. Verify and document that all employees have not been excluded from participation in federal health care programs, and be sure to include Medicaid exclusion lists.
  5. Verify and document the licenses of all employees including all states in which they have practiced.
  6. Conduct new employee compliance training and education as well as training on the prevention of fraud and abuse for all employees, with documentation and evidence of successful completion and a passing quiz grade.
  7. Provide further training and education in documentation, coding, and billing for therapists and those responsible for claims submission.
  8. Review your Electronic Medical Record (EMR) to ensure compliance with Medicare requirements not only on “teeing” up due dates and the proper forms, but verifying compliance with reporting of time and billing of codes.
  9. Conduct a claims review test of your billing system to ensure that the codes on the claim were the codes that the rendering therapist identified for billing and are supported by documentation.
  10. Establish an auditing and monitoring program that expands beyond chart review to include other risk areas identified. Be sure to document findings and follow-up plan.

How are things in your market? Are you concerned or excited about mergers and acquisitions? Are you concerned and excited about compliance? Do you want to add value to your practice? It’s time to build goodwill.

References

1. Martin P, The war for independence. Clinicient Empower: Boston; September 2015.

2. Office of Inspector General (OIG). Fed Regist. 2000;65 (194). Notices.

3. We have not addressed HIPAA compliance in this article, which in no way suggests it is not a part of compliance.

Nancy-Beckley

Nancy J. Beckley, MS, MBA, CHC, is certified in health care compliance by the Compliance Certification Board and is a frequent speaker and author on outpatient therapy compliance topics. She advises practices on compliance plan development and audit response. Questions and comments can be directed to nancy@nancybeckley.com.

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