Progress Toward Reimbursement for Telehealth

By Alpha Lillstrom
May 5, 2016

These days more providers, patients, and payers are evaluating the utility and benefits of using technology to support or provide health care services remotely. The use of telehealth is a significant and rapidly growing component of health care in the United States. Also known as telemedicine, the term encompasses everything from electronic visits, video technology, and remote monitoring to provide maintenance and preventive care for patients, to diagnosis and treatment when it is clinically appropriate. In some cases telehealth is used to provide access to care over distances that would otherwise present insurmountable obstacles to care. In other situations the technology improves convenience for both the provider and the patient. Over half of U.S. hospitals now use some form of telemedicine.1 In fiscal year 2013, more than 600,000 veterans accessed Veterans Affairs (VA) care using a telemedicine program—for a total of more than 1.7 million episodes of care.2 Even when effective mitigation of challenges is taken into account, reimbursement continues to present the most formidable obstacle.3 While your specific practice might not yet be delving into providing care using telemedicine, some are. Policy is evolving to make it more feasible and reimbursable.

Show Me the Money


How to recruit and retain quality employees.

By Kim Stamp

James Collins, in his bestselling book Good to Great, said, “Great vision without great people is irrelevant.” I would take that a step further and add, “Without great vision, it is difficult to recruit and retain great people.” Creating an effective recruitment and retention plan is vital to the success of our private practice clinics.

Hiring in today’s physical therapy market is significantly more difficult than it was even five years ago. A September 2015 Forbes magazine article included physical therapy as one of the top 10 toughest jobs to fill in 2016. This makes hiring good therapists a challenge and retaining our current quality staff members a top priority. Let us look at how we can create an effective recruiting strategy and an innovative retention program for our current staff members.

Over the years, I have participated in numerous interviews, and without fail I find that one of the main things physical therapists are looking for is a place where they feel uniquely valued as an employee. My experience has led me to believe that seasoned therapists are looking for a company that will allow them to treat patients according to their passion and expertise, and that new grads are looking for a company that will take an active role in mentoring them.

We are living in an age where large national institutions are buying up smaller private practices and transforming them into clinics that pigeonhole physical therapists into their corporate system. This gives private practice clinics an opportunity to build a staff of exceptional practitioners who care for patients on a more individualized level. This diverse treatment approach is enticing to physical therapists looking for a quality company to work with. At the same time, hiring a new grad and mentoring them into a quality therapist can be a wonderful way to build your staff. Recently graduated physical therapists are usually more open to learning a particular style of treatment than those who have been practicing for several years. So, if your clinic specializes in a particular treatment approach, consider targeting new physical therapists that you can shape into the type of practitioner who will mesh well with your clinic’s style.

Creating effective strategies for attracting, recruiting, and retaining quality candidates is both multifaceted and immensely important. In today’s market, we must find a way to make our clinics stand out. In order to do this we must first be clear on our overall company vision. As mentioned at the beginning of this article, it takes both great people and great vision to be successful. Narrow down what your company values and then create a vision statement that concisely expresses what you believe and what you are looking for. It may be helpful to ask yourself why someone would want to work for your company. If you cannot immediately and clearly answer this question, you have some work to do.

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Now more than ever, we have to sell our company to prospective employees. Knowing what your company values, and being able to concisely communicate those values, is paramount. Once you have become clear about your vision, make sure to insert that into your job announcement. More than anything else, you want your job ad to capture a therapist’s attention. Take your time when crafting your announcement and do not hesitate to look at what others are writing so that you can stand out in the crowd.

Another recruiting strategy to consider is accepting student interns in your practice. There are many positive aspects to being a clinical instructor, and one of those is having the opportunity to evaluate whether the student is a good fit for your company. In addition, the student has the opportunity to see what it would be like to work with you and the rest of the team. It is difficult to evaluate whether someone is a good fit just by doing an interview or two. Having a student intern for a few months will give you a clearer picture of how that person will function if they were to be hired. Reaching out to area physical therapy schools and offering to take interns is a good tool to use when trying to build your team.

Retaining quality staff is just as important as hiring the right people, and investing in our current staff is money well spent. Consider offering a monthly or quarterly incentive bonus based on patient feedback, revenue, productivity, or any combination of these or other factors. Another tactic is to increase the amount of time and money you designate for therapist’s continuing education each year. Or consider paying for the therapist’s license and/or professional dues over and above their continuing education. Last, take time to consistently recognize your staff in tangible ways. Whether it is with a monthly employee appreciation award or handwritten thank you notes to your staff, make it a priority to encourage, support, and reward your team. Therapists want to feel valued by their employers, not just for the revenue they generate but for the hard work of giving quality care to their patients.

Staying competitive in today’s challenging job market is difficult. As private practice owners and administrators, it is imperative that we become both strategic and innovative in our recruitment and retention practices. By following these suggestions, you can attract, and keep, quality employees for years to come.


Kim Stamp is the regional business manager for South Sound Physical & Hand Therapy in Olympia and Tacoma, and the vice president for the Washington State Physical Therapy Managers Association. She can be reached at

Staff Recruitment and Retention

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. Accessed March 2016.

Allyson Palmer
Executive Director, PPS


Good to Great

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

Because They Cannot Say 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

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