Negotiating? Shut Up and Listen

By Tannus Quatre, PT, MBA

If you own or manage your business, you negotiate a lot. It is not just traditional contracts or formal agreements that I am talking about. I am talking about just about everything that has a desired outcome.

Whether discussing price with a vendor, compensation with an employee, or lease terms with your landlord, you are negotiating—you must remember this fact.

If you do not first acknowledge that you are in the midst of negotiation—and the person across the table does—you are apt to lose out on something you did not even know you could have been playing for. Ouch.

I do want to be clear however, that negotiating does not have to be a “zero sum” game—in fact, it really should not be. For you to win, someone else does not actually have to lose. The best negotiations result in wins for all parties—the prized outcome of all good negotiators.

And while win-win wins are the ultimate prize, the foremost goal should be to ensure you do not shortchange yourself. Walking away from a deal that did not have enough in it for you may carry some level of disappointment, but this is far better than the regret (or worse yet—the ignorance) of not getting your fair shake.

To protect yourself, I try to keep one principle at the forefront while negotiating. I listen.

Listening does not mean you do not have something to say. There are important aspects of negotiating that require you to plant your flag—making your stance be known. Do this too early though—especially before you know what makes your counterpart tick—and you have begun operating with limited knowledge. And knowledge is power when negotiating.

Talking compensation with an employee? Ask them what they are looking for; this will give you the opportunity to help them with a path toward that end.

Discussing price with a vendor? Give them some base parameters about what you are looking for (or can afford), and then let them fill in the blanks for how they can accommodate your needs.

Trying to agree on where to spend date night with your spouse? Well…I will let you handle that one (if anyone knows the formula for successfully pointing this to the football stadium, let me know).

Where flexibility is present—and most times there is —there are many paths to a desirable outcome. If you know how to use it, arming yourself with every bit of information you can uncover is going to work in your favor. Listening is a key tool.

Remember that it is not a criminal act to allow yourself every advantage you can get. If there is one thing we need in the physical therapy profession, it is the ability to give ourselves an edge. I will shut up now and let you do the same.


Tannus Quatre, PT, MBA, is a physical therapist and entrepreneur dedicated to improving the profession through innovative business and marketing solutions. His work can be seen in such projects as PT Pub Night® and He is president of Vantage Clinical Solutions and can be reached at

Thinking Outside the Box

Corporate employee health is an opportunity for private practices.

Russell Certo, PT, OCS, and William McCormick, PT, MS, CSCS

At the 2014 Private Practice Section (PPS) meeting, it appeared that the general theme in many of the educational presentations was how primary orthopedic practices could expand their services to include medical fitness or general fitness exercise programs to their service offerings. There were many ideas as to how to best provide those services, including a small add-on fitness service with minimal disruption or, at the other extreme, provide employee wellness programs to corporate clients. Both the presenters and the participants discussed several strategies and business models. It was apparent that we are all trying to find ways in which we can expand our relevance/presence within the medical delivery system and grow our own businesses. One model or method to achieve this goal is developing a corporate employee health (CEH) program.

According to the Employee Benefit Research Institute 52 percent of employers are now self-insured companies.1 Because of certain provisions within the Affordable Care Act, it is estimated that over the next 5 years, 75 percent of all employees in the private sector will be covered by self-insured health insurance.2 Self-insured health insurance is simply an insurance product where the employer assumes the financial risk for providing health care benefits to its employees. In almost all cases, these companies contract the actual claims processing to a third-party administrator (such as Blue Cross). In an attempt to control the risk of health care claims, these employers have instituted “wellness” programs. However, many of these strategies do not measure outcomes and/or tie results to claims information. The most common form of wellness programming provided by the employer is an online health risk assessment (HRA) whereby the employee voluntarily answers a series of questions online and the software program provides an analysis and simple strategies for improving health risk markers. For example, if the employee smokes, the HRA suggest they stop smoking or if the employee has not had a yearly physical, the HRA suggests they visit their doctor for a physical. More sophisticated and robust “wellness” programs engage an outside contractor who analyzes claims history and the HRA information and provides the company with a snapshot of their employees’ overall health, creating general risk pools in which employees are placed. Additionally, the contractor is able to designate specific diagnoses or medical conditions of the employees that drive the health care claims cost higher.

In almost all instances, these self-insured employers are provided some data analysis by their third-party claims administrator or contractors but are never given appropriate or effective strategies for actually engaging employees in healthy lifestyles. We have identified this self-insured market as the greatest opportunity for growth for private practice physical therapy companies looking to provide medical exercise prescriptions. This opportunity exists for not only the single office practice but also for the multisite and large practices. We believe that physical therapy practices can become the “what’s next” solution for CEH programs. In the big picture, our practices can provide a meaningful fitness program that engages employees within individual companies, but we can also become partners with the third-party administrators that provide benefit coordination to many self-insured employers. In addition, these services provide us the opportunity to partner with the data analysis contractors who can then sell our interventions as part of their services to provide lifestyle management programs to the employee.

In the past 10 years, many of us have added fitness services to our primarily orthopedic practices by providing our discharged patients with a place to continue exercising. Many practices have used this service to expand into a cash-based business that supports the overall business model. Some of us have been able to develop diagnosis specific programs, partnering with primary care physician groups and growing our practices by as much as 30 percent because our referral base is larger and our footprint in our communities is bigger. Additionally, in our case, we have partnered with other private practices across the country to develop a network of like-minded practices that share our data, outcomes, successes, and even our failures. It is easy to find naysayers that say these add-on medical fitness programs have not been profitable for physical therapy businesses. Our experience has been that our fitness programs have been break-even propositions when looked at as a stand-alone entity. However, the medical fitness addition has increased our physical therapy income by 30-40 percent, providing a range of return on investment between 4:1 and 9:1 in some cases. Additionally, our partnerships with primary care physicians has made us more relevant in our local medical community, offering us new opportunities that we would not otherwise have had if we did not develop a fitness service.

In terms of the CEH program, we identified the larger self-insured employers and then subdivided that group into companies that had an onsite fitness center and those that did not provide onsite fitness. Marketing our experience in medical fitness and using our data, outcomes, and total-cost-of-care reductions collected over the past 10 years, we have been able to capture the attention of the decision makers at these companies. In general, we propose that these companies embed our employee in their fitness center, in some cases manage the fitness center for them, and begin to provide appropriate, effective, data driven exercise to their employees. We generally begin with a pilot program that identifies and engages the higher risk employees who are driving the health care claims higher. We have proven that our model of medical fitness will move employees from high-risk pools to moderate-risk pools and moderate-risk employees to low risk, potentially saving corporations hundreds of thousands of dollars annually. Our program not only includes exercise prescription but also provides educational seminars, nutritional information, and lifestyle management strategies that engage employees and retains 75 percent of the employees participating in the pilot program.

In terms of cost savings, there are obviously direct savings from a claims perspective but there will also be cost savings from the employer standpoint of reduced absenteeism, better productivity, and improved employee morale. For our physical therapy practice, we are able to create an income stream from the management of the onsite fitness center, individual payments for each employee enrolled, and over time, a shared savings model of payment. Also included in the income stream is the potential for additional physical therapy services at our clinic or onsite at the corporation.

For many of us, we have successfully tapped into the opportunities in our markets to provide outpatient orthopedic physical therapy services that are very traditional in nature. The old adage that “if you are not growing you are dying” is appropriate. We all recognize that if we do not adapt to changes in health care, we will become irrelevant and our business will struggle. As a group, we have realized that we can make a difference by providing appropriate exercise to medically compromised patients who cannot be served by the neighborhood fitness club and the local YMCA. We are the experts at delivering these medical fitness prescriptions and we are accepted members of the health care delivery system. Our growth in private practice for the single entity office and for the large multisite physical therapy business is in coordinating lifestyle management services that drive the cost of care down, flattening the cost curve, and sharing in those cost savings. These opportunities provide us another chance to serve our communities, work within the medical delivery system, and maintain our presence, relevance, and standing within that system.

Russell Certo, PT, OCS, of MOG at Grand Island Physical Therapy PC. He can be reached at

William McCormack MS, PT, CSCS, of MOG National. He can be reached at


1. Employee Benefit Research Institute. Accessed November 2015.

2. Employee Benefit Research Institute. Accessed November 2015.

PPS Mastermind Group Program Announced


If you have been to a national meeting, such as the Private Practice Section (PPS) Annual Conference, you have no doubt enjoyed the opportunity to exchange business ideas and stories with fellow members from around the country at the bar, over coffee, or in the exhibit hall between sessions. These conversations can be energizing, but then when you return to work after the conference, frustration ensues because you have difficulty setting into motion what you learned, heard, and/or discussed. You lack the support, accountability, and details, so you return to business as usual. You know there is a better way, but you just cannot figure it out on your own.

Recognizing this frustration and need the PPS board of directors, by a unanimous vote, approved the formation of the ground-breaking Mastermind Group program. In its quest to provide value and innovation to members so that they can stay ahead of the rapid changes in health care, the PPS board is continually proactive in identifying new ways to deliver value to members.

The Mastermind Group helps its members learn, improve, and achieve success. In the PPS version of the Mastermind Group, a professional facilitator will form groups of six to ten executives based on size and type of practice (among other factors). The groups will meet twice a year for structured face-to-face meetings. Content experts may be secured using PPS resources to provide education and stimulate discussion.

Participants challenge each other to question assumptions, assess strengths and weaknesses, set goals and, above all, accomplish those goals. Members support each other and hold each other accountable to those goals. The group requires trust, commitment, and confidentiality. Therefore, members are assigned to groups that do not include potential or current competitors.

Participation is interactive. Members give and receive advice and ideas. The groups learn and grow together, leveraging the unique strengths of each other as a willingness to ask probing questions and openly share experiences builds the foundation for mutual success.

The first meeting of the mastermind groups will take place in Alexandria, Virginia April 27 to 29, 2016. Groups are being formed now. Please visit the Private Practice Section (PPS) website or call the PPS office for more information and to complete an application. Once your application is received you will be contacted for a personal interview by the program facilitator. The purpose of that call will be to learn more about you and your goals so that you may be placed in the optimal group.

Finally, we are pleased to announce that Randy Roesch has been brought on as the program facilitator. Roesch has a long track record of vision, dedication, and leadership in PPS. She has had a successful career as a business owner. She brings a wealth of credibility and acumen to the position.  

In the summer of 2015, PPS ran a pilot program to refine the Mastermind Group concept. Here are comments from those who participated:

Owning a private practice takes daily diligence, an enormous effort to numerous details, and a ton of personal confidence. Delivering exceptional clinical and operational excellence requires humility toward your peers and vulnerability to the extent that someone else may know a better idea or process. The peer advisory process forces owners beyond their daily norm.”
– Darrin Schober, Owner, Optimum Therapies, Eau Claire, Wisconsin

Having a vehicle to bring together fellow practice owners in a collaborative environment as we did in Washington, D.C., at American Physical Therapy Association (APTA) headquarters was priceless. We each had an opportunity to share our strengths with a group of well-respected peers. I returned from our meeting looking at marketing and operations from a different perspective, and I can say that it had a major impact on my practice and my thought process. It was invigorating, relationship building, and sparked innovative thought. That alone truly created a valuable experience that continues to build on itself. Who would not benefit from the equivalent of a board of advisors to bounce ideas off of?”
– Dan Rootenberg, SPEAR Physical Therapy, New York, New York

The intimacy of the small group setting offered by PPS Masterminds promotes a trusting environment that cannot be achieved with traditional networking. And it is the trust that allows private practice owners, both new and experienced, large and small, to sit down side by side and effectively work on the issues affecting our industry. Within six months of leaving the initial Masterminds meeting, I have implemented five major practice changes that have influenced my clinic’s growth. I cannot imagine not participating in an opportunity like the Masterminds group. It is an unparalleled form of mentorship that is not available elsewhere in physical therapy.”
– Kristen Wilson, Action Potential PT, Glen Mills, Pennsylvania

The peer advisory pilot was an invaluable opportunity to learn from peers in a safe, honest, and dynamic environment. I was challenged to think about many aspects of my practice: management, marketing, professional development, and my own leadership style. I left excited and refreshed with new ideas and a broader understanding of the opportunities that existed to further develop my practice. Finally, I developed trustworthy, genuine relationships with like-minded people that I know will continue to develop and enrich my professional career.”
– Michelle Collie, Performance PT, Providence, RI

It Is Not Because They Want Physical Therapy

By Tannus Quatre, PT, MBA

What do you sell? Do you sell physical therapy? How about exercise? Education? Yeah, kind of. However, it is not why our customers buy.

Digging deeper, our clients are buying “the ability to do something.” The ability to live life. The ability to lift the grandkids. The ability to run a marathon.

And there is a distinct difference between selling “physical therapy” and selling a marathon. Marathons mean something to those who run them. It is a life accomplishment. It is an identity. Physical therapy means something to physical therapists. It is our identity.

Our clients do not buy physical therapy because they want physical therapy. They buy it because they want to do their thing—whatever that thing is. Knowing this should shape our approach to our communities, and our approach to our services. Both approaches should have plenty of focus, which is not on physical therapy.

Ready for some tips?

  • Take a look at your marketing materials. Do they focus primarily on your credentials, training, and services, or do they focus on what you have done to get your clients back to doing what they love? Do you use generic marketing language to sell your services or do you let client testimonials do most of your selling for you?
  • Take a seat in your waiting room. As you look around, do you see evidence of the work you do in the lives of your community? On your walls, do you see newspaper articles about those you have helped in your community? Do you see jerseys signed by the local sports teams you have served?
  • Browse your website. Is it focused on your staff, services, and location, or does it highlight the lives of those you serve in your community? If you removed all the content (leaving only the images behind), would you appeal to your target clientele, or would you look like every medical clinic and hospital in your area?
  • Read the last 10 social media posts from your clinic. Is it a one-way conversation sharing evidence that supports physical therapy, or is it an engaging back and forth between your brand and the members of your community? Are you sharing stories about the active lives in your community who represent your value, or are you sharing information about yourself?

I hate to break it to you (and me), but we became physical therapists because we love physical therapy. Those we serve love themselves, their families, and their lives. Physical therapy is a means to an end, and the sooner we focus our message on what physical therapy does (and not what it is), the sooner our communities will choose us first.


Tannus Quatre, PT, MBA, is a physical therapist and entrepreneur dedicated to improving the profession through innovative business and marketing solutions. His work can be seen in such projects as PT Pub Night® and He is president of Vantage Clinical Solutions and can be reached at

What Do We Really Get Paid?


Benchmarking Price for Outpatient Physical Therapy Services

By Kelly Sanders, PT, DPT, OCS, ATC

The American Physical Therapy Association (APTA) Private Practice Section (PPS) Payment Policy Committee started what has become known as the Milliman Project to answer a few key questions for PPS members.

These questions include:

  • What are physical therapy services really reimbursed at?
  • What are the geographic differences?
  • What is the difference in price—comparing other alternatives for musculoskeletal pain?
  • What is the difference in price—comparing the other services in the continuum of care?

In an effort to answer these questions, the PPS Payment Policy Committee engaged the Milliman Management Consulting Company, an international actuarial and consulting firm, to analyze commercial health insurance and Medicare claims data (excluding workers compensation and Medicaid). Data for physical therapy services, evaluation and management (E&M) codes, chiropractic, radiology, and orthopedic services for price comparisons—and as a point of reference—for bundled payment arrangements for all practices that bill on a Centers for Medicare & Medicaid Services (CMS) 1500 form. Specifically, this data was pulled from 2012 claims and was stratified by geographic region. The data is blinded to payer identity and provides average allowed amounts. Allowed amounts include the total of payer and patient financial responsibility. Also included is per-member, per-month (PMPM) data that is a key metric for payers as it provides a measure of their costs.

In an effort to look not only at physical therapy pricing, but also pricing for alternative interventions to physical therapy, codes evaluated by the Milliman Company included the following code ranges:

  • 97001-97762 – Outpatient Therapy Codes
  • 27125-27138 – Total Hip Replacement
  • 99211-99215 – Evaluation and Management Codes
  • 27440-27447 – Total Knee Replacement
  • 98940-98942 – Manipulation
  • 72148-72149 – Lumbar Magnetic Resonance Imaging (MRI)

In review of alternative treatment interventions, the data suggested that physical therapy was the lower cost option. Specifically, data on chiropractic care suggested not only that physical therapy was more cost effective but also demonstrated better outcomes with less visits and less return patients. Lumbar MRI data supported that using physical therapy as the first treatment intervention for musculo-skeletal injuries could decrease payer costs.

Overall, in review of the data, the Payment Policy Committee came to the following conclusions. First, there was a fair amount of variability on cost to payers by Current Procedural Terminology (CPT) code. Additionally, there was significant variability in the amounts paid to providers based on the geography where services were rendered. Commercial payer average allowable amounts were between the 50th and 75th percentiles and overall were 33 to 50 percent higher than Medicare’s allowable amounts. The allowed amounts in the Milliman data are higher than allowed amounts that private practice physical therapists are receiving. The conclusion we have come to is that hospital and physician practices are receiving higher payments than private practice physical therapists that are skewing those allowed amounts in the data.

A separate observation was that many providers’ billed amounts were close to the Medicare Fee Schedule, thus many were not getting paid the allowed amount by some commercial insurances and thus losing dollars. Based on this observation, the recommendation is that practices evaluate their billed amounts verses the allowed amounts on Explanation of Benefits (EOBs) and consider raising their billed amounts.

What are the take-away points? First, this data in combination with some key data on your practice should assist you in guiding contract negotiation or renegotiation. If you do not already know, review your practice costs to determine what level of payment is needed to sustain your practice and desired profit margins. Once determined, use the Milliman data to review your existing payer contracts as well as to guide you in new contract negotiation. Ask yourself, are the fee schedules in your contracts above your costs by an appropriate margin and how do they relate to the Milliman data for your region and coding? Once reviewed, prioritize which contracts and fee schedules you should consider renegotiating and what payment level you need to be successful. Assess which CPT codes your practice is billing, and consider if carving specific codes out of a contract is a reasonable proposal to your contracted payers. Finally, work to understand the payer’s perspective. What are their costs? Use PMPM data for the CPT codes you are discussing to help determine the payer side.

For detailed information on this topic, the Payment Policy Committee has posted both webinars on the Milliman project. These webinars can be found on the APTA PPS website under the Education tab. Follow the links to “Recorded Webinars” and look for the free webinars titled “What Do We Really Get Paid? Benchmarking Price for Outpatient Physical Therapy Services (April 2015)” and “What Does Everyone Else Get Paid? Benchmarking Price for Outpatient Physical Therapy Alternatives, Part 2 (September 2015).” Additional resources on Payment are also available on the APTA PPS website under the Payment tab in the column on the left side of the screen.

Kelly Sanders, PT, DPT, OCS, ATC, is the president of Movement for Life, Inc., a group of physical therapy clinics operating in California, Arizona, and North Carolina. She is also a member of the American Physical Therapy Association Private Practice Section Payment Policy Committee. She can be reached at

Copyright © 2017, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.