Negotiating? Shut Up and Listen

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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.

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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 BuildPT.com. He is president of Vantage Clinical Solutions and can be reached at tannus@vantageclinicalsolutions.com.

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 1themog@gmail.com.

William McCormack MS, PT, CSCS, of MOG National. He can be reached at bill@mainemog.com.

References

1. Employee Benefit Research Institute. www.ebri.org/pdf/briefspdf/EBRI_IB_413_Apr15_RCS-2015.pdf. Accessed November 2015.

2. Employee Benefit Research Institute. www.ebri.org/pdf/briefspdf/EBRI_IB_413_Apr15_RCS-2015.pdf. Accessed November 2015.

PPS Mastermind Group Program Announced

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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

Change Is Still the New Norm

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By Terry C. Brown, PT, DPT

As we look out at the landscape of private practice physical therapy, there is so much to take in. I have written before how change is the new norm, and I stick with that premise.

What I contemplate today is whether change is the demise of the small independent private practice as we have known it in the past. Are the days of the young entrepreneur five years out of school, taking a big loan, and hanging out their own shingle gone? Are only large-scale multiclinic operations able to prosper in today’s environment? Are hospitals, positioned to control the postacute health care dollars, going to squeeze the small independent provider out of the market? Is the playing field created by referral for profit so uneven that a locally owned private practice cannot compete? Interesting questions and some would have us believe that in fact the answer to these questions is “yes.” However, I believe the answer is a resounding “no.”

After spending a week in Orlando at the Private Practice Section annual conference, I can assure you the small independent private practice is alive and well. The entire air of the conference was positive with excitement about the future of private practice. I met and talked with many excited young entrepreneurs who are in their first 5 years of practice and who are innovative and doing well. They shared with me their successes and failures and what makes them unique in their marketplace. Each of them shared that the competition of hospitals, Physician-Owned Physical Therapy Practices (POPTS), and corporate-owned clinics is real but has simply pushed them to be more innovative and provide better service. They relate that the consistency of their therapists and their focus on patient relationships gives them the edge in being the public’s choice for outpatient physical therapy. What is more is that they came to this conference because this is where they find the ideas, tools, and relationships to be successful in their practices.

My friends, I heard of no doom and gloom while in Orlando. What I did hear about is an industry that is adapting to the marketplace and finding ways to be successful. I heard no anger over what others were doing, but rather I heard business owners looking for ways to make their private practice the consumer’s first choice. Yes, small independent private practice is alive and well. There has been and always will be a place in the market for these providers. Change is the new norm. The Private Practice Section is the home to provide you with the tools you need to change with the times and remain a vibrant choice in the health care market.

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A Fresh Start

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By Allyson Pahmer

Happy New Year! It is January, the month when thoughts turn to resolutions, setting goals, and fresh starts. I love the idea of a clean slate every 12 months; it always feels like a get out of jail free pass, a way to hit the reset button and try to improve what has not been working, or take a new approach to something that has not gone the way you had planned or hoped.

It is fitting, then, that the theme of this issue is “Best Practice.” I hope the articles that follow provide you with some ideas on how to improve your own performance and set business goals for the coming year—even if you are simply measuring against last year’s performance. I remember a familiar refrain from graduate school: “That which gets measured gets done.” What will you measure this year to track your performance improvement? Have you already identified the key performance indicators (KPIs) for your practice?

The Private Practice Section (PPS) board, volunteers, and staff have been working hard to give you some new tools and build new value for your membership that may help you along that quest. First, we are so excited to unveil the new PPS Mastermind Group program. You can read more about how the program works on page 17, but essentially a mastermind group is “networking on steroids.” It is a small group of PPS members, matched by business type and size, who get together at least twice per year to address common issues—whether it be marketing or management or collections or payment. This past summer, a group of your peers (fellow PPS Members) pilot-tested the program, and they unanimously endorsed it as something they found valuable.

The second project being launched is the “Fit Factor” website, a tool developed by the PPS Marketing and Public Relations Committee that you will be hearing more about in the coming months. The goals of the website are to equip physical therapists (PTs) with something they can use to educate consumers and increase awareness of what private practice physical therapists do. Access to this online marketing tool will increase the value of your PPS membership by driving potential patients to the “’Find a PT” site, as well as offer access to a library of videos for private practice physical therapists—another great member benefit. The beta site was unveiled at November’s PPS Annual Conference to a group of about 75 attendees and it was enthusiastically received and drew terrific feedback about how to enhance the site’s usefulness. We cannot wait to unleash it to the PPS community!

As the new PPS executive director, I, too, am identifying the KPIs for PPS and setting my own goals for ways to improve the Section’s service to and value for our customers: you, our members. New management at the top is the ultimate clean slate, so if you have ideas for new member benefits or would like to see a change in how we serve our members, I am all ears. Please write or call and help me create a Section that you are proud to call your home.

With best wishes for a prosperous and healthy new year,

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