Young Influencers


Millennials are 75 million strong in the workforce and the economy—how to capture the attention of this generation.

By Ingrid Sparrow, PT, CMPT

With this January’s inauguration of a new president, it is unclear what changes will occur in the national health care insurance system. But what is clear, and is hopefully included in your annual planning, is the significant impact of the Millennial generation in the workforce and as health care consumers.

Millennials are the 75 million Americans born between 1982 and 2003, now outnumbering baby boomers. Since 2015 the number of Millennials in the workforce is greater than that of the GenXers, by 2020 Millennials will make up 50 percent of the workforce, and by 2030 this will increase to 75 percent. In 2017 it is estimated they will be spending about $200 billion a year on health care and consumer goods.1

This Millennial generation is much written and talked about, with many generalizations related to age, maturity, life experiences, and personalities. What is agreed is that Millennials have grown up in a technologically driven environment with information and the world at their fingertips. Their method of learning new things, how they interact with friends and employers, and their expectations of work and of health care services are very different from those of their parents and grandparents. These are factors that influence how physical therapy clinics will market and deliver care to Millennials, and which encourage employers to evaluate the workplace environment and the role of work to these employees. To assist in this, we will look at the following categories.

Values and Motivations
Millennials place a high value on the use and availability of technology. They are often looking to the intangibles of flexibility, autonomy, cool workplace, and the desire to learn through experience. They may actually have a higher expectation of employers for work satisfaction as they are looking for work/life balance. They like to see the big picture and place a high value on making a positive impact and giving back to the community. And contrary to current popular perception, Millennials are often workaholics in that they value their work contribution and are not confident it can be done by fellow employees. A perception of fairness and transparency in the workplace, regular feedback, career development, and collaboration are important to them.2 3

Millennials and Health Care
Current trends show that Millennials are more concerned about ease and convenience of care than they are with establishing a relationship with their providers. This may reflect in part that this generation is still fairly young and healthy, and it may change as their need for health care increases. What is unlikely to change is their interest in getting an upfront estimate of the cost of care and their preference for receiving and paying bills electronically. They are much more receptive to telehealth than previous generations. Millennials check their phones an average of 40-plus times a day and thus are most accessible by text or email rather than snail mail or voicemail.4 They are much more inclined than older generations to use and trust social media when choosing care, and while they trust doctors they often do not seek care due to barriers of cost, long wait times, and difficulty scheduling appointments. They like exploring online customer reviews before deciding if they would like to be your customer. And they have grown up viewing health holistically. In conclusion, they approach their health care choices as they do their retail choices.

What Does This Mean for the Physical Therapy Clinic?
These factors pose a new challenge for physical therapy clinics: How to market a relationship-driven process more like a retail product? While the use and value of social media platforms is being debated, it is agreed that your website is your “go to” for current and prospective patients. It has been shown that Millennials do not as readily respond to direct marketing but rather prefer to do research on their own. They go to a website looking for information on your business and the care they will receive, prefer intake forms that can be completed online, and value ease in making an appointment online (which may work better for a one-time consult than for ongoing care). As videos that showcase your business and tell your story in an entertaining fashion are valued by this generation, you may want to include them on your website. And it is good business practice to routinely assess the ease with which your website can be found using a variety of browsers and on portable devices, and as needed to work with a professional on search engine optimization.


1. Accessed January 2017.

2. Accessed January 2017.

3. Accessed January 2017.


Ingrid Sparrow, PT, CMPT, is the owner of Sound Physical Therapy in Seattle, Washington. She can be reached at

Increasing Market Share

Looking to other countries’ models of health care can hold the key.

By Sturdy McKee PT, MPT, CEO

We have established previously that physical therapists have a total market penetration of around 5 percent.1 To review, using low back pain as an example, we know that about 50 percent of people with low back pain go to see their primary care providers. Of those 50 percent, between 7 percent and 11 percent, depending on location, end up accessing a physical therapist.2

So, how do we increase that number? How do we increase our market penetration?

We are lucky to have marketing experts assisting physical therapists with getting the word out about what we do and how we can help people. They are helping physical therapists with social media marketing, workshops, brand building, and content marketing. All of these methods can help. In this environment, how do we further this effort in order to accelerate market penetration and new patient referrals?

Sometimes what’s old is what’s new. And in that vein, the United Kingdom’s National Health Service is piloting a “scheme,” as they call it, to place physiotherapists directly into general practice as part of the primary care team. It will begin in North Wales.3 It has been found that placing physical therapists into primary care practices saves time for the general practitioners and reduces referrals to “hospital-based services,” further diagnostics, imaging, etc., by 16 percent, saving the system money.

Were we to consistently implement this system here, we could increase the number of appropriate patients getting to physical therapists. We know the need exists. But sometimes we wait for governments and companies to implement programs that we could be implementing on our own. And that is where “innovation” comes in.

What is to stop us from arranging these types of initiatives directly with primary care physicians and providers? Do you know any family practice physicians or general practitioners who are looking to improve how they care for their patients?

Statistically, 10 percent to 28 percent of patient visits to their primary care doctor are for a musculoskeletal reason.4 A primary care physician will see 100–125 patient visits in a week.5 That means between 10 to 35 of those patient visits are for a musculoskeletal issue. Of those, how many do you think would benefit from seeing a physical therapist? This is a judgment call and will vary by practice, but a conservative estimate would be around 50 percent. Following that logic, that leaves 5–17 patients a week, in each and every primary care provider’s practice, who would benefit from the services of a physical therapist. Do you have any primary care referral sources who are sending 20–60 patients a month to see a physical therapist?

So, given this, are there opportunities for us to work more closely with existing primary care physicians? And what about urgent care centers?

What if you were successful in having a physical therapist from your practice spend a half-day each week in a primary care physician’s office or at a group practice? The physician’s staff could triage the incoming phone calls and schedule most of the musculoskeletal patients at a time when the physical therapist was available. This process might not capture all patients who would benefit, but it would be an opportunity to get more people to the right provider earlier, as well as educate the primary care providers around what kinds of patients are appropriate to send to a physical therapist.

Imagine if in your community you could move from 5 percent market penetration to 10 percent. That would be a doubling of the new patients that you could help and see. Provided we continue to deliver outstanding quality and results for this expanded population, this would help to further spread the word and thereby increase our market penetration even further.

We have the research to substantiate that we save money and quicken time to recovery when people get to a physical therapist earlier in the injury cycle. We have to start finding improved ways to increase the number of people who get to us. This results in better patient outcomes, cost savings for the system, and significant business growth for your practice.

Call to Action
Ideas are great. Articles are great. My challenge to you is to do something with this one idea. Can you, today, call three primary care physicians with whom you already have a relationship? Can you begin the conversation of how you might better help their patients with musculoskeletal issues? And when you do, please reach out and let me know! I’d love to hear your success stories!


1. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs, 2012. Spine 2012; 25:2114-21.

2. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs, 2012. Spine 2012; 25:2114-21.





Sturdy McKee is a physical therapist, business coach, and advisor who can be reached at or @Sturdy.

Innovative Business Concepts Entrepreneurialism


How to redefine your business model for success in today’s market.

By Lisa Chase, PT, OMPT

In this ever-changing health care climate of higher deductibles, global payments, Health Insurance Portability and Accountability Act (HIPAA) regulations, and adjusted covered services, physical therapists are being pushed to redefine their business model to achieve success as private practice owners. The days of relying on third-party payments and doctors’ referrals are long gone and are now being replaced with a diversified portfolio of cash-based models, wellness services, product sales, and savvy social media strategies to drive business.

Diversify Your Portfolio
Physical therapists are caring, empathic individuals who share the common goal to serve our clients, help them heal from an injury or illness, and regain optimal function of daily living. Much of our training is focused on our craft, with little emphasis on strategic planning, business management, marketing, and branding. As we set out to create our dream of owning a private practice in today’s climate, we need to consider diversifying our portfolio in order to achieve ongoing success.

When clients come to see a physical therapist for an injury, they are initially looking for assistance on how to heal, but if you ask the right questions, you will also find that they want to prevent further injuries and understand ways to maintain their gains. Who better than a physical therapist to help design and coordinate such programs? But I am not talking about just offering a gym membership or a place to continue their exercise program. I challenge you to consider a new business model in which an integrated care approach becomes mainstream, and physical therapists become the health care providers of choice to help navigate the waters of health and well-being.

Addressing the true cause of injury and having a holistic team approach can be a key component to a patient’s recovery and the value they find in your services. Mark Bookhout, PT, MS, FAAOMPT, has an integrative health care wheel that helps identify all areas contributing to a person’s health and well-being. From there a treatment plan can be developed that includes rehabilitation and overall total body wellness to optimize their recovery and ongoing well-being.

As the client comes to the end of their rehabilitation, they can move into a program that focuses on lifelong performance with access to many different services such as health coaching, massage, Pilates, personal training, wellness and cooking classes, yoga/meditation, recovery technology, and posture restoration. This can provide clients with a collaborative approach that addresses the multitude of issues that often impact each individual’s health and well-being. As a private practice owner you can get creative with ways to offer these services by either networking with like-minded small businesses to help each other promote complementary services or by integrating skilled independent contractors into your business model. Sharing overhead, front office support, and marketing dollars while coming together to help clients achieve their goals is a win/win for all parties.


To complement integrative services, offering cutting-edge technologies, holistic treatments, and unique products helps keep your practice at the forefront of this ever-changing health care industry. There are a ton of programs, services, companies out there to help diversify your portfolio, speed recovery, and set you apart from the pack. Additionally, offering a versatile retail product line can help add convenience and complement the healing process for your current client base as well as the community, leading to new referrals.

Refine Your Message and Change Your Mindset
The days of targeting physicians for referrals are long gone as many of the doctors’ offices offer their own physical therapy in-house or are too busy being inundated by regulations and third-party payer requirements for reimbursement. Instead, find your niche, brand yourself as the expert in your community, and target your clients directly. As an entrepreneur in today’s climate, if you are not maximizing your use of internet strategies, you are missing a valuable opportunity to connect with current and future clients. Think internet strategies aren’t important or you don’t have time for social media interaction? Think again and consider a few of these statistics:

  • Mobile devices drive over 50 percent of all e-commerce traffic.
  • Over 50 percent of the world’s population is under 30 years old.
  • More people own a mobile device than a toothbrush.
  • Grandparents are the fastest growing demographic on Twitter.
  • Ninety percent of buyers trust peer recommendation.1, 2, 3

The American Physical Therapy Association (APTA) Vision 2030 states, “In clinical practice, collaboration with developers, engineers, and social entrepreneurs will capitalize on the technological savvy of the customer and extend the reach of the physical therapist beyond traditional patient/client-therapist settings.”

To stay connected with your clients, you need an innovative marketing system that does not revolve around you as the practice owner and is easy to duplicate. The easiest way to do this is to create an interactive website, write blogs, create videos, and use social media as a platform to showcase your practice and your expertise.

Technology Is Just a Click Away
Electronic medical records (EMRs) have come a long way from just storing medical records and managing your insurance billing. Today, clients are much more internet savvy and expect easy access to medical records, online medical history questionnaires, invoicing, and even scheduling through their mobile devices. Using technology to streamline business operations can not only serve your clients but also help your bottom line. For example, you may create a customized app that offers clients quick access to schedules, online booking, workshops, classes, and discounts and connects them to our social media outlets. An EMR allows clients to complete all their paperwork prior to arriving for their first visit and automatically stores it so the record is ready for the physical therapist during their initial evaluation. This helps streamline the check-in process and increases front office efficiency so that scanning and filing are eliminated. At check-out, clients have the option to schedule online at their convenience, giving them more flexibility and customization with their experience.

Another way to stay connected with your clients is through online home exercise software. There are many products out there that may serve your needs.

Business as Usual No More
Great physical therapists do much more than just treat patients. Times are changing, and if we don’t want to be left behind we need to take a proactive approach with our practices and implement new ways to connect with our clients and the community. There are so many amazing physical therapists changing the world and changing the way we run our practices. Find them, learn from them, and then give back to your fellow colleagues by mentoring, teaching, and sharing your experiences to help grow our profession. In the end, think BIG, be different, and deliver a product that your clients are looking for.


1. Accessed November 2016.

2. Accessed November 2016.

3. Accessed November 2016.

Lisa Chase, PT, OMPT, Astym Cert., is a PPS member and owner of Back 2 Normal Physical Therapy, Inc., where she provides expertise in integrative physical therapy with particular interest in comprehensive and holistic manual physical therapy treatments and prevention of spine, sports, and orthopedic injuries. She can be reached at or visit her website at

Defining Values


Are we ready and how do we account for the variety of our patient population?

By Eric Cardin, PT, MS

The aroma overtakes you as you enter: fresh baked cookies—homemade, placed on a white plate, and draped with a white dish towel. Once a month, sometimes it seems like once a week, patients bring cookies, hugs, and big smiles. Clearly we have done something right. However, are there G-codes for “the patient brought us cookies”?

Is value in physical therapy simply the cost of a service? When a patient defines value, how does it differ from how the clinician defines the same thing? Patients experience physical therapy for an extended period of time, which is a great opportunity for them to define their own personal experience and make a judgment on the outcome of their care. Clinicians tend to be disconnected from the measurement of value, oftentimes finishing the case with a quantification of change in impairments and increasingly through the use of standardized questionnaires and tests. Outcomes are measured against a known baseline or some reproducible benchmark. We discuss and place a high importance on patient customer service, but when we accept that “value” is defined by the patient’s experience and their outcome, are there some things we should be talking about that are not easily defined?

Private practice physical therapy is as diverse as the communities we serve, and patient populations can vary widely across geographic areas. Variations in populations, when further dissected, bring variations in age, education levels, and culture. Who our patients are, where they are from, what their life experiences are, what their education level is—these are all questions of who our patients are as individuals. When we measure their response to therapy and ask them to describe the value of their experience, we need to consider the variables that are beyond our control.

Some of the easiest patients are the ones who arrive to your office prepared. They’ve done a little research, they are thoroughly motivated, in their mind you are the professional—the expert—and they are ready to follow your lead to a positive outcome. These patients attend therapy regularly and they are diligent with out-of-clinic recommendations. As therapists we are eager to hand them a functional scale or a customer service survey. Other patients are more of a challenge. Every therapist has an example in their mind of former patients who range from “difficult” to “nightmare,” and the reality is that we’ve got to measure how they “value” therapy as well. As much as we turn and will turn to technology and standardized tests to find these answers, are we prepared and capable of accurately measuring value? Statistically, do we exclude these patients from the measure as outliers? The reality is that oftentimes more challenging patients who are not technically difficult (in that they lack clear demonstrable comorbidities) can present intangible challenges based more on the emotional and social aspects of an individual. These challenges can be cost drivers. Two patients with the same surgeon start therapy in your office on the same day after the same surgery and receive the same care. One is done in 10 visits and one in 20. Both are restored to normal function; both are happy with their outcome. In an era of value-based payments, are we praised or penalized for returning both to their prior level of function?

Continued discussion and advocacy is needed to ensure that we are not ignoring outliers. We must make sure that a market driven by value does not force difficult patients into higher concentrations in certain markets or out of access to quality physical therapy in general. Physical therapy is as unique as it is important in the health care continuum, and as it continues its reach and scope it will see a continued expansion of patients who access care. With more patients, we as a profession need to be ready to accept and care for all those individuals. Cookies or no cookies.

Eric Cardin, PT, MS, is a PPS member and executive director of South County Physical Therapy in Auburn, Massachusetts. He can be reached at

Innovative Business Concepts


How private pay allows for a truly patient-focused facility.

By Lisa Corsa, PT, DPT, MPT

Phrases like these are often used to differentiate one physical therapy practice from another. Of course we all want to provide the best possible care for our patients, but in light of today’s financial medical model, where insurance payments dominate the pay structure, owners of rehabilitation facilities have to make hard choices on the type and amount of care that can be administered.

When I started my physical therapy practice, 18 years ago, I set out to make a difference in the community with the kind of services my team and I could provide. That meant not accepting insurance of any kind and building my business strictly on a private pay model.

While some may view closing the door to insurance as a loss of significant revenue, we are all aware of the restrictions that insurance coverage can put on treatments and timelines. However, we found that the private pay model actually opened the door to the opportunity to provide elite rehabilitative services that are aligned more closely with the patients’ needs—and to me this is what defines a truly patient-focused facility. Having the freedom to make decisions beyond insurance barriers is enabling my team and me to rehab people to a level that is far beyond the standard outcomes, based on my experience. And I am proud to say that after nearly two decades in business, my clientele has been built strictly by word of mouth. We’ve never done any advertising.


Going Beyond Traditional Equipment
The route we took with our practice meant acquiring rehab equipment that goes above and beyond the traditional, investing in machines that give personalized information for each patient so we can specifically tailor the treatment program while purposefully using all the modalities we have on site.

One piece of equipment we have chosen to invest in is our advanced therapy pool equipped with an underwater treadmill and cameras. We have found that our patients are greatly benefitting from the nearly weightless environment the water provides to optimize recovery. People in wheelchairs, those with limited mobility—the opportunities are endless! And in fact, we’re finding the therapy pool is useful 99 percent of the time for patient rehab.

One of the incredible aspects of offering aquatic therapy as part of our practice is that we are now attracting a broader population of conditions to our clinic—for example, people with neurological and/or degenerative conditions. For these folks, being able to perform specific body movements in the water and see themselves on camera—cameras that can allow them to have better control over their movements—not only helps the patients physically but mentally and emotionally as well. They are reporting a new sense of hope about their situation when they can get out of their wheelchair or take those first few steps in the pool. We see people more motivated and intentional about recovering when they feel what it’s like to move again.

Always Seeking New Solutions
One of the areas I see that’s underserved is the preoperative market or “prehab,” that is, rehabilitation before surgery. While the concept of rehabbing a patient before surgery is fairly new, I’ve been a fan for more than a decade. It’s not covered under insurance so many clinics don’t offer it. But again, for us, this is where not accepting insurance works in our favor.

Our aquatic therapy offering has been a boon for the prehab service we now offer. By putting a patient in the warm water therapy pool on the underwater treadmill, he or she is able to perform exercises and remain active in spite of the discomfort on land. We essentially keep the patient “strong” in the weeks leading up to surgery.

After surgery, the patient returns for two weeks of post-op therapy—a rehab timeline that’s often shorter because of the prehab. This has been keeping our staff very busy.

Sure, there’s a financial barrier for patients to overcome before committing to paying out of pocket for prehab treatment, but once they see it leads to improved muscular responses postsurgery, they realize the value. And that value is hard to contain. Former patients are our best referral sources. Not only will they return for prehab before their next replacement surgery, but they share their successful outcomes with their friends. Word has gotten out about our prehab aquatic therapy program, and people fly in from all over the world to be treated by us.


Learning and Leading by Example
I am extremely passionate about my work and enjoy sharing my out-of-the-box ideas on the business side of owning a physical therapy clinic, including helping move the needle on new ways of thinking in our industry. I discovered early on that there is a segment of the population willing to pay you if you can improve the quality of their life and offer them a level of service not found in traditional medicine today. They appreciate and see real value in authentic one-on-one consultative physical therapy. Here’s a case study of how my flexible business model allowed me to transform someone’s life. A man came to me with a diagnosis of Parkinson’s disease. I started an exercise program for him based on that medical diagnosis, but he complained of a strange chest pain. He stated that he had had a routine stress test and cardiac workup, but the pain kept getting worse. I reviewed his past medical history, discovering he had never had a coronary CT angiography, so I contacted his cardiologist to discuss my concerns. The physician appreciated my extra attention and ended up ordering the test for the patient. The shocking results showed full blockage necessitating open-heart surgery, which saved the man’s life.

Had I been constrained by the need to base all my time with him on standard protocol exercises focused solely on Parkinson’s, I would not have delved deeper to get to the cause of his chest pain. This is why I’m a firm believer of taking a whole body systems approach to health care—really focusing on patients, seeing them beyond the diagnosis that brought them through my doors. My advice is to listen to their story. Stay focused solely on them. Never allow complacency to creep in. When you push beyond your facility’s perceived limitations, even just a little, the results can be transformative.

By Lisa Corsa, PT, DPT, MPT, is the owner of Premier Therapy Services in Boca Raton, Florida. She can be reached at

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