Getting Upstream

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Designing and growing innovative niche programs for injury prevention.

By Curt DeWeese, PT

In October 2007, my practice had been open for four years, and I wanted to differentiate it from competitors and create new revenue sources. I attended the conference “Newest Concepts in Work Injury Management and Prevention” in Chicago, hosted by Susan and Dennis Isernhagen. At the conference, Manny Keisser, then manager of Cast Health and Wellness at Disneyland Resorts in California, spoke about occupational health and safety at Disneyland. Manny’s dynamic presentation captured my attention. Two of his principles have remained ingrained in my thought process for business development and differentiation. His first statement was “I’m so busy pulling people out of the river that I don’t have time to go upstream to find out (and stop) who is pushing them in.” I underlined it and tabbed the page; it described the day-to-day operation of treating patients in a busy clinic. The people I saw were already injured—about a third of them had been injured at work. There was no time or opportunity to prevent the injuries. And often, I did not understand my patient’s job title, much less what they were actually required to do at work. I worked on restoring range of motion, increasing strength, and improving tolerance of activity. Relationships with the employers were limited, including participating in employer health fairs and teaching some back and lifting safety classes. I was onsite at the company, but did not really know anyone. I viewed this time that pulled me away from the clinic and patient care as a nuisance.

Practice Strategy

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The four disciplines of execution in physical therapy private practice.

By David Browder, PT, DPT, OCS

One of the most pervasive challenges that private practice owners face is the need to work, not only in their business, but also on their business. With declining payment, shrinking margins, and a challenging regulatory environment, you have increasingly less room for error on the business side of private practice. Setting goals and planning how to achieve them should be a part of your business routine.

The most difficult part of strategizing is not having great ideas, awareness of our environment, or even knowing how to plan. The challenge private practice owners face is executing the plans they make. The 4 Disciplines of Execution Model (4DX) by Chris McChesney, Sean Covey, and Jim Huling outlines a set of disciplines and practices to ensure that we can execute on our goals. Physical therapy private practice owners can utilize this method so their ideas are translated into actions and these actions yield results.

Secret to Success

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Lessons learned during the first year of private practice.

By Jeanette M. De Witt, PT, MPT, LAT, ATC

From July 1998 through January 2012, I practiced in a wonderful hospital system in Ohio that allowed me to gain experience, attend educational seminars, and advance my career from a staff physical therapist to a supervisor. Although I was content with my position, I always held high hopes that I would own my own clinic “one day.” After a family vacation to Wisconsin and falling in love with the state, my family decided to move, and I returned to a staff physical therapist position. However, after seven months, I found myself missing the supervisory responsibilities I had once enjoyed at the hospital. I elected to give private practice a whirl and reached out to a company that assists therapists in opening their own clinics and decided to pursue my dream. After a month of interviews, I joined the company’s network and embarked on my first year as a clinic director. This was a large leap of faith from which I have greatly benefitted. My practice was truly built from the ground up as at the time of signing, the clinic location was not even confirmed yet!

Changing Environment

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Bundled payment for post-operative physical therapy services.

Rob Worth, PT, DPT, OCS, ATC/L, MTC

“The times, they are a changin’.” These iconic words sung by Bob Dylan ring true today in many aspects of physical therapy private practice and health care payment. I believe that the changes in health care and health care payment may actually be good for high-quality physical therapy providers who are able to adapt to the new environment. For physical therapists to be leaders in providing cost-effective, expert musculoskeletal care in an evolving health care system, we must dedicate ourselves to innovation and collaboration. This will require us to contribute to managing the total cost of care for patients, their conditions, and their overall health care management. The days when we were paid for treatment units rather than for producing outcomes are numbered. This shift from volume-based payment to value-based payment has already started to occur and will benefit the physical therapy practices that are dedicated to providing the highest quality of care at a reasonable cost. One component of value-based payment is the bundled care model.

Managing and Supporting Others Through Change

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With all of the uncertainty facing health care in the coming years, the concept of change is inevitable.

Michael Connors, PT, DPT, OCS and Janey Evans, RN, BSN, CPCC-ACC

In the current health care environment, we continually adapt to the changing demands in our physical therapy practices. As clinicians and practice owners, we face challenges and changes from payers, regulatory agencies, and patients. The shift toward utilizing electronic medical records in outpatient therapy practices has placed an undue amount of stress and uncertainty on many owners and practitioners who have not yet made the transition from paper. In many situations, a practice may switch from one EMR to another in search of enhanced efficiency or management capability. With every change, regardless of the nature of the transition, an individual must prepare.

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