Will Private Practice Survive?

By bringing innovative programs to your community, your business will continue to thrive.

By Lynn Steffes, PT, DPT

As I travel the country and have the honor of working with private practices nationwide, I hear what I refer to as “the six million dollar question:” In this ever-changing health care climate will private practices survive? I respond with a resounding “Yes!” But not without a few caveats: Private practices must:

  1. Exercise the agility that is inherent to being a small business.
  2. Be lean and study their expenses, while controlling their overhead.
  3. Build and leverage relationships they have in their communities and with their patients.
  4. Explore opportunities to collaborate with each other to create economies of scale.
  5. Celebrate the cost effectiveness of their setting in a cost-conscious personal and health care economy.
  6. Innovate new programs to bring highly valued services to our patients, our communities, and our health care system!

The first five solutions are often already on the “radar screen of private practice owners.

So how do practices begin to embrace and meet the challenges of number 6?

We must identify the emerging trends and greatest burning needs for our population and build cost-effective (see 4) services through our practices to serve the needs of our patients and our communities (see 3). Perhaps the most burning need in health care is brain fitness!

The enhancement of cognitive health through fitness and wellness may be one of our nation’s most important priorities in the next decade. Age is the greatest risk factor for cognitive impairment and as the Baby Boomer generation passes age 65, the number of people living with cognitive impairment is expected to jump dramatically. In fact, more than 10,000 Baby Boomers are turning 65 each day. After 65, the risk of being struck by the disease doubles every five years, so almost half of people suffer from this disease by 85. What this single disease may do in the next few decades boggles the mind, resulting in nearly 10 million Baby Boomers who will die with or from Alzheimer’s and Dementia (AD). “The National Institute of Health’s research funding for AD research already low in comparison to other major diseases, some have called this one of the biggest predictable humanitarian catastrophes in the history of America.”

Cognitive impairment is a very costly disease, for patients, families and the U.S. government who anticipates spending billions on care. “The projected rise in Alzheimer’s incidence will become an enormous balloon payment for the nation—a payment that will exceed $1 trillion dollars by 2050,” warns Robert Egge, vice president for public policy for the Alzheimer’s Association. “It is clear our government must make a smart commitment in order make these costs unnecessary.”

Since research has demonstrated that prescribed exercise has the single greatest opportunity to make a difference, I believe that this is an obvious calling for our profession. Both education and exercise are key components of building an effective cognitive fitness program. As physical therapists, we know that these skills are cornerstones of our skill set. Physical therapists are highly engaged with the primary target for this service: the Silver Generation. Individuals—ages 50 to 70—whose top concerns include their future cognition as it pertains to the aging process. Strong evidence exists that the current boomer generation is concerned about cognitive health and fears Alzheimer’s disease.

“Nigel Smith, director of strategy at AARP, framed the conversation by sharing that 80 percent of the 38,000 adults over 50 surveyed in the 2010 AARP Member Opinion Survey indicated “Staying Mentally Sharp” as their top ranked interest and concern—above other important concerns such as Social Security and Medicare.” In addition, these Baby Boomers also happen to have the highest disposable income for cash based programs. They are known as “….the wealthiest generation in history…”.

I strongly believe that this prevention and wellness strategy belongs in the physical therapy market space. This is where people can come for confidential assessment, exercise planning, and education based on the latest research available. A clinic-based program enables physical therapy clinics to implement a cost-effective and holistic approach.

I initiated development on a program named BrainyEX to honor both of my parents and my family members who have been on the difficult journey of Alzheimer’s disease and vascular dementia for over a decade; a journey that had little hopeful guidance and is both heart wrenching and frightening to travel.

The first BrainyEx pilot was highly successful in empowering participants to not only feel capable of impacting their cognitive health but showing significant changes in their lifestyle including exercise, dietary changes, sleep & stress management. The initial results were measured by Lumosity and in-clinic cognitive testing—all improved.

PT Plus in Elm Grove, Wisconsin, was our small pilot sight. Amy Snyder, MPT, DPT, and owner PT Plus, Milwaukee says, “Our practice has hosted a focus group and the pilot cognitive fitness program. Our client’s interest and enthusiasm to learn more about cognitive fitness has astounded me. I believe that brain health and wellness has been under served by the health care system. No one asks the questions or provides interventions until a problem occurs. As physical therapists we have a wonderful opportunity to reach out to or communities and empower them to make health choices that will keep both their body and mind well for years to come.”

We hope your clinic will explore brain fitness too. It is definitely a key part of answer to the six million dollar question!

lynn-steffes Lynn Steffes, PT, DPT, is president and consultant of Steffes & Associates, a national rehabilitation consulting group focused on marketing and program development for private practices nationwide. She is an instructor in five physical therapy programs and has actively presented, consulted, and taught in 40 states. She can be reached at steffbiz@gmail.com.

Anatomy of a Successful Political Fundraiser

Private practice physical therapists from Oregon and Washington gathered in Portland to meet with U.S. Senator Ron Wyden, the new chair of the Senate Finance Committee.

By Clem Eischen, PT, and Diana Godwin, Esq

On May 31, more than 35 private practice physical therapists from Oregon and Washington gathered at a café in downtown Portland, Oregon, to meet and have brunch with U.S. Senator Ron Wyden (D. Oregon), the new chair of the Senate Finance Committee.

The agenda included a discussion by the Senator of the issues and challenges ahead as Congress works to revise health care financing, particularly proposed Medicare reforms. The Senate Finance Committee has jurisdiction over changes in the Medicare laws and will decide on the reforms for which we have been advocating in recent years.

The Senator was gracious in soliciting and listening to the concerns of our private practice members, as well as responding to questions. After the more “formal” part of the event, Senator Wyden sat down with us to share a buffet brunch and later stayed for a round of picture taking—lots of arms around shoulders. Jerome Connolly, PPS lobbyist, and Mandy Frohlich, APTA lobbyist, also attended the event.

How did the chair of one of the most powerful committees in the U.S. Senate come to spend almost two hours breaking bread and discussing issues with private practice physical therapists on a Saturday morning?

In March, shortly after Wyden was appointed as chair of Senate Finance, Diana and I flew to Washington, D.C., to meet with him and other key staff in his Senate offices. Tom DiAngelis, PPS president, Jerome Connolly, and Mandy Frohlich accompanied us. Although meetings with the new chairman were in high demand, we were able to meet with him because we both had long-standing relationships with him. Clem—now retired—had a private practice in Portland for many years and hosted meetings at his clinic with Wyden and other physical therapists, and he had supported Wyden in his early campaigns for the House and then the Senate. Clem worked on a committee on national health insurance for Wyden and arranged for Wyden to be a guest speaker at a Sports Medicine Seminar, which Clem co-sponsored when the U.S. Olympic Dream Team played its first exhibition game in Portland in 1992. Diana went to law school with Wyden in the 1970s and had hosted a fundraiser for him in her home during his last Senate race.

A couple of weeks before our scheduled March meeting with the Senator, we started kicking around the idea of hosting a fundraiser for the Senator when he was back here in Oregon during a Congressional break. In late February, Diana contacted Senator Wyden’s campaign staff to discuss potential dates, logistics, a fundraising target to which we would commit, and Federal Election rules. We quickly formed a small task force to coordinate our efforts: Connolly, Mike Matlack, and Frohlich, DiAngelis. We would be the local team on the ground.

The Wyden campaign had a date available in early April when the Senator would be home. We realized this was too soon to get everything organized—particularly since we committed to raise a minimum of $20,000 at the event—so we went back to the campaign staff and settled on the date of May 31.

The next step was to design the invitation that the APTA PAC would “snail mail” to all members of the PAC and email to all PPS members. Diana would also send the invitation to the clinics that she represents in Oregon and Washington. Before we could complete the invitation, we had to locate a venue. We needed a good location, one that had a private meeting space and could serve a nice brunch at a reasonable price. (Practical tip: While you will want to do something nice, you also want to minimize costs so that more of the money raised can go to the legislator or candidate.)

The Wyden campaign had a line on a space they had used for previous fundraisers, but unfortunately, after booking, the venue backed out and we had to start over. Diana phoned and emailed 10 or so other possible venues before locating the magic combination of location, menu, and price. Once we booked the new venue, we could finalize the invitation. (Practical tip: Start working on the invite as soon as possible. The campaign staff has to approve the wording of the invitation to ensure it includes caveats regarding federal rules on contributions (no corporate donations—personal donations only; the correct information on how to make donations online; where to mail checks and to whom the checks should be paid. Plus, we wanted to include a photo of the Senator, so we had to get that from the campaign staff, all of which takes time.)

Once the invitation was ready, we crafted an accompanying letter to inform our PPS members across the country about how important this event was to our national objectives and urge them to contribute toward our fundraising goal. That done, the task force kept track of donations from around the country, answered questions, and thanked the PPS members who sent emails telling us they had donated. Diana stayed in touch with the campaign staff to discuss details and monitor the contributions that were coming in by check or online to the campaign website.

(Practical Tip: Always maintain good communication with the local campaign staff and respond promptly to whatever they need. They will be delivering the legislator to your event and will be keeping him or her apprised of your efforts and progress. Also, do the organizing work yourself rather than rely on the campaign staff. On the morning of our event, one of the campaign staffers who accompanied the Senator told Diana that they had never before participated in a fundraiser where they did not have to do any work—and they specifically made sure the Senator knew that we had handled everything.)

Less than two weeks away from the date of the event, we found ourselves short of our fundraising goal, so the team got back to work. Tom DiAngelis sent out another plea for support to PPS members, Clem made personal phone calls to his key contacts around the country, and Diana urged her Oregon and Washington physical therapists to come through. We also enlisted the help of a private practice business group headquartered in California and they sent out the word to all their contacts. (Practical Tip: Having a small, hard-working team dedicated to hosting a successful event is key.)

Diana kept track of the physical therapists who had responded that they would be attending in person and had her staff prepare name tags the day before and up to the last minute for late responders. Three days before the event, we checked in with the café to let them know the final head count and finalize the menu. Diana arranged for a no-host bar to be available for those who wanted libations stronger than coffee or juice. (Practical Tip: Alcohol is typically welcomed by attendees at these events.) The day before the event, the campaign staff requested short bios of the hosts and the issues that the physical therapists would like to discuss so the Senator would be fully prepared. Diana scrambled to complete and email these to the staff.

By the morning of the event, all was in place and everyone had a good time. All the wonderful private practice physical therapists who attended and those who contributed money made the event a tremendous success—we raised over $45,000! According to his staff, Senator Wyden was thoroughly impressed.

Thank you all.

Mark Anderson

APTA Federal Government Affairs Leadership Award recipient.

Interview by Kelly Sanders, PT, DPT, OCS, ATC

This year, the APTA Federal Government Affairs Leadership Award was given to PPS member Mark Anderson. Established in 2013, this annual award was created to recognize the efforts and achievements of an APTA member in advancing the association’s federal government affairs objectives. We caught up with Mark to discuss his contributions in this area of advocacy and find out what piqued his interest in this important area of APTA service.

Q: Would you share a bit about your background and the roles you have played in the government affairs arena over the years?

A: My interest in government affairs issues started as Utah chapter president. Multiple state issues were brewing, and I tried to take a proactive approach in dealing with issues before they heated up. Rodney Miyasaki, an earlier chapter president, set a great example [by] getting direct access without any opposition. I began going to Washington, D.C., in the early 1990s and made my first Capitol Hill visits in 1994.

Q: What was the catalyst that got you involved in government affairs? Was it a particular issue, person, etc?

A: I learned quickly that Hill staff “made the world go round.” Establishing relationships and providing Congressional staff with information and assistance went a long way. One day, I got a call from a Representative’s chief of staff saying the member was bringing Newt Gingrich (then Speaker of the House) to town. She asked if I could rally our troops to get some people to attend. I quickly reached out to a local physical therapy school and our chapter, and at the end of the day, we had a sizable crowd present for the event. Time and time again, providing needed data and being consistent in messaging has paid off. Over the past 15 years, I have had the opportunity to be an APTA key contact for Orrin Hatch. During this time, I have been able to get to know and work with his health policy advisors. We have established friendships and spent time discussing issues in Washington as well as in our state. I have become very comfortable contacting Senator Hatch’s office whenever we are facing time sensitive issues that affect our profession. I am confident that we provide them with accurate information and information that is focused on our patients.

Q: What issues are you particularly passionate about right now? What do you think are the most important issues facing physical therapy right now?

A: Each year our lobbying efforts focus on three primary issues. Trying to work on more issues seems to take away focus. Depending on the year, we have focused on the therapy cap, direct access, referral for profit, and student loan repayment assistance. During the past 10 years, my number one legislative issue has been the therapy cap and associated limitations. Due to the length of time we have spent on this issue at the Hill, it is very unusual for any of our Congressional contacts to not have a solid understanding of the therapy cap. If you were to ask me what issue I am the most passionate about and the one I love to educate and discuss, it would be referral for profit and the in-office ancillary exceptions. In the past two years we have been able to discuss this issue as a potential way to pay for costs associated with fixing the cap. Congress always wants to know how much a particular issue will cost. It is very nice to report a savings with fixing referral for profit and a budget neutral for student loan assistance.

One of the most enjoyable offshoots of my legislative work has been taking students and other therapists to visit Congress. Planning a visit and assigning speaking points is exciting. Having a new attendee’s experience be a positive experience and watching their confidence build as the day unfolds is exhilarating. Over the years, Kim Cohee (Utah’s APTA key contact) and I have been able to share this experience with a significant number of therapists and students.

In the many years I have been walking through the halls of Congress, I have never felt the urgency of our messages more than I do today. Congress is polarized. Blame is plentiful. If we do not maintain a steady effort in reminding policy makers what is at stake, our patients and our profession will lose all that has been gained.

Kelly Sanders, PT, DPT, OCS, ATC, is a member of the Impact editorial board. She can be reached at Kelly@movementforlife.com.


What media giants like Amazon can teach the private practice owner.

By Nitin Chhoda, PT, DPT

This is an analysis of an article that appeared in the April 23, 2012 issue of Forbes magazine. www.forbes.com/sites/georgeanders/2012/04/04/bezos-tips/

Amazon’s business model has evolved significantly since Jeff Bezos founded the company in 1994 while driving cross-country from New York to Seattle. During a fascinating 40-minute interview at a recent annual event called “Invent” in Las Vegas, Bezos revealed some fundamental insights into the way he enabled Amazon to emerge as the biggest retailer in the world.

Here are five ways in which Amazon’s fundamental business practices can help every entrepreneur, young or old.

  1. “We only win when our customers win. We sell our hardware (Kindle) at breakeven. We make money when people use the device, not when they buy the device.”

    Lesson for the private practice owner

    Focus on a “patient centric” experience. When patients interact with your practice (and your staff), the practice will see more referrals, increased adoption of cash paying programs, higher customer value, and more goodwill in the marketplace. Align with patients as much as possible. Create long-term benefit for patients with new and innovative ways to serve patients.

  2. “The more important question is not ‘What’s going to change in the next 10 years, it is ‘What is NOT going to change in the next 10 years.’”

    Lesson for the private practice owner

    Build a business that endures the test of time by asking, “What do customers really want?” Create a foundation around the things that remain constant over a period of time. A customer will always want better service and more options at a lower price, faster than ever before.

  3. “The big ideas in business are always obvious but it is hard to maintain a firm grasp of the obvious at all times.”

    Lesson for the private practice owner

    The things that matter are right under your nose. Don not look for that “secret sauce” or “competitive edge.” The biggest changes to your business are based on the fundamental principles of value creation and supply versus demand. If you can dedicate time, energy, and resources toward the things that really matter to patients, you will grow your practice and increase value for your patients.

  4. “The balance of power is shifting from providers to consumers.”

    Lesson for the private practice owner

    Shift your marketing from traditional advertising to direct-to-consumer advertising with targeted marketing. As a private practice, reach out to other local businesses that cater to your patients. Align your benefits with them, and this action will help you find new ways to reach patients. Think of innovative ways to reach your customers, since they have the decision making power and are becoming increasingly aware of it.

  5. Successful invention involves a high rate of experimentation, and it’s something that customers care about. Build a customer centric, not product centric, company.

    Lesson for the private practice

    Do not be afraid of trying new things in your practice. If you are right, your patients will give you feedback. If you are wrong, they will not care. The more you experiment, the more likely you are to identify ways to keep and grow your patients.

    Offer additional, ancillary services that help patients get better and healthier, and do not “restrict” yourself to traditional models of care.

Finding Your Niche


One physical therapy practice gets creative with its aquatic programming.

Veronica Paquette, PT, ATRIC, PRC

Running a physical therapy practice is similar to running any kind of a business: You need to find (or make) a niche. What that niche consists of is up to you and your team, but it has to stand out among the other options patients and physicians have.

Years ago, our Vermont practice needed to increase not only the number of patients we wanted to see, but also our options for treating those patients. Though we use land-based methods, we realized that being able to offer a complementary type of therapy treatment would be advantageous for both our patients, as well as our business. After careful planning, we determined that adding aquatic programming to our physical therapy techniques was the innovation we needed to round out our abilities and offerings.

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