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.

APTA Core Values in Action


It Is Easier Than You Think!

By Claire M Mysliwy, SPT University of Illinois at Chicago, DPT, Class of 2014

As students, we talk at length about the core values that guide our profession: accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility. But how exactly can I put these values into action? I am only a student, only one individual. Can I really make a difference? It definitely seems overwhelming at times. However, students, as well as practicing professionals, can find ways to get involved, stay involved, and make a difference in our profession on an individual basis with the APTA.

Mission Possible: The Private Practice Success Blueprint for 2014

By Andrew Vertson, PT, DPT, ATC

Executive Summary: Having a specific mission, sharing your specific vision, and monitoring your practice formula work together to build a strong, viable practice.

They say if you know where you are coming from, you know where you are going to go. As a private practice owner and as pillar of your community, there is nothing more important than a powerful, grand vision that excites and motivates others. Here are five guidelines that will help you create a vision that will not only set you apart, but also helps you to define your goals, and create parameters to exceed them and surprise yourself in the process.

1) Make The Vision of Your Practice BIGGER and BETTER Than Everyone Else

Patients can go to any physical therapy practice they choose, and doctors can refer to any physical therapist, so what are you doing to INSTANTLY set yourself apart? Here’s one example. You can make this a part of your vision: To help 50,000 people in your community live pain free, healthy lives by 2015. You should get every single patient; every single doctor involved in your mission right away, and explain to them why they should be a part of it. The key words here are – RIGHT AWAY. One of the mistakes a lot of private practice owners make with a mission is to make it a ‘free for all’. Your mission (and its followers) needs to have an air of exclusivity to it, almost like an insiders club. When the human brain perceives a bit of a barrier to entry, it becomes more likely to say “I want this” as opposed to when you think “I can do this anytime, and if I won’t then someone else will. I don’t have to do it RIGHT AWAY” That’s exactly how most visions start with a bang, and the enthusiasm gradually goes go down the drain. So, not only do you set it up so that a ‘select few’ can become a part of your mission, you also set up mechanisms for accountability so that the ‘insiders’ have to do something CONSISTENTLY for you to make strides towards the shared vision. Notice that I said shared vision. Once a vision crosses over the ‘threshold’, it no longer becomes YOUR vision, it becomes OUR vision. It transcends you and gains a life of its own.

2) Explain Your Vision Using Multiple Modes Of Delivery; Printed Booklets, Audio, Video

People have different learning styles. To teach people what your vision is all about, make use of multiple modes of education. Be creative in the way you explain your vision. Examples include videos in your website, audio CD’s, DVD’s, and printed booklets. For most individuals, video is a preferred medium for information consumption. A video on your website that explains your mission will be more powerful than anything you say or print.

3) Share You Vision With As Many People As Possible And Always Write A Future “Paced” Vision

Here is an example: Dear friend, The year is 2015, and we just realized that we helped 50,000 people live pain-free and become healthier in the community. We conducted a patient appreciation event, which was attended by over 300 individuals in our community. We had a great time visiting old friends and meeting new ones. It was an amazing experience, considering that a large number of our patients were suffering from chronic pain and were overweight. Now they’ve gone on to become pillars of our community and have been able to help their friends and family live pain-free and healthier lives. For most of our patients, it was like a family reunion, seeing friends they made all the way back in 2011 when they first met in our clinic. Since that first year, our community has grown exponentially and now reaches over 50,000 individuals across 7 counties speaking 5 different languages.

4) Make It Easy For People Explain You Vision To Other Individuals

Make it as easy as possible for people to explain your vision to others. They need to be able to explain “the who”, “the what”, and “the why” of the vision. Most importantly, they need to be able to tie in the vision with some aspect of their personal lives. When an individual has a deep, meaningful connection with your vision, they will become your most ardent supporters. The reason we go to school and become physical therapists is usually because we want to impact and change people’s lives and be compensated fairly well in the process. We are taught to be excellent clinicians (as we all are), but when it comes to running a business, our expertise can fall short. The truth is, there is a big difference between being a viable practitioner and a viable practice owner. Getting patients to walk in is one part of the equation. Treating them well (literally) and conditioning them to refer from day one will be a critical component of a successful practice in this new economy. Post discharge follow up using a combination of email, text messaging on their mobile phones, direct mail, phone call follow ups is the differentiator between a clinic struggling for referrals and one that is overflowing with patients. This isn’t just about ‘educating patients’ and doctors about the benefits of physical therapy, this is about becoming an important part of the patient’s day to day life.

5) Introducing the “Private Practice Success Formula”

This is called the “Private Practice Success Formula” and it can be summarized as

PS + VP + AF + PM = Private Practice Success

The new economy practice will have the following components in place even before the practice opens its doors for the first time: PS = Prospect Stimulators A prospect stimulator is an educational tool (book, audio CD, DVD, online course) that helps educate patients and leads them back to the clinic for more information. For example, an audio program on “7 things you can do to overcome low back pain” which leads to an offer for an appointment in the clinic can function as a ‘prospect stimulator’. Every clinic should have at least 5, preferably 10 or more prospect stimulators that are constantly distributed using various channels in the community VP = Valuable Prospects A high school student without insurance and the means to pay for physical therapy may not be a good candidate for your services (from a business point of view) as compared to an executive with the right type of insurance, someone who will not hesitate to pay his copay and even an appointment cancellation fee (which should be mandatory in all practices). Your practice must maintain visibility in front of your most ‘valued prospects’ using a web presence (search engine optimization), social media (Facebook, Twitter, LinkedIn), print (strategically placed advertisements), direct mail (postcards to a targeted mailing list) and personal phone call follow ups (with selected patients) to drive them, their friends and family back to your clinic. This should not be a ‘once in a while’ thing. It has to be done for 2-3 hours every week, since this activity will sustain your practice during tough times. AF = Ascension Funnel The biggest mistake made by most private practice owners is the wrong offer. Patients are completely desensitized at the prospect of a ‘free consultation’. They don’t even care for a ‘complimentary evaluation’ in an ad filled with nice images and pictures of the physical therapist. Every advertisement should have one purpose and one purpose only – to get the contact information of the prospect and introduce them to your marketing funnel. Once the prospects information (name, email, phone number) is obtained, someone from your office, who is very experienced in ‘closing’ the patient so they NOW want to come in, is important. Too many practices waste tens of thousands of dollars trying to ‘close’ the patient right away with an ad. This is a cardinal sin – it’s like proposing on the first date. The chances of success are pretty slim. The ‘new economy’ practice will patiently get the prospect to know, like and trust the practice and/or practitioners with personal stories and testimonials that elicit emotion and ‘human connection’ as opposed to color pictures, beautiful equipment in an ad that patients will spend 15-30 seconds reading. PM = Patient Metrics Every strategic private practice owner must keep an eye on important business metrics that pertain to each patient. The success of a ‘new economy’ practice is measured by the following ‘patient metrics’

a) The ‘LVP’ or lifetime value of the patient. This can be increased significantly by offering more products and services. It can also be increased by raising your prices for such products and services, which are not price regulated and independent of insurance reimbursements

b) The ‘PL’ or patient longevity – is the patient coming back to you or referring their family and friends? How many of your patients are becoming your ambassadors and coming back to you or driving more people to your door? Increasing patient longevity through patient conditioning is the fastest way to grow a practice. It yields greater results and take less time, money and effort than trying to ‘schmooze’ doctors and build new referral relationships

c) The ‘TS’ or therapist status, with regards to the importance of physical therapy – Are you constantly (yet delicately) reminding patients about your expertise, authority and the benefits of physical therapy? Patients lose enthusiasm for ANY service over a period of time and you need to build systems to keep them constantly engaged, enthused and motivated to come in for treatment and become your ambassadors. You must promote the ‘concept’ of wellness and how physical therapy can help, NOT the ‘brand’ or the ‘company’ that provides it. Patients are interested in the process of treatment, but this interest wanes dramatically after the first few visits, leading to an inevitable decline of therapist status

d) The number of patient visits each week. This is directly related to ‘volume’. Most practices assume that increased volume equals increased profits. While this may be true, it’s possible to increase net profits WITHOUT increasing patient volume by increasing LVP, PL and TS

Andrew Vertson, PT, DPT, ATC, is a PPS member, founder, and CEO of Intecore Physical Therapy in Orange County, CA. He can be reached at Intecore Physical Therapy 26700 Towne Centre Drive, Suite 120 Foothill Ranch, CA 92610 949-597-2103

Class Action Settlement

Class action settlement with coventry health care affects physical therapists who treat injured workers.

By Diana E. Godwin, Esq.
June 2014

On June 2 an official notice from the U.S. District Court in Oregon will be sent out to approximately 38,000 medical providers around the country, including physical therapists, who had a First Health PPO Provider Agreement during the period of March 25, 1999 to the present. The notice will inform the providers that a settlement has been reached in a class action case against Coventry Health Care, Inc., (Coventry) involving payment to providers for certain workers’ compensation medical bills.

The full title of the class action lawsuit is Chehalem Physical Therapy, Inc. v. Coventry Health Care, Inc.

The notice you may receive is ten pages of dense print and explains that the class action lawsuit relates to how Coventry has calculated the discount on payments to providers for workers’ compensation medical services. Specifically, the lawsuit claims that when a provider bills below the maximum fee specified under a state workers’ compensation fee schedule, Coventry applies the discount rate in the provider’s participating provider contract to the lower billed amount, rather than calculating the payment as the lesser of the provider’s lower billed rate or the stated percentage discount off the maximum fee under the state fee schedule, as the language of the contract requires. (For example: The maximum payable for a certain CPT code under the state workers’ compensation fee schedule is $100. The provider bills $90 for that CPT code. Under a First Health PPO contract that specifies a discount rate of 80 percent, the provider should be paid $80, which is the lesser of the $90 billed or 80 percent of the maximum fee schedule amount. Instead, Coventry has applied the 80 percent discount to the lower billed amount of $90 and tells the workers’ compensation insurer to pay the provider only $72 (80 percent of $90.)

Among the benefits achieved for providers under this settlement are money damages and injunctive relief. The injunctive relief in the settlement gives providers who currently have a First Health PPO contract the right to terminate or “opt-out” of just that portion of their contract that applies discounts to workers’ compensation medical care.

The information telling providers about the opportunity to opt-out of having discounts taken against their workers’ compensation medical billings is found in Paragraph 13 on page 6 of the notice. It says that if you no longer wish to have your worker’s compensation billings discounted in this incorrect manner (or have them discounted at all) you may terminate just the workers’ compensation portion of your contract, while still remaining a member of the First Health preferred provider network for private health patients. Please note that your right to terminate the workers’ compensation portion of your contract must be exercised by no later than July 2—30 days from the date of the notice. Do not miss this very short window of time to take advantage of this opportunity!

As one of the lawyers who brought the class action case against Coventry, you will see my name listed in the notice. I am also a member of the Administrators’ Council. As part of my legal practice, I serve as the executive director for two statewide private practice organizations, Oregon Physical Therapists in Independent Practice (OPTIP), with 165 members, and the Private Practice Special Interest Group (PPSIG) of the Physical Therapy Association of Washington, with 170 members. One of the class action plaintiffs, Chehalem Physical Therapy, located in Newberg, Oregon, is a member of OPTIP. In addition to Chehalem Physical Therapy, the second class action plaintiff is South Whidby Physical Therapy, located on Whidby Island in Washington and owned by Andy Goetz, a member of PPSIG and a PPS/APTA member. We all owe them our thanks for stepping up to serve as the representative plaintiffs on behalf of all of the medical providers around the country who are in the class.

I have had many opportunities at PPS annual conference to discuss the problems of participating provider contract discounting in workers’ compensation with a number of PPS members from around the country. Unlike the situation with private health patients who are “steered” to members of a PPO network through the mechanism of a lower copayment, a lower percentage of coinsurance, or a lower deductible, workers’ compensation patients do not pay for their medical care, so there are no financial incentives or mechanisms by which to steer these patients to providers who are members of a PPO network. Since there is no “steerage” of patients, there is no quid pro quo, or benefit to the provider for accepting discounts on their workers’ compensation billings.

The PPS members I have spoken to have expressed frustration with the fact that if they want to see private health insurance patients who have First Health as their PPO network, they have had to sign a First Health contract that requires them to accept discounts not only for their private health patients, but also for their workers’ compensation and motor vehicle accident patients. The First Health contract has been an “all or nothing,” “take it or leave it,” proposition.

For the first time, as a direct result of this national class action settlement, private practice physical therapists will have the opportunity to rectify the situation.

Diana E. Godwin, Esq., is an attorney at law and member of the in Portland, Oregon. She can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.