Understanding opportunities in working directly with employers.
By Curt DeWeese, PT*
The entrepreneurial practice owner is challenged to identify ways to expand and diversify revenue-producing programs. Establishing relationships with employers is another opportunity to create unique service lines, guide referrals to the clinic, and market the practice. Getting training and gaining confidence in how to use the unique skill set we possess as therapists are the first steps in establishing mutually beneficial relationships with employers.
As clinic owners or therapists working in private practices, the current climate of reduced insurance reimbursement, higher patient copayments, and increased administrative demands to obtain payment for services all drive up the risks in maintaining a successful practice. Keeping visit volume at acceptable levels, successfully marketing the practice, and attracting and maintaining excellent staff add to the daily challenges of practice owners. Working directly with employers to expand your business, establishes a service line within your practice to guide patients to the clinic while also creating an opportunity for revenue generation. This initially feels like a big risk because it may negatively impact visit volume as you get started, and require time away from the clinic. However, the potential rewards are significant.
Each actively employed patient seen in the clinic is potentially affected at his or her job by the condition being treated. The injury does not have to be work related to influence that person’s ability to perform their job functions. Back pain related to moving furniture over the weekend impacts sitting tolerance at a computer workstation, and elbow pain from tennis or golf may limit use of hand tools in manufacturing. How do we use our abilities as musculoskeletal experts to understand the patient’s job demands, build a rehabilitation program to restore function, and bring these areas together for optimal outcomes? What opportunity exists for us to expand this relationship beyond the patient/employee to include the employer?
When working with an athlete with a knee injury who plays a sport requiring planting and cutting, we work on removing swelling, increasing range of motion, and improving strength. As the program progresses, we can then introduce running in straight planes and then add activities for agility and the needed planting and cutting. We can build sport-specific rehabilitation programs based on our knowledge of the sport. We may have played the sport at a much lower level or even just watched a game, but we have an understanding of what this athlete will need to perform as they return to activity.
I once had a patient who was a press operator with a shoulder problem. I was able to work through the first stages of controlling pain and swelling, restored motion, and increased strength. I thought we were home free as he returned to work. But because I did not fully understand the essential functions of the press operator job position, I did not get into the work-specific exercises that were needed. He subsequently returned in a very short time with an exacerbation. I realized I needed to know more about his job functions, how he performed them, and the equipment used. I could only understand that by seeing his work environment; I had to get on site at his place of employment.
When reaching out to employers, having a common interest is a great assist in getting the meeting. An employee out of work is that linkage; the employer wants them back, and that is the physical therapist’s ultimate outcome. Having a specific job to look at with a defined goal often makes getting the appointment easier than trying to establish a meeting to introduce yourself and your practice. This visit is for the therapist’s benefit; increased understanding of job demands and work postures will assist with better patient outcomes and satisfaction. These visits can be done at no charge as a way to establish the relationship with the employer. The outcomes are as simple as better understanding of what work-specific exercises are needed in the treatment program to more complex where the employer seeks a simple report of five ergonomic stressors and suggestions for improvement. It is the building block to the “know me” phase. Just as great outcomes and satisfaction of patients from a new referral source generate confidence, trust, and additional referrals, the relationship building with the employer becomes a source of new opportunity. Ongoing collaboration on site for ergonomics, education, and early intervention will produce results of decreased Occupational Safety & Health Administration (OSHA)–recordable incidents, reduce injury frequency, cut lost and restricted days, and drive cost savings. Those steps will lead to the “trust me” phase where the employer seeks input as a partner in safety, injury prevention, and assisting with claim management.
Our skill set makes us experts in the ergonomics of the human machine. We understand the stressors that lead to tissue breakdown or cause repetitive motion injuries. Providing onsite early intervention in the realm of first aid can prevent a small irritation from becoming a full-blown injury and claim. Workers will often persevere with discomfort because they need their job. They will give up hobbies and other leisure-time activities to be able to continue working. When the symptoms become so severe that there is disrupted sleep and inability to perform work functions, the issue will take greater intervention to correct. Being on site and correcting work postures, tool choices, and position of the work performed will abolish the soft tissue and repetitive motion stressors before the condition progresses. This is a benefit to the employee who wants to stay at work comfortably, the employer who avoids a lost time claim, and the therapist who is getting good outcomes and a direct pay revenue source from a new onsite contract.
How this is good for business
Establishing onsite presence with an employer is generally a fee-for-service relationship. There is an hourly or weekly charge for the services provided. This is a direct pay revenue source that supplements the established traditional insurance-reimbursed therapy services provided in the clinic. There are myriad other types of these arrangements being created by therapists such as wellness, sport performance training, and fitness centers. More and more, entrepreneurial practice owners are reaching new markets to diversify opportunities and create new revenue sources. Consulting with employers is another excellent option. Additionally, while providing onsite services, there is an entire population of potential physical therapy consumers who would benefit from seeing a physical therapist in the clinic. Those employees who do not respond to early intervention first aid care can be referred for formal treatment in the clinic. Trusting relationships are created with the workers, who seek input for nonwork-related symptoms or care for family members. All of these situations create opportunity for marketing and sharing the value of your practice.
Gaining understanding of the criteria OSHA uses to classify the intervention provided is in the realm of first aid versus medical treatment. Working knowledge of the Americans with Disabilities Act Amendments Act (ADAAA) is also important. Consider offering job function analysis to objectively report the physical demands of job titles, identify ergonomic stressors and ways to correct them, and develop and administer functional testing for post-offer and return to work placement. There are resources online and continuing education programs to help you obtain the tools you need. The Private Practice Section has many members who are actively working with employers and various industries. Network, ask questions, and use the outstanding resources our section offers.
Curt DeWeese, PT, is a PPS member, COO of DSI Work Solutions, and president of Work Injury Solutions & PT, PC, in Webster, New York. He can be reached at firstname.lastname@example.org.