Added Value


Contracting with employers is good for business.

By Wade VanDover, PT

In the past, when we talked about workplace and occupational health services, we found employers to be more “reactive” than “proactive.” However, due to rising health care costs, including increases in workers’ compensation and health insurance, and limited budgets, we find employers finally interested in getting injured workers back to work quickly and keeping workers from being injured in the first place—as a measure of cost-saving strategies. More and more employers value “proactive” steps and value contracting physical therapists who can provide not only treatment, but also injury prevention and other occupational services.

My business partner, Paul Treinen, and I opened Big Stone Therapies in 1990, providing outpatient physical therapy services. We provided typical outpatient physical therapy. As our business grew, we added occupational therapy, speech language pathology, and massage therapy. Today, we are proud that Big Stone Therapies has grown into a thriving rehabilitation business with clinics in 22 long-term care facilities, 12 hospitals, and 3 private practice clinics. We have 272 workers in Minnesota, South Dakota, and North Dakota.


Nearly 15 years ago, after we noticed that many of our patients had sustained injuries while at work, Paul and I made the decision to expand our business into occupational health services. This decision gave us the opportunity to approach the businesses and industries in the communities we were serving and also contract with them for services beyond outpatient physical therapy. We partner with employers to analyze jobs, write job descriptions, assist them in hiring workers whose physical abilities match the work, work with the employer to identify unsafe work practices, and provide worker education—all in addition to implementing a functional rehabilitation program when needed. Contracting was at the heart of our occupational health business. We knew we had to find a way to develop relationships that would result in sustainable contracts. Sometimes offering every occupational health service immediately scared businesses away. We discovered by starting slowly with one successful service, contracting other services became easier. When employers could see the safety and productivity of their workers improve by our efforts, it was easier for them to agree to add other services.

Another effective strategy for us has been providing an employer with a service at no cost. After a predetermined period of time, we show the employer the impact. We demonstrate “value” by showing them what they would have spent on that particular service; for instance, a job-specific worker education session prior to return to work after a worker sustained a strain/sprain, as well as performing a job analysis and developing a functional job description to assist placement and return to work after a work injury. The goal is to get the employer’s buy-in to longer term services such as developing functional job descriptions, designing a prework screen program, and developing warm-up programs.


We have also found that networking through human resource personnel has been a great way to get our foot in the door of a business. We also offer to speak on a variety of occupational health topics and invite businesses to educational meetings to “meet the experts.” These lead to contracts with local businesses. Company image and building trust with employers is an important component in securing local contracts. Our staff are active in the local schools, churches, and community organizations. This involvement is a method of giving back to our communities, while at the same time creating goodwill that can help gain new business. We believe the relationships we have developed with other businesses have played an important role in building community awareness of our brand and the services we provide. This creates a profound ripple effect in generating outpatient physical therapy referrals, physician relationships, and employer business.

During our initial meeting with a new employer, we assess the needs of the company. We need to determine where they are feeling the most pain in terms of costs and/or worker lost time. We find the “pain” usually comes from one of three areas: the work, the worker, or the work site—something is not right in one of these three areas, which results in worker injuries and lost revenue for the company. Once the “pain” is determined, we implement a plan specific to their needs and develop a contract. We offer a full range of occupational health services including pre-employment screens, creating a functional physical component to the job descriptions, ergonomics, post-injury screens, educational seminars for workers, injury prevention, and onsite clinics.


The contract will need to spell out what Big Stone Therapies’ obligations/services provided will be and what the obligations of the employer will be. We prepare a simple service contract, but have the final document reviewed by an attorney. Some of the elements that we include in a contract include the following:

A. The legal names and addresses of all parties involved.

B. The conditions/terms of the contract, outlining what each of the involved parties will provide, including:

  1. Functional Job Analysis/Functional Job Description (FJA/FJD) for the title of the positions and the rate to be charged.
  2. Prework Screening (PWS) development for the title and number of positions.
  3. Implementation of Prework Screening on new hires, the title of positions, and the rate to be charged per screen, along with a description of communication to a company representative following the screens.
  4. Additional services that will be provided, including job reviews, description, and rate.
  5. Any mileage and drive time that will be charged and at what rate.

C. Payment terms and penalties incurred by each party should they not fulfill the conditions/terms of the contract.

D. Language indicating that both parties have read the contract, agree to the conditions/terms, and ability to terminate or amend the contract.

E. Signatures and date signed.

Companies typically experience a decrease in workers compensation injuries through implementing occupational health services. Additionally, workers who have been injured at work receive treatment before the injury causes more damage and loss of work time, which is critical to a company’s success.

For example, our clinic in Marshall, Minnesota, works with about 38 businesses that vary in size from small businesses to a number of companies with hundreds of workers. We have a number of contracts with state agencies and seasonal workers. In our geographic region, workers compensation insurance covers most occupational health services adequately. Fortunately, we have found that cash-based business is very attractive to the majority of employers with whom we work, and they believe that occupational health programs are a good investment. For us, contracting with employers is a good line of business. It is rewarding to know that we can help employers while impacting the lives of their workers, as well.


Wade VanDover, PT, is a PPS member and chief executive officer of Big Stone Therapies. He can be reached at

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

Are you a PPS Member?
Please sign in to access site.
Enter Site!