The Four P’s

By Angela Wilson Pennisi, PT, MS, OCS

Having returned from the Federal Advocacy Forum in the spring (see Claire Mysliwy’s article on APTA Core Values in Action), and then attending a community meeting where my Congressman spoke a few weeks later, I was reflecting on characteristics of successful advocacy. Compared with everything else I do every week or month, the brain power required to participate in regular advocacy ranks at about the level of changing the paper towel roll in the clinic washroom. In keeping with that level of mental effort, I decided that my approach to building relationships with my legislators could be summed up with “Pennisi’s 4 P’s”:

Narrow Networks


Narrow networks return with promise of cost control—and backlash.

By Jerome Connolly, PT, CAE
July 7, 2014

Provider networks are anything but a new phenomenon in the insurance industry. Payers have been engaging preferred providers for decades dating back to the managed care era. Consumers have had to factor in provider availability and coverage when selecting a health plan if they were involved in such a selection process. This process of consumer choice has been magnified by the adoption of the individual mandate included in the Affordable Care Act (ACA). Likewise, once the initial choice is made, patients must make decisions at the time a health care need emerges—do I stay in network and pay less or choose to incur higher out-of-pocket expenses by accessing an out-of-network provider? Often, this is when they discover their provider of choice is not in the insurer’s network.

Getting Upstream


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.

Game Changers


Finding your niche for the 21st century.

By Ian Kornbluth, PT, MPT and Tom Walters, PT, DPT, OCS, CSCS

In the 20th century, the profession of physical therapy was considered a niche within the health and wellness industry. Physical therapists were specially trained practitioners who differentiated themselves by simply possessing a unique skill set in the areas of physical examination, rehabilitation, and treatment. This was a good time to own a physical therapy practice—competition was minimal and insurance companies were paying top dollar for these premium niche services.

Sharing Risks & Rewards


Owners re-assess the traditional models of hiring on salary.

By Deb Gulbrandson, PT, DPT

“No pain, no gain.” Physical therapists hear this a lot from patients who run five miles when they should have only run two, or something similarly challenging but unwise.

Recently private practice owners themselves seem to be suffering more pain and less gain, with decreased payment and rising expenses. In a service business, the highest expenses by far are employee costs, including salaries, taxes, and benefits. More and more, owners are re evaluating the traditional model of hiring a physical therapist on salary with benefits. For years, physician groups, accountants, and attorneys have been using a different model whereby individuals are paid in relation to the amount of revenue they bring in. Or, as I’ve heard it said inelegantly, “they eat what they kill.” For owners whose staff expect annual raises, while the per visit rate is flat-lining or worse, “something’s gotta give.”

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