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  • 2014-09-September

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.

Please Participate

By Tom DiAngelis, PT, DPT

At this time of year, I would be remiss if I did not mention the two most important events that the section gears up for and ask you to participate. I am referring to the PPS Annual Conference and the elections for PPS office this November.

Attendees of the PPS Conference know it has been the place for private practioners to gather and share ideas for decades. The conference has grown significantly over the years—the quality of programming has steadily improved, and PPS has been able to provide more and more for members. While the expense has risen drastically, we have been able to maintain the cost at the same rate. This is in part due to improved attendance, excellent management by our outside conference-planning group, Let’s Meet, our staff, and the increasing number of exhibitors who want to attend. Let’s Meet and the PPS staff have created great demand for the exhibit hall so that we now have waiting lists for exhibit hall space—which helps keep attendance price reasonable. I encourage you to visit the PPS website (www.ppsapta.org) to read about the great lineup of conference speakers this year. The Program Work Group has done an excellent job of providing topics that are relevant to our practices today, as well as help us plan for the future. The annual conference is where the best networking opportunities are for private practice. Do not miss this opportunity that could significantly impact your practice for years to come. If you are attending, download the conference app (PPS 2014) to your smart phone so you can have it all at your fingertips.

The most important event at this year’s conference will be electing new members for the Board of Directors. This is a big election year for the Board as we elect a new president and vice president, as well as one director. We must commend the Nominating Committee—that also has a position on which we are voting—for providing us with a great slate of candidates from which to choose. Their candidate statements were in the last edition of Impact and are available online. I urge you to respect those who are running for office by reading their statements and voting. If you have questions for them, send them an email or call them directly—your vote is important. It is disheartening as a candidate when you work so hard and see so few of our members participating in such an important event for the section, so please cast your vote. Remember, you do not have to attend the conference to vote as absentee voting is available. You can also find information for absentee voting on the website.

This is your opportunity to participate in the two biggest events of the year for PPS and for you as a member. Thank you for your membership and your participation.


Patient or Customer?

By Tannus Quatre, PT, MBA

Health care has roots in tradition and authority. Medical providers—experts in the human condition—have long been put on pedestals by those they serve out of respect and reverence for their knowledge. While there is nothing fundamentally wrong with a relationship built on respect and admiration, some believe that the inherent imbalance of power between the provider and patient has perverted basic market influences such as customer choice, price transparency, and competition.

As consumers bear increasing financial responsibility for their care, a shift is occurring in which consumers are becoming more discriminating with regard to choice of provider. This shift is coming as a shock to many providers entrenched in the health care paradigm of yesterday.

Acknowledging this shift and responding to it with an approach to a market that views consumers not as patients (old paradigm) but rather as customers (new paradigm) will allow providers to continue to evolve our profession in a way that serves new demands as they come our way.


Tannus Quatre, PT, MBA, ATC, CSCS, lives at the intersection of physical therapy and entrepreneurship, spending his time helping physical therapists build and operate successful practices through his company, Vantage Clinical Solutions. He specializes in marketing, finance, and business planning, and authors and speaks regularly for the APTA and PPS. He can be reached at tannus@vantageclinicalsolutions.com.

How to Get 120 New Patients

By Paul Martin, PT, MPT, CBI, M&AMI

I have a strategy that will bring you more than 120 new patients in the upcoming year if you commit to doing it. This strategy builds “real” relationships with physicians. So often, we as physical therapists believe that we can build a relationship with physicians simply by stopping by their office or bringing them lunch. Been there, done that—those strategies are getting old. If you really want to build relationships with physicians you need to create social situations where physicians actually let their guard down and have a little fun.

Commit to a discipline of one social outing with a physician every month over the next 12 months. Take the physician to his or her favorite sporting event, concert, show, golfing, fishing, or to his or her favorite restaurant—anywhere that you can create a relaxing atmosphere and the physician will actually have fun! Consider taking your spouse and inviting the physician’s spouse. Or better yet, take one of your therapists and request that the physician bring a guest. A small group will stimulate interesting conversation. And no, do not talk about how great you are as a physical therapist. Find things in common to give you a reason to get together again, or at the very least stay in contact due to a common interest. This is true relationship building and you will get at least 10 more referrals a month from each physician. That equals 120!!


Paul Martin, PT, MPT, CBI, M&AMI president of Martin Healthcare Advisors, is a nationally recognized expert on health care business development and succession planning. As a consultant, mentor, and speaker, Paul assists business owners with building value in their companies. He has authored “The Ultimate Success Guide,” numerous industry articles and weekly Friday Morning Moments. He can be reached at pmartin@martinhealthcareadvisors.com.

Mark A. Anderson, PT

Mark A. Anderson, PT, is president and founder of Mountain Land Rehabilitation in Salt Lake City, Utah. He can be reached at mark@mlrehab.com.

Mountain Land Rehabilitation includes Mountain Land Physical Therapy, Brighton Rehabilitation, Western Rehabilitation Health Network, and Mountain Land Rehabilitation Home Health with 32 outpatient clinic locations, six hospital contracts, 49 skilled nursing facility contracts, two home health agencies and 60 home health contracts, and 950 full- and part-time employees. The practice was founded 29 years ago.

Most influential person who enhanced your professional career and why: The most influential person in my professional career was my grandfather. Growing up next door to him, I spent considerable time with him as he ran his small business. He taught me not to be afraid of taking risks and to work hard. He also taught me the “Golden Rule—to always consider what is best for others as you do business with them.”

Describe the flow of your average day and when or if you still treat patients, perform management tasks, answer emails, and market: My career path has led me out of clinical practice and into various management roles within our organization. As president, my primary role is to develop and implement the organization’s strategies. I am involved in business development, market forecasting, and business relations. I am involved in state and federal government affairs, with focus on health care regulation and legislation.

Describe your essential business philosophy: Promote our vision and core values throughout the organization. I place great value on my partners, our employees, and our patients. Everything we do should assist all stakeholders to achieve their greatest potential.

What have been your best, worst, and toughest decisions? Hiring the right people for the team is the most important decision we make. Finding exceptional people who share our values and are passionate about our profession is paramount in achieving success.

How did you get your start in private practice? In 1984, I opened an outpatient practice in Park City, Utah. I practiced out of an old house with the waiting room in the front room and hydrotherapy in the kitchen. It was a lot of fun.

How do you stay ahead of the competition? I strongly believe in an abundance mentality. Over the years, I have gone to great lengths to work with and collaborate with our competition. From forming therapy networks to establishing study groups, I have never regretted building rapport. I was taught many years ago by my first physical therapist employer that having an exceptional therapist open up an office down the street is actually a positive, not a negative. High quality, ethical competition is good for everyone.


What are the benefits of PPS membership to your practice? I have been going to PPS conferences for as long as I have been practicing. I owe much of my understanding of the business side of physical therapy to my peers in the PPS. I always come away from PPS fall conference with many new pearls of wisdom. I also have gained countless friends and resources within the membership of PPS.

What is your life motto? Make work fun, and it is no longer work. One of our core values is “have fun.” I believe I am the champion of this core value.

What worries you about the future of private practice/what you are optimistic about? I am concerned that payors may lose perspective of the value and worth of physical therapy. Unscrupulous business practices and referral for profit scenarios tarnish our reputation. I am optimistic for the growing need for physical therapy care for an aging population. We are the cost-effective alternative to promote independence and function within this population.

What new opportunities do you plan to pursue in the next year? We are building expertise in several niche areas. We believe that diversifying from third-party paid services is an important element of our future success. We also are on a quest for standardizing our outcome and electronic medical record data collection to better prepare for case rate reimbursement and affordable care organization collaboration opportunities. 

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