Only outcomes data will tell.
By Heidi Jannenga, PT, DPT, ATC/L
It is 2016—and we are living in a world where everyone wants to get more for less, even in health care. In fact, our entire country is in the midst of a massive health care reform effort, much of which is focused on delivering higher-quality care at a lower cost—which explains why so many of the recently created health care regulations, programs, and payment models reward value.
So, how does this impact physical therapists? We know our services are valuable, but unfortunately, that value is not widely understood or accepted among payers, patients, or other providers. It is our responsibility to change that—to make sure everyone knows how valuable physical therapists really are. This will ensure we do more than survive this new, value-based health care environment; we will thrive. First, we must actually prove the value of our services, ourselves, and our profession. And we must do so objectively—with outcomes data.
The Triple Aim
You may be wondering why tracking patient outcomes is so important all of a sudden. While it has always been an important aspect of evidence-based practice, the demand for this type of data collection has amplified in the last few months as a result of the Institute for Healthcare Improvement’s Triple Aim,¹ which is the driving force behind US health care reform. As the name suggests, the Triple Aim has three main objectives:
- Achieving better results (i.e., better patient outcomes)
- Decreasing the cost of care
- Increasing patient satisfaction
If you have been practicing for even a short while, you know how common it is for things in the policymaking world to move at a turtle’s pace. However, that is not the case here. In fact, the federal government is not wasting any time in its quest to reduce health care spending. To that end, in 2015, the US Department of Health and Human Services (HHS) announced it will:
- Base 30 percent of all Medicare fee-for-service (FFS) on alternative payment models by the end of 2016.²
- Increase that proportion to 50 percent by 2018.²
- Link 85 percent of FFS payments to outcome measures by the end of 2016.²
- Bump that percentage to 90 percent by the end of 2018.²
This rather aggressive timeline means that providers who do not jump on the outcomes-tracking train may end up feeling the pinch of an even more dire payment situation. Think about it: Medicare payment rates are already a common cause for complaint—and private payers tend to follow Medicare’s policy lead. So, in all likelihood, most—if not all—payments will be linked to value within the next few years.
So, what is outcomes tracking, anyway? In short, it is a way for health care providers to objectively measure patients’ functional progress and success via outcome measurement tools (OMTs). Typically, patients complete these at the onset of care, at the end of care, and at various points between. Of course, you, as the physical therapist, are able to see each patient’s progress, but the only way to draw meaningful conclusions about your patients’ progress overall—as well as your staff’s performance as a group—is to track those outcomes in an objective and scalable way. In other words, in order to demonstrate your value as a physical therapist, you need data—and outcomes tracking is the best, most logical method of obtaining that data.
Now, that being said, there is a big difference between merely recording numbers and generating meaningful, actionable insights, because when you do the latter, you can achieve three really important things:
1. Improve Patient Care
Outcomes data is unique, because it is tied to the efficacy of care. When providers can proactively collect and analyze this information themselves, they gain insight that they can use to improve care, streamline operations, identify best practices, and guide business decisions. The benefit of outcomes data does not stop at the individual provider level: When therapists create a large pool of collective data with the intent to improve patient care, the entire industry benefits, because we gain the ability to prove the effectiveness of physical therapy across the board. When we do that, payer networks will have more of an incentive to make physical therapy widely available and affordable to beneficiaries, which means patients will have better access to our cost-effective, noninvasive treatments.
2. Influence Payment Rates
In the past, many therapists shied away from collecting outcomes data because they were afraid it would negatively impact their contracts and, as a result, their finances; and that fear had some merit. Luckily, though, times are changing, because more of the data we are collecting today actually reflects the value we provide our patients. As an industry, we have the opportunity to demonstrate our ability to improve our patients’ lives and highlight the downstream cost savings we achieve. Once we collect enough data, we can leverage it to negotiate better payment rates, boost referrals, and even advocate for policies that ensure we are taken into consideration for future payment models. The more data points we gather, measure, and transform into meaningful, actionable information, the more influence we will have in creating the future we want.
3. Position Physical Therapists as Key Health Care Players
According to a research study cited by the American Physical Therapy Association (APTA),³ patients who seek therapy early in the course of treatment for low back pain generate significantly lower health care costs than patients who do not. And that is just one study. There are plenty of other musculoskeletal conditions for which this holds true. Unfortunately, it seems we might be the only ones who know this—because the general public does not. And with collaborative care models becoming the new norm, it is time we step in and claim our position as primary care practitioners—and command the recognition we deserve. To do so, we need concrete proof that definitively shows the results we are capable of achieving. In other words, we need outcomes data—and the right kind of outcomes data at that. This means we must:
- use standardized tools to collect outcomes data,
- select measurements recognized outside of the rehab therapy realm, and
- push to make our findings more widely available outside of individual clinics.
The Benefit to Your Practice
By now you know that outcomes data is an important piece of the proving-our-value puzzle—and that it impacts both care quality and payments. You also know that if physical therapists produce outcomes data on a large enough scale, it will help all of us better assert ourselves as neuromuscular experts. But those are longer plays. What about some immediate gratification? Well, as it turns out, outcomes data actually can help you be a better physical therapist and run a better practice—now. That is because you can use the data you collect to:
- Better assess clinical performance through benchmarking.
- Compare your clinic’s data to various data points for clinics in your region/specialty.
- Identify areas of need/competitive deficiencies and create correctional plans.
Sounds good, right? Now, on to the tactical stuff.
We are all clear on why outcomes data is beneficial and important, so let us talk about how to start tracking it. First of all, you can breathe a big sigh of relief, because you’re probably already completing outcomes tools and recording the information as part of your standard documentation, which is great. All that is left, then, is to establish the right processes and implement the right software—because to collect and analyze data in an accurate, timely, and consistent manner, you will need some type of software.
Of course, if you prefer to administer paper tests to your patients, you can still print them out, but it is best to record and store the results in a therapy-specific outcomes tracking software. I suggest doing so in a user-friendly, web-based system—preferably one that integrates with your electronic medical records (EMR). That way, you do not have to waste time—or risk any associated errors⁴—with double data entry. Plus, the system will instantly record the data you collect within the appropriate medical record. This type of software makes it much easier to hold yourself and your staff members accountable for consistently collecting outcomes information. This last step is important, because with any data-tracking endeavor, consistency is key.
Additionally, the right software contains a hand-picked library of evidence-based, industry-accepted tests that are already familiar to—and respected within—the health care community at large (e.g., QuickDASH, LEFS, Oswestry, Neck Disability Index, and Dizziness Handicap Inventory). You also want those tests to be risk adjusted for complicating factors such as age, weight, litigation, diabetes, cancer, and heart diseases, so you can easily and accurately compare different types of patients.
Now, collecting meaningful data will take a little bit of extra work, but think of it less as a burden and more as an opportunity—one that will soon be the norm. Like any worthwhile endeavor, the end result is worth it. Physical therapists have a huge opportunity here to shine in this pay-for-performance era—and to take the driver’s seat for a change. If we execute on this correctly, we will have the power to save our patients money, improve our clinics’ bottom lines, and solidly position ourselves as primary care providers. Now that is a win-win-win.
1. The IHI Triple Aim. Available at www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx. Accessed February 12, 2016.
2. Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. HHS.gov (2015). Available at www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html. Accessed February 12, 2016.
3. Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients with LBP. Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients With LBP (2015). Available at www.apta.org/ptinmotion/news/2015/4/9/adherentptlbp. Accessed February 12, 2016.
4. Goldberg SI, Niemierko A, Turchin A. Analysis of Data Errors in Clinical Research Databases. AMIA Annual Symposium Proceedings (2008). Available at www.ncbi.nlm.nih.gov/pmc/articles/pmc2656002. Accessed February 12, 2016.
Heidi Jannenga, PT, DPT, ATC/L, is the founder and president of WebPT. She can be reached at firstname.lastname@example.org.
Reflections from past winners of the Private Practice Section’s Student Business Concept Contest
By Dr. Chris Wilson, PT, DPT, CHES
Another great Private Practice Section Annual Conference has come and gone. Last year, I was lucky enough to attend as the 2014 winner of the Student Business Concept Contest. This year I took part as a Private Practice Section member as well as an owner. Serving on the Membership Development Committee, I had the privilege of meeting and interacting with this year’s winners first hand (as well as the fast moving newly-formed SSIG leadership). I was reminded of how much impact the Student Business Concept Contest had on me and thought it was a great time to reach out to other past winners and see if they had similar experiences.
First, let’s talk a little background. Every year since 2006, PPS has sponsored the contest with up to two students winning an all-expenses paid trip to the PPS Annual Conference. Destinations have previously included the Broadmoor in Colorado Springs as well as other resort-type destinations in New Orleans and Orlando. The financial value of the conference is estimated at $2,000 but the real value to the innovative students (who are selected based on their unique and complete business concept proposal) is found in the experiences they have.
In 2008, Travis Orth won. At the time, it was a much different contest—less about a business concept and more an essay contest about the future of private practice physical therapy. While Travis is still working toward a goal of opening a multidisciplinary clinic with superior patient care, he notes specific benefits of winning the contest. In particular, meeting the PPS president at the time, Steven Anderson. Anderson is the president of Therapeutic Associates. Thanks to their connection, Travis landed his first job and had numerous other offers based on connections he made at PPS Annual Conference. His advice to current students: “Talk to as many people as possible, just take in the whole experience!”
In 2009, Jeff Donatelle also won the essay contest by describing his aspirations to be a private practice owner. Jeff was smart to solicit the advice and editing skills of a mentor at the private practice in which he was finishing a clinical rotation. He notes that attending the annual conference as the student winner exposed him to innovators and forward thinkers who dominate the private practice section. It galvanized his resolve to work in a private practice physical therapy setting as well as instilling in him a unique understanding in the value of the PT PAC for which he has lead successful fundraising campaigns. He notes that it was a great experience and actively encourages today’s students to submit nominations.
In 2010, Mike Giunta was the first winner of the Student Business Concept Contest in its current format. His unique model revolved around incorporating community events such as food and clothing drives with wellness and fitness initiatives. Mike was also one of the first to bridge his idea into a real product that his clinic sponsors regularly. Like Jeff, he notes a primary benefit of winning the contest was the value derived in a unique networking opportunity. And, like Jeff, he also secured his first job outside of physical therapy school through connections made at Annual Conference. However, one unique value proposition he notes is that simply taking the effort to apply is a great exercise in thinking outside the box. He notes that developing a mindset of young professionals who think outside the box is critical to the future of the profession.
In 2012, Justin Lee was selected as one of the winners for his concept RevoPT. It was a unique way to create custom home exercise programs with smartphone technologies. Justin and his partner Michael Wehrhahn were further along than most in winning the concept having won some other awards and investors along the way. They approached the Annual Conference as an opportunity to sell their product and, in hindsight, view that as a mistake. Like the other winners, Justin noted the real value is likely the connections made and he was unable to make as many connections because of his focus on selling his product. However, he did gain a better appreciation for the business mindset and business considerations of private practice owners as a result of his participation. His big takeaway: You need to understand your value proposition and be able to articulate it in a way that is meaningful to your target audience.
In summary, there are a great deal of benefits from both submitting and winning the contest. In addition to an all-expenses paid trip to fantastic destinations, you are also developing an outside the box mentality, establishing a unique network of mentors, gaining a unique understanding of the business side of PT and possibly securing a great position after you graduate. Applications are due July 2015, so start developing your concept now and submit at http://www.ppsapta.org/c/StudentContest.cfm.
By By Tannus Quatre, PT, MBA
Our clients want to learn from us, and, in turn, we want to teach them. However, who has the time?
This is an issue faced by physical therapists everywhere. Outside of the patient care itself, how do we find time to educate, improve, and show value to our clients?
One way is by being a pundit.
While sometimes taking a bad rap (especially in the political arena) as “talking heads” or ideologues, pundits serve an important purpose in today’s media market. Pundits are (or should be) experts in a specific subject. They offer commentary and opinion and, through this guidance, provide value by creating a bridge between often complex information that could be of benefit to a patient if it could be understood.
Pundits do not produce the news; they make it relatable and interesting. They do not create the market, they speak to it. They do not publish the reports, they comment on them. They carry a light load.
As an expert in the movement sciences, your load can be light as well, all the while providing meaningful insights to those around you.
To be a pundit:
- Be on the lookout. Look for news and current events for which you have a relevant opinion, and share it with those around you. Topic areas may include news coverage of notable injuries, sporting events, or other health-related topics.
- Form relationships. To be a pundit, someone has to know you are (or want to be) one. It is the media’s job to make the news interesting. To do so, they need us—resources who can make their stories relatable and understandable. Reach out to local media outlets and nurture these relationships so you will be at the top of their minds when a pundit is needed.
- Be social. You do not need to wait for a news reporter to contact you in order to be a pundit. In today’s world in which all news is a mere click away, use your own social media channels to provide commentary about current events pertaining to your expertise. In many ways, your own social media channels can be the most effective for purposes of engaging a market.
- Share. Even if you do not have the time to formalize a written opinion about a trending topic, by virtue of sharing the information with those around you, an invitation to partake in discussion can be openly extended. A daily habit of sharing online links, quotes, or trending topics can take mere minutes, and provide vast opportunity to share your expertise with those who need you.
By Nitin Chhoda, PT, DPT
“If you cannot do great things, do small things in a great way.” -Napoleon Hill
When a therapist becomes a business owner and runs their own practice they are often faced with the decision of whether or not they want to grow their practice. From a numbers standpoint only, I am going to highlight why growing your practice makes sense. There are also other factors other than the numbers that could influence your decision with regards to growth.
A practice has one physical therapist, and all the revenue in the practice is generated by that physical therapist. This “primary physical therapist” is also the owner and has an income goal of $300,000 a year.
Let’s say the primary physical therapist:
- Completes 60 patient visits a week
- Gets reimbursed $80 per patient visit
- Brings in $4800 in weekly revenue
Assumption: The practice has marketing mechanisms in place that bring in 20 to 25 patients a week, with each patient scheduling an average of three appointments a week.
In this situation, let’s say the weekly expenses (including rent, utilities, and payroll of staff including the front desk salary) are $2,000. We have identified all four of the key practice metrics. The net profit of the clinic (total income minus total expenses) is about $2,800.
Even though the net profit is $2,800, the income goal of the practice owner ($6,000 a week based on the target of $300,000 a year) has not been met.
For this example, I am assuming that the corporate structure is a limited liability company (LLC). With an LLC, the profit of the business becomes the income of the owner. If you have another corporate structure, it is best to seek the advice of an accountant or certified tax professional.
Now, let us say that one additional provider is added to the clinic.
With the right marketing, the net profit of $2,800 continues and a positive return on investment takes place. The practice starts to grow. This creates the need to hire an additional therapist.
If an additional therapist was brought into the clinic, and he / she also had the same productivity, then that secondary physical therapist also:
- Completes 60 patient visits a week
- Gets reimbursed $80 per patient visit
- Brings in $4,800 in weekly revenue
Assumption: With effective marketing and planning, you can fill the schedule of the secondary therapist. The secondary physical therapist has similar efficiency and similar revenue generation potential (treatment time, documentation time, billing methods) as the primary provider. Expenses see a nominal increase because systems and software to automate and streamline documentation, billing, and marketing are already in place.
Now, let us assume that the salary of this full-time physical therapist is $40 an hour, including benefits, so you are looking at $1,600 a week in expenses. The rest of your expenses do not go up. They stay the same and have already been taken into consideration in scenario one.
The net profit for the clinic from this secondary provider (total income minus new expenses that include the salary of this physical therapist) is about $3,200.
The combined income from the primary ($2,800) and the secondary ($3,200) is now $6,000 a week. This allows the owner to reach the objective of $300,000 a year in net revenue for the practice.
In this scenario, a one-man private practice owner can achieve financial independence by adding just one more provider to the practice. There is a simple, but powerful lesson here.
The Powerful, Life-Changing Lesson
As you add more providers, a significant portion of their income drops straight to the bottom line of the practice. With the first provider, a large part of the income is used to cover costs of rent, utilities, payroll, and miscellaneous costs.
In making the decision to grow, based on the above scenarios, its important to look at your “practice metrics.” Here are a few that you might consider:
- Weekly patient visits
- Average reimbursement per visit.
- Average weekly expenses (rent, utilities, staff, and miscellaneous expenses).
- Income goal
This data will reveal vital clues about where you are and where you should be going.
Based on your income goals, you can reverse engineer the financial trajectory of your practice. With simple numbers, you can pave the way to success.
To grow a practice, it is important to be in continuous marketing mode. Marketing is the engine that drives your practice. In any given week, the number of initial evaluations should meet or exceed the number of discharged patients if you want to grow your practice.
Understandably, this can be a challenge because marketing is not something we are taught in physical therapy school. This means that practice owners have got to be in constant marketing mode. As an owner, you can never take your foot “off the gas,” and you have to plan ahead for your practice.
The only way to be in constant marketing mode is by using the right systems and the right people. In fact, well-planned marketing campaigns that bring in a positive return on investment allow you to:
- Increase income
- Hire additional therapists
- Build your expert status with patients and physicians
- Reduce stress
If you are a private practice owner and a treating therapist, it is hard to juggle marketing, documentation, and patient care. However, the biggest breakthroughs happen when you pull yourself away from the day-to-day activities of your private practice and look at the big picture.
If you are just starting out, rent, utilities, and salary will be your biggest expenses.
As you become more advanced with your marketing, you can answer questions such as:
How much am I willing to spend on marketing, without hesitation, to acquire a new patient in my practice?
Knowing your maximum threshold here will help you reverse engineer your marketing budget, and allow you to make smarter decisions about how to grow your practice. This is called the patient acquisition cost or PAC value for your practice.
Before you estimate your PAC, you must know: your net profit per new patient. Typically, private practices make between 10 and 25 percent net profit per patient, but this depends on several factors like overhead and reimbursements.
For instance, If your average reimbursement (collected amount) is $70 per patient visit, and the patient comes in for 12 visits, your gross revenue is $70 x 12 = $840. Your net profit (after expenses like wages, utilities, rent, marketing) is $140 (which is 20 percent). The question now is—how much of that $140 are you willing to spend (on more marketing) to acquire new patients?
The top five ways to lower your patient acquisition cost
- Detailed tracking of your expenses with different marketing mechanisms (ask your accountant for help if numbers are not your strength)
- Identifying not only how many patients came in, but also where they came from
- Tallying up the numbers to identify your exact PAC and eliminating one mechanism each week (the one with the highest PAC needs to go)
- Word of mouth referrals from existing patients (the low-hanging fruit for growth in your practice)
- Engaging patients with current events and trending topics that interest / affect patients through workshops, newsletters, and social media
When it comes to growing your practice, it is the little things that matter the most.
Nitin Chhoda, PT, DPT, is a PPS editorial board member and is the chief executive officer of In Touch EMR and In Touch Biller Pro. He can be reached at email@example.com.
Tom Bates, PT, is the owner of Therapy Staffing and Outpatient Therapy Clinics in southeast Idaho. He can be reached at firstname.lastname@example.org.
Practice and location: Therapy Staffing and Outpatient Therapy Clinics, southeast Idaho
Practice specifics: Tom Bates has been practicing physical therapy for 17 years and today has seven separate locations varying from outpatient clinics, hospital-based contracts, and school contracts with 50 plus employees.
What or who is the most influential person/book/event? Without a doubt it would be my wife, Theresa. She has been a constant support and her dedication to our family through her role as a mother and spouse has allowed me to succeed many times over. I also am currently reading a book about the leadership philosophy of Bill Walsh. It has fantastic insight into how to be a highly successful leader with easily transferable tips for any business.
What is your average day like? There is no average day. I currently see patients in a couple of our outpatient settings three days a week and work on corporate issues one to two days a week. With as many different locations and types of therapy settings that the company is involved in, each day is somewhat unpredictable.
What is your business philosophy? My business philosophy has continued to transform over the years, but there are some constants that I feel are crucial to my success. I almost never say no. When physicians and patients made requests, our company tried to find a way to get it done. This built trust and reliability. I involve the patient as much as possible. The more invested and involved a patient is in the point of contact the more effort they expend. Have fun! Injuries stink, rehab should not. Uplift and laugh with your patients. I believe it is one of my best tools.
How did you start your practice? My first foray into private practice was with a fellow graduate and a company that invested in us. After a few years we split up assets and ventured out on our own. This has morphed into opportunities to contract with hospitals, schools, and outpatient clinics. Over the years, I feel the most important lessons I have learned are that there are some extremely bright individuals who work hard to be successful. Many of those people are members of the Private Practice Section (PPS) and are really willing to share philosophy, concepts, and tips on building a better business with you. You can read books and go to lots of courses, but if you want to be truly successful in private practice, join PPS and be involved. You are not on an island with unique challenges that no one else experiences. It will transform your practice, guaranteed.
What is your life motto: If you want it, go get it. If you are passionate about something, you most likely enjoy doing it and if you enjoy doing it, you will be better than the next person at that task. Life is simply too short to spend it doing something you do not enjoy.
What worries or excites you about the future of private practice? I do not worry about the future. I just look at contingency plans for every possible event. If you strategically plan for future possibilities and decide now what you will do in the heat of the moment you are going to make better decisions and are far less likely to fail. The things I see on the horizon are outcome-based reimbursement and cash-pay patients due to rising copays and deductibles.
What are new opportunities you see? Aggressively expanding our pediatric footprint. My wife and I want to leave a legacy in the form of a family-centered pediatric facility that gives back to the community, which has supported us in many ways.