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  • 2016-02-February

Growing Pains

By Lynn Steffes, PT, DPT

Many private practices focus on growing referrals and revenue while ignoring the expense of doing so. Keep in mind that if your practice has a 20 percent profit margin, every additional $100 in revenue you generate nets approximately $20 for your bottom line. However, if you save $100 in expenses, you will realize a net $100 gain to your bottom line.

Perhaps 2016 is the time to look at expenses that you may have ignored? Reducing your cost per visit by managing your overhead can create positive financial changes. Sit down and spend a little time reviewing each line item on the expense side of your profit and loss report.

A few items to consider that you may be ignoring:

  • Your petty cash spending: Is your practice “running to the store” for items regularly or are you doing bulk purchasing and taking advantage of any group purchasing on those items your practice uses every day?
  • Your subscriptions: Do you pay monthly for Internet services, magazines, and web services? Is there a better deal to be had or can a few be eliminated?
  • Your business insurance: When was the last time you really had competing bids? You can improve your premiums.

A few big items that you might address over time:

  • Your lease space: Is there an opportunity to approach your landlord to renegotiate? Should you consider downsizing or subletting excess space?
  • Your capitol equipment leases and purchases: Are you monitoring your return on investment (ROI) of large equipment? Do you have the right patient population? Services to support the item?
  • Your staffing mix: Do you have the optimal therapist, assistant, support staff, and administrative staff combination?
  • Your compensation: Do you need to reevaluate a base pay with incentive compensation model? Or address raises given without consideration of true financial performance?
  • Your benefits: Should you reevaluate your staff development plan and look to offer more cost-effective virtual continuing education opportunities in combination with traditional coursework?

Make 2016 the year you reduce your cost per visit and build a better bottom line from the expense side of the equation.


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.

Bob Worden, PTA, ATC, MBA, MS, CAGS

Bob Worden, PTA, ATC, MBA, MS, CAGS, is the Senior Partner of Pinnacle Physical Therapy in Plaistow, NH, and is a Partner in the Pinnacle Rehabiliation Network. He can be reached at Bob@Pinnaclerehab.net.

Practice Location: Pinnacle Physical Therapy, Plaistow, New Hampshire

Who is the most influential person that enhanced your professional career? My high school athletic trainer, George Jessup, took me under his wing from 1969 to 71 as his student athletic trainer. He inspired me into my lifelong career in sports medicine. He taught me the balance of intellectual curiosity, family, friendship, fun, and hard work. Foremost, never being afraid to admit what you do not know and to research the answer.

What is your favorite book? How to Win Friends & Influence People by Dale Carnegie. Demonstrating honest and sincere appreciation and being genuinely interested in other people are lessons entrenched in my daily life.

What is the average flow of your day? Every day, I prepare for and treat a full patient load. Managing the business within the style of the one-minute manager rules and managing by walking through the practice allows me to keep up with the daily clinic tasks, community activities, and American Physical Therapy Association (APTA) involvement. Every day ends with a call to my wife and three adult children to help keep the train running on the tracks.

What is your business philosophy? First, we market our practice through each and every patient by providing evidence-based individual physical therapy. Paying attention to the patients’ physical, psychological, and social needs is critical to that end. Marketing our physicians through our patients has given us an incredible growth and retention rate. Developing strong intrapersonal relationships with our patients and stressing our role as their primary care musculoskeletal specialist for life is our mantra. We always want to be the first call to service any orthopedic needs.

Second, we believe you cannot keep what you have unless you give away what you have! We spend considerable resources to support community programs. Sponsoring school activities, sports programs, the Lions Clubs, Knights of Columbus, the senior center, the local food pantry, Wounded Warriors, Coupons for Military Families, the Chamber of Commerce, and The New Hampshire Lions Camp Pride for special needs children with diabetes are our focal community organizations. This has graced our reputation as a socially responsible member of the business community.

What is your business motto? The harder you work, the luckier you get! If you have fun at work, you never work.

What have been your best learning experiences since the inception of your practice? Being an active member of the New Hampshire American Physical Therapy Association (NHAPTA) Board of Directors, Legislative Committee, and New Hampshire Physical Therapy (NHPT) Political Action Committee cofounder has given me great insight into APTA, knowing resources and furthering my belief that change is possible through involvement. New Hampshire is a state that proves the adage that all politics are local. My three years of service on the American Physical Therapy Association (APTA) Models of Service Delivery Task Force was an incredible experience. Sitting at the table with the best in our profession was instructive and powerfully inspiring.

What are the benefits of being a Private Practice Section (PPS) member? Having incredible resources and educational opportunities has helped guide our practice through the ever-changing health care environment.

How do you motivate employees? Each practice owner is truly a human resources director. You need to keep every employee’s life balance as a priority. Family should always come first. Reward measurable positive performance generously and lead by example. Patient care should be fun. When it is not, then it is time to reassess. Often the easiest solution is time off to recharge.

What have been some of your best and most difficult decisions? Joining the Pinnacle Rehabilitation Network as an affiliate LLC member was my best career move. It allowed me to focus less on management and dedicate our team energy to patient care. Choosing my clinical partners Barbara St. Jean, PT, DPT, and Eric Combs, PT, MSPT, who manage the clinical practice, provides balance to management. We added Zac Blais, physical therapy assistant, to our staff allowing us to implement many of the models of service delivery task force recommendations, and this has given us a seamless team approach to patient care.

The toughest decision was removing a failing employee. In spite of the painful nature of this process, learning that addition by subtraction was a valuable lesson.

What worries you about the future of private practice? The triple aim philosophy of delivering the lowest cost physical therapy services, positive outcomes, and high patient satisfaction may not pay the dividends in patient market share it should. We are seeing take it or leave it unfair contracts without negotiation. Intermediaries skimming off clinical reimbursement by discouraging care with unnecessary burdensome administrative work and unfair denials. Hospitals and insurers teaming to collect patient insurance premiums in an Accountable Care Organization (ACO) arrangement may preclude private practice referrals. It is troubling when our cost for services is often one-third of that arrangement.

I am hopeful evidence-based manual therapy performed cost effectively will prevail. Educating the public and legislating consumer protection laws will allow us to compete on a level playing field.

What are new opportunities planned for this year? We will continue to generate new relationships with our expanding patient base, extend a new relationship with a new Young Men’s Christian Association YMCA (or Y) in our town while continuing to focus on developing further manual therapeutic interventions. 

Growing the Brand

By Dr. Chris Wilson, PT, DPT, CHES

At the Private Practice Section (PPS) annual conference in Orlando this past November, the Membership Development Committee convened to create a strategic plan for the next few years. Collectively we are excited with the new direction and initiatives we are working on.

First, one of the undertakings is a reimagining of the student business concept contest. Last year we added a checklist to help provide guidance and remove barriers to applying. However, we have found that the variance in projects is so vast it is in need of a major overhaul to level the playing field. Our goal is to simplify the process for both the students and those reviewing the submissions.

The next idea takes a systematic approach to defining the value of the Private Practice Section (PPS) to members and potential members. Too often when we review surveys about why people are members the overwhelming answer is: “the people.” Great, I love the people, too, but if that is the only reason or the first reason that comes to mind, good luck growing and sustaining a membership base in the mobile and social media age. Further, if the main reason is networking, that represents one type of member and demonstrates our failure to deliver to other membership types. To address this, we plan to create a “win bank” to quickly and objectively demonstrate and recall the value that we provide and the success that we have had in supporting the physical therapist in business.

Finally, we are going to target at least two sections to learn their needs and identify means to deliver on those needs to grow our membership and our brand while helping guide other physical therapists to success in business. The net result of this and other activities will be a net growth equaling and surpassing our best year out of the previous five.

Thank you to Anna Moore for her mentorship in preparing me for my role as the new chair of the committee and her leadership in general as the outgoing chair. Thanks to Audrey Waldron and Kathy Stenslie for their years of dedicated service. Thanks to Clay Watson and Robert Snow for staying on the committee. And welcome to Charlie Bigelow, Kelly McFarland, and Scott Hebert.

Food for Thought

By Stacy M. Menz, PT, DPT, PCS

There are great articles in this month’s edition of Impact focusing on customer service, which approach the topic in different ways. I found the articles to be very informative with multiple take-home strategies.

Stephen Albanese lays out a “Roadmap to an Amazing Patient Experience.” This roadmap includes the idea of full staff engagement and looks at the patient experience from all angles throughout the process. The roadmap spells out each touchpoint for patient interaction, discusses the Platinum Rule (which is a step beyond the Golden Rule in my opinion), and looks at feedback as growth opportunities.

Jerry Durham and Ann Wendel break down “The Customer Lifecycle” so that you can get a glimpse into how they create a customer for life. They have three specific customer touchpoints that they focus on: before, during, and after. The three areas are evaluated so you can put a plan in place to ensure your customers return.

Jeff Moore looks outside the box at “The Other Side of Customer Service.” He focuses on educating the community and the public on how physical therapy can benefit them. He pinpoints go-getters who want to make a difference in their community and consequently in the lives of their customers.

After reading these articles as well as all the other articles in this issue and online, I am excited to work toward implementing some of the ideas offered and bringing the thought of customer service to my staff. I am curious to hear and discuss their perspectives as related to how we can continue to enhance this essential area.

What are things that you and your business do well that create an exceptional customer experience?

And finally, you probably noticed that this month’s president’s letter is replaced by a committe report. Terry will submit his letters quarterly going forward and in other months we will share committee reports to keep you up to date on all association news.


Summitting the Direct Access Peak


Applying 7 steps toward sharing our diagnostic abilities!

By Lynn Steffes, PT, DPT

As a huge proponent of direct access in physical therapy I am stunned at how often some degree of direct access is available by law and accessible through many third-party payers and yet poorly exploited by both patients and physical therapists themselves.

I am convinced that one of a private practice’s greatest opportunities to continue to gain market share in your community lies in maximizing direct access. What are the underlying barriers to direct access? Many people believe that it might be law or third-party payment, but I think it is much more than that.

For five years, I have had doctor of physical therapy students in my home state of Wisconsin (which has been a direct access state for over a decade) survey individuals about their perceptions regarding physical therapy.

A few of the key questions have been related specifically to direct access.

  1. Can you seek services of a physical therapist without a physician referral?
    1a. If your response is “yes,” would you seek those services?

The trend over the past few years has been an increasing number of “yeses”—an awareness that direct access is possible. However, many report that they would not go directly to a physical therapist for fear that:

  1. Their insurance would not cover therapy without a physician referral.
  2. They believe that they must first visit their medical doctor to “determine what is wrong” or “to be given a diagnosis so the physical therapist knows what to do.”

Bottom line the survey says… I can see a physical therapist, but they cannot diagnose the problem. This is a huge barrier that we must overcome!

7 Simple Steps to start your climb

  1. Study your individual state’s direct access laws and develop policies that maximize your use of them.
  2. Study your top five third-party payers and know their specific policies of the need for referrals and develop policies that maximize them.
  3. Script your entire team on the strongest direct access policy application. Focus first on your receptionists and anyone involved in the intake process.
  4. Create a simple direct access message and post it on your website, put it in your consumer collaterals, publish it in your patient welcome packet, and send it as a follow-up email reminder after discharge.
  5. Each time you call to verify benefits for a new patient, determine the specific direct access policy, and, if available immediately, educate your patients about its availability for their future care. Be sure to tell them that this applies also to their family members (and coworkers) who are on the same policy.
  6. Create a strong narrative approach to therapist’s history taking and examination—demonstrating that we are able to medically screen for red flags /other diagnoses and that we are capable diagnosticians without the costs and risks of imaging. Be certain that your patient understands that you would seek additional medical consult if needed—either during the evaluation or later in the course of care. Let them know that you will communicate with their physician or other health care team members with or without a referral as needed and agreed to by the patient.
  7. Reference your training and restate your ongoing assessment over the course of care and reemphasize direct access for additional care.

Begin your climb today!


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.

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