By Michelle Collie, PT, DPT, MS, OCS
Over the course of my career, I have had numerous discussions about how to define and message what private practice physical therapy is. Why is it that physicians, nurses, and dentists can easily define what they do, while physical therapists often offer a long-winded and simultaneously vague explanation? How can we expect the public to understand the value of our services—and our role in health care—if we continue to have difficulty defining it?
With this in mind, I am delighted to share the happenings of the Private Practice Section (PPS) Marketing and Public Relations Committee. The committee’s objective is to provide marketing and public relations educational programming and tools for individual members to implement within their communities and with their local media. The committee wants to encourage a grassroots effort where members have the tools and the confidence to comfortably promote their practices and ultimately improve the public’s understanding of what we offer.
This year, a number of this committee’s initiatives have come to fruition. After two years of work, “The Fit Factor” has been launched. This interactive, online survey will increase consumers’ awareness of the scope of private practice physical therapy, drive people to local private practices, and provide a fun opportunity for people to benchmark where their physical health is compared to the rest of the population. Webinars will educate members about how this tool can be used in their promotional campaigns. And this is only the beginning; the Fit Factor website and collateral materials, including educational videos and newsletters, will continue to evolve.
Simultaneously (and in answer to numerous member requests), marketing gurus Lynn Steffes and Scott Wick are producing a wonderful series of videos covering things you need to know when planning your marketing, such as budgeting. They will cover areas such as internal, referral source, consumer, community, and outreach marketing. This series will ensure all members have a basic understanding of marketing and public relations and will improve results when utilizing the tools our committee develops.
This year, we are also excited to offer our membership professionally written monthly press releases. Previously, these press releases were available only to our media corps, a group of 100 practice owners around the country involved with our committee’s public relations campaign.
Finally, we want to hear about your success stories. How did you gain new patients from the Fit Factor? Was your press release picked up? Which of our new marketing strategies resulted in success? Sharing your stories will help other members and strengthen our profession in these changing times.
I am grateful for the leadership of the outgoing chair Don Levine who has developed a committee of dedicated, knowledgeable, and experienced members. I would like to thank Scott Wick, Erica Meloe, and Jessica McKinney for continuing to serve on the committee, and I want to welcome our new members Darren Rodia and Jessica Burchett. We look forward to working together to effectively promote private practice physical therapy—and to help us all speak to our integral role in the health care landscape.
By Paul Martin, PT, MPT, CBI, M&AMI
As we analyze the best therapy businesses in the country, we are seeing more and more staff therapists becoming “owners” within the companies in which they work. This is a great strategy to retain your most valuable asset—your clinical staff. The challenge is to make sure that you structure these relationships in order to align your interests with your therapist partners, and to protect the parent company from potential legal issues in the future.
The most common form of partnership, if your state laws allow it, is to create a separate Limited Liability Corporation (LLC) in which the parent company becomes the majority owner, and the staff therapist becomes a minority owner. Be sure that ownership is purchased and never given away, and that the resources that are being provided by the parent company are properly valued and paid for by the newly formed company. These partnerships become a great way to build value in your company and create a strong foundation for future growth.
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.
Tim Pedersen, PT, is the owner of Synergy Physical Therapy in Fairhaven, Massachusetts. He can be reached at Tpedersen6@comcast.net.
Locations: Fairhaven, Massachusetts. 10 employees. Synergy Physical Therapy has been open for 5 years. Tim Pedersen has been practicing physical therapy for 25 years this year.
What or who is the most influential book/person/event that enhanced your professional career? There have been so many wonderful people throughout the years who have influenced, taught, encouraged, and guided me. I do not know if I have said this publicly before but Diane Cordeiro was one of my first supervisors and has been a friend and wonderful mentor for most of my professional career. She provides a benchmark that I aspire to emulate. Clifton Greenwood showed me what it means to truly care for the people that work for you.
What is the flow of your average day? I get in at 7 a.m. and open the office and take care of reviewing the clinic schedule, complete any paperwork, and usually begin treating at 8 a.m. I take some time each afternoon just before lunch to follow up on emails and other business matters. I enjoy treating patients so I do a lot of treatment hours each week. After five years I am starting to carve some time to work out more regularly in the evenings and prioritize my time a bit more.
How would you describe your essential business philosophy? My philosophy is to provide the best personal service to our clients. They should never feel like they could be doing their clinical program without us. A patient needs to feel that their time is well spent, that they are not just one body among many, and that we care about them. Even an unsuccessful course of therapy is a win for us if they feel that we listened to them, educated them, and did as much for them as we could.
What have been your best/worst/toughest decisions? The tough decisions are when to hire additional staff and when to fire staff. Show compassion in every daily interaction and things generally run smoothly, but you have to know when to cut the cord or be disciplinary and that is not always easy. I think the toughest thing to do is to manage the balance between my clinical time, administrative time, and personal time.
How do you motivate your employees? I motivate my employees by seeking their advice and opinions on what directions we should take, what equipment they want, and what training and education is important to them. I also motivate them by showing them that I value their time and their opinion in what we do. Our staff is very important to me and I want them to feel like a family team so that they are each vested in each other’s success as well as the clinic’s success.
How did you get your start in private practice? I had always wanted my own practice. I had been a manager for many years, then started and grew an outpatient practice for another organization. While I loved them, it was not mine and was never going to be. A clinic closed in my town and I saw it as an opportunity. After a lot of planning, projecting, and discussion with my wife, I decided to move ahead. She was teaching Zumba so we saw it as an opportunity to provide additional exposure for the new clinic. We wrote a lot of clinic names on scraps of paper and napkins but ultimately fell in love with Synergy, which is defined in the Merriam-Webster Dictionary as “the cooperative effort of two entities to achieve a more successful or productive result”—the patient and the therapist, the therapy and the fitness work together to achieve better health. It seemed to fit.
How do you stay ahead of the competition? We are constantly learning and striving to provide the most individual therapy programs. We do a lot of learning. We place the emphasis on our patients and we make sure that our communication to the physicians is short, clear, and concise to show that we value their time.
What have been your best learning experiences (mistakes) since the inception of your practice? Every day is a learning experience. I have been involved in running a clinic for many years but still learn new things about contracting, billing, and running the practice all of the time. I think that Rick Gawenda’s seminar on outpatient therapy Current Procedural Terminology (CPT) Coding, Billing, and Documentation was a great resource for keeping us set up for compliance.
What are the benefits of Private Practice Section (PPS) membership to your practice? I love getting each issue of Impact, which keeps me up to date on changes within the profession, insurance issues, and management. It gives me some focus on running my practice. PPS membership provides me with networking opportunities that help me run and grow my practice.
What is your life motto? Love, learn, enjoy your family, and never ever be afraid of hard work.
What worries you about the future of private practice physical therapy/what are you optimistic about? I am very optimistic about the future of Direct Access and the autonomy of the physical therapy practice.
What are some new opportunities you plan to pursue in the next year? We are evaluating electronic health records/electronic medical records (EHR/EMRs) and are hoping to increase our involvement in the community.
How adding a student can amplify growth.
By Anthony Sinacore, ATC, SPT
It is not easy deciding how to add on to your already strong and promising business plan, especially when everything is going well. Your revenue is building, your clientele is strong, and you are marketing yourself well within the community; you have done your homework. But like anything else, you also know that it is not going to stay like this forever and that every day you grow, your competition grows as well. So now you are forced to make a difficult and strategic decision—one that could help set you apart from everyone else, but one that also has the potential of financial repercussions. And let us face it, your chief financial officer, managing partners, or investors will not like the sound of change when your bottom line is beginning to blossom. So what can you do to keep your business ahead of your competitors, even before you feel them as a threat?
There is a way to meet these goals, a simple and safe way that bypasses the “high-risk, high-reward” decisions that practice owners face when on the brink of future growth of their company: Add a student into your clinic.
As a third-year student myself, all of my experience has come from clinical rotations. I may not have the years of wisdom of some of the authors in this issue, but for the last seven years, I have become really good at immersing myself within a variety of clinic settings. You read that correctly: seven years. (Three were from athletic training school where I spent time in physical therapy–based clinics; three from physical therapy school; and one year in between when I worked in an outpatient orthopedic clinic as a certified athletic trainer and rehab aide.)
For 16 to 20 weeks at a time, I have been able to take a glimpse into how each company’s day-to-day operations can bring them one step closer to meeting quarterly goals and showing value within their community. I have experienced good clinics, bad clinics, and great clinics; and I have noticed certain characteristics that tend to separate one from another. Though all of them (aside from the year that I was employed) have taken on a student, it is the way they each utilized their students that was a key factor in this separation.
Benefits to Your Employees
As a practice owner, students can be your safe haven for boosting morale. It is easy to get stuck in a rut with day-to-day practice, and an easy way to incentivize your employees is to have them become certified clinical instructors (CIs). With a little bit of encouragement, all students want to learn how to treat patients. Otherwise, why would they spend so many tuition dollars to be there? So even if it starts with only a few patients per day, a student can be that extra set of eyes or hands you need to help correct faulty mechanics, continue with someone’s treatment diary, or educate on the importance of a home exercise program. This extra bit of help can make all the difference between therapists working only to keep their productivity up versus providing a higher quality of care. One thing I have noticed at almost every clinic where I have worked is that documentation continues to increase, and the workday grows longer because of it. So it might be a difficult transition initially, but having a student in their second or third year of physical therapy school who can take half or one-fourth of your caseload can save you time to work on documentation while maintaining clinic productivity standards.
Improve Patient Outcomes
Another benefit of having a student is that they can keep you up to date with the latest evidence. This idea is no gimmick; it is the truth. Since the transition toward the doctor of physical therapy (DPT) degree, programs have further institutionalized the use of evidence-based practice (EBP) within their curriculum. More importantly, clinicians who have been practicing for more than 15 years and still have only a bachelor’s or master’s degree need to work harder to keep up with current literature.
The American Physical Therapy Association (APTA) conducted a survey in 2002 in which 488 therapists discussed their personal beliefs and utilization of EBP in their practice. Of this sample, 84 percent indicated that they agreed or strongly agreed that they needed to increase the use of evidence in their daily practice. Additionally, 65 percent reported performing fewer than two database searches per month, and 74 percent reported using professional literature in the process of clinical decision making five or fewer times per month. What I thought was significant was that nearly half of the respondents (46 percent) indicated that “insufficient time” was the biggest barrier to using evidence in practice and nearly 67 percent rated insufficient time as one of their top three barriers. The article further noted, “A large proportion of our respondents indicated that they were interested in improving their skills related to incorporating evidence into practice.”1
We have already mentioned that a common complaint is that there is not enough time in the day. So how is it possible to review and implement new evidence through the week?
Simple. Host a student.
A student will want to prove to their clinical instructor that they know how to take the information learned in school and implement it into practice. Inspire them to teach you something new while with you. As a goal, you can discuss with them the importance of learning from each other. You are obviously there to instruct them and assist them in becoming an experienced professional, but if they can inform you of any practice methods with lacking or no scientific evidence, how can it hurt your practice? This is an opportunity to help build the confidence of the student while endorsing positive and timely outcomes for your patient. Plus, I do not know of any managing director who would dissuade anyone from continuing his or her education relatively free of charge and without taking any paid time off.
It may also be beneficial to have students track patient outcomes using validated measures and compare them to old practice methods. This method can hold students accountable for the care they are providing.
If time is your biggest enemy, you can maximize efficiency by learning and mentoring at the same time. Education. Is that not why they are here?
Obviously, this idea of hosting a student does not have to focus on helping out your bottom line. As is the nature of the job, clinicians enjoy educating people on their skill sets. We teach patients every day about what we do and what they can do to “optimize movement and improve the human experience.”2 So naturally, adding a student can be another opportunity to educate and impact someone early on in his or her career. Individuals who are successful in private practice did not arrive at success by chance. With a wide understanding of the human body combined with numerous years of experience, successful clinicians gather their own “clinical pearls” along the way. It would be my guess that these hints of wisdom are a large part of what makes each clinic successful. What better way to create a legacy than to help students practice with the same methods that helped you prosper?
Networking with Their School: A Key to the Future
Let us not forget how the student got to you in the first place. Whether they are attending a university in your general area or not, keeping a relationship with their program can help preserve your clinic’s visibility.
Ideally, you are going to want to continue hosting students at your clinic and an easy way to do that is by gaining a reputation as one of their “go-to” clinical sites. Advertise your clinic’s strengths. Is your practice heavily manual therapy based? Does it offer women’s health services? Do you treat neurological pathologies? These are all qualities that can highlight your company in the midst of a long list of potential clinical affiliations. A 2005 study published through the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) looked at the availability of thrust manipulation training within physical therapy programs’ clinical opportunities. The study found that 70 percent of the directors of clinical education were unsure which sites employed clinical instructors trained in thrust joint manipulation, and 85 percent did not consider whether thrust joint manipulation training was provided when scheduling the experience.3 This study expresses that a relatively untapped resource exists for promoting and marketing your niche practice to schools across the nation.
So simply put: If there is a university in your area with a physical therapy department, reach out to them. Hold meetings with their director of clinical education and discuss how your goals can align with theirs. If they are not in your area, maximize your exposure by keeping in contact with their core faculty. Express the value of placing a student in your clinic and what skills they will acquire during the rotation to advance their skill set. In time, this relationship could even open up opportunities for further collaboration; for instance:
- Guest-lecturing classes within their didactic curriculum
- Becoming a clinical faculty member and assisting during lab sessions or site visits
- Sponsoring a continuing education course (I am sure any program could use your help with the “Pittsburgh-Marquette challenge” hosted by the APTA Foundation for Physical Therapy.4)
Creating a partnership in any way will always help promote your clinic. Once you have formed these types of relationships, the opportunities for you and your employees could be endless.
Create a Legacy
You do not need to have a large clinic to host students. I have worked in clinics with only one physical therapist, a physical therapy assistant (PTA) or two, and about two office employees. While most students will not ever get an opportunity to be in a clinic this small, I have found it to be one of my more valuable experiences. It was here where I was largely exposed to the administrative side of private practice. I can attribute the experiences I gained in this setting to being one of the main reasons that I joined the Private Practice Section, as well as to further aspire to open my own practice one day.
I realized that treating patients was only half the battle; the other half was the constant dealing with insurance agencies, physicians, health networks, and collection agencies. This was the first time as a student that I heard terms like “accounts receivable” or “sustainability management,” among other terms and factors that business owners must understand to keep their clinic afloat. Chiropractic institutions have historically done a good job educating their entry-level clinicians on managing and starting private practices. This standard is not as universal among physical therapy programs, which incidentally leads to a vast amount of fresh clinicians entering the workforce with little knowledge of the benefits of private practice. Hosting a student at your clinic can help promote small business and encourage students, such as myself, to push for what they may still consider “the American Dream.”
Who knows, by the end of their rotation you may have been unknowingly training a trustworthy and proficient individual who now understands your practice model. If the time is right and they are searching for a job following graduation, this may be an easy and dependable hire because “feeling out” and recruiting a potential employee who fits into your clinic can be difficult in itself.
References
1. Jette DU, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83:9: 786-805.
2. American Physical Therapy Association. Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision. 2013. www.apta.org/vision.
3. Boissonnault W, et al. Thrust joint manipulation clinical education opportunities for professional degree physical therapy students. J Orthop Sports Phys Ther. 2005;35:7: 416-423.
4. American Physical Therapy Association. Foundation for Physical Therapy. Pittsburgh-Marquette Challenge. www.foundation4pt.org/ways-to-give/marquette-challenge. Accessed on January 4, 2016.
If you are not capable of hosting a student in your clinic for whatever reason (cash-based, Medicare only, a violation of your policies/procedures) but would still like to offer assistance to students seeking advice on practice management, consider becoming a sponsored mentor to a student through the PPS mentoring program.
To find out more, contact ppsssig@gmail.com.
Anthony Sinacore, ATC, SPT, is a student in the University of Pittsburgh DPT Class of 2016. He currently serves as the vice president of the PPS student special interest group and is an editorial board member of Impact magazine. He can be reached at jsinacor@gmail.com.
Using automation increases efficiency, referrals, and profits.
By Steve Young, PT, DPT
Fourteen years ago and out of school only 16 months, I said “yes” to taking ownership of a struggling physical therapy clinic. My sense of excitement was only slightly overshadowed by a sense of burden: The clinic was losing $7,000 a month. I had before me the challenge and the opportunity to turn things around and to build the practice of my dreams.
My experience as a practice owner is that the growth of a physical therapy practice occurs in phases. The first phase is limitless optimism and lots of learning, next comes nailing down the structure and management phase, and finally the systematizing and automating phase. The automation phase of practice growth can be one of the most important and beneficial to your practice.
So what are the benefits of automation?
When you automate, you put systems in place that will generate beneficial output with minimal manual input. In other words, automation can produce benefit to your practice by utilizing minimal staff time or effort. Automation systems can help grow your profits, allow for you and your staff to use time more efficiently and productively, and help build the value of your practice while increasing the quality of your service.
So what can you automate?
You can automate many of the activities in your practice that are repeated exactly the same way more than a few times a month. Examples would be inventory management, generating new patients online, charging copays, sending correspondence to patients, prompting patients to write online reviews, education, and prompts to decrease patient cancellation rates.
What do you need to automate certain systems in your practice?
Depending on what you want to automate, the resources can vary. In most cases you may want software that has autoresponder capabilities, credit card process capabilities, your electronic medical record (EMR) system, and a mind mapping software or a whiteboard to map out clinic processes.
Let us explore several useful ways to use automation that when implemented could have an impact on your practice profits and efficient use of staff time.
I have estimated that it takes a receptionist working in an average practice two minutes to take and process a patient copay. That includes taking the payment, possibly making change, writing the receipt, and getting a signature on a credit card slip. So, how can we save two minutes on every visit?
By using a Customer Relationship Management (CRM) system that includes a credit processing system. Several examples include, but are not limited to, Infusionsoft, Salesforce, Pipedrive, Insightly, Base, and ConnectWise PSA.
When your patient first registers for their initial evaluation, you can ask them for payment by using their credit card. With a simple script focusing on the benefits to them by using their credit card (saves time, less paperwork, easier to track), you can obtain card information. This information can then be entered into a credit processing system. From there, many CRM systems can be set up to autocharge with a simple “push of a button” for specific events like cancellations, visit arrivals, or equipment sales made during their treatment visits. Now, two minutes can be cut down to only a few seconds.
You can do so much more…
From day one, our patients are entered into our CRM system. They now can be sent a sequence of emails telling them more about our practice, our staff, our management, our practice specialties, and our practice culture and vision. This email sequence is designed to build a connection between our patients and our practice. It is used to educate them regarding cancellation policies, to encourage them to complete home exercise programs, and to encourage them to refer friends and family to our practice. We use a sequence of seven emails to help improve visit compliance (more profits and better treatment outcomes), to improve compliance in performing their home exercises (better outcomes), and to increase friend and family referrals.
Here is an example of a sequence of emails we have successfully used:
Day 1, email no. 1: Share your practice vision and office culture.
Day 2, email no. 2: Give a health tip and offer that you are never too busy to help their friends and family as well as them.
Day 5, email no. 3: Educate on the healing process while emphasizing the importance of consistent home exercise.
Day 9, email no. 4: Give health tip.
Day 14, email no. 5: Get feedback from them via a patient satisfaction survey (example: Net Promoter Score).
Day 20, email no. 6: Give a health tip and an additional reminder that you are never too busy to help friends and family.
Day 30, email no. 7: Ask the patient to write a review on your Google page.
Now that you know how you can save time and connect regularly with present patients, how can you generate new patients using the same autoresponder concept?
Using your web page, you can insert an opt-in form for visitors to enter their email address. There are ways to prompt a prospective patient to do this. For example, in exchange for their email address, you can share with them a health care–related video, more information about your practice, or a printed report or article related to the benefits of physical rehabilitation. The articles or video could be specific to your practice specialties. Many potential patients will find that information obtained via a special video or article will solidify their decision to make an appointment with your practice. Others may still hesitate. For those that hesitate, you now have their email address and can send them additional information and even ask them to contact you by phone if they would like to discuss possible options for physical therapy treatment. This automated system can generate patients consistently without effort once it is built.
Begin automation one step at a time and work with what you are comfortable with. It may take some time and effort to research the CRM and autoresponder system you wish to use, but once implemented, it can save you time and money and will help build your practice. Automation and autoresponder systems can also help you to better establish and maintain relationships with present patients as well as attract new patients to your practice far better than many other marketing mediums such as television, radio, or print ads.
Automation is the present and the future. It will be important to every private physical therapy practice to continue to explore all of the ways automation can keep our practices alive and well—and also save us precious time.
Steve Young, PT, DPT, is chief happiness officer at Body Solutions in Voorhees, New Jersey. He can be reached at steve@bodysolutionsinc.com.
