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 firstname.lastname@example.org.
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.
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.
Expand your practice to better service your community.
By Alpha Lillstrom
April 4, 2016
It is an unfortunate reality that our veterans can experience delays in accessing care or wait unacceptably long periods for an appointment at a Veterans Administration (VA) facility or clinic. While progress has been made, many veterans are looking for better and more convenient ways to access the care they need. Thanks to much public outcry and two recent laws, a veteran who is enrolled in VA health care now has more choices. These laws enable private practice physical therapists to expand their businesses by enrolling as contract providers with the Veterans Health Administration (VHA).
The VHA is the United States’ largest integrated health care system with over 1,700 sites of care; it serves 8.76 million veterans each year.1 However, despite its size, it has been unable to meet the health care needs of veterans. In response to a nationwide scandal that emerged in 2014, the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act)2 was signed into law on August 7, 2014. This law established a Veterans Choice Program (Choice program) that will end on August 7, 2017—or earlier if the allocated funds are exhausted. The Choice program is separate from Tricare (the health care insurance program for retired members of the military and their families3) and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries.4 Instead, this is a temporary program with specific eligibility rules for those already enrolled in VA health care. This law allows a veteran to use a community-based provider if he or she has had to wait over 30 days for access to care. Under the Choice Act, geographic eligibility is based on whether the veteran lives over 40 miles from the closest VA facility; therefore, once the geographic test is met, an enrolled community-based provider can be utilized regardless of how close their office or clinic is to a VA facility or to the veteran’s home. This use of community-based providers, including physical therapists, is intended to address the two most glaring obstacles veterans face when trying to access necessary care.
Although improvements were noted, delays persisted due to a lack of consistent guidelines and ineffective management. Moreover, thousands of veterans remained frustrated and confused by the new system. On July 31, 2015, a second law, the Veterans Choice Improvement Act (VCIA)5 was enacted to address lingering issues veterans experienced while attempting to access the care they were entitled to receive.6 The VCIA waives the previous 30-day wait requirement if care is clinically indicated. The law also improves the VA’s plan to consolidate community care by streamlining referrals and authorizations, as well as improving the process for providers in order to reduce the wait time between when care is provided and when the VA pays said providers. Additionally, in response to the reality of limited travel routes for veterans living in rural areas, this legislation modifies the distance factor used when determining who can utilize the Choice program—VCIA measures the distance a veteran lives from a VA site of care by 40 driving miles.
On December 1, 2015, in response to further criticism from veterans, members of Congress, and other stakeholders,7 the VA announced additional changes to the program. Under the updated parameters, a veteran is eligible for the Choice program if he or she is enrolled in the VA health care system and meets at least one of the following criteria8:
- told by his or her local VA medical facility that they will not be able to schedule an appointment for care within 30 days of the date the veteran’s physician determines he or she needs to be seen, or within 30 days of the date the veteran wishes to be seen if his or her physician did not specify a date;
- lives more than 40 miles driving distance from the closest VA medical facility with a full-time primary care physician;
- needs to travel by air, boat, or ferry to the VA medical facility closest to his or her home;
- faces an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or simplicity or frequency of the care needed, and whether an attendant is needed. The staff at the veteran’s local VA medical facility will work with the veteran to determine eligibility for any of these reasons; or
- lives in a state or territory without a full-service VA medical facility.9
Veterans Choice Program Mechanics
In the past, the Patient-Centered Community Care (PC3) has been the VA’s method of purchasing care for veterans from community-based providers. The Choice program supplements the existing PC3 by allowing coverage for even more services for eligible veterans while also providing veterans more flexibility in choosing whether to receive care in the community or through the VA. In order to be eligible for VA health care benefits and the Choice program, a veteran must have a service-connected disability, have served for a minimum length of time, and fall below a certain income level.
A veteran must initiate access to the Choice program by calling their third party administrator (TPA). The phone number is clearly listed on his or her Veterans Choice card. Before health care can be delivered through the Choice program, it must first be authorized by the regional TPA. There are two TPAs covering six PC3/Choice regions. Health Net is the TPA for half of the United States (regions 1, 2, and 4) while TriWest Healthcare Alliance covers regions 3, 5A, 5B (Hawaii), and 6 (Alaska).10 Preauthorization is required to ensure that the treatment in question is service connected. If a veteran is treated for a non-service-connected disability, that veteran may incur a fee for that care. While physical therapy is likely to be covered, not all services are.11
Enroll as a Veterans Choice Program Provider12
Before a physical therapist can provide care to a veteran through the Choice program, he or she must enroll as either a PC3 or Choice provider, but not both.13 Most PC3 providers are automatically eligible to participate in the Choice program. If you are interested in becoming a provider for the Choice program, you must first establish a contract with one of the TPAs—Health Net or TriWest—by calling 866-606-8198. Through contract, the TPA and Choice program providers establish an agreed-on amount for services, generally 100 percent Medicare reimbursement.14 Rates above 100 percent Medicare reimbursement may be negotiated for providers located in highly rural areas.15 However, it is important to note that PC3 contract reimbursement will be at a negotiated rate below 100 percent of Medicare.16 Therefore, while the Choice program is temporary, it could be worth the effort to become a Choice provider now and a PC3 provider later. If you are currently a Tricare provider with the Department of Defense, you will have to enroll separately as either a PC3 or Choice provider with the VA in order to participate in this program. The Veterans Choice program agreement is intentionally simple and less than three pages long. Once signed by the provider, it should be finalized by the TPA within two days.
The reimbursement process is also intended to be user friendly. First, one must complete an application form on the appropriate TPA’s website. On receiving the authorization package for the medical appointment from the TPA, providers can proceed with providing care to the veteran. After the appointment, providers must file a claim with the appropriate TPA. The VA is keen to maintain complete medical records; therefore, the TPA requires providers to also submit a copy of the records for medical care and services provided to the veteran.17 On successful processing, claims will be paid to the provider by the TPA.
In order to be a PC3 or Choice provider, a therapist must be accessible to veterans and accept the payment rates outlined in the law as well as be in compliance with Medicare, federal, and state regulatory requirements. Additionally, a therapist must maintain at least the same or similar credentials as a VA facility. If care beyond what was originally authorized is necessary, a secondary authorization (SAR) is required. In the past, secondary authorizations were limited to 60 days per year; however, SARs are now based on an episode of care and can last up to a year. These SARs are granted by the TPA, not the VA.18
In order to facilitate utilization of the program, the VA has provided a number of resources to both veterans and providers. There is a national Choice Program Call Center at 866-606-8198 that will verify eligibility and answer programmatic questions. Every VA medical center has a “Choice Champion” to help veterans and providers work with the program. In addition to the general program website,19 the VA also has a number of resources specifically created for providers that are available online.20
In order to address unacceptable delays and backlogs at VA hospitals and clinics, the Veterans Choice Program aims to provide veterans improved access to community-based care. By enrolling as a PC3 or Choice provider, private practice physical therapists can expand their practices to include caring for these veterans. Private Practice Section members evaluating their options should: (1) decide if participation in the Veterans Choice Program is beneficial or desirable for their practice; and, if so, (2) determine their preference of becoming a PC3 or Choice provider. On making this determination, those private practice physical therapists who enroll with their regional TPA as a provider will be ready to serve veterans in their own community-based clinics.
2. P.L. 113-146, www.congress.gov/113/plaws/publ146/PLAW-113publ146.pdf.
3. www.tricare.mil. Accessed February 2016.
4. www.va.gov/PURCHASEDCARE/programs/dependents/champva/champva_eligibility.asp. Accessed February 2016.
5. P.L. 114-41, www.congress.gov/114/plaws/publ41/PLAW-114publ41.pdf. Accessed February 2016.
6. www.gpo.gov/fdsys/pkg/BILLS-114hr3236enr/pdf/BILLS-114hr3236enr.pdf. Section 4005. Accessed February 2016.
7. The Veterans of Foreign Wars and other veterans advocacy groups kept a close eye on how the program was implemented and expressed concerns such as “35 percent of veterans who believed they were eligible for the program were offered the option to participate . . .there are still a number of hurdles that must be addressed if the Veterans Choice Program is to live up to its name.” www.military.com/daily-news/2015/09/28/veterans-find-va-choice-care-program-has-delays.html. Accessed February 2016.
8. www.blogs.va.gov/VAntage/24346/va-makes-changes-to-veterans-choice-program. Accessed February 2016.
9. This includes Alaska, Hawaii, and New Hampshire (but excludes New Hampshire veterans who live within 20 miles of the White River Junction VAMC) and the United States Territories (excluding Puerto Rico, which has a full-service VA medical facility). Accessed February 2016.
10. www.va.gov/opa/choiceact/documents/FactSheets/VACAA_Provider_Fact_Sheet_Choice_Program_508c_Internet.pdf. Accessed February 2016.
11. For example, there is a very limited benefit package for dental care, and emergency department visits are not covered. Accessed February 2016.
12. On Nov. 30, 2015, the VHA presented a webinar about the VCP and how practitioners may become providers for the program: www.raconline.org/topics/returning-soldier-and-veteran-health/veterans-choice-program-webinar.
13. www.triwest.com/en/vapc3-provider/Quick-Reference-Guides/VACAA-VAPC3-Differences_Network-Provider.pdf. Accessed February 2016.
14. www.ruralhealthinfo.org/topics/returning-soldier-and-veteran-health/pdf/veterans-choice-program-faqs.pdf Accessed February 2016.
17. TriWest can receive both documents by fax or electronic means. However, Health Net can only receive medical documentation by fax, but the claim can be received electronically. Accessed February 2016.
18. www.triwest.com/en/vapc3-provider/Find-a-Form/Secondary-Auth-Request.pdf. Accessed February 2016.
19. www.va.gov/opa/choiceact. Accessed February 2016.
20. www.va.gov/opa/toolkit/June2015_VCPToolkit_101ForPartners.pdf and www.va.gov/opa/choiceact/for_providers.asp. Accessed February 2016.
Alpha Lillstrom is a registered federal lobbyist working with Connolly Strategies & Initiatives, which has been retained by PPS. An attorney by training, she provides guidance to companies, nonprofit organizations, and political campaigns. For six years, she served as Senior Policy Advisor and Counsel for Health, Judiciary, and Education issues for Senator Jon Tester (Montana), advising and contributing to the development of the Affordable Care Act, as well as working on issues of election law, privacy, government transparency, and accountability. Alpha has also directed Voter Protection efforts for Senators Bob Casey, Al Franken, Russ Feingold, and Mark Begich. She was Senator Franken’s Policy Director during his first campaign and was hand-picked to be the Recount Director for his eventual 312-vote win in 2009.
Communicate how patients want to communicate.
By TJ Janicky, PT, DPT
Technology is progressing, whether we are paying attention or not. The pace of technological acceleration is described by Moore’s Law, which states that overall processing power for computers will double every two years.
I recently learned that Moore’s Law has held true, and it is no surprise that “most of us are grossly underestimating how large this culture shift is,” as described by Gary Vaynerchuk, entrepreneur, author, and speaker. Vaynerchuk was the keynote speaker at this year’s American Physical Therapy Association (APTA’s) Private Practice Section conference in Orlando. He touched on many topics such as social media platforms and content, “your practice should be a media company first,” and that most of us are never more than arm’s length away from our cell phones.
And since we are never far from our cell phones, one company has developed an easy and secure way to communicate with patients in the style that many prefer—texting. Vinitial is a secure, Health Insurance Portability and Accountability Act (HIPAA)–compliant texting app for patients and providers, with no need for exchanging cell phone numbers.
I recently learned that most work email is not HIPAA complaint and neither is personal cell phone texting.
The company was created by physical therapist Dave Kittle, PT, DPT, with a focus in optimizing communication in the outpatient setting. “Many patients have questions or comments between visits that do not require a phone call and typically would not compel the patient to send an email,” Kittle explains. “When patients hear from their therapist or front desk that the practice uses a secure texting app for communication, traditional barriers preventing questions and communication are then minimized.”
Here are some clinical uses/scenarios I came up with:
- Change in symptoms (increase or decrease)
- This specific home exercise resulted in . . .
- My taping application causes itchiness or a rash.
- I am running late, can I still come in?
- I tried to jog/run and . . .
- Since starting therapy, I am feeling . . .
Your front desk can also be involved with administrative questions such as:
- Can you remind me of my copay or current balance?
- Can you clarify my benefits?
- How many authorized visits do I have?
- Is the office closing early or opening early due to snow?
- I am in a work meeting unable to call; I will have to cancel today.
Vinitial is an easy iOS and Android app download that is free for patients and staff clinicians. Patients then search their therapist’s name and send him or her a text.
Check out Vinitial, LLC, at www.vinitial.com or join the conversation on Twitter @VinitialApp.
TJ Janicky is an Impact editorial board member and outpatient physical therapist at Johns Hopkins Hospital in Baltimore, Maryland. TJ can be reached at email@example.com and @TJ_Janicky on Twitter.