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.
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 tjanicky@gmail.com and @TJ_Janicky on Twitter.
Be prepared to answer the door when the IRS comes knocking.
By Lisa Mackell, PT, MPT
Imagine yourself sitting at your desk one day, and your telephone rings, and it is your state tax department calling, informing you that you have been randomly selected for a sales tax audit! “A sales tax audit?” I asked. “We barely sell any products at all.” Well, this happened to us one early spring day in 2013. Now, I am not an accountant, and tax laws vary in all states, but there are things that we learned throughout this process that will be valuable to all practice owners and save you time if this ever happens to you.
First and foremost, a “sales, use, and occupancy tax audit,” as it was formally called, is not to verify that you charge sales tax on any items that you may sell to your patients. In fact, that was a very small part of this audit. The bulk of this tedious audit was to verify that we, as a business, paid sales tax on everything that we purchased through the business for the last three tax years. So, we set up an appointment with the auditor, and for a solid week, this auditor was in my office, going through boxes and files of invoices, receipts, Quickbooks, and reports, to verify that we could show and prove that we had paid sales tax when we were required by the state to pay it.
Here are some tips, based on our experience, that we suggest you put in place at your practice:
- Keep all receipts and invoices for all purchases made, not just for income tax purposes, but also for potential sales tax audits. Our audit went back three years, but seven years should be a safe timeframe based on the Internal Revenue Service (IRS) recommendations for keeping records.
- We had always believed that a lot of our supplies—and suppliers—were not subject to sales tax because they were for “medical use.” We learned that this was not true. The tax law in Pennsylvania stated that the only time an item was not taxable was when that item was purchased for the sole use of one and only one patient, purchased for that patient at the time, and only used by that patient. In other words, if you purchase kinesiotape in bulk, and then sell to patients, this is taxable, because you did not order that specifically for that particular patient at the time of purchase. This would also apply to crutches, electrodes, braces, etc. If you purchase an ultrasound machine, that is also taxable because it is not used solely for the use of one particular patient.
- When a vendor does not charge you sales tax, it is your responsibility to pay that sales tax, to your state, in a return that you file. We have learned which of our vendors were not charging us sales tax, and we now pay the tax for all of the invoices from those vendors on a quarterly basis.
- Sales tax is also applied to certain services you receive. Our Information Technology (IT) service technician was not charging us sales tax on any of his service calls for computer repairs—as he was also unaware that any of his work was taxable. We now know that certain computer repair work is taxable and certain work is nontaxable. All of our invoices for the last three years had to be revised.
- Capital equipment was a large part of our audit. We are right next to the state of Delaware, which does not charge sales tax. Regardless, we are responsible for paying sales tax as a Pennsylvania company. Keep this in mind as you purchase large equipment from out-of-state vendors that may not charge you sales tax as a cost savings benefit to you.
- Be very involved in the process if you are audited. There were many items that our auditor was incorrect on, which we were able to debate and prove we were correct. Your state should have a booklet or guide that will itemize every possible item and whether or not it is taxable. This will help you be prepared in the event of an audit so that you can understand what your tax liabilities truly are.
I am sure you are wondering—what was the damage? At first, the auditor estimated that we would owe about $15,000 in back taxes. After we went through the itemized list, debating things that the auditor did not understand how they were used in our business, the final outcome of our tax liability was $4,694.03. Since this was our first audit, we also had to pay the interest and a failure to file fee, but we were able to appeal the major penalty. The total amount that this audit cost us to the state was $6,338.36. Keep in mind, additional costs to the company included some accountant costs, and I lost about a week of work while I sat with this auditor finding files, invoices, and receipts, and reviewed these with her.
Be prepared—keep your records, receipts, and invoices. We all hate to pay taxes, but I hope this personal experience at least arms you with some proactive tips to prepare your business for better protection against a sales, use, and occupancy tax audit.
Lisa Mackell, PT, MPT, is the founder and owner of Theraplay, Inc., a pediatric therapy company that provides physical, occupational, and speech therapy services. Theraplay currently has seven outpatient centers, as well as contracts providing early intervention and school-based services throughout Pennsylvania and Delaware. Lisa can be reached at lmackell@theraplayinc.com.
