By Terry C. Brown, PT, DPT
One of the single greatest resources that can make our practices go from good to great is having a dedicated staff that believes in the practice and are with us for the long haul. Every practice owner knows that the people with whom they surround themselves play heavily into the practice’s success or failure.
Most of us are people persons and we can get someone in the door. We understand the need for a competitive salary structure and benefits. We are good at getting them on board, then spending time and money training and molding them into productive team members.
However, how many of us have a comprehensive retention program? Being good at getting folks in the door has nothing to do with keeping them as a longtime faithful employee. Why is this? I think many of us have a misconception about what factors matter for retention. Most of us built our businesses believing that salary, benefits, and incentives would keep our employees satisfied . . . when in reality the drivers go deeper into the human psyche to the actions and attitudes that make employees feel successful, secure, and appreciated.
As private practice owners, we must strive to engage all employees to feel as if they have ownership in the practice. We need to treat them as partners in our endeavor and ensure we meet their needs. I believe there are some core areas that we could all look at to make our employees feel like owners.
First and foremost, remember that communication is a two-way street. Listening and communicating your vision are equally important. Structure your communication to inform, emphasize, and reaffirm to employees that their workplace contributions have an impact. Properly done, communication with your staff will provide you with the insights you need not only to run your business better but also to know how your employees feel about working for your business. Employees need the chance to be heard and recognized.
Empower your employees to do their best. This requires having measurable objectives for each employee and providing steady feedback to them. Studies confirm that people have a deep desire to feel they are succeeding and that their talents and capabilities are being used in a way that makes a difference to the business. When people sense their actions are fulfilling this desire, they begin to develop a sense of belonging and a feeling that your company is their company.
Next is putting your company in a position of competitive advantage. Set yourself apart from the competition. People want to work for a winner. Be active in your community and engage your employees in those activities you support. Build loyalty by earning trust, respect, and commitment from your employees as they work along with you in volunteer efforts to better your community.
We as private practice owners should provide the place for young entrepreneurs to come and build a home that provides them with opportunity for success in the way that each of them defines it. I hope this issue of Impact helps you develop your staff as a competitive core of “business owners” that are providing top care in your community for years to come.
By Tannus Quatre, PT, MBA
My dad always taught me not to take “no” for an answer. It has served me well both personally and in business.
While I am pretty sure the message Dad was trying to get across was to assert myself, there is a slight twist on this lesson that works well when selling your services: Do not let “no” be an answer.
When selling, many people are essentially asking the question, “Will you buy this from me?” A question that starts with the word “will” has two possible final destinations: “yes” or “no.”
That is not good enough. We do not want “no” as an answer. A good salesperson works hard to ensure the answers are all just different shades of “yes.”
Sounds great, but how does this all work? Here are a few tips that work to keep “no” out of the vocabulary for your customers.
Ditch the words “will” and “would.” When attempting to close a deal (schedule a patient, solicit a referral), never use the words “will” and “would.” Questions starting with these words can end in “no.” Starting your questions with words such as “when” and “how” provide options that do not facilitate “no” as an answer.
Do: “When is your next availability?”
Do Not: “Would you like to schedule your next appointment now?”
Use your watch, not theirs. Oftentimes, getting to “yes” takes several tries. As many will attest, a single lunch with a physician group does not by itself open the floodgates to new referrals. When a “yes” is not achieved, make sure that follow-up plans are directed by you, not them. If you did not get what you want, schedule a follow-up on your timeline and get agreement on your follow-up plan.
Do: “Thanks for your time today, I’ll plan to follow up with you in a couple weeks to check back in.”
Do Not: “Thanks, well just let me know if you want to follow up on this at a later time.”
Change the subject. If you do not see the answer you are looking for on the horizon, do not force the issue. Changing the subject will still give you the opportunity to leave a good impression and to work on getting to “yes” at a later time.
Do: “OK, enough about physical therapy for now . . . you said you had kids, where do they go to school?”
Do Not: “OK, it does not sound like you are ready for physical therapy right now. Let me know if you change your mind.”
Always leave an opening. Unless you have determined that you no longer want the business from your customer, never, ever, ever, let the conversation resolve with a final “no.” There is always the potential to earn the business at a later time, and leaving an opening to a future conversation can be key to landing good business down the road.
Do: “OK, it looks like you are all set for now but listen, I am going to stay in touch with you, and please make sure to reach out if your needs change before we talk again.
Do Not: “OK, well I am sorry I cannot serve you right now. I appreciate your time.”
“No” is a dirty word in sales, and it can unwittingly harm those who need our services. We have to be assertive. So, do not take “no” for an answer . . . better yet, do not let “no” be an answer.
Tannus Quatre, PT, MBA, lives at the intersection of physical therapy and entrepreneurship, spending his time helping physical therapists build and operate successful practices through his company, Vantage Clinical Solutions. He specializes in marketing, finance, and business planning, and authors and speaks regularly for the APTA and PPS. He can be reached at firstname.lastname@example.org.
Mergers and acquisitions compliance.
By Nancy J. Beckley, MS, MBA, CHC
The mergers and acquisitions frenzy: It is likely to hit your market, or about to hit your market. At the Private Practice Section (PPS) annual meeting 18 months ago, two major market acquisitions were announced, which lit up conversations in the exhibit hall for the duration of the conference. Practice owners are accustomed to looking at exit strategies or succession plans unique to their practice; however, now practice owners have to take notice of major therapy companies migrating around the country and immersing themselves into new, untapped markets as well as penetrating deeper into existing markets.
An exit strategy that a practice owner may be contemplating on a 10-year horizon may have to be moved up before the market is gobbled up. We are now facing market factors affecting the therapy landscape locally, regionally, and nationally—including accountable care organizations (ACOs), Medicare’s Comprehensive Care for Replacement of Joint that just rolled out in 67 markets, Medicare reimbursement penalties for Physician Quality Reporting System (PQRS) reporting deficiencies, and the Office of Inspector General (OIG) Work Plan’s continued inclusion of physical therapists in private practice. Not to mention physician offices with therapy, and hospitals gobbling up physician practices.
A recent presentation to physical therapists and practice owners by Paul Martin provided context to the heat being generated in the hot outpatient therapy market1:
- Outpatient therapy is a $29.6 plus billion industry with strong growth prospects.
- There is relatively stable reimbursement compared with other health care sectors.
- The outpatient therapy market is fragmented, even with the presence of large companies owning over 500 plus clinics.
- The population is aging.
- Outpatient therapy business is “scalable” and not hard to grow once in a market area.
- There are relatively few barriers to entry into the outpatient therapy market.
- The de novo cost to build new clinics is minimal.
- There are three to five regional therapy companies in each state.
- Performance factors of the publicly traded therapy companies provide a positive outlook.
- The “invasion” of private equity has fueled growth; it seems everyone wants in on the action generated by the prospects of positive returns with an investment in outpatient therapy.
And according to Martin, “The private equity groups studied all the above dynamics, and the battle for outpatient therapy market share began.”
What should a practice do? Whether your practice is simply formulating a succession plan or an exit strategy, or is on the market, open to the opportunity for a sale, or a reluctant seller, compliance should figure in your practice plan now and in the future. What? In the middle of this article on hot revenue prospects in the outpatient physical therapy market, we are discussing compliance? Yes, indeed we are! Maybe you were thinking that only if you are seeking to sell, or find yourself a reluctant seller due to market conditions, a compliance program is in order. For all practices an effective compliance program will potentially assist in mitigating problems—and that could be anything from having an excluded provider on your roster, inappropriate use of provider numbers, lack of proper supervision for physical therapist assistants, documentation errors, or the mother lode of coding and billing errors. You are probably wondering what this has to do then with selling a practice? Or mergers and acquisitions? Is it not the case that potential buyers are looking at my practice in terms of revenue and other metrics such as units per visit, visits per referrals, and associated costs and the like? Maybe you are working with a business broker or legal firm representing your practice to develop a business portfolio and practice profile to shop around to potential buyers. A potential buyer or investor in your practice will be interested in risk that may accrue over the future horizon related to the civil and criminal statutory lookback period for violations of the major health care laws including the False Claims Act, Anti-Kickback Statute, Civil Monetary Penalties laws, Exclusion Authorities, and the Stark law. In a stock purchase the buyer is buying your past acts, which can be discovered long after the closing, with the buyer on the hook for potential paybacks, fines, and penalties.
While this is not intended as a primer on health care laws, suffice it to say that an understanding may prevent violations including improper use of the group therapy code payments to physicians for referrals that are presented as “medical directorships.”
All that notwithstanding, in today’s market there is value in compliance even if it is seemingly intangible. Compliance does not produce revenue, but it presents an opportunity for goodwill on your financials. As with all goodwill valuations, compliance goodwill may not be as clear a valuation as a revenue run based on patient referrals, but rather signals commitment to a program that is designed to detect, correct, and prevent compliance problems. The operative definition, of course, implies an effective compliance program.
So where to start building compliance goodwill? Implementing a scalable compliance program based on a compliance plan following the OIG Compliance Program for Individual and Small Group Physician Practices is the perfect place to start.2 A couple of takeaway recommendations to elevate your compliance program should include, but not be limited to3:
- Complete a practice risk assessment in which you actively seek to identify issues to be addressed by your compliance program.
- Develop and scale a compliance plan that identifies your company’s code of conduct, compliance program guide, and relevant policies and procedures.
- Have your employees, contractors, board members, and owners attest to their understanding of and obligations under your compliance program.
- Verify and document that all employees have not been excluded from participation in federal health care programs, and be sure to include Medicaid exclusion lists.
- Verify and document the licenses of all employees including all states in which they have practiced.
- Conduct new employee compliance training and education as well as training on the prevention of fraud and abuse for all employees, with documentation and evidence of successful completion and a passing quiz grade.
- Provide further training and education in documentation, coding, and billing for therapists and those responsible for claims submission.
- Review your Electronic Medical Record (EMR) to ensure compliance with Medicare requirements not only on “teeing” up due dates and the proper forms, but verifying compliance with reporting of time and billing of codes.
- Conduct a claims review test of your billing system to ensure that the codes on the claim were the codes that the rendering therapist identified for billing and are supported by documentation.
- Establish an auditing and monitoring program that expands beyond chart review to include other risk areas identified. Be sure to document findings and follow-up plan.
How are things in your market? Are you concerned or excited about mergers and acquisitions? Are you concerned and excited about compliance? Do you want to add value to your practice? It’s time to build goodwill.
1. Martin P, The war for independence. Clinicient Empower: Boston; September 2015.
2. Office of Inspector General (OIG). Fed Regist. 2000;65 (194). Notices.
3. We have not addressed HIPAA compliance in this article, which in no way suggests it is not a part of compliance.
Nancy J. Beckley, MS, MBA, CHC, is certified in health care compliance by the Compliance Certification Board and is a frequent speaker and author on outpatient therapy compliance topics. She advises practices on compliance plan development and audit response. Questions and comments can be directed to email@example.com.
Make recruitment and retention part of your marketing plan.
By Michelle Collie, PT, DPT, MS, OCS
If the first marketing goal for every physical therapy practice is to bring in new patients, the second goal should be focused on the recruitment and retention of both clinical and administrative staff. Each of these goals informs the other. Consider these six marketing and public relations tips to ensure your staff recruitment and retention strategy is successful.
1. Define and promote your culture. Determining if a candidate is a “cultural fit” is extremely important for recruiting and retaining candidates that are best suited to your practice. Social media provides the perfect opportunity to share the culture of your workplace. Post photos and videos that truly represent the kind of people you would like to attract. Dress-down days, company sports teams and clubs, celebrations—choose what represents your culture. Staff will organically begin sharing posts, and continuing to spread the word about your practice’s culture.
2. Seek opportunities to promote that your practice is a great place to work. Seek local awards that celebrate and promote the best places to work in your community. Receiving such awards provides credibility that your practice is in fact a fun and rewarding working environment. Preparing the application engages current staff—and hopefully provides you all with a reason to celebrate. Employee engagement promotes retention, and employees certainly love to celebrate together!
3. Reward your staff’s effort to market your practice. We encourage and often reward our patients for telling their friends and family about our practices. Similarly, you should encourage and reward your staff for recommending your practice as a place to work! Rewarding staff with a gift card, bonus, or public acknowledgment will reinforce this positive behavior and further develop his or her personal connection to your practice.
4. Market your current staff. Staff bios on your website, social media posts, and press releases announcing staff accomplishments will not only help current staff feel valued but will also message the type of clinicians and the clinical opportunities that exist in your practice.
5. Develop relationships. Marketing is about developing relationships. LinkedIn, your local American Physical Therapy Association (APTA) chapter, physical therapy programs as well as other community-based organizations and boards provide endless opportunities to develop relationships with potential employees as well as those who may recommend your practice as a place to work. Practice leadership is often challenged by the amount of time required for relational activities but unless the effort is made, the practice of recruiting will be limited to more passive methodologies.
6. Advertising a position is marketing your practice. When the time comes to advertise a position, carefully consider the wording and information provided. Just as a standard description of your physical therapy practice will likely not entice a patient to choose your practice, a standard description of a position you have available may not entice a person to apply. What makes your practice different or unique?
If you clearly define your workplace culture using these tips offered, you are likely to have the right people on the bus—and a satisfied workforce leads to satisfied patients. It is a win-win!
Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at firstname.lastname@example.org.
By Paul Martin, PT, MPT, CBI, M&AMI
In the current outpatient rehabilitation market, growth is not an option. There are multiple companies acquiring businesses across the nation and rapidly growing in their local markets. One of the best ways to grow your business is by establishing new clinics in contiguous markets. The challenge in most cases is finding therapists who can treat and manage these new locations.
We recommend building a program to mentor your existing staff to become those next clinic directors. Develop a career ladder in your business that points to a staff therapist growing to become a manager. Then create a training program that helps a therapist build those skills to become your next successful clinic director.
We work with some of the best rehabilitation businesses in the country, and one of the key attributes to these companies is a strong bench of therapists who can be called on to fill a need for a new clinic director.
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 email@example.com.